Health Insurance

March 6, 2011   ·   0 Comments

Lesson 11:

www.stockssavvy.comOne can find everything he wants to know about Health Insurance. We have covered from the basics on Health Insurance to comparing different Policies from Different Insurers & which suits which age group?

It is a contract between the Insurer & the Insured wherein the former agrees to pay to the latter hospitalization expenses to the extent of an agreed sum assured in the event of any medical treatment out of an illness or an injury. In the nutshell the Health Insurance is a policy which covers you & your family against medical expenses due to sickness, accident etc. The Insured in return has to pay a regular premium to the insurer.

It is indubitable that Health Insurance has become an important element in one’s life owing to increasing medical costs these days & uncertain environment; it comes to your rescue acting as precautionary measure in today’s tough time while acting as a life saver boat in case of any medical contingency. If you don’t have Health Insurance, you end up paying hefty medical bills in the event of hospitalization out of illness or injury, therefore insuring your family against Health Insurance is a must thing & should surely be a part of your regular financial planning. All we have is our health which needs to be protected & taken care of by acquiring the best health insurance policy suited for us.

Types of Health Insurance Plans

Health Insurance Plans are segregated into three categories, firstly the Mediclaim Plans by Non-Life or General Insurance Companies, secondly the by both Life & Non-Life Insurers and thirdly the Critical Care Plans offered by both Life & Non-Life Insurers.

Mediclaim Policy is basically a reimbursement plan offered by General Insurers wherein the insured gets reimbursed of the total bill amount of the medical expenses to the extent of an agreed sum assured. It includes the room charges, ICU charges, surgery & doctor charges etc. It includes a lot of exclusions which the policy holder must read before buying the Mediclaim. The Mediclaim includes the following two further categories:

1) : It is a very common plan these days which covers your entire family under one premium payment giving coverage to the family members together. This plan is being offered by almost all the General Insurance Companies with a specific criterion of covering individuals in the age group between 90days and 55years.
2) : It is the second variant of Mediclaim which covers a group of individuals simultaneously. This form of insurance includes the category of Employer’s Health Insurance Cover wherein the sum assured normally varies between Rs. 15,000 and Rs.5, 00,000.

Hospitalization Cash Policy is a plan offered by both Life & Non-Life Insurers wherein the Insured gets pre-determined cash benefit on a daily basis irrespective of the hospitalization expenses being incurred. It is not a fully comprehensive health insurance plan because it doesn’t cover the cost of medical treatment but pays lump sum amount to the policy holder on per day basis during the treatment/hospitalization. It acts a complimentary plan to the Mediclaim plans. TATA-AIG General Insurance & Royal Sundaram offer Hospital cash benefit plan among Non-Life Insurers.

: It is offered by both Life & General Insurers covering an individual for certain specified critical illnesses like cancer, stroke etc. This is also offered as a rider by Life Insurance companies for quite some time now attached to their Life Insurance Plans. You must take a cover either as a rider or as a standalone plan in your portfolio.

Health Insurance Tax Benefits

Health Insurance products are eligible for tax benefits under section 80D of the Income Tax Act, 1961. Premium paid under health insurance holds a tax deduction upto Rs 15,000 for you, your spouse and dependent children.
Further more you can also claim another Rs. 15, 000 for tax deduction for your parents, in case of senior citizens (65 years or more) the above deductions are increased to Rs. 20,000

For instance a person wants a health insurance for himself, his spouse & their children, the Family Floater plan offers insurance coverage to the entire family under one premium payment. Let’s take an example wherein the person insures himself, his spouse & the dependent children with the individual insurance plans with a sum assured of Rs. 1 lakh each, he ends up paying premium ranging between Rs. 1000 – Rs. 2000 for each family member. On the other hand if the person would have opted for the family floater plan with the sum assured of Rs. 3 lakhs, the total premium would surely be less than the separate premium payments in individual health insurance plans. Moreover the separate health plan holds the cover of only Rs. 1 lakh as against Rs. 3 lakh in case of the Floater plan thus helping the family in case the medical treatment costs go beyond that.

Cashless settlement implies that an individual doesn’t have to settle a hospital bill out of his pocket; rather the bill gets settled directly by the insurance company.

When you buy a Health Plan you are issued a Health Card along with the policy documents which would entitle you to get cashless claim at any of the company’s network hospitals.

Comparison for Different Health Insurance for No of Individuals: 2 Adults & 1 Kid for a Sum assured for 3 Lac Rs. with Senior Member age as 30 Years

Company Plan Name Eligibility Annual
Premium
Maternity cover Pre-Existing Diseases coverage Cashless Facility
Apollo Munich Easy health Insurance Min. age: 91 Days
Max. age: 60 Yrs
Rs.5500/- Yes (After waiting period of 4 yrs) Yes (After 3 policy years) Yes(Over 4000 Hospitals)
Bajaj Allianz Family Floater Health Guard Min. age: 91 Days
Max. age: 55 Yrs
Rs.6783/- N.A Yes (after 4 years of continuous renewal) Yes(Over 2400 Hospitals)
Bharti Axa SmartHealth Insurance Policy Min. Age: 90 Days
Max. Age: 65 Yrs
Rs.5448/- N.A Yes (After 4 policy years) Yes(Over 4000 Hospitals)
Future generali Health Suraksha family Min. age: 91 Days
Max.age: 45 Yrs
Rs.5505/- N.A Yes (after 4 years of continuous renewal) Yes(Over 4000 Hospitals)
ICICI Lombard Health Advantage Plus Min. age: 91 Days
Max. age: 60 Yrs
Rs.5920/- N.A Yes (after 4 years of continuous renewal) Yes(Over 3500 Hospitals)
MAX Bupa Heartbeat Health Insurance Policy No age restrictions to enroll Rs.9829/- Yes (Only after 2 years of waiting period) Yes (after 4 years of continuous renewal) Yes(Over 4000 Hospitals)

Compare Family Health Insurance Plans

Coverage ICICI- LOMBARD Bajaj-Allianz Royal Sundaram Reliance General Insurance Star Health Cholamandalam
Family Floater Star Package Health shield Health Wise policy Family Health Optima Chola Family Insurance Plan
Pre & Post Hospitalization Expenses 30 days prior and 60 days after hospitalisation 60 days prior and 90
days after hopitalization
30 days prior and 60 days after hospitalization. Reliance Standard: 30 days prior and  60 days after hospitalization,
Reliance Silver: 60 days prior and 90 days after  hospitalisation
30 days prior and 7% of the hospitalisation expenses in Post hospitalization, max up to Rs. 5000 60 days prior and 90
days after hospitalization
Room & Boarding Expenses Covered No limit Covered, No Limit Reimbursment up to 1.5% Covered It ranges from Rs. 500-Rs. 1500 depending on the city Rs. 1500-Rs. 3000
Pre-existing diseases Covered after 4th year Covered after 4th year Covered after 4th year Reliance Silver – Covered after 2nd  year
Reliance Standard- Covered after 4th year
Covered
Eligibility Senior most family member: 19 – 60 years (Renewable till of 70 years)
Others members: less than 19 years
18 yrs – 55 yrs (Renewable till of 70 years)
Children 3 yrs – 5 yrs if both the parents are insured, 6yrs – 18 yrs if one parent is insured.
Self, Spouse and dependant parents up to the age of 50 years and dep children(91 days- 18 yrs) 3months – 65 years. 5 months – 60 years up to 55 yrs for proposer
and 65 for parents
Cashless Facility over 3500 network hospitals in India over 2400
hospitals in India
over 2000 hospitals in India Over 4,300 hospitals in India. over 1300 hospitals in India
Bonus sum assured increases by 5% every claim free year upto a maximum of 50% of original sum assured. 5% Limit shall be increased by 5% every year,
max up to 10 years
5% on every claim renewal max up to 50% No
Family Discount 10-15% long term discount, if policy is taken for 2 or more years 10% for covering 3
or more family members
Reliance Silver: up to Rs 750
Reliance Standard: up to Rs 500
10% discount on
Premium on the renewal of the policy in the claim free year
5% for 2 People,
10% for 3 or more peopple
Ambulance Charges Covered No Limit covered emergency
charges (upto Rs 1000)
Ambulance referral
facilities
covered from Rs 500 to Rs1000 750, max up to 1500 coverage for expenses incurred
on it to nearest hospital up to Rs 1000/-
Health Check-up Above 55 years Above 45 years Above 50 yrs Above 45 yrs Above 60 yrs
Cost of Health Check up Free health check-up coupon for any one insured family member. yes,reimburse max up to Rs 1000/- after 4 claim free years yes, reimburse max up to Rs 750/- after 5 claim free years free Check up after 4 claim-free renewals. reimburse the exp incurred
for general health and
eye exam
Sum-Assured 2 lakh to 4 lakhs 0.5 lakhs to 10 lakhs 1.5 lakhs to 5 lakhs 2 lakhs to 5 lakhs 1 lakh to 5 Lakhs 2 lakhs to 10 lakhs

Lowest Health Insurance Premium for a Single Person at Different Age Group

Sum Assured: 3 Lac Rs.

Age Premium Company
25 Years 1917 Rs. Royal Sundaram
30 Years 3140 Rs. IFFCO TOKIO
35 Years 3140 Rs. IFFCO TOKIO
40 Years 3330 Rs. Royal Sundaram
45 Years 4117 Rs. Oriental Insurance
50 Years 5326 Rs. Royal Sundaram
55 Years 6664 Rs. Oriental Insurance
60 Years 5933 Rs. Cholamandalam

What do you do in case of a claim?

You should walk into a network hospital & get the treatment done & the bills paid through the Health Card. In case of hospitalization you need to give the card number to the network hospital, you must pre-authorize from the TPA (Intermediary between the Insurance Company & the hospital) & will process the cashless settlement after the verification of your policy details. You should know the formalities required for cashless settlement as some insurance companies are required to be notified 48 hours before hospitalization.

If you don’t opt for cashless settlement, you need to settle bills at the hospital and get them reimbursed later.

• Room & Boarding expenses: There are further limits to this feature varying from company to company.

• Ambulance Charges: They are normally covered upto Rs. 1000.

• ICU charges, doctor, consulting, anesthetist and surgeon fees, operation and other diagnostic and surgical material costs are covered.

• Day-Care expenses such as Chemotherapy, Dialysis & Radiotherapy etc.

• Pre & Post Hospitalization Expenses which normally are 30 days prior and 60 days after hospitalization.

• Cashless Hospitalization is offered by almost all Non-Life Insurers.

• You must read the policy exclusions & the limitations in various covers properly before buying a Health Insurance plan because you should know what all covers your policy include & exclude.

• You should note the number of network hospitals covered in the Insurer’s list of network hospitals as this will help you to get cashless & hassle-free claim.

• You must read the names of critical diseases being covered before buying a Critical-Care plan.

• You must know that the medical expenses incurred within the first 30 days of buying the health insurance plan are not covered unless the injury has occurred out of an accident.

• You must disclose all the Pre-Existing diseases to the insurer before buying the health plan as the insurer doesn’t cover them, now a day’s General Insurers have started covering these diseases normally after 3-4 years varying from company to company.

There are lot of companies which are providing Medical insurance to their employees.

Two reasons why one should check the Premium on these Policies before buying any medical policy from the market are:

1)      Companies get Medical Insurance policies for Group of their employees. Hence, with more no. of people, premium are less than what one need to pay if he need to buy it from the direct Insurance Company.

2)     Group Mediclaim policies give the Insurance benefit from the first day from the premium paid. This is particularly beneficial for the ones who need to buy insurance policies for their  parents. In case of getting an Insurance Policy directly from the Insurance Company, there will always be a waiting time which one needs to complete before he can claim on any benefits.

Do you think we missed on something on Health Insurance in this Article. If yes, please let us know. Sharing your Views will be really appreciated.

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Rajesh Singla

Rajesh is the founder & CEO of Stockssavvy, Stocks analyst,financial advisor by choice,software engineer by fate,biker,gamer,cricket lover n enthusiastic person. He believes in doing things not just to get by but to get Ahead...

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