Health Insurance offers coverage to the policyholder for medical
expenses. It saves the policyholder in case of any health emergency. It covers all the medical
expenses incurred by policyholders who own at the policy.
The medical expenses covered under the policy include the cost of
surgery, drugs, treatment, and the services provided by the hospital. This provides financial
stability to cover the cost incurred during a medical emergency.
In simple words, it provides reimbursement for medical expenses with a
monthly payment of a small amount. Group health insurance falls under the employee benefit schemes,
but the premiums are partially covered by the employer. In simple words, group insurance manages the
welfare of the employees.
The policy chosen by the insured provides coverage for many medical expenses. This includes –
Surgical expenses, Daycare expenses, and Critical illness, etc.
Let’s assume in a city there are 100 people. Ravi is one among them. Ravi takes health insurance of
1Cr up to the age of 54 years, after which his son/daughter starts earning. Out of 100, the average
number of people who become ill is around 15%. This means only 15 people claim from the paid amount.
The Balance amount goes to the bank’s management operations.
Thus, the claim can be settled from the premium collected from other policyholders. This, just like
sharing the risk of one individual with a huge group. This is how the life insurance industry runs.
Unless a huge disease affects people, the insurance companies can settle claims.
Insurance companies have catered to every need of their customers in
the last decade. Hence, they have started introducing plans to suit the different needs of their
customers.
This plan offers insurance protection with the below benefits.
- Cashless hospitalization
- Reimbursement of medical expenses
- Compensation for expenses for pre and post-hospitalization expenses
- Coverage for home treatment and much more
Add Ons can also be taken with Individual health plans. This enhances
basic coverage of the insurance. The policyholder has to pay an extra amount besides the premium.
This plan is generally taken by employers. This policy helps the employees to leave the concern
about the health of their employees. The employees through their Medi-Claim policy can claim the
expenses inured from the hospital itself.
This helps the employee to be more attached to the organization. As the employee doesn’t have to
pay any premium directly.
As the name suggests this plan is taken by an individual for his whole
family. With this plan, the policyholders pay a single premium, and the sum assured becomes
claimable for one person among the family.
If one person from the family faces illness, with the health insurance
the particular person can claim the expenses.
Health Insurance is a financial investment that lets the investor save money spent on his health
expenses. Let’s have a detailed discussion on its benefits below.
Here, the primary objective is to provide the best health care service without relying on
your income or savings.
It covers all the expenses from medical charges, medical bills, and costs of medicines, treatment,
and other services that are incurred to treat the illnesses.
Thus, it takes away the burden of finance at the time of a medical emergency.
Apart from curable illnesses, there are other dreadful illnesses that require better coverage and
incur long-term expenses
Illnesses such as cancer, liver failure, and brain tumor require intensive care (surgery, therapy,
and transplant, etc.) These treatments incur a huge amount of money to be spent as medical expenses.
To cover such life-threatening health issues which come at a high cost an individual can opt for a
health insurance policy.
Thus, when an individual gets a health insurance policy he receives a lump sum upon the diagnosis
of the health issue that falls under the predetermined list under the policy.
Policyholders don’t have to spend their savings on the expenses, instead the same can be claimed
with the insurance policy.
Nowadays several insurance companies provide the facility of the claim that involves cashless
transactions.
This is applicable when the policyholder gets admitted to the insurer’s network hospitals. Network
hospitals are hospitals that are in agreement with the insurance company for a health insurance
policy.
In this case, the transaction takes place between the company and the hospital. The policyholder is
not involved between them.
The policyholder can fill out the pre-authorization form using the health insurance card to avail
of the cashless facility.
Generally, every organization offers their employees health insurance cover but only till their
employment with the organization. If the employee has to leave the organization the medical expenses
can’t be claimed from the company.
There are many cases where the employees lose their employment as a result, they lose their health
insurance coverage as well.
To avoid such problems, it would be an additional coverage to protect you and your family in terms
of finance and risk.
One of the most familiar advantages is the tax benefits. There are various tax benefits depending
on the age category. The premium paid under the health insurance scheme is covered under section 80D
of income tax 1961.
Claims through reimbursement is a process where the insurance company compensates the insured after
his treatment. In simple words, the insured pays the medical bills and he/she reimburses the pay
later from the insurance company. The types of Health Insurance claims are…
- Cashless claim process
- Claim for an expected event
- Emergency claim
This type of claim process involves no cash and helps you to reduce the burden of handling cash.
In this process of claim, the insurance provider directly pays the hospital all the costs incurred
for the treatment.
The insurance holder can use the card provided by the company. This process has a condition where
the policyholder should be admitted or receive treatment only from the partner hospital or the
insurance company to utilize this benefit.
In certain scenarios, the doctors inform the policyholder in advance about the treatment for the
illness.
In such cases, the individual policyholder can inform the insurance provider about the amount
payable. Generally, this process is expected to be completed 4 days prior.
However, the period of intimation varies according to the companies. The policyholder has to submit
the cashless claim through physical means or electronic mode.
After this process, the insurance company coordinates with the hospital with the further process to
initiate the plan.
Certain scenarios are unplanned and unforeseen. The process of a claim for an emergency begins with
the customer care of the insurance company.
Once the customer care informs about the situation, the network hospital is liable to fill the
cashless claim form and submit it to the insurance company.
The hospital receives the submitted form after after a thorough checking. The insurance company
takes care of the cost incurred for the treatment and service of the hospital.
The policy demands documents at two instances. One is when the policyholder decides to buy a new
policy second is when he claims the maturity amount. Lets discuss the two instances below.
To apply for a new health insurance policy below is a checklist that will be useful for the
policyholder to organize the required documents. But remember, Our financial advisors suggest
analyzing a policy thoroughly before choosing it as it should be a One time Investment.
Accordingly, the insurance company requires proof documents which majorly comprise medical bills.
On submission of these documents, they are verified by the insurance company.
Some companies even use third parties to ensure that policyholders don’t file a false claim and
filing such claims are considered to be fraudulent. Hence, the document is verified and found
legitimate, then the claim amount is settled.
Below are the list of the required documents.
- Passport size photographs of the Policyholder
- His / Her Medical reports
- Filled and signed proposal form
- Age Proof – (Voter ID card, Pan card, Aadhar card, Driving license, Passport, Birth
Certificate).
- Identity proof – (Voter ID card, Passport, Aadhar card, Driving License)
- Address proof – (Ration card, Driving license, Passport, Rent agreement, PAN card, Aadhar card,
Utility bills)
