Health Insurance: Overview

The phrase "Ever-rising costs" has become the synonym of medical expenses in India. It is the cost to be borne against diseases and health treatments that people are worried about more than their health. If you belong to the same category, do not worry any more since health insurance is there for your rescue. Let us understand the health insurance basics and its overview.

Health insurance, also known by the name Medical Insurance and Mediclaim, is the scheme that ensures financial assistance for you and your wards against any financial limitations rolling out because of the health crisis. In some cases, it may also incorporate disability and medical necessities on a long term basis.

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What Is Health Insurance ?

If we talk about health insurance policy, in legal terms, it is the contract between the health insurance policyholder (insured) and the health insurance company (insurer) in which the insurer wows to provide financial support to the insured and his dependents by going as per the terms and conditions defined in the health insurance policy. The insured is able to avail the health insurance benefits by paying a fixed amount of pre-determined cost called the health insurance premium which the insurer charges against the commitment of providing the sum insured to fulfill the raised health claims.


What Does It Cover?

The health insurance policy generally, covers medical costs during hospitalization as well as pre and post stages of hospitalization. The level of coverage mostly depends upon the type of the health insurance policy, the sum assured and the health insurance company's norms. Health insurance in India is gaining tremendous popularity, as the health sector inflation is constantly on the rise.

You would find two categories under which health insurance policies are distinguished- Mediclaim Policies and Fixed benefit health insurance plans.

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Types of Health Insurance Plans

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1.Individual Health Plan

Valid for a single person and provides for hospitalization and various surgeries up to the limit of the sum assured chosen by the individual at the time of signing the policy.

  • Largely, an individual health insurance plan (IHIP), or 'mediclaim', would cover expenses if you are hospitalized for at least 24 hours.

  • These plans are indemnity policies, that is, they reimburse the actual expenses incurred up to the amount of the cover that you buy.

  • Some of the expenses that are covered are room rent, doctor's fees, anesthetist's fees, cost of blood and oxygen, and operation theatre charges.


2.Family Floater Plan

Protection plan for the entire family in which the sum insured amount can be utilized by any family member for any number of times.

This is a fairly new entrant in the health insurance firmament. Is being launched after extensive market research.

It takes advantage of the fact that the possibility of all members of a family falling ill at the same time or within the same year is low.

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Under a family floater (FF) health plan, the entire sum insured can be availed by any or all members and is not restricted to one individual only as is the case in an individual health plan.

Let's look at an example. Say, a family of four has individual covers of Rs 1 lakh each. If the cost of treating one person crosses Rs 1 lakh, then the rest has to be borne by the family out of its own money. If, however, the entire family is insured for Rs 4 lakh through a floater policy, then any of the members will be covered for that amount in any year. To the extent of the annual cover, any number of members can avail the money.


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3.Senior Citizens Plan

Insurance is considered a form of long-term savings for senior citizens. This money provides financial stability and also helps them in times of need. Medical insurance enables senior citizens to pay for health checkups, emergency medical costs and long-term treatment. The income tax benefit on insurance premiums is up to Rs. 15,000 under Section 80 D of the Income Tax Act, as on March 31, 2007. Medical insurance is provided through several private insurance companies and four public sector general insurance companies. These are:

  • National Insurance Company

  • Oriental Insurance Company

  • New India Assurance

  • United India Insurance Company

The National Insurance Company offers the Varistha Mediclaim Policy for senior citizens. This policy covers hospitalization and domiciliary hospitalization expenses under Section I as well as expenses for treatment of critical illnesses, if opted for, under Section II. Diseases covered under critical illnesses are coronary artery surgery, cancer, renal failure, stroke, multiple sclerosis and major organ transplants. Paralysis and blindness are covered at extra premium.

Oriental Insurance Company provides a Comprehensive Health Insurance Scheme, a Group Insurance and an Individual Mediclaim Policy. These policies pay for hospitalization or domiciliary hospitalization of the insured in case of a sudden illness, an accident or surgery. These conditions should have arisen during the policy period.


4.Critical Illness Plan

A Critical Illness plan means to insure against the risk of serious illness. It will give the same security of knowing that a guaranteed cash sum will be paid if the unexpected happens and one is diagnosed with a critical illness.

The purpose of a critical illness plan is to let you put aside a small regular amount now, as an insurance against all this happening.

Bajaj Allianz, in its efforts to provide a customer centric solution is offering an insurance policy to cover to some of these critical illnesses like Cancer Coronary Artery bypass surgery First Heart attack Kidney Failure Multiple sclerosis Major organ transplant Stroke Arota graft surgery Paralysis Primary Pulmonary Arterial Hypertension.

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Daily Hospital Cash

Daily cash benefits are a defined benefit policy that pays a defined sum of money for every day of hospitalization. The payments for a defined number of days in the policy year and may be subject to a deductible of few days.

Unit-linked health plan (ULHP).

Looking at the constant growing need of health insurance among people, insurers use new age marketing tools to reach out to potential customers. Providing general overview and an option to buy health insurance online has not only simplified sales for insurers but also has provided a informative platform for insurance seekers to look upon.