Health Insurance - Meaning & Definition
Health insurance covers cost of an insured individual’s medical and surgical expenses. Subject to the terms of insurance coverage, either the insured pays costs out-of-pocket and is subsequently reimbursed or the insurance company reimburses costs directly.
• What is Health Insurance?
Health insurance is an insurance product which covers medical and surgical expenses of an insured individual. It reimburses the expenses incurred due to illness or injury or pays the care provider of the insured individual directly.
● Types of Health Insurance
Every individual is different and has a unique set of needs. A single health insurance product is not enough to cover every person’s individual requirements. This is precisely where there are a number of different types of health insurance plans available. Let’s take a look at what they are:
1. Individual Health Insurance
You can purchase an individual health insurance policy to provide cover for yourself, your spouse, your children and your parents. These policies typically cover all kinds of medical expenses, including hospitalisation, daycare procedures, hospital room rent and more. Under an individual health insurance plan, each member has their own sum insured amount. So, let’s say you’ve taken an individual plan for yourself, your spouse and both your parents with a sum insured of INR 8 lakhs. Each of you will be able to claim a maximum amount of 8 lakhs per policy year against your health insurance.
2. Family Floater Health Insurance
A family floater plan allows you to cover your family members under a single policy and everybody shares the sum insured amount. These plans are typically more affordable than individual plans since the sum insured is shared. Let's say you purchase a family floater plan for you and your spouse with a sum insured of INR 8 lakhs. In a single policy year, you can make claims worth only INR 8 lakhs. Your spouse may make claims worth INR 6 lakhs and you could make claims worth INR 2 lakhs or vice-versa. Typically, family floater plans are ideal for young nuclear families.
3. Senior Citizens Health Insurance
These health plans have been designed specifically keeping the medical needs and requirements of senior citizens in mind. Most senior citizens policies offer additional cover, such as domiciliary hospitalisation and even some psychiatric benefits. Since older citizens are more likely to have health issues, these policies may require a full medical check-up beforehand and could be more expensive than regular insurance policies.
4. Critical Illness Insurance
There are a number of lifestyle-related diseases that are on the rise. Health issues such as cancer, stroke, kidney failure and cardiac diseases can be very expensive to deal with and manage long-term. This is precisely why critical illness insurance policies have been created. They can either be purchased as a rider or add-on with your regular health insurance plan or separately as their own plan. These policies offer cover for very specific issues and often provide claim payouts as a single lump sum payment after the diagnosis of a critical illness.
5. Group Health Insurance
Unlike individual and family floater policies, group health insurance plans can be purchased by a group manager for a large number of individuals. For example, an employer can purchase group insurance for all their employees or a building secretary may purchase such a plan for all the residents of the building. These plans are fairly affordable, but they often only provide cover for basic health issues. Employers often purchase these plans as an additional benefit for employees.
● Benefits of Health Insurance
Purchasing health insurance is crucial for a number of reasons. Let’s take a look at the most important benefits of our health insurance policies:
- Helps Deal with Rising Medical Costs
People purchase health insurance policies to safeguard their finances against ever-rising medical costs. An accident or medical emergency could end up costing you more than a few thousand rupees. With a medical insurance plan, you enjoy cover for everything from ambulance charges to daycare procedures, making it easier for you to get the care you need to recover.
2. Critical Illness Cover
Many health insurance policies will also offer cover for critical illnesses at an additional cost. Given the rising incidence of lifestyle-related diseases today, this is another crucial cover to have. You will be provided with a lump sum payout in case you are diagnosed with any of the covered critical illnesses. These issues are often very expensive to deal with and manage, so critical illness cover is another vital benefit of having health insurance.
3. Easy Cashless Claims
Every health insurance provider will tie-up with a number of network hospitals where you can enjoy cashless claims. This makes the entire process of receiving emergency medical care much easier. At a network hospital, you aren’t really required to pay for any of the covered treatments. For all valid claims, we’ll take care of the medical costs, without you having to pay for anything, except non-covered expenses and the mandatory deductibles.
4. Added Protection
If you enjoy cover under a group health insurance plan, you may wonder why you should purchase your own health insurance policy. Well, individual health insurance plans offer provider more and better cover than group plans. Additionally, if you happen to leave the group at any time, you risk losing the cover, which could make you and your finances vulnerable.
5. Tax Savings
Under Section 80D of the Income Tax Act, 1961, premiums paid towards the upkeep of health insurance policies are eligible for tax deductions. For a policy for yourself, your spouse, your children and parents below the age of 60, you can claim a deduction of up to INR 25,000 per year from your taxable income. If you’ve also purchased a policy for a parent who is over the age of 60, you can claim an additional deduction of INR 50,000.
●How Health Insurance Works?
Like every kind of insurance policy, health insurance also helps you deal with the financial repercussions of an accident or emergency. Let’s take a look at how health insurance actually works. The process starts when you apply to purchase a plan. Depending on your age, medical background, sum insured required and the type of plan youve selected, you will be provided with premium quotes. In some cases, you might be asked to do a few medical tests before the insurance provider decides whether they’d like to provide you with the required cover. Once the terms and conditions are finalised, you will be provided with a policy. Each policy comes with a few waiting periods. The initial waiting period is only for a few weeks or a month. During this time, you will not be able to make any non-emergency claims. Let’s say that you require some kind of surgery after the waiting period. If you’re able to get the treatment in a network hospital, you can let us know about the surgery, and we’ll get in touch with the hospital directly to settle all the payments. When you’re discharged from the hospital, you will only have to pay for additional expenses that are not covered and the voluntary co-pay amount, if any. If you’re getting treatment in a non-network hospital, you can make all the payments and then file for a reimbursement claim. Either way, you can get the treatment you require without fretting about burning a hole through your pocket.
Difference BetweenMediclaim Plan or a Critical Illness Insurance Plan?
A mediclaim plan or health insurance policy works a little bit differently as opposed to a critical illness insurance plan. Let’s take a look at the differences between these plans:
Type of Payout
Mediclaim plans are known as indemnity plans. This means that the claim amount you receive will help offset costs as per actuals. These payouts are provided against actual medical costs and bills.
On the other hand, critical illness plans offer a lump sum payout of the sum insured once you are diagnosed with a covered critical illness. You can use the money to pay for treatment, repay debts or even replace your lost income.
What’s Covered
Regular mediclaim policies offer cover against a wide range of issues. Everything from accidents to surgeries, AYUSH and domiciliary treatments are covered under these policies.
Critical illness plans, on the other hand, provide a lump sum payment only for very specific critical illnesses.
What’s Better?
If you weigh out both the options, health insurance plans and critical illness policies offer very different benefits. If you’re planning on purchasing a policy, it’s a good idea to buy a regular mediclaim policy and get additional critical illness cover. You need both to secure your finances for the future in case anything untoward were to happen to you.
