Comprehensive Health Insurance
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What is comprehensive health insurance?
Comprehensive health insurance refers to a health plan that offers wider coverage as compared to a regular mediclaim plan. This policy can cover you and your loved ones under the same plan, and the sum insured can be shared. Usually, you need to buy additional coverage for medically advanced treatments like organ donation, robotic surgeries, etc., but, for convenience, you can get such things included under one comprehensive health plan.
What are the benefits of a comprehensive health insurance policy?
The benefits of a comprehensive health insurance policy are as follows.
Financial benefit
Having financial support during a medical emergency is one of the most important benefits of buying a comprehensive health insurance policy. You can avail of this financial help in either a cashless or reimbursement claim depending on where you choose to receive treatment. It would help if you got admitted to a network hospital to receive a cashless claim. While you can get treatment in a non-network hospital, pay the bill, and then get the charges reimbursed.
Value added-services
Insurance companies may include various value-added services in their comprehensive plan. For example, free teleconsultations with certified doctors, preventive health check-ups, discounts on medicines, etc.
Lifetime renewability
Usually, health insurance companies have a set exit age of up to 75 years. After a policyholder attains this age, they cannot renew the plan. But with a comprehensive plan, one can get the option of lifetime renewability. This means the policyholder can continue their health plan for as long as they like.
Add-ons advantage
You may be given an option to choose more coverage by paying slightly more premium. Add-ons like Room-rent Waiver, Daily Hospital Cash, Maternity Benefit, etc., can be helpful during hospitalisation. The monetary benefit they provide in the long run might be higher compared to the extra premium you pay while buying a comprehensive policy.
No Claim Bonus (NCB)
No Claim Bonus or cumulative bonus is awarded when you don't raise a claim during the policy period. Under health insurance, the NCB is given as a percentage-wise increase in the sum insured.
For example, a bonus of 5% can increase your sum insured by 5% for the next policy period. Say you have a health plan with a sum insured of Rs. 10 lakhs and you receive a 5% NCB. Your sum insured will increase to Rs. 10.5 lakhs upon renewal. Thus, your sum insured can increase in the future if you don’t raise a claim in the current policy period.
Tax benefit
If you pay tax as per the old regime, then you get a tax benefit for buying health insurance for you and your family. Under section 80D of The Income Tax Act, you can claim up to Rs. 25,000 (if you are below 60 years of age) and Rs. 50,000 (if you are more than 60 years of age). You can also claim a tax benefit if you are buying health insurance for your senior citizen parents. Additionally, you can get a benefit of Rs. 5,000 for availing of preventive health checkups. Note that these numbers are subject to changes.
Why is having a comprehensive health insurance plan important?
Having a comprehensive health insurance plan is important because it provides all-around coverage during a medical emergency. These plans also allow policyholders to add multiple dependents. You can thus rest assured that you and your family members can receive timely medical treatment without worrying about the finances.
Comprehensive plans also offer elaborate coverage and flexibility to buy add-ons as compared to regular health insurance policies. Coverages like wider pre and post-hospitalisation period or daycare treatment under these plans help you reduce the out-of-pocket expenses during a medical event. Thus, it is advisable that you opt for comprehensive coverage while buying your health insurance plan.
What does a comprehensive medical insurance plan cover?
A comprehensive medical insurance plan covers the following.
Hospitalisation expenses
You can claim expenses starting from pre-hospitalisation in case of planned treatment. For example, you may be required to undergo specific treatment to prepare for surgery. Then comes the costs for the days you are admitted to the hospital. This includes emergency hospitalisation as well. Followed by post-hospitalisation charges. These three conditions are covered under a comprehensive policy.
Coverage for daycare treatments
Daycare treatments are medical procedures that require less than 24 hours of hospitalisation. These can be complex surgeries. Nowadays, certain surgeries have become more efficient due to advanced technological developments in the field of medicine—for example, cataract surgery. A comprehensive medical insurance plan provides coverage for such daycare treatments.
AYUSH treatment
AYUSH treatments are an alternative medical treatment form that includes Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. Insurance companies have started covering such treatments and may offer hospitalisation cover for registered AYUSH hospitals.
Domiciliary hospitalisation
Domiciliary hospitalisation refers to a person being treated at home. Such a situation can arise due to many different reasons like unavailability of hospital beds, inadequate medical facilities, etc. The cost of such treatments is covered under a comprehensive policy.
Ambulance charges
The ambulance charges for a particular medical event are covered under health insurance. Note that the number of ambulance trips covered can vary from insurer to insurer. For example, with ACKO Health Insurance Policy, an unlimited number of ambulance trips up to the sum insured, i.e. Rs. 1 crore, are covered.
Organ donor expenses
Donating an organ requires a person to undergo treatment and surgery. This can involve pre and post-hospitalisation treatment and hospitalisation in order to perform the surgery. Related expenses can be covered under the comprehensive healthcare insurance plan.
Pre-existing diseases coverage
Pre-existing diseases are medical ailments that a person suffers from when they buy a health insurance plan—for example, asthma, diabetes, or issues with blood pressure. Insurance companies cover such diseases under a comprehensive policy after a fixed waiting period.
Note that the above section is just for explanatory purposes. Please refer to the respective policy wordings for details.
Eligibility criteria for buying comprehensive health insurance
All people above the age of 18 years are eligible for a dedicated health insurance policy in India. This is also called the entry age for a medical insurance plan.
It is suggested that a person must buy health insurance as early as possible to avoid a potential rise in premium at the later stages. This might be why insurers usually need people above the age of 45 years to undergo pre-policy health check-ups. These are routine diagnostic tests that help determine the applicant's current health status.
How is a comprehensive health insurance premium calculated?
The comprehensive health insurance premium is calculated by weighing different factors related to coverage, sum insured, insured person's age, number of dependents, etc. These factors can vary from person to person; thus, two people with a similar health insurance plan can be charged different premiums.
Sometimes insurers also present the option of co-pay or voluntary deductible. Here the policyholder promises to pay a pre-decided part of the claim amount during settlement. If the co-pay clause is applicable, then the premium may also reduce to an extent.
Consider using the health insurance premium calculator if you want to get an idea about the plan's cost. All you have to do is enter relevant details related to you, and the dependents (if applicable) and the calculator will generate a quote. Usually, insurers (such as ACKO) embed the premium calculator in their purchase journey. This means you will see a free quote while buying the policy.
Things to keep in mind while buying a comprehensive health insurance policy
Making haste while buying medical insurance can lead to high out-of-pocket expenses during a medical emergency. But you can avoid this by weighing available options and considering the following.
The balance between coverage and premium: Usually, coverage and premium go hand in hand. More number of inclusions means a higher premium. But sometimes, a policy may be expensive and still not provide enough necessary coverage. Look for health plans that offer the right balance between coverage and premium.
Exclusions of the medical insurance plan: Being aware of the things that are not covered under the plan, i.e. exclusions, can help a lot in case of claims. If you claim against an exclusion, the insurance company will reject it. This can lead to disappointment, especially during distressing situations. Thus, make sure that you read through the list of exclusions carefully before buying health insurance.
The room rent clause: The room rent clause can be tricky as the entire hospital bill gets affected if you choose a room that costs more than the allowed limit.
Services and turnaround time of the insurer: An insurance company’s reputation often depends upon the kind of services they provide. Making sure that the insurer has a quick turnaround time will help you spend less time completing a certain action. For example, actions like making changes in the policy, renewing health plans, making claim settlements, etc., can be completed quickly when the insurer provides a quick resolution. Also, look for an insurer who has a round-the-clock customer care centre.
Availability of add-ons: Sometimes insurance companies provide optional coverages that can prove to be quite useful in a medical emergency. For example, Daily Hospital Cash add-on. This add-on can cover additional expenses when you or a loved one is hospitalised.
Waiting period: Most insurance companies enforce at least 2 to 3 types of waiting periods on a health insurance policy. This includes the initial waiting period, waiting period on pre-existing diseases, etc. Note that you cannot raise a claim for a particular illness for an applicable waiting period. Be aware of which type of waiting period is enforced for which ailment.
Deductibles and deductions: Deductibles refer to an amount you must pay at the time of claim settlement (usually 10% of the claim amount). Similarly, an insurance company applies certain deductions on the claim amount (for example, non-medical expenses that include registration/admission charges, cost of surgical blades, digestion gels, etc.). These can increase your out-of-pocket expenses. Learn more →
Frequently asked questions
Following are some commonly asked questions and their answers about a comprehensive health insurance policy in India. In case you have more queries, please write to us at [email protected].
Does a comprehensive health plan provide 100% coverage?
Usually, a comprehensive plan does not provide 100% coverage as there are conditions like waiting periods and deductibles. However, with the ACKO Health Insurance Policy, an approved claim is paid in full amount. There is no waiting period for disclosed medical conditions and no deductions at the time of claim settlement.
What should I look for when buying a comprehensive health insurance policy?
The top five things to look for when buying a comprehensive health insurance policy are as follows.
Coverage
Sum insured
Premium
Exclusions
Services
If these five things are as per your expectations, then you have a suitable health plan for a future medical contingency.
What is the major difference between a comprehensive and a regular health insurance policy?
The major difference between a comprehensive and a regular health insurance policy is that a comprehensive policy provides more than the basic hospitalisation coverage. For example, coverage could include outpatient department (OPD) expenses, teleconsultations, etc. On the other hand, a regular health plan may have limited inclusions.
What can happen if I avoid sharing details about my current health status while buying a comprehensive policy?
The worst that can happen if you avoid sharing your current health status with your insurer is that your health insurance claim will get rejected.
Disclaimer:
*Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**In case the pre-existing disease surfaces after a policy is issued. However, at the time of claim, if it is found that the policyholder did not disclose any known pre-existing diseases while buying the policy, the claim may get rejected.
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