Health insurance policy is a legal contract between the policyholder and the insurance company. It highlights the contract’s term, premium, sum insured, coverage, etc. The contract also includes terms and conditions under which the insurer is bound to bear the cost of medical care of the policyholder and his/her family.
What Is Health Insurance?
Health Insurance like any other form of insurance provides financial support in the timHealth or medical insurance shields the primary policyholder from financial cost of hospitalization arising out of an accident, sudden illness or planned hospitalization. Insurance companies cover policyholders and their family with the facility of cashless hospitalisation or offer to reimburse any medical expenses incurred during the policy period.e of need. Health insurance covers the cost of medical expenses incurred due to hospitalization or treatment for the insured.
Insurance providers tie-up with a group of partnered hospitals, known as network hospitals. Through these hospitals you can avail cashless treatment for medical and surgical expenses. Generally, insurance companies offer to reimburse hospitalization costs of non-network hospitals. The government of India also encourages citizens to avail a health insurance by offering tax exemptions on health insurance under Section 80D of the Income Tax Act, 1961.
Healthcare and wellness expenses are rising every day. Hence, a well covered health insurance in India has become one of the basic requirements. Depending on the type of health insurance plan, you can avail different types of coverage for expenses related to surgical, critical illness, hospital, diagnosis, etc.
All About Health Insurance Policy:
A health insurance policy plays a vital role in offering financial coverage during hospitalization. It is a legal contract between the insurance company and the policyholder assuring you of financial help in case of hospitalisation. Here are some of the most important aspects of the health insurance that will help you make the right choice.
Common Health Insurance Terms and Definitions:
Every day, it’s becoming important for healthcare customers to know about the terms and definitions used in the health industry. Here, you’ll find some of the common definitions and terms related to a health insurance policy.
- Pre-Existing Illnesses: A health issue that has been diagnosed, or for which you have been treated before purchasing a health insurance policy.
- Network Hospital: A group of hospitals that insurance companies tie-up to offer medical services through cashless process of hospitalisation.
- Waiting Period: It’s a period after which you can begin availing the benefits of the health insurance policy. The waiting period can vary between health insurance companies and the type of plan you opt for.
- Inclusions: All that is included in your health insurance plan is considered as inclusions and it is listed under the terms and conditions in the policy document.
- Exclusions: All that is not included in your health insurance is considered as exclusions. Similar to ‘Inclusions’, exclusions are also mentioned in your policy document. It’s important that you know them before you decide.
- Sum Insured: The total amount payable by the insurance company to a policyholder for medical expenses. In other words, it’s the total amount that the insurer will pay in case of hospitalisation.
- Claim Request: A request by the policyholder for the insurance company to pay for medical expenses arising out of hospitalisation.
- Dependent: Any individual, either spouse or child or parents, that is covered by the primary insured member’s policy is known as dependent.
- Effective Date: The date on which the policyholder’s coverage starts.
- Premium: The amount you pay annually/quarterly/monthly to the insurance company in exchange for insurance coverage.
- Add-ons: Coverage options that enable you to increase your basic plan for an additional premium.
Also, check: COVID-19 Health Insurance
Importance of Health Insurance:
It’s not just a good idea to buy a health insurance plan, but it’s a necessity due to the ever-increasing costs of medical care. It acts as a financial cover arising out of emergency hospitalisation of self or any member of your family. By overlooking a health cover, it could possibly lead to a dent in your savings or you may even have to borrow funds for the unexpected hospitalization.
Medical emergencies come unannounced and with medical care becoming increasingly expensive, it’s imperative to opt for health insurance and purchase a policy which will cover members of your family as well.
Benefits and Features of Health Insurance Plan:
Health insurance providers offer different types of plans to suit your needs. Hence, different plans offer different features related to surgeries, medical treatments, etc. Here are some of the advantages of health insurance plan:
- Pre- and Post-Hospitalisation Expenses: The cost of medical treatment 30 days before and 90 days after your hospitalisation is covered under health insurance.
- Hospitalisation Coverage: A health insurance plan will cover the expenses arising out of hospitalisation due to a sudden illness or accident. For this coverage, a minimum of 24 hours of hospitalisation is required so that you can register a claim against your medical insurance policy.
- Ambulance Coverage: Health insurance policies cover expenses related to ambulance services.
- Domiciliary Hospitalization: Some insurance companies cover the cost of the medical treatment availed at home. Check with the insurance company if this feature is available in your policy.
- Health Check-ups: Some of the insurers offer general health check-ups; however, there could be a waiting period before you can take advantage of this service. It’s a good idea to check if the insurance company offers routine health check-ups so that you are aware of your current health condition.
- Day Care Procedure Expenses: Medical treatments such as angiography, dialysis, radiotherapy, eye surgery, chemotherapy, etc. are considered as Day Care Procedure. Some of the health insurance policies cover this type of medical treatment.
- Critical Illness Treatment: Based on the type of medical insurance policy, critical illnesses such as cancer, stroke, artery diseases, paralysis, amongst others are covered. Check with your insurance provider before buying health insurance if these critical illnesses are covered. Some insurers may offer it as an additional feature with an additional premium.
Apart from its benefits, here are some of the features and benefits of health insurance in India, which act as an excellent source of investment.
- Tax Benefits: By availing the family floater health insurance, you can claim tax deductions of up to Rs.25,000 under Section 80D of the Income Tax Act, 1961. An additional exemption of up to Rs.25,000 can be claimed if you are covering your parents below the age of 60 years. If either of your parents is over the age of 60 years, you can claim up to Rs.50,000. And, up to Rs.1 lakh by claiming Rs.50,000 if one of the family members is over the age of 60 years and an additional Rs.50,000 for parents over the age of 60 years. Please note that tax benefits might change in the next financial year.
- Additional Health Coverage Over and Above Your Employer’s Cover: Several organisations provide health insurance policy to their employees with a group insurance plan. However, this type of insurance is not customised according to your requirements. By having additional medical insurance it protects in case you lose your job or move to a different organisation, leaving you and your family uninsured. Standalone health insurance policies protect you and your family in such scenarios.
Health Insurance with Tax Benefits:
The health insurance premium for the policy period offers tax relief under Section 80D of the Income Tax Act, 1961. And, for senior citizens, the Finance Act, 2018 provides higher tax benefits for premium paid towards the health insurance.
The total tax exemption on health insurance under Section 80D is as follows:
|Details||Self, Spouse, Children||Parents||Total Deduction|
|No one over 60 years||Rs.25,000||Rs.25,000||Rs.50,000|
|The policyholder and his/her family are less than 60 years and parents are above 60 years of age||Rs.25,000||Rs.50,000||Rs.75,000|
|The policyholder and parents have attained the age of 60 years and above||Rs.50,000||Rs.50,000||Rs.1,00,000|
- The premium can be paid in any mode other than cash.
- Tax benefits under Section 80D are in addition to the deductions of up to Rs.1.5 lakh under Section 80C.
- You cannot claim tax exemptions for your in-laws, sisters or brothers.
- Single premium health insurance policies paid in a single year for a policy period of more than a year can claim tax benefits subject to the limits of Rs.25,000 of Rs.50,000.
Preventive Health Check-Up Tax Deductions:
Under Section 80D of the Income Tax Act, you can claim a tax deduction of up to Rs.5,000 for expenses related to preventive health check-ups. If you are below the age of 60 years, the maximum claim tax deductions is of up to Rs.25,000 which covers you, spouse and your dependent children.
So, how much tax can you save on preventive health check-ups? This depends on the tax rate applicable to your income post claiming all the eligible tax deductions. Here’s a simple calculation based on different tax slabs:
|Income Tax Slabs||Tax Savings|
Buy/Renew Health Insurance:
Managing health can be complicated sometimes. However, most health insurance plans have a variety of online tools to help you buy health insurance. You can apply for health insurance online, which lets you compare, choose IDV or increase coverage based on your needs. You can also renew health insurance online from the comfort of your home or anywhere, simply visit the website of the insurance company and you can process your mediclaim policy renewal online.
How do I Apply for Health Insurance Online?
It takes a few steps to ensure you and your family are well covered with a suitable health insurance policy. You can apply for health insurance online by following the below steps:
Steps to Buy Health Insurance Online:
- Step 1: Visit the insurance company’s website. Example: acko.com
- Step 2: Enter a few details such as your age, dependent details and choose from different types of insurance based on your needs.
- Step 3: Pay the premium and receive your policy document instantly to your email address.
Steps to Renew Health Policy Online:
- Step 1: Visit the insurer’s website or their mobile app. Example: acko.com
- Step 2: Login with your username and password if you are renewing the policy with the same insurance company.
- Step 3: To renew health insurance with another insurance provider, visit their website for transfer or port the health insurance.
- Step 4: If you are renewing the policy with the existing insurer, then upon login you will be prompted to renew the plan. Pay the renewal premium and receive the policy document to your email address.
Benefits of Buying Health Insurance Online in India:
Ensuring you are financially covered through health insurance is one of the primary objectives and buying it online is even more easy with the advent of digital transactions. Below are some of the benefits of buying health insurance online in India:
- Compare with several insurance providers.
- Choose from different types of health insurance plans.
- Avail maximum coverage at a lower premium.
- Check claim settlement ratios and various other factors of health insurance companies.
- It saves you time. You can buy health insurance from the comfort of your home or anywhere as far as you have an internet connection.
- No need for an agent or middleman, thereby reducing the cost to get health insurance.
- Convenient and easy to transact or buy the policy.
How to Choose Best Health Insurance Plan:
Health insurance policies in India are varied. From individual to family floater plans, health insurance should be assessed based on your requirement. Here are a few tips to choose the best health insurance policy:
Get the Right Coverage
To select the best health insurance coverage, it should cover you with a wide range of medical problems and enhanced benefits. These can be pre- and post-hospitalisation cover, illnesses that you may be at risk due to your family history, transportation, home care treatment, daycare expenses, etc. Ensure you choose the health insurance plan that offers a wide coverage at a lower premium.
Choose Family Floater Over Individual Plan
Individual plans are suitable for individuals who prefer health insurance only for themselves. However, if you want health insurance which covers your family, then choose the family floater plan. It offers maximum benefits at a competitive price.
Compare Health Insurance Quotes Online
Use the health insurance premium calculator to understand the parameters which influence the price of the plan. This will let you know which parameters to tweak and suit it based on your personal preferences. You can choose from different insurance companies and their prices for a health insurance that suits you and your family.
Check Network Hospital Coverage
A health insurance policy which can be accepted across a wide range of hospitals and specialities will be of help to you at times of emergencies. Choose an insurance company which is tied with several good hospitals across the world.
Choose a Policy With Minimum Waiting Period
Like every other insurance policy, health insurance policies are not without terms and conditions. Hence, choose the one which has a lower waiting period for pre-existing conditions and diseases. Generally, mediclaim policies offer a lesser waiting period for such conditions. Choose for the one with less waiting period.
High Claim Settlement Ratio
Insurance companies with high claim settlement ratios offer an insight into how the insurance company reviews its claim settlements. This reflects that the insurance company will not reject a claim without a valid reason. It is also your responsibility to read their terms and conditions about claims and use it to your advantage.
What is Cashless Health Insurance?
Cashless health insurance policies mean that the insurance company settles the medical bill directly with the hospital. With inflating healthcare costs, sudden or unexpected hospitalisation can burden your finances. Cashless hospitalisation is a great way to lessen the burden and health insurance companies provide the assistance of paying off the medical bill directly to the hospital.
Also, cashless Mediclaim policy enables you to receive good quality medical care without the need to pay from your end. Instead of paying for the healthcare services by struggling to arrange money, cashless medical insurance offers the ease of an alternative mode to pay for services.
You can simply show your health card or state your policy number at any of the insurance provider’s network hospitals and avail cashless transaction. Additionally, cashless health cover can be availed in case of emergency as well as planned hospitalisation.
How Does Cashless Health Insurance Facility Work?
Choosing a good health insurance policy for your family might safeguard you from unexpected or planned hospitalisation and thereby avoid any unexpected expenses. However, we sometimes tend to overlook the finer details by choosing a traditional method of reimbursement, where the insurance company reimburses you for the medical costs after the treatment. This is where cashless facility scores over reimbursement.
Cashless medicare services is a type of benefit with health insurance and can be availed in both individual and family floater medical insurance. Before you understand the process of a cashless claim, let’s understand the nuances of a cashless health insurance policy.
The primary aspect of the cashless facility is the network hospitals. Insurance companies tie-up with a wide network of hospitals to provide cashless facility to the policyholder. If you do not avail healthcare services from one of these network hospitals, then you cannot take advantage of the cashless facility.
In case of an unexpected hospitalisation due to a medical emergency or an accident, you can avail cashless hospitalisation by informing the insurance company. They will register the claim and connect with the hospital towards medical expenses arising out of your hospitalisation, subject to the terms and conditions of the policy.
When you are aware that you or your family would be undergoing treatment, inform your insurance provider in advance, as stated in the insurance policy. The insurance company will bear the cost of pre and post-hospitalisation expenses. You need not bear the cost of medical care up to the number of days that are mentioned in the policy document.
Now, let’s understand the process of cashless health insurance claim:
- Approach the network hospital of your insurance company and provide your policy details. They will get in touch with your insurance company to initiate the process. Ensure you have got yourself or your family admitted at one of the network hospitals listed by the insurance company.
- During the initial process of hospitalisation, you need to fill the form to initiate the cashless hospitalisation. This form is sent to the Third Party Administration (TPA), based on the terms and conditions of the policy, the TPA will either authorise or deny the insurance cover and will also let you know the limit of the expense.
- Upon TPA authorising the hospitalisation, all claims will be processed up to the admissible limits.
Advantages of Cashless Health Insurance
Be it an emergency or a planned hospitalisation, cashless medical insurance are of great importance. Let’s look at some of the benefits of cashless health insurance:
- The facility decreases your financial burden and helps recover without worrying about funds for medical care.
- It’s of great help if you do not have immediate liquid cash to pay for the hospitalisation cost.
Things to Keep in Mind While Buying a Health Insurance with Cashless Facility
Here are some of the tips while buying cashless medical insurance:
- Cashless facility is available only with insurance companies’ network hospitals.
- Ease of registering a claim through the cashless facility.
- There could be a possibility of your claim being rejected. Read the terms and conditions of the policy carefully.
Types of Health Insurance Plans in India:
To cater to different requirements of customers, insurance companies have designed various types of medical insurance plans to suit customers’ needs. Below are the various types of health insurance policies in India:
1) Individual Health Insurance Policy
Under this type of medical insurance plan, the policy provides financial coverage to an individual policyholder. Generally, it covers certain illnesses and offers cashless hospitalisation, pre and post hospitalisation cover, reimbursement and several other Add-ons.
2) Family Health Insurance Policy
Under this plan, you can include family members in one single health insurance policy. Family members include you, your spouse, dependent children and parents. This type of medical insurance offers an assured sum amount to all the family members. While this policy demands a higher premium compared to an individual insurance policy, the cost to buy separate individual policies can be higher.
3) Senior Citizen Health Insurance Policy
Designed exclusively for senior citizens, this type of health insurance in India provides medical insurance to individuals aged above 60 years. It offers cover against health issues during old age. Senior citizens may be asked to go through a medical check-up before the insurance policy is offered. Also, the government of India offers tax exemptions for senior citizen medical insurance making it a good investment.
4) Critical Illness Health Insurance Policy
These plans are designed as a standalone or as Add-ons to your base policy. They are targeted at critical illnesses such as cancer, heart attack, stroke, loss of limbs, organ transplant, blindness, coma, kidney failure, amongst others. Since this type of health insurance is made for specific illnesses, they do come with a higher premium. The insurance plan pays the amount specified as a lump sum which can be used for expenses related to the critical illness.
5) Maternity Health Insurance Policy
These plans are designed especially for those who plan on bearing children. It may be offered as a standalone plan or as an add-on to the base policy. This policy covers medical expenses for the mother and the newborn, child delivery (normal or caesarean), pre and post-natal costs, hospitalisation expenses as well as any complications that may arise. It also covers the newborn up to the term period of the policy.
6) Personal Accident Insurance Policy
Usually offered as an Add-on to the base policy, Personal Accident health insurance provide hospitalisation and compensation in case of death, injury, disablement, mutilation or impairment. Included as an Add-on to the base policy, this policy provides extra coverage to the policyholder apart from hospitalisation due to an accident.
7) Employee/Group Health Insurance Policy
Several companies offer medical insurance to its employees which are known as Group or Employee Health Insurance policy. These plans are described to include and exclude employees as they join or leave the organisation. The policy covers hospitalisation expenses, illness or accidents, pre and post-hospitalisation, domiciliary hospitalisation and daycare treatments.
8) Pre-Existing Illness Cover
Certain insurance companies set a waiting period of up to 4 years before they start to cover pre-existing diseases under the insurance contract. To close this gap, you can choose the pre-existing illness cover as an additional feature by paying an extra premium. This way you are covered for pre-existing illnesses apart from your basic medical cover.
9) Preventive Health Check-Ups Cover
Insurance policies offer medical check-ups part of their health insurance plan. You can claim a certain percentage towards expenses related to health check-up for the policy period. Both yourself or your family can take advantage of this feature. Usually, bundled into the basic plan, new-age insurance companies offer extra cover towards health check-ups. Also, the government of India supports by offering tax exemptions towards health check-up costs.
What is Covered Under Health Insurance?
Your health insurance is a binding contract between you and your insurance company. It typically covers most doctor and hospital visits, medicines, surgical costs, wellness care, and medical devices. It also takes care of treatment in case of critical illnesses or serious medical conditions. However, it does not cover certain illnesses which are listed as exempt. A basic health insurance plan may include:
- In-Patient Hospitalisation Cost: Medical expenses incurred during hospitalisation for more than 24 hours, which includes room rent, doctor’s or surgeon’s fee, medicine costs, etc.
- Pre- and Post-Hospitalisation Expenses: Health insurances cover expenses incurred before and after hospitalisation. This is usually capped at 30 days prior and 60 days after hospitalisation.
- Day-Care Treatment: Certain day-care or treatment costs for advanced medical conditions are covered under medical insurance.
- Certain Pre-Existing Diseases: Some of the pre-existing diseases may be covered after 2 or 4 years of continuous coverage with the insurance company.
- Cashless Hospitalisation: Insurance providers offer cashless hospitalisation at any of its network hospitals.
- Preventive Health Check-ups: You can make use of the health check-ups provided by some of the insurance companies. Typically, this benefit is available after the waiting period.
- Ambulance Cost: Basic emergency ambulance charges are covered.
What is Not Covered Under Health Insurance?
While the basic medical insurance policy covers most of the hospitalisation expenses, there are treatments and medical conditions that are not covered. Here are a few of them:
- Cosmetic Surgery: Liposuction, Botox or surgeries of a similar kind are not considered as life-threatening or dangerous. Hence, they are not covered under a health insurance policy.
- Pre-Existing Diseases: This could vary from one insurance company to another. Some of the insurers do not cover pre-existing diseases such as diabetes, high blood pressure, while some of them do cover with a waiting period. In some cases, with a payment of additional premium, insurers might cover pre-existing diseases.
- Diagnostic Expenses: Most of the costs incurred due to blood tests, CT scans performed at a diagnostic centre, nursing home or hospital are not covered under health insurance.
- Miscellaneous Charges: Charges towards registration, admission and service fee are not covered under the medical insurance plan.
- Certain Drugs: Some drugs used during hospitalisation are not included under the basic health insurance plan.
- Substance Abuse Related Illnesses: Some of the critical illnesses related to substance abuse such as alcohol or tobacco or intoxicating drugs may not be covered.
- OPD Treatment: Out-patient treatment is generally not applicable in health insurance, although some insurance companies do offer the feature on payment of an additional premium.
- Suicide/Attempted Suicide: Insurance providers do not cover illnesses or injury due to any act of suicide or attempted suicide or self-inflicted injury.
- Sexually Transmitted Diseases: Illnesses arising out of sexually transmitted diseases are generally excluded in health insurance plans.
Eligibility for Health Insurance Policy:
The eligibility criteria for health insurance may vary from one insurance company to another; however, the general criteria to be eligible for medical cover are as below:
- Entry Age of the Policyholder: The entry age for the primary policyholder is from 18 to 65 years; however, some insurance company may increase the limit.
- Entry Age of Family Members: The minimum entry age is 18 years and a maximum of 65 or 70 years for adults. In the case of dependent children, the minimum entry age is 90 days – although some insurers may even include them from 30 days – to a maximum of 25 years.
- Medical Condition: You may have to undergo a medical examination to get health insurance if you are buying a policy after the age of 45 years. Insurance companies prefer to know your medical condition before offering a health cover. You also have to declare any pre-existing diseases to the insurer. Based on your medical condition, the premium for the health policy may differ.
To avail a health insurance policy, below is the list of documents required:
- Proof of Age: Documents such as your Driving License, Voter’s ID, Passport, Birth Certificate, etc. are accepted as proof of age.
- Identity Proof: Acceptable documents are PAN card, Passport, Driving License, Voter’s ID, etc.
- Proof of Address: Documents include Ration card, Passport, Voter’s ID, Aadhaar card, bank statement, telephone/electricity bill, etc.
- Medical Test Report: If you are asked to furnish, then you’ll have to undergo a medical check-up and submit the report.
- Photographs: You’ll have to submit the required number of passport size photographs.
Difference Between Health and Mediclaim Insurance:
Mediclaim policies are designed to cover basic hospitalisation costs and specified illnesses; however, the coverage or the sum assured will be compromised. Mediclaim cover can be viewed as a low-premium health insurance policy.
On the other hand, health insurance policy is designed to cover the policyholder comprehensively. Apart from basic hospitalisation cost, it can cover pre- and post-hospitalisation costs, critical illnesses, etc. depending upon the selected cover and policy wordings.
If you want a comprehensive health cover, health insurance offers the best benefits and features; however, if you want a limited health coverage with a low-premium health cover, then Mediclaim policy can be an option.
Medical Insurance for Family:
Family health insurance is designed to offer medical coverage for you and your family members. Under the medical insurance for family, you can cover yourself, your spouse, children, and dependent parents for a sum assured. All family members can claim up to the maximum sum assured during the policy period for unplanned or planned hospitalisation.
Benefits of a Family Health Insurance
Here are the major benefits of a family medical insurance plan:
- In-Patient Hospitalisation.
- Hospital cash.
- Daycare treatments.
- Pre- and post-Hospitalisation.
- Ambulance charges.
- Cashless hospitalisation.
Types of Family Health Insurance Plan
A family medical insurance policy can be broadly classified into two types of cover, below are the details:
- Medical Insurance: Under this type of family medical insurance plan, the policy typically reimburses the cost of hospitalisation for the healthcare treatment. The insurer bears the hospitalisation cost through cashless treatment or through the form of reimbursement.
- Critical Illness Insurance: Generally, the critical illness cover is offered through the insurance company’s Add-ons. Under this coverage, the insurer covers the policyholder’s family against critical diseases such as stroke, heart attack, kidney failure, amongst others.
Advantages of a Family Health Insurance Policy
One of the main benefits of a family health coverage is that it acts as a single policy covering you and your family members in return for a premium. It also has other advantages, below are the details:
- Tax Benefits: You can claim tax exemption on the premium paid towards your family medical plan under Section 80D of the Income Tax Act, 1961, while the Finance Act, 2018 provides higher tax deductions for premium paid for senior citizens.
- Cost Saving Investment: Family health insurance acts as an umbrella to all the family members while an Individual policy is designed to cover a single policyholder, making the family plan cost-effective.
- Avail Discounts: Generally, insurance companies offer discounts on family plans compared to individual plans making it a better alternative.
- Hassle-Free Experience: Since it’s a single policy for the entire family, you need not pay multiple premiums for each of the family members.
- Ease of Adding New Family Members: With family health cover, you can add a new family member to the existing policy by informing the insurer; however, you’ll have to purchase a new individual policy for the new member in case you have opted only for an individual policy.
- Parents and Parents-in-Law Coverage: Some insurance companies offer to include your parents or your parents-in-law in the family health plan, making it accessible for all your family members to have a medical coverage.
What is Covered in a Family Health Insurance?
Similar to the individual medical cover, the family health coverage offers:
- In-patient hospitalisation.
- Daycare procedures.
- Pre- and post-hospitalisation cost.
- Ambulance charges.
- Domiciliary hospitalisation.
- No-claim bonus.
What is Not Covered in a Family Health Insurance?
Here are some of the exclusions in family health coverage:
- Pre-existing diseases (waiting period).
- Pregnancy, childbirth and vaccination are generally excluded.
- Cosmetic surgery.
- Dental or joint replacement.
- Sexually transmitted diseases such as HIV.
- Congenital diseases.
Individual Health Insurance Vs. Family Health Insurance
Insurance companies offer two types of health insurance policies to cater to different needs. Both these types of insurances have their pros and cons. Let’s compare the family floater and individual policy to understand how they are unique for medical care.
Difference Between Family Floater and Individual Health Insurance Plan:
The individual coverage is issued in the name of the primary policyholder only. So, you’ll have to purchase different policies for different members of your family. Each of the family members will have a dedicated sum assured and premium amount.
However, the family floater medical insurance policy covers all the family members in a single plan. The sum assured is shared between all the family members. And, apart from the sum assured, below are some of the differences which you should know about:
- Sum Insured: A family medical policy insures all the members of the family with a single sum assured amount. This can be utilised by any or all of the family members and will decrease as and when it’s claimed during the policy period. However, in an individual plan, the sum insured is limited only to one individual and will decrease as and when the individual claims.
- Coverage: Under the family floater scheme, the policy is extended to the primary policyholder, his/her spouse, and two dependent children. Some insurance providers also offer to cover parents, parents-in-law, siblings, and three or four children. In an individual health insurance cover, only one individual is protected under the contract.
- Premium: Insurers determine the premium of family medical insurance by considering the age of the oldest family member, while for individual health policy, the premium is determined by considering the age of the individual policyholder.
In conclusion, both individual and family floater policies are designed to cater to different requirements. While the premium for the individual plan is higher compared to a family floater, that should not be the only criteria for you to choose a family floater plan. For a young family, medical insurance for family is ideal, while an individual health insurance coverage is suits best for a high-risk medical condition of an individual.
Difference Between Individual Health Insurance Plan and Corporate Health Insurance Plan:
Does your employer provide health insurance? Is it adequate to cover you and your family? A medical insurance policy plays an important role in everybody’s life. As you age, there might be medical conditions that require medical care. So, does your employer’s medical insurance cover you when you grow old? The best defence is to have you and your family covered extensively with a family medical insurance plan.
To know the difference between corporate and individual health insurance plans, let’s understand the meaning, features and benefits so you can make an informed decision.
Corporate Health Insurance: An organisation or company buys the Group Insurance plans to provide medical coverage to its employee and their family.
Individual Health Insurance: It’s a comprehensive policy which covers only an individual or only his/her family (if opted for a family floater policy).
The cost or the premium for corporate health insurance is relatively less than the individual medical policy. This is because the organisation offers medical coverage at low or no cost to you. However, under the individual medical insurance, you have to bear the entire cost of the premium, which is typically more compared to a group health care.
No Claim Bonus (NCB):
Despite not raising any claims during the policy period, you do not receive any benefit such as NCB in group policies. However, you enjoy NCB in individual or family medical insurance coverage.
Under the individual plan, the policy is applicable at all times; however, under the group health insurance plan, it covers you as long as you are employed with the company.
Both types of plans have their pros and cons based on your requirement. Having an individual or a family medical insurance plan provides an additional coverage to you and your family, especially during medical emergencies, making it beneficial than a corporate policy.
How to Choose the Best Family Health Insurance Policy?
A family medical insurance plan should ideally offer you and your family complete medical coverage either during planned or unplanned hospitalisation. While there are numerous family insurance plans in the market, the sum assured amount, hospital network and the services of claim are important factors that you consider before buying one.
One of the effective methods to choose the best family medical insurance is to buy the plan through an online insurance company. Digital insurance companies are offering family health insurance online, making it hassle-free and less cumbersome. It’s essential that you don’t select a policy just because it’s cheaper. Check the Sum Assured to know how well you are covered financially.
Additionally, check the insurance company’s Claim Settlement Ratio and how they service an insurance claim. The reliability and track record of the insurance company should be verified to understand how they react to an insurance claim. You could also check with your friends, colleagues or visit the insurance company’s social media handles about the reviews.
Check the exclusions listed in the policy document, this will help you understand medical conditions for which you cannot raise a claim. Finally, check the list of network hospitals that the insurance company has tied-up with. It’ll be good if you choose an insurer with a network hospital near your home.
Health Insurance for Women:
Everybody should have a medical insurance policy to protect themselves in case of a planned or unplanned hospitalisation. Health insurance plays a pivotal role in everybody’s life. It is required regardless of gender. There could be a medical need at every stage of a woman’s life that may or may not be covered in a general medical insurance coverage.
Hence, having a women’s medical insurance policy should cater to your specific requirements. New-age digital insurance companies have made it easier to apply for women health insurance online. Most of these online medical coverages offer protection against critical illnesses.
Factors Which Affect Women’s Medical Insurance Policy:
- Individual or family floater health insurance.
- The waiting period for pre-existing diseases coverage.
- The waiting period for maternity coverage.
- Value-added services.
- Network hospitals.
- Limit of room rent, age and treatment cost.
- OPD expenses.
Benefits of Women Health Insurance Plan:
Here are some of the common benefits of women medical insurance plan:
- Cashless hospitalisation.
- Maternity coverage.
- Pre- and Post-Natal expenses.
- Vaccination costs of newborn babies.
- Tax benefits.
- Critical illnesses coverage.
What is Covered in Women Health Insurance Policy?
Before you decide on purchasing a health insurance policy for women, you need to understand what is included in the policy. Here are some of the common inclusions:
- In-patient hospitalisation.
- Pre- and post-hospitalisation cost.
- Daycare procedures.
- Ambulance charges.
- No-claim bonus.
- Domiciliary hospitalisation.
What is Not Covered in Women Health Insurance Policy?
There are some common exclusions in medical insurance for women. Here are some of them:
- Pre-existing diseases (waiting period).
- Cosmetic surgery.
- Critical illnesses unless offered as standalone coverage.
- Sexually transmitted diseases such as HIV.
- Dental or joint replacement.
- Congenital diseases.
Women Health Insurance Eligibility
Below is the eligibility criteria to avail medical insurance designed for women:
- Age Limit: Women in the age group of 18 years to 65 years can apply for a health insurance coverage.
- Children: Children in the age group of 90 days and 25 years are eligible for a medical insurance policy.
- Medical Condition: If you are above the age of 45 years, some insurance companies require a medical test before they can offer a policy.
To apply for a women’s health insurance plan, here are the documents that are required:
- Age Proof: Passport, Driving License, Voter’s ID, Birth Certificate, etc.
- Identity Proof: PAN card, Passport, Driving License, Voter’s ID, etc.
- Address Proof: Ration card, Aadhaar card, Passport, bank statement, electricity or telephone bill, Voter’s ID, etc.
- Photographs: Apart from the mentioned documents, you must submit the required number of passport size photographs.
Difference Between Health Insurance and Critical Illness Insurance Policy:
Several of us might think medical insurance and critical illness insurance are one and the same. However, they are unique and different. Here, we list the differences between health and critical illness insurance policies:
Illnesses and Expenses Covered:
A health insurance policy covers expenses arising out of hospitalisation, while the critical illness cover pays the full sum assured if you are diagnosed with a critical illness.
The primary objective of a critical illness insurance policy is to cover you financially and compensate for the high medical costs due to the treatment of a critical illness. Typically, critical illnesses include Non-Communicable Diseases such as cancer, heart attack, stroke, kidney failure, etc.
Health insurance policy period is for a year and then renewed for another year. On the other hand, critical illness insurance plan is typically purchased for a period between 15 to 20 years.
Medical insurance policies cover the actual medical costs incurred during your hospitalisation by submitting medical bills and the medical reports to avail the benefits. But, in a critical illness insurance policy, the insurance provider pays a lump sum amount irrespective of the actual expenses incurred.
Generally, the waiting period of a health insurance plan is 30 to 90 days (not applicable in case of an accident). However, the waiting period under the critical illness insurance plan differs between insurance companies and is applicable only after the diagnosis of the critical illness.
Claim or Reimbursement Settlement:
You can raise a claim for medical expenses if you are hospitalised for more than 24 hours under the health insurance plan. In case of critical illness cover, the entire sum assured will be paid to the policyholder subject to survival of the insured is more than 30 days of the treatment or surgery.
The regular health insurance coverage’s premium is higher compared to a Critical Illness Plan as the former offers a comprehensive coverage. In the case of the critical illness plan, the premium is lower as it covers only certain illnesses. And, if you are diagnosed with any of the listed critical illness, you receive the sum assured as a lump sum amount.
In conclusion, the medical insurance is a requirement to protect you and your family in case of hospitalisation. And, a critical insurance plan will cover you in the future if diagnosed with a critical illness which your regular health insurance might not cover. That said, several medical insurance companies offer critical illness coverage as an add-on to the base plan.
Difference Between Health Insurance and Term Insurance:
While being two of the most important types of insurance plans, both term and health insurance have their unique benefits and features. Health insurance covers medical expenses you might have incurred arising out of hospitalisation and/or critical illnesses, while term insurance provides financial coverage to your nominee/s in case of demise of the primary policyholder.
It’s important to include both types of insurance plans to your financial portfolio. Hence, ensure you and your family are well covered in case of any unfortunate situation. Here, we explain both the policies so that you can make an informed choice.
|Features||Health Insurance||Term Insurance|
|Coverage||It covers you and your family members from unexpected medical expenses.||It protects the insured person’s family financially upon the demise of the insured.|
|Claim Settlement||The sum assured can be claimed as and when required with no specific period. With an Add-On such as Critical Illness, the insurance company pays in lump sum.||The sum assured is paid to the beneficiaries of the policy as a lump sum amount.|
|Premium||The premium is slightly higher.||The premium is generally cheaper than health insurance.|
|Maturity Benefits||The policy comes with No-Claim Bonus as a discount to the policyholder.||There are no maturity benefits; however, it’s a financial coverage to the beneficiaries of the policy.|
|Returns||Health insurance acts as an investment plan which helps you financially during medical emergencies.||This is not the regular investment policy. However, there are customised policies which offers certain sum if the primary policyholder is alive beyond the policy end date.|
Benefits of Term Insurance Policy
Here are some of the benefits of Term Insurance policy so that you can make an informed choice:
- Acts as financial support to your family (beneficiaries) in the case of your demise.
- Premium amount payable is usually cheaper than health insurance.
- Offers tax benefits as per the existing Income Tax laws.
- High sum assured with low premiums.
Benefits of Health Insurance Policy
Here are some of the benefits of Health Insurance policy which sets is apart from term insurance plan:
- In-patient hospitalisation.
- Pre- and post-hospitalisation coverage.
- Accidental hospitalisation.
- Cashless hospitalisation in any of the insurer’s network hospitals.
- Domiciliary hospitalisation.
- Ambulance costs.
- Maternity as an Add-on benefit.
- Critical illnesses covered in the case opted as an Add-on feature.
- No-claim bonus.
Health Insurance Portability:
When you transfer your health insurance policy from one insurer to another or from one policy to another of the same insurance company is known as health insurance portability, subject to the policy was maintained without any break. By porting your health insurance plan, you also transfer any credit gained for pre-existing conditions and the waiting period of any exclusions.
How to Port Health Insurance Plan?
Here is a step by step guide on how the process of health insurance portability works:
Step 1: You should apply to such insurance company 45 days prior to the expiry or the renewal date of your existing policy or you can do so within 30 days thereof.
Step 2: You must duly fill the proposal and the portability form, sign and submit it along with the required documents to the insurer.
Step 3: Ideally, the insurance company should revert within 15 days of submitting the application. If you do not receive any intimation, then the insurer does not have the right to reject such a proposal.
Documents Required for Health Insurance Portability
Below is the list of documents required with applying for porting your existing health insurance policy:
- Copies of your existing policy document.
- Pre-insurance medical examination reports (if applicable).
Rights as a Policyholder:
When you port your existing health insurance plan to another, below are the rights that you enjoy:
- You can transfer your health insurance plan to other general insurance company or specialised health insurance provider.
- You can transfer any individual or family floater policies.
- If you have completed the tenure of the ‘waiting period’ on pre-existing conditions or diseases, the new insurance company should consider the waiting period while offering the new insurance policy.
- The new insurance company should provide at least the sum insured offered by the previous insurance company.
- Both the insurance companies should complete the process of porting your health insurance plan within the stipulated time set by the IRDAI.
Health Insurance Portability Conditions:
The apex body of the insurance policies in the country, the IRDAI has listed several conditions to port from one insurance company or one plan to another. Here are the details:
- You can initiate the portability only at the time of the renewal.
- Apart from honouring the credit for the waiting period of pre-existing conditions, all other terms and conditions including the premium will be set by the new insurance company.
- Prior to 45 days of the policy renewal:
- You need to write to your previous insurer requesting to port the policy and specify the new insurance company’s name to which you plan to port the policy.
- Renew your plan without any break.
Health insurance portability is applicable to individual and family floater health insurance plans issued by non-life insurance providers.
Also, check: Arogya Sanjeevani Health Insurance Policy
Government Health Insurance Schemes in India:
In an effort to provide affordable and quality healthcare, the government of India has introduced several government health insurance schemes to cater to different requirements. The health insurance schemes offered by the government include both the Central and State Government initiatives.
List of Government Health Insurance Schemes in India
Here is the list of health insurance schemes launched by the government of India:
- Ayushman Bharat
- Awaz Health Insurance Scheme
- Aam Aadmi Bima Yojana
- Bhamashah Swasthya Bima Yojana
- Central Government Health Scheme
- Chief Minister’s Comprehensive Insurance Scheme (Amma Health Insurance)
- Employees’ State Insurance Scheme
- Karunya Health Scheme
- Mahatma Jyotiba Phule Jan Arogya Yojana
- Mukhyamantri Amrutum Yojana
- Pradhan Mantri Suraksha Bima Yojana
- Rajiv Aarogyasri Community Health Insurance Scheme
- Rashtriya Swasthya Bima Yojana
- Universal Health Insurance Scheme
- Yeshasvini Health Insurance Scheme
- West Bengal Health Scheme
Government Health Insurance Plans Vs. Private Health Insurance Policy
Both these policies have their unique features and benefits. It caters to different requirements of the policyholder. Let’s look at how they differ:
|Government Health Insurance Plan||Private Health Insurance Plan|
|Lower premium||Higher premium|
|Highly discounted by the government||Competitive pricing|
|NCB not available||NCB available|
|Provides coverage with an upper limit||Full coverage on most medical expenses|
|Moderate sum insured amount||Higher sum insured amount subject to payment of higher premium|
|Targeted at low-income individuals or families||Open to everybody|
Health Insurance Claim Process:
The settlement of claims is one of the primary aspects of a health coverage plan. There are two methods insurers settle claims: in-house claims or third-party administrators (TPA). As a policyholder, you can raise claims in two ways: Cashless and reimbursement.
To avail the cashless hospitalisation, you should get your treatment done at a network hospital listed by the insurer.
Through this method, you need to clear the medical care expenses arising out of hospitalisation first and then raise a claim for the reimbursement of the costs. You need to ensure that all hospitalisation-related documents are with you to submit the same to the insurer.
How to Make a Claim?
Generally, the below steps are followed to raise a claim for hospitalisation:
Step 1: Doctor advises hospitalisation.
Step 2: Inform your insurance company about the hospitalisation.
Step 3: If it’s a cashless claim, then hospitalisation can be availed at one of the network hospitals of the insurer. And, for reimbursement claim, undergo the medical care at any of non-network hospital and make the payment.
Step 4: Under the cashless hospitalisation, the hospital will contact your insurance provider to arrange cashless treatment. If it’s reimbursement, then submit the application along with all the required documents to the insurance company within the stipulated time.
Details to be Kept Ready While Making the Claim:
When you intimate your insurance company about the hospitalisation, you need to have certain details ready to initiate the process, here are the details:
- Policy number.
- Policyholder’s contact details.
- Name of the person who is hospitalised.
- Relationship of the person who is hospitalised.
- Hospital name.
- Nature of ailment in the case of health claims.
- Nature of accident in the case of an accident.
- Time and date of the accident.
Health Insurance Claim Process for Cashless Facility:
Follow the steps below to raise a claim if you are utilising the cashless facility:
Step 1: Get admitted to one of the insurer’s network hospitals.
Step 2: Provide or show the medical insurance policy’s ID card to the hospital authorities.
Step 3: Duly fill the cashless request form and submit it to the hospital.
Step 4: The hospital will coordinate with the Third-Party Administration or the insurance company regarding your hospitalisation.
Step 5: Upon authorisation, your cashless hospitalisation will be initiated.
Step 6: Verify and sign all the medical bills upon discharge.
Health Insurance Claim Process if Cashless Hospitalisation is Denied
In case the Third Party Administrator or the insurance company denies your cashless hospitalisation, then follow the steps below:
Step 1: Settle all the medical bills.
Step 2: Ensure you get all the documents provided by the hospital such as discharge summary and bills.
Step 3: Raise a claim to be reimbursed by the insurance provider.
Health Insurance Claim Process for Emergency Hospitalisation with Cashless Facility
In case of emergency hospitalisation, follow the steps below:
Step 1: Get admitted to the hospital.
Step 2: Obtain and duly fill the pre-authorisation form.
Step 3: The hospital will inform the insurance company about the hospitalisation along with the medical condition of the person admitted.
Step 4: Verify and sign the bill.
Step 5: Ensure you have a copy of the medical bills and discharge summary for your reference.
Documents Required for Health Insurance Claim:
Below is the list of documents required while raising a claim with your medical insurance provider:
- Duly filled health insurance claim form.
- Patients discharge summary.
- Prescription and cash invoice.
- Investigation report (X-Ray/ECG/Scan/Laboratory)
- Medico-Legal Certificate (MLC) or FIR in case of an accident.
- Copy of your insurance card.
- Cancelled cheque in case of reimbursement.
- Original medical bills and receipts.
Frequently Asked Questions
Here are the frequently asked questions about health insurance policies:
Below are the differences between the two types of insurance policies:
> Healthcare expenses in the Personal Accident Cover are not covered even if the costs were due to an accident, while the health insurance policy offers claims towards injury, illness and other medical conditions.
> Personal Accident Cover provides coverage due to accidental death while the health insurance policy does not.
> Disabilities is not covered under health insurance coverage.
To avail a medical insurance policy, the minimum age of the policyholder offered by different insurance companies varies between the ages of 18 and 21, and a maximum of 60 years and 100 years. As for the dependents, the entry age for children begins from 90 days until 18 or 25 years, while for adults it remains the same as the primary policyholder.
Under the co-pay clause of the policy, the policyholder has to share the claim an co-pay a predetermined amount.
Yes, dependent children between the age of 90 days and 25 years are eligible to be covered under the policy.
Any ailment, medical condition, injury or related medical conditions for which you have symptoms or signs, and/or diagnosed, and/or received medical treatment or advice within a stipulated time period prior to the first policy by the insurance company is considered as pre-existing diseases.
The maximum amount that the insurer will pay in case of hospitalisation of the policyholder or the beneficiaries of the policy, which is as per the terms and conditions of the insurance policy, is known as sum insured or sum assured.
The period only after which you can start availing the benefits of the health insurance policy is known as the waiting period.
As per the terms and conditions, you can raise several claims during the policy period subject to a maximum of the sum insured.
A hospital which has an agreement with the insurance company for offering cashless hospitalisation is called a network hospital. Only at a network hospital can you avail cashless treatment, while you have to raise a claim through the reimbursement procedure if treated at a non-network hospital.
Under the cashless treatment, you need not settle the medical bills, instead, the insurance company will settle the payment for your hospitalisation.
Yes, can claim tax deductions under Section 80D of the Income Tax Act and the Finance Act, 2018 offers tax benefits of up to Rs.25,000 for a family floater policy which includes the primary policyholder, spouse, and dependent children. In case you include your parents aged below 60 years, then you can claim an additional deduction of Rs.25,000. And, if your parents are above 60 years, the deduction is up to Rs.50,000.
Yes, you can nominate a person under Section 39 of the Insurance Act, 1938. While the policy is active, during your lifetime, you can nominate any person or persons to whom the insurance company will pay benefits under the health insurance upon your unfortunate death.
To benefit from the health insurance, the amount you pay to the insurance company is known as Premium.
Diseases covered under the permanent exclusions will not be covered under the health insurance policy.
Insurance companies require a medical test generally for persons above the age of 45.
Below are the factors which influence the calculation of a premium:
> Individual or Family Floater Policy.
> Sum insured.
> Age of the senior-most member.
> Add-ons (if selected).
> Sub-limit (if selected).
Your health insurance policy offers a grace period of 15 days. Before this period ends, you can renew the policy to continue the policy validity. However, any claims raised during the 15 days will be rejected until the premium is paid. Additionally, if you do not renew the policy within the grace period, the policy will lapse.
Yes, you can transfer your policy from one insurance provider to another as per the circular issued by the IRDAI. This process is known as portability of health insurance plan.
Some insurance companies provide cover for general health check-ups, but it has a waiting period before you can take advantage of the benefit.
A family floater health insurance plan covers you and your family members such as your spouse and dependent children and/or parents. Compared to individual plans, which caters to one individual, the family floater is robust, offering a wide coverage for the family.
News Related to Health Insurance :
New Rules For Health Insurance To Be Followed From October 01
– September 30, 2020
Recently the Indian health insurance industry has undergone a lot of changes. New rules have been laid down by the high court and IRDAI. These rules are to be followed from October 01, 2020. Here are the details: New illnesses like genetic diseases, mental illnesses, Neuro disorder, robotic surgery, oral chemotherapy, psychological illness etc. will form a part of a health insurance policy along with coverage for COVID-19. The pre-existing diseases clause previously had a waiting period imposed on the coverage of the policy, it lasted for years on some policies. Now the pre-existing diseases that are diagnosed 48 months ago can be covered within three months of buying the policy. Coverage for an implant and diagnostics, pharmacy bills, etc to be included in the health insurance policy. A claim cannot be rejected on the basis or misrepresentation or late filing if the policy has been actively renewed for eight consecutive policy periods. According to IRDAI, the insurance company has been given 8 years to investigate the medical history of a policyholder. Telemedicine to become a part of health insurance. Online consultation has gained much popularity during the COVID-19 pandemic. As per another rule that will be implemented, a policyholder can choose to buy multiple health insurance plans. He/she can apply for a partial payment to the health insurance company of his/her choice if one company cannot pay the full claim amount. All health insurance policies bought on or after October 01, 2020, will be as per the above-mentioned rules.
Health Insurance Industry Returning To Normalcy With 25% Growth In August 2020
– September 24, 2020
The IRDA regularly publishes consolidated reports about the performance of various insurance sectors in India. According to a report about the health insurance sector, there is a growth of 25% as compared to reports published in August 2019. It is being observed that these numbers indicate the return of normalcy in the health insurance sector that was affected by the economic downfall. This was caused due to the COVID-19 pandemic. The economy of India suffered massively since the outbreak, however it looks like there is a certain amount of improvement now that the government has eased lockdown restrictions, i.e. unofficially called Unlock 4.0. According to the official date, currently there are 966382 cases of COVID-19. 4674987 people have been discharged or cured and unfortunately 91149 have succumbed to the deadly virus. Considering the growth rate in the health insurance sector, it can be said that slowly the condition is improving.
Health and Auto Insurance Buying Process Becomes Totally Online
– September 14, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) has made an important announcement with regard to buying and selling of insurance policies. This announcement has been made keeping in mind the ongoing COVID-19 pandemic. The apex insurance body has allowed insurance companies to sell health and auto policies in a totally online manner. Thus, the overall process of purchasing these policies has been made completely online. As a result, there will be no requirement of physical documents such as the application form or hard copies of the policy. This new change is applicable in cases where the sum insured does not go beyond INR one crore. This new rule is said to be applicable until March 2021. The IRDAI had issued a circular to all general and health insurance companies regarding this new rule on 10 September 2020.
Now Avail Group Covers for Newly Launched Health Plans
– July 31, 2020
The ongoing COVID-19 pandemic has caused turmoil across industries. To offer some sort of a backup to the public, the Insurance Regulatory and Development Authority of India (IRDAI) had recently launched two policies: Arogya Sanjeevani and Corona Kavach. These were launched as individual policies. However, recent updates suggest that these two policies can be availed as a group cover as well. Group insurance plans are standard plans that cover a group of people under one policy. Thus, employers can offer these policies to their employees as a part of Employee Health Insurance. It can be offered by both public as well as private-sector employers. In the case of these group plans, most of the terms and conditions remain the same but there can be a change in the premium. The insurers have some flexibility in charging the premium for group policies in accordance with IRDAI guidelines.
Date For Enrollment Under Sarbat Sehat Bima Yojana Extended For Farmers
– July 27, 2020
The date for Sarbat Sehat Bima Yojana that is the Ayushman Bharat Yojana in Punjab, has been extended to include farmers and their families under health insurance. The Ayushman Bharat Yojana is the Indian Government’s flagship program that provides free health insurance for low-income groups in the country. By extending the date of applying to the Sarbat Sehat Bima Yojana, the authorities aim to include 9.5 Lakh farmers under the benefit. Applications from farmers will be accepted until 05 August 2020. Farmers with ‘J’ form and ‘sugar cane weighment slips’ are expected to apply for the scheme with self-declaration and other documents as published by the authorities. Eligible families can get in touch with the Market Committee office or Commission Agent (Arhtiya) to apply under the Sarbat Sehat Bima Yojana on or before 05 August 2020. Eligible members and their nominees can avail cashless treatment in any of the empanelled hospitals, which include 208 government and 546 private hospitals. The coverage provided under this scheme is Rs. 5 Lakh per family per year that can be availed to get treatment for 1396 diseases.
Punjab: Farmers Can Submit Applications for the Rs. 5 Lakh Health Insurance by 24 July
– July 21, 2020
The state government of Punjab has asked farmers to avail the Rs. 5 lakh health insurance scheme by 24 July 2020 for the cashless treatment under the Ayushman Bharat Sarbat Sehat Bima Yojana Punjab for the current financial year. The premium for the insurance will be borne by the Punjab Mandi Board and the farmers need not pay the same. Both farmers and their families will be covered under the scheme through which they can avail cashless treatment at network hospitals for 1,396 ailments, which includes cancer treatment, heart surgery and accident-related treatments. Beneficiaries can avail treatment from 546 private hospitals and 208 government hospitals in the state. Farmers need to fill the ‘J’ form to enroll in the scheme. Also, the self-declaration is available with the market committee and commission agent or it can be downloaded from the mandi board website. Eligible beneficiaries will receive a special insurance card to avail the treatment.
COVID-19: Treatment At Makeshift Hospitals to be Covered Under Health Insurance
– July 21, 2020
The insurance regulator said that the treatment of COVID-19 at makeshift hospitals will be covered under health insurance approved by the government. The number of cases has been on the rise, which has prompted state governments to permit makeshift hospitals to treat COVID patients. In a circular, the Insurance Regulatory and Development Authority of India (IRDAI) said that in an effort to make sure that treatment of the novel coronavirus, temporary or makeshift hospital approved by the state or central government should be considered as a hospital and all insurance companies should settle claims from these hospitals. The circular further specified that if a patient is admitted to a makeshift or temporary hospital, then such hospital will be considered as a network hospital and the claim should be settled accordingly. It also asked third-party administrators to take note of the circular and honour claims raised by COVID-19 patients through these types of hospitals.
IRDAI Directs Insurers to Settle Health Insurance Claim for Hospitalisation in a Makeshift Hospital
– July 17, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) in a circular said insurance companies should settle health insurance claims for hospitalisation in a makeshift hospital. The announcement comes amid rising COVID-19 cases across the country and metro cities are running out of beds, which has prompted state governments to provide makeshift hospitals. However, there have been several instances of claims being denied, especially if treated at makeshift hospitals. In a circular, the IRDAI said that to ensure that the cost of COVID-19 treatment is covered under the terms and conditions. Hence, temporary or makeshift hospitals approved by the respective state government regarded as a network of hospitals and insurance providers should settle the claims. It asked third-party administrators to adhere to the circular to allow claims to be settled for COVID-19 treatment at a makeshift hospital.
Punjab CM Gives Nod to Cover 9.5 Lakh Farmers Under Health Insurance Scheme
– July 16, 2020
Punjab Chief Minister Amrinder Singh gave nod to bring 9.5 lakh farmers & their families under the health insurance scheme of Ayushman Bharat Sarbat Sehat Yojana (ABSSY). Through the scheme, beneficiaries can avail treatment facilities such as cancer treatment, major surgical treatments such as heart surgery, accident cases and joint replacement. Treatment facility of up to Rs. 5 lakh can be availed by the beneficiaries at any of the 208 government hospitals and 546 empanelled hospitals. The health insurance scheme in Punjab was launched back in 2019 by the state government. The release said that the health insurance scheme will cover a total of 9.5 lakh farmers with effect from 20 August 2020. Farmers can get cashless treatment facilities and the Mandi board will pay the premium for the health insurance.
Insurance Regulator Allows Insurers to Launch Standard Corona Kavach Health Insurance
– July 14, 2020
India’s insurance regulator Insurance Regulatory Authority of India (IRDAI) has approved health and general insurance companies to launch the standard health insurance for COVID-19, Corona Kavach health insurance in the country. The Corona Kavach is an exclusive health insurance plan which covers treatment for COVID-19, including the cost to procure PPE, oxygen, gloves, masks, etc. The Sum Insured in this standard coronavirus health insurance is a minimum of Rs. 50,000 and a maximum of Rs. 5,00,000. The policy can be availed by people between the age group of 18 and 65 years. The policy can be purchased as a family floater type which includes spouse, dependent children and parents/parents-in-law. Also, it covers comorbidities and pre-existing conditions and can be bought for 3.5, 6.5 or 9.5 months of tenure. Policyholders can avail home treatment for up to 14 days under this plan.
IRDAI In Favour of Short-term Health Insurance Policies for Coronavirus
– June 25, 2020
Insurance companies can now offer specific short-term health insurance policies to cover the novel Coronavirus thanks to the Insurance Regulatory and Development Authority of India (IRDAI). Here, the short-term is defined as a period that is more than three months but less than twelve months. Now, insurers can offer a 3-to-11-month Coronavirus-related policy to the people. Note that a fixed policy period of 12 months will not be deemed as a short-term cover. IRDAI issued a circular on 23 June 2020 stating the guidelines to introduce the short-term health insurance plans, which can be offered by Life, General, and Health insurance providers. However, Life insurance providers can only offer benefit-based policies, whereas General and Health insurance providers can offer both benefit-based as well as indemnity-based policies to the people. These short-term health insurance policies can be for an individual and a group.
IRDAI Notifies Health Insurance Providers Not to Contest Claims After Eight Years of Premium Payment
– June 16, 2020
In a fresh set of guidelines, the Insurance Regulatory and Development Authority of India (IRDAI) has said health insurance providers cannot contest claims after eight continuous years of premium payment. The notification came after the insurance apex body said that the main aim is to simplify the general terms and clauses in indemnity-based health insurance plans. This does not cover personal accident cover and domestic/international travel. Also, this was done to ensure uniformity across the insurance industry by simplifying the policy wordings of the terms and conditions. The new guidelines will be applicable to all health insurance policies that are not in compliance with these guidelines. This will be revised when they are due for renewal from 1 April 2021. Also, the guideline says that health insurance companies cannot contest claims after 8 continuous premium payments unless permanent exclusions are specified in the policy or proven for fraud.
New IRDAI Directives Allow Telemedicine Coverage Under COVID-19 Health Insurance
– June 12, 2020
IRDAI has ordered insurance companies to extend coverage for including telemedicine in their health insurance plans. Insurance Regulatory and Development Authority (IRDAI) is a government body that governs the Indian insurance sector. Including Telemedicine under a health insurance coverage will prove to be beneficial especially in the current COVID-19 pandemic where patients are supposed to remain in quarantine. This will ensure patients get access to quality health care services and help in containing the spread of Coronavirus to some extent. An increasing number of COVID-19 cases among medical staff can also be reduced with telemedicine.Telemedicine is a method through which patients can get a professional medical opinion like treatment and prevention, or diagnosis via telecommunication technology. Medical practitioners are to adhere to the Telemedicine Practice Guidelines dated 25th of March 2020 laid down by the Ministry of Health and Family Welfare (MoHFW). The claim for Telemedicine consultation can be made by a policyholder under the Outpatient Department (OPD) coverage of their health insurance policy.
Maharashtra Announces Rs.50 Lakh Insurance for Journalists
– June 9, 2020
The Maharashtra State Government announced Rs.50 insurance coverage for journalists and media personnel under the State’s accident cover. This announcement was made by the Public Health Minister on Thursday. Previously, the government had included other COVID-19 frontline warriors such as doctors, police, nurses, Anganwadi workers and home guards under the scheme. Journalists and other media personnel who are on active duty will be part of the State’s comprehensive personal accident coverage of Rs.50 lakh. Until the details of the package are worked out and the scheme comes into force, COVID-19 warriors will be covered through ex-gratia assistance of Rs.50 lakh.
Free Health Insurance Policy To All Citizens in Maharashtra
– May 5, 2020
The state government of Maharashtra announced that it will offer a free health insurance scheme to all people in the state. Maharashtra will be the first state to announce such a scheme in the country. This will be extended through the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) scheme. Citizens of Maharashtra can avail free and cashless treatment or hospitalisation. To apply for the scheme one must provide their domicile certificate and ration card. The state health minister said that the scheme was extended until now to 85% of the population, now the remaining 15% will be covered under the scheme. Employees of state government, white ration cardholders and semi-government will be eligible to apply for the scheme. He added that a Memorandum of Understanding has been signed between the government and General Insurance Public Sector Association for the treatment of the novel coronavirus or COVID-19 cases at private hospitals in Mumbai and Pune.
Health Insurance Scheme for COVID-19 Warriors Announced by West Bengal Government
– May 3, 2020
The state government of West Bengal has announced a health insurance policy for COVID-19 warriors including journalists with a sum insured amount of Rs.10 lakh. On the occasion of Press Freedom Day, Chief Minister Mamata Banerjee said that the press should be respected for their contribution to the society and they are the fourth pillar of democracy and should be able to perform their duties without any fear. The health insurance scheme of Rs.10 lakh will cover frontline coronavirus warriors and journalists so that they can perform their duties fearlessly.
Insurance Regulator Directs Health Insurance Providers to Settle Claim in 2 Hours
– April 23, 2020
Insurance Regulatory and Development Authority of India (IRDAI), the apex body for insurance companies in the country has directed that claims should be settled within two hours by health insurance companies. The circular said that from the time they receive the authorisation request, the hospital should receive authorisation on cashless treatment within two hours. It also said that the decision of the final discharge should be communicated to the hospital within 2 hours from the time the insurers or the third party administrator receives the final bill or any necessary needs from the network provider or hospital. The IRDA also asked health and general insurance companies that appropriate guidelines are issued to their respective third party administrators during this time of lockdown in an effort to contain the spread of the coronavirus in the country.
COVID-19: Health, Vehicle Insurance Renewal Date Extended
– April 16, 2020
Amidst the ongoing lockdown to contain the spread of the infectious COVID-19 in India, the common man is facing several hardships. The Centre, in an effort to bring some relief to Third-party health and vehicle insurance policyholders, has extended the date to renew their policies without being affected by a lapse of the insurance coverage. Insurance policies which are falling due between 25 March to 3 May 2020 have been extended to be paid by 15 May 2020. Failure to renew third-party health insurance policies on the due date get an extension of one month; however, there is no coverage during this extended period. As for the third-party motor insurance policies, there is no grace period and a penalty is charged for failure to renew it by the due date. However, with this announcement by the Finance Ministry, policyholders can get some relief to pay the renewal premium of their health or vehicle insurance till 15 May 2020.
Indian Bank Offers Up to Rs.4 Lakh Insurance Cover To Business Correspondents
– April 15, 2020
Indian Bank said it has offered insurance coverage of up to Rs.4 lakh to business correspondents which are instrumental in ensuring the availability of essential banking services especially in the rural and unbanked areas during the ongoing lockdown to contain the spread of the novel Coronavirus. The public-sector bank is offering the cover under the Pradhan Mantri Suraksha Bima Yojana and Jeevan Jyoti Bima Yojana. Business correspondents of banking services include those providing primary banking services such as cash withdrawals, deposits and other services especially in the remotest regions of the country. The Centre has announced a second lockdown to contain the spread of COVID-19 in the country and only essential goods and basic banking services are available currently.
Health and General Insurers Cleared by IRDAI to Market COVID-19 Health Insurance Policy
– April 3, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) has cleared Acko General Insurance and 29 other insurance companies to market COVID-10 health insurance policy in India. The COVID-19 health insurance scheme will cover the hospitalisation expenses airing out of treat for the deadly Novel Coronavirus infections. The policy will offer coverage of Rs.1 lakh and Rs.5 lakh and the idea behind the new policy is to streamline a policy exclusive for the treatment of the COVID-19 infection and offer a standard insurance policy with common features. The standalone policy will be launched by the selected insurance companies but will be known as ‘Aarogya Sanjeevani Policy’. The price will be decided by those insurance companies.
COVID-19: Health Care Workers to Get Rs.50 lakh Health Insurance for 3 Months
– March 20, 2020
The Indian government has proposed to offer health insurance to health care workers to the tune of Rs.50 lakh per person. This includes paramedics, sanitation employees, doctors and ASHA workers. During a press conference, Finance Minister Nirmala Sitharaman said that health insurance coverage will be provided to health workers for a period of three months. The health insurance comes into effect from 25 March 2020. The coverage will include ward boys, safai karamcharis, nurses, paramedics, ASHA workers, technicians, specialists, doctors and other health workers. They will be covered under the Special Insurance Scheme. About 22 lakh health workers are expected to benefit from this scheme.
IRDAI Asks Insurance Companies to Conduct Board Meeting Through Video Conference
– March 23, 2020
In the wake of rising Coronavirus infections in the country, the Insurance Regulatory and Authority of India (IRDAI) to conduct board meeting only through video conferencing till the end of June 2020. Also, insurers have been given 30 additional days to submit their third-quarter returns. The apex body of insurance in India has appealed to all insurers, its intermediaries and distribution channels to be more sensitive to requirements of policyholders during this trying times in the country. It also asked them to operate through telephonic or digital mode. It said that all details such as services, office working hours and the alternative arrangements for payment of premium, renewal or the claim process to be displayed on their respective website.
IRDAI Brings in Changes to the Definition of Pre-Existing Diseases
– February 12, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) has recently changed the definition of pre-existing diseases in health insurance. In a circular, the IRDAI said that it has removed the modified or additional clause from the existing definition in an effort to make it more simple and customer-friendly. The IRDAI said that if some illnesses were identified within three months of purchasing the health insurance policy, then it would be considered under pre-existing diseases. However, as per the recent circular, these diseases will not be considered as pre-existing diseases.
Health Ministry Says Rs.3,520 crore Have Been Released to States in Two Year Under AM-PMJAY
– February 6, 2020
Under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Health Ministry has released Rs.3,520 crore to states in the last two years. The Ministry also said that the reasons for slow use of funds were because four states were not implementing the scheme. The four states include Delhi, West Bengal, Odisha and Telangana. Also, states such as Punjab and Rajasthan joined the scheme late 2019 hence the lower utilisation of funds. Also, large states like MP, UP and Bihar are implementing the scheme for the first time and hence, the traction has been slow. AB-PMJAY is India’s flagship health insurance plan, which is also considered the biggest in the world.
Budget 2020: Ayushman Bharat Scheme, Health Sector Gets a Boost of Rs.69,000 Crore Under
– February 4, 2020
Expanding the Centre’s flagship scheme, Ayushman Bharat, Finance Minister of India allocated Rs.69,000 crore in the current Budget 2020. The scheme is considered as the World’s largest government-funded health insurance plan. Through the expansion, the scheme will witness more hospitals being set up in Tier 1 and Tier 2 cities in the country under the Public-Private Partnership (PPP) model. Tax proceeds from the sale of medical devices will be utilised to fund government hospitals in these regions, while Rs.6,000 crore has been allocated for the PMJAY scheme.
Over 1 Lakh Community Health Officers to be Placed at Health Centres by 2022: Ayushman Bharat Scheme
– December 12, 2019
The Central government’s flagship health scheme, Ayushman Bharat, will employ 1,20,000 community health officers who will be assigned at health and wellness centres by 2022. All sub-centres, primary health centres, and urban primary health centres will be upgraded to Health and Wellness Centres (HWCs) in an effort to offer comprehensive primary health care. The plan is also to create 1,50,000 HWCs by the end of financial year 2022. The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to offer health insurance policy with a coverage of Rs.5 lakh per family per annum. The scheme will cover over 10 crore poor families across the country.
IRDAI Circular Allows Policyholders to Select Thier Own Health Insurance TPA
– December 11, 2019
A circular issued by the Insurance Regulatory and Development Authority of India (IRDAI) states that policyholders need not depend on the insurance company to choose a third-party administrator (TPA) while buying health insurance. Now, the policyholder can select a TPA of their choice from the host of TPAs engaged by the insurance company. In case, the TPA is terminated by the insurer, the policyholder has the choice to choose any TPAs listed by the insurer. If the policyholder does not choose any TPAs, the insurer may choose its choice of TPA.
Proposal to Lower Sum Insured Amount on Standard Health Indemnity Insurance
– November 29, 2019
The Insurance Regulatory and Development Authority of India (IRDAI), which is the apex body of the insurance sector in the country, has proposed to lower the sum insured amount from Rs.1 lakh to Rs.5 lakh on individual and family floater policies. Through this proposal, the public is allowed to opt a suitable health insurance cover, offering basic hospitalisation costs. The difference is the premium charged on these types of insurances. Earlier this year, the IRDAI had made it mandatory for all general insurance companies to provide a standard health indeminity insurance with a basic sum insured amount between Rs.50,000 to Rs.10 lakh.
NITI Aayog Report Proposes Mandatory Health Insurance for All
– November 18, 2019
The government think tank, NITI Aayog, in its report has proposed mandatory health insurance for all in India. It said that the current health insurance schemes in India are highly fragmented at the level of risk pools and payers. Apart from the Ayushman Bharat as well as the packages offered by the National Health Mission (NHM), the government may explore the mandatory health insurance for future risk pooling options.