Health Insurance
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What is Health Insurance?
Due to the lifestyle choices, the health-related issues are common nowadays, and any big medical expense can burn a hole in your financial protection umbrella. To provide protection to your financial planning the Health insurance plays a major role. It is an insurance policy which provides the financial coverage to hospitalization expenses, medical consultation and in some case even the post and pre-hospitalization expenses against a small annual insurance premium for the insurance plan. A health insurance policy like other policies is a contract between an insurer and an individual/group in which the insurer agrees to provide specified health insurance cover at a particular “premium” subject to terms and conditions specified in the policy.
Basic Health Insurance Policy
In the Basic Health Insurance Policy the coverage is limited to hospitalization expenses you might need in case of accidents, day-care procedures, surgical treatments or critical illnesses. However, the features, limits and sum assured will vary from insurer to insurer.
Top-Up for Health Insurance Policy
Once the Sum Insured for your Health Insurance plan is extinguished, you will need additional coverage, this is where the top up for your health insurance policy works. However, the features, limits and sum assured will vary from insurer to insurer.
Health Insurance in India can be broadly classified into the following types-
1. Individual Health Insurance: As the name suggests, it is a Health insurance which only covers the Individual or self and it is purchased by the individual only not by an employer or organization or a company. This Insurance plan covers the hospitalization and medical costs of an individual, subject to the sum insured. For a minimal amount of annual premium, the Individual gets the coverage for the whole year with respect to the sum insured.
2. Family Health Insurance: This Insurance covers the complete family members in a single health insurance plan. It helps as generally not all the members will be ill at the given time, thus the floater as compared to the individual plan is more in case of the Family Health Insurance. These plans cover medical consultation and hospitalization expenses plus some insurance plan offer reimbursement of pre and post-hospitalization expenses too. Most health insurance companies in India offering family insurance have a wide network of hospitals that help the insured people in times of an emergency.
3. Maternity Health Insurance: As the name suggests, Maternity Health Insurance offers coverage for the pregnancy and the related expenses along with the pre and post hospitalization expenses too. Some plan also covers the Baby during the period of pregnancy delivery and Ambulance expenses too. A maternity insurance policy is available as an added rider or add-on with regular health insurance plans. This ensures coverage for costs linked to both normal and cesarean deliveries for babies.
4. Critical Illness Health Insurance: This insurance plan covers the insured against life-threatening or critical illnesses such as stroke, renal failure, cancer, heart attack, etc. A lump sum amount is provided as the coverage sum (benefit based policies) at the time of diagnosis of the covered illness by the insurance policy. This amount can be used in case of expense in the treatment of these diseases.
5. Personal Accidental Insurance: A personal Accident Insurance is essential for everyone, anyone can take it. Even after taking the precautions, you never know when an accident can happen, in case of accidents the result can be fatal, and disablement or loss of limbs. This policy ensures the financial stability of an individual and his family if he/she gets injured or unfortunately dies in an accident. The premium of a personal accident cover depends on the occupation you are in. This policy ensures the financial stability of an individual and his family if he/she gets injured or unfortunately dies in an accident.
6. Heart Health Insurance: With the increasing cost of medical expenses related with cardiac ailments, we need to be prepared for Heart-related issues as nowadays the cardiac ailments are common due to lifestyle choices. We understand the exclusive need for financial protection needed for Heart-related issues and medical procedures. This policy provides financial protection in case you are diagnosed with a cardiac condition.
7. Cancer Health Insurance: Cancer Insurance is a policy that provides financial assistance to the person diagnosed with cancer. A cancer-specific insurance policy offers cover for various expenses related to diagnosis & treatment, including chemotherapy, radiation, surgery, hospitalization, etc. The sum insured depends on the policy premium and insurer health terms and conditions.
8. Senior Citizens Health Insurance: Senior citizen health insurance plans are for the older individual starting from the age group of 60 to lifelong. As the health risks increase with age, any disease can turn down your financial stability with medical expenses.
Why Health Insurance?
Due to the lifestyle choices, the health-related issues are common nowadays, and any big medical expense can burn a hole in your financial protection umbrella. To provide protection to your financial planning the insurance plays a major role in case the need arises. Buying the policy is important as unlike other investments, health insurance does not help in achieving any future goal or lifestyle expenses, but nevertheless, it plays an important role in a sound financial plan. Hospitalization can burn a hole in your pocket and derail your finances. All this can be avoided by just paying a small annual premium which would lessen your stress in case of medical emergencies. A good health insurance policy would usually cover expenses made towards doctor consultation fees, costs towards medical tests, ambulance charges, hospitalization costs and even post-hospitalization recovery costs to a certain extent.
What is covered in Health Insurance?
1. Cashless Treatment: Generally Insurance providers hae a wide network of Hospitals on there panels. If you are going to any hospital which is there on the panel, you can get the cashless treatment depending on your sum insured and the Insurere policies.
2. Hospitalization cash benefits: Every day hospitalization expenses are covered to reduce the financial burden of the insurance holder. This would be a great help to the insured as this amount would compensate for the loss of earnings and other costs.
3. Pre & Post hospitalization expenses coverage: Your Insurance policy also covers pre & post hospitalization medical expenses upto a certain period, depending on the insurance plans purchased and the Insurer policies.
4. Transportation Charges: Insurance policy also covers the expenses related with the ambulance towards the transportation of insured member.
5. No Claim Bonus (NCB): If the insured does not file any claim in a year the Insurance providers adds a no claim bonus to the sum insured for the next year in the policy without any additional charges. In other words, it is the reward offered by the insurer for not making any claim during a particular policy period.
6. Medical Checkup: Various options for regular or annual health checkup options are provided depending upon the insurer and the annual premiums.
7. Room Rent: Insurance policy also covers hospitalization expenses like room expenses depending on the annual premium being paid by the insured.
8. Tax Benefit: Premium paid on Health insurance is tax deductible under section 80D of the Income Tax Act.
What is not covered in Health Insurance?
- Cosmetic Surgery
- Dental Treatment ( Unless Happened becoz of Accident )
- Weight Loss Surgery
- Colour change Surgery
- Treatment caused by Unlawful Activity
- Abortion
- Outpatient Treatment ( very Few Policies may Cover Upto certain Amount )
- Sexually Transmitted Diseases
- Treatment for HIV
- Treatment for Pre existing Diseases ( Upto the specific Waiting Period as per the Policy )
- Supplements – If it is not a part of treatments.
How to Select the Right Insurance Policy?
It is difficult to choose the best insurance policies as all insurance company provides almost similar type of insurance policies. Every health insurance plan available in the market differs in the context of the coverage it offers. While the basic tenets of the coverage remain same, their absolute limits vary. Still there are some basic guidelines to choose a Insurance Provider:
1. Sum Insured – Sum insured is the amount for a year that your Insurance Company can pay against your medical expenses. Any amount above and beyond the sum insured will have to be taken out from your own pocket or you can go for the top up plan if available.
2. Minimum Entry Age and renewability clause – It depends on the guidelines provided by IRDA and terms and conditions of the policy. Now you can renew your plan without any maximum age limit. However, some plans still have a limiting age on renewal and such renewability feature should be checked.
3. Room Rent Capping – Health insurance policies have condition for room rent capping based on the annual premium paid by you, which means that you are eligible to claim expenses only up to a room costing capping. In case you opt for a room above this mentioned capping, you will have to bear the additional expenses from your own pocket.
4. Inclusion and Exclusion –
• Inclusions are the types of procedures or services that are covered by your health insurance policy. That means if you make a claim on these items, you will receive the benefit stated in your policy against the medical expenses occured.
• Exclusion – Health insurance policies have some exclusions which every policyholder must know before buying any plan. Every insurance policy has its limitations. Check the limitations and in case you need some more go for the rider along with the policy to cover that or else choose a plan which covers that.
5. No Claim Bonus – If the insured does not file any claim in a year the Insurance providers adds a no claim bonus to the sum insured for the next year in the policy without any additional charges. In other words, it is the reward offered by the insurer for not making any claim during a particular policy period.
6. Check the waiting period – Some health insurance plans have a limited period exclusion for certain ailments. This exclusion period is called a Waiting Period and different plans have different waiting period. For example, ailments like fissure, piles, hip-bone replacement, etc. have a 2 year waiting period before it is covered. However, if you have any pre-existing ailments, like diabetes, hypertension, etc., you should look for the plan with the lowest waiting period or buy specialized plans designed to cover your ailments.
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Radheyshyam Chauhan
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“Caring & Easy”
“Thank you for taking great care of our insurance requirements. You and your team at Reliable Policy have been wonderful to us in a selection of right insurance.”

Pranav Jha
Director
“Fast Approvals”
“I hold Reliable Policy in the highest regard as far as customer service goes. Whether by email or phone, I get the required information and answers I need.”

Ankit Bidhuri
Junior Engineer
“Easy Process”
“Thank you Reliable Policy for all your patient assistance and support during the state of confusion and helping us bundle everything together for insurance.”

Radheyshyam Chauhan
Sr. Software Developer
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