Health Insurance Plan

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Health insurance is a type of insurance coverage wherein, an insured can claim payments for his medical and surgical expenses.

Buying a health insurance policy for yourself and your family is important because medical care is expensive, especially in the private sector. Hospitalisation can burn a hole in your pocket and derail your finances. It will become even tough, if the person who brings in the money, is now in a hospital bed. 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.  

Benefits of having a Health insurance Policy

  1. Cashless Treatment: If you are insured, you can get cashless treatments as your insurance company would work in collaboration with various hospital networks.
  2. Pre and post hospitalization cost coverage: Insurance policy also covers pre and post hospitalization charges up to the period of 60 days, depending on the insurance plans purchased.
  3. Transportation Charges: Insurance policy also covers the amount paid to ambulance towards the transportation of insured.
  4. No Claim Bonus (NCB): This is the bonus element which is paid to the insured if the insured does not file a claim for any treatment in the previous year.
  5. Medical Checkup: Insurance policy also provide options for health checkups. Free health checkup is also provided by some insurers based on your previous NCBs.
  6. Room Rent: Insurance policy also covers room expenses depending on the premium being paid by the insured.  
  7. Tax Benefit: Premium paid on Health insurance is tax deductible under section 80D of the Income Tax Act.

Individual Health Insurance

An Individual Health Insurance plan is meant for a single person. As the name suggests, it can be bought by a single individual. The individual who gets himself insured with this plan is compensated for the expenses incurred for illness and medical expenses. Such types of medical insurance plan cover all the hospitalisation, surgical, pre and post medication expenditures till the insured limit is reached. The premium of the plan is decided on the basis of the buyer’s age and medical history. Moreover, the insured individual can cover his spouse, his children, and parents, too by paying an extra premium under the same plan. However, if you get insured for any existing illness, there is a waiting period of 2-3 years for claiming the benefits.

Family Health Insurance

Popularly known as the Family Floater Plan, Family Health Insurance Policy secures your entire family under a single cover.

Health Insurance for family covers all the members of your family including your spouse, kids, and elders. Only one member of the family has to pay the premium, and the entire family gets insured in a single premium,while a discount is applicable on the premium.

In case two family members are getting simultaneous treatment, you can claim the insurance for both of them till the limit is reached. The premium is decided on the basis of the age of the eldest member to be covered up in the plan.

Health Insurance Claim Process

A health Insurance policy equips you to get the best healthcare treatment without worrying about the huge costs payable at the time of discharge. Therefore knowing about the claim process is an essential piece of information that the insured individual should be aware of at all times. The two main types of health insurance claim which an individual can choose from when making a claim are:

  • Cashless Claim Process
  • Reimbursement Claim Process

When the insured individual provides their health insurance details to the respective hospital, he/she begins to receive treatment. Upon discharge, the hospital will forward the medical bills to the designated health insurance company. The company will then audit the expenses and settle the outstanding payment due to the hospital. This process is hassle-free for the insured as the payments are between the hospital and insurance company. In the reimbursement claim process, the insured individual who has been admitted to a certain hospital pays for the entire treatment until discharge.

Once the insurer has paid for the treatment and hospitalization costs incurred, he/she have to make a reimbursement claim to the particular insurance company. The insured individual will have to provide original bills of the hospital to the health insurance and claim reimbursement. The insurance company will audit the claim and will then decide to approve or reject it. On approval of the insurance company, the claim will be made to the policyholder. The insurance company will notify the insured individual in case the claim has been rejected.


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