Health Insurance

Medical technology has undergone tremendous advancements, and this positive change is helping doctors treat even the most complicated diseases. While we marvel at this transformation of the healthcare industry, the steep increase in the medical treatment costs has worried us as medical inflation impacts our finances. Another dimension to the problem is the growing health risks owing to the demanding lifestyle. Medical emergencies have the potential to wipe out your savings. This fact points towards the need for a health insurance plan to safeguard your family from financial hardships. Moreover, with benefits like cashless hospitalization, there is no hassle to get timely medical care.

The amount of health insurance coverage you will need depends on your medical needs, age and health risks, the city you live in, and various other factors. Here are some points to consider that will help you make an informed decision:

• Medical Inflation: Medical treatments are getting expensive. So, depending on your health condition and the treatment you may need, choose an adequate sum insured.
• Age: Ageing increases our chances of catching illnesses and even exposes us to injuries. So, considering these risks, go for a cover that will suit your medical needs.
• Senior Citizens Coverage: Your elderly parents at home are in a phase when they may need medical attention and long-term treatment. So, opt for a policy that fits your requirements.
• Metro Cities: If you live in a metro city, then be prepared to spend more on medical bills. Choosing a higher sum insured will keep your family financially safe.

A host of factors, including the sum insured, type of coverage, policy term, number of insured members, age of the insured members, pre-existing medical conditions, will impact the premium cost of a health insurance policy you have chosen. Let’s suppose if a person opts for a family floater plan covering self (around 30 years), spouse (around 30 years), and one child (less than 5 years), for a sum insured of Rs 5 lakh and policy tenure of 1 year, the average premium would be about Rs. 12,333 including 18% GST.

You can now calculate the health insurance premium using a simple digital tool known as the health insurance premium calculator. This tool helps you get the right estimate of the amount of premium you will have to pay for your policy. It considers various factors to calculate the premium, including the information you have entered. Here are the steps to calculate your premium:

• Visit the Health Insurance Premium Calculator page
• Enter details, such as the number of insured members and birth-date of the eldest family member.
• Mention the sum insured or coverage you need
• Customize your policy by selecting the tenure
• Click on ‘Calculate Premium’ to get the result

You cannot get coverage under a medical insurance policy immediately for any illness except accidents/injuries. You can avail of the policy benefits only after completing the 30-day initial waiting period.

The earlier you get a health cover, the better it is for your financial safety. It is a golden rule when it comes to investment in health insurance plans. We are witnessing a rise in medical costs in India, and the growth in the cases of lifestyle ailments, at the same time. So, when a medical emergency is a high possibility, it is necessary to choose a health cover. Moreover, the premium costs of health plans increase with age. Besides, the chances of having a pre-existing health condition also increase as we grow older. A pre-existing ailment is a factor that can make you pay a higher premium. Thus, going for a health cover early in life is a smart decision.

Network hospitals are hospitals that are empanelled with us and provide you cashless medical treatment. We have 8250+ network hospitals in our network. You can get admission at any of these hospitals for cashless treatment by presenting your health card and submitting a pre-authorization form at the insurance desk. We will directly settle your hospital bills, subject to policy T&C. However, those hospitals that do not come under our network are non-network hospitals where you cannot get the cashless facility. In case you have opted for a non-network hospital, you can file for a reimbursement claim and submit the necessary documents. After our claim management team verifies your documents, we will reimburse your expenses, subject to policy T&C.

Every health policy comes with a waiting period clause. The waiting period is that period you must complete before you can get a claim for the specified medical expenses. There are three types of waiting period:

• An initial waiting period of 30 days
• A waiting period for pre-existing diseases
• A waiting period for specified ailments/ treatments

Your health insurance policy will expire if you do not pay the premium by the policy period end date. However, even if you miss the premium due date, you will be allowed a grace period - 30 days immediately following the policy period end date - to pay the renewal premium. The policy will not provide coverage during the period for which the premium is not paid.

Under a health insurance policy, policyholders are eligible for No Claim Bonus (NCB), which is a reward that you receive for not making a claim during a policy year. It is a bonus amount that becomes available as an increased sum insured for every claim-free year. Thus, it provides you an added cushion to bear medical expenses in the future. Care offers a 10 percent increase in your sum insured for a claim-free year. The NCB amount will not exceed 50% of the sum insured under the policy. The accrued bonus is reduced by 10% in the event of a health insurance claim made by the insured.

Pre-existing diseases are the diseases, illnesses, injuries, or related conditions for which a person receives medical advice/ was diagnosed by a medical practitioner within a period of 48 months before the effective date of a policy issued by the insurer or its reinstatement. Yes, health policies will cover pre-existing medical conditions, but there is a waiting period you have to complete before you can get a claim for the treatment.

If you have a medical insurance policy, you have a chance to increase your savings as you become eligible to get income tax benefits under Section 80D of the Income Tax Act. That is, you will be allowed to claim a tax deduction on your policy premium for which you have made a payment to us. You can claim the following deductions on your premium, depending on the coverage you have selected:

• Tax deduction on the premium up to Rs 25,000 in a year for an individual plan or a family health insurance plan covering self, spouse, and children
• Tax deduction on the premium up to Rs 50,000 per year for a family health insurance which covers senior citizen parents
• Suppose you have paid a lump-sum premium in a single year for a multi-year policy term. The tax deduction is calculated by dividing the total premium by the policy years. The deduction is available up to the limit of Rs 25,000 or Rs 50,000, as applicable.

The sum insured refers to the maximum coverage amount or payout that an insurer will be liable to pay an insured in case of an unforeseen medical emergency or planned medical treatment. The sum insured is based on the principle of indemnity, where the insurer will cover the medical expenses one incurs up to the sum insured under the health insurance plan. The claim amount that exceeds the sum insured will have to be borne by the insured person.

Yes. You can have multiple health insurance plans. If you have opted for more than one indemnity-based plan with other insurers or us, then you can opt for any of these plans to settle your claims, provided that the claim amount payable is up to the sum insured of such policy. If the claim amount under a single policy exceeds the sum insured, you have the right to choose the insurer to settle the claim. If you have opted for our plan, we will settle the medical expenses, subject to the policy terms and conditions.

Although you can include your elderly parents in your medical insurance policy, we recommend going for a separate health insurance cover for parents. If they are above 60 years, consider going for a senior citizen health insurance plan. It is essential to do so as their healthcare needs are different from yours due to the ageing factor.

A comprehensive health insurance policy will cover various expenses related to your medical treatment, including advanced procedures like robotic surgery and modern day care treatments. Care offers cover for more than 540 daycare procedures.

Smoking is an unhealthy lifestyle habit that can severely damage vital organs in the body, including the lungs, brain, and heart. It can lead to lung cancer, stroke, and heart diseases, exposing a person to grave health hazards. We may take this factor into account when assessing your health risks and calculating the health insurance premium.

Yes, an insured person is allowed a grace period of 30 days immediately following the policy period end date to pay the renewal premium for a health insurance policy. Timely premium payment is crucial to prevent the policy from getting lapse and ensure you get continued coverage.

It is advisable to go for a separate health insurance policy even if you are covered under a corporate group policy. There are a few reasons you must take this decision. Corporate policies are beneficial, but they have some limitations. Firstly, such policies will no longer be valid once you leave the employer or switch jobs, leaving you uninsured during that time. If you are looking for financial security after retirement, you should certainly invest in a personal health insurance policy.

Secondly, the coverage provided by such corporate group policies may be inadequate to meet your needs if you are incurring high medical expenditures. On the other hand, by opting for separate health insurance, you will have the option to customize your policy as per your needs instead of going for the standard features that corporate group mediclaim plans offer.

Yes, you can include your kid under an individual health insurance plan if the age is 5 years or above. If the age is less than 5 years, you can include them in a family floater plan with other family members who are 18 years or above.

Many comprehensive health insurance plans offer the OPD benefit as an optional cover for an additional premium. Under this benefit, the policyholder will get reimbursement for the OPD expenses, including OPD consultations, diagnostics, and medicines, up to a specified limit subject to T&C

Pre-policy medical tests are usually required for older individuals, those with pre-existing condition in medical history or who have opted for higher sum insured. However it is best to go for a medical check-up when opting for a health policy so as to ensure hassle free claim settlement.

You can increase the sum insured in my health insurance at the time of policy renewal. Policyholders have the option to increase the sum insured after certain medical tests and a revision of the claim history. But it can't be increased further if the existing sum has already met the sum insured limit of your policy.

Health insurance, unlike mediclaim, covers various medical expenses besides hospitalization, and comes with benefits like annual health check-up and no claim bonus. One can avail of the policy coverage by paying a regular premium and can file a claim either through reimbursement or opting for a cashless facility available at network hospitals. Moreover, the insured can go for timely policy renewals and continue the same policy.

For cashless claim, you need to submit the pre-authorization form and present your health card and identity proof at the network hospital. In case of a reimbursement claim, submit the claim form and documents, such as identity proofs and hospital bills. The details required include name, contact information, policy number, past medical history, proposed line of treatment, duration of treatment, etc.

Yes, the health insurance claim may get rejected due to several reasons, such as incorrect facts, non disclosure of pre-exisiting conditions, claims under exclusions, etc.