Tuesday , October 24 2017

HEALTH INSURANCE





Health Insurance is the one most common phrase heard in our normal day to day life. We know a lot of known people in our life who are either covered by Individual/Family Health Cover.

Yet, there are many who still do not feel the need to get themselves/their family health Insurance. The reason behind this could be many few of them being Negligence, Not aware about benefits etc.

We all will agree with the fact that due to our busy lifestyle it gets difficult to take care of our health. Also, the medical expenses are growing rapidly day by day. Thus, it has become more crucial for us to secure ourselves and our loved ones from unforeseen medical expenses.

WHAT DOES A HEALTH INSURANCE MEAN?

Health insurance is a kind of plan in which an individual/family will be covered from unforeseen future medical expenses. In simpler words, it means that if the person/people who were covered by health Insurance gets hospitalised for more than 24 hours then all the medical expenses are done by them/family will be borne by the insurance company.

WHAT ARE THE FEATURES OF HEALTH INSURANCE?

  • Health insurance works on the concept of Indemnity. It means that insured will be only paid for his loss/expenses incurred; he cannot make benefit out of it.
  • It covers pre and post hospitalisation expenses as well, up to a specific limit as set by the company like 30 & 60 days respectively. In some companies, it goes up to 180 days.
    • Pre-hospitalization means the expenses incurred by insured on the same disease for which he later got hospitalised
    • Post-hospitalization means the expenses incurred by insured after discharge from hospital to get perfectly healthy
  • List of day care procedures is also covered as per the company rules.
    • Day care procedures include those diseases for which 24 hours of hospitalisation are not required due to technological advancement. Example cataract, dialysis etc
  • Domiciliary Treatment cost is also covered by Insurance Company
    • Domiciliary treatment is that in which the patient is treated at home because the patient is in critical situation and cannot be shifted to hospital/ if the hospital states that no beds are available
  • For most companies after a certain age if somebody wants to take insurance then they have to undergo medical test arranged by the company. In most of the cases after 45 years of age, Medical test becomes mandatory
  • If the Medical test gets approved than then the cost of the Medical test is borne by the company; provided they will have to take the policy. But, if it gets rejected then the cost of medical test will bear by the individual himself
  • If due to medical reasons it becomes mandatory for a client to undergo any organ transplant then the cost of insured, as well as the cost of organ donor, is covered by this plan
  • The cost of the emergency ambulance is also covered in all companies. In some companies, cost of an air ambulance is also covered.
  • “No claim bonus (NCB)”of a fixed percentage is given to the insured for each claim free year. Percentage may vary company to company, it goes up from 5% to 50%
  • Few companies cover Ayush treatment as well but only via reimbursement. Ayush treatment is done some panel hospitals where ayurvedic treatment is done.

Points to remember

  • Rider Facility is also provided Ex: critical illnesses
  • Room Rent Limit what exactly it is? It is a kind of hidden clause that few companies have under which they may have a limit up to which room charge in a hospital could be. For example, 1% of the sum assured. In such a case no matter even if you have taken higher cover then also per day room charges cannot exceed that limit.
  • Therefore, few now companies have come up with individual/family floater insurance in which no room limits are there.




WHAT IS THE ELIGIBILITY CRITERIA FOR TAKING HEALTH INSURANCE POLICY?

  • Entry age to take policy is 91 days to 65 years
  • Sum assured starts from 1 lac and goes up to 1 crore
  • It lifelong renewal
  • Premium payment mode Is annually
  • No medical test is required up to 45 years of age for basic sum assured
  • Portability is available

WHAT IS THE TAX BENEFIT OF TAKING MEDICAL INSURANCE?

The tax benefit is provided under Section 80(d). Limit for tax benefit is as follows:

  • If individual takes Cancer insurance policy for self then the amount paid as premium will be treated as saving up to INR 25000, but if you are a senior citizen then the rebate is INR 30000
  • Also, if you take this policy for your parents then you can take rebate of INR 25000. However, if your parents are senior citizen then limit of the rebate is INR 30000 separately

However, if the policy is taken for yourself and your parents who are senior citizens then total maximum rebate available under this section is INR 55000.

WHAT IS THE EXCLUSION FOR TAKING POLICY?

  • Waiting period of 30 days covers except any accidental injury, although there is company like Max health insurance which provides medical cover from day 1
  • Any Pre-existing diseases/conditions will not be covered from day 1. Those diseases can be covered if the company has some waiting period clause
  • Few diseases such as Cataract, hysterectomy, hernia, joint replacement etc. are excluded for 2 years
  • HIV or AIDS
  • Mental disorder
  • Cosmetic surgery or weight control treatments

LIST OF FEW COMPANIES

  • Apollo Munich Health insurance
  • Bajaj Allianz
  • ICICI
  • Max Bupa health Insurance
  • National
  • New India
  • SBI
  • Star Health insurance
  • United India
  • Tata AIG

 

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