What is Health Insurance, Its Meaning, Benefits & Types
Imagine a safety net that catches you in life’s unexpected health storms. 😯That is health insurance for you! It protects you financially, covering the medical costs that can arise at any time in life.
From routine check-ups to emergency treatment, health insurance offers peace of mind and access to quality healthcare. A thorough understanding of health insurance meaning, benefits, and types can help you choose the best plan for your needs.
What is Health Insurance?
Health insurance provides financial coverage to an insured person against medical and surgical costs that occur from accidents, illnesses, or injuries. It either pays the insured person's care provider directly or reimburses the expenses incurred due to illness or injury.
An individual can avail of such a policy against monthly or annual premium payments for a specified tenure. During this period, if an insured has an accident or is diagnosed with a severe illness, the insurance provider bears the expenses incurred for treatment.
How Does Health Insurance Work in India?
The workings of health insurance policies in India are easy to understand. The insurance company covers the policyholder's medical costs up to the predetermined sum insured in health insurance, and the policyholder pays a premium for coverage.
Here is how a health insurance policy works in India:
- You can choose a plan based on coverage needs, including in-patient hospitalization, pre/post-hospitalization expenses, and specific illnesses.
- After purchasing the policy, you have to pay a premium, either annually or in instalments, which depends on factors like age, health status, coverage amount, and chosen benefits.
- Every policy has a certain waiting period in health insurance, which means you cannot benefit from the policy for this duration.
- In case of hospitalisation, your insurance company will cover the cost of the incurred medical expenses.
- You can claim the expenses in two ways:
- Cashless Claim: Treatment costs are covered directly by the insurer at network hospitals.
- Reimbursement Claim: The policyholder (you) must pay first and then submit the bills to get the reimbursement.
- And here is the good news: For years without claims, insurers offer bonuses on your policy.
Why Is Health Insurance Important in India?
Approximately 73 million Indians suffer from type 2 diabetes, which is expected to grow to 134 million by 2025.
Women between the ages of 15 and 49 have elevated rates of conditions like anaemia, high blood sugar, and hypertension.
The age-standardized death rate from cardiovascular disease in India is over 272 per 1,000,000 people, significantly higher than the global average of 235.
What do these statistics signify? These are the possible medical complications individuals might develop during their lifetime and the corresponding expenses for treatment of the same.
These staggering figures and rising medical expenses demonstrate the importance of health insurance policies in India. These policies offer comprehensive coverage of healthcare expenses against periodic premium payments made by the policyholders.
What are the Benefits of Health Insurance Plans?
Nobody thinks of having health insurance before we truly need it. However, knowing all the benefits is crucial to buying a health insurance policy! Here are some:
1. Hospitalisation Expenses
Any medical condition requiring urgent hospitalisation is covered under health insurance plans. However, claims are only entertained if the disease has not been previously diagnosed when the insurance plan was not availed of.
Renowned insurance providers also extend hospitalisation expenses incurred under the following situations:
- Treatment Against Critical Illness - Some insurance providers extend substantial amounts equal to or greater than the sum insured to cover all underlying expenses to treat critical diseases. This includes the cost of hospitalisation, diagnosis and medication, etc.
- Accident and Illness-Related Hospitalisation Coverage - Medical expenses borne in the course of hospitalisation due to illnesses or accidental injuries also come under this category. Major insurance providers offer comprehensive treatment charges up to or higher than the sum insured.
2. Pre and Post Hospitalisation Charges
A health insurance plan can cover pre and post-hospitalisation expenses. Pre-hospitalization expenses include diagnosis expenses, doctors’ fees, medications, etc.
Most insurance companies also reimburse post-release expenses such as medication, routine check-ups, injections, etc.
3. No Room Rent Cap on ICU Room Charges
There is no room rent cap on the type of bed you choose. Health insurance policies also cover ICU bed charges. An insured individual can also choose to stay in a private room, the costs of which can be billed against the respective insurance provider up to a total insured amount.
4. Cover Against Mental Illness
Hospitalisation in due course for mental treatment is also covered under such health insurance policies. With rising rates of mental health issues in India and globally, this facility allows individuals to seek professional help for a well-rounded life.
5. Daycare Procedures
Expenses incurred for daycare treatment at hospitals, such as dialysis, cataract, tonsillectomy, etc. are covered under most health insurance plans.
6. Road Ambulance Charges
A standard health insurance policy covers any road ambulance expenses incurred during times of medical emergency. This poses a significant benefit as premium hospitals often charge substantial amounts for transportation.
7. Refill Sum Insured
Under such a health insurance policy, you can make claims amounting to the sum insured twice a year, provided the medical conditions differ each time.
8. No Claim Bonus
For every non-claim year, insured individuals are extended discounts or a higher sum insured (at no additional cost) in the succeeding years, which can help to reduce their premium charges payable annually or to extend their sum insured coverage.
9. Daily Hospital Cash Cover
Daily cash allowance is provided by stipulated institutions, enabling individuals to make up for the loss of pay during times of hospitalisation.
10. Zero or No Co-payment
Insurance companies cover all medical bills generated during an insured individual's treatment procedure up to the sum insured. Zero co-payment supports a patient financially, allowing him/her to focus solely on recovery.
11. Zone Upgrade Facility
In India, treatment costs usually vary from one city to the other. It is especially higher in metropolitan cities like Delhi and Mumbai.
With a zone upgrade, you can avail of higher financial coverage for treatments in different city zones. Zones are classified according to the city’s medical expenses. The higher the medical expense in a particular region, the higher it is placed in such a classification.
*Currently, at Digit, we have no Zone Upgrade Add-on. However, you will get an additional discount on the premium if you are based in Zone B.
12. Domiciliary Care
Comprehensive health insurance policies cover all expenses incurred for home hospitalisation expenses. This includes medication, nurse fees, injections, etc., payable for a patient's comprehensive treatment.
Eligibility Criteria for Buying Health Insurance
A number of variables, including the policyholder's age and any pre-existing conditions, affect the qualifying requirements for purchasing a health insurance plan. The following requirements should be fulfilled to be eligible for the majority of health insurance plans:
Types of Health Insurance Policies in India
Tax Benefits of Health Insurance in India
If you avail of a health insurance policy, you can avail of tax benefits in health insurance under Section 80D of the Income Tax Act, 1961. The table below illustrates the break-up of tax exemptions on your health insurance policy:
Disclaimer: You can only claim these tax deductions under 80D with the Old Tax Regime. The New Tax Regime of FY 2023-2024 does not offer any tax deduction under 80D.
Common Myths About Health Insurance Explained
Health insurance is often misunderstood! Many say it is only for the elderly, while others say it only covers medical bills. Both are far from the real truth. Here are some common myths with facts check to help you make smarter decisions regarding your health.
#Myth1 - Young people don't need health insurance
Well, there is no guarantee that an accident or illness won't occur, even if you are fit and fine. Therefore, getting a good health insurance policy is a good idea for everyone, regardless of age or health status.
#Myth 2 - My health insurance will cover all my expenses
Every health insurance plan has a list of exclusions and limitations as per IRDAI regulations. It is recommended that you review all of the policy information and the coverage that your insurance provides.
#Myth 3 - You can get instant coverage after buying
Not all the time. There may be a waiting period for certain health insurance plans. Only once the waiting time has passed are some illnesses covered. Read about your specific policy waiting period.
#Myth 5 - Online health insurance plans are fraud
Seeing people holding onto this myth in the current digital era is disheartening. Online health insurance is highly popular and safe. When you buy a health insurance plan online, you might get some of the greatest and most affordable offers.
#Myth 4 - I do not need to discuss my pre-existing disease with my insurer
When purchasing health insurance coverage, it is crucial to disclose your pre-existing conditions. Insufficient details or failure to disclose pre-existing conditions may result in the claim being denied and the policy being cancelled.
#Myth 6 - People who smoke and drink are not covered under health insurance
Some health insurance providers provide coverage to smokers & drinkers. Given the hazards, smokers and drinkers would have to pay a higher premium and go through a rigorous pre-medical screening to obtain health insurance coverage.
Difference Between Health Insurance vs Life Insurance
While a life insurance policy aims to secure the financial requirements of an insured’s dependent family members in the event of untimely death, a health insurance scheme gives an individual access to quality health care and treatment facilities.
Now, you must be clear about what is health insurance and why it is beneficial. By choosing the right plan, you can be covered for emergencies, routine care, hospitalizations, etc.
Remember, making an informed choice today ensures a healthier tomorrow! 😎
FAQs on Health Insurance Meaning
Can existing health insurance policies be ported from one insurance provider to another?
Yes, policies can be ported from one insurance company to another, provided that the policyholder has completed their existing policy period and is due for renewal.
What is the claim process for health insurance policies?
You can opt for reimbursement or cashless claims under your health insurance policy. For cashless claims, the insurance provider settles your claim directly with the hospital where you or your family member sought treatment.
In case of reimbursement claims, the insurance provider reimburses you for the treatment costs incurred in due course.
What does health insurance mean in simple terms?
In simple terms, health insurance is a financial protection the insurance provides to cover the medical cost involved in accidents or illnesses.
Is there a right age to buy a health insurance policy?
There is no right or wrong age to purchase health insurance. However, buying it as soon as feasible is advised to keep your premium low. The earlier you purchase it, the lower the premium.
Is it mandatory to undergo diagnostic tests before buying a health insurance policy?
No, not in all cases. Medical testing is not required before purchasing health insurance coverage. However, if an applicant is older than 45, most Indian health insurance providers require medical test results.
Can I increase my insurance sum if I already have a health insurance policy?
Yes, increasing your sum insured at the time of policy renewal is possible. If your current insurance does not increase your sum insured, you can purchase a top-up plan or another health policy to increase the coverage.
What are the essential documents required to buy a health insurance policy?
Some essential documents necessary to buy a health insurance policy include an Adhar card, PAN card, passport, driving licence, 10th or 12th mark sheet, etc.
Can I have more than one insurance policy?
Yes, you can have more than one insurance policy. This will help you have a higher sum insured and provide you with wide coverage for your health.
Can we add family members to an existing health insurance?
Yes, you can add your family member to your existing health insurance or obtain a family or individual floater health insurance policy to protect your family financially in an emergency.
What happens if I forget to pay my premium for health insurance?
Insurance companies constantly remind you to pay your premiums before the last day. However, you can lose your insurance coverage if you fail to pay your premiums promptly. However, the terms under which premiums must be paid vary depending on the health insurance provider.
What is the waiting period for health insurance?
The waiting period is a crucial consideration when buying health insurance coverage. It describes the amount of time the insured must wait to obtain their insurance benefits, and these waiting periods differ from policy to policy.
Why should I buy a health insurance policy?
Some of the primary reasons why you must buy a health insurance policy include:
- It covers the cost of the rising medical expenses
- It helps in maximising your tax saving
- Keeps you financially secure
- Helps to get the right treatment at the right time
- Protects you from critical illness
What is a network hospital in health insurance?
In the context of health insurance, a network hospital is a hospital that has partnered with the insurance provider to offer consumers cashless care. Policyholders can receive cashless care without paying for it if they seek medical attention at a network facility.
Are there any extra costs involved in health insurance except the premium?
No, there are no additional costs involved in the health insurance except your premium. It is unethical for the insurance companies to charge extra fees over the premium.