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What is Health insurance plan – why to buy?

Growing health concerns everyday makes it important to choose a good health insurance plan that covers you and your loved ones. It's very confusing to understand the plans, jargon, and the real benefits. Team EZTax.in made an effort to simplify to choose a good health insurance plan for you.

What is health insurance?

In India, with the government operated public healthcare and hospital facilities are fairly operated at a lowest standards, except a few, the only option for an average family is to depend on private sector operated health care facilities. Using such are awfully expensive and unaffordable et times for many individuals and families in India.

What is Health Insurance Plan ?

Health Insurance is a type of insurance that offers coverage to the insured individual / family for medical, surgical, prescription expenses in case of a health emergency.

Health insurance plan (aka health insurance policy) is a plan taken by the policyholder to protect his / her family for a sum insured (total yearly benefit) with an annual health insurance premium (annual fee).

Health insurance plans offered by companies in India provide various benefits such as cash-less claims, daily cash allowance when treated with in the networked hospitals / facilities covered by the Insurance Company, in addition to income tax benefits one may get.

What is Health Insurance Plan & Why is it important for you

Need for health care became an ever-important subject in our society. Quality infrastructure to treat health issues are limited to certain cities, became expensive and unaffordable for much of the society. Typical hospitalisation expenses may cost in Lakhs. Taking a health insurance plan for an yearly premium help you access hospital facilities at a much discounted or free for up to the sum insured as long as the facilities are with in the insurance provider network.

In addition to medical coverage, the plans cover preventive medical expenses, pre-, post-hospitalisation expenses, Pregnant Delivery, New-Born baby cover (including C-section deliveries and vaccinations for newborns), offer free health check-ups along with the income tax benefits under Section 80D of income tax act in India.

In essence, the health insurance plan should be part of your personal finance planning to reduce stress on your pocket and uncertainty.

Important Health Insurance benefits

Today there are around 28 health insurance companies offering plans in India, each company further offering 10-20 plans to cover various needs to its policy holders. A challenging task to pick a right plan for your individual or family needs that can be really be useful in a health emergency.

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Team EZTax.in identified 7 important benefits in choosing a good health insurance plan for you.

1. Cashless Treatment (or Expense Reimbursement)

Main reason for choosing the health insurance plan in most cases is to treat illness without paying much from your pocket. In India, unlike other countries, main benefit of health insurance is to cover hospitalisation expenses.

At the time of medical emergency, health insurance plans provide the facility of cashless treatment with in their hospital network where the insurance company pay the expenses directly to the hospital.

Not all hospitals provide cashless benefit, in such situations, one may pay the expenses to the hospital and reimburse from the insurance provider afterwards.

Typical expenses covered are in-patient treatment, day-care treatments, ICU, Surgery expenses

2. Pre & Post Hospitalization Expenses
Many plans cover related expenses before and after hospitalisation such as ambulance service, medical tests, medicine taken while joining. The period of coverage varies based on the health issue, your eligibility under the plan, and the hospital you chose to get served.
3. Daily Hospital Cash

A small money with certain limits were given as a daily expense for covering food, transportation to hospital, minor treatments. This generally a small money but very handy at the time of emergency.

4. Claim Settlement Ratio

A factor being followed as an industry standard whether the claims requested are processed in favour of a customer and in time or not ? IRDAI (Insurance Regulatory and Development Authority of India ), a regulatory body to protect the interests of the policyholders issue Claim Settlement Ratio statistics to maintain transparency.

Higher the Claims Ratio means the higher the chance of getting the claim settled. When reading these ratios, one need to pay attention to volume of business each insurer is handling per year. Some small, foreign insurance companies may be having higher claim settlement ratio but they may have neither a good hospital network, nor insurance plans that you desired to have.

5. Customer Support

When a policy holder is in stress, a peaceful, receiving, no-surprise customer service is priceless. While it is difficult to know a company's support handling network, one way to look to gain insight is from other policy holder experiences. Look for genuine independent reviews, experiences and recommendations.

6. No Claim Bonus (NCB)

No Claim Bonus (NCB) is a discount on your insurance premium (annual payment) Or increase in coverage amount that you can avail when you renew your policy, if you haven't make any claims (et times fewer claims) for last year. Many times, this is an option one need to select at the time of buying the health insurance.

You can accumulate and increase the coverage amount generally up to 50% over few years from the original coverage amount.

Its essentially an Incentive for being healthy and not claiming any insurance. It's encouraging the disciplined to save.

7. Hospital Network

While premium (your payment) and claims (what you receive) are important, it is more important to know types of hospitals accept your insurance. Treatment is the main reason why one want to get the health insurance.

Pay attention to accessibility, number of hospitals, specialisation covered for policyholder needs, along with the reputation to stay afloat as a company.


Conclusion

Despite of health insurance importance, only ~20% of the people are covered under either private or public health insurance plans or schemes.

Out of which more than 60% of the health insurance is handled through public insurers such as The New India Insurance Co Ltd, The Oriental Insurance Co Ltd, United India Insurance Co Ltd, National Insurance Co Ltd


Frequently asked Questions on Health Insurance Plans

1.How a typical health insurance plan described ?

While the insurance policy document contains very comprehensive coverage on what's covered and what's not, below describes how a plan look like.

Plan NameEZCare Comprehensive Insurance Policy
PurposeComprehensive coverage to in-patient & certain out-patient treatments along with pregnant and new-born requirements
EligibleAny one with 6 months to 65 years. Applicable for both individuals and families.
Sum AssuredRs. 5-30 Lakhs
Premium ChargesStarts from Rs. 6000 per year. Varies based on existing conditions, age, family size.
No Claim Bonus (NCB)Up to 50% of the sum insured amount offered for every claim-free year.
CoveragePlan covers preventive medical expenses, pre-, post-hospitalisation expenses, Pregnant Delivery, New-Born baby cover (including C-section deliveries and vaccinations for newborns), hospitalisation expenses, also offer free health check-ups
Not CoveredSelf-inflicted injuries, health issues related to Natural Disasters & Wars, Cosmetic Surgeries, HIV/AIDS, Dental transplants.