Category: Health Insurance

Neuro and Spine

How to Cover all your health risks with a right Health Insurance Policy ?

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Having health insurance has always been important but it is all the more important considering we are amidst a Pandemic and similar health crisis will keep occurring due to the rise in population, urbanization, climate change, rise in global travel, and other factors. An adequate insurance policy provides you with much-needed financial assistance in case of any medical emergency and covers treatment expenses incurred on pre and post-hospitalization, room rent, ambulance services, doctor’s fee, ICU charges, medicine costs, and so on. Thus, medical insurance protects your savings from any unexpected expenses due to medical treatments.

Insurance played an important role in the pandemic-struck 2020, from protecting one’s income for the benefit of surviving family members to having a risk-cover to meet hospital bills, the importance of insurance has risen in 2020. This makes it extremely important to review one’s insurance needs in 2021 and make up for any inadequacies at the earliest.

The purpose of insurance is to protect against unforeseen risks. While life insurance is meant to provide financial aid in case of the untimely death of the bread earner in a family, health insurance helps to meet the medical cost in the case of hospitalization.

What is a Health Insurance Plan?

Health insurance plans / medical insurance reimburses the insured individuals for their medical expenses that include costs related to surgeries, hospitalization, treatments, and the like arising due to injuries, illnesses, or even accidents. In case of a health insurance claim settlement, the insurer, that is the insurance company, pays the benefits to the insured as per the terms and conditions of the policy document.

In other words, a medical insurance policy is an agreement between an insurance company and the insured where the former agrees to provide the specified payment/compensation for medical expenses in case the latter is ill and requires hospitalization. In most cases, health insurance companies have tie-ups with hospitals, known as network hospitals where the insured can avail of treatment without paying even a single penny.

Best Health Insurance in India


Oriental Insurance – Happy Family Floater Plan

Happy Family Floater Health Policy offered by Oriental Insurance covers medical expenditures incurred by the whole family under a single sum assured. The family comprises of Self, Spouse, Children, Parents, and Parents-in-laws. There are two plans available in Family Floater Silver and Gold. With this plan, you can claim medical costs owing to any ailment/ injury/ accident that necessitates hospitalization. Available in three plans Silver, Gold, and Diamond. Sum Insured from Rs.2lacs to Rs.20lacs. Organ Donor Benefit- When Insured Person is the donor, Medical Second Opinion –Reimbursement, Maternity Expenses Cover, New Born Baby Cover,  Life Hardship Survival Benefit under all Plans, Restoration of Sum Insured, Increase in Day Care Procedure List. Covers about 24 day-care procedures that do not require a minimum of 24 hours hospitalization. You are entitled to a no-claim bonus of 5% up to a maximum of 20% on the premium if you renew the policy without any break.You can claim for hospitalization, nursing home charges, surgery, medicines, drugs, pathological tests, and so forth during an organ transplant. The insurance company will compensate you for the medical expenses related to your hospitalization 30 days before the hospitalization. A 30 days cooling-off period for all claims except any arising out of accidental injuries. This plan does not cover maternity costs.

https://www.coverfox.com/health-insurance/oriental-health-insurance/happy-family-floater-policy/

 

·     Manipal Cigna – Pro-Health Plus

This policy is suitable for couples who have or are planning for kids, ProHealth Plus provides a comprehensive cover when looking to start on the family path. Sum Insurers invest between 4.5 – 50 lakhs, With about premium of 16,072 per annum (The Premium value is indicative for the below mentioned profile Age – 30, Zone – 1, Cover type – Family Floater ( 2 adults), Tenure- 1 year, Premium payment mode- Single.)  along with a cumulative bonus booster of  25% increase in sum insured per year. PRO HEALTH plan comes with basic covers, value added covers, and optional covers to choose from more importantly includes Multiple restoration, Daycare cover, Ayush cover, Free health checkup cover along with maternity cover

https://www.manipalcigna.com/hospitalization-cover/prohealth-insurance/prohealth-plus

 

·     HDFC Ergo General Health

This health insurance plan offers completely cashless treatments at our network hospitals along with a host of other attractive features to meet your healthcare needs.  You will get 100% of your cover restored instantly after your first claim. It also gives a 2xmultiplier benefit with 100% additional policy cover as no claim bonus. Complimentary health check up’s and in case of hospitalization get daily hospital cash from 1000 upto Rs 6000. This policy covers hospitalization expenses, pre & post-hospitalization, daycare procedures, emergency road ambulances, organ donor expenses, also includes all modern treatments and recovery benefits. Complete coverage 60 days prior & 180 days post your hospitalization. This ensures better planning of your hospitalization needs. 10,000 hospitals, Maximum 50  lacs cover

 

https://www.hdfcergo.com/health-insurance/optima-restore-family-floater-plan

SBI Arogya Premier Health Policy

SBI General’s Arogya Premier Policy is designed for the exclusive few – meeting their unique requirements. With wider medical coverage, insured person can go for the very best healthcare and consult top medical experts without any worries. Any Individual can take this Policy for himself and/or his family with a minimum entry age is 3 months and maximum entry age is 65 years. There is no exit age. Eligible Hospitalization Expenses, Pre and Post Hospitalization (Including Domiciliary Hospitalization) Expenses Coverage, Day Care Expenses, Ambulance Expenses, Organ Donor, Alternative Treatment, Domiciliary Hospitalisation, Maternity Expenses, Health Check-up, Reinstatement of Sum Insured, Cumulative Bonus:, HIV/AIDS Cove, mental illness, genetic disorder,  No pre-policy medical test up to the age of 55 years for people with no medical history. Benefits like 141 Day Care expenses covered, AYUSH Cover, Cumulative Bonus: 10% of SI for each claim-free year, up to 50%, Coverage from Rs 10,00,000 to Rs 30,00,000.

Tax Deduction: Under Sec 80D and Reimbursement of health check up to Rs 5000 in case of no claim for 4 years

https://content.sbigeneral.in/uploads/92dde0ad90b94e2e9d670bcba2bf7cc2.pdf

 National Insurance Company Limited

With a constant increase in healthcare costs and the ever-rising instances of diseases, health insurance has become a necessity of the day. National Parivar Mediclaim designed by National Insurance Company is a type of plan, which gives complete protection to the entire family members under a single sum insured. The coverage benefits under the policy can be availed by any insured family member. National Parivar Mediclaim  Policy is an indemnity floater health insurance, covering the members of a family under a single sum insured. The policy covers expenses in respect of inpatient treatment (Allopathy, Ayurveda, and Homeopathy), domiciliary hospitalization, reasonably and customarily incurred for treatment of a disease. Room charges subject to 1% of sum insured per day and Intensive care unit charges subject to 2% of sum insured per day (including nursing care, RMO charges, IV fluids/blood transfusion/injection administration charges).  Surgeon, anesthetist, medical practitioner, consultants, and specialist fees. Anaesthesia, blood, oxygen, operation theatre charges, any disposable surgical appliances subject to a maximum of 10% of the sum insured, medicines and drugs, diagnostic materials and X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of stent and implants. Coverage upto 10 lacs

 

https://nationalinsurance.nic.co.in/sites/default/files/Parivar%20Mediclaim%20for%20Family.pdf

 

 

The Arogyada
www.arogyada.in
April 9, 2021 / by Deepika Jagasia

Top 10 Benefits of Health Insurance in India

Health insurance initially seems to be like an unnecessary expense. But its importance is not realized until we or someone in our family falls ill and medical bills start touching the roof.

We may end up compromising on the room in the hospital, sharing it with somebody or even in the general ward just to keep our bills down . The frustration of cash flowing out of hands usually boils down on the healthcare staff who are in the front line interacting with us.

People never shy away in spending on an exotic holiday or on good food or on expensive branded clothes, but somehow health always tends to take a backseat in today’s fast paced life. Today external appearance has become everything and those candid shots at international exotic locations have somehow become parameters of the quality of life.

In the pursuit of a grand life people usually fail to save for these healthcare and personal emergencies and end up cursing their luck and get depressed with their life later.

Health Insurance these days has become a boon and has starting covering most of your medical bills, along with special lifetime events like pregnancies.

Below are Top 10 Benefits of having a Health Insurance in India:

 1. You get Tax Benefits on Health Insurance 

Usually it is good enough a incentive to start saving for the time of emergencies instead of giving extra tax to the government. You can avail tax deduction on premium paid under health insurance policy as per applicable provisions of Section 80D of Income Tax Act, 1961.

So this is one of the unavoidable reasons to invest in a health insurance policy.

2. You can avail cashless admission



While you are in a middle of a medical emergencies, there is no need to look for cash and borrow from your relatives. These days all big hospitals can admit without cash if they are amongst the network hospitals of your purchased health insurance.

3. Pre and Post Hospitalisation Expenses



Many health insurance policy cover even the pre and post hospitalization benefits which usually includes Medical expenses incurred, immediately, 30 days before and 60 days after hospitalisation.

4. Domestic Road Emergency Ambulance Cover



Reimbursement is also given for the expenses incurred on availing an ambulance service offered by a hospital / ambulance service provider in an emergency condition.

5. Maternity Benefits


All you newly married and going to get married couples, this ones for you. You can have a pregnancy what you always dreamt of, if you plan ahead and buy a health insurance policy with maternity benefit. This includes reimbursement for medical expenses incurred for both normal delivery and cesarean section. Usually the waiting period for maternity cover is 3 years. This cover shall be limited to 2 deliveries. Some policies cover both Prenatal and Postnatal expenses also.To bbe eligible for this you and your spouse should bein the same policy.

6. Your newborn is also covered once he/she is born



The new born child can also be covered under few policies. In few deliveries, the newborn my need initial supportive medical care before he/ she is strong enough to sustain. This coverage is for initial NICU and other medical expenses during hospitalisation for a maximum period upto 91 days from the date of birth of the child. This cover will be provided only if maternity cover is opted.

7. Convalescent Benefit



When you are ill or injured and in hospital, usually the economical liabilities tend to increase rather than decrease. Som health policies give you a benefit amount if you are admitted for consecutive 10 days or more (eg Rs 10,000) once during the policy period.

8. They also give you expenses for Nursing care at home


Some amount (Lets say Rs 3,000 per day for 15 days) is also given post hospitalisation for the medical services of a nurse at your residence.

9. Your wellness and preventive health checkups are also covered

All the expenses pertaining to routine health checkups and for other wellness and fitness activities taken by you will be reimbursed by few health policies.

10. You can also opt to receive Outpatient treatment expenses


Reimbursement for the medical expenses incurred as an Outpatient department (OPD) can also be covered in some health insurance policies.

Below I have listed down few frequently asked questions, this for a general understanding, specific health insurance criteria vary from policy to policy. This you should properly verify by checking the policy guide before purchasing your health insurance.

What all does Health Insurance Cover?

All expenses pertaining to in – patient hospitalisation such as

  • Boarding and nursing expenses
  • Intensive care unit charges
  • Surgeon’s and doctor’s fee
  • Anesthesia
  • Surgery charges
  • Theatre charges
When will be my pre-existing conditions covered?
Pre-Existing conditions / diseases are usually covered after 2 years of continuous coverage under the policy.


 How many times can I get free health check ups?

Usually a customer is allowed for a Free Health Checkup at a designated centre. The
coupons are provided to each Insured for every policy year, subject to a maximum of 2 coupons per year for floater policies

How can I get Cashless hospitalization?

You can avail a cashless hospitalisation at any of the network hospitals of the insurer. A list of these hospitals / providers will be available on the website of the insurer.

Can I get reimbursement later, in case I did not apply for health insurance during admission?

 Yes you can, but it is always better to go through the cashless route, as most of the paper work and administrative work is done by the hospital third party administrator staff. This saves you from the trouble you doing all the submission work yourselves.

Don’t forget to like or share if you found this useful!

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The Arogyada
www.arogyada.in
July 8, 2017 / by drsandeep.net

Five Key Challenges for Indian Health Insurance Industry

In the current scenarios Indian health insurance industry can be considered to still be in its infancy. The next few years posit a plethora of challenges. Have highlighted key five areas of concern.

1. Lack of standardised transactions between the insurer and hospitals or the insurer and insured. This often results in individual interpretation and methodology for processes like claims and pre-authorization

2. Use of non-standard terminologies with regards to treatment protocols and care plans. In fact absence or minimal documentation and implementation of standard care pathways become a cause of conflict with regards to services covered/not covered for payment via the insurer. This gets further aggravated with extremely poor usage and implementation of ICD codes

3. Skewed penetration (much higher in urban India than rural) of private health insurers within the Indian population leading to asymmetric distribution of risk. This ultimately on one hand bleeds the insurer, on other hand hits the insured due to higher premiums and finally also the hospitals due to higher rejection rates

4. Non SLA based transactions between hospitals and insurers. Response time and request closure time for crucial transactions like pre-auth filling, pre-auth approval, claim filling, and claim approval is still not a strictly followed dimension.

5. Both hospital and insurer hold sensitive patient data but we are still far from having any form of implementable India specific law or guidelines to protect and securely exchange patient data between two major pillars of healthcare industry

The Arogyada
www.arogyada.in
January 8, 2014 / by drsandeep.net