Do you have confusion on choosing the right health insurance policy?. Many of us have the same complaint, because the lack of awareness on insurance policies in India. There are numerous factors to be considered before choosing an health insurance policy. First step would be to learn about the different types of medical insurance policies available in the market. Same policy will not be suitable for every one. One has to select the policy depends on his age, family dependency, rick on life, etc. The following sections explain you the different types of health insurances and when it is suitable for your needs. If you have any doubts, please post it in the comments section. If you like the article, subscribe to our future articles here.
Health Insurance Related Articles
- Tax Exemption for Medical Insurance u/s 80D
- Health Insurance Entry age for Senior Citizens
- 15 Days Lock-In period for Health Insurance Policies
- Switching health insurer without losing benefits
- Importance of Health Insurance
Individual Health Insurance Policy
As the name implies, this health insurance policy is taken for the individual family members. If you stay in the hospital for 24 hours of time, this policy will help you to claim the expenses incurred for medicine, room rent, doctor fees, operation theater fees. You will have to renew the policy every year. If you have not claimed for one year, you will get the deduction in the next year’s premium or more coverage with the policy. This process is known as No Claim Bonus. You can not claim for the existing deceases up to four years after the new policy commences. It is general rule applies to all the policies.
Family Floater Policy
This policy is taken for the whole family. The main advantage of this policy is that you need not take the separate policy for each member in the family. Compare to individual policy, slightly more premium you have to pay for the family floater policies. But, the entire family can enjoy the higher coverage. For example, if the total coverage is Rs.500000, single member in the family can use the entire coverage if there is no other claims in the same year. There would be very less probability that all the members in the family needs claims.
Critical Illness Policy
It is not separate policy. It can be subscribed with any of the life insurance or health insurance policy. The purpose of this policy to protect policy holder from the selected major deceases like Cancer, Heart Attack, etc. You have to check the list of deceases covered under this policy before choosing this policy. Policy holder has to survive for 30 days after identifying the deceases to get the claim amount. You are eligible to claim only if the policy is at least 90 days old.
Senior Citizen Health Insurance Policy
Most of the health insurance policies matured after the age of 60 years. It becomes necessary to take the new policy after 60 years. The senior citizen health insurance policy covers up to the age of 80 years. Few policies may give covers up to 90 years. Note that senior citizen policies will come with lot of restrictions compare to other health insurance policies.
Points to Consider about Health Insurance
- The below are the few pots worth remember for the any health insurance policies.
- Insurance company can not refuse to renew the policy unless there is some fraud or policy holder has hidden some vital information to the insurance company. This rule announced by IRDA very recently.
- Insurance company can not force policy holder to move to another plan.
- Insurance company must disclose the details about renewal dates and options for renewal.
- 15 days of grace period allowed for renewing the health insurance policy (note that it is 30 days for the life insurance. don’t confuse life insurance and health insurance).
- 30 days waiting period is applicable to any new health insurance policy. If you have taken any new health insurance policy, up to 30 days you can not claim any hospitalization charges. It is exception if there is any urgent expenses like accident.
- There are no limit on number of claims allowed per year. The total claim amount should not exceed the sum assured.
- Naturopathy and Homeopathy treatments are not covered under a standard health policy.
- Maternity/Pregnancy related expenses are not covered under the normal health insurance policy. But, company provided group health insurance policies provides these expenses.
Summary
I hope this article helps you to differentiate the basic types on the health insurance policy. It is important to select the right policy for the hassle free claim. It is well known fact that there are lots of complaints against the settlement on claims. It happens when we have taken the policy without considering our actual needs. Please bear in mind that, choosing the right health insurance policy on right time is very important. Thank you for reading this article. If you have any doubts, please post it in the comments section.
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June 13, 2010 at 9:01 pm
Thanks Krishna,very nice article but the article lacks some important information,i think
The Third Party Administrators are intermediaries who connect insurance companies, policyholders and health care providers.
The Insurance Regulatory Development Authority (IRDA) selects the TPAs on the basis of strict professional norms.
Services offered by the TPA
The TPA undoubtedly aims to give the health insurance industry the required boost in India.
The services provided by TPA are as follows:
* ID card: TPA provides ID cards to all their policyholders in order to validate their identity at the time of admission.
* The TPA’s undertakes “Pre-authorization” before a surgical procedure to ease claim processing
* 24 hours customer support services: The TPA provide assistance through their 24 hrs call center that provides information regarding policyholder’s data, provider network, claim status, benefits available with existing cardholder, etc All these details are furnished on request.
* Cashless Hospitalization: Each policyholder is provided with a list of empanelled hospitals where in he/she can avail cashless hospitalization.
* Claim Management: On behalf of the insurance companies TPA administers and settles claims for hospitals and policyholders.
Policyholders have the privilege of expressing their grievances to the concerned insurance company or at the consumer’s court if they are not satisfied with the services of a TPA.
The specialized functions of the TPA include:
* The TPA keeps and maintains all the records of medical insurance policies
of an insurer.
* The TPA issues identity cards to all the policyholders. The policyholders will have to show the identity cards to the hospital authorities before availing any services from the hospital.
* In case of a claim, policyholders will have to inform the TPA on a 24 hr toll- free line provided by them
* After informing the TPA, the policyholder will be directed to a hospital where the TPA has a tied up arrangement. However, policyholders have the option to be admitted at another hospital of their choice in which case, payment will be on reimbursement basis.
* TPA pays for the treatment; they issue an authorization letter to the hospital for the admission of the policyholder in the hospital.
* At the point of discharge, all the bills will be sent to the TPA while they are tracking the case of the insured at the hospital.
* TPA makes the payment to the hospital.
* TPA sends all the documents necessary for consideration of claims, along with the bills to the insurance company.
* The insurance company then reimburses the TPA
June 14, 2010 at 7:43 am
HI Don,
Thank you for the details. I would write another article on this topic with missed information.
Thanks,
Krishna
June 30, 2010 at 12:58 am
I was confused about which one to choose. While surfing on internet, I had found http://www.insureatclick.com they provides policies of various insurance companies in India. Executive of Loyal Insurance Brokers had solved all the queries regarding health insurance and suggested a good insurance plan and activated it quickly.
March 2, 2012 at 5:39 am
Dear Mr. Krishna,
Can u suggest, as to which type of Health Insurance policy will be suitable for the family of 2 couples (2 of age 30 yrs & 2 of age 60 yrs).
Whether they should take Family FLoater policy or Individual policy??
Regards,
AParna Nema.
June 15, 2012 at 1:53 am
In the India there is many companies provide medical insurance. My friend took a mediclaim policy from private mediclaim company. They are provide cashless benefit with well known hospitals but they charge higher premium. Can you suggest me some good mediclaim companies for me and my family health protection.
Thanks.