Health Insurance

Health insurance provides risk coverage against expenditure caused by any unforeseen medical emergencies. In current time of high medical inflation rates, failing to hold adequate amount of health insurance cover can prove to be a major personal financial disaster. This could lead to either poor health care because of non- affordability or spiral an individual into financial distress due to high medical bills.

Medical inflation has so far outpaced overall inflation in the last few years. The oft- quoted figure for healthcare inflation in India is 15% a year compared to overall inflation of 6-7 per cent in the past few years.

A health insurance report published by the IRDA (Insurance Regulatory and Development Authority) of India published in 2011 says the average claim in case of major diseases was Rs 1,34,550 in 2009-10 compared to Rs 98,101 in 2007-08, a compounded annual growth rate of 17 per cent.

That was in 2009-10. What was the cost of major medical treatments/procedures in India in 2012 -13?

There is a popular saying about Health insurance “Buy health insurance when you don’t want it, because you may not get it when you want it”.

FAQs

What is Health Insurance OR Mediclaim?

Health Insurance/Mediclaim are protection against unfortunate medical costs. A health insurance policy is a contract between an insurer and an individual /group in which the insurer agrees to provide specified health insurance cover at a particular premium. The health insurer usually provides either direct payment (cashless facility) or reimburses the expenses associated with illnesses and injuries.

Health Insurance is cover against disease, illness and accidents. It takes care of the hospitalization expenses subject to maximum sum insured.

Why do I need Health Insurance?

Healthcare is expensive. Technological advances, new procedures and more effective medicines have driven up the cost of healthcare. This increase has to be borne by the consumer, making treatment unaffordable for too many. Think for a moment about the enormous medical costs you would incur if you or your family member suffered a major accident or were suddenly stricken by an illness. Uninsured people live with such risks everyday. Health insurance seeks to shield you from that risk. It provides the much needed financial relief.You also get tax benefit under section 80D of the Income Tax Act.

I have health insurance from my company. Why I need personal one?

Company insurance is a tailor-made policy for one year period only, if you change the company you may not get the same cover in your new company, if the hospitalization bill is more than company health insurance sum assured OR if you start your own consultation or business, immediate health insurance will not cover all event of hospitalization.

Will I get the entire amount of the claimed expenses?

The entire amount of the claim is payable, if it is within the Sum Insured and is related with the in-house treatment as per policy conditions and is supported by proper documents, except the expenses which are excluded. Even you can claim pre and post hospitalization expenses.

What do you mean by pre and post hospitalization?

Relevant medical expenses incurred before and after hospitalisation for a specified number of days. Relevant medical expenses means expenses related to the treatment of the disease for which the insured is hospitalised.

What is Cashless and Reimbursement Facility?

Cashless means you can walk into any of the network hospitals across the country and get treatment without having to pay for your medical bills, having admitted for minimum 24 hours.

If you admitted to a non-network hospital, your expenses will be reimbursed within fifteen working days on receipt of complete documents and reports.

What is Network /Non-network Hospitalization?

A Hospital, which has an agreement with a Health Insurance Company OR TPA for providing cashless treatment, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at the network hospitals. Non-network hospitals are those who have not agreed to the Health Insurance Company OR TPA terms and conditions and any policyholder seeking treatment in these hospitals will have to pay for the treatment and later claim as per normal procedure.

What is a TPA?

Third Party Administration (TPA) is a service given to a Mediclaim policyholder by providing cashless facility for all hospitalizations that come under the scope of his/her Mediclaim policy. It is appointed by Health Insurance Company to serve their policy holders.