|
What is Health Insurance ?
-
Health Insurance also known as Mediclaim in India provides you the cover
against the medical care costs arising from disease or accidental injuries.
-
Depending on the terms of the health insurance policy it covers all or
part of the medical costs of treating the disease or injury including doctor's
consultation charges, medicine and nursing costs. Treatment can be sought in
any recognized nursing home or hospital across India.
-
Health insurance in India can be bought both as an individual or a family
or as a group.
How does health insurance work ?
To purchase health insurance, you need to pay an annual fee to the company for
this coverage known as “premium. You choose the amount of coverage that you
want, by paying a high or low premium. The higher the premium the more the
coverage. Lets say, you choose a coverage of Rs 500,000 for the year. If
during the course of the year,you incur some medical costs due to disease or
injury – the insurance company will reimburse you up to the maximum of Rs.
500,000. This Rs. 500,000 can be used in one time or through multiple claims
in one year. ”
This payout by the insurance company can be claimed in two ways :
1. After the charges have been paid by your upfront. Claimed as a
reimbursement.
2. Cashless settlement – where if the treatment is sought in a hospital which
is associated with the insurance provider , the insurance company pays the
hospital directly.
Different Kinds of Health Insurance
Individual Mediclaim Policy
This is the plain mediclaim or health insurance policy for an individual
protecting this person from the expenses incurred due to disease or injury.
Floater Policy
A floater health insurance policy covers your entire family under one policy
with one sum insured and one premium. It covers all the expenses as covered
under mediclaim only the cover is now extended to the family instead of one
person. This cover can be used by any member of the family any number of
times. The advantage of this policy is that saves money by spreading the cover
across family members.
Critical Illness Policy
Insurance companies define certain specified illness or diseases as
“critical”. If you have a critical illness policy, then the insurance company
will pay you a lump sum payment if you are diagnosed with a critical illness
as defined by the insurance company.
Overseas Mediclaim Policy
An Overseas Mediclaim Insurance policy provides cover for medical expenses
incurred abroad for treatment of illness and diseases contracted or injury
sustained during the insured period of overseas travel. Anyone who is
traveling abroad for business or pleasure or for educational purposes should
have this policy.
Student Medical Insurance
Student Medical insurance covers the cost of health care while studying
abroad. It is an essential requirement of many foreign universities for its
overseas students. Students are generally advised to buy it in India as it is
substantially cheaper than buying it abroad.
Tax Saver
This is a new class of insurance launched to take full advantage of the income
tax benefit under section 80 D of the Income Tax Act 1961. The premium is
fixed at Rs 15,000 for all plans. For Senior Citizens aged 65 and above, the
premium is Rs. 20,000 This plans includes reimbursement of OPD expenses upto
Rs. 10,000. This includes diagnostics tests, dental treatment and related
expenses.
While deciding on your coverage, you may come across a term called “rider”.A
rider is a certain add on which gives you additional benefits. You will have
to pay for the rider but usually the incremental costs are minimal. You cannot
purchase a rider without first having a health insurance policy. Some of the
riders commonly available with health insurance policies are :
a) Accidental Death Benefit
In case of death of the policy holder due to an accident within the policy
period, the nominee (mentioned in the policy) is compensated with the sum that
the policyholder was insured for.
b) Permanent and Total Disability Cover
This rider insures against the permanent and total loss of limbs or sight due
to an accident. This compensation is given as a lump sum benefit. It is
payable only if the disablement results in inability of the policy holder to
be gainfully employed.
c) E Opinion Rider
This rider covers the expenses of second opinion via e-consultation services
for a patient based in India suffering from a serious illness. The policy
holder can seek a second opinion from a doctor within network hospitals across
the world. Qualified physicians from this network must give a written report
which includes a diagnosis and treatment plan within 7 working days.
d) Children's education allowance
A specific allowance is paid for payment of tuition fees and related costs so
that your children's education is not affected during the period that you are
indisposed.
How much does health insurance cost?
Insurance is usually available from Rs 50,000 to Rs 500,000 in multiples of Rs
25000 or Rs 50,000 depending on the insurer. You can choose the coverage that
you need depending on your budget and your anticipated needs.
c) Age of the oldest family member who is proposed to be covered
The premium is determined by the relative health of the person who is seeking
insurance – insurance keeps becoming expensive as you grow older. As older
people are considered to be more vulnerable to illness.
Tax Benefits with Health Insurance?
As per Section 80D, of the Income Tax Act any amount of health insurance
premium paid up to Rs. 15,000. Would be allowed as deduction from the total
income for income tax calculation purposes.
A higher amount of up to Rs 20,000 is permitted for senior citizens.
Things to watch out for:
Health insurance will not cover all the costs that you might incur for medical
related reasons. But it will still go a long way in saving your money.
Even after buying health insurance it is essential that you set aside some
part of your savings for health related expenses as the product inherently has
some limitations that one should be aware of when planning for the future.
* No coverage for routine medical expenses, checkups or medicines.
A minimum of a day's hospitalization is needed to claim health insurance. If
you incur an expense that does not result in hospitalization (like a hairline
fracture for instance), you cannot claim any compensation
* Limited coverage amount
Insurance companies usually have a limit of up to Rs 500,000 on their
policies. So your compensation is limited to that amount. Modern medical care
especially for critical diseases is very expensive and may not be covered by
Rs 500,000 alone and you might need to foot the excess bill.
* Limited coverage for the elderly
Medical insurance is usually made available only up to a certain age limit
(for most insurance companies this is 65 years). So you are above this age
limit, you will not be given a fresh policy and on the same lines the existing
policy will not be renewed after a certain age. Ironically, this is the age
when individuals need financial assistance the most; although the Government
and IRDA have encouraged the insurers to take out special policies for senior
citizens it is yet to be implemented.
* Exclusions in policies might result in expenses for you
Medical insurance policies usually have exclusions. This means that they do
not compensate the policy holder for certain illnesses/medical problems. If
the policy holder is afflicted by any of these medical problems, he will have
to pay for the expenses on his own. Expenditure on pregnancy and related
ailments are not covered under individual health insurance policies.
* Need Protection against loss of income
Lastly, health insurance only covers the expenses that you might incur for
treatment but it does not protect any loss of income due to injury or disease.
It should ideally be complemented by disability insurance for total protection
of your family.
|
