Health Insurance is one of the fundamental aspects of financial planning. When we have to select this plan for our family we need to see which are the important factors that matter the most in the plan selection. There are standalone health companies in the market that have in-house claim settlement where the claim process is slightly faster. Other companies settle it through third-party administrators popularly known as TPA.
Health Insurance policies are mainly classified into two types.
- Individual Policy Which means separate insurance cover for each family member.
- Floater Policy is a blanket policy that has sharing insurance cover for all members covered in the policy.
Which expenses are normally covered in the health Policy?
It mainly covers expenses before hospitalization which may vary from company to company from 30 days to 60 days and post-hospitalization expenses from 60 days to 90 days. Actual Surgery cost, Room Rent, doctor fees, Medicine Cost, Diagnostic test cost.
There are also premium benefits available in the policy like
Maternity benefits, OPD Benefits, Annual Checkup (Cost up to limit specified by a company based on the sum assured of the policy and applicable in case of no claim in the previous year.)
Ad-don riders like critical illness cover, personal accident policy act as income protection in case of partial, permanent disability, or accidental death. Restore benefit allows to avail benefit of the sum assured twice or thrice in the policy term depending upon various products offered by the company.
It gets activated when the entire policy sum assured is exhausted and most of the time available for the use of different disease treatments. Very few companies allow to use it for the same disease. This facility is available without paying any extra premium in the policy.
No Claim Bonus is also a very important feature of the policy. Copayment means amount to be paid out of pocket in case of claim which may range from 10 % to 50% for entry in the policy at a higher, especially above 60 years.
Also, Sub-limits for any diseases need to be closely checked. Accident hospitalization is covered from day one in the policy, the inflectional diseases are covered after 30 days.
There are specified diseases that have 2 years waiting period, preexisting diseases are covered by some companies after 3 years while some companies after 4 years. The waiting period for preexisting disease can be reduced by paying an additional premium with a buyback option in few companies. Tax Benefits under section 80 D up to 25000 for(Self, Spouse plus kids) plus in addition to that also for parents up to 50000. Total 75000 Effective Tax Saved by a person in the 30 % tax bracket is 22500.
Portability from one insurance company is possible before the due date of renewal and process to be done at least 30 days in advance if you are not satisfied with the existing insurance company. Continuity benefit is available in the policy if ported before the renewal.
Grace period for premium payment should never be opted to incase of health policy as continuity benefit is available if policy renewed in grace period but if a claim arises in grace period it is not payable. Top-up policies are also good options to have good health insurance cover in addition to your existing health policy provided by the company or purchased by self. Ideal insurance for a family of 4 should be at least 25 lakhs sumassured.
Claims can be settled in two ways one is cashless and the second is reimbursement. In cashless claims hospital takes care to communicate and process the claim whereas in reimbursement right from claim intimation to document submission policyholder has to take care of himself or with the help of their financial advisor. In this case, timely intimation of claim and submission of documents plays a very important role. Usually claim should be intimated with 24 hrs of hospitalization.
Documents required while registering the claim are policy number, claim intimation number customer id, name of hospitalization, date and time of admission and discharge, duly filled claim reimbursement form along with hospital sign and seal. All original bills, test report, payment proof. We suggest keeping on xerox set for future reference as originals get submitted to the company.KYC Documents of proposer like Pan card, Adhar Card, Cancelled cheque with printed name on of account holder on the cheque.KYC of person admitted in the hospital Pan card and AdharCard.