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Got Questions? We Got Answers.
What is Insurance?
Insurance is a contractual obligation between two parties, an insurance company (known as the insurer) and an individual/group of individuals (known as the insured).
The insured individual is required to pay a fixed amount of money at regular intervals to the insurer known as a premium, in return for which the insurer promises to cover the expenses of any contingent financial losses that arise in the future.
What is Health Insurance?
Health insurance is a contractual agreement between an insurer and an insured individual, under which the insured individual is obligated to pay a fixed amount of money regularly to the insurer as specified within the contract. In exchange for the premium paid, the insurer promises to cover any contingent medical expenses incurred by the policyholder (as specified within the policy documents).
The medical expenses can pertain to hospitalization expenses due to illness, disease, or personal accident. The claim settlement of insurance companies can be of 2 types, one being the reimbursement of all medical expenses incurred and the other being cashless hospitalization, provided the treatment is done at one of the insurer’s network hospitals.
Why is Health Insurance required?
With the technological advancements in the medical sector and with the increasing expertise of all practicing professionals, the cost of medical expenses have been growing at a very rapid rate. As a result, medical treatments, although vital for people, are becoming increasingly unaffordable for people. This makes medical insurance an utmost essential for people, as medical expenses due to treatments burn a deep hole in their savings.
Types of Health Insurance Plans
The various types of health insurance plans offered are as follows-
Individual Health Insurance Policy- Under individual health insurance plans, the coverage is provided to the medical expenses incurred by only an individual policyholder.
Family Floater Health Insurance Plans- Under this type of health insurance plan, the insurer provides coverage against all contingent medical expenses incurred by family members (such as spouse and/or children) under one insurance plan.
Insurance plans for corporates- This health insurance plan provides coverage for the various employees of an organization.
Health Insurance Policy for senior citizens- This health insurance plan provides coverage exclusively for senior citizens (above 60 years of age), in-line with the terms and conditions of the insurance company’s policy.
Critical Illness Cover Insurance- This health insurance policy covers critical illnesses such as cancer, paralysis, stroke, heart attack, etc. The extent of coverage and the type of coverage differs from across various insurance companies.
Daily Cash for hospitalization insurance plans- This insurance policy provides daily cash benefits for medical expenses incurred.
What Medical Insurance Plans cover
Hospitalization expenses incurred due to illness, disease, or personal accident.
Pre hospitalization expenses as well as post-hospitalization treatments and other medical expenses incurred.
Ambulance expenses are covered by the insurer.
Domiciliary expenses (treatment availed from home) are covered.
ICU, Day Care procedures, health check-ups are covered by the insurer.
Donor expenses (in some cases).
Maternity Cover (in some cases).
Tax Benefits Pertaining to Health Insurance
Health insurance plans conventionally provide tax benefits for policyholders under section 80D of the Income Tax Act, 1961. The premium paid by policyholders towards the health insurance policies gets a tax rebate up to Rs. 1,50,000.
Exclusions of Health Insurance
Pre-Existing Diseases (in some cases).
Certain diseases are excluded from the first year of coverage.
Convalescence, general debility, congenital external defects, venereal disease, intentional self-injury, drugs/alcohol, STDs, sex-change surgeries, cosmetic/plastic surgery.
Health Insurance Eligibility
Conventionally, an individual between the age of 18 years and 65 years is eligible for a health insurance policy. The health insurance companies require an individual above the age of 45 years to go through a medical examination to check if the individual has any pre-existing diseases or not. One would be required to submit a declaration of good health if no pre-existing illnesses are found.
Moreover, most medical insurance companies reject applications of individuals based on their habits, especially in the case of smokers.
Health Insurance Documentation
Some documents required to be filled while purchasing health insurance plans are-
Medical Reports (in some cases)
Passport Size Photographs