Health Insurance

 

Medicare or medical costs are rising year on year. As a matter of fact, inflation in medicare is higher than inflation in food and other articles. While inflation in food and clothing is in single digits, medicare costs usually escalate in double digits. For an individual who hasn’t saved that much money, arranging for funds at the time of emergency is very difficult. This is particularly daunting for seniors, given that most ailments strike at an advanced age.

Health insurance is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider.

Health cover provides a facility by which you can either have a cashless treatment done in the hospitals or if the hospitalization is an emergency, you will be reimbursed for the expenses provided you inform the insurer within the stipulated time frame. All those feeling the need ‘NOT’ to have a Mediclaim just because it is ‘NOT’ needed or doesn’t give ‘Monetary Returns’, I request them to please broaden their minds and think clearly for once. Agreed Mediclaim policy does not give you monetary returns, but the cushion they give you in case you do need hospitalization, is worth every penny of the premium paid.

There are broadly three types of health insurance in India:

 

Hospitalization Plans

 

Hospitalization plans reimburse the hospitalization and medical costs of the insured subject to the sum insured. For this reason, the plans are also known as indemnity plans.

Expenses associated with hospitalization can be classified as follows:

  • Pre-hospitalization expenses: When you’re unwell, you will most likely consult a physician first, who gets relevant investigations done before advising hospitalization. Such medical expenses incurred before hospitalization are called pre-hospitalization expenses.
  • Hospitalization expenses: All expenses incurred as part of your hospital stay as an in-patient can be termed as hospitalization expenses.
  • Post-hospitalization expenses: Some part of your treatment may extend beyond your hospitalization. It may involve follow-up visits to the doctor, prescription medication, further investigations, etc. Such medical expenses are called post-hospitalization expenses.
  • Domiciliary hospitalization expenses: This typically includes expenses related to domiciliary hospitalization – at-home medical treatment for more than three days for cases which in the normal course would require hospitalization. The exact circumstances / terms / exclusions related to domiciliary hospitalization would be spelled out in your policy document.

Apart from hospitalization expenses, your health insurance policy may also cover pre- and post-hospitalization expenses, and offer a cap for domiciliary expenses.

Claims

Depending on the situation and your policy coverage, you can make two types of health insurance claims:

  • Cashless: The essence of cashless hospitalization is that the insured need not make an upfront payment to the hospital at the time of admission. You may not have any out-of-pocket expenses towards hospitalization in this scenario. Cashless hospitalization can be availed only at a Medi Assist network hospital and upon approval of your pre-authorization application.
  • Reimbursement: A reimbursement claim is one where you pay all the expenses related to the hospitalization of the insured and claim a reimbursement of your expenses after discharge. Reimbursement claims may be filed in the following circumstances:
    – Hospitalization at a non-network hospital
    – Post-hospitalization and pre-hospitalization expenses
    – Denial of pre-authorization for cashless facility at a network hospital.

Visit our website, www.mediassistindia.com, for the updated list of network hospitals

Hospital Daily Cash Benefit Plans

 

The daily cash benefit plan is a defined benefit policy. As evident from the name,the policy pays out a defined sum of money for every day of hospitalization regardless of actual costs. For instance, the hospitalization costs for a day may be Rs 2,000/day and the defined daily limit of the policy could be Rs 1,500/day, in which case the insured receives the latter. On the other hand, if the hospitalization cost is Rs 1,000/day, he still receives Rs 1,500/day.

Critical Illness Plans

 

When a major illness strikes, it not only means large costs for medical care but it also puts immense pressure on the family to manage their living expenses while the patient recoups. In such a situation your Critical Ilness insurance can come to your aid by not only covering hospitalization expenses but also providing you with lump sum compensation that can help you meet your day to day expenses like child's school fees, Car and House EMIs, credit card payments etc

Bharti AXA Critical Illness insurance covers you in the event you are diagnosed with any of the 20 critical illnesses covered. Upon diagnosis and a survival period of 30 days, we pay you a lump sum compensation equivalent to the sum insured of your plan - Rs. 2 lakhs, Rs. 3 lakhs or Rs. 5 lakhs. You can use this money as you wish, to cover your medical bills or maintain your family.

These are benefit-based health insurance plans which pay a lumpsum amount on diagnosis of predefined critical illnesses and medical procedures. The illnesses are specified at the outset. By nature, critical illnesses are high severity and low frequency and cost of treatment is higher compared to regular medical problems like heart attack, stroke, among others.