About Health Insurance objective of this 30 question guide is to give you as much information as possible about Health Insurance.
1) What is health insurance?
A health insurance policy will provide a cover to you and your family against sudden medical contingency or bodily injury arising from Physical condition, Psychological condition, Accident related, Occupational related, Environment related, Life style related and Travel related.
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2) Why health insurance?
Every human being is exposed to various health hazards. Medical emergency can strike anyone without pre-warning. Inadequate facilities in government hospitals, High expenses in Private hospitals, Rising cost of Medicines, Diagnostic charges and Specialists makes it necessary to have Health insurance.
3) What is the kind of medical emergency that can strike?
A medical emergency can be Medical illness, Injury / Accident, Major illness, Critical illness and Chronic illness.
4) What impact will a medical emergency have on you and your family?
A medical emergency can Burn a hole in your pocket, Immediate need for medical aid, Loss of quality life, Loss of career options / Income, Disruption in home life, Mental trauma and incapacitation.
5) What does a standard insurance policy cover?
A standard health insurance covers Room and boarding expenses provided by the hospital, Nursing expenses, Diagnostic and medicine expenses, Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees, Anesthesia, blood, oxygen, operation theatre expenses, cost of surgical appliances, medicines and drugs and similar expenses such as Pre-hospitalisation and post hospitalization expenses subject to conditions and limits.
6) What are the benefits of buying health insurance at a young age?
It is best to take medical insurance at a younger age, when the insurance seeker does not suffer from any ailments or sicknesses. This is important because as one ages, there is a greater likelihood of developing ailments and as such Health insurance premium tends to increase with age -- more the age, higher the premium. Existing ailments are not covered at the time of opting for medical insurance. Hence it would be prudent to opt for the insurance cover at an early age. Furthermore, taking a policy earlier can also save the trouble of undergoing a medical check up.
7) How is premium determined?
Premium depends on several factors such as Your age, Amount of coverage required, Number of family members covered, Other additional benefits, Your health condition and Your earnings.
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8) How does a health policy differ vis-Ã -vis a life insurance policy?
The health insurance plan is more comprehensive in its coverage. All expenses involved in hospitalization fall under its purview. Life insurers usually cover critical illness and hospital cash extensions (only room rent charges) on life policies, which do not include doctors fees, expenses incurred on buying medicine and surgery costs etc.
9) Why is it important to disclose health details when I buy a policy?
Mention of details is critical since insurance companies assess the policyholders risk profile on the basis of his/her health. An insurance contract works on the principal of utmost good faith, which implies that information furnished by a policyholder is true and correct. Moreover, non-disclosure can also lead to rejection of a claim.
10) What are the types of Health Insurance?
Group insurance: Group medical insurance offers insurance cover to a group with a common trait – it may be employees of a company, members of a club or an association or members of a co-operative society etc. Many employers now provide medical insurance as a perquisite to their employees.
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Individual insurance: Individual insurance caters to the specific needs of an individual. Premium for an individual insurance is higher than group insurance.
Floater: A floater is a unique plan wherein the value of sum insured opted can be used by all the members of the family or by a single-family member. Basically, the sum insured amount floats over all the members covered. For example: if the policy is bought for 3 lacs, then either all three members of the family can use Rs 1 lac each or one member can use the entire cover of 3 lacs.
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11) What are the benefits of Group Insurance?
Benefits of Group Insurance are Premium under group insurance is less than a stand-alone personal insurance policy, Discount offered depends of the size of the group, A quick and effective way to extend cover to a large chunk of population, Products can be customised to the size of the group and Group insurance is more flexible and provide more benefits.
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12) What are the benefits of a Floater Plan?
Benefits of a floater plan are A single policy takes care of your entire family, Single premium for the entire family, The sum insured floats over the entire family, One single policy covers the details of entire family, No hassles of tracking renewals for different members.
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13) What is TPA?
TPA stands for Third Party Administrator. A TPA is a specialized health service provider rendering variety of services like networking with hospitals, arranging for hospitalization and claim processing and settlement. While the insured is benefited by quicker & better health service, insurers are benefited by reduction in their administrative costs, fraudulent claims and ultimately bringing down the claim ratios. An insurance company can have more than one TPA and a TPA can serve more than one insurance company.
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14) What are the scope of services of TPAs?
The scope of services of TPAs include: Maintain database of policyholders, Issue of identity card to all policyholders, Provide ambulance service, Provide information to policyholders about hospitals, Check various investigations, Provide Cashless service and Process claims.
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15) What should I keep in mind before obtaining services from TPA?
Don’t insist for admission to the hospital merely for investigation, evaluation or health check-up as these are not approved by TPAs, In case of cashless hospitalisation, ensure to seek pre-authorisation approval from the TPA, Don’t carry back any original documents at the time of discharge from the hospital, if the TPA approves your cashless claim, Don’t forget to sign the claim form, In case of emergency hospitalization at a non-network hospital, don’t forget to submit the claim form with your signature (or signature of the claimant) along with all the required documents to the nearest TPA office within 7 days from discharge.
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16) What is cashless hospitalization?
Cashless hospitalization is service provided by an insurer wherein you are not required to settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the insurance company. However, prior approval is required from the TPA before the patient is admitted into the hospital.
17) What are the types of cashless claims?
Planned: Where the insured is aware of the hospitalisation 2-3 days in advance.
Emergency: Where the insured or any covered family member meets with sudden accident or suffers from bout of illness that requires immediate hospitalisation.
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18) What do I do in case of planned / emergency hospitalisation?
In case of planned hospitalization: Contact the toll free help-line number, Fax / submit the required documents, Obtain approval from the TPA , Obtain authorisation for network / non-network hospitals, Avail health treatment.
In case of emergency hospitalization: Rush the patient to the hospital, Patient avails treatment, Family contacts toll free number provided by the insurer, Family submits required documents, Family obtains approval from the TPA, Family obtains authorization for network / non-network hospitals, Hospital bills are directly settled by the TPA.
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19) What are the documents required for filing a non-cashless claim?
The following documents are required:- Duly completed claim form, Xerox copy of the policy, Bills, receipts and discharge certificate/card from the hospital in originals, Bills from chemists supported by proper prescription, Receipt and pathological test reports from a pathologist, Medical practitioner / surgeon prescribing the test, Nature of operation performed and surgeon’s bill and receipt.
20) How can I prevent rejection of my claim?
Understand your policy in detail. Be informed about the ‘Fine print’, exclusions and details pertaining to depreciation and deductions, Do not hesitate to ask details of deductions or rejections, Read the list of coverage and exclusions in policy wordings, Ensure that you declare all the pre-existing diseases at the time of enrolment, Do not claim for any hospitalisation and diagnostic studies / investigation charges, which do not confirm existence of an illness or injury that requires hospitalization, After filing your claim, make sure that you maintain minutes of your interaction with the insurer in black and white.
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21) What is a Health Card?
A Health Card is an identity card, which will identify you as the insured and will provide you access to the network hospitals. You receive a health card along with your policy document.
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22) Explain network hospital and non-network hospitals?
Network hospitals form part of insurance company’s network i.e. the insurance company has a tie-up with such hospitals to provide cashless facility. While non-network hospitals do not form part of insurance company’s network list and do not provide cashless facility. However, a customer can avail medical treatment and can claim reimbursement from the insurance company on submission of relevant documents.
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23) What are the things to be read in Policy Wordings?
The list of coverage and exclusions under the policy, Additional benefits over and above basic coverage, Duration of pre-and post-hospitalization expenses, Number of network hospitals, No claim bonus (NCB) eligible under the policy.
Health Insurance:-
Healthcare is an integral and critical concern of any household. Your family means a lot to you and hence you want the best for them. Protecting your family against any untoward medical contingency is your top priority. Choosing between health plans is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ, both in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others. However, with wide array of products available in the market, taking a decision becomes difficult.
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24) What are the points to be considered before buying a health policy?
a) Cost-benefit Ground: The cost of buying should justify the benefits covered under the policy. In other words, you have to strike a right balance between the cost and benefits available.
b) Adequate Cover: Adequate cover refers to your need to cover your entire family (i.e.spouse, children and your dependent parents). Thus, you should opt for a policy, which covers your family at a minimal cost. Presently, there are floater policies available in the market, which would cover your entire family more efficiently.
c) Age Factor: Age is another critical factor that needs to be taken into account. In case of children as well as parents, the age factor becomes more important since beyond a particular age, coverage might not be possible. The required age for buying a policy would vary from insurer to insurer.
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25) How to choose the right insurance policy?
Be an informed customer, Do proper research on companies and products, Read the fine print carefully, Purchase a medical insurance policy with basic health care coverage, Buy a policy at a young age to avail benefits, Keep your family health history in mind before opting for add-ons, Try to cover your entire family and Review your policy every year.
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26) How much you should invest in health insurance policy?
- If you are a student: Individual health insurance policy with basic coverage, up to Rs 1 lac is recommended.
- If your are a 25-35 years with 1 child, Comprehensive health insurance coverage for the entire family without maternity benefit. Either 3 individual policies or a floater cover along with investment of 50% of one months salary in health insurance is recommended.
- If you are a 35-45 years with 2 child, Comprehensive health policy without maternity benefit. Four individual policies or floater cover for the entire family along with investment of 10-20% of your annual income in health insurance is recommended.
- If you are a 45-55 years with 2 child, Increase your health insurance cover. Individual cover for yourself and your spouse preferably, then investment of 25-30% of your annual income in health insurance is recommended.
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27) How to identify your needs before selecting a life insurance insurance cover?
Before considering any kind of purchase, it becomes imperative that individuals first identify their needs. An individual is single and earning but has no financial dependants, then he may not really need life insurance. This stems from the fact that nobody is going to be 'financially hurt' in the absence of the insured (i.e. the individual in question).
On the other hand, we can consider a married individual who has family members dependent on him. He also happens to be the sole earning member in the family. Such an individual obviously needs life insurance. This stems from the fact that his entire family is dependant on him for financial support and in his absence, their lifestyle would be severely impaired. Such individuals should have adequate life cover as early as possible.
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28) How much insurance do you need?After having identified the need to buy insurance, the next step is to ascertain the amount of cover needed. The concept of human life value (HLV) can help in deciding how much life cover an individual should opt for. The HLV takes factors like the individual's annual income and expenses along with the inflation rate into consideration while calculating the value.
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29) How to choose between various companies plans?
Its vital to compare policies across companies. Before zeroing in on an insurance plan from any company, individuals should compare policies across insurance companies. This will help them in evaluating which insurance plan is best suited to their needs. One way of doing this is by contacting the insurance agent and asking him for a comparative analysis of insurance plans. Another way is by visiting the websites of different companies and scouting for relevant information. And the easiest way is to simply logging in at http://www.insurancemall.in/ and comparing plane of various companies over best features and best prices.
30) What makes http://www.insurancemall.in/ so unique?
It is India’s first compare-buy portal developed by Bonsai Team. It not only allows one to compare, buy and print policy online but it also educates one with the following:
- General information about insurance
- Frequently asked questions about insurance
- Accurate information about Claims Assistance
- Guidance with purchase of right kind of policy
- Information on renewals of policies
- Required information of insurance companies
- And finally a demo on how to purchase insurance online.
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