What is Health Insurance?
The term health insurance, popularly known as Medical Insurance or Mediclaim is a type of insurance that covers your medical expenses. The concept of health insurance is new in India but its awareness is growing fast. Health insurance comes in handy in case of severe emergencies. Life is unpredictable, insurance can make it safe and secure from bearing huge financial loss. A health insurance policy is a contract between an insurance company and an individual. Sometimes it is associated with covering disability and custodial needs. The contract is renewable annually.
Health insurance is affordable and carries the assurance and freedom from insecurities that threaten normalcy now and then. The type and amount of health care costs that will be covered by the health plan are specified in advance. Health plans are available in two formats, individual and group plans. In an individual policy you are personally the owner of the policy. While in a group plan, the sponsor owns the policy and the people covered under it are called its members.
Why Health Insurance?
Medical expenses are sky high these days. An appointment with a doctor might churn out big bucks. The elaborate medical treatment expenses could eat into your savings meant for the future. Health insurance policy kicks in to ensure that you get the required treatment and your pocket is still under control. Having health insurance is important because the coverage helps people get timely medical care and improve lives and health. It covers the risk of financial difficulties in the event of long illness. The awareness has been enormous in the last couple of years. This must have been in response to the series of uncertainties people have observed in recent times like the terror attacks.
Benefit depends on the policy you choose and the coverage it provides. Here is a list of basic coverage provided by most of the health policies.
1. It helps securing a better future by paying a fraction as an expense today called the premium.
2. It reduces saving huge amount of financial losses, risk of financial breakdown in case of expensive medical and post-illness care.
3. It definitely induces a sense of security to the insured.
4. It provides financial security to the family members.
5. It covers your hospitalization and medical bills.
6. It also covers disability and custodial bills.
7. You can avail tax benefits on the premium paid under section 80D of the Income Tax Act.
8. The best factor, you can also opt for health insurance policies even after the age of 60
What does your Health Insurance Cover?
Health is an important aspect of our lives. Right from ages we had been cautious and concerned about our health and the risks involved in it. Today the awareness is rising and the response is positive. More people are interested in owning health insurance. Each year new illnesses and disorders are discovered by the researchers. This means our health is at constant risk and is wise to get insured. Health Insurance is a necessity and a measure which helps overcome huge losses. It might be an expense today, for a safe and insured tomorrow. These are the coverage we can broadly define:
Basic Coverage – A health insurance plan should provide cover for hospital rooms, doctor or surgeon fees, medical tests, medicines and related expenses. It provides you with essential protection plus a range of optional extensions that can be selected to suit your specific insurance requirements.
Specific Health Plans – It provides covers for critical illnesses or diseases such as heart attack, kidney failure, etc; most insurers offer critical illness plans. Another set of specific insurance plans target ailments such as diabetes and cancer. These plans offer cash on hospitalization, reimbursement for expenses incurred on surgical treatments, and such like.
Critical Illness Plan – Critical illness insurance is designed to provide financial assistance in the form of a lump sum, tax-free payout to help you overcome the financial stress and difficulties associated with diagnosis of a serious illness. Critical illness insurance plans supplements mediclaim, which reimburses the hospitalization and medical expenses. Critical illness insurance plans are benefit plans that pay the amount equal to sum assured, if the critical illness strikes, irrespective of expenses incurred on treatment.
How to file a health insurance claim?
Taking health insurance and paying premium is one story and filing for claim is another. Claiming benefits can be quiet tricky at times so you have to be smart and careful while filing for the claim. To file a Health Insurance claim with your Insurance company one has to keep the following things in mind.
1. Claim form duly filled and signed by the claimant.
2. Discharge Certificate from the hospital
3. All documents pertaining to the illness starting from the date it was first detected i.e. Doctor’s consultation reports/history
4. Bills, Receipts, Cash Memos from hospital supported by proper prescription.
5. Receipt and diagnostic test report supported by a note from the attending medical practitioner/surgeon justifying such diagnostics.
6. Attending doctor’s certificate stating the nature of the operation performed, bill and receipt. Attending consultant’s / specialist’s / anesthetist’s bill and receipt, and certificate regarding diagnosis.
7. Certificate from the attending medical practitioner / surgeon that the patient is fully cured.
8. Details of previous policies if the details are not already with TPA except in the case of accidents.
For a Planned Hospitalization
Contact the Third-Party Administrator for your Health Insurance Policy and inform them of the planned hospitalization. Also verify the coverage terms of your policy and ensure that the Hospital / Medical Facility where you are planning to get treatment is in the Insurance company’s Network. In case of a hospital that is not in the network understand the costs that will be covered. If your Insurance company offers cash-less facility then ask the TPA about the process to follow.
In case of an Unplanned Hospitalization
Inform the TPA as soon as possible to get the Claim forms and understand the procedures for filing a claim. Keep in mind that your claim form and all supporting documents should be filed within 7 days of completion of treatment.
Once treatment is complete get all the necessary documentation from the hospital and surgeon. You will have to settle all bills out of your own pocket and get reimbursed by the Insurance Company. Check your policy to understand where pre and post-hospitalization expenses are also covered. Complete the Claim form, attach all supporting documentation and mail/fax to the TPA.
In certain cases your claim maybe rejected if the treatment is not covered by your Health Insurance policy. If your claim is denied make sure you write to the Insurance company within 15 days and lodge a complaint. In case of partial payments, check with your TPA for the reasons. In most cases providing additional documentation might help recover the rest of your claim.
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