What Is Health Insurance?

Good health is the foundation of happiness. But factors like smoking, alcohol consumption, climate change, increased population, etc. makes us more susceptible to health problems. What if you or your loved ones face a sudden medical emergency? What if you don't have enough funds to afford the treatment? That sounds pretty scary, doesn't it?

While no one likes thinking about the possibility of being injured or hospitalised, it is pertinent to be prepared for any scenario because the financial impact of these treatments can be huge. You should buy health insurance as soon as possible to protect yourself and your family. It acts as a cushion against these expenses.

Let’s have an in-depth look at what health insurance is.

What Is covered Under Health Insurance?

A health insurance plan is essentially a comprehensive cover for hospitalisatio n expenses. Here’s a quick look at what it covers -

  • In-Patient Hospitalisation Costs

    Expenses incurred during hospital stays are covered by health insurance policies. Hospitalisation costs include medical treatment expenses, room rent, ICU charges etc.

  • Pre & Post-Hospitalization Costs

    Pre-hospitalization costs are the costs incurred before undergoing treatment or getting admitted to a hospital. These include blood tests, X-rays, OPD consultations etc.

    Health insurance also covers the expenses you incur after you are discharged from the hospital, called post-hospitalization costs. These costs include follow-up visits to your doctor, diagnostic tests, rehabilitation, etc.

  • Organ Donor Hospitalisation

    During an organ transplant surgery, the organ donor may incur surgery costs and hospitalisation expenses. These costs are covered under most health insurance plans.

  • Daycare Treatment Expenses

    Some surgeries or treatments, such as gallbladder removal, hernia, chemotherapy etc., are completed in a few hours and don't require hospitalisation. The costs associated with these treatments are covered by health insurance.

  • Domiciliary Hospitalisation

    When you can’t move to the hospital due to non-availability of beds, an injury/illness where shifting is impossible, or any other reason - you can opt to receive the treatment at home. This is called Domiciliary Hospitalisation. A majority of health insurance policies cover expenses associated with domiciliary hospitalisation.

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This is not an exhaustive list. The scope of coverage varies across insurers. Please go through the policy wording to know the inclusions of the policy.

Why Should You Purchase Health Insurance?

  • To Protect Your Family

    You want to protect your family at all costs and ensuring their health and well-being is your top priority. A comprehensive health insurance policy is one of the best ways to ensure your family's good health and financial security.

  • To Combat Increasing Healthcare Costs

    Access to quality medical care has become a challenge for many people across the country - because of skyrocketing medical inflation. The cost of treatments, medication, equipment, consultations, etc. is rising continuously. These expenses might get pretty heavy on your pocket, especially if there’s a medical emergency. Health insurance can be a lifesaver for dealing with such a situation. It protects you and your family against exorbitant medical expenses.

  • For Better Coverage Than A Healthcare Fund

    You may have saved up a healthcare fund as a backup to deal with any sudden healthcare costs and emergencies. But, this money may not prove to be a good enough shield when faced with the monstrous costs of medical treatments and hospitalisation! Quite literally. Especially in the case of preventative care and nuanced medical procedures. A single hospitalisation can even have the potential to wipe out your entire savings. You should ideally have both a healthcare fund and health insurance to ensure adequate coverage for any potential medical expenses.

  • To Make The Most Of Your Youth

    Insurance providers generally assess your health based on the results of your medical tests. Some insurers may make medical tests mandatory after the age of 45. As you age, the risk of developing health issues increases, and insurance companies will factor this risk into their calculations when determining the premiums for your policy. By buying a suitable policy while you are young and healthy, you will be able to take advantage of lower premiums and better coverage.

  • To Preserve Your Savings

    With a health insurance plan, you can rest assured that your medical bills are taken care of. This means that you don't have to worry about sacrificing your future goals or cutting into your savings to cover medical expenses. It can also save you time and effort, since many insurance companies offer cashless treatment at network hospitals, so you don't have to go through the process of filing for reimbursement.

  • For Tax Benefits

    Health insurance offers various tax advantages. Under Section 80D of the Income Tax Act, 1961, premiums and payouts are exempt from taxation.

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Calculate Your Health Insurance Premium

When Should You Buy Health Insurance?

We all tend to believe that young people are not susceptible to severe diseases. But the bitter truth is that anyone can contract any disease or experience a sudden health crisis, no matter their age. Being financially prepared is extremely important, so you don’t burn off your savings and undergo even more mental stress.

As you grow old, the restrictions and conditions of insurers only increase. It is quite difficult for older people to get a health insurance cover - their request might either be denied or the premiums might be too expensive.

In short, you should be covered by health insurance for your entire lifetime. The earlier you buy a plan, the easier it is.

Right time to buy Health Insurance

Things To Remember While Purchasing Health Insurance

It's important to keep certain things in mind when buying health insurance to avoid any sort of difficulties later on. Let’s have a look -

  • Decide The Sum Insured

    The most important factor to consider while buying health insurance is the sum insured. It is the maximum amount the insurer will pay for the medical expenses incurred for any type of hospitalisation.

    Since medical inflation is on the rise, adequate coverage is crucial to deal with exorbitant healthcare costs. Make sure you choose a sufficient sum insured that can comfortably meet your medical needs.

    Secondly, as you get older, upgrading your health insurance coverage may prove to be challenging due to age and health factors.

    Thus, it is important to purchase a health insurance policy that is able to keep up with the increasing medical inflation and provide you with the coverage you need in your later years.

  • Comprehensive Coverage

    Having comprehensive coverage will ensure that a majority of your medical expenses will be covered by your health insurance. Comprehensive coverage includes coverage for doctor visits, pre and post-hospitalisation costs, daycare treatment costs, ambulance fees, check-ups, etc. You can be sure that you will have access to the care you need with fewer out-of-pocket expenses.

  • Affordable Premium

    The best health insurance plan should have comprehensive coverage and also reasonable premiums so that you don’t have to use up a huge chunk of your finances for paying premiums. You need to find the right balance between premium cost and coverage. It should be enough to cover your medical costs and shouldn’t hamper your present budget.

  • Check If Hospitalisation Is Medically Necessary

    You can only get health insurance coverage if the hospitalisation/treatment is deemed 'medically necessary'. Hospitalisations and treatments are considered medically necessary if they meet the following 4 conditions:

    It is necessary to manage the illness or injury.

    It provides safe, adequate, and appropriate medical care in terms of scope, duration, and intensity.

    A medical practitioner unrelated to you recommended it.

    The treatment complies with professional standards widely accepted in international medical practice.

    A claim may be rejected by your insurer if the above conditions are not met.

  • Check The Room Rent Limit

    A room rent limit is the limit up to which your health insurance will cover per-day hospital room charges. Room rent limits are included in most health insurance plans with a sum insured up to Rs. 5 lakhs.

    If you choose a room that has a room rent of more than what you’re eligible for under your health insurance plan, the insurer won’t only deduct the difference in room charges but will also proportionately deduct all associated medical expenses.

    So, check whether your policy has a room rent limit and try to buy a policy that does not impose such financial restrictions. If your policy has such a limit, you should plan to port to a policy without any limits.

  • Check The Specific Disease Waiting Period

    A waiting period is a duration during which certain illnesses or treatments will not be covered. It applies even if you don't have these diseases at the time of buying the policy. Some insurers may apply a 2-4 year waiting period for treatments for specific diseases like hernia, slipped discs, sinusitis, knee replacement surgery, etc.

    Your insurer will not pay a claim for such diseases/treatments if the waiting period specified in your health insurance policy has not been completed. And, upgrades to your health plan will not cover these specific diseases/treatments during the waiting period.

  • Check For Financial Limits On Specific Treatments/Procedures

    Some insurers may put a limit on certain diseases or treatments. With such limits, you may be forced to pay a significant amount even if you have adequate coverage.

    For instance, Monica buys a health insurance plan with a sum insured of Rs. 5 Lakhs. In the policy, the limit for hernia surgery is Rs. 50,000. Say she undergoes hernia surgery costing Rs. 1 lakh. In this case, the insurer will only pay Rs. 50,000 and the remaining Rs. 50,000 is her responsibility.

    To ensure you are not left with an unexpected expense, you should choose a health insurance policy that does not come with these restrictions.

  • Keep An Eye On Copayment Clauses

    If you have a copayment clause in your health insurance policy, it can affect your claim. Health plans with copay clauses require you to pay a portion of the claim. The insurance company pays the rest. It is best to buy a policy without a copayment clause or with the lowest copay to avoid major expenses from your end.

  • Assess The Treatment Costs Of Various Hospitals

    Hospitals do not have any rules in place when it comes to billing in India. They can charge different rates for the same treatment. And it may get exorbitant.

    An insurer primarily looks at the fee charged by similar-grade hospitals in a given area for a specific treatment. Consequently, insurers are able to ensure that they are not overpaying for services that can be acquired at more reasonable prices. They use reasonable and customary charges as a benchmark for determining what is considered a fair price for treatment. So, if you go to a hospital that charges more than what other hospitals in the same area charge, your insurer will only reimburse you for charges that are reasonable and customary.

  • Non-Medical Expenses Coverage

    Health insurance does not provide coverage for non-medical expenses or the cost of consumables such as gloves, nebulization kits, oxygen masks, etc. So, these costs can add up quickly and can be a financial burden in the event of a hospitalisation. So, opt for consumables cover with your health insurance to cover such non-medical expenses.

  • Fill In The Proposal Form Accurately

    The insurer agrees to assume the risk of lifelong hospitalisation or treatment expenses when it offers health insurance policies. Your proposal form serves as the basis for issuing you the policy. Therefore, it is important to ensure that all information you provide is accurate.

    If there are any incorrect details or concealment, it can lead to unnecessary complications if the insurer discovers them later. They may reject your claim and even cancel your policy.

    So, you should be honest and accurate on the proposal form and provide the insurer with details of any major injuries, illnesses, and surgeries you have had in the past.

  • Keep Track Of The Policy Conditions

    Insurance companies are permitted to change policy benefits, conditions, and costs with the approval of the IRDAI. It is also possible for them to terminate your health insurance plan and migrate you to a different plan with different benefits.

    Any changes to the policy terms must be notified to you three months prior to the new terms taking effect. To ensure you stay informed of any changes, it is essential to provide your correct contact information to the insurer and make sure it is updated.

  • Providing Correct Details To The Doctor

    As part of the hospitalisation process, the doctor will ask you about your past medical history, medications, allergies, etc. It is important that all these details are provided to the doctor carefully and accurately. During the course of treatment, doctors compile a case paper that contains details regarding the patient's past medical history, the year of diagnosis, medication, allergies, etc. These case papers will then be shared with the insurance company by the hospital. Hence, it is important to ensure that the case paper contains up-to-date and accurate information.

  • Maintain Proper Documentation

    In order to file a claim for health insurance, you will need to submit various documents like doctors’ prescriptions, diagnostic reports, proof of payment, invoices, etc. If any document is missing, the insurer will deduct that expense before paying the claim.

    So, you should maintain a single folder for all your bills, receipts, and other documents. Furthermore, keeping a record of all your documents will save you time and effort when filing a claim. You should pre-number all invoices and receipts you receive from the hospital/doctor. This will make it easier to find the documents you need, so you can focus on the filing process and not waste time searching for them.

  • Have A Look At The Insurers’ Claim Settlement Ratios (CSR)

    CSR refers to the percentage of claims settled against the total number of claims received by an insurance company in a financial year. It helps you gauge the insurer's worth. A company with a high CSR is more likely to settle claims, increasing the likelihood of your claim being approved.

  • Check The Insurer’s Solvency Ratio

    The solvency ratio represents an insurance company's ability to meet long-term financial obligations and settle claims. It reflects the financial status of insurance companies. In accordance with IRDAI regulations, all insurance companies are required to possess a solvency ratio of 150%. A higher solvency ratio signals that a health insurance company is financially stable and has a higher proportion of assets. This means that even if there is a large claim, the company has sufficient financial resources to pay them off.

  • Verify The Insurer’s IRDAI Approval

    The Indian Insurance Regulatory and Development Authority (IRDAI) regulates and develops the country's insurance industry. Insurance companies registered with IRDAI must comply with all of its rules and regulations and be transparent in their operations. In other words, you should always choose an IRDAI-approved company if you want to buy health insurance for yourself or your family - to ensure your hard-earned money doesn't go down the drain.

What Are The Exclusions Under Health Insurance?

Health insurance policies may not cover certain medical costs and treatments. These are known as exclusions. It is important to know what isn't covered under your policy in order to avoid any problems in the future.

  • Permanent Exclusions Of Health Insurance

    A permanent exclusion is a situation or condition that does not fall within the scope of the insurance policy and will not be covered. This means that any costs associated with a permanent exclusion will be your responsibility, not the insurance company’s.

Types Of Permanent Exclusions

  • Standard Permanent Exclusions

    There are standard exclusions in every insurance policy that will never be covered at any cost, like -

    Diagnosis & Observation

    Obesity & Weight Control

    Drugs & Narcotics

    Cosmetic/Plastic Surgery

    Gender Change Treatment

    Risky Or Adventure Sports As A Profession

    Unproven Treatments

    Note: This is not an exhaustive list. Please read the terms and conditions of the policy or discuss with your financial advisor to understand the list of exclusions specified in your policy.

  • Additional Permanent Exclusions

    There may also be additional exclusions for medical conditions or specific situations other than the standard permanent exclusions specified in the above section. If you suffer from certain diseases or serious medical conditions that the insurers consider too risky to cover, they may exclude them permanently from the policy. However, insurers are permitted to permanently exclude only those illnesses listed under regulation. A permanent exclusion cannot be applied to diseases that are not enclosed in the list.

  • Temporary Exclusions Of Health Insurance

    Temporary exclusions are also known as waiting periods. A waiting period is a time span during which the insurer will not provide coverage for certain diseases/treatments.

Types of Waiting Period

  • Initial Waiting Period

    Only accidents are covered from day one of purchasing health insurance. All other treatments/diseases are subject to a 30-day waiting period.

  • Pre-existing Diseases Waiting Period

    A pre-existing disease refers to any condition, ailment, injury, or disease diagnosed or treated by a doctor within 48 months prior to the date of issue of your health insurance policy. Pre-existing conditions will be subject to a waiting period of 2 to 4 years.

  • Specified Disease/ Procedure Waiting Period

    The insurer also applies a 2-4 year waiting period for specific medical conditions and treatments, such as hernias, haemorrhoids, chronic kidney disease, spinal disorders, etc. The list of illnesses will be mentioned in the product brochure or policy wording.

    Note: You should be aware that a health insurance policy may not cover situations beyond the ones mentioned here. Hence, prior to making a purchase, ensure you read the policy wordings.

exclusion of health insurance plans
Not Covered In Health Insurance
  1. Pre-existing disease for a Fixed Term
  2. Cosmetic Surgeries
  3. Injuries caused due to suicide attempts

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Health Insurance Claim Process

Our world today is prone to lifestyle diseases. Unhealthy diets, insufficient physical activity, tobacco use, and alcohol consumption are a few reasons behind the rise in non-communicable chronic conditions. To keep yourself and your family protected from unforeseen circumstances, you invest in health insurance. You duly pay the premiums and do everything needed to keep the policy running.

You also learn about the nuances of health insurance - the types, the benefits, the add-on options it provides, among others. But what happens at the most crucial time of making a claim under that plan? How do you figure that out?

Making a health insurance claim can be a technical and tedious process, more so when you are already going through so much. This is why it’s important to get it figured out beforehand. Worry not! We are here to take you through the entire process, step-by-step, in this article.

Types Of Health Insurance Claims

We’ll begin by understanding the two most common methods of making a claim.

Cashless facility, claimed through the hospital

This process comes to the picture when you seek treatment in a networked hospital. A networked hospital is one which is tied-up with your insurance company. If the hospital you have chosen is on your insurer’s approved list of cashless hospitals, they will settle the medical bills directly with the hospital. It is a convenient process for you, as it saves you the trouble of tedious paperwork or paying cash upfront.

A reimbursement claim, filed directly with the insurer

Under this option, you are required to pay the hospital bill and the costs of medical treatment upfront. Then file for reimbursement claim directly with your insurer, and they’ll reimburse the cost as per the policy wordings. Such claims occur if you avail treatments at a non-networked hospital, or if your insurance company does not allow cashless claim settlements.

Two Important Steps To Take When You Realise A Hospitalisation Is Required

Choosing The Right Hospital

When you meet with an emergency, you don’t have the luxury to choose the best hospital. But when you have enough time on your hands to decide, you can go for a planned hospitalisation. You can select a hospital with state-of-the-art facilities, medical equipments, and healthcare resources.

You also need to check whether the hospital you have shortlisted falls within the scope of your insurance coverage, i.e, whether it is listed with the insurance company.

For instance, Niket gets diagnosed with cardiomyopathy. He knows he needs to get hospitalised in the near future to undergo an open-heart surgery. Hence, he goes through the latest list of cashless hospitals on his insurer’s website and chooses one. He ensures a cashless arrangement right before his hospitalisation, so that when the difficult time arrives, his claims can get settled quickly.

Choosing The Room Category

Health insurance policies often have a room rent limit or category limits. The insurer mentions it in your policy document for your reference.

It can either be a specific amount, for example, Rs. 2000, or in percentage, i.e. 2% of the sum insured.

Try to go for a hospital room within these limits. Otherwise, if you choose a higher cost room/category, you might have to bear a proportionate cost of the expenses billed, in addition to the room cost difference.

Ask your hospital for an estimated cost of total treatment, including the room rents.

Read the fine-print in the policy document carefully.

Check the document and see which room rent limit is applicable. Make a decision accordingly.

If you have multiple health insurance policies, check if you can claim policies that don't have room rent limits first. This way, you will be free to select the room type as per your requirements and comfort.

Now that we are aware of the types of claims that can be made, let’s dive into the intricacies of their processes, one by one.

Cashless Claim Process

Here are the steps involved in availing a cashless claim settlement -

  • Reconfirm If The Hospital You Have Chosen Has A Cashless Arrangement With Your Insurance Provider

    Some hospitals may have different arrangements for corporate policies and personal insurance policies - be aware of this difference.

    Carry a copy of your policy and take their confirmation of the same.

    Once confirmed, ask the hospital desk for a checklist of all the documents they will require of you for a smooth process.

    Further, check for any sub-limits for specific ailments in your policy. This will give you an idea of the additional costs you’d have to bear personally.

  • Submit A Pre-Authorization Request

    Pre-authorization is the process by which the insurer approves to pay for costs associated with your medical visit.

    Inform the insurance desk at the hospital about the policy you hold, and submit all the documents they demand.

    You will be asked to fill up and sign a claims form, a part of which will be later filled by the doctor/hospital staff.

    The insurance desk will take the process ahead with the Insurance company or Third-Party Administrator (TPA) - the agent of the health insurance corporation.

  • Keep Emergency Money Handy

    In case your pre-authorization approval is delayed, or the treatment is urgent and cannot wait for the final approval, the hospital might ask you to make an advance payment.

    Always keep emergency money or an active payment method handy for such situations.

    This advance is later refunded (fully or partially) when the insurance company approves the cashless claim request.

  • Submit The Required Documents

    Policy copy or cashless card

    All past medical records leading to the hospitalisation

    KYC for the patient

    Police FIR (in case of accidents)

  • Take Care Of The Following Steps -

    Process The Paperwork In Advance

    In case of a planned hospitalisation, submit the form at least 3-4 days prior to the admission. If you are the patient, to prevent avoidable delays, send in a responsible family member to complete the paperwork before you get to the hospital. In case of emergency hospitalisation, submit the form within 24 hours of hospitalisation.

    Track The Progress

    Upon submission of the pre-authorization form, you can track the progress on the TPA app or website. Answer all queries raised by the insurer at the earliest, which will ensure an uninterrupted claim settlement. An insurance company can delay or reject an authorization, if the documents are not submitted or the queries are not answered. In such a case, you will have to go for the reimbursement process.

    Keep copies of all documents submitted

    Ensure that you have a soft-copy (or at least photocopies) of every document you submit, as the insurer might ask for them later.

    Track The Billing Everyday

    With a clear picture of how much the final bills could be, you can then either inform the insurer of any additional charges, or use another policy if the current coverage is insufficient.

    Keep A Record Of All Pre-Hospitalization Expenses

    Medical expenses incurred before the hospitalisation will have to be claimed separately with the insurer. Store all the original prescriptions, bills/receipts, reports (including films) that led to the hospitalisation, since these can be claimed separately. It is also important to have prescriptions from the first doctor you visited, with the problem that led to this hospitalisation. especially if they are from another hospital/clinic.

    Keep Medicine Bills After Purchase

    If you purchase medications at the hospital counter, even before getting discharged, they too will get covered under cashless claim.

    Be Prepared For The Final Billing

    Once the doctor finalises your discharge date, check with the hospital insurance desk, and submit the final paperwork (including the final bill and discharge summary) to the insurance company. Do this as early as possible.

    If any documents are still pending, the insurance company will notify you. Track the progress through the insurance company's online tracker, and submit the missing documents at the earliest. Once all the papers are submitted, it will usually take between 2 to 6 hours to receive an approval from the insurer.

    In case the final approval does not arrive or is delayed, you may have to wait at the hospital, or pay upfront and claim the amount later as reimbursement.

    Learn About The Claim Approval Process

    As per the terms and conditions of your insurance plan, approved claims will show an account of the expenses approved and unapproved . You need to read through the claim settlement summary carefully. Expenses such as co-payment, proportionate deduction, exclusion for consumables, etc. need to be borne by you.

    For example, if your insurance policy has a co-pay (or co-insurance) clause of 15% and your medical expenditure has amounted to Rs.60,000, you will have to pay Rs. 4,000 out of your own pocket, and the insurer will cover the remaining Rs. 56,000.

    Hospitals may keep some deposit with them even after your discharge, as retention money, till they receive their payout from your insurer. Save this receipt and collect the refund once the payout has been made.

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Reimbursement Claim Process

Reimbursement can be made in three situations -

For the entire treatment: right from pre-hospitalization till post-hospitalization.

In case of cashless claims: every cashless claim has a reimbursement component - for pre-hospitalization and post-hospitalization expenses.

When one policy is used for a cashless claim and the remaining amount is claimed through reimbursement.

Whatever may be your situation, you need to go through the following steps -

  • Claim Intimation

    In case of any situation where you need to redeem a claim amount, notify the insurance company first. Call them on their toll-free number, or send an email/SMS to inform them about the hospitalisation, within 24 hours of the admission.

    Enquire about the timeframe within which you can submit the reimbursement claim after discharge, so you are aware of the deadlines.

  • Collecting And Maintaining The Documents

    The speed and success of your claim entirely depends on how well you can document the process and keep the records.

    Ask your insurer for a list of all the documents you need to submit for a successful claim, and start putting them together.

    From the date of discovery to the time of recovery - ensure that all documentation is properly collected and maintained.

    Include all documents - from doctor consultations, prescriptions, bills, receipts, test reports (including X Ray or MRI films) to pharmacy bills - and everything else in a secure folder.

    To keep a track of all the medical expenses, create an Excel sheet and fill up all the costs incurred - from consultation fees to the final room rent and discharge bill.

    Fill up the claim form carefully after reading it, and provide all the details correctly.

  • Documents Required To Make A Reimbursement Claim

    Health card or policy copy.

    Photo ID of the insured person

    Claim form - filled and signed. A part of this form has to be filled by the hospital with the treating doctor’s sign.

    All prescriptions for medicines, medical tests including prescriptions from the first doctor you visited, with a complaint leading to this hospitalisation in original.

    All pharmacy bills in original.

    All test reports, including films & CDs (Xray, MRI) in original.

    Hospital bill with patient details, including itemised bill in original.

    Discharge summary from the hospital in original.

    All other original bills before the hospitalisation associated with your treatment. The bills for expenses after the hospitalisation can be claimed separately after 60 days or the time mentioned in the policy.

    Your bank details, which can be provided through a cancelled cheque for NEFT transfer of your reimbursement. Note that insurers do not send cheques, they only make online transfers.

    In case of an accident, an FIR or a medico-legal certificate or a summary of the accident may be required.

  • Make A Duplicate Copy Of All The Original Documents You Submit To The Insurer, And Retain Them For Your Own Record.

    If the insurance company raises queries, you can present the copies of the documents submitted.

    Track the claim status on the insurance company's portal or app regularly to be aware of such requirements, and address them at the earliest.

  • Claim Settlement

    Your insurer will credit the amount to the bank account you provided while submitting your claim.

    They will communicate with you about the summary of deductions made. Go through the mails/sms you receive, and understand the deductions well.

    In case you have any doubt, you can duly raise a query with the insurance company.

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It’s true that the final responsibility of claim settlement lies with the insurer, but as a policyholder, you can do your part to make things work out a bit faster and a lot smoother. It can be really overwhelming to take care of the claims process, especially if you are the patient. Therefore, sit with a family member, or a person you deeply trust, and go through the technicalities in advance. This article aims to be a helping hand and make the difficult times easier for you.

Types Of Health Insurance Plans

  • Individual Health Insurance

    Individual health insurance is tailored to the individual's specific needs and provides medical coverage that may be necessary for the individual's health and well-being. It covers medical charges such as surgery costs, pre and post-medical expenses, etc. Moreover, individual health insurance offers flexibility and control, allowing you to customise the cover to suit your exact requirements.

  • Family Floater Health Insurance

    In a family floater health insurance, your family can be covered under the same policy, and all the members can share the sum insured. The premiums may be lower too. Furthermore, with a Family Floater Health Insurance plan, you can enjoy the convenience of paying only one premium for the entire family, instead of multiple premiums for individual policies.

  • Senior Citizen Health Insurance

    Senior citizen health insurance is specifically created for senior citizens who are usually above the age of 60. They have a higher risk of getting sick, due to their age and the weakening of their immune systems. Therefore, the premium for this policy is higher to cover any potential medical costs that may arise. This policy covers medical expenses, including pre- and post-hospitalisation, accident-related damages, domiciliary hospitalisation, psychiatric treatments, etc.

  • Group Health Insurance

    Group health insurance plans are provided by large organisations or firms to their employees. They offer financial protection against accidents, illnesses, critical illnesses, psychiatric illness, maternity costs, etc. Additionally, the premiums are lower because the risk is spread out over a large group, making the plans more affordable. It is important to bear in mind, however, that once the member leaves the group/organisation, their health insurance coverage is no longer valid.

  • Maternity Health Insurance

    Maternity Cover provides a financial safety net for parents planning to have a baby, by covering the costs of delivery, pre and postnatal care, infertility treatments, etc. and ensuring that the family can focus on the joys of parenthood. Expenses related to the newborn baby may also be covered up to the first 90 days. The cover has a waiting period of 9 months to 4 years (this may vary across insurers).

  • Top-Up & Super Top-Up Health Insurance

    Top-Up and Super Top-Up health insurance plans provide additional coverage on top of your existing health insurance policy. They help to bridge the gap between your existing health insurance coverage and any additional medical expenses you may incur.

    These plans come with a 'deductible’. A deductible is a predefined amount you need to pay from your pocket before the health insurance company starts paying for medical expenses. This clause acts as a safety measure for insurance companies to ensure that people don't make frivolous claims.

Why Should You Buy Health Insurance Online?

  • Buying Online Saves You Time

    You get a range of options to choose from and instant policy quotes too. You can compare and buy the policy in a few clicks.

  • Information And Services Are Accessible At All Times

    You can get policy-related information and services anytime - at your own convenience, without needing to worry about time constraints or availability.

  • Comparing Policies Is Way Easier

    By comparing the policies offered by different providers, you can assess which one offers enough coverage for your needs at the best price.

  • You Get A Lot Of Options To Choose From

    Many web aggregators and insurance companies now sell health insurance online. Each insurance company has multiple plan options to choose from. You can evaluate and compare the multitude of choices you have to get the health insurance plan that’s the perfect fit for your needs.

  • You Can Get Exciting Offers & Discounts

    Most insurance companies may offer premium discounts when you buy a policy online - as there are no middlemen involved.

How To Buy Health Insurance Online At SMC?

  • Visit https://www.smcinsurance.com/

  • Select ‘Health Insurance’.

  • Enter the number of family members you want to insure.

  • Enter your Pin Code and Mobile number.

  • Enter your Pin Code and Mobile number.

  • You can customise the plans according to your needs by selecting the sum insured, changing the policy term, choosing add-ons, etc.

  • You can also compare the plans, check the premiums, etc.

  • Once you zero down on a plan, select on ‘Buy Now’ and complete the application process.

Benefits Of Comparing Health Insurance Plans Online

  • It’s Simple And Hassle-Free

    It is easy to compare all available policies and their benefits online. It helps you make an educated decision without having to consult agents or providers. Furthermore, the online platforms are available 24/7, allowing you to make decisions at your own pace.

  • It’s Cost-Effective

    Insurance platforms may offer discounts if you purchase health insurance online. This makes it an economical choice, as it is possible to obtain quality coverage at an affordable cost.

  • It Helps You With Premium Calculations

    Online premium calculators provide you with an estimate of the premium you will have to pay for a particular policy. This helps you to compare the different policies available and make an informed decision about which one is most suitable for your needs. Additionally, it allows you to adjust the amount of coverage and other parameters to find a plan that is within your budget.

  • You Can Customise Your Plan With Various Add-Ons

    There are several add-ons available with health insurance plans, like -

    Accidental Disability Rider: Provides financial protection if you become disabled as a result of an accident. In the event of complete disability, the total sum assured will be paid. However, if you’re partially disabled, a portion of your sum assured is provided based on the severity of the condition. Please note that the conditions related to the payout will vary across insurers.

    Room Rent Waiver: Room rent is the per-day bed or room charges that you are required to pay when you get admitted to a hospital. A room rent limit is a limit up to which your health insurance will cover the per-day hospital room charges. Some policies come with a room rent limit. If you want to avoid the limit, you can opt for a room rent waiver add-on. It will increase or waive the room rent limit laid down by your health insurance plan.

    Maternity Cover Rider: This add-on covers expenses associated with pregnancy like delivery expenses, medical bills, and other related costs. It may also cover a newborn baby for a certain period of time or cover vaccination of the baby. The conditions vary across policies. Please note that the coverage can be availed only after the waiting period is over.

    Critical Illness Rider: If you are diagnosed with any of the critical diseases listed under the policy, you will receive a sum of money.

    Hospital Cash Rider: If you opt for this rider, you will receive a cash amount every day you are admitted to the hospital. To qualify for coverage, you need to be hospitalised for at least 24 hours.

    This is an indicative list of riders. There may be more, depending on the health insurance policy you choose.

  • Comparing Policies Is Free Of Charge

    Many insurance platforms offer free quotes online so that people can compare policies and prices easily.

  • You Can Pick The Optimal Level Of Coverage

    Online health insurance calculators provide an easy-to-understand visual comparison of plans and their coverages, allowing you to compare deductibles, co-pays, out-of-pocket limits, and other features. This helps you choose a plan that best meets your needs in terms of coverage and cost.

Health Insurance Tax Benefits

A health insurance policy not only provides financial protection against hospitalisation costs, it also offers tax advantages. You can claim tax deductions on the health insurance premiums you pay every year under Section 80D of the Income Tax Act of 1961. Deductions are available for health insurance coverage purchased for yourself, your spouse, your dependent children, and your parents as well.

Tax Deduction Limits Under Section 80D

Under Section 80D, the maximum deduction you are eligible to claim varies by your age and the age of your family members -

Here are the claim deductions for different categories -

Category Tax Benefit
You and your parents are below 60 years A claim deduction of up to Rs. 25,000 is available for yourself, your spouse, and your children and Rs. 25,000 for your parents. Consequently, a maximum deduction of Rs. 50,000 can be claimed if all your family members are under 60 years of age.
You are below 60 years and your parents are above 60 years A claim deduction of up to Rs. 25,000 is available for yourself, your spouse, and your children and Rs. 50,000 for your parents. In this case, a maximum tax deduction of INR 75,000 can be claimed.
You and your parents are above 60 years A claim deduction of up to Rs. 50,000 for yourself, your spouse, and your children and Rs. 50,000 for your parents. Thus, if you and your parents are over the age of 60, you can get a maximum deduction of Rs. 1,00,000.
You are a member of HUF

Hindu Undivided Family (HUF) consists of a common ancestor and all male lineal descendants, their wives, and unmarried daughters of a common ancestor.

HUF members younger than 60 years of age can claim tax deductions on health insurance premiums paid - up to Rs. 25,000. HUF members over the age of 60 can claim deductions up to Rs. 50,000.

You are a Non-Resident Indian

Non-resident Indians (NRIs) can claim a deduction of up to Rs. 25,000 for health insurance purchased in India for themselves, their spouses, and dependent children.

An additional deduction of up to Rs. 25,000 can be claimed for parents under the age of 60 and Rs. 50,000 for parents above the age of 60.

Important Things To Keep To Mind

Health insurance premiums paid in full, including taxes, are eligible for deductions under Section 80D.

Tax deductions are only available if you pay the premiums by bank transfer, credit card, check, or demand draft. Cash payments for premiums aren't eligible for tax deductions except for preventive health checks.

Tax deductions under Section 80D are not available if you are covered under your employer's health insurance plan. However, if you are paying a portion or the entire premium, you can claim the deduction.

In order to qualify for a tax deduction, health insurance policies must be purchased from entities approved by the government or IRDAI (Insurance Regulatory & Development Authority of India).

Payments for preventive health checkups also qualify for tax deductions. You can claim a maximum deduction of Rs. 5000. It's possible to get a deduction even if your preventive health checkup was paid for in cash.

What Are The Factors That Affect Health Insurance Premiums?

  • Sum Insured

    Your health insurance premium is affected by the amount of coverage you choose. The sum insured is the maximum amount of money you can claim from the insurance company for medical expenses. Keep in mind that if you have an inadequate sum insured, your hospital bill may go beyond it and you will have to pay the difference yourself. It is therefore important to choose your sum insured carefully, so you don't end up with major out-of-pocket expenses.

  • Type Of Policy

    Depending on the health plan you choose, your health insurance premium will vary. For instance, in some cases, individual health policies for each family member may cost you quite a bit compared to family floaters.

  • Pre-Existing Diseases

    A pre-existing disease refers to any condition, ailment, injury, or disease diagnosed or treated by a doctor within 48 months prior to the date of issue of your health insurance policy. If you suffer from a pre-existing medical condition, such as diabetes, high blood pressure, or asthma, you will likely incur large, recurring hospital expenses. Their premiums will be higher than the premiums of healthy people of the same age group.

  • Medical History

    Your and your family’s medical history will also have an impact on the premium amount. If you have a medical history or if your immediate family members (like your parents or grandparents) have shown a history of cancer, heart disease, diabetes, etc., you are more likely to develop these diseases - placing you at a higher risk. Consequently, your premium will rise. This means that it's important to be aware of your and your family's health history, as it could have a direct effect on your own health and the cost of your health insurance.

  • Lifestyle Habits

    Your premium may also be affected by lifestyle habits such as smoking, chewing tobacco, or snuffing. These lifestyle habits are considered to be factors that increase an individual's risk of illness, and may thus, result in higher premiums. This is because risk of lung infections, cancer, and other critical illnesses is high for smokers, posing a huge risk for insurers.

  • Add-Ons

    Add-ons are additional benefits you can add to your base health insurance policy to enhance your coverage. For example, maternity benefit cover, critical illness cover, room rent waiver, etc. Keep in mind that you will need to pay an extra premium for these covers.

  • Co-payment

    A copayment is basically a percentage of the claim amount that you will have to pay from your end. Your insurer pays the rest. Say your policy includes a 15% copay clause. If you make a claim, you'll need to pay 15% of the claim amount from your end and the insurer pays you 85% of the claim amount.

    Some health insurance policies may include mandatory co-payment clauses, while others may allow you to choose your co-payment amount. A higher co-pay will lower your total premium. But, you will need to pay a larger amount during claims. Conversely, having a lower co-pay will result in a slightly higher premium, but you will pay less during claims. Make sure you read your policy wording to know the copay percentage applicable in your policy.

  • Job

    Your insurance premium will also be affected by the level of risk you face at work. Individuals who are exposed to higher levels of risk might have to pay higher premiums. For instance, a person who works in a school as a teacher will pay less than someone working as a fireman or in a factory where injuries are more common.

Health Insurance Migration And Portability

The process of moving your policy to another policy within the same insurance company is called migration. It is necessary to inform the insurer 30 days before the renewal date if you wish to migrate your policy. And, the process of moving your policy to another policy offered by a different insurance provider is referred to as porting. To port your policy, you must inform the insurer 45 days before the renewal date.

Advantages Of Migration And Portability

Waiting periods may apply to certain illnesses, treatments, pre-existing diseases, etc. In case your existing policy does not work for you and you need to purchase a new policy, you'll have to serve the waiting periods all over again. However, if you migrate or port your policy, you need not serve the waiting periods you have already completed. Your accumulated benefits, like the no claim bonus, will also remain intact.

Disadvantages Of Migration And Portability

Here are some drawbacks of migration and portability -

There is a possibility that you will end up paying a much higher premium for the new policy.

There might be a waiting period for any newly-diagnosed diseases.

New policies may include different limitations and exclusions.

A denial of your application is always possible.

Health Insurance Renewal

Health insurance policies expire after a certain period of time. You cannot make a claim if your policy has expired, whether cashless or reimbursement. To avoid such lapses in your coverage, you need to regularly renew your health insurance policy as per your policy’s terms. Health insurance renewal basically means extending the services of your policy. It is important to renew your health insurance policy on time to continue to enjoy its benefits.

Things To Evaluate While Renewing Your Health Insurance

  • Add Or Remove Family Members

    During renewal, if you and your family are covered under a floater, you have the opportunity to add or remove family members and also modify the coverage to accommodate all their medical needs. For instance, you can add your spouse to your health plan if you have recently been married or if you have a newborn baby in the family, you can add them to your policy. Or you also have the option to remove a family member in the event of their death.

  • Enhance Your Sum Insured

    Rising medical inflation, advanced healthcare treatments, growing population, increased pollution are a few things that have led to soaring healthcare costs. To ensure that your health insurance is sufficient and to protect you and your family in the long run, it is important to analyse if the coverage you have is enough, and whether upgrading it is necessary. And, renewing your health insurance is a good time to upgrade it. Make sure that you and your family have enough health insurance coverage for a minimum of 20-30 years while taking inflation into account.

  • Keep Track Of Changes In T&Cs

    Insurers are allowed to modify policy terms and conditions after taking prior approval from the Insurance Regulatory and Development Authority of India (IRDAI). So, before renewing your policy, check with your financial advisor to see if there have been any changes. As per the IRDAI portability guidelines, you have the option to migrate or port your existing health insurance policy if you are not satisfied with the revised terms.

  • The Option Of Portability Is Available

    You can port your policy if you are unhappy with the services provided by your insurance company or its features and benefits no longer appeal to you. With health insurance portability, you can switch providers while keeping your accrued benefits intact. If you wish to port your policy, you should notify your insurer 45 days prior to the renewal date.

  • Add Relevant Riders

    You can add riders to your basic health insurance plan to widen your base coverage. Health insurance offers riders like the critical illness rider, maternity rider, room rent waiver, etc. When renewing a policy, you can choose riders according to your needs. For example, if you have an accidental death benefit rider, the insurer will pay the rider payout to your family - if you pass away due to an accident.

Summing Up!

Health insurance is a necessity at all costs. Now that you know the importance of health insurance and its benefits, you can go ahead and decide on the type of health insurance that is right for you and your family.

Questions about Car Insurance

Frequently Asked Questions

Well, Mediclaim and Health Insurance policies are basically the same. Health insurance was termed ‘mediclaim’ in the past. Both of them cover your treatment and hospitalisation costs - whether it’s because of an accident, illness, or injury. The coverage includes hospitalisation expenses, pre- and post-hospitalisation expenses, doctors’ fees, medicine costs, etc. You need to pay regular premiums to keep the policy active.

As per the IRDAI, a pre-existing illness is referred to as a medical condition, illness, disease, or injury, that has been diagnosed and treated within 48 months before purchasing a health insurance policy.

Health insurance claims are of two types – cashless claims or reimbursement claims. If you file for a cashless claim, your insurer will settle your hospital bills directly with the hospital and if you apply for a reimbursement claim, you will need to pay the medical expenses upfront and then apply for reimbursement.

When you are purchasing a health insurance policy, it is crucial to keep certain things in mind including your medical needs, the family members you want to cover, the type of plan, premium, benefits, features, sum insured, network hospitals, financial limits, exclusions, etc. You should also check the insurer’s reviews.

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Why Customers Love Us

Why Customers Love Us?

  1. We provide quick claim assistance.
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  3. We are transparent operations with no hidden cost.
  4. We pursue your claims till the very end.
  5. We understand your needs, and advise most suitable insurance products.

Our Customers' Stories

Sharing the experience of happy and satisfied customers with you.

Sameer Yadav

I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More

Dheeraj Bhatia

I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More

Jyoti Sharma

We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More

Sumit Khanna

Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More

Kishor Kumar Bijlani

My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More

Megha Singhal

I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More