How Health Insurance Functions in India
If someone is given a critical sickness diagnosis or sustains serious injuries in an accident, they lose their whole life's savings. In contemporary times, having health insurance is a necessity. It offers protection from the expense of medical care and other related expenses. Hospitalisation costs, pre- and post-hospitalisation costs, ambulance fees, room rent, doctor consultation fees, daycare treatment fees, evacuation fees, severe illness-related costs, etc., are covered under health insurance.
The best course of action if you want to safeguard your savings against medical costs is to have health insurance coverage. Although consumers buy health insurance, many still wonder how it functions. The following are some of the queries and their responses:
Let’s Talk More About Health Insurance
Health insurance is intended to offer the policyholder financial support should they face a medical emergency. The policyholder is expected to periodically pay a premium in exchange. The maximum claim amount permitted by the insurance provider, known as the sum insured limit, is the amount up to which medical expenses are covered.
A health insurance plan typically covers hospitalisation costs, pre and post-hospitalisation expenses, daycare procedures, costs associated with organ donation, ambulance fees, pregnancy costs, AYUSH treatments, etc. The extent of coverage, however, differs from policy to policy.
Besides, some add-on covers are included in health insurance plans and can be added to your policy to expand its coverage. Some most popular health insurance add-ons covers are - shorter PED waiting periods, critical illness coverage, OPD coverage, hospital daily cash, etc. Also, not all health insurance policies have the same premium.
A health insurance policy's premium is determined by variables, including the insured's age, medical history, city of residence, sum insured, level of coverage, deductibles, add-on coverage, etc. The deductible is the sum you agree to shell out during a claim.
Renewing Your Health Insurance
You pay a premium when you acquire health insurance coverage. Typically, premium payments for health insurance policies can be made annually, biannually, quarterly, or monthly.
A health plan's holder must renew the plan on or before the policy expiration date. This is necessary because once a policy expires, insurance coverage ends. Therefore, renewing your health insurance plan before it expires is a requirement if you want to be covered for medical expenses at all times.
When you need to renew your health insurance policy, get in touch with your insurance provider and ask it for a renewal. You can also renew your health insurance plan online as an alternative. Simply go to the insurance provider's website, choose the policy that needs to be renewed, and pay the renewal premium to prolong the term of your policy.\
Read more - The Importance of Health Insurance On-time Renewal
How Do Health Insurance Claims Work?
You must file a health insurance claim with your insurance provider after you incur medical costs in order to get them covered. But as soon as they get your claim, your insurer will check to see if the condition or course of treatment is covered under the terms of your health insurance policy.
Only if your condition or treatment is covered by your coverage will you be able to receive the medical reimbursement.
The insurer will verify with the hospital where you are receiving treatment in order to determine whether your condition or treatment is covered. If you go to a network hospital, you are qualified for the cashless hospitalisation option, and the third-party administrator (TPA) will be in charge of paying your hospital costs on behalf of the insurance provider. Before paying the hospital bill, the TPA will review your medical records to make sure you have paid your deductibles. Some insurers may not have a TPA; in that case, the insurer will do everything for you in case of hospitalisation in a network hospital.
Every health insurance provider in India has a network of associated hospitals where patients can receive care without paying for it in cash. However, you cannot use cashless treatment if you are receiving care at a non-network hospital. You need to pay your medical bill in this situation as soon as you are released from the hospital. After your discharge, you can file a claim with your insurance provider by providing the necessary paperwork. When you are discharged from the hospital, don't forget to gather your medical records.
When your insurance provider receives your request for reimbursement, it will review your records to see if your sickness or treatment is covered under your policy. If so, the claims staff will start the process of paying back your medical bills.
Read more - A Simple Guide on Filing Claims in Health Insurance
Conclusion
Health insurance is simple to purchase and is beneficial to use. Just make sure you grasp how health insurance functions so that you can experience it without problems. To select the finest health insurance plan within your budget, consult websites run by insurance brokers like us - Paytm Insurance where you can compare health insurance policies and select the right alternative.
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Considerations for Purchasing Health Insurance
- Claim process
- If the health insurance covers the family
- Insurance premium amount
- Hospitals in a network
- Maternity compensation
- Pre and post hospitalisation clauses
- Renewals
- Free medical examinations
All health insurance policies must typically include an entrance age of at least up to 65 years old in compliance with the regulations of IRDAI (Health Insurance) Regulations 2016 (HIR 2016), which are governed by Regulation 12(i). Health insurance policies are renewable every year. So, you can renew every year and continue to receive health insurance benefits all your life.
The sum insured amount stated in your health insurance policy is the maximum coverage amount.
Health insurance premiums don’t remain the same throughout, although there remains no variation during a specific policy term, which can be of 1 to 3 years. Usually, premiums of most health insurance policies change every five years based on your age slab. So, if you are in the age slab of 36-40 years, the premium will remain unchanged till you are in this slab. Once you move into the next slab, the premium rises. If you opt for additional covers on renewal, the premium will rise.
Yes, you can do so. Insurance companies allow premium payments around 30-45 days before the renewal date.