Type of Coverage to Verify When Purchasing Medical Insurance

Health or medical insurance is an important means through with which you can shield yourself from facing financial losses and risks occasioned by hospitalization, medical complications, or other causalities of ailing health. As in the case of India the healthcare is dynamic with respect to time and so the problem of receiving utmost health care without bearing additional cost, medical insurance aids that part greatly. So in the following section of this health insurance in India, let me explain the primary information about the health insurance along with the basic health care, which we should cross check before going for the health insurance.

Importance of Medical Insurance

Unfortunately, illnesses and accidents can occur at any time, and staying in the hospital, having regular treatments, and taking prescribed medicines may pinch your purse. If you have insurance for health by the insurance companies in India it assures you get medical attention at the right time without fear of cost. This has the impact of providing a needed source of revenue for individuals and families to offset these costs.

Types of Health Insurance Policies

It is useful to clarify that Indian individuals can obtain medical insurance in different formats, but each format offers a different set of features and options in terms of potential coverage. Below are the common classifications for health insurance plans.

1. Individual Health Insurance

A person is shielded through the individual health insurance policies against the occurrences of hospitalizations, illness and any other medical expenses. These policies offer cashless hospitalization facilities, pre and post admission expenses as inclusions and other optional extra features as maternal benefit and critical illness benefit.

2. Family Floater Health Insurance

Under one head, a health insurance coverage is provided to the entire family and this plan is known as the Family floater health insurance. It makes it possible for any of the family members to utilize the sum insured and, therefore, makes it an affordable health policy for families. Another plan which is almost at par with individual health insurance offering the similar coverage for hospitalization, medical procedures and other expenses incurred under Health care is the ‘Family Floater Policy’.

3. Group Health Insurance

It will be equally important for employers and organizations to volunteer group health insurance policies so that the medical needs of the employees might be well catered for. These policies sometimes may have other features such as wellness programs and maternity, free-standing outpatient coverage and others like it. One of the effective ways that can help to ensure healthcare accessibility to many people in a company is to get a group Health Insurance.

4. Critical Illness Insurance

It is also referred to as the critical illness insurance or the critical medical expense insurance and covers specific crucial diseases including cancer, heart attack, stroke, kidney failure among others. Critical illness insurance delivers a one-time payout to the policyholder incase, they are diagnosed of an ailment as covered under the policy. This money can be used to clear other expenses such as other fees, medical bills or even other losses incurred in cases of pay out.

Benefits of Health Insurance

Policyholders of medical insurance receive a number of advantages, such as-

1. Financial Protection

The essence of medical insurance is the provision of monetary coverage against unexpected medical treatments and procedures; thus, the population does not need to be concerned about therapy and treatment fees.

2. Cashless Hospitalization

Many insurance policies permit policyholders to be treated at network hospitals, be it on cashless basis or on reimbursable basis yet they are not required to pay for their treatment costs.

3. Pre- and Post-Hospitalization Expense Coverage

Other expenses such as pre- and post-hospitalization, diagnostic and treatment costs, consultations with other physicians and surgeons, drugs, etc. are also included in medical insurance except for the hospital charges.

4. Tax Benefits

According to Section 80D of the Income Tax Act, premiums paid for medical insurance policies are excluded from the tax charged on policyholders, which means that policyholders stand to gain a lot.

Essential Coverage Which Needed in Medical Insurance

Based on the extent of one’s health needs, coverages are provided differently by various health insurance providers, but you need to confirm the following coverages which can guarantee sufficient protection. This is the overview of the key coverage aspects that should be checked before purchasing medical insurance in India.

1. Hospitalization Expenses Coverage

It can be noted that one key advantage of medical insurance is the coverage of the costs that relate to hospitalization. Determine if the policy considers all the expenses that may be incurred in the course of being hospitalized such as accommodation, nursing fees, physician charges, ICU and other hospital charges and fees. In particular, ensure that some minimum limits that can cover the future costs are included in the policy.

2. Pre and Post-Hospitalization Expenses

Huge expenses such as the out-of-pocket for diagnostic tests, doctor visits and prescription drugs both before and after admission are embraced by medical care. To reduce costs and stay financially protected, the plan should also include these pre and post hospitalization expenses for a certain period, which is usually up to 30 to 60 days before and after hospitalization.

3. Daycare Procedures Coverage

Most services are even provided at clinics or childcare facilities, which do not always involve admission of the patient into the hospital for around-the-clock care. Since they might attract a lot of costs, determine whether the insurance addresses expenses incurred in day care such as chemotherapy, dialysis, cataract surgery, minor operations among others.

4. Ambulance Charges Coverage

In reference to emergency situations, such as unavailable medical help is crucial particularly when it comes to getting people to hospitals. Emergency transportation – this refers to carriage by an ambulance to the nearest hospital or medical facility is a service that could also be incorporated into the policy.

5. Coverage for Pre-Existing Diseases

Pre-existing condition policyholders are then those individuals with existing diseases before accepting the policy. Those insurance companies or the general insurance companies may exclude the pre-existing condition or they may offer some coverage for it after the, say, 90 days waiting period. Understand how the policy deals with the pre-existing diseases and if patients have to wait for a certain period before being eligible for a certain amount of cover.

6. Network Hospitals

Find out cashless treatment options offered by the insurance company in different empaneled hospitals or other service providers. In this scenario, being a member of a network of hospitals ensures that there is easy access to health care services without the hassle of having to pay for the hospital and or medical bills upfront.

7. Co-Payment and Deductibles

While they refer to the upfront and capping amount that the policy holders are expected to finance themselves, co-payments refer to the portions of the medical costs that policy holders is required to bear. There are likely similar deductibles, which you should take into consideration to be able to predict your other costs – co-payment % (percentage).

8. Additional Benefits and Add-Ons

There are some specific add-ons and perks of medical insurance plans which consist of health related bonuses like wellness benefits, facilities of some other systems of treatments (like homeopathy and Ayurveda), maternity benefits and facilities related to newborn baby. This shall help you consider the following extra features when choosing the right plan for healthcare needs and requirements.

9. Renewability and Lifetime Coverage

Select an insurance policy that you can always renew regardless of the digital age you are in. Always ensure that the policy given should sustain forever in many aspects because sustaining forever is very important to assure financial stability and also because the healthcare needs increase as we advance in age.

10. Exclusions and Limitations

However, for your understanding of the area of coverage and areas that are not covered by the policy, it is important that you go through the policy document carefully. This feature highlighted costly treatments for self-inflicted lifestyle conditions such as obesity, injuries, non-medically proven treatment methods, and beauty enhancements as typical exclusions.

Conclusion

Consequently, it can be deduced that the medical insurance plays a significant role in financial planning as well as managing healthcare systems in India. This makes it especially important for individuals to be properly covered in terms of medical insurance since the health costs are on the rise, and the rate of onset of lifestyle diseases is also going up. Out of the different types of medical insurance policies which exist, medical insurance as a concept and its benefits can be understood by people while they opt for the health insurance that can protect themselves and their families during emergencies against heavy medical charges and avail their required medical help in time.

Image credit- Canva