Health Insurance

What is not covered in health insurance?

There are some certain things that are not covered in the health insurance plan. These are:

1. Cosmetic surgeries are not reimbursed.
2. Orthodontic surgeries (teeth related) are not included.
3. Non consumable that are listed by the insurance company are also not covered.
4. Diseases like HIV-AIDS, STDs, infertility, hormone replacement therapy, weight management sessions etc. ate also excluded.

Types of Health Insurance

Every living has their own needs and requirements and to meet those, insurance companies provide variety of health plans to choose from as per your family health background and lifestyle needs.

Cardiac care plans - All heart related illness and surgeries are included in this plan as in the past few years the heart related diseases has tremendously increased due to lifestyle and environmental impact.

Maternity Plans - There are certain plans which allows you to get through your important milestone of your life without any hassle. It includes hospitalization expenses, MTP expenses and expenses upto 2 deliveries and may cover the expenses of the new born baby till a specified duration.

Critical illness Policy- This plan provides insurer cover against all the major critical illnesses as mentioned in the policy terms like cancer, diabetes, kidney disorder and heart related complications. Since, these crucial diseases have major life threatening impact and their treatment costs a fortune. The insured will get the sum assured at the time of diagnosis and doesn’t have to wait till the end of the treatment.

Family Floater - Having a stable source of credit gives you mental satisfaction that yoThese are most commonly used and comparatively cheaper plan as it includes children, spouse and in certain cases parents and extended family is also included in it. This feature makes it cheaper to buy as compared to buying individual policy for each member.

Extended family plans - Family of spouse or the siblings, they can get attached to the main policy as this feature is provided by certain insurance companies. So, it works like a comprehensive health coverage plan for the entire family.

Dengue Care plan - Every year, during the monsoon season we get infected by the endemic dengue disease which has severe impact on our body as its treatment is quite costly. Such health plans makes you financially prepared for the future possibilities.

Personal Accidental Plan - Accidents are the major flag bearer of life’s uncertainties. Anyone anywhere can get impacted with the accident which can leads to partial, temporary or permanent disability which is further linked with long recovery period and rehabilitations. IN this case, Personal accidental Plan helps you meet the financial needs by providing you a lump sum amount to meet the expenditure and further household expenses.

Top-up plans - These help you get more insurance coverage at a little higher cost. These are best pair for your existing health cover. They generally come with a threshold limit, in order get the sum assured, you need to get the claim above the deductible in a single claim.

Super top-ups - In comparison with the top-ups, these are much better to choose as instead of single claim, super top-up allows you the claim above the deductible in multiple claims to trigger the sum assured.

Cancer care plans - If you have a dedicated family history of getting cancer then it is better to get a dedicated health plan to meet with the risk with substantial funds for the treatment of disease.

Senior citizen plan - old age people are most vulnerable to diseases due to lack of immunity and difficult recovery. That’s why senior citizen plans helps you monetarily to meet the massive medical expenditure without impacting your daily cash flow.

Worldwide emergency plan - The travels who gets to travel the world can invest in such health plans who get them medically covered in the foreign land in case of any emergency.

Diabetes plan - There are only a few insurance providers who cover the diabetes in the policy and all the related complications that arises with it. It depends on policy term, but some policies include diabetes from the day 1 even if it is pre-acquired or some allows after certain waiting period.

Cashless Medical expenditure and its advantages

Cashless medical expenditure feature is most trending feature which is provided by all insurance companies to save you from the trouble of funds allocation at the time of hospitalization. By this, the insured gets the immediate admission in the hospital without delay for funds allocation.

How does it work?

Planned medical treatment- In case you are getting admitted for annual checkup or it is pre-planned then you can check with the affiliated hospitals under your policy terms and works out the details with the third party administrator appointed to you by the insurance company.
Emergency Hospitalisation- In emergency situation, you have to provide your health card details with your third party administrator present in the hospital and you will get a confirmation that whether you can avail the benefit of cashless facility or you will have to claim the reimbursement after the treatment. If cashless, then as per policy guidelines you might get claim within 6 hours.

What is not included?

In cashless facility, there are certain expenditure that is not included. Such as, attendant or visitor charges, ambulance, toiletries, service charges, documentation charges and other minor expenditures as pre-described in your policy terms.
Rejection of claim- Claim can be rejected by the insurance company in certain cases. If the cover amount has already been exhausted/used or the information provided by the insured at the time of applying for the policy is incorrect so, it won't match with the data in these cases the claim gets rejected. In case the insured has acquired any disease which is not covered in the policy terms then it becomes a factor for rejection of a claim.

Benefits of Cashless feature

1. There is no need for sudden or immediate accumulation of funds in case of emergency hospitalisation. The insurance company got you covered as now the medical expenses would be taken care of by the insurer.

2. No hassle of filing forms after forms. TPA appointed by the insurance provider in the hospitals would directly coordinate with the hospital for all the relevant information needed for the documentation.

3. In case, you won't be able to get the treatment in the network hospital in case of emergencies then your TPA would provide quick assistance and you can still apply for the reimbursement after the submission of relevant documents.

Factors that impact health insurance premiums

Health insurance is a necessity but it is vital to look out at the premiums paid by you for it. From all these, selecting the best which meets your needs yet is budget-friendly.

Family floaters at a low premium - Family floaters are always the optimum choice for people looking for high-quality insurance features with large sums assured at an affordable premium. However, in family floaters, generally, the senior citizens are excluded because they are prone to diseases and the premium for senior citizen plans is high.

Extra cost for riders - to add any feature to your existing policy can be done with the add-ons or riders. With riders, you can avail of extra medical cover at some extra premium amount. Generally with these riders, one can avail of these benefits as per their need - critical illness cover, personal accident cover, hospital expenditure etc.

Deductible impacts the premium - at the time of hospital expenditure, a part of the total money is paid by the insured and the rest is borne by the insurance provider. The higher the deductibles, the lower would be the premium rates.

Age and pre-existing diseases - The earlier you avail the benefit of health insurance; the lower would be the premium. Moreover, even the lifestyle impacts directly. Healthy lifestyle with no smoking, no drinking habits adds to the fact of lower possibilities of acquiring any diseases. Low risk leads to low premiums.

Why invest in Health Insurance?

Health insurance is the need of the hour. The sooner you get it the great benefits you can avail. But sooner or later, you will see yourself buying health insurance.

Emergency Funds: No one keeps cash or has ample funds always to meet the expectations of life. A sudden accident or any critical illness can impact you and in the need of hour instead of gathering funds, you should focus on your treatment procedure.

Meet the Hospital expenses: It is not hidden that nowadays medical expenditures cost heaven to a person. This makes the private medical care unreachable to over half of the population and the government hospitals aren't equipped to provide the best treatment. To meet with the cost of private hospitals, health insurance is a necessity.

Safety against ever: growing diseases: Everyday we encounter a new disease being discovered and impact heavily on people. Along with that, the high paced lifestyle turns the impact more vigorous. In the world of uncertainties, it is vital to have health insurance to meet with the sudden changes of life.

Tax benefit: People always look for the type of investment in which they save taxes. What is better than investing in your health? The health insurance not only helps you to prevent from the unexpected life's medical crises but also helps in saving money for your healthy future.

Easy to buy: Buying policies is not a task, anymore. With the technological advancements, now anyone can buy health insurance anytime, anywhere with full 24×7 support. No need to worry about medical jargon or policy's technical terminology as Onspot provides you one step solution in the most convenient and customer-friendly way to make their life easy.

Tips to buy health insurance -

Onspot Cover is the most trusted place for you to provide right details in crisp and concise manner to help you to make the right decision.

Analyse your requirements - Your family members, your income, overall expenses, medical history etc. Everything makes an impact on your choice while buying health insurance for you or for your family.

Choose the best company - Health claims if not provided at time then why anyone would want to invest in that. That's why, while buying a health insurance, comapny's reputation in terms of claim settlement ratio, amount settlement ratio, liquidity ratio and customer services. All these points matter a lot.

Appropriate sum assured - it is vital to access your future needs and choose the plan with adequate sun assurance. Do not settle for less to save the premiums. Being under-insurance will bring the same but somewhat less hassle as being uninsured.

Compare thoroughly - There are numerous policies with countless features. Thorough comparison in terms of premium, terms, benefits and claims is of utmost importance before selecting any plan.

Focus on major expenses - the smaller expenses like ambulance expenses or daily cash can be neglected while optimising policies because the major expenses which could be a burden otherwise are important to be analysed. Major expenses like ICU charges, doctor's visiting charges and limit on room rent.

Network hospitals - Check the network hospitals mentioned in the policy to analyse the nearby ones so that in case of emergency, you would be well aware that where you have to go. Also, it would help you to research about the hospital and choose out of them which is well-equipped and have good reputation.

Comparison between health insurance:

With multitude of companies out there that are offering numerous health plan, it is important for the policy taker to analyse each plan thoroughly and then select the best out of them as per their needs. If you randomly choose one out of many then you could loss the one that might be the right one for you as per your budget and features.

Cover Amount - sum assured is based on the health of the policy taker, age and lifestyle but it also depends on the finances put by the insurer and the risk he can take. The larger the sum assured, the less would be the hassle or future funds needed by you at the time of hospitalisation. Comparing health plans ensures you the high vover amount with least possible premiums with maximum features available for you as per your premium budget.

Co-pay feature - All health insurances have this feature in which there is mutual agreement between the insured and the imsurance provider that the certain percentage of the total medical expediture would be piad by the insured and the rest would be borne by the insurance provider. For example, if stated in the policy that the insured would pay 5% of the total medical expenditure then the rest 95% of the expenses would paid by the insurance company. That's why it is important to access all the information thoroughly in all the health insurances to get the best deal for you.

Network hospitals- Medical hospital that are in your vicinity would help you to get timely medical care. Along with that you could easily avail cashless facility and it would be easier for you to manage the paperwork. In such case, it is important to choose the insurance provider that has a maximum hospital network and includes the reputed ones.

Pre-existing cover- Every health insurance provider are extremely bound on which diseases they cover in their policies and that's why they set a waiting period in case of pre-existing ones to minimise their risk. While opting for a health insurance, choose the one with minimal or no waiting period.

Capping- Many health plans set an upper cap or upper limit to the extent you can avail claim during hospitalisation. The upper limit is generally on the rent of the hospital room, doctor's visiting charges and some other overhead charges. While opting for a health insurance, choose the one after thorough analysis.

Sub-limits- There are certain limits maintained by the insurer in some disease that allows you the claim to certain pre-mentioned amount. For eg. If you got kidney transplant and your medical expenses are around Rs 1lac and your health policy allows you the claim of only Rs 70,000 then the rest Rs 30,000 would be borne by the insured. While selecting a health insurance, compare the terms thoroughly.

Health insurance renewal process:

Renewal of health insurance is vital so that you won't lose any pre-existing benefits. Such as the waiting period on the diseases and No claim bonuses. Wihout timely renewal, your policy will lapse and you won't be able to avail the benefits.

Important Information before renewal- In case you forgot to renew the policy on the due date then you can still have the chance to do so within the next 30 days(grace period).

Furthermore, you can change your existing service provider or the policy plan if you are not satisfied with the current one. This feature is known as the policy portability.

Renewal can be done both offline and online mode as per your choice.

Facts to know before renewal- if any claims are made during the period between policy expiration and renewal, then the insurance company won't allow it. You must pay the renewal premium in gace period before applying for the claim.

In case, if you are porting your existing policy to other insurance provider, then the existing features of the policy remains same.

Health insurance claim process:

Insurance providers allow two main features in which the insured can avail the claim.

Cashless: in this facility, the insured would be provided with a cashless card at the time of policy purchase and that card when provided at the network hospital at the time of hospitalisation then the medical expenses would be paid by the insurance company directly to the network hospital. The cashless facility would be approved by the insurance company after the pre-authorisation form is filled and submitted to them.

Reimbursement: in this facility, insured pay the medical expenses at the hospital and can later claim for the reimbursement of the medical expenses after submitting all the relevant paperwork.

The claim process for the cashless facility -

1. Information must be provided to the insurer about the need for hospitalisation.

2. Reach out to your network hospital and present your cashless card to the TPA(Third Party Administrator) or the claim desk to avail the facility.

3. TPA will get in touch with the hospital to get the relevant details for the pre-authorisation form which would include all the medical scans, treatment details etc. Later these details will be sent to the insurer for approval of the cashless claim.

4. After checking all the details and documents, the insurer will get in touch with the hospital to start the treatment.

5. At the time of discharge, the hospital will sent all the medical reports, bills and other official documents to the hospital for the final claim.

6. The pre-mentioned deductibles, pre-payments and other expenses that are mentioned in the policy would have to be borne by the insured as these are not covered by the insurance company.

Reimbursement claim process for single insurer:

1. Information must be provided to the insurer about the need for hospitalisation.

2. Claim form available at the insurance company's website should be filled after the treatment.

3. After filling the form, attach all the relevant documents, bills, discharge summary and any other document in original should be sent to the insurer.

4. Keep all the medical documents with you, in case the insurance company further needs it.

5. Follow up with TPA or the company to ensure the proper filling of the documents and know the status of claim.

6. After everything is provided and is approved, the claim will be approved in 30-40 days.

Reimbursement claim process for multiple insurer:

1. Information must be provided to all the insurers about the need for hospitalisation.

2. Claim form available at the insurance company's website should be filled with whom you wnat yo file the claim after the treatment.

3. After filling the form, attach all the relevant documents, bills, discharge summary and any other document in original should be sent to the first insurer.

4. Make sure to get the multiple attested copies if you want to apply for multiple claims from multiple insurers.

5. Once the claim is issued by the first insurance provider, a letter will be issued by them that they have the original documents and the claim has been passed by them.

6. This letter should be attached with the set of documents and forms and passed to the second insurer. A cover letter should also be attached in which it should be stated clearly the amount you have received from the first insurance along with their company name.

7. Follow up with TPA or the company to ensure the proper filling of the documents and know the status of claim.

8. If everything approves, your claim will be passed in 3 days.

9. Repeat the same process with other insurers.

Health Insurance Portability

It is a feature provided by the insurance company in which you can avail the better policy benefits along with the already provided benefits to maximise the results out of your policy. In this feature, you can shift from your current policy provider to the other with the same policy and you won't have to wait for the fresh waiting period.

How to apply?

Prior to 45 days to the expiry of the existing policy, insurer can fill the form of portability with the new insurance provider. Anyone who is not satisfied with the current policy provider, the network hospitals or even the sum assured can apply for the portability.

Benefits

• Lower or competitive rates of premium for the sum assured.
• Better services offered by the new insurance company.
• Migrate to the one which have higher claim settlement ratio to get the easy and quick claims.
• Upgradation to better health plan is available.
• The waiting period of around 30 days for the commencement will be waived off if you port instead of buying a fresh policy.