Doctor speaks
Everything you need to know about health insurance
08 October 2020
With the lifestyle diseases becoming more common by the day and the cost of healthcare on a consistent rise, health insurance has become more important than ever.When you’re looking for the best medical help possible, your health insurance is a legal promise from the provider that they will be there to help you financially. But to be able to make the best of your health insurance, you need to understand it well, and waiting till the last moment is not the right approach when it comes to insurance – whether it’s buying or understanding the terms and conditions. So, let’s not waste another moment and understand your health insurance better.
Some important terms
Sum insured: Also known as coverage amount, it is the maximum amount that the insurance provider is liable to pay in case of a claim. You can use up the whole amount in one go or for several claims in the policy year.
Pre-existing condition: It is any ailment or disease that the insured person is already suffering from at the time of purchasing health insurance.You must declare any such condition in your insurance form.
Waiting period: After purchasing health insurance, this is the amount of time you need to wait for before you could make a claim.Typically, it is 1 month for regular claims and 4 years for pre-existing conditions.
Exclusions: These are the diseases, conditions or situations in which your medical expenses are not covered by the provider. You must note these carefully before purchasing your insurance policy.
Co-pay: You can opt for co-payment to bring down your premium. In that case,you agree to pay a fixed amount for any medical treatment and the rest of it is paid by the insurer.
Types of health insurance
Health insurance can be broadly divided into four categories. These are:
Individual health insurance: As the name suggests, this health insurance would only cover you (one person), so the whole of the sum insured can only be used by the person insured. This is best for an adult who does not have his/her own family.
Family floater health insurance: This health insurance covers the whole family under one plan, which in most cases includes you, your spouse, your children and often your dependent parents as well. Here the whole family can use the sum insured,but some plans like Heartbeat from Niva Bupa offers individual sum insured for up to 19 relationships. This is best for people with a family.
Critical illness insurance: Since a lot of illnesses such as cancer, kidney failure, cardiac arrests etc. are not covered by most plans, one can also opt for this specialised health insurance. For example, Niva Bupa Criticare plan covers 20 critical illnesses. These plans are best for people with a family history of a critical illness.
Senior citizen insurance: Since your needs vary a lot from some on in their retirement age, some providers also offer specialised senior citizen health insurance. While one should get health insurance as early as possible, if they haven’t taken one till the age of 60, they can look into senior citizen insurance plans.
Most common features
In most cases, your health insurance will include the following features/benefits.
Cashless hospitalisation: At a network hospital of your insurance provider, you can get hospitalised and avail covered medical treatments without having to pay any cash.
No claim bonus: You can avail some discount on the premium for not making any claims in the previous year.
Day care treatment:You get coverage for short procedures that don’t need hospitalisation like dental, ENT etc.
Domiciliary treatment: If you need to get treatments at home, your insurance will cover that as well.
Pre- and post-hospitalisation care: It means that your policy will cover the medical expenses a certain number of days before and after the hospitalisation too.
Maternity and new-born coverage: Some health insurance plans like Niva Bupa Heartbeat offer maternity benefits and covers the new-born till the end of the policy year for no extra premium.
Health insurance may seem daunting, but if you understand the basics of it, it can be really painless to buy and use. Niva Bupa makes health insurance easy to understand and purchase. Click here for more.
