How Do Health Insurance Policies Work in India?

With changing lifestyles and increasing medical costs, having backup, especially for your health, has become crucial. Not only can your medical needs take an emotional toll on you but also eat up your life savings. Insurance plans offer numerous perks such as pre and post hospitalisation cover, alternate treatment, ambulance cover, etc. But the question about how health insurance works never leaves the mind of a layman. So, allow us to take you through this in detail.

Here’s How Health Insurance Plans Work in India:

  • It begins with purchasing a policy from an insurance company after you compare health insurance plans on factors like benefits, exclusions, features, etc. Once you finalise the plan you want to buy, the insurer will then estimate the premium based on various aspects. These can include your age, income, pre-existing conditions, and many others.
  • You may have to take a medical test if you are over 45 years, to check if there are any health issues depending on the insurer. The premium of your health plan will also take the sum assured into consideration and then you will get the final quote. You can choose the premium payment frequency depending on your needs. You can ensure details such as deductibles and co-payment with the insurance company for making successful claims.
  • For hospitalisation, you may have cashless facility where you can get treatment at a network hospital. You can go to the Third-Party Administrator (TPA) who will settle the medical bill with the hospital. It is vital to go through the network hospitals of the insurance company so that you can seek medical help in case of an emergency. If you don’t go to a network hospital, then you would need to pay the bill and later the insurer shall reimburse you the expenses. But you may have to bear a part of the expenses due to co-payment. This can depend on the terms and conditions of your plan.
  • In case your policy doesn’t offer cashless facility, the reimbursement is the method that you can use. You will need to maintain all the bills, discharge papers, receipts, reports, doctor’s summary, etc. and submit it with the TPA. After verifying the documents and your claim details, you shall get the rightful compensation.
  • Your insurance plan might also offer the benefit of daily hospital cash, but it can vary from insurer to insurer. In case you are hospitalised for a set number of days, you can enjoy hospital cash paid to you for taking care of other expenses. If you do not have this cover under your plan, you can opt for an add-on or a standalone policy.
  • There are various policies available to take care of specific requirements such as health insurance for senior citizens, critical illness plan, family floater policy, etc. Thus, you can purchase an insurance plan that provides maximum coverage based on your needs.
  • If you do not have any claims in the given policy term, then you will be rewarded a bonus for zero claims by the insurer. This benefit can include free-health check-up, addition to your sum assured or a lower premium.

With this, you know how health insurance plans work and how you can go about it. Thus, you can have a backup during a medical requirement without any trouble!

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