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MEDICAL INSURANCE

Typically speaking, changing lifestyle, changing food habits, increased pollution and other things related are making people more prone to more medical disorders. Health disorder and hefty medical bills are now becoming part of our regular household budget, which was not the scenario few years ago. So in a scenario like this if you want to plan things in advance and don't want to burn your hands in paying all those heavy bills when a medical emergency arise , get the right Medical insurance policy from the right insurer with features and coverage best suited to your needs.
While deciding upon the coverage you want from your policy and the other auxiliary features that you are looking from your insurance provider to offer would decide the premium that you would pay per year. Keeping this into perspective keep a clear understanding of needs before deciding upon any policy .You shouldn't judge a policy only by the premium that you pay because nothing comes free and if you are looking something specific you should ready to pay for it otherwise your policy might not be of any help when you actually need it.

Benefits A Medical Insurance Policy Offers:

a) Cash less benefits: All insurance companies do have their respective tie ups with individual hospitals and hospital chains across India to give their customers cash less claim facility. In a case when you are faced with a medical emergency and you need an instant financial support you can visit any of these hospitals and just spell out your policy number then your hospital and insurance company can care of the rest and you can be rest assured of the treatment that is necessary for you.

b) Cover for critical diseases: Critical medical ailments like cancer, kidney failure , heart attack ,paralysis etc are generally part of the regular cover offered by a regular policy so if you have specific needs your medical insurance policy can cover that but may come as a extra or augmented feature.

c) Pre-existing medical disorders: Before you even decide upon your medical insurance policy you might be already affected by some medical disorder. Generally a regular policy would not cover anything that happens to you because of them as there is higher probability of you getting affecting by them well before you have passed a sustainable period of your policy term. Your Medical insurance policies offer cover for meeting medical cost for treating ailments arising out of pre-existing diseases but generally when you have passed 2 or 3 years.

d) Pre and Post Hospitalization cover : Your medical policy can also come with an extended cover for a period of 30 to 60 days of hospitalization cost before or after the treatment of the ailment

e) Ambulance charges and other charges: There are many charges which generally treated as an extra cost that you might have to pay which is other than the cost of treatment. Medical policies do come with features can help you to cover this extended cost so that you are not forced to pay an extra

f) Tax benefits: The money that you pay for premium is liable to get you tax benefits under section 80 D of the Income tax act. The maximum value of tax benefits which you can enjoy if you fall under the age group of 18 to 50 years is Rs.25000 whereas for people above this age group are entitled to get a maximum benefit of Rs.30,000

Types Of Medical Insurance Policies Offered By Insurance Companies:

Your Medical condition as a state is quite different from others and depends a lot on your age group, the profession you are into and various other factors. From the broader perspective Medical insurance policies are broadly classified as per the application. The various policies on offer are:

1) Individual medical insurance policy: Meant strictly for Individual Medical Insurance to cover for cost involved in medical treatment which involves hospitalization cost, special cost in case of critical illness and surgery with add on features to meet custom requirement.

2) Family Medical Insurance policy: A Family Medical Insurance policy in terms of features is quite similar to an individual policy but the best part of policy is that it is floater in nature. The benefit of being floater is that any member of the family can use the total cover and available under the policy as per individual. A family policy is bit cheaper in terms of premium that you would pay if we compare it consolidated value of premium that you might pay if you brought individual polices for every body .

3) Senior Citizen Medical Insurance policy: In a regular policy people generally get covered are in the age group between 18 to 60 years but in case senior citizen policies the age categories are much higher may be in the age group 60 to 75.People at this age group have very specific needs so if you are looking at buying a medical insurance policy for your old parents then it is possibly a senior citizen policy that might of your help.

Buying A Right Medical Insurance Policy Online:

As insurance companies come different variants of medical insurance plans so it become very tough for deciding the right product that actually suits. It is not always the cost that you pay to buy a policy that decides a right or wrong policy but the overall coverage and the features offered should be right factor.
Doing an online comparison can be of great help for deciding upon the right feature and right coverage. Factors to be considered for comparing online:

Cash less option: Please look at possible tie up of your insurance provider specially close to your city of stay which can help you access the cashless option is a better way

Co-pay: While availing for cashless claims you policy may ask you pay a part of the hospital cost by yourself and the rest to be taken care by your insurance provider so it better look for zero co-pay options

Renewability: This refers to the maximum numbers of years your policy would give you cover .This is an important factor because it might happen that you policy become inefficient when you actually need it.

Scope of coverage: Look at the amount of coverage your insurance company offers against the amount of premium that you pay plus what all sections are covered under it. The policy which provides a wider coverage and is comprehensive in nature can be helpful in all possible medical emergencies

Claim settlement ratio and process: Claim settlement ratio defines the effectiveness of your insurance provider in settling numbers and amount of claims out of the total claims made by other policyholders and plus you need to understand the effectiveness by the time period under which claims are settled by insurance provider . A better score on these parameters in also a defining factor in deciding the right insurance provider and policy.

Coverage of the pre-existing ailment: Generally all insurance policies don't cover pre-existing ailment from the day one of the policy term . The insurance company may start giving you a cover in this case only after you have passed 2 to 3 years of your policy term. Compare the policy based upon less time the insurance provider takes to cover preexisting diseases .

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Why It Is Important To Invest In Health Insurance plans In 2017?

In a country which has the second highest health care inflation of 12% among all Asian countries, health care is actually becoming a pain for a lot of Indians. The pain is further aggravated by the fact that we still don’t efficient public health care services which should have been providing services at a discounted rate which has lead to more dependence on private facilities and which is quite unbearable for lot of households and makes it tough for them to manage financial turmoil in a state of health emergency. The most effective way the to take this  problem can be by building effective financial reserve for handle the emergency .The cost effective option to build that reserve is to buy a health insurance plan. In fact if you don’t have a health insurance plan in place then it should be the most important commitment that you should make for 2017...This supposedly should be the most effective investment which you should plan for the year 2017.

So if you are planning to fulfill your health insurance this year, below is the list of thing that you should look into in your health insurer’s plans so that you make the most effective decision:

Hospitalization benefits: In the earlier days the only way you can raise a claim with your health insurer is when you have gone through a 24 hour hospitalization. Though the concept has changed drastically but still a lot of policies do have certain limitations which defines what would be covered and what is the amount that would be covered so while buying a health insurance do look at the various clauses governing which this part of the  benefit.

Day to Day care related benefits:  With recent advancements in medical science today a lot medical treatment doesn’t even require somebody to get a hospital admission. All a lot of ailments can be handled by OPD services provided by various hospital. While planning for your health insurance in 2017 you should look at guidelines regarding day care health procedure and check is there any limitation governing the same.

Cashless facility: Today all health insurance plans offer cashless facility but the challenge lies in understanding are there any hospitals under your insurer's network present in current city of residence. Though cashless is an efficient way  to settling claims and you don’t have panic for financial aid when you are faced with a medical emergency but the factor regarding presence of hospitals through which you can access this facility is also very important.

Room rent: This is actually bit tricky benefits. A lot of health insurer limits the type of services that you can opt under a specific plan and hospital room facilities in one of them. A  better of this very important because it's misinterpretation can put you in a state where your others claims can also be denied.

Ancillary benefits : You should understand the during the state of a medical emergency other than the major cost like hospitalization , doctor advise and medicine cost there are a lots of ancillary cost involved which we often ignore. One of the most common of them is Ambulance services which can be at times can become very costly. While investing in a health insurance plan do check at things relating how claims would be settled by your insurer against all these costs.

Other than these important things which are defining factors to identify which policy to buy and which not , you can always take tax benefits on Sec 80D on the premium that you would pay this year and in the future years subject to the conditions the regulation don’t change. Another thing is that important is that you always do an online comparison of all health insurance plans before investing so that the decision that you take this year should have long term benefits.

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Understanding Top-Up Health Insurance plans in India

Combating health cost today is one of the toughest challenge people are facing . In a situation when uneven lifestyle ,bad eating habits etc are becoming a common phenomenon leading to regular medical requirements and which is further supplemented by a higher health care inflation compared to regular inflation the need for effective amount of health insurance cover is becoming very important. Few years back an amount Rs.3 lac of health cover was enough for a family of four but considering current situation you would be called underinsured. But this additional health insurance cover requirement comes with an extra cost and can always be a burden for lot of people and that is where top up health cover becomes an effective solution.

What is a top up health insurance?

When you already have an existing cover and the same is inadequate looking at the current context so to get  an extra cover you can look for below given options:

a)Buying a new policy from scratch may be from a new insurer

b)Buying just a top up plan from the existing insurer.

But let us now understand how the two options are different so that you can get a better clarity about top up plans. When you buy a top up plan there is always a concept of deductible. A deductible can be defined as the amount of claim until which your top Health insurance plan would not give you a settlement but if the claim amount of exceeds that particular amount then your top up plan become liable to cover that cost. Take for example, your base health cover is Rs.3 lacs and you have opted for an additional top up Rs.4 lac. In case you raise a claim of Rs.5 lac then first you base policy would cover the initial Rs.3 lac and the remaining of the Rs.2 lac would be covered by the top up plan. Because of the concept of deductible the premium cost of any top up plan is always lower than the buying a new health policy.

Things you should look in a top up health insurance plan:

Though top up is a much cheaper option and reduces premium burden from you but you should have a clear understanding of the amount of deductible. Claims under deductible also come with various limitations which should be kept in mind. It is always recommended to have a top up cover equivalent of the cover of your base policy. Other than this you should have a clear understanding that in case multiple hospitalizations top cover are not very effective.

So in terms of having a proper planned approach right amount of health insurance cover and also keeping cost of premium low one should always have the right mix of base and top plans.

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Why Heart Disease Related Health Insurance Is Becoming More Important?

Some of the astonishing facts released by WHO in it’s report shows an higher propensity of Indians getting their first heart attack at a very early age. Compared to Europeans an average Indian generally gets his/her first attack during the age of 50 and the survey even shows at least 25% of Indians get their first heart attack at the age of 40. The rise of heart related problems in rise during due to uneven lifestyle, bad work hours and improper eating habits.and this calls for higher demand for health insurance solutions to handle any financial emergency arising out it.

 

Any heart disease which is at a curable stage calls for higher spends on hospitalization ,medicine and doctoral advisees and when we see the same from the point of view of covering the same with your already existing comprehensive health plan may be an impossible thing in most of the cases.In recent few health insurance companies have started offering health insurance plans specific to heart diseases.All these plans come with twin cover benefits , they not only cover health related cost in case of occurrence of an emergency  but they also provide an added term cover which in case of death the benefits are given to the dependents.

 

With rising occurrence of heart related disorders and rising cost of heart related treatment has lead to a rising demand for heart related health insurance . All heart related health insurance plans are actually long term plans with policy term of 10/15/20 years with a maximum of 75 lacs of sum assured under a single plan. Some insurance players have also launched dual benefits plans which covers both heart related and cancer related ailments under a single plan. Cancer related ailments is also on rise.Going by the WHO data most of the cancer related ailments are repercussions of diabetes ,which is again one of the most popular lifestyle disorders among Indians.Compared to 2000 data the number of Indians suffering from diabetes have actually doubled by 2013 taking the number to 63 millions.This added benefit of the heart related health plans makes it most have to products for most Indians.


All heart related health insurance plans are generally reimbursement plans which means they don’t offer any cash less facility .Compared other comprehensive plans which have lot of sub-limits on various type expenses , heart plan don’t have them making it is a very useful plan for the policyholders.Though all these heart related plans are gaining a lot of popularity and people are a getting a lot of benefit from them but it is always that one should look at the terms & conditions of any policy before they buy one. Online health insurance comparison plans can be looked as one of the smart ways to do it and get the highest benefit.

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How Much A Co-Payment Option In Health Insurance Plan Is Relevant?

In today’s lifestyle context Health insurance has become a major enabler for handling financial risk which may arise due to bad health condition. With health care inflation at its peak access to better medical facilities and hospitals have become quite expensive. So making a prudent decision while buying a health insurance plan is very relevant looking at your future objectives with respect to your financial plan.To control the cost of health insurance premium , an insurance buyer can opt for a co-pay option.Co-pay was previously more relevant in case of group health plans but now it is available for individual policy holders too.Let understand how much is the co-pay option relevant with respect to your medical costs and health care choices

Let’s understand what copay is, when a policyholder opts for a co-pay option he/she actually agrees to pay a part of the claim whenever it arises. The co-pay option can range in a percentage of 10%-25% The major benefit of a co-pay is option is that if the policyholder opts for a 20% co-pay option in a health insurance plan , he/she might end up paying 20% less premium for the same amount of cover with respect to one who has not applied for it.The insured stands to gain largely when no hospitalization happens during term of the policy.In case when the health insurance claim arises the policyholders need to pay his/her part first and post which the insurer claim settlement process comes in play.

Different insurers have different co-payment health insurance policies, some of the most common are,

a) Class of service: In case the policy stipulates the policyholders to avail certain standard of service like deluxe room during hospital and if the policyholder opts for a higher standard of service he/she might end up paying a part of the claim.

b) Hospitalization in metro cities, few insurers ask to the policyholder to share the claim amount if he/she opts for getting hospitalized in a metro city . In case it is smaller cities the rule is not applicable.

c) Treatment in certain category hospital, most of the insurers have their list of premium hospitals . In case you opt for hospitalization care in any hospital which falls under the premium list , the policyholder would be asked to pay a part of the claim which it arises.

d) Another type of co-pay option is applicable if the policyholders opts for getting a treatment in a hospital which is not part of the empanelled list of hospitals of the insurer so it is also advised to reach to your insurer before getting admitted to a hospital.

Though co-pay might seems as a relevant feature but the option should be used with complete understanding. In case when the policyholder is young and healthy the co-pay can help you save a lot of money because generally during the early periods of the policy there is a higher chance you not getting hospitalized. On the other hand when you are considering a co-pay option at an older age things can turn awkward. Generally at an older when the medical costs are generally very high , if the policyholder opt for a co-pay option he/she might end up paying huge amount of money from his/her own pocket.

So though co-pay as an option can give you discount in premium but the relevancy of the same changes with the situation so be very cautious while selecting any extra features in a health insurance plan.

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Reason why insuring your child’s health is important?

Changing lifestyle patterns have led to lot of people losing discipline in life. Though the availability of healthcare is abundant today but still people in our generation are not so healthy compared to earlier generation. Early infection to malicious diseases at an early age in now a common phenomenon. With this changing paradigm health and lifestyle health insurance is no more a product just for the elderly even your children needs it. With health insurance inflation hovering around 15% in last few years, not having a health insurance is actually very risky. Though health insurance being a financial protection product, people generally ignore the fact that having a health insurance policy for the children of the family is equally important.

 

The fact which nobody can’t ignore in today’s life is the medical emergency can anybody and anytime irrespective of any age. Though people are an elder age are more prone to health issues naturally but let’s not deny the fact that the younger children are not safeguarded in any sense. In fact medical treatment of children always require special expertise and needs special treatment and care due to variety of reasons. Let’s understand the fact why child health insurance is very important for your child:

 

  1. Child at an younger age have very weak immune system which limits their power to fight vulnerable diseases. Due to this fragile they always need more specialized and extra health care.
  2. Children have a high propensity to contract to diseases compared to adult. They often get in contact with other children during play and study who are already suffering from communicable diseases and as they are not so mature the same get more easily contracted by diseases. They tend to not eating health and hygienic food all the time. They are even more vulnerable to physical strain a lot due to sporting activities they get into. So at this particular age the child is more prone to health emergencies merely because of the occupation which requires the need for having an effective health insurance policy for the child member of the family.
  3. Children are also very prone to accidents due slower reflexes compared to grown ups.Till the time they develop these reflexes they remain prone to these accident and diseases.


While children are always prone to illness and more susceptible diseases arising of a medical emergency at any point of time is a common phenomenon. They are always in the need of  specialized care from pediatrics and specific medical care and which involves also extra cost. Higher health care inflation can lead always lead to unknown financial insecurity which calls for the need of an effective health insurance policy for your child so don’t ignore it.

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How Should One Plan For Health Insurance If You Are Planning To Have Kids?

Planning for a newborn is always overloaded with emotions but with rising cost of pregnancy and rise in cost of raising a kid in today’s time make it also an important financial decision which need to be looked into from the strategic point of view considering your current financial status.We all understand the happiness associated when you hear the good news from your doctor,especially when you are expecting a baby.It is actually a new phase in your life but it is also quite financially challenging for people living in urban centres.The cost associated with medicare for both the mother and child is quite unavoidable at this stage and you end up incurring huge expenses.

But do you think the problem can be take care by any health insurance plan?

Going by the basic rules of insurance, a health insurance company should not be covering the situations relating to pregnancy because anyways this is not an unplanned risk but still there are specific plans which are available today which cover pregnancy related expense only when the policyholder opt for an add-on cover for the same.

What is a maternity health insurance?

At any point of time we can’t overlook the cost associated with pregnancy. Looking at the current cost dynamics it may be cost you in the range of Rs.60000 to Rs.2 lakhs. Your regular family health insurance plans generally provide a maternity benefit under an existing policy just as an add-on cover.So completely depending on family health plan can be disastrous for pregnancy related cost.There are few things that can be looked into which defines the basic feature of a plan

a) Your Maternity plans covers all expenses relating to hospitalization and cost related to delivery of the baby either through normal or caesarean mode.

b) Covers all pre and post hospitalization expenses and also cost related to pre and post natal care.

c) Generally cover the newborn but with certain sublimits.

d) In most of the cases the cost of ambulance which is used for ferrying the mother to the nearest network hospital is also covered

Other than the above benefits there are generally certain limitations with maternity health plans which should be well thought over in advance so that you get maximum claim settled.

a) Most regular health plans offering maternity benefit as an add-on always come with waiting periods of 24 to 36 months so if you are planning for a baby in the immediate future then the pregnancy will not be covered.

b) There is always a limit in pregnancy cost that would be covered by your policy.For the most of the plans though it depends on the sum assured of the plan but in a regular scenario not more than Rs.50000 would settled while you make a claim.So you only get just 20% to 30% of your expenses getting covered under the maternity plan.

So how should parents plan?

a) Do just buy health insurance plan because it offers maternity benefits because there is always a limit to what would get covered.Try to evaluate all features before you buy one.

b) Since in most of the case only 20% to 30% of the maternity cost is covered so you should always have financial backup to fund the rest of the expenses.

c) In any case , if your employer is always providing a group insurance plan, while making claims for pregnancy one should consider the same as the first option. Generally corporate group plans have less limitations compared to regular individual and family plans.In this way you also save your NCB discount on the individual plan which can used for other serious needs

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