In-Patient Hospitalisation Costs
Medical expenses incurred during hospitalisation for more than 24 hours, which includes room rent, doctor’s or surgeon’s fee, medicine costs, etc. are covered as per the policy terms.
Health Insurance helps an individual to be financially protected from all the medical expenses in case of hospitalization. Today a quality healthcare treatment is super expensive, hence health insurance has become a basic requirement. An adequate health insurance policy helps a person to concentrate more on his own health recovery rather than thinking of how to pay the huge bills in case of hospitalization.
Through health insurance, a person can take cashless treatment from the network hospitals without spending a single penny from his pocket. At the same time, he can avail tax benefit u/s 80D and thereby reduce his tax liability.
Medical emergencies like accidents or illnesses are inevitable. We all have seen the aftermath of covid-19 pandemic. Today young people have become more prone to lifestyle diseases like diabetes, blood pressure, obesity etc. due to their sedentary lifestyle. With the increase in inflation of the country, cost of medical expenses has also increased with leaps and bounce over the last decade. Today medical treatment costs are sky high due to the increased demand of quality healthcare treatment, especially in private hospitals.
Therefore, a health insurance policy will guard you financially against such increased cost of medical treatment during any medical emergency without compromising on the quality of your treatment.
Changes in the current lifestyle and pollution is impacting our lives daily. People are falling sick more often, thus increasing the treatment costs at the hospitals. Health insurance can only be the saviour for such expensive medical costs.
Let’s look at the major benefits provided by most of the health insurers in the market:
We all go through different life stages. The requirements change as we go along the life stage. For e.g. When you are single, there is not much responsibility unlike when you are married with a kid, where there is extra responsibility and greater financial risk. Also, when we grow old, the requirements are completely different as age comes with several illnesses and medicines.
There are plans that will rightly cater to different requirements of human life stages, and we should choose the one that’s most beneficial to our own requirements.
Medical expenses incurred during hospitalisation for more than 24 hours, which includes room rent, doctor’s or surgeon’s fee, medicine costs, etc. are covered as per the policy terms.
Health insurances cover expenses incurred before and after hospitalisation for a specific time period.
Medical treatments such as angiography, dialysis, radiotherapy, eye surgery, chemotherapy, etc. are considered as Day Care Procedures. Some of the health insurance policies cover this type of medical treatment.
Some of the insurers do not cover pre-existing diseases such as diabetes, high blood pressure, while some of them do cover with a waiting period of 2-4 years of continuous coverage with the insurance company.
Based on the type of medical insurance policy, critical illnesses such as cancer, stroke, artery diseases, paralysis, amongst others are covered. Check with your insurance provider before buying the health insurance if these critical illnesses are covered. Some insurers may offer it as an additional feature with an additional premium.
You can make use of the health check-ups provided by some of the insurance companies. Typically, this benefit is available after the waiting period. It’s a good idea to check if the insurance company offers routine health check-ups so that you are aware of your current health condition.
Many insurers cover ambulance costs for transportation of the insured person in case of a medical emergency.
Health insurance covers the medical and surgical expenses of the organ donor while harvesting a major organ from the donor’s body.
Some insurance companies cover the cost of the medical treatment availed at home with certain conditions. Get complete information from your insurance provider before buying.
Alternate therapies like Ayurveda, Unani, Siddha, and Homeopathy, popularly known as AYUSH treatments are also covered in health insurance policies with a minimum of 24 hrs of hospitalization.
Out-patient treatment is generally not applicable in health insurance, although some insurance companies do offer the feature on payment of an additional premium. This includes costs towards diagnostic tests, pharmacy bills and doctor consultations.
Adventures can give you an adrenaline rush, but when coupled with accidents, it can be hazardous. Health insurance plans do not cover accidents encountered while participating in adventure sports.
If you ever end up causing injury to your precious self, then unfortunately health insurance plans will not cover for self-imposed injuries.
It can be disastrous and unfortunate. However, the health insurance plan does not cover any claim that is caused due to wars.
Health insurance plan does not cover accidental injury while you are participating in defence (Army/Navy/Air Force) operations.
Though these diseases are critical, health insurance plans do not cover them.
Treatment of obesity or cosmetic surgery is not eligible for coverage under your health insurance plan.
As per the study, medical expenses are increasing by 17% every year. Thus, it’s extremely vital to take a health policy right away. A health insurance not only protects you financially during an illness, but also during events like accidents, which can occur at any age, at any time.
While choosing a health plan, we need to think through few things like:
1. Coverage Amount: This can be determined based on the location/city that you stay in.
For eg., people staying in Tier I cities (or metro cities) must have a base of ₹10 Lacs cover, while others at Tier II & III must have at least ₹5 Lacs of health cover.
2. Family Floater or Individual Plan: Depending upon the number of members in your family, decide what’s best for you.
Generally, in a family floater plan, you can include your spouse, children and even parents. Thus, all the members of the family are dependent on a single cover. On the other hand, in an individual plan, each member of the family has a separate fixed cover amount. You can compare the premium and total benefit between the two and decide what suits your requirement.
3. Room Rent Caps & Sub-limits: Caps or sub-limits are certain thresholds set on various expenses. Some insurance providers may or may not come with such sub-limits on hospital room rents, which should be understood properly before buying the health plan. You can find health plans which will have no sub-limits on room rents, that will allow you to stay in the choice of your room when hospitalized.
4. Copay and Deductibles: There are certain health plans which will come with copayments or deductibles, which means a part of the claim amount needs to be paid by the customer first and then only the rest amount will be paid by the company. The premium for such plans will be little lower than the usual one.
5. Option for Cashless Claim: At a time of medical emergency, nobody likes to run around collecting documents and filling reimbursement forms. Every health insurance provider is tied with certain hospitals that give cashless treatments, making it hassle-free for the customers.
6. Waiting Period: As per health insurance norms, there is certain waiting periods that needs to be abided, like
In the present days, where there are too many players in the market trying to prove that they are the best insurance providers, it is really confusing to choose the best one. Following points will help you make wise decisions towards financial protection for your family against medical emergencies.
Higher the age, higher is the premium due to increased health risks.
Any previous health issues or diseases like diabetes, Blood Pressure, Heart Problems, premiums in such cases will go high due to the higher risk.
Higher the coverage you need, higher the risk the company takes to cover you financially. Hence higher is the premium.
Health insurance companies charge different prices based on the city that we leave in. Most of them differentiate premiums based on Zones, i.e., Tier I (major metro cities), Tier II (other than metro cities) and Tier III cities (comprising towns and sub divisions). Tier I has the highest premium and Tier III has the lowest.
Sometimes people choose extra coverage in the form of riders like Accidental Rider, Critical Illness Rider, Hospital Daily Cash rider, etc. Such extra benefits come with an extra premium.
File your claim in either of the two ways – Cashless or Reimbursement
Cashless claims can be made by following the steps given below:
Step 1: Intimate the insurance company or TPA within 24 hours of hospitalisation in case of emergency, and 48 hours prior in case of planned hospitalisation. Customer Care will guide you through the required process.
Step 2: Fill the pre-authorization form.
Step 3: You will receive an approval letter once your documents have been verified.
Step 4: The insurance company will settle the bill for you directly at the network hospital.
You will be required to follow below steps to make a reimbursement claim:
Step 1: Go to the Claims Section in the company website and download the claim form or contact the TPA.
Step 2: Submit the claim form and the relevant documents. You can also call up the toll free customer care number to get proper guidance.
Step 3: You will receive an approval letter from the claim management team of the insurer.
For illinesses link Cancer, Heart Diseases, etc.
For Consultation, tests, medicine, etc.
Reduce waiting period for pre-existing diseases
*Standard Terms & Condition Apply. Premium discount is provided by insurer for a 3-year policy and 4 or above insured family members. CIBPL/Health/WebBanner/English/Dec-21/001
Yes. You do need a personal health insurance plan as your employee health insurance covers medical expenses only till the time your employment is valid in the organization the moment you leave the job your policy term ends. Looking at the medical inflation it is important to have a personal health insurance plan, which you choose as per your medical needs unlike a corporate health plan which is commonly designed for all employees.
Portability helps you change your health insurance plan so that you don't have to again go through a fresh waiting period term instead smoothly move from one insurer to another if your current plan is not helping you cover rising medical costs.
A pre-existing disease is a condition, ailment or injury that already exists at the time you buy a health insurance policy and these PEDs are generally excluded from the policy coverage for an initial waiting period. It could be diabetes, hypertension, thyroid, asthma etc.
Cashless hospitalization is a process wherein the insured person doesn't have to pay a medical expenses out of his pocket in case of a hospitalization or surgery and the entire . However, you may have to pay certain deductibles or non medical expenses at the time of discharge.
Whenever you plan to have a surgery there are certain pre hospitalization expenses such as diagnosis cost, consultations etc similarly post discharge there could be similar expenses to monitor the health of the insured patient, such expenses are termed as pre and post hospitalization expenses.
Yes, you may have to undergo medical tests before buying health insurance. Also, some health insurance policies ask for it only if you have a pre existing illness or you are above 40 years old
You can add your family members at the time of buying the policy or at the time of renewal.
You can include your child post 90 days of birth up to the age of 21 or 25 years. It varies from company to company, so please go through plan eligibility from the product brochure.
A minor below the age of 18 years can not buy a health insurance policy. Hence they can buy an individual health insurance plan for themselves once they are 18 years old. However, they can get themselves covered under a family floater health insurance plan before the age of 18 years.
You get to pay a lower premium and higher benefits. Probability of having a pre-existing illness is low hence waiting periods may also not impact you. Also, common illnesses such as flu and accidental injury can happen at any age so staying covered even when you are young is important.
Yes. You can always have more than one health insurance plan based on necessity and coverage requirements as every plan works differently and offer varied benefits
Waiting period is the time span during which you cannot register a claim to avail some or all benefits of the health insurance from your insurance provider for a specified illness. This means you must wait for a specified amount of time before you make a claim.
This is the period where you have the option of cancelling your policy without any penalty if you feel the policy is not meeting your requirements. Depending on the insurance company and the plan offered, the free look period can be 10-15 days or even longer.
Network hospitals often referred as cashless hospitals are tied up with your insurance company due to which you can avail cashless hospitalization benefit, however, whenever you get admitted at a non-network hospital you have to pay the bills first and later claim for reimbursement. Always choose a health insurance company which has a large network hospital tie-up.
When the insured person is in such a state that he/she cannot be moved to a hospital or the treatment is taken at home due to non-availability of room in the hospital is termed as domiciliary hospitalization
Expenses like pre- and post-hospitalization expenses for your diagnostic tests, consultations, and medicine costs are covered. Insurers would also cover ICU, bed charges, medicine cost, nursing charges and operation theatre expenses.
There is no right or wrong age to buy a health insurance policy. However, it is recommended to buy a health plan early to get lower premiums. You can buy a health insurance plan for yourself once you are 18 years old. Before that you can get yourself covered under a family health insurance plan.
No. Health insurance cannot be bought individually by a minor, however the parents can cover the child under their family floater health insurance.
Whenever you get admitted at a non-network hospital you must pay the bills from your pocket first and later claim for reimbursement from your insurance company. However, your health insurance company will provide reimbursement only up to the amount of Sum Insured. Always choose a health insurance company which has a large network hospital tie-up.
Yes. Health insurance plans are designed keeping in mind the modern medical requirements. Hence, we cover diagnostic expenses incurred on X-ray, MRI, ultrasound, blood investigations etc. All health insurance plans cover diagnostic charges during hospitalization, pre-hospitalization and post discharge as well.
Buying a health insurance plan online is no different than receiving a policy copy physically, in fact buying online is quick and hassle-free. You do get your cashless card via courier/postal services. To know about cashless hospitals you can visit the company website or dial customer care number.
We cover medically necessary expenses such as blood investigations, diagnostic charges such as CT scan, MRI, sonography etc. You also get covered for hospital room rent, bed charges, nursing charges, medicines and doctor visits
Yes, Most of the health insurance policies offered by companies do cover modern treatments and robotic surgeries.
Yes. You need to raise an endorsement request and ask for a change in nominee details.
You do not have to worry if your policy has got lapsed during hospitalization as you get a grace period of 30 days post expiry, however if you do not renew your policy within the grace period and hospitalization happens post grace period then you policy lapses and you will have to pay for the medical expenses.
Waiting periods are applied right at the inception of the policy. It doesn't really change with renewal. However, with every renewal you tend to waive off the waiting period until you reach a time when you have no waiting period and your policy covers you for most of the treatments.
Yes. You can, only if your child is an Indian citizen. Or else you must get student travel insurance for your kid.
Consumers of tobacco are exposed to higher risks! If you consume tobacco in any form, there are high chances that you may develop some ailment at a later stage for which you might have to claim the treatment cost. Hence, insurance companies look at such individuals as high-risk category and charge high premiums.
Cumulative Bonus as the name goes is the bonus/ reward that one gets for remaining fit and not filing a claim. The benefit of cumulative bonus is granted in the year of renewal by making an increase in the sum insured amount, only up to a certain year for every claim-free year. This helps you avail higher Sum Insured without paying anything extra.
With many companies you get a family discount if you cover 2 or more family members under a single health plan on an individual sum insured basis. You can also avail long term policy discounts on buying health insurance for more than 2-3 years. Some insurers also offer fitness discounts on renewals.
Ideally No. Health insurance plans in India are offered to Indian citizens only.
If you cancel your health insurance plan within the free look period you will get your premiums refunded, after adjusting underwriting cost and pre-acceptance medical costs, etc.
Yes. Network hospitals have a pre-agreed tie-up with your insurance company hence every network hospital offers a cashless treatment facility.
There's no limit on the number of claims. If your sum insured gets exhausted then you may not be able to raise claims. We recommend buying plans that help you by offering coverage post sum insured gets exhausted by restoring the lost sum insured. This helps you register more claims in a year.
Yes. There is a possibility that your pre-authorization request for cashless claim may get rejected if you have filed a claim for an ailment/disease which is either permanently excluded, falls in waiting period or if your sum insured has exhausted.
For reimbursement claims you need to intimate the insurance company within a period of 30 days post discharge.
The claim settlement ratio (CSR) is the percentage of the number of claims that the insurance company paid out during a financial year out of the total claims incurred. It reflects if the insurer is financially capable to pay for its claims.
The claim settlement ratio (CSR) is the percentage of the number of claims that the insurance company paid out during a financial year out of the total claims incurred. It reflects if the insurer is financially capable to pay for its claims.
Your policy continues as is only the amount you claimed for gets deducted from your sum insured. However, post renewal your sum insured again gets back to what you had opted for at the time of renewal
Not really, however, having a high cover health insurance like ₹1 crore health plan helps you tackle all the possible medical expenses. You don't have to worry about rising medical expenses at all.
You can raise either a cashless claim request by contacting the insurance department at the network hospital or inform your insurer post discharge about the hospitalization and send invoices to avail reimbursement benefits.
You need to intimate your insurer/raise a claim request as soon as possible, maximum time is 30 days post discharge.
Mediclaim process is the modern day reimbursement process, wherein you raise a claim post discharge by submitting original invoices and treatment documents
Yes. There are waiting periods depending upon the policy. Usually there is a waiting period for specific ailments/diseases which could be for 2-4 years.
With the development in technology, treatments and the availability of more effective medicines the cost of healthcare has steeply increased. All this increase ends up being a burden for the consumers, making healthcare unaffordable for many. This is where health insurance policies come into play, as they take care of the hospitalization and treatment charges, leaving the consumer free of financial woes. Get yourself a health insurance plan now.
Yes. You can port your health insurance policy with any other insurer without impacting your waiting periods.
Waiting period is fixed at the inception of the policy; it is not dependent on the sum insured. Hence, even if you increase your sum insured your waiting period continues until you keep renewing to get away with the waiting period term.
Yes. If you have not made any claims for the entire policy term, then you get a cumulative bonus, which gets added to your base cover, thus increasing your total coverage at no extra cost. You may also get a fitness discount on your renewal premiums provided your health parameters such as BMI, diabetes, Blood pressure, etc., are improved.
Possibly yes. If you do not renew your policy within the grace period, then your policy lapses, and all the benefits are ceased immediately. In that case you need to buy a new health plan and you lose all the benefits that you may have accumulated in the last.
Yes. You can add or remove optional/add on cover at the time of renewal only. This is not permitted during the policy tenure.
You usually get a grace period of 30 days to renew so you can renew within the grace period, however if your grace period is also over then your policy lapses and you need to contact your insurer for renewing the expired health insurance plan.
It takes less than 5 minutes to renew a health insurance policy online. Keep your policy number and other few details ready and get your policy renewed here.
You get a grace period of 15-30 days to renew so you can renew within the extended period. However, if your grace period is also over then your policy will lapse ceasing all the benefits. You now must buy a fresh policy with a fresh waiting period and other benefits.
Yes. Health insurance plans will cover hospitalization expenses related to Covid-19 treatment. You can also buy covid specific health plans like Corona Kavach or Corona Rakshak to get adequate benefit.
Such insurance policy provides coverage for injury, disability or death due to an accident. Such policies will give lump sum compensation depending on the severity of health damage.
While mediclaim takes care of ordinary hospitalization expenses, a critical illness policy gives coverage for treatment of critical illnesses like cancer, stroke, coronary heart disease, major organ failure, paralysis, etc. In such policies the insurers agree to pay a lump sum amount on diagnosis of such dreadful disease, which otherwise are excluded in a normal policy. General and health insurance companies provide critical illness cover for 1-5 years, which implies that you can avail ample coverage for longer term.