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Why is health insurance policy important & why should you buy it?

Medical insurance is a form of insurance which covers the medical costs incurred in case of medical emergencies. These plans, thus, take care of the financial burden associated with medical contingencies. In today’s age, when illnesses and diseases are on the rise, a health insurance plan becomes necessary. Though medical developments have provided a cure for most of the illnesses, such as cures and treatments come at very expensive costs. These costs become unbearable for the common middle-class man. A health plan, by covering these costs, takes off the financial strain caused by frequently occurring illnesses. It, therefore, proves to be an essential requirement for every individual looking to secure his finances against medical contingencies.

Why should you buy health insurance online?

There has been a constant rise in the percentage of health-related risks over a few decades. This has made it more and more necessary for us to get ourselves insured and avoid any financial crisis during medical emergencies. Buying insurance policies online has a number of benefits over traditional mode of investing in policies-

• Time Saving
  The availability of so many policies online has made it easy to get quotations for the policies of your choice and it also helps you in saving the time you would have spent talking to an insurance agent.
• Easy Comparison
  With all the information available within the reach of your hands, you can compare the policies, calculate the premiums and choose the best plan for your budget.
• Lot of ChoicesWhen you come to an insurance platform like Turtlemint, you have a lot of options, making it easy to go through a range of plans and products.
• 24*7 AvailabilityYou can get policy-related information and service all round the clock
• Instant CoverageOnline health insurance providers provide you with an policy document and thereby making your insurance active immediately. Although the method is so fast, it is extremely reliable and safe. At Turtlemint, we make sure that your transactions are kept safe and private.
• Discounts Most insurance companies offer premium discounts when you buy a policy online. You must always be on a lookout for the best deals that are easily available online.

Key features of health insurance

The notable key features of any health insurance in present market are-

1. Coverage
   The coverage includes the comprehensive expense of everything that can happen during a health emergency. It includes pre-hospitalization, post-hospitalization and ambulance charges. Most insurances also cover critical health diseases like cancer, stroke, heart attack, etc.
2. Renewal Benefits
   Most companies offer a no claim bonus benefit to its customers if no claim request is made by them in the previous year. Some companies also offer benefits in the form of discounted premiums or increased cover or a complete free health check up every year as well.
3. Co-payment
   It is one of the great features offered by good health insurance companies, helping to reduce the yearly premium. You have to pay a percentage of the total expense while the company will pay the balance.
4. Cashless Treatment
   Most health insurance companies have a collaboration with a number of healthcare centres and hospitals. When you seek treatment in a network hospital, the insurance company will pay your bills directly and you will have to pay only for the uncovered expenses.
5. Tax Benefits
   Under section 80D of Tax Act 1961, you will enjoy tax exemptions for paying premiums on health insurance. The tax benefit can be enjoyed both by you and your family members.
6. Flexibility
   You can change the premiums to be paid every month or the term life of your policy after a certain period.

Health insurance policy inclusions

A basic medical insurance plan provides all the essential coverage features. You would find coverage for the following – 

• Inpatient hospitalisationthis includes coverage for room rent, ICU room rent, cost of treatments, doctor’s fees, surgeon’s fees, nurses’ fees, etc.
• Pre and post hospitalisationexpenses incurred before being actually hospitalised and after being discharged from the hospital are covered under this head
• Ambulance costscosts incurred in transporting the insured to the hospital is covered up to a specified limit
• Daycare treatmentstreatments which do not require hospitalisation for a minimum of 24 hours are covered under this section
• Organ donor expenses expenses incurred on harvesting an organ from a donor are covered
• Domiciliary treatments treatments taken at home because the insured cannot be moved to the hospital or because there are no vacant beds in the hospital would be covered
• AYUSH treatments these treatments are alternative, non-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy. Most health plans cover medical expenses incurred on these treatments.

Besides these common coverage features, different medical insurance policies provide different coverage features too which make the plan comprehensive in nature.

Health insurance policy exclusions

Though medical insurance plans provide coverage for most of the medical expenses, there are some expenses which are not covered. These are called plan exclusions. Some common ones include the following –

• Pre-existing illnesses during the waiting period
• Illnesses occurring within the first 30 or 60 days of buying the policy
• Congenital ailments and diseases
• Cosmetic treatments
• Pregnancy-related treatments, unless specifically covered
• HIV/AIDS infection
• Illnesses or injuries occurring due to war or related perils, aviation, nuclear contamination, self-inflicted injuries, alcohol or drug abuse, etc.

To know the exact exclusions, you should read the policy document. Different medical insurance policies have different inclusions and exclusions. So, understanding the policy details before buying the policy becomes essential. It’s best to disclose your medical history truthfully before you buy a policy to ensure your claim expectations are met. Discuss this with our expert to figure out your best options – we will maintain strict confidentiality.

Why buy A health insurance plan at an early age?

There are too many reasons to justify the point why an individual must start investing early in his life:-

1. Comprehensive cover
   If you make the wise decision of buying a health insurance plan early in life then you’ll enjoy the benefit of a much more comprehensive coverage. You will get more security and enhanced coverage that would be difficult at a later stage.
2. Cheaper Premiums
   The company charges less premiums from younger individuals as they are expected to be in the pink of health and thus less chance of claim.
3. Tax benefits for long
   Under section 80D of Tax Act 1961, you will enjoy tax exemptions for paying premiums on health insurance. If you purchase it at a younger age, you’ll enjoy the benefit for a longer time.
4. Long tenure of coverage
   Taking health insurance at a young age assures more coverage in the longer period of time.
5. Bonus
   Most insurances provide a ‘no-claim’ bonus when the policy is renewed and the cover is not availed in the previous year. If you buy the insurance at a young age and keep collecting the no-claim bonuses on policy renewal, it will increase your coverage amount when you’re old and grey.
6. Waiting period
   Most coverage features come with a waiting period of 30 days to 4 years, if you invest early in the policy, you may avail the facilities when required instead of stumbling on the waiting period.

What are the factors that affect health insurance premiums?

There are certain major factors that affect the type of coverage you will receive on your insurance. Some of the most important of them are as follows-

1. Age
   The general rule of thumb is, higher the age, higher the premium. It is because older people are more likely to suffer and claim the insurance than young people who are in the pink of their health.
2. Past Medical History
   It highly affects the amount of premium you are going to pay. If you have a pre-medical condition, then the premium charged is higher. However if you are relatively healthy, the premium is less.
3. Occupation
   Your occupation highly influences your premium rates. For example, if you are a corporate employee or a teacher, the premium would be less, however, if you work at a construction site or factory, premiums are generally high. This happened due to the degree of risk factor that is involved with both kinds of task.
4. Body Mass Index (BMI)
   People with a higher BMI are prone to more ailments like heart diseases, type 2 diabetes, breathing problems, high blood pressure and cancer than people with lower body mass index. Hence the premium is higher for the people with more BMI.
5. Smoking habits
   Insurance companies view smokers as high-risk insurance buyers since they are more inclined towards health risks. Therefore, smokers are charged more premium in comparison to non-smokers.
6. Geographical Location
   The location where you stay affects your premium cost since certain regions lack proper healthy food options, climate and health facilities.
7. Policy Duration
   If you choose a longer term plan, the premium would be less that is why investing earlier in health insurance is always suggested.
8. Co-insurance feature
   If you choose the co-insurance feature of the company while purchasing the policy, your premiums reduce to a great extent.

Tax benefits of health insurance

What’s better than enjoying two facilities with one investment? Under the section 80D of Tax Act 1961, if you invest in the premiums of a health insurance, you can enjoy tax exemption upto a certain limit. The following table shows the tax breakdown-

Eligibility	Exemption Limit* as per the Budget Bill FY 2022-23
For self and family (spouse, dependent children)	Up to INR 25,000
For self, family + parents (all below 60 years of age)	Up to (INR 25,000 + INR 25,000) = INR 50,000
For self and family (where the eldest member is below 60 years of age) + parents (above 60 years)	Up to (INR 25,000 + INR 50,000) = INR 75,000
For self and family (eldest member is above 60 years of age) + parents (above 60 years of age)	Up to (INR 50,000 + INR 50,000) = INR 1,00,000

What is the difference between health insurance and mediclaim policy?

Basis	Mediclaim	Health insurance
Coverage Offered	A mediclaim plan covers only hospitalisation, accident-related treatment and pre-existing diseases up to a pre-specified limit.	A health insurance plan provides comprehensive medical coverage for pre-hospitalization charges, hospitalisation charges, post-hospitalization charges, ambulance expenses, and more. On top of it, the plan offers compensation in case of loss of income due to an accident.
Add-on Covers	No add-on cover is available.	It may offer multiple add-on covers, including critical illness cover, personal accident cover, maternity cover, etc.
Flexibility	Mediclaims are not flexible in terms of coverage.	Health insurances are flexible when it comes to coverage and premium. The premium can be increased or decreased, especially for long term plans..
Critical Illness Cover	Mediclaims do not cover critical illnesses.	Health insurance covers more than 30 critical diseases, such as cancer, stroke, kidney failure, etc. depending on the policy.
Claims	Claims can be made multiple times until the assured sum is exhausted.	Claims can be made multiple times until the assured sum exhausts and sometimes with restoration benefit, even beyond that.
Hospitalisation	To avail mediclaim benefits, getting hospitalised is necessary.	To avail health insurance benefits, it is not necessary for the insured to get hospitalised. Health insurance provides pre-hospitalization, post hospitalisation and daycare coverage too.

Health insurance riders

Riders are the facilities that come with insurance policies that can be purchased for extra cover and added benefits. Here are top 5 insurance riders that you must know about-

1. Maternity Cover Rider
   This add on covers the expense of childbirth. The primary coverage will be provided for the delivery and might be restricted for pre and post delivery. It may not cover the child care expenses and vaccinations. Howeverclass=”linkaction” , it entirely varies among policies.It can be availed after the waiting period is over.
2. Accidental Disability Rider
   Critical illness policy adds coverage if you are disabled due to an accident. If completely disabled, the total assured sum is provided. However, you’re partially disabled only a percentage(depending on severity) of the assured sum is provided.
3. Hospital Cash Rider
   Under this rider, you will receive a cash amount for every day that you spend in hospitalisation. For most policies, you must spend at least 24 hours before availing the coverage.
4. Critical Illness Rider
   Under this policy, if you are diagnosed with any of the critical diseases listed under the policy then you will receive the assured sum under the rider. This can be purchased along with insurance or a stand alone.
5. Room Rent Waiver
   Certain policies come with a cap on room rent. For example, if the room you rented charges you INR 4,000 everyday but your insurance covers only INR 2,000, you’ll have to pay the rest of the amount from your pocket. To avoid this you can avail this waiver. One added benefit is, you can choose your own room (subject to certain conditions).

List of documents required for health insurance claim settlement

For successful claim settlement in your health insurance policies, you have to submit a set of documents. These documents include the following –

• The claim form, filled and signed
• Pre-authorization form for cashless claims
• Doctor’s recommendation for advice on hospitalisation
• All original medical bills
• All investigative and diagnostic reports in original
• All hospital records in original 
• Consulting medical practitioner’s certificate 
• All pharmacy and medicine bills

Health Insurance claim settlement procedures

To make a successful claim in a health insurance policy, policyholders are required to follow the below-mentioned process –

In case of cashless claim settlement

• The policyholder should inform the insurance company of the claim. This information is to be given by filling up and submitting a pre-authorisation form. The insurance company analyses the form and approves cashless claim settlements. The form should be submitted at least 4-5 days before a planned hospitalisation. If, on the other hand, the hospitalisation was an emergency, the form should be submitted within 24 hours of hospitalisation
• The health card or the policy bond should be produced to the hospital along with the identity proof of the insured
• The company would then take care of the medical expenses
• All medical documents, reports and bills should be submitted to the insurance company along with the claim form.

In case of reimbursement claims

• The insured should get admitted to a non-network hospital and avail the necessary medical treatments. Payment for the treatments would have to be done by the policyholder himself
• Once the insured is discharged from the hospital, the discharge summary or discharge certificate should be collected
• The claim form should be filled and submitted with the discharge certificate, medical reports and all original medical bills
• The insurance company analyses the documents submitted and reimburses the claim amount to the policyholder’s bank account.