Health Insurance

 As we discussed previously that there are two types of insurance 

       - Life Insurance 

       - Health Insurance

We have already discussed about life insurance in details in first blog, you can search it by searching insurance and you will find it there, so here we are going to discuss about health insurance.

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Health Insurance: -

As life insurance is related to death thus health insurance is insurance that is quite useful that include the expenses of your hospitalization.

for example: -

  - suppose someone got serios injury through accident and he does not have any health insurance, now he/ his family has to pay all the hospital bills all by themselves.

  Now if the person has that health insurance, then there will be no hassle like paying hospital's operations cost, room cost etc. that family has to pay, thus in this situation health insurance plays an important role.

NOW this is about how health insurance works and why it is important now bellow we are going to discuss about what are the factors that one must check before taking one policy for himself and also going to discuss about some terms that is used in health insurance which is important to learn before talking health insurance from a company.

So, there are two types of health insurance plan, one is for individual and other includes full family with you.

ᐧ Floater: -

 

           Taken a health insurance for whole family with just one premium is known as floater.

Now we are going to discuss about pros and cons of floater-

Pros -

         It is not that expenses.

Cons -

         If you take cover of 5 lacs, then in a year you can claim up to only 5 lacs for family.

 

ᐧ Suppose a person got ill and he requires four lacs for his surgery (in a family) then its only one lac remain with what you can claim when another person (you have referred in policy) got ill, if he got ill, you only could claim one lac in that year, and rest of the money you have to pay by yourself. 

Best advise will be for elder people you should take individual plan and for younger, can take floater plan.

         Because in case of elder premium got much too higher.

ᐧ Individual: -

            

          For one person only. In this case premium comes lesser than floater plan and this plan should take for elder unusually.

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          Now we are going to discuss about some minor expenses that must include in our policy-

  Room Rent: -

     One should go for a policy which does not have any cap on room rent.

And if there is a cap then make sure rest of the charges is not linked with the room rent.

Example for better understanding: -

 If you take a policy with claim of 5 lacs, then some of its percentage is given to you for your room rent (let's say 1% and 2%) which is 500000* 1/100 = 5000. It means only 5000/- rupees of room you can take on rent of the budget of room crosses 5000/- then you have to give this amount by yourself.

 Or sometimes this room rent is linked with other charges as (injection etc.) then this all will have to pay by yourself.

          So, take a policy which does not have any cap on it, if there is then we have to explore more and find policy where room rent is linked with rest pf the expenses.

  Sub Limit: -

    

     As you taken policy worth of 5 lacs but there could be condition that for heart surgery you can only get 2-3 lacs.

             So, any policy which has limit on diseases, we should avoid.

  Co-Pay: -

    

     In co-pay you have to give some expenses of surgery by your pocket, rest of the expense company will give you.

      Usually, this type of policy defeats our purposes.

So, we should avoid those policy, where their option of co-pay.

  Zonal Policy: -

      In these policies premium differ from cities to cities.

Suppose we have taken policies in tier 1 city, there premium will be so high.

On other hand in tier 2 cities, premium will be medium (not so high, not so low)

Or tier 3 cities, premium of health insurance will be low.

If you take policy with tier 3 cities, and you use to live in tier 1 and tier 2 then their co-pay occurs and only some amount company pay (say 60-70%) and rest of the amount you should give by your pocket.

  * Therefore be/ show honesty while taking any insurance policy (term or health). If you do so the chances of getting claim increases.

  Reasonable and customary clause: -

          Suppose you got a surgery of 1.5 lacs in a hospital, but company gives you only 1 lac, they investigate at all that there is another hospital, where the surgery requires only 1 lac. So, company will only give you 1 lac and rest of the amount you have to pay by yourself.

 

 *SO be aware, take policy where there i no reasonable and customary clause.

Usually, these types of clauses used to see in group or floaters policies and in not in individual policies.

    But it's not final, you should confirm first and then to take policy.

 

* You can change group policies to individual policy, so don't get it to be closed till maturity.

  Top-Up: -

          Should not take Top-Ups BUT do take super Top-Ups if any company offers.

It means if your base policy budget is reached then through top-ups, you can get extra for whatever expense it is you can pay through top-ups.

Let's say your policy is of 5 Lacs and your surgery's total amount is about 7 lacs then in a year you can get 2 lacs through top-ups.

 Top-ups comes into play only and only whenever base cover is exhausted.

    Pre and post hospitalization: -

               Usually, company gives pre and post hospitalization. Pre - 60 days and post hospitalization - 180 days.

when, let's says a doctor consulted to take medicines because it's your surgery after 1 week then cost is paid by health insurance (of medicines) you have taken.

       But this is to be checked that how many pre and post days a company is offering.

   Preexistence disease: -

             If you have some diseases during taking policy, then you will not get the claim. Then you have to wait for 3-4 years.

If you don't have any preexistence disease, then you can claim your health insurance after 30 days.

   Day care coverage: -

   

            There should be a day care coverage in your policy. It is that you go for a surgery to a hospital and comes back same day.

  No claim bonus: -

  

            If you haven't claimed any claim, then they (company) offer a bonus to you.

  Cashless Hospitals: -

 

          Insurance company is tied up with that hospital.

Bonus Tip -

Q - where one can find best policy either its term or health?

Ans. Policy Bazar.com

Policy bazar is the platform where you can find best policy for yourself, so give it a shot if you are going to have a plan for you.

p.s- this is not sponsored by policy bazar.

So that's it for the health insurance, all you required to take policy. If you know all about these things which are discussed above, then you are all set and assure yourself that you will not get any hassle after buying that of the insurance.

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