Hospitalization Plans: Hospitalization plans are those health insurance plans that reimburse the hospitalization and medical costs of an individual, subject to the sum insured. Hence, these plans are also known as indemnity plans.
Family floater Plans: Family health insurance plans cover the entire family in one health insurance plan. It works under the assumption that not all members of a family will suffer from illness at one time. These plans cover hospital-related expenses which can be pre and post hospitalization. Most health insurance companies in India offering family insurance have a wide network of hospitals that help the insured people in times of an emergency.
Senior Citizens Plans: As the name suggests, senior citizen health insurance plans are for the older people of the family. These plans cover health issues arising during old age. As per IRDAI guidelines, each insurer must provide cover up to age of 65 years.
Maternity Plans: Maternity health insurance plans provide coverage for maternity and other additional expenses. These policies take care of both pre and post-natal care, and delivery of baby i.e. normal or caesarean deliveries. Just like other health insurance plans, the maternity insurance providers usually have a wide range of network hospitals and also takes care of ambulance expenses.
Hospital Daily Cash Benefit Plans- Hospital Daily cash benefits is a defined benefit policy that provides a certain sum of money for every day of hospitalization.
Critical Illness Plans: These plans are benefit-based policies, where a lump sum benefit amount is paid on diagnosis of covered critical illness. These diseases are usually specific, with high severity and low frequency in nature. Hence, the treatment cost is high when compared to day to day medical / treatment need. Some of these illnesses include heart attack, cancer, stroke etc.
The health insurance coverage differs from one insurance company to another. All you can do is compare different health insurance policies provided by different health insurers keeping the coverages and exclusions in mind. Usually, a health insurance plan covers the following medical expenses;
Health insurance plans offered in India provide cover for the following essential health benefits:
In-Patient Hospitalization- Medical expenses related to hospitalization due to an illness or an accident, which is for a period of more than 24 hrs.
Pre-Hospitalization - Medical expenses that one incurs due to illness during the days immediately preceding the hospitalization.
Post-Hospitalization - Medical expenses that one incurs for a certain period after being discharged from the hospital.
Day-Care Procedures- Medical expenses for treatments, which do not require 24 hours hospitalization due to technological advancement.
Domiciliary Treatment- Covers the expenses for treatment done at home for which hospitalization would be needed.
Emergency Ambulance - Costs related to using ambulance service for reaching the hospital.
Ayush Benefit - Treatment done using Ayurveda, Unani, Sidha and Homeopathy.
If there is an organ transplant of the insured, all the donor’s expenses would be covered.
Health check-up expense
Pre-existing diseases (conditions applicable)
Maternity/new-born expenses (conditions applicable)
In case you wish to enhance your health insurance cover, you can buy riders at an additional premium or buy top-up health insurance plans.
Mentioned below is the list of the exclusions in a health insurance:
Pre-existing medical conditions: Pre-existing medical conditions are the ailments that you might already be suffering from while applying for insurance. In all probability, pre-existing medical conditions are not covered under medical insurance plans. However, health insurance providers have started providing coverage for pre-existing medical conditions after a waiting period ranging between two to four years.
Pre-Existing Diseases: In case you are suffering from any illnesses or health conditions before buying a health insurance plan, are known as pre-existing diseases. Usually, every health insurance company has a waiting period of 2-4 years or more that would roughly depend upon the type of disease as well as the risk in case your health insurer agrees to cover it. Certain pre-existing health conditions such as cataract, few chronic diseases, joints treatment, kidney stones, arthritis, etc. could be the exclusions in a health insurance plan.
Cosmetic surgeries: Cosmetic surgeries are one of the most common health insurance exclusions. However, cosmetic or plastic surgeries that are performed after accidents are covered in several health insurance plans. Also, joint replacements and dental treatments are usually excluded in health insurance policies.
Injuries caused during suicidal attempts: An insured is not covered in case he intentionally causes harm to himself. Hence, injuries caused during suicidal attempts are not covered in health insurance plans by any insurance provider.
Therapies: Health insurance plans do not cover therapies such as acupuncture, naturopathy, magnetic therapies and alternative forms of therapies.
Pregnancy: Certain medical expenses including child birth, pregnancy, vaccination, etc. could not be covered under a health insurance policy. There would be a waiting period of around 1-2 years. Post completion of this waiting period, you will be eligible for receiving decent benefits in case you plan for a child.
Waiting Clause: Almost every health insurance company do not cover illnesses that are a part of the inclusions of the health insurance plan. However, there are certain exceptions such as accidents and deaths. A waiting period of 1-2 months would be applied post which you will get the advantages of the policy.
Surgeries: Certain surgeries such as dental surgery, joint replacement, cosmetic surgery, etc. are generally not covered in a health insurance policy.
There are several parameters to be considered before you invest in a health insurance plan. Some of them are-
Your budget:- One needs to consider the financial budget of the family, based on which he/she invests in a health insurance plan that covers all risks related to health of the insured and their family members.
Co-payment:- Another consideration factor that one must consider is whether or not the health insurance plan provides a co-payment facility. A standard feature, co-payment is defined as a fixed percentage of each claim amount that has to be paid by the insured.
Number of family members covered:- While investing in a health insurance plan, one must always consider the number of family members that shall benefit from the policy. Most insurance providers cover up to 4 to 6 family members under a family floater health insurance plan in India.
Claim settlement process- Claim settlement was a cumbersome process which obstructed a person from investing in a health insurance plan. All insurance providers in today’s day and age, provide easy, hassle-free claim settlement procedures that makes it convenient for the insured.
Addition of new family member-Addition of a new family member is a moment of joy. Hence, when investing in a health insurance plan, one must also consider the conditions in the policy in case you wish to get the new family member added and insured under your health insurance policy.
Compare health insurance plans- Before investing in a health insurance plan, one must compare the policies from the best insurance providers and select the one that best suits his needs.
Health insurance companies offer a wide range of policies, tailor-made to suit the unique health requirements of their customers. Hence, varied plans include different features related to medical treatments, surgeries, etc. Here are some of the salient features of health insurance policies: