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‘Health is our wealth’ is not just a saying but a way of life everyone should incorporate. In today’s day and age where health issues are common and medical costs rampant, one should focus on keeping his health and well being in tip-top shape. That being said, one must also be prepared for any eventuality. There is a wise old saying ‘Hope for the best but prepare for the worst.
Having a health insurance plan is critical in today’s time. Everyone should be insured, be it bachelors, couples, senior citizens, or even children. Purchasing the correct health insurance plan can be of tremendous utility when the times get tough.
This page aims to talk about the most important aspects of health insurance and strives to ensure that all readers can make a prudent decision after reading this page. Topics to be discussed are:
A health insurance policy is a contract between a health insurance company and the policyholder. The health insurance company indemnifies the policyholder against health-related expenses for the exchange of a premium. Let us understand this with a simple example.
Example: Let us say Mr. Jatin has bought a health insurance plan with HDFC ERGO. He has opted for coverage of Rs 10 Lakhs and paid a yearly premium of Rs eight thousand. Let us assume that Mr. Jatin meets with a minor accident and is hospitalized. His hospitalization expenses amount to Rs 5 Lakhs. As Mr. Jatin has a health insurance policy, his entire medical expenses will be paid for by the health insurance company. Had Mr. Jatin not bought a health insurance company he would have to bear the entire financial brunt of the medical expenses.
There are quite a few types of health insurance plans thus one should know about the differences between these plans before opting for one. Let us briefly learn about the various types of health plans:
The claims process is an integral part of purchasing a health insurance policy. You must be well versed in this process before purchasing a health plan. Let us understand the claims process in general. The claims process is generally classified into two, reimbursement claims and cashless claims.
A reimbursement claim is when the policyholder will initially need to pay out of his pocket first, then he must apply to the insurance company to get his reimbursement.
Step 1.) Inform your agent or insurance company
First and foremost you will have to inform your agent or your company about any hospitalization. Do not delay in intimating them as this could cause issues while settling the claim.
Step 2.) Collect all documents
Ensure that all important documents are collected and managed properly. Relevant documents include: Hospital bills and receipts, medical certificates, medical reports, admission and discharge summary, pharmacy bills and receipts
Step 3.) Fill-up claim form and submit documents
Upon discharge, you will have to fill your claim form with the relevant information and submit it to your agent or insurance company. You must ensure that all the fields are populated with all honesty and there is no falsification.
If there is any falsification it can result in claim-related complications on account of violation of principles of insurance. You will also have to hand over the file of the original documents you have gathered. Ensure that you keep a xerox copy of the said file for your record.
Step 4.) The insurance company reimburses you
If all papers are in order, the insurance company should release your claim within 15 days. If they fail to release your claim within 15 days, you should escalate your complaint to the grievance department of the company. If there is no resolution from their side, you can raise the issue to the IRDA via their Integrated Grievance Management System (IGMS)
Cashless claims are handled in a slightly different way. This is where the insurance company directly settles the bill with the hospital. It does not need for the policyholder to make any payment to the hospital in the first place.
Step 1.) Inform your insurance company or your agent
First, you will have to inform your agent or insurance company about the incident. This is critical as the agent/company may refer you to a network hospital where cashless claims are permitted. You should also keep in mind that cashless claims can only be handled in affiliated hospitals, so you will have to locate your nearest preferred cashless hospital before hospitalization.
Step 2.) Present your cashless card
You will now have to present your cashless insurance card to the hospital admissions department. Upon presenting the card, the hospital staff will call your insurance company and validate the policy.
Step 3.) Admission
Once your policy is validated, you will be granted admission into the hospital. You do not need to keep track of bills and hospital documents as the hospital will internally transfer the relevant documents directly to the insurance company. You can however request the hospital for duplicate copies. You can also request the insurance company for duplicate copies for your record keeping.
Step 4.) Discharge
You will now be discharged once the treatment is completed. You do not need to apply for reimbursement to the insurance company as this was a cashless hospitalization.
Claim Settlement %
Star Health Insurance
Care Health Insurance (formerly Religare)
IFFCO Tokio General Insurance
Bajaj Allianz Health Insurance
Max Bupa Health Insurance
HDFC ERGO Health Insurance