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Health Insruance or medical insurance is a contract between the insurer and policyholder where the insurance the insurance company helps the insured to meet medical expenses. A Health policy provides the benefit of reimbursement of medical expenses or cashless treatment for an illness or accidental injurys.

Health Insurance is a type of insurance that offers medical coverage against medical expenses arising out of a health emergency. A Health Insruance plan offers financial assistance to the policyholder to cover hospitalization expenses,day care procedures,ICU Charges and Critical illness benefits.

Top Reasons to Buy a Health Insurance Plan

Medical inflation is increasing every day making treatments expensive. If you get hospitalized for a critical illness or lifestyle disease, you may end up losing all your savings. The only way to afford quality medical treatment during a health emergency is by buying a health insurance policy. Take a look at some of the top reasons to buy a health insurance plan below:

Beat Medical Inflation -A health insurance policy can help you pay your medical bills, including pre and post-hospitalization expenses, today as well as in future despite the rising medical costs.
Afford Quality Medical Treatment - It helps you to afford the best quality medical treatment and care so that you can focus only on getting cured.
Fight Lifestyle Diseases - It allows you to pay for the long-term treatment of lifestyle diseases like cancer, heart attack, etc. that have been on the rise with the changing lifestyles.
Protect Your Savings - It helps you to protect your hard-earned savings by covering your medical expenses so that you can avail the required treatment without any financial worries.
Avail Cashless Hospitalization Facility - It allows you to obtain a cashless hospitalization facility at any of the network hospitals of your insurance provider by raising a cashless claim.
Get Tax Benefits - It enables you to save tax on the health insurance premium that you’ve paid under section 80D of the Income Tax Act for better financial planning.
Ensure Peace of Mind - It allows you to obtain medical treatment with peace of mind as you do not have to worry about paying the hefty hospital bills.

Key Benefits of Health Insurance Plans in India

Health insurance plans offer a variety of health benefits to the insured depending on the plan. Following are the key benefits of buying a health insurance plan in India:

Hospitalization Expenses - A health insurance plan covers the medical expenses incurred on getting admitted to a hospital for more than 24 hours. It includes room rent, doctor’s fee, medicine cost, diagnostic test fees, etc.
Pre & Post Hospitalization Expenses - It covers the medical expenses that you may have incurred on an illness before getting hospitalized as well as follow-up treatment expenses incurred after getting discharged. The pre-hospitalization and post-hospitalization expenses are covered up to a fixed number of days as specified in the policy document.
ICU Charges - A health insurance plan also covers the cost of availing treatment in an ICU during hospitalization.
Ambulance Cost - It covers the cost of ambulance services availed to reach the nearest hospital during a medical emergency.
Cashless Treatments - All health insurance providers in India offer cashless treatment facilities at their network hospitals. You do not have to worry about arranging money to pay the hospital bills if you get admitted to a network hospital as it will be settled by your insurer under cashless claims.
Day Care Procedures - It also covers the cost of availing day care treatment that requires hospitalization for less than 24 hours.
Pre-existing Diseases - The best health insurance policy also provides coverage for pre-existing diseases after you have completed the waiting period. Usually, pre-existing diseases are covered after a waiting period of 2 to 4 years.

What is Covered in a Health Insurance Plan?

Most health insurance companies in India cover the following medical expenses under a Health insurance policy:

In-patient Hospitalization Expenses - The Hospitalization expenses incurred during the treatment of an illness or injury are covered provided the hospitalization for more than 24 hours.
Pre-existing Illnesses or Diseases - After the completion of the waiting period, you can file a claim for the expenses incurred on the treatment of any pre-existing illness or condition.
Pre and Post Hospitalization Expenses - Medical expenses incurred on blood tests, x-ray, and other medical check-ups that are required before hospitalization are taken care of by the insurance company. Similarly,the cost of medicines and preventive health check-ups that are done to ascertain your health after the discharge from the hospital is covered under the health insurance plan.
Ambulance Charges - Although the coverage amount varies from insurer to insurer, most medical insurance plans cover emergency ambulance charges.
Maternity Cover - Medical expense incurred during the pregnancy and delivery are covered along with newborn baby expenses
Preventive Health Check-ups - Regular health check-up facilities are also made available in some health insurance plans in india.
Day-care Procedures - Daycare treatments where hospitalization is not required for more than 24 hours are covered . It includes eye surgery, dialysis, and other common daycare surgeries as mentioned in your policy document.
Home Treatment Cover - It also covers the expenses incurred on getting medical treatment at home on the advice of a medical practitioner .
AYUSH Benefit - A health insurance plan also reimburses the medical costs incurred on Ayurveda, Unani, Siddha or Homeopathy treatment up to a specified limit.

What is Not Covered in a Health Insurance Plan?

The Following medical expenses and situation are not covered in health insruance plan:

Unless there is an accidental emergency, claims arising during the initial 30 days of buying a health insurance plan are not covered.
Coverage of pre-existing diseases is subject to a waiting period of 2 to 4 years.
Critical illnesses coverage usually comes with 90 days waiting period.
Injuries caused by war/tarrorism/nuclear activity.
Self-inflicted injuries or suicide attempts.
Terminal illnesses, AIDS, and other diseases of similar nature.
Cosmetic/plastic surgery, replacement of hormones surgery etc.
Dental or eye surgery expenses.
Bed rest/hospitalization and rehabilitation, common illnesses etc.
Treatment/diagnostic tests and post care produres
Claims arising out of adventure sports injuries

Note:- It is recommended to check your policy wording to get a detailed list of exclusions.

Key Factors to Consider before Buying a Health Insurance Plan

There are a few factors that you should consider closely to make the right decision while buying a health insurance plan:

Check the Scope of Coverage -The policy coverage and the sum insured amount will decide the type of illnesses and surgeries that you can claim during the policy term. Closely look at the benefits offered like hospitalization expenses, daily cash benefit, COVID hospitalization cover, critical illness cover, maternity cover, etc. while choosing a health plan.
Adequate Sum Insured - The sum insured amount is a crucial deciding factor in selecting a medical insurance policy. Looking at the ongoing inflation it is advisable to buy a health insurance plan with a minimum sum insured of Rs 10 lakh that can go up to Rs 1 crore. If it’s a family floater policy or senior citizen insurance, the higher the sum insured the better the coverage will be.
Policy Type - There are different types of medical insurance policies that are available in India. As per your requirement, you can choose to buy individual health insurance, senior citizen health insurance, family floater or critical illness plans. Moreover, you can buy Top up Super top up health insurance along with your existing health plan to enhance the coverage. This is beneficial in case your base sum insured gets exhausted during the treatment. You can choose this option at the time of policy purchase and renewal.
Waiting Period Clause - Your health insurance policy only comes into action once the initial waiting period is over. If any claim is filed during the initial waiting period except for accidental hospitalization claims, the insurer can reject it. Moreover, the waiting period clause also applies to pre-existing diseases like thyroid, blood pressure, diabetes, etc. It is also applicable to specific illnesses, treatments, and maternity cover. You can choose a plan with a minimal waiting period.
Co-payment Clause - Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (insured). The co-payment option does not have any effect on the sum insured. It allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Only opt for this clause if you can pay off a portion of your hospitalization bills, that can be 10% and above without a financial burden.
Room Rent Sub-limits - A health insurance plan may have various sub-limits and the most common one is the room rent sub-limit. For instance, if your medical insurance policy comes with a sum insured of Rs 3 lakh with a sub-limit of 1% on daily room rent , then your room cost will be covered up to RS 3000 per day. Any additional amount on room rent will have to be paid from your own pocket. So a health plan with no or minimal sub limit is advisable.
Network of Cashless Hospitals -Check the list of network hospitals for an insurance company where cashless claims ccan be filed. The Maximum number of network hospitals you have in your vicinity, the better are the chances of availing cashless hospitalization benefits.
Lifelong Renewability Option - Medical Insurance policies are usually renewed every year. When the policy term is about to end, in order to continue the insurance coverage the insured has to pay the insurance premium at the time of renewal. When buying a health insurance plan, choosing a plan with a lifetime renewal option is benefiicial in the long run.
Check the claim settlement radio - This is an important criterion to assess the credentials of an insurer. You should always go with a company with good claim settlement record. A claim settlement record. A claim settlement ratio above 80% can be an ideal choice .

How to File a Health Insurance Claim?

Health insurance plans come with additional benefits of cashless treatment and expense reimbursement by the insurer. One can file a claim for expenses incurred as per the sum insured limit of the health insurance policy. Following are the two types of claim processes:

1. Health Reimbursement ClaimsFor the treatments availed in the non-network hospitals, the policyholder can file a claim for reimbursement of the treatment charges. Once the treatment is completed, the insured needs to settle the bill, collect all the documents, and then file a claim with the Insurer or the TPA for reimbursement.
2. Cashless ClaimsIf the treatment is availed in a network hospital or cashless hospital, then the policyholder will be eligible to avail cashless treatment services. Once the treatment is completed the insurance company settles the bill directly with the hospital.

For both cashless and reimbursement claims the procedure for planned and emergency hospitalization may vary as given below:

In Case of Planned Hospitalization
- In case of planned hospitalization, you need to inform the insurer at least 48-hours before the treatment.
- Once you get the approval from the TPA, you can then file for reimbursement and cashless claims on submission of the claim form
- Also, submit other related documents like medical bills, reports, discharge summary, etc.
- In the case of cashless claims, the hospital bill is directly settled by the insurer .
In Case of Emergency Hospitalization
- In case of emergency hospitalization, you need to inform the insurer within 24 hours of getting hospitalized.
- Showcase your health card at the hospital
- Submit the pre-authorization form to get TPA approval for emergency hospitalization for cashless claims
- If approved, the insurer will settle the claim amount directly with the network hospital
- If you fail to get TPA approval, you would need to file for reimbursement later.
- Submit all the required documents like hospital bills, discharge bills, etc.
- The claim amount will be paid to you.
Documents Required for Health Insurance Claim Reimbursement
- Discharge card issued by the hospital/network hospital
- In-patient hospitalization bills signed by insured for authenticity
- Doctors’ prescriptions and medical store bills
- Claim-form with insured’s signature on it
- Valid investigation report
- Consumables and disposables prescribed by the doctors with complete details
- Bills of doctors’ consultation
- Copies of the Insurance policy from the previous year and the current year/copy of ID Card of TPA
- Bills of doctors’ consultation
- Any other document(s) asked by the TPA

FastInsurance Insurance Company

Buying health insurance can be easy if you approach the right channel. Having said this, FastInsurance can be a good platform for choosing the right insurance policy. FastInsurance Insurance Broker Private Limited has made the process of comparing & buying a health insurance policy easier in comparison to earlier days. A Person has easy access to complete details of almost all health insurance plans available in the Indian insurance market at a competitive price.

FastInsurance is here with absolute commitment to your health insurance needs. We guide you, assist you and take you through the journey right from selecting the best health insurance plan up to the final stage of filing your claims. We strive to make the buying and documentation processes easier for you.

FastInsurance help to check numerous health insurance plans and zero down on the plan that best fulfills your needs. Moreover, the post sale services are extended to the customers online as well even at the time of medical insurance claim
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At this equipped and comprehensive insurance platform, you can make all possible comparisons related to features, premiums, the best sum insured and claim settlement ratios for all the best health insurance plans in India.

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