A standard health insurance policy is a mutual agreement between an insurance provider and the policyholder. In this contract, the insurer commits to offering financial support to the policyholder in case of a medical emergency. Based on the terms of the respective plan, a health policy provides cashless treatment options and reimbursement benefits for medical expenses that the policyholder incurs during treatment.

This policy serves as both financial security and a protective shield, ensuring the policyholder can access quality healthcare services without any financial worries.

Given this steady rise in medical expenses, it’s very important to have a reliable and holistic health insurance plan.

Here are key reasons why buying a good health insurance plan makes a difference:

• Protects your savings: A comprehensive health insurance plan offers coverage to protect your savings during medical emergencies, so unexpected costs don’t hamper your finances.

• Keep up with medical inflation: Healthcare expenses continue to rise, but with a holistic health insurance plan, you can afford quality treatments without financial worries.

• Access to quality healthcare: Health insurance allows you to get treated at top healthcare facilities, often with cashless options at network hospitals.

• Covers lifestyle-related ailments: Many plans also cover conditions like diabetes, hypertension, cancer, and heart issues, offering support for both sudden and long-term health needs.

• Cashless hospital facility: You can access treatment without making immediate payments, allowing you to focus on recovery instead of finances.

• Tax benefits: Premiums paid for health insurance are eligible for tax deductions under section 80D of the Income Tax Act, offering financial relief beyond medical support.

Before buying a health insurance plan, it's important to understand its core features:

• Sum insured: The sum insured determines the level of health coverage you’ll receive. Choosing a higher sum insured offers better protection, ensuring that if costs exceed the limit, you won’t need to pay out of pocket. Tip: Start with a higher coverage limit, which you can adjust as needed over time.

• Waiting period for pre-existing conditions: Health plans typically have a waiting period before certain pre-existing conditions are covered. This period varies depending on the insurer, the condition, and the specific policy. Review the waiting period details in the policy document.
  Tip: If you have pre-existing conditions, choose a plan with a shorter waiting period so that coverage starts sooner.

• Sub-limits: Hospital room rent is often capped at a percentage of the total sum insured, with ICU limits typically higher. Carefully review these sub-limits to avoid unexpected expenses.
  Tip: Consider plans without sub-limits, even if they cost a bit more, to minimise out-of-pocket expenses.

• Network hospitals: Health insurers have partnerships with specific hospitals, known as network hospitals, where you can use cashless services. Confirm that your preferred hospitals are in the insurer’s network for easier access to care.
  Tip: Choose an insurer with a large network of hospitals for maximum convenience and cashless options.

• No claim bonus: Like in motor insurance, health plans offer a no-claim bonus if you don’t file a claim in a year, increasing your sum insured at no additional cost.

• Copayment options: With copayment, you share a fixed percentage of healthcare costs with the insurer. To reduce your out-of-pocket costs, select a plan with a low copayment percentage.

• Plan exclusions: No health plan covers everything. Exclusions vary by plan and provider, so knowing these before taking the policy, it helps avoid surprises during claims.

• Pre- and post-hospitalization expenses: Health plans cover related expenses before and after hospitalisation, often for 30 days prior and 60 days after discharge. Check your policy to confirm these periods, as they may differ by plan.

Health insurance offers a number of valuable benefits that provide support during medical emergencies. Here are some key advantages:

• Hospitalisation charges: Most health insurance plans cover hospitalisation costs for health issues that arise after purchasing the policy. Some insurers also offer specialised plans, such as critical illness or accidental coverage, to provide extra support for serious conditions.

• No ICU room rent limits: Many plans don’t limit ICU room rent, allowing you to stay in a private room if needed. However, if costs exceed the coverage, any extra expenses will need to be covered out of pocket.

• Mental health coverage: Health insurance plans now also cover treatment for mental health conditions, as mandated by IRDAI, given the rise in mental health awareness and treatment needs.

• Bariatric surgery coverage: Some policies offer coverage for obesity treatments, though these often come with slightly higher premiums.

• No room rent limits: Health insurance policies often cover hospital room rent costs, ensuring transparency in what’s covered.

• Daycare procedures: Treatments like cataract surgery, dialysis, and angiograms that don’t require a full day of hospitalisation are typically covered by most health insurance plans.

• Ambulance charges: Most health plans include coverage for ambulance costs incurred during a medical emergency.

• Refilling sum insured: Certain plans allow you to file multiple claims within a year up to the sum insured, as long as each claim is for a different medical issue.

• Daily cash cover: Many health plans provide a daily cash allowance during hospitalisation, helping offset income loss while you recover.

• Zone upgrade: Health insurance costs vary by region, with metro cities often being more expensive. A zone upgrade add-on allows for better coverage in high-cost areas, reducing overall premium costs by 10% to 20%.

• Domiciliary treatment coverage: Some plans cover treatments at home when hospitalisation is not possible, following the doctor’s advice.

• Organ donation costs: If an organ transplant like a liver or kidney is necessary, these costs are often covered, depending on the policy terms.

In a medical emergency, cashless treatment can be a lifesaver. Here are some major benefits:

• Quick access to treatment: With a cashless health insurance plan, you can receive immediate care without worrying about upfront costs. Just inform the hospital within 24 hours for emergency admissions or 48 hours for planned procedures.
• Full use of plan benefits: Cashless treatment allows you to make the most of your health plan's benefits without the hassle of paying out of pocket and later filing for reimbursement.
• Coverage while travelling: If you fall ill while away from home, cashless treatment is available at any network hospital across the country, ensuring you’re covered no matter where you are.

Purchasing health insurance requires careful consideration to ensure you get maximum coverage and a smooth claim process. Use this checklist to evaluate the best plan for your needs:

• Health insurance for parents: Designed specifically for your parents, these plans ensure coverage for medical treatment and hospitalisation during emergencies.

• Health insurance for children: Tailored to meet children's unique medical needs, covering consultation fees, diagnostic tests, medications, and sometimes immunizations.

• Health insurance for women: Focused on the unique medical coverage needs of women, these plans often cover diagnosis, treatment, medications, and maternity expenses.

• Individual health insurance: Covers a single person for treatment and hospitalisation expenses.

• Family floater health insurance: A single policy that covers all family members, including self, spouse, children, and sometimes parents or parents-in-law, depending on the plan.

• Senior citizen health insurance: Designed to meet the specific healthcare needs of those aged 60 and above.

• Group health insurance: Provided by employers to cover their employees throughout their employment.

• Maternity health insurance: Offers coverage for pregnancy-related complications and childbirth, including both normal and C-section deliveries.

• Cancer health insurance: Covers the costs associated with cancer treatment, often providing a lump sum upon diagnosis to cover medical expenses.

• Personal accident health insurance: Provides financial protection for injuries, disabilities, or death resulting from accidents, with coverage typically up to ₹ 25 lakhs.

• Critical illness insurance: Covers serious health conditions like cancer, kidney failure, and heart attacks. Each insurer has its own list of covered critical illnesses, so it’s important to review the details before purchasing.

Comparing similar health insurance plans from different providers is essential for finding the most suitable coverage at an affordable rate:

• Getting the right coverage: No single plan is perfect for everyone. Comparing options helps you find the plan that best suits your unique needs.

• Managing costs effectively: A comparison allows you to secure the best coverage within your budget, ensuring cost-effective protection.

• Understanding terms and conditions: By comparing plans, you gain clarity on the policy details, helping you make an informed choice.

• Exploring extra benefits: Reviewing various plans can reveal additional benefits or riders that might add value to your coverage.

• Customising coverage: Comparing health insurance options lets you find a plan that closely aligns with your specific requirements, offering a tailored fit.

• Ensuring value for money: A careful comparison ensures that you get the best possible value for your investment.

• Staying in control: By comparing plans, you maintain control over your decision-making, choosing the coverage that matches your needs perfectly.

1.Pre-existing conditions (PEDs):

These are not covered until after the specified waiting period.

2.Certain specific ailments:

Conditions like hernia, piles, and fistula often aren’t covered in the first year of the policy.

3.Early-stage ailments:

Health issues occurring within 30-90 days of plan purchase are usually excluded.

4.Cosmetic treatments:

Non-essential cosmetic procedures are typically not covered.

5.Dental treatments:

Except for dental injuries caused by accidents, dental work is usually excluded.

6.Sexually transmitted diseases (STDs):

These are generally not covered.

7.War-related injuries:

Illnesses resulting from war or similar events are excluded.

8.Substance abuse:

Health issues arising from excessive alcohol or drug use aren’t covered.

9.Experimental treatments:

Unproven or experimental therapies are excluded.

10.Self-inflicted injuries:

Injuries caused by self-harm are not covered.

11.Adventure sports injuries:

Health issues from participation in risky activities are often excluded.

12.Maternity-Related Exclusions:

Unless specified in the policy, maternity expenses, IVF treatments, and newborn care are not covered by default and usually require an add-on.

13.Criminal activities:

Illnesses or injuries from engaging in criminal acts aren’t covered.

Health insurance plays an important role in catering to people’s medical needs. Here are some of the key reasons why having health insurance is so important:

• Covers medical expenses: Health insurance provides financial protection during medical emergencies, eliminating the need for upfront payments.

• Cashless hospitalisation: Access to cashless hospitalisation is available at network hospitals across the country.

• Protects your family: Family floater plans can cover your entire family under a single policy for added security.

• Critical illness coverage: Some health plans cover serious illnesses, providing financial support during difficult times.

• In-patient care: Health insurance covers in-patient hospitalisation, including room charges and medical procedures.

• No claim bonus (NCB): Many health plans offer an NCB for each year without claims, increasing your coverage without extra costs.

• Additional riders: Customise your plan with riders to expand your coverage based on specific needs.

• Customisable plans: We understand that everyone’s needs are different. That's why INSURE24 offers customisable health insurance plans that you can tailor to fit your unique requirements.

• 100% digital: With INSURE24, buying health insurance is hassle-free and fully digital, allowing you to manage everything from the comfort of your home. No paperwork, no waiting just a quick and easy buying process.

• Affordable premiums: INSURE24 offers affordable premiums, ensuring you get the protection you need at a price you can comfortably manage.

• Transparency and trust: At INSURE24, we believe in complete transparency. No hidden terms, no surprises—just clear, honest policies that you can trust for your health and peace of mind.

1). Documents Required for Buying

• Age proof like passport, birth certificate, etc.

• Identity proof like passport, Aadhaar Card, etc.

• Address proof like passport, DL, utility bills, etc.

2). Documents Needed for Claim

• A duly filled and signed claim form

• Recent passport-size photo

• All the hospital bills, receipts, documents, reports, prescriptions

• Pre-authorised claim form for cashless claim

• Identity proof

3). List of Documents Necessary to Claim Under Reimbursement

For reimbursement claim, you need the following documents:

• Discharge summary from the hospital

• All the receipts, bills, prescriptions, reports, and documents, issued during hospitalisation

• Identity proof

1). Cashless Claim

For a smooth cashless claim settlement, follow these steps:

• Inform your insurer and contact the hospital TPA desk regarding your hospitalisation in a network hospital within 24 hours

• Duly fill in, sign, and submit the pre-authorisation form

• Once the treatment process is complete, submit all the bills, receipts, and documents issued so far along with the discharge summary

• The insurance provider will liaise with the hospital authorities and directly settle the approved claim amount

• You have to settle the remaining dues and complete the process.

2). Reimbursement Claim

In this type of claim, you need to pay for the expenses out of your own pocket and then file for the claim after discharge.

• Immediately inform your insurer regarding the development and your hospitalisation

• Once the treatment process is complete, settle the entire hospital bill out of your pocket.

• Contact your insurer at the earliest after discharge.

• Submit all the prescriptions, reports, invoices, receipts, and documents along with the discharge summary and a duly filled and signed claim form

• Once all the documents are verified to be correct, you receive the approved claim amount directly to your registered bank account.

It's important to highlight that health insurance has become an important policy to have, given the rising costs of healthcare. It’s a good idea to invest in a plan sooner rather than later. You can easily buy the best health insurance online from INSURE24 with just a few clicks from your computer or smartphone. Just make sure to keep the tips and advice shared on this page in mind to get the best coverage as per your needs.