Indian health financing scene raises several challenges, which are:

  • increasing health care costs,
  • The high financial burden on the poor eroding their incomes, and
  • The increasing burden of new diseases and health risks.

  • Given the above scenario exploring health-financing options becomes critical. Health Insurance is considered one of the financing mechanisms to overcome some of the problems of our system.
    It is necessary to have it for the health aspect and help tax exemptions and premium paid towards health insurance under Section 80D of the Income Tax Act 1961.

    A Health Insurance Policy would typically cover expenses reasonably and necessarily incurred under the following heads regarding each insured person subject to the overall ceiling of Sum Insured (for all claims during one policy period).
  • Room, Boarding expenses.
  • Nursing expenses.
  • Fees for anaesthesia, surgeons, physician, consultants, specialists.
  • Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radiotherapy, Cost of the pacemaker, Artificial limbs, cost or organs and similar expenses.

  • Not just medical facility, it also provides other advantages such as tax benefits. It helps tax exemptions on the premiums under Section 80D of the Income Tax Act, 1961.

    Choosing Health Insurance

    Insurance companies have tie-up arrangements with a network of hospitals in the country. If the policyholder takes treatment in any network hospitals, there is no need for the insured person to pay hospital bills. Through its Third-party administrator (TPA), the Insurance Company will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy must be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital, in which case he must pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.

    Family Floater Insurance

    A family floater health insurance is a policy that covers the entire family in one health insurance plan. Floater means a single sum insured can protect all members in the one policy. The Sum assured is available to anyone member or all members in any eventuality during the healthcare policy.
    If any one of the members falls ill, the coverage up to sum insured (amount of cover, or maximum limit of the hospital costs to be reimbursed by the insurance company you opt for your family) is available. At the same time, the other healthy members are also covered. The entire family will have more comprehensive coverage, with hospitalized members being supported by the non-hospitalized ones.

    Individual Health Insurance

    Individual Health Insurance policy covers only one person by paying a yearly premium amount depends on the person's age and the coverage amount. For personal health plans, each member has a separate sum insured. In a floater health insurance policy, once a child covered under the policy reaches a specified age – ranges between 18 to 25 (it differs from policy to policy), they are treated as adults.
    They must be removed from the floater health insurance plan for the plan to continue.

    Health Top Up and Super Top Up Insurance

    What if there is a situation of multiple hospitalizations within the same year? Unlike normal hospitalization policies, top-up plans come with a deductible or threshold limit.
    A top-up cover will pay you for your claim amount (bill for a single hospitalization). A super top up plan, on the other hand, considers ‘the total of all the bills’ in any given year. It covers ‘multiple’ hospitalizations and looks at the aggregate claim. This means the plan puts together several cases of hospitalization to calculate the deductible limit.
    Top up insurance comes with low premiums, simple to understand with no hidden charges/conditions It gives additional protection at an affordable price when hospitalization costs are very high. This is irrespective of whether the insured has any other Health Insurance Policy or not. Single Sum Insured/Threshold Level for all family members covered under the Policy. Parents can take a separate policy for themselves or the son/daughter can cover them under a separate policy.

    A Critical Illness Benefit Insurance

    A Critical Illness benefit policy provides a fixed lumpsum amount to the insured to diagnose a specified illness or undergo a specified procedure. This amount helps mitigate various direct and indirect financial consequences of a critical condition. Usually, once this lump sum is paid, the plan ceases to remain in force.

    Abhivridhi Tip

    Always consider buying a benefit policy like hospital cash along with your Health Insurance.

    Enjoy unique benefits and perks on getting Insurance from team Abhivridhi Insurance Brokers. Get in touch now.