Rising medical costs are one of the biggest reasons for bankruptcy in India. According to a report by NDTV, Healthcare expenses have increased by over 15% annually. A single cardiac procedure can easily cost ₹5-10Lakhs, while cancer treatment can drain life-saving worth ₹15-20 lakhs or more.
Depending only on your savings to handle such emergencies is like walking without a safety net. What happens when your emergency funds fall short? This is where a comprehensive health insurance policy becomes your financial lifeline. In this blog, we discuss how health insurance plans work in India
What is Health Insurance
Health insurance is an agreement with an insurance provider that helps cover your medical expenses. A health insurance policy acts as a financial shield against the cost of healthcare services, such as hospitalisation, doctor consultations, surgeries, medicines, ambulance services, etc.
Some key features of health Insurance are as follows :
Cashless Hospitalisations
IRDAI has made it mandatory for health insurance companies to offer cashless hospitalisation at their network hospitals. As a policyholder, you can opt for cashless claims so you do not have to pay out of your pocket during admission. A health insurance company directly settles your medical bills with the hospital, allowing you to focus on recovery without financial stress.
Pre and Post-hospitalisation Cover
Health Insurance also has an amazing feature of pre- and post-hospitalisation expenses. Pre-hospitalisation includes diagnostic tests, investigations, and medication and post-hospitalisation expenses include follow-up treatments after hospitalisations.
Waiting period
Another feature of health Insurance is the waiting period. It refers to the time period during which certain benefits or coverage are not available under a health insurance policy. For instance, a waiting period of 2 to 3 years for pre-existing diseases is an extremely common clause in most health policies.
Co-payment
Co-payment means you pay a fixed percentage of your medical bills, while the insurance covers the rest. While it lowers your upfront premium, it can lead to higher costs during hospitalisation. Opting for a zero co-payment plan can help avoid these extra expenses.
How Does Health Insurance Work in India?
Irrespective of the type of health insurance you choose, the process of how health insurance works in India largely remains the same. Here’s the complete journey, from selecting a plan to making a claim.
Finding the Right Health Insurance Plan
The first and most important step is choosing a suitable health insurance policy. With so many options available, it can feel overwhelming. To make the right decision, consider these factors:
- Coverage Amount: Assess your current and future healthcare needs. Choose a sum insured that can adequately cover hospitalisation, treatments, and emergencies.
- Insurance Company: Choose a reputable health insurance company. Compare their plans, hospital network, claim settlement process, premiums, and customer reviews.
- Customisation: Look for health insurance plans that allow you to add riders or top-up policies to enhance coverage when required.
- Premium: Check if the premium matches the coverage offered. Avoid choosing the cheapest plan, as it may lack comprehensive benefits.
- Terms and Conditions: Read the fine print carefully. Understand inclusions, exclusions, waiting periods, co-payments, and sub-limits before you commit.
Paying the Premium
Once you finalise a health insurance plan, the next step is premium payment. You can pay premiums annually, half-yearly, or monthly, based on your financial comfort.
- Choose a frequency you can maintain to keep your medical insurance policy active.
- If a higher sum insured feels unaffordable, you can buy a base health insurance policy with a modest sum insured and add a top-up policy. This way, you get larger coverage at a lower cost.
Making a Claim
When you face hospitalisation or medical expenses, you need to file a claim with your insurer. This is how the process works:
- Cashless Claim: If you visit a network hospital of your health insurance company, you can opt for cashless hospitalisation. Here, the insurer directly settles the bill with the hospital.
- Reimbursement Claim: If you get treated at a non-network hospital, you pay the bills first and then request reimbursement by submitting all documents to the insurer.
- Documentation: Ensure you have all the required documents, like hospital bills, discharge summaries, prescriptions, and diagnostic reports.
- Claim Conditions: Familiarise yourself with reasons for claim rejection, such as non-disclosure of pre-existing conditions or treatment for excluded illnesses.
What is the Health Insurance Claim Settlement Process?
When a medical emergency requires hospitalisation, your health insurance policy ensures financial support through either a cashless facility or a reimbursement facility. Understanding both options helps you know how claims are handled.
Cashless Facility
Most insurers have a wide network of hospitals where you can receive treatment without paying out of pocket. The hospital directly settles bills with the best health insurance company in India, subject to your policy terms and conditions.
Reimbursement Facility
If you are admitted to a non-network hospital or your plan does not offer cashless settlement, you can pay the bills yourself and later file a reimbursement claim. The insurer will refund the eligible expenses once you submit the required bills and documents. This ensures transparency and gives you clarity about your out-of-pocket payments.
Key Steps in Both Facilities
- Submit your claim request within the specified timeline.
- Provide all valid medical records, bills, and supporting documents.
- Review your policy regularly to stay updated on inclusions, exclusions, and renewals.
By following these steps, you can ensure a smooth and hassle-free health insurance claim settlement process.
Final Thoughts
Health insurance acts as a shield against the rising medical costs in India. With benefits such as cashless hospitalisation, coverage for pre-and post-hospitalisation expenses, and flexible plans, it allows you to focus on recovery instead of financial stress. By selecting a trusted provider like Niva Bupa Health Insurance, you gain access to a wide hospital network, simple claim procedures, and all-around protection for your loved ones.
