Health Insurance FAQ’s

Health Insurance FAQ's

WHAT IS BENEFITS OF DAY CARE HEALTH INSURANCE?

Day care health insurance comes with many benefits. Some of the benefits are: 

Day care health insurance plan covers the expense incurred buying medicines.

It also covers like diagnostic tests which are otherwise will be covered only if the insured is

hospitalised.

It covers various day care treatments like Tympanoplasty, middle ear reconstruction, incision of tear glands, cataract operation, ENT treatments, ophthalmology, and radiotherapy.

Day care health insurance plan gives you tax benefits.

If you have a health insurance policy that covers domiciliary hospitalisation, some of the treatments they cover are:

 

# Expenses incurred to get blood, anaesthesia, and oxygen

# Diagnostics tests and X-ray charges

# Cost incurred to purchase medicines and drugs

# Consultation fees, doctor charges, and specialist fees

# Home nursing service expenses

Although used interchangeably, mediclaim is technically not the same as health insurance. Broadly, the difference between the two types of health covers lies in the quantum and breadth of coverage offered. Even though it is considered a form of health insurance, mediclaim plans are more specific in their coverage i.e. it is usually only for hospitalisation expenses, particular illnesses and hospitalisation/treatment in case of accidents. Health insurance plans on the other hand can be customised to cover expenses pertaining to pre/ post-hospitalisation, ambulance charges, critical illnesses etc.

An individual insurance plan is designed to cater to the needs of one person. The sum assured is completely used by the individual person. However, in a floater option, the sum assured can be used by anyone of the members under the insurance plan. Floater options are perfect for families where more than one member require insurance coverage.

The below documents are required when you submit a reimbursement claim:

 

# Duly-filed reimbursement claim form

# Health card and identity proof of the insured

# Original hospital bills

# A copy of the discharge summary

# Original pharmacy bills

# A bill for ambulance charges, if it is covered by your insurer

# Original cancelled cheque

# Any medical investigation report like ECG, X-ray, MRI, CT scan, or any other reports.

Premiums are charged based on the age and location of the insured member and the sum assured chosen. In case of plans on a family floater basis, premiums are calculated based on the age of the oldest member. Premiums in this case are also affected by the family size i.e. the number of family members covered under the policy.

Listed below are some tips that you can follow to select the best health insurance plan:

 

Buy a comprehensive health insurance plan that suits your requirements.

Keep an eye on the exclusions.

Do not land up paying higher premium to get low co-pay.

Give importance to the incurred claim ratio and claim settlement ratio of the insurance company.

Choose an insurance plan which comes with high No-claim Bonus.

Research well about the plan and the insurance company.

Compare various health insurance plans online.

Yes, premiums paid on health insurance plans qualify for tax benefits as per Sec80D of the Income Tax Act.

There are many myths when it comes to health insurance in India. Some of the myths are as follows:

 

# Many of us think that you are insured from day one as soon as you have purchased an insurance plan. However, most of the insurance plans have a waiting period within which period no claims would be entertained.

# A low premium plan is not the best plan in the market.

# Another myth that we have in India is that health insurance plan does not cover maternity expenses. Most of the health insurance plan comes with an option to attach maternity benefit rider which covers pregnancy-related expenses.

# The number of day care procedures listed in your policy document matters. # # Always check for border classification when it comes to treatments covered instead of each minor medical treatment listed.

# Buying a health insurance online is not secure.

This is whereby claimants avail medical services at their network hospitals without making upfront payments (subject to approvals). This is different from reimbursement of claims whereby claimants make upfront payments for treatment and subsequently submit bills to the insurance company for compensation.

Thanks to the sophisticated technology we have in the medical field! What took us days now takes us less than 24 hours. Many medical treatments can be given in few hours because of the advancement in the medical industry. If the treatment can be given to the policyholder as an outpatient, it will be termed as day care procedures. Some of the day care procedures are:

 

Tympanoplasty

Middle ear reconstruction

Incision of tear glands

Cataract operation

ENT treatments

Ophthalmology

Radiotherapy

A floater option means that under one single health insurance plan, the sum assured amount can be used by all the members covered under the particular policy. All family floater health insurance plans have this option. Unlike individual health insurance plan, the sum assured is not for a single person under floater option.

Day care procedures ate those medical treatments that do not require the patient to be hospitalised for a minimum of 24 hours. Day care treatments can be done in few hours so it is done as an outpatient procedure. There are many insurers who offer health insurance coverage specially designed for day care treatments.

Under some plans, the insurer and the insured are jointly liable to meet expenses. The policyholder will pay a certain percentage towards expenses incurred. If policyholders exercise this option, they are often given reductions in premiums.