Understanding Health Plans: A Simple Guide To Insurance Coverage, Premiums, And Making The Right Choice
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Every person in this day and age needs to have Health Insurance. With rising prices for healthcare services and especially the fast-paced urban life taking a toll on people’s mental and physical well-being, one can never predict what medical emergency or ailment might arise. 

Medical insurance or health insurance helps safeguard a person and their family members during medical emergencies, ensuring that one has ample financial assistance.

In this article, we aim to simplify health insurance for you and hope to help you make an informed decision about choosing the right insurance plan for yourself and your family. We will address frequently asked questions about health insurance to clarify most of your doubts about the topic. We will also try to answer queries like “What are the different health insurance plans?” and discuss how health insurance works. We will also speak about a plan’s affordability and how one can select a plan that is ideal for them.

What Is Meant By Health Insurance?

A health insurance policy is a contract between an insurance corporation and an individual. The insurance company agrees to handle the individual’s medical expenses if they are admitted to the hospital or need medical assistance. This is, however, done in exchange for a monthly amount the individual agrees to pay to the company.

What Is an Insurance Premium? How Is the Amount of an Insurance Premium Decided?

The amount the individual agrees to pay the insurance company is an insurance premium. The insurance companies set the health insurance policy premium based on the person’s medical history, the number of family members to be covered under the policy, their ages, any pre-existing conditions, lifestyle, etc.

For instance, a person who is an avid smoker or drinker will have a higher premium than a person who doesn’t. The insurance company will perform a thorough health checkup before deciding on a premium amount. This step is mandatory as it helps the company gauge the chances of the person being diagnosed with specific diseases and move ahead accordingly. It also informs the person about their health and allows them to understand their body and implement lifestyle changes to avoid critical ailments.

What Are the Documents Required to Buy a Health Insurance Policy?

Insurance companies require you to produce documents to buy a health insurance policy. They usually require proof of Identity, Age, Address Proof, Passport size photographs, a series of medical reports, and any previous medical history. 

The documents collected in India are Birth certificates/10th and 12th standard Marksheets (For proof of Age) and recent electricity bills. Passport (For Proof of address and citizenship) There are also other documents, such as an AADHAR Card, Voter ID, Driving Licence, etc., that can and shall be produced while applying for a health insurance policy.

Additionally, depending on various factors and the insurance company’s business model, the company shall ask for more documents. It also depends on the person applying and the current status of their health.

Different Types of Health Insurance: What Are the Different Health Insurance Plans?

Health insurance as a whole can also be divided into categories. We’ll look at the different types of health insurance and how each differs from the other. This section will help you differentiate between them and choose the best health cover for yourself. This section will educate you about what type of health insurance plans are there in the market. After you read this article, we hope that doubts such as “What are the health insurance types?” are solved.

Individual Health Insurance: What Are Individual Health Insurance Plans?

This type of health insurance covers the healthcare expenses for an individual. This policy covers healthcare expenses from admission to the hospital, daycare, medical bills, etc. Each member has their insured amount and their premium. The insurance aid is capped at that particular amount every year. For example, if you have bought a health insurance cover worth ten lakhs for yourself and your family members, each of you will be able to claim up to Rs 10 lakhs each year.  

Family Health Insurance: What Is Family Health Insurance?

Similar to individual health insurance, the entire family is covered under a single plan. If an individual opts for family healthcare insurance, they pay one premium for all their family members. Under this insurance plan, if the family is insured for, let’s say, 20 lakhs, the person can claim any amount up to 20 lakhs and split it any way they please to use it for themselves and their family members. For example, if a person is insured for Rs 20 lakh, they can claim up to Rs 20 lakh for his entire family combined. This type of health insurance is usually ideal for urban nuclear families.

Group Health Insurance: What Are Group Health Plans?

When an individual joins an organisation as an employee, it might offer them healthcare benefits. These healthcare benefits are in the form of a health insurance policy. Such health insurance policies tend to be cheaper on the premium as the risk of health problems is spread among many people. Group health insurance is the most affordable due to its low premium. The claim settlement period also tends to be low for such insurance as this is an additional benefit for the employees or members of an organisation.

Critical Illness Insurance:

Some diseases are such that they require special care, and since they are chronic, they demand lifestyle changes. Cancer, Kidney Diseases, Liver ailments, various autoimmune conditions, and severe chronic infections fall under this category. These illnesses require the patient to be under long-term care and medication. 

Critical illness care is developed for such situations. In these cases, the insurance company disburses a one-time lump sum amount for the patient/individual to use for their use. They can use this amount for OPD visits, medical costs, and other expenses they might need during treatment. If their chronic condition renders them unable to work, the amount can be used as a supplement to their monthly income.

Points To Consider While Buying A Health Insurance Plan: What Should One Be Careful Of While Buying A Health Plan?

While buying a health insurance plan, it is crucial to understand every aspect of the plan in question. Every detail should be checked and examined. Reading through the fine print, asking as many questions as possible, and clearing all your doubts is essential. Taking your time with things and reviewing all the available options is also essential. 

One can use various insurance aggregators for the same. Examine the wait periods and exclusions as well. A waiting period is the time an individual has to wait to claim insurance payout for a particular pre-existing condition. For example, if a person buys a health insurance plan and has diabetes, they would have to wait for a certain period (generally a year) to avail of the payout for diabetes-related medical expenses.

Benefits of Health Insurance

The most definite benefit of health insurance is that it enables a person to deal with rising medical expenses. Moreover, it gives financial assistance in critical conditions. It also helps an individual save taxes as per Indian laws. 

FAQs

Q. What are the best health insurance plans in India?

A: It is difficult to judge the ‘best’ health insurance plan. How ‘good’ a health insurance plan is can be highly subjective and depends on many factors. Each individual has different pre-existing conditions and different family medical histories as well. The best way to look for the ideal medical insurance plan for oneself is to go through various insurance aggregators and browse their plans. Each person can choose a plan that is ideal for their requirements with an affordable premium considering their financial standing.  

Q. What are some excellent health Insurance plans?

A. Individual health insurance plans are the more basic of the health insurance plans. Each individual needs to assess their health condition, lifestyle, and medical history to judge which health insurance plan is best for them and their family.

 Q. What are affordable health insurance plans?

Some companies offer basic health coverage for as low as Rs 500 monthly. However, the health in terms of affordability and the number of things covered, the best ones are usually the group health plans. This is mainly because it is for a large group within an organisation, so the premium per person is low. 

Conclusion:

We hope this article acts as a helpful guide for individuals seeking a better understanding of health insurance. Our aim is to simplify the details of insurance plans, providing guidance to readers as they navigate the process of selecting the most suitable coverage for themselves and their families. Emphasising the importance of understanding policy details and taking the time to make informed decisions, our intention is to empower readers to choose their health insurance with confidence. The mentioned benefits of financial security and tax savings further emphasise the importance of incorporating health insurance into one’s overall financial plan.

Buying health insurance for oneself and their loved ones is an important life decision which is essential in order to safeguard your and your family’s future. With an understanding of the various aspects of the medical insurance market, you can now make well-informed decisions tailored to your specific healthcare needs.

But not a lot of people in the country are aware of health insurance and the types of plans available. Then, when a medical emergency arises, they are forced to resort to other ways of arranging for funds, like borrowing large amounts of money at a higher rate of interest from money lenders, selling their land or jewellery and so on. 

One cannot argue that healthcare in India is costly, and the costs are rising by the day. And to reduce this financial burden that individuals face when a medical emergency arises, Ketto, an Indian crowdfunding platform, has introduced HealthFirst, which is a comprehensive preventive healthcare plan. HealthFirst emerges as a beacon of hope, protecting individuals from the financial burden of healthcare costs. It distinguishes itself by addressing not only traditional inpatient care but also offers free physical and online OPD consultations, daily hospital cash, and surgery care benefits worth Rs 10,000 and up to 70% discounts every day on lab work and medication, thereby helping you manage your finances if a medical emergency were to arise. 

By integrating preventive measures and comprehensive surgical care, Ketto aims to reduce the financial strain individuals and their loved ones may face during health challenges.

Understanding Health Plans: A Simple Guide To Insurance Coverage, Premiums, And Making The Right Choice
Darshan Supekar