One of the largest joints in the body, the knee is often a cause of concern for most individuals. A healthy knee, which allows us to move, walk and run around with fluidity and flexibility, is now facing the brunt of modern lifestyles and habits. With increasing disposable incomes, availability of home delivery of food and everyday items, and easy transportation people have become less mobile.

Right from clothing to grocery, everything can be ordered and delivered from the comfort of your home or office, without the need for visiting the store. Moreover, the unhealthy lifestyle including reduced physical activity and poor eating habits are adding onto the burden on the knees along with causing other problems such as obesity, high blood pressure, diabetes, and putting the heart at risk.

Having a knee replacement surgery could be a life changing decision, irrespective of your age. However, make sure you ask yourself and your doctor these 5 questions before opting for knee replacement surgery.

1. Have you tried enough alternative options?

Usually doctors first suggest non-operative options such as physical therapy, weight loss, suitable light exercises or medications to strengthen the knee. Knee surgery is more of an “elective” procedure rather than a prescribed option. Hence, make sure you evaluate these options and try them to check if it alleviates the pain and makes life easy with natural remedies and less invasive procedures.

2. Are you doing it at the correct age?

Knee replacements are not as durable as your natural knee structure and lasts for only 15-20 years. If you are getting a knee replacement done at the age of 50 then you may want to reconsider a revision surgery at the age of 65 or 70. Moreover, considering that you will be older by the time you reach your 60s or 70s, the second surgery would be more difficult and harder to perform successfully. Hence, it is advisable to consider knee replacement surgery if you are over 50 years.

3. Which would be the ideal surgery for your knee?

Getting a total knee replacement surgery is not the solution for your knee pains. Your knee surgery depends upon a variety of factors which include your age, physical health, extent of the pain and discomfort, and other factors. Hence, it is best to take opinions for the ideal surgical procedure for your knee pain. There are various knee surgery options such as total knee replacement, partial knee replacement, knee arthroscopy, cartilage treatment as well as knee osteotomy.

4. What could be the outcome of your surgery?

Knee surgery could be a life-altering decision as it will not only affect you physically but mentally too. It is best to research and take different opinions from trusted and experienced surgeons to evaluate the possible outcomes once you undergo the surgical process. Knee replacement does not guarantee improved mobility or pain alleviation, although it may certainly help your cause. Hence, it is important to have appropriate expectations and prepare yourself mentally to undergo the treatment.

5. What could be done to increase the odds for a successful surgery?

As life swings back to the new normal after the lockdown has lifted, we are faced with newer challenges. The biggest one is stepping out of our homes to resume our work life in times when COVID-19 cases in India have not even ceased to multiply. So what could be that one thing that can guard us against the COVID-19 pandemic other than wearing a mask, using a hand sanitizer, maintaining social distancing and getting a Complete Health Insurance ? It’s our very own immune system! It is a pre-requisite to keep it strong and what could be a better way to do so naturally than through some easy yoga poses.

Yoga has proven time and again that it can help reduce our stress levels and keep us calm. Stress, on the other hand, is known to have an adverse impact on our immune system because of the chronic inflammation that it triggers. So when yoga has an anti-inflammatory effect on our body, in a way it ends up keeping our immune system intact. As a result, we are in a better position to defend our health from infections or flu.

Read more about how you can support your immunity against COVID-19

Now, yoga can’t do much for you if you only keep watching some amazing ‘How to do yoga to boost immunity’ videos all the time. Also, it won’t help to start practicing yoga and then give up in 3-4 weeks. For yoga to work for you, you need to keep practicing it with consistency. Don’t be turned off thinking you don’t have a fancy mat, activewear, belts, or bricks to get started with yoga. Yoga, in its purest form as practiced in ancient India, still proves to be equally fruitful to health. Hence, on the occasion of International Yoga Day, we have put together a yoga sequence that will help you reduce stress and boost your immune system without you having to depend upon any extra gears.

Though yoga keeps you healthy and safe physically as well as mentally, a health insurance plan keeps you safe financially, so that you grab your yoga mats and practice yoga stress-free.

Start by doing a gentle warm-up of 5-10 minutes:

• Rotate your head clockwise and anti-clockwise.
• Swing your arms in circles.
• Do some jumping jacks.
• Twist your waist, stretch towards the left side and then right.
• Move your ankles in circles.

Once you feel your heartbeat rising gradually, it’s about time to begin the yoga asanas.

1. Trikonasana (Triangle pose)

Known to strengthen your shoulders, chest, core and legs, this pose leaves you feeling relaxed.

 
.

Duration:: Hold the pose for 30 seconds. Take 5 to 10 deep breaths. Repeat 3 times on every leg.

Benefits of triangle pose: Releases the tension in your shoulders, reduces stress and anxiety, improves blood circulation, concentration and balance. It is considered to be one of the best yoga poses that boost your immune system.

2. Uttanasana (Forward Fold)

This is a powerful pose where oxygen reaches your brain since it is at a lower position than your heart, leaving your cells energized..

 
.

Duration: Hold the pose for 15-30 seconds and take deep breaths.

Benefits of forward fold: Eases congestion in sinuses, thereby boosting your immunity. Relieves stress, anxiety and beats insomnia. Keeps you calm.

3. Bhujangasana (Cobra pose)

This pose falls under Suryanamaskar (sun salutation). It opens your lungs, strengthens your spine and increases your energy.

 
.

Duration: Hold the pose for 15-30 seconds and breathe normally.

Benefits of corbra pose:Relieves stress and fatigue, elevates your mood. Also helps with asthma and breathing problems.

4. Shishuasana (Child pose)

This pose will help you relax after you have nailed the earlier three poses. Unlike the others that must be done in the morning, you can do this pose whenever you need a break in the middle of a stressful day.

 
.

Duration: Hold for 1 to 3 minutes.

Benefits of child pose: Works best for getting a sound sleep, eases back pain, relaxes your entire body and boosts your immune system by stimulating the lymphatic system.

5. Matsyasana (Fish pose)

When you get into this pose, the thyroid gland is stimulated, which further helps to boost your immunity. Matsyasana also eradicates toxins from your digestive system.

 
.

Duration: Hold the pose for 30-60 seconds. Breathe normally.

Benefits of fish pose: Combats anxiety and fatigue. Helps with respiratory problems, eases back pain, releases tension in your neck and shoulders.

6. Viparita Karani (Legs up the wall)

A fairly simple pose, but you can’t imagine a yoga sequence to boost your immune system without it. It relaxes your nervous system and thus helps to strengthen your immunity.

 
.

Duration: Start by holding the pose for 5 minutes, then increase the duration with practice.

Benefits of legs up the wall pose: Relieves stress, headache, migraine, insomnia, anxiety and menstrual cramps. It is also known to help with fertility problems.

7. Anand Balasana (Happy baby pose)

It can help you end your yoga session on a fun note. It is a great pose to detoxify your hips and calm your mind.

 
.

Duration: Hold the pose for 30-60 seconds. Breathe normally.

Benefits of happy baby pose: Releases tension from your lower back, increases vitality, reduces stress and fatigue, elevates mood and rejuvenates your mind. Thus, working wonders to boost your immunity.

5 health tips you should not miss to follow even on a busy day:

• Meditate
• Eat on time
• Get enough sleep
• Drink enough water
• Add green veggies to your diet

Spike in medical inflation has significantly pushed up hospitalisation expenses, making health insurance an absolute must. Knowing about the list of network hospitals is among the several things you must consider while buying a health plan. There are several benefits on offer while undergoing treatment in a network hospital.

However, that doesn’t mean that you can’t avail of treatment in a non-network hospital. It’s essential for you, as a policyholder, to understand the difference between network hospitals and non-network hospitals so that you can make a prudent choice when the need arises. This article aims to decipher the differences between the two on different parameters. Let’s get started.

Meaning of Network Hospitals in Health Insurance

Network hospitals in health insurance refer to hospitals and clinics with which your health insurer has a collaboration, and these hospitals are on the empanelled list of your insurer. Every health insurer has a tie-up with different hospitals (in your state and outside), clinics, and treatment care centres.

These are known as network hospitals with which your health insurance company has a contract. When you get admitted to any network hospital, you are eligible to receive cashless treatment facilities, subject to the policy’s terms and conditions.

Meaning of Non-network Hospitals in Health Insurance

Non-network hospital means hospitals, clinics, and treatment centres that are not on the empanelled list of your health insurance. In other words, your insurer doesn’t have a collaboration with them. If you end up hospitalised in a non-network hospital, you can’t avail cashless treatment facility.

Though every health insurance company strives to have an extensive network of hospitals, some are left out. No health insurance company can have a tie-up with all the hospitals and medical treatment centres present in the country. However, leading hospital chains and reputed clinics are on the empanelled list of health insurance companies.

Parameters on Which Network and Non-network Hospitals Differ

1. Cashless Treatment Facility

Cashless treatment facility is one of the fundamental differences between a network and a non-network hospital.  It essentially means that you don’t have to end up paying upfront when you are hospitalised in a network hospital. Inform your insurer about hospitalisation and submit the relevant documents to the third-party administrator (TPA).

In a network hospital, your insurer directly settles hospitalisation expenses incurred. However, the case is different in the case of a non-network hospital. When you get yourself treated in a non-network hospital, you have to make payments upfront.

Once you are discharged, you need to submit the relevant bills and reports to your insurer. After due diligence, the insurer reimburses you the hospitalisation expenses incurred based on the policy purchased by you.

2. Documentation and Formalities

Documentation and formalities are a straightforward process in a network hospital. Present your health card to the TPA (third-party administrator), get in touch with your health insurer, and you are done. They take the process forward. You don’t have to undergo the cumbersome process of keeping all documents, including doctor’s reports, bills, etc to claim your insurance.

However, things are different in a non-network hospital. You have to keep all the documents carefully as misplacing them can lead to claim rejection or being reimbursed a lower claim amount. If you happen to lose any document, arranging a duplicate for the same can be challenging. This will also delay the claim settlement process.

3. Cash Arrangement

When you get treated in a network hospital, you don’t have to worry about cash arrangements. As said, everything is cashless. However, if you get treated in a non-network hospital, you may need to deposit some cash upfront for admission. Also, you need to make regular payments during the course of treatment, which can be pretty challenging.

During testing times such as these — when income is under stress due to the COVID-19 pandemic — arranging and paying cash in short intervals can be an uphill task. In such situations, you may end up borrowing money on high-interest rates that can further dent your finances.

Breakfast is important because it is the first meal after the longest period of fasting in a day. Usually, there is a gap of 10-12 hours between the previous day’s dinner and the next day’s breakfast. Whether you are a school-going kid, a gym enthusiast, a workaholic professional or a stay-at-home person, skipping breakfast can not only make you weary throughout the day but also increases your risk of developing a variety of diseases and illnesses. According to experts, integrating a healthy breakfast into your daily routine not only benefits your physical health but also enhances your mental wellbeing. However, many people are unaware of what to eat for breakfast and some even skip their morning meals. Today, in this article, we will focus on what to eat for breakfast and why.

What to eat for breakfast?

Whole grains:

Whole grains are the grains of pseudo-cereals and contain all three parts of the grain—the bran, endosperm, and germ. Some of the common whole grains breakfast foods that are healthy include: 

• Multi-grain dosa
• Oatmeal
• Barley
• Whole-wheat bread

Why are whole grains a key to a healthy breakfast?

• Whole grains provide fibre as well as a variety of essential nutrients and minerals. Some of the vital minerals in whole grains include zinc, iron, magnesium, and phosphorus. 
• Whole grains contain antioxidants, fibre, and vitamin K, which helps in lowering the risk of a heart attack.
• Since whole grains are high in fibre, most health experts believe that it helps in preventing obesity and helps in weight loss.
• Replacing refined grains from your morning breakfast and replacing them with whole grains lowers your risk of type 2 diabetes.

Whole grain wheat fibre components act as a prebiotic, aiding digestion by feeding beneficial gut bacteria.

Lean Protein:

Lean protein foods are those that are high in protein but also low in less healthy nutrients such as dietary cholesterol and saturated fat. If you are looking for healthy breakfast food options that are rich sources of lean protein, consider including the following in your meal plan: 

• Sprouts salad
• Scrambled egg or cottage cheese (paneer)
• Tofu chilla

Oats uttapam and idli

Why include lean protein foods in your breakfast?

• Lean protein keeps your body healthy by helping you lose extra weight.
• If you are a gym enthusiast, incorporating lean protein in your breakfast can help you gain muscle.
• Since lean protein contains very little amount of saturated fat, it lowers the risk of cardiovascular diseases.
• Many lean protein sources such as yoghurt and chicken have high levels of zinc that help in boosting our immune system.
• Lean proteins not only help you lose weight but also provide your body with the vitamins and minerals it needs to keep your metabolism functioning smoothly.
• Lean proteins are known for lowering blood pressure levels and increasing LDL cholesterol or, say, the good cholesterol in your body.

Low-fat dairy:

When compared to full-fat milk, low-fat dairy products have fewer calories and more protein. Consuming low-fat dairy products for breakfast lowers the risk of heart diseases since they contain less saturated fat. Some of the healthy low-fat dairy products that you can add to your breakfast are:
• Skimmed milk
• Yoghurt
• Ice cream
• Cottage cheese

Why include low-fat dairy in your breakfast?

• Low-fat dairy products such as yoghurt and cottage cheese are abundant in protein and calcium that help in building your muscles and improving your bone density.

Including low-fat dairy or fat-free dairy in the diet helps in lowering the risk of cardiovascular diseases, metabolic syndrome, obesity, and diabetes.

Fruits and vegetables

Including fruits and vegetables in your breakfast is also a great way to reduce your calorie intake. Since they are an excellent source of vitamins and minerals, fruits and vegetables come with a host of advantages. Some of the healthy fruits that you can include in your breakfast are:

• Pineapple and cherry for anti-inflammation
• Grapefruit, strawberries, and kiwi for boosting your immune system
• Pomegranate for antioxidant
• Watermelon for body detoxification

We generally tend to lead our lives within a fixed routine. Tasks like cooking, driving, cleaning do not require us to exhibit our mental strength. Just as you take steps to ensure your body is fit and healthy, you need to do brain exercises for your mind to remain healthy.

These monotonous tasks do not provide our brain with enough stimulation, which is needed to keep our brain active and functioning well.

Here are eight ways to not only achieve brain fitness but also make your day enjoyable and exciting:

Meditation

Beginning your day with mediation is one of the great techniques for brain exercises. It helps you feel refreshed overall and energized. According to studies, mindful meditation is highly effective. It stimulates new neural pathways, thereby improving your self-observational skills and helping you increase your mental flexibility.

Besides, meditation has also been found to help improve your attention span and focus, empathy, and even build your immunity. Moreover, it has also been observed that meditation has the power to enhance your working memory's capacity, thus helping you keep your brain sharp.

Use non-dominant hand

The most effective techniques for brain exercises are those that are not necessarily easy. Using your non-dominant hand or the hand you don't usually use is one of the interesting ways to increase your brain sharpness.

For instance, if you use your right hand for most tasks like brushing your teeth or even gardening, try doing that with your left hand. Since your brain is used to your dominant hand, using your opposite hand is challenging and one of the great brain exercises and stimulators.

Try crosswords

Indulging in crosswords or Sudoku or playing games like Tetris for approximately 15 minutes is another effective technique for brain exercises and a fun way to challenge your brain. These activities can significantly help you improve your brain's speed and memory and your analytical skills since they rely on logic, word skills and maths besides also being fun.

Studies have found that crosswords improve your attention span and focus on desired tasks while enhancing your working memory, cognitive abilities, and overall functioning.

Eat healthy

Studies have found a link between green leafy vegetables, fruits, whole grains, legumes, nuts, fish, and olive oil in your diet and improved brain sharpness, cognitive skills, and overall mental health.

Regular intake of these foods reduces the risk of Alzheimer's by more than 50%. Eating healthy is thus extremely good for achieving brain fitness and maintaining good brain health.

Body fitness = brain fitness

Exercise helps you achieve brain sharpness and fitness and prevents your brain from ageing fast. When you do physical exercise, it is as good as your brain indulging in activities. A study found that doing physical exercise and thus indirectly doing brain exercises reduces your risk of experiencing dementia and cognitive impairment.

Doing exercise such as walking or doing push-ups has been found to increase the generation of new brain cells, thus enhancing your brain's sharpness.

The COVID-19 pandemic tossed life off gear in a matter of weeks throwing global economies in disarray. While the trail of devastation because of the deadly virus is well-documented, it also gave several critical lessons on different aspects, with health insurance being one of them.

The once-in-a-century pandemic gave essential lessons on imbibing health insurance, which can help you stay better prepared should such an event occur in the future. What are these? Let’s find out.

Health Insurance is Not a Want Anymore

While the need for health insurance plans was always there, many people took it as an unnecessary expense. There was no significant urge to buy health insurance among the majority of the people. However, the pandemic changed this outlook. Data shows that people purchasing comprehensive health insurance plans stood at approximately 32% during pre-COVID times, and it shot up to 55% after the pandemic.

Insurers witnessed a significant demand for health plans coming their way - a testament that health insurance is not a want but a modern-day need. Financial literacy advocates have always highlighted the need and importance of health insurance in one’s portfolio; it took a pandemic of this magnitude to drive home the point.

So, if you don’t want your finances to take a dip because of COVID-19, it’s paramount to buy a health insurance plan at the earliest.

Have Adequate Sum Insured

Sum insured is one of the vital aspects to look for while buying health insurance, and it is the maximum amount your insurer pays in case of hospitalisation. The COVID-19 pandemic has changed the dynamics of purchasing health insurance plans and what was earlier thought to be adequate is not the case now.

Many cases have come to the fore where hospitalisation bills have run into lakhs of rupees and are significantly higher than the sum insured offered by the policy. Hence, it’s essential to opt for a plan with a high sum insured to minimise out-of-pocket expenses. If you live in a metro, where treatment costs are higher than non-metros, it’s prudent to opt for a policy with a sum insured of at least Rs. 15 to 20 lakhs.

Though it pushes up the premium, it will come to your rescue, should you need hospitalisation. Another way to ensure adequate coverage is to avail a top-up plan. A top-up plan is cheap and works on the concept of deductible. Once you have paid the deductible amount mentioned in the top-up plan through your base policy, the benefits kick in. It’s a cost-effective way to ensure you have a wider net to deal with large COVID-19 bills.

After two years since the imposition of Covid-19 restrictions in Mumbai and Maharashtra, the Maharashtra government withdrew all Covid-19 curbs on 1st April 2022. The decision was made following a sharp decline in cases during a state cabinet meeting chaired by Chief Minister Uddhav Thackeray on 31^st March 2022.

Covid-19 in Maharashtra took a significant toll on life, as the state was one of the worst hits during the pandemic. Cases were significantly high during the first, second and third wave of the pandemic. 

However, things have changed over the past few months with concentrated efforts from the authorities and front-line workers. Hence, the Maharashtra Government decided to withdraw all the Covid-19 restrictions imposed under the Disaster Management Act, 2005.

Health insurance is essential in order to ease the financial burden that arises due to a medical emergency, surgery, or critical illness. There are many health insurance plans offered by different insurance companies with different add-on covers and benefits. You should opt for the policy that best suits your needs and gives you respite in difficult times, such as the hospitalization of yourself or a loved one due to an untimely injury or illness. At the same time, it is important to know the kind of treatments and health conditions your medical insurance plan does not cover. Understanding these exclusions is crucial to avoid surprises during critical times.

What are Health Insurance exclusions?

Health insurance exclusions refer to the situations, medical conditions, or treatments excluded from your health insurance policy coverage. These exclusions are mentioned in the policy document and highlight the boundaries of what the insurer will and will not cover.

For instance, if a policy excludes cosmetic surgeries, any expenses related to such treatments will not be reimbursed, even if the policyholder files a claim.

Exclusions generally fall into two categories:

1. Permanent exclusions: Conditions or treatments never covered by the policy.
2. Temporary exclusions: Conditions or treatments excluded for a specific period (e.g., pre-existing diseases during the waiting period).

Common Health Insurance exclusions

Below are some of the most common exclusions in health insurance policies:

1. Cosmetic Surgery

A surgery of this kind is not life-threatening or dangerous, thus Liposuction, Botox, or surgeries of a similar kind are not covered under a health insurance policy.

2. Pre-existing Diseases

Now this varies from one insurance provider to the other. Some insurance providers do not provide coverage for high blood pressure and diabetes, while some do. Some insurance companies offer cover for pre-existing diseases if the insured continues with the policy for a considerable period of time such as 12 - 48 months. In the case of some insurers, payment of additional premiums will cover the insured for pre-existing diseases.

3. Pregnancy and Abortion

Medical treatment expenses for pregnancy and abortion are not covered under health insurance. Even if it is a cesarean section or complication due to pregnancy, insurers do not consider pregnancy as a condition to be included in a health insurance plan. Most of the insurance providers do offer financial protection for abortion unless it is crucial in saving the mother’s life. In such an unfortunate instance, the case should be presented post-certification by a medical practitioner to the insurance company. Some companies also provide additional maternity covers. Note that voluntary abortion is not covered under health insurance. 

4. Diagnostics Expenses

Charges incurred to identify the virus or pathological surveillance (blood test, CT Scan) of your body performed at a hospital or a nursing home are not accounted for in a health insurance policy.

5. Miscellaneous Charges

Registration charges, admission fees, and service charges are not considered for claims by a medical insurance plan.

6. Health Supplements

Health tonics and protein shakes, which is not consumed by an individual to counter disease are not included under health insurance. However,  if these supplements are recommended by a medical practitioner as part of treatment while the individual is hospitalized, only then it rightfully falls under an insurance plan.

Why Do Health Insurance Plans Have Exclusions?

Health insurance exclusions are not arbitrary; they serve specific purposes:

1. To Keep Premiums Affordable

By excluding high-risk or non-essential treatments, insurers can offer affordable premiums to a broader customer base. Covering every possible condition or scenario would make health insurance unaffordable.

2. To Reduce Fraudulent Claims

Exclusions act as safeguards against false or inflated claims for non-essential or self-inflicted injuries, ensuring fair play for all policyholders.

3. To Align with Risk Management

Insurers calculate risk based on historical data and trends. Excluding high-risk activities or conditions helps manage financial liabilities.

4. To Focus on Essential Treatments

Exclusions allow insurers to prioritise coverage for essential and widely needed conditions, such as hospitalisation and critical illnesses, rather than niche or cosmetic procedures.

5. To Set Clear Policy Boundaries

Clearly defined exclusions prevent ambiguity and help policyholders understand the scope of their coverage.

How Do Insurance Companies Decide Exclusions in Health Insurance Policy?

Insurance companies set exclusions based on multiple factors, including medical, financial, and regulatory considerations. Here’s how they decide what to exclude:

1. Actuarial Risk Assessment

Actuaries analyse disease prevalence, treatment costs, and claim frequency data to identify high-risk conditions that could financially burden the insurer.

2. Regulatory Guidelines

Regulatory bodies like the Insurance Regulatory and Development Authority of India (IRDAI) provide guidelines for exclusions to ensure standardisation and fairness across policies.

3. Market Trends

Insurers consider trends in customer behaviour, demand for certain coverages, and industry norms to decide on exclusions. For example, policies without maternity benefits cater to younger, single individuals.

4. Cost-Benefit Analysis

Treatments or conditions with a high cost but low probability of occurrence are often excluded to maintain financial viability.

5. Focus on Insurable Risks

Insurers focus on risks that are insurable and measurable. Non-measurable risks, like those associated with substance abuse or experimental treatments, are excluded.

FAQs

1. Can exclusions in a health insurance policy be removed?

Some exclusions, like pre-existing diseases, can be covered after completing the waiting period. Riders or add-ons can also remove certain exclusions, such as maternity coverage.

2. Are exclusions the same across all health insurance policies?

While many exclusions are standard, specific exclusions can vary between insurers and policy types. Always read the policy document carefully.

3. How can I minimise the impact of exclusions?

• Opt for policies with fewer exclusions.
• Use add-ons or riders to extend coverage.
• Choose comprehensive plans with features tailored to your needs.

4. Are alternative treatments like Ayurveda or Homeopathy excluded?

Many insurers now cover alternative treatments recognised by the AYUSH system. However, unproven therapies may still be excluded.

5. What happens if I file a claim for an excluded condition?

Claims for excluded conditions will be rejected. Ensure you understand your policy’s exclusions to avoid such scenarios.

6. What are common exclusions in health insurance policies?

Pre-existing health issues, cosmetic surgeries, self-harm done on purpose, optional medical therapies, and experimental treatments are standard exclusions under any health insurance.

7. Do health insurance policies in India have exclusions for international or foreign individuals?

Yes, insurance policies in India may exclude foreign nationals from their coverage unless they are mentioned and included in the policy.

8. Are there age-related exclusions in medical insurance?

Yes, several health insurance policies have limitations on coverage, especially for older policyholders. People above 60 are thus advised to go for Senior Health Insurance plans, which are better suited for their advanced age and medical conditions.

Conclusion

Exclusions under a health insurance policy are as important as the inclusions. They ensure that policies are affordable and sustainable for larger groups of people while catering to the medical needs of each policyholder. It is advisable to familiarise yourself with things like exclusions at the time of buying the policy. Read the documents carefully and consult the insurer in case of any questions. Remember, by being aware of the nitty-gritty of your insurance, you can ensure that it becomes your safety net when you need it the most.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

The COVID-19 disease, which gripped the world during early 2020 after the rapid spread of coronavirus, has had detrimental effects on the world till now. Not only it has resulted in the untimely death of millions of people around the globe but also it ruined the economy of many countries. In India, the coronavirus has caused the death of more than 1.6 lakhs people till now.

However, things are expected to improve after the vaccines for covid-19 were introduced by different countries around the world. In India, the Serum Institute of India (SII) and Bharat Biotech released the covid-19 vaccines known as ‘Covishield’ and ‘Covaxin’ respectively. In January 2021, the Health Ministry of India introduced its plan to begin a vaccination drive to vaccinate the Indian population against this disease.

However, not everyone or anyone is supposed to take the vaccine right away. In the first phase of the vaccination drive, the healthcare workers and frontline warriors against the covid-19 disease received the vaccine. Whereas, during the second phase, people above the age of 60, and those above the age of 45 with co-morbidities are being vaccinated.

Both SII and Bharat Biotech as well as the Government of India have listed the risks and side-effects associated with the covid vaccines. Read on to know who should and who should not take the covid vaccine in India.

Who can take the vaccine?

During the second phase of the vaccination drive, the Government of India has allowed the people above the age of 60 and those between 45 to 59 with co-morbidities to take the vaccine. It means that anyone falling in this age range (barring a few exceptions which we have mentioned later) can take the covid-19 vaccine in India.

Those with co-morbidities are required to submit a certificate of co-morbidity, duly signed by a registered medical practitioner, for taking the vaccine. This certificate can either be uploaded at Co-Win 2.0 by the beneficiary itself while registering for the vaccine or a hard copy can be submitted at any covid vaccination center.

Here is the full list of co-morbidities:

• Heart failure during the past year
• Post cardiac transplant or Left Ventricular Assist Device (LVAD)
• Valvular Heart Disease
• Congenital heart disease with severe PAH
• Coronary Artery Disease with past Hypertension or diabetes
• Angina with past Hypertension or diabetes
• CT/MRI documented stroke with past hypertension or diabetes
• Diabetes or Hypertension for more than 10 years
• Kidney/Liver/Hematopoietic stem cell transplant
• End-stage kidney disease on Haemodialysis or CAPD
• Current and prolonged use of oral corticosteroids or immunosuppressant medications
• Decompensated cirrhosis
• Severe respiratory disease requiring hospitalization in past two years
• Lymphoma or Leukaemia or Myeloma
• Cancer or cancer therapy
• Sickle cell disease or Bone marrow failure or Aplastic anemia or major Thalassemia
• HIV or AIDS infection
• Persons with disabilities

The COVID-19 pandemic struck in December 2019 and since then, have wreaked havoc in the entire world. Till date, approximately 19 crore cases of Covid-19 have been reported across the globe, resulting in more than 40 lakh casualties. The spread of this disease reached its pinnacle by mid-2020 but slowed down a bit in 2021.

However, just when the world thought that the end of the pandemic is near, a new covid variant named “Delta Plus” was spotted by the experts. This strain of coronavirus, which has been found in more than ten countries so far, is seen as a cause of concern among the health experts as it is believed to mutate rapidly and can transmit much more easily. Buying health insurance would be the great option in this pandemic to save your savings.

Also, the doctors believe that the new covid delta variant can cause more severe symptoms in the infected patients, as compared to other strains. Continue reading to know all the information that is there in the public domain about this covid variant so far.

What is the Delta Plus variant of COVID-19?

The new Delta Plus variant of COVID-19 has been formed due to a mutation in the delta variant of the coronavirus, which is also known as the B.1.617.2 variant. As per the experts, the cause of this mutation is the delta variant acquiring the spike protein mutation K417N to form a new variant which is scientifically called AY.1 variant.

According to the doctors, the new covid variant has almost 40-60% increased ability to transmit and can cause more serious symptoms in the infected patients. Also, the positivity rate as well as death rate can go up due to this variant.

Where was this variant first found?

The first case of the covid delta plus variant was found in Europe in March 2021. Since then, health experts around the globe along with the World Health Organization (WHO) have been keeping a close watch on the impact and transmissibility of this covid-19 variant.

England was one of the first countries where the delta plus variant began to spread. Till date, this variant of the coronavirus has been found in more than 10 countries, including India and Nepal. As per the Union Health Ministry of India, around 300 cases* of Delta Plus variant of Covid-19 has been detected in our country so far.

Apart from India, the cases of delta plus variant has also been found in the United States of America (USA), UK, Portugal, Spain, Switzerland, Japan, Russia, China, Nepal, and Poland.

What risks does this variant pose?

As we have already mentioned, the new Covid variant possesses 40 to 60% increased ability to transmit*. As per the WHO, “the delta plus and other circulating variants of the coronavirus pose a high risk to public health, as they have demonstrated an increased transmissibility”.

Furthermore, the Government of India as well as health officials have declared this variant of coronavirus as a “variant of concern”. Also, this variant is believed to reduce the effectiveness of monoclonal antibody treatment technique, where an antibody cocktail of Casirivimab and Imdevimab is used to treat the patients infected with the coronavirus.

As per the SARS-CoV-2 Consortium on Genomics (INSACOG), the delta plus variant of Covid-19 is a cause of concern due to the following reasons:

• Increased transmissibility
• Strong binding impact on receptors of lung cells
• Potential reduction in monoclonal antibody response

Coronavirus vaccine: What happens if you delay your second dose of vaccination?

The COVID-19 disease that gripped the world during the early months of 2020 after the rapid spread of the COVID-19 variant had detrimental effects on the people and the economy. It led to the untimely death of millions of people across the globe and adversely affected the economy of many countries. In India, the number of deaths due to COVID-19 is more than 4 lakh to date. So, it is important to be covered with a good health insurance plan which can cover COVID-19 related expenses.

However, the situation has started to improve, and the death rates are declining, after the introduction of COVID-19 vaccines by different countries around the world. In India, the Serum Institute of India (SII) and Bharat Biotech released the two COVID vaccines labelled ‘Covishield’ and ‘Covaxin’, respectively. In January 2021, the Health Ministry of India started possibly the biggest vaccination drive anywhere across the world to vaccinate the Indian population against this disease. Vaccines have shown promising results in minimising the threat of the virus that causes the COVID-19 disease. The immune response to vaccines is so reliable that the public health department has started a mass drive to provide booster shots to frontline workers. The disease control and prevention departments are confident in the booster shots' effectiveness. However, the additional shots are only available to a selected group of people and will be made available to the general public following the authorisation or approval of the government.

Gaining immunity against the coronavirus requires a person to get two full shots or doses of the COVID vaccine. The second dose of Covaxin can be taken after 28 days of the first dose, whereas for Covishield, the time between the first and second doses should be at least 84 days. However, due to multiple reasons, many Indians have missed the timeline for taking the second dose of the COVID vaccine.

In this article, we will evaluate what can happen if you delay your second dose of COVID vaccination. But first, let’s look at some possible reasons that can lead you to miss your second dose of vaccine:

1. Health concerns

Some health concerns and recent complications can prevent you from taking your second dose of the COVID vaccine on time. As per the doctors, if you’ve contracted COVID-19 during the last two-month period, or if you are experiencing COVID-like symptoms presently, you should not take the vaccine shot.

2. Pregnancy

If you get pregnant after the first shot of COVID vaccination, your second shot might get delayed. Right now, there is not much data and additional information on how COVID vaccination can impact an expecting mother and the foetus. Hence, it’s advisable to consult your Ob-Gyn physician before taking your second vaccination dose during pregnancy.

3. Unavailability of vaccine

The unavailability of vaccine doses is one of the major reasons behind many Indians missing their second dose of COVID vaccination. Although the Government of India has initiated the biggest vaccination drive in our country, India's huge population means that we can't rule out inadequate vaccine supply.

4. Lockdown

The second wave of coronavirus in India was devastating. As a result, strict lockdowns were imposed by various state governments across the country, which prevented many people from going to the vaccination centres for taking their second jabs.

What if you miss your second dose of vaccination?

It’s never advisable to miss your second dose of COVID vaccination. You must positively try to get your second shot within the window mentioned in your vaccine certificate. If you fail to take the second shot, you may remain less protected from the deadly coronavirus. And in case you get infected with the virus, the chances are that the vaccine will not be effective.

As per a statement from the Former Head of the Indian Council for Medical Research, the first dose of the COVID vaccine only does the “Priming” job. It means that it creates a booster immunity in a person’s body against COVID-19. However, complete immunity is attained only after receiving the second dose of vaccine within a stipulated period.

Also, the partial immunity achieved from the first dose can diminish over time if the second dose is not taken. The majority of people who died after receiving their first dose died due to their vaccination being incomplete. Hence, it’s very important to get the two doses of COVID vaccination within the pre-determined period.

And if, for any reason, you miss your second dose of vaccine, visit the CoWin app or portal and schedule your appointment for your second dose of vaccination as early as possible.

The second wave of the COVID-19 pandemic hit India severely. The Delta variant (also call the Indian variant) of the coronavirus, which is believed to be behind the rise of second wave of COVID-19 in India, spreads much faster and can have a very drastic effect on the infected patients. As a result, the positivity rate of coronavirus as well as the mortality rate is much higher this time around. Buy health insurance policy that provides coverage against all hospitalization-related expenses, including coronavirus and black fungus treatment.

Even as India continue to struggle with the impact of COVID-19’s second wave, rising cases of black fungus infection among those recovering from the virus brought fresh concerns for the Government and citizens alike. As per the Central Government’s data, there were about 8,848 cases of black fungus infection in India on 22^nd May, 2021. And these figures were spiraling at a rapid rate.

Experts are calling this infection “A Pandemic within Covid-19 Pandemic”. As per the reports, number of people dying due to black fungus infection in India is steadily increasing. From black fungus symptoms, to causes, to its treatment, we have discussed everything you need to know about this disease in this article. Continue reading.

What is Black Fungus?

Also known as Mucormycosis, black fungus disease is a fungal infection which is presently seen in patients who are suffering from COVID-19 with co-morbidities such as HIV/AIDS, uncontrolled diabetes, and Mellitus cancer. If not controlled during its initial stages, black fungus infection can prove to be fatal for the patients.

What causes Black Fungus?

Black fungus or Mucormycosis is basically a rare fungal infection which is caused by a group of moulds or fungus known as Mucormycetes. These moulds are considered separate from plants and animals kingdom, and are found in plants, soil, water, decaying organic matter, and sometimes in animals and humans.

As per the doctors, the primary reason behind the development of fungal infection in a COVID-positive patient is prolonged exposure to moisture during oxygen therapy. Use of ordinary tap water in flow meters of oxygen cylinders are also believed to cause black fungus infection. This can also be triggered due to the use of mould-tainted oxygen pipes and humidifiers.

Who all are at risk?

As per the Ministry of Health, black fungus infection in India is mostly detected amongst people who are recovering or have recovered from the COVID-19 disease. This infection can occur anytime to a coronavirus patient i.e. either during his/her hospital stay or several days to few weeks after discharge.

People who have sinus problems or those who are on medications for lung problems are most susceptible to catch black fungus infection during the treatment of COVID-19. Besides, those who are suffering from diabetes, cancer, blood malignancies, and iron deficiency are prone to this fungal infection.

In the world of sky-high medical expenditures and sudden health problems, health insurance is undoubtedly necessary. A well-formulated health insurance cover gives you access to competent and quality healthcare facilities at all times. It helps you tide over medical expenses in a planned manner without creating a financial burden.

However, they entail a considerable premium amount that deters many individuals from taking an insurance cover, thereby isolating themselves from the host of benefits offered by the health insurance policies.

Insurance companies provide the health insurance co-pay feature as a part of their policy that you can use to reduce the premium payable amount. In this article, we shall discuss what is co-pay, its features, and benefits for insurance holders.

What is co-pay in health insurance?

The co-pay feature is an optional clause offered by health insurance companies in their policy. It is an arrangement between the policyholder and the insurance company wherein they share the medical expenses based on a mutually decided co-pay percentage. 

This co-pay percentage is the share of medical expenses that shall be borne by the policyholder in the event of a medical eventuality covered by the policy. For example, Ananya takes a health insurance cover with a co-pay feature of 15%. She incurs a medical bill amounting to Rs. 1 lakh. With the co-pay feature, Ananya will have to pay Rs.15,000 (1,00,000 x 15%), and the insurance company shall cover the balance. 

You may wonder, why would one take a policy where he/she has to pay out of their pockets? And why would the company offer such a feature?

Benefits to the Insured

• Reduced premium

The insured pays a specific portion of his/her medical expenses under the health insurance co-pay scheme. This feature provides the insured person with a direct benefit in the form of a reduced premium amount which is otherwise quite significant. Higher the co-pay percentage, lower the premium amount.

• Direct savings

Health insurance policies are of a pre-determined tenure, and you have to pay the same premium amount irrespective of whether you file a claim or not. With a co-pay health insurance cover, you pay a relatively lower premium amount. If you do not have any claim during the policy period, you have direct savings in the form of a lower premium amount.

Benefits to the insurer

• Promotes honest customer behaviour

Co-pay health insurance brings about a sense of ownership among the policyholders. It is common for policyholders to avail the services of expensive, luxury medical facilities unnecessarily and cover the expenses by filing claims with the insurance company.

In co-pay health insurance covers, policyholders realise that they will have to bear a portion of the medical expenditure, even if nominal. The clause encourages them to opt for services that are necessary and reasonable. 

• Reduction in misuse and fraudulent claims 

Insurance companies are often faced with inflated medical bills and fraudulent claims due to a nexus between healthcare facilities, insurance agents, and scammers disguised as policy holders. In such situations, insurance companies have no choice but to pay claims for medical services that were, in reality, not rendered to patients. It creates a dent in the insurance companies’ profitability and operations. 

With co-pay health insurance policies, patients know that they have to pay a certain sum of the expenses from their own pockets, which naturally keeps frauds at bay.  

India, went through a tough time during the second wave of coronavirus. The symptoms experienced by the infected patients were much more severe this time around. In fact, during the second wave of coronavirus in India, a greater number of middle-aged people (those who are aged between 30 to 50 years) and pregnant ladies got infected.

As per a recent study by Oxford University, pregnant ladies who are COVID-19 positive and their unborn babies might face a higher risk of complications than what was known previously. Women with co-morbidities are at an even higher risk. In many cases, the virus affects the unborn baby by reducing the amniotic fluid around it.

However, that doesn’t mean there is a need for panic. Not every pregnant woman, who is infected with the coronavirus, faces the same symptoms. Though, there could be some complications during the advanced stages of pregnancy as the immunity of a mother becomes weak during this time, mild cases of COVID-19 during pregnancy can be tackled at home with proper diet, rest, and exercise. Securing yourself with Health Insurance that covers covid-19 will be the best solution you have.

In case you’re pregnant and have tested positive for COVID-19, here’s what you should do to keep yourself and your baby safe.

1. Take all necessary precautions and follow Covid-safety protocols

We all know that prevention is better than cure. Make sure you are following all COVID-safety protocols laid down by the Government. It includes practicing social distancing, staying away from public places, and avoiding meeting anyone who has possible COVID-19 symptoms. Also, wash hands frequently or use hand sanitizers whenever you touch any high-contact surface.

It’s understandable that as a pregnant lady, you can’t avoid going out completely. You might have to visit your gynecologist or go out for antenatal activities. However, whenever you step out of your home, don’t forget to wear your mask, and take hand sanitizer with you.

2. Don’t panic and stay positive

Even if you’ve tested positive for coronavirus during your pregnancy, there is no need to panic. Don’t run immediately for hospitalisation as mild cases of COVID-19 can easily be cured at home with a few precautions and medications. Take proper rest and have a healthy diet.

Another thing is you should stay as happy and positive as possible. This will not only provide you the strength to fight with the disease but also keep your child in a good shape.

3. Isolate yourself. Get teleconsultation with your doctor

It’s obvious that you would never want someone else in your family to get infected with the virus and suffer. The first thing you need to do when you notice the coronavirus symptoms in yourself is to get isolated. Do not let anyone enter your room except if there’s an emergency.

Take regular teleconsultations with your doctor. Follow his/her advice strictly while taking your medicines. Keep checking your body temperature and blood’s oxygen saturation level every three to four hours. In case you notice anything adverse, inform your doctor immediately. Do not self-medicate in any case.

Premium is an essential factor that you must take into consideration before buying health insurance. This is because only if you pay it on time can you avail the benefits of your policy. It’s interesting to note that premiums for the same plan may differ across policyholders. While you can easily get a quote from your insurer, keeping in mind these factors can help you calculate health insurance premiums.

Factors Affecting Health Insurance Premiums

• Age

It is a vital factor affecting health insurance premiums. Premiums increase with age. This is because the body is more susceptible to diseases and ailments as and when you age. The insurer thus covers a greater risk and hence charges you more.

Therefore, it’s is advisable to buy health insurance when you are young and healthy. It will help you make significant savings.

• Lifestyle Habits

The lifestyle you lead has a direct bearing on health insurance premiums. If you are addicted to smoking or drinking, it will push up the premium amount. On the other hand, if you don’t, the insurer charges you less for the same policy offering the same coverage.

Smoking and drinking increase the chances of falling ill, leading to subsequent hospitalization. With a higher risk element involved with these habits, you need to pay more to your insurer.

• Coverage Amount

Health insurance premiums are directly proportional to the coverage amount. It means higher the amount, higher the premium. To put it numerically, you need to pay more for ₹ 10 lakh coverage than ₹ 5 lakh.

• Co-pay and Sub-limit Clauses

Co-pay refers to the amount you need to pay from your pocket towards hospitalization bill(s), while sub-limit is the cap on expenses such as room rent, doctor’s consultation fee, etc.

These clauses are there in health insurance plans to prevent misuse. A low co-pay and high sub-limit entail paying a higher premium.

• Age of the Eldest Member in Case of a Family Floater Plan

In case you are willing to buy a family floater plan which provides coverage to all family members, the premium amount depends on the age of the eldest member. More the age, higher the premium.

• Pre-existing Ailments

If you have any pre-existing ailments or diseases, premium increases. For example, if you are suffering from diabetes or hypertension, you need to pay more towards your health insurance plan.

• Riders Opted For

Health insurance riders are add-ons that you add to your base policy. Adding riders to your policy increases the premium amount to some extent. With riders, you can further fortify your coverage.

Using Health Insurance Premium Calculator

While the above steps can help you get an estimate of the premium you need to pay, a health insurance premium calculator makes the job extremely easy and fast. Today, almost all insurers have this calculator on their website, with the help of which you can get premium quotes effortlessly.

A health insurance policy has become a necessity in today’s times. It protects the policyholder against the skyrocketing medical costs he/she may incur during a medical emergency. A standard health plan covers a range of expenses, including hospital’s room rent, doctor’s consultation fees, costs for medicines and diagnostic tests, etc. But, do you think having only regular health insurance is enough?

Sedentary lifestyle and increasing complexities in our living standards have made us more prone to serious illnesses and diseases. In India, more than 5 lakhs people are diagnosed with cancer every year and approximately 24 lakhs people suffer from cardiovascular diseases. The treatment of such diseases is usually very expensive, and a normal health insurance plan may not cover it by default.

It means that in case you contract a critical illness, your regular health insurance policy may fail to cover you adequately and you might end up losing all your life-savings. That is why, you must procure a separate critical illness insurance policy or attach a critical illness rider to your regular health insurance plan.

It will keep you financially protected against some life-threatening diseases such as cancer, heart attack, stroke, kidney failure, and paralysis.

Below are the five vital reasons to include critical illness rider in your health insurance plan:

1. Coverage against several chronic ailments

As mentioned above, the critical illness rider will provide you financial protection against several chronic ailments which generally include cancer, heart attack, stroke, kidney failure, organ transplant, liver diseases, and paralysis, among many others.

Though the number of ailments which is covered by the policy varies from insurer to insurer, usually a critical illness insurance rider helps covering all major life-threatening diseases.

2. Fixed sum assured upon diagnosis

Critical illness insurance plans are fixed benefit plans. It means that by attaching a critical illness rider to your regular health plan, you will become eligible to receive a fixed amount of money in case you get diagnosed with any critical ailment mentioned in the policy document. This sum assured will be paid to you irrespective of the actual amount you incur for your treatment.

Also, this sum assured will be paid directly to you which means that you can use it in whatever way you need. For example, you can use it to pay for the treatment costs, medicines, diagnostic tests, and also for paying your EMIs and meeting daily living expenses of yourself and your family members when you’re not able to earn a livelihood.

3. Tackle the huge medical expenses

As mentioned above, critical illnesses such as cancer, heart attack, and kidney failure are usually very expensive to treat and care for. For example, average cost of treatment for cancer is estimated at ₹ 10 lakhs, whereas certain lung diseases can take up to ₹ 20 lakhs for treatment.

In the absence of a critical illness cover, tackling such huge medical expenses can become next to impossible for a common person. Also, the critical illness insurance will ensure that you get the best possible treatment for covered diseases at the best healthcare facility around the world.

How To Choose Right Health Insurance At Different Stages Of Life?

Today, a health insurance policy has become imperative for everyone. Rising cases of lifestyle diseases and constantly increasing cost of healthcare facilities have made health insurance a necessity for everyone. Apart from covering almost all healthcare expenses a policyholder may incur during a medical emergency, a health insurance plan also helps him/her avail regular health check-ups and income tax benefits.

But, have you ever wondered if a specific health insurance policy is enough to provide you sufficient coverage for your entire life? The answer is “No”. As your health condition keeps on changing throughout your life, your health insurance needs also change accordingly. For example, a young person who is usually fit and healthy require a relatively smaller health insurance cover than an elderly person who is more prone to diseases and infections.

In this article, we’ve tried to explain the health insurance needs of a person during the different phases of his/her life and how should he/she choose the right health insurance cover for himself/herself at every stage. Read on.

When you’re young and single (in early 20s)

During this phase of a person’s life, he/she is pretty healthy and barely has any responsibilities. That is why, a large health insurance cover is not required at this stage. Hence, you can take a standard health insurance policy with a coverage amount of around ₹ 2 to 5 lakhs. Additionally, you should also consider the points mentioned below:

• Opt for a health insurance plan which fits your budget. As, at this stage of life, you are either not earning or have just started your career, paying high premiums for a health plan makes no sense.
• If you can, go for a health insurance policy with higher co-pay or deductibles.
• Consider your health condition and pre-existing diseases. If you have some pre-existing diseases or if you pay frequent visits to doctors, you should opt for a health insurance plan with higher coverage.
• Also, consider your profession while choosing a health plan. If you’re in a profession which involves working in conditions which are hazardous for your health, opt for a plan with high coverage.

When you are in your 30s or late 20s

When you enter this phase of life, you will suddenly find a plethora of responsibilities on your head. During this stage of your life, you could either be already married or have started planning for your marriage. You might have even started thinking about having a child in future.

Keeping in mind the number of dependents and responsibilities on you, you will need to increase your health insurance cover during this phase. Also, this is the time when you could be facing a lot of stress while managing your professional and personal life. Ideally, you should opt for a health insurance cover of ₹ 10 to 15 lakhs during this stage. You should also keep in mind the points mentioned below:

• You should get regular medical check-ups to find out if you have any pre-existing diseases. It’s common to develop certain lifestyle diseases such as Type II diabetes, hypertension etc. in this stage of life.
• You can opt for a family floater health insurance policy. It will provide comprehensive medical coverage to you, your spouse, and your children (if any).
• If you’re planning for a kid, you should go for a health insurance plan which comes with maternity benefits and new-born cover. In case your health insurance policy doesn’t provide maternity cover by default, you can add it as a rider.

The spread of coronavirus during the start of 2020 wreaked havoc in the entire world. More than a 100 million people got infected with the virus, resulting in the death of more than 2 million people. India was no different with more than 10 million cases and around 1 lakh deaths due to coronavirus. In fact, India ranked third among the worst affected countries after the USA and Brazil.

When the coronavirus vaccine in India was launched on 16^th January 2021, we all thought the pandemic days are gone and started to breathe freely. However, the joy was short-lived. The disease hit the country even harder in the form of the second wave of coronavirus. As a result, the number of coronavirus cases in India started going up rapidly and this time, the symptoms were even more severe.

As per the official records, as much as 2,16,828 new COVID-19 cases were recorded in India on 15^th April 2021. This was the highest number of cases recorded in our country in a single day till date. As a result, many state Governments including Maharashtra, Uttar Pradesh, Gujarat, Punjab, Delhi, and West Bengal announced either complete lockdowns or night curfews.

A negative COVID-19 report obtained within 72 hours was also made mandatory by many state Governments for air travellers from other states of India. In this article, we have explained how this second wave of coronavirus in India has been different and more severe than the first wave. Continue reading.

First wave vs Second wave

The surge in COVID-19 cases during the second wave in India has been more rapid than the first wave during August to October last year. The cases rose at double the pace in the second wave of coronavirus in India. While it took 32 days for cases to rise from 18,000 to 50,000 during the first wave, it took only 17 days for the cases to rise from 18,377 to 50,000 during March 2021.

The total number of cases being recorded in a single day was also much higher during the second wave. During the first wave, the highest number of cases recorded in a single day stood a little over 1 lakh. However, the number of cases in a single day during the second wave had touched the figure of 4 lakh.

India becomes second worst-hit country in the world

After the onset of the second wave of coronavirus, India overtook Brazil to become the second worst-hit country in the world. So, far the country has recorded around 3 crore COVID-19 cases, which keeps it only behind the USA (3.27 crore cases). India surpassed Brazil in terms of total number of COVID-19 cases only in April 2021 after staying at third position for several months.

When it comes to the total caseload, Maharashtra remains the worst-hit state during the second wave as well, followed by Uttar Pradesh, Punjab, Chhattisgarh, and Kerala. Along with the number of active cases, the fatality rate has also gone up during the second wave of coronavirus in India. The death count on 14^th April stood at 4.22 lakh.

A health insurance policy has become imperative for everyone today. Not only does it provide thorough coverage against the healthcare expenses the policyholder may incur during a medical emergency, but also it allows the insured person to avail free health check-ups and timely treatment for illnesses.

However, you should remember that most health insurance plans come with lots of terms and conditions. You should know these terms and conditions before buying the policy to avoid any rude shocks during the time of claim settlement. One such term associated with health insurance plans is “room rent limit”.

Room rent limit is a common sub-limit found in many Mediclaim policies. Before knowing more about health insurance room rent limit, let us first discuss what room rent is in health insurance.

What is Room Rent in Health Insurance?

When a person gets admitted to a hospital, he/she has to pay daily rent or per day room charges to occupy a room or bed in that hospital. Room rent in health insurance refers to the coverage for these boarding charges or per day room charges that the policyholder may have to pay while he/she remains admitted to a hospital.

Room rent largely depends upon the type of room and hospital a policyholder opts for. For example, room rent for a single or double occupancy room is more than a ward or a multiple-occupancy room. Similarly, room rent for private hospitals is much higher as compared to the same type of rooms at government hospitals.

Understanding Hospital Room Rent Costs in India

Hospital room rent costs in India differ based on the city, type of hospital, and room category. For instance:

• General wards in urban hospitals typically cost ₹1,000–₹2,500 per day.
• Semi-private rooms range from ₹3,000–₹7,000 per day.
• Private rooms can cost ₹5,000–₹15,000 per day.
• Deluxe or suite rooms in high-end hospitals may charge ₹20,000 or more per day.

These costs can quickly add up during extended hospital stays, making it critical to understand how your medical insurance handles room rent.

How is Room Rent Limit Specified in the Health Insurance Policy?

Now that you know about the room rent, it would be fairly easy for you to understand the concept of room rent limit in health insurance. It is the capping or limit imposed on the coverage of room rent of a hospital by a health insurance policy. The room rent limit can either be expressed as an absolute amount or as a fixed percentage of the sum insured.

In other words, the room rent limit in medical insurance policy is the maximum amount of per day room charges a policyholder can claim when he/she gets admitted to a hospital. Any amount above this sub-limit will have to be borne by the policyholder himself/herself.

For example, if your health insurance room rent limit is ₹ 5,000, then the maximum room rent you can claim under the policy is ₹ 5,000. In case the limit is expressed as “2% of the Sum Insured”, and you have chosen ₹ 5 lakhs as the sum insured, your room rent limit will be ₹ 10,000.

Types of Room Rent Limits in Health Insurance Coverage

Room rent limits in health insurance can be classified as follows:

1. Capped Room Rent:

Policies with capped room rent specify a fixed amount or percentage of the sum insured. For example:

• Fixed cap: ₹3,000 per day.
• Percentage cap: 1% of the sum insured per day.

2. Category-based Restrictions:

These policies cover specific room categories, such as semi-private rooms. Choosing a private or deluxe room may result in a higher co-payment by the policyholder.

3. No Room Rent Limit:

Some comprehensive plans do not impose any restrictions on room rent, allowing policyholders to choose any room type.

How Does Room Rent Limit Impact Your Overall Health Insurance Claim?

Room rent limit in health insurance is a very important concept. Your entire claim for health insurance coverage will depend on this room rent limit. Not only does it cap the maximum per day room charges you can claim on a policy, but it also limits other expenditures such as doctor’s fees, treatment costs, etc. Let’s understand this with the help of an example.

Suppose, you purchased a health insurance plan with a Sum Insured of ₹ 5 lakhs where the room rent is 1 percent of the Sum Insured. This means that the actual room rent limit for your policy will be ₹ 5,000. Now, if you get hospitalised and choose a room whose rent is below ₹ 5,000 per day, you will be able to claim for all expenses incurred on hospitalisation, without any deductions.

It means that if you incur ₹ 3 lakhs during the hospitalisation, you will get the entire ₹ 3 lakhs amount from the insurer upon filing a claim.

However, if you choose a room whose rent is more than ₹ 5,000 per day, your claim amount will be deducted in equal proportion by which the room rent exceeds the room rent limit of your policy. It means that if your room rent is ₹ 7,500, then you will get only 5000/7500 i.e. only 67 percent of the total expenses incurred by you during hospitalisation.

It means that if you incur ₹ 3 lakhs during hospitalisation, you will get ₹ 2.01 lakhs only (3,00,000 * 0.67) from the insurance provider. This is because hospitals charge differently for the same services for different room types. It means that the fee for a doctor’s visit in a shared room can be ₹ 1,000, whereas the fee for a visit by the same doctor in a private room can be ₹ 2,000. Hence, insurance companies pay a proportionate claim if the policyholders opt for expensive rooms.

Benefits of Health Insurance Plans Without Room Rent Charge Caps

Choosing medical insurance without room rent limits offers several advantages:

1. Flexibility in Room Selection:
   Policyholders can choose any room type, including private or deluxe rooms, without worrying about additional costs.
2. No Proportionate Deductions:
   Since there’s no cap, there are no proportionate deductions on the overall hospital bill.
3. Comfort and Privacy:
   Patients can opt for more comfortable and private rooms, which can positively impact recovery.
4. Hassle-free Claims:
   With no room rent restrictions, the claim process becomes simpler and less stressful for the policyholder.

While such health insurance plans may come with higher premiums, they offer more benefits and comprehensive coverage, proving useful in times of critical illnesses and hospitalisations. 

FAQs

1. What is the room rent limit in insurance?

The limit on the cost of a hospital room covered by a health insurance policy is called the room rent limit. It can be between 1% to 2% of the total insured amount, but it varies for each insurance provider.

2. What happens if I exceed the room rent limit specified in my policy?

If you choose a room with rent higher than your policy’s cap, the insurer may apply proportionate deductions to the entire bill. Additionally, you’ll need to pay the excess rent out of pocket.

3. Are ICU charges included in the room rent limit?

ICU charges are typically higher and may have separate limits in the policy. It’s essential to read your policy documents for specific details.

4. Can I upgrade my policy to remove the room rent limit?

Yes, most insurers allow policy upgrades to include features like no room rent cap. Contact your insurer for details on premium adjustments.

5. Is it worth paying higher premiums for a policy without a room rent limit?

Policies without room rent limits offer greater flexibility and reduce the risk of out-of-pocket expenses during hospitalisation, making them worth considering for those who prioritise comfort and convenience.

6. Do corporate health insurance plans have room rent limits?

Many corporate health insurance plans impose room rent limits. It’s advisable to review the terms and consider additional personal health insurance if needed.

Conclusion

The concept of room rent limit in health insurance is beneficial only till you are choosing a room whose rent is below the capping. Otherwise, it can significantly affect the claim amount that you will get. Hence, the best option is to go for a Mediclaim policy with no room rent limit. By opting for such a policy, you will be able to avail treatment in the room of your choice, without worrying about the capping.

For instance, you can purchase ICICI Lombard’s Complete Health Insurance Policy which has no capping on room rent. Additionally, this policy is easy to purchase and comes with an option of lifetime renewability.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

Time and again, the Government of India has taken steps to ensure optimum care and protection of its citizens. From bringing about developmental and infrastructural changes in the healthcare industry to providing social security through various subsidised health insurance policy schemes, the Indian Government has left no stone unturned in showing concern for its citizens.

Back in the year 2015, the then Finance Minister of India – Late Mr. Arun Jaitley – launched three social security schemes during the Budget Speech. All these schemes were aimed to provide social security to those working in the unorganised sector in India. One of these three schemes was Pradhan Mantri Suraksha Bima Yojana (PMSBY).

Through this article, we have tried to throw some light on the PMSBY scheme and what it is all about. Continue reading to know more.

What is Pradhan Mantri Suraksha Bima Yojana (PMSBY)?

As mentioned above, the Pradhan Mantri Suraksha Bima Yojana (PMSBY) is one of the social security schemes which was launched by the Government of India during the 2015 Budget Speech in the Parliament. The PMSBY scheme is a Government-backed accident insurance scheme which provides protection against accidental death and disability to individuals between 18 to 70 years of age.

This scheme is highly helpful in preparing an individual for unexpected emergencies by providing an accident insurance coverage of up to ₹2 lakhs at a highly affordable premium of ₹20 per annum.

PMSBY scheme details

The primary features of the PMSBY insurance scheme include:

• Coverage for a year and is renewable on annual basis
• Indians as well as NRIs can avail the benefits of this scheme
• Provides coverage of up to ₹2 lakhs against death and full or partial disability caused due to an accident
• The annual cover will remain valid from 1st June till 31st May
• To avail the benefits under this scheme, each member will have to pay an annual premium of ₹20
• Annual premium of ₹20 will be auto-debited from the beneficiary’s bank account

Inclusions & exclusions under the PMSBY scheme

Here is what will be covered and what won’t, under the PMSBY insurance scheme:

• Accidental death of the applicant will be covered by the scheme.
• If the applicant dies by suicide, it won’t be covered by the scheme.
• If the applicant dies because of murder, it will be covered by the scheme.
• Permanent total disability, i.e. loss of both eyes, hands, or feet will be covered.
• Permanent partial disability, i.e. loss of one of the eyes, hands, or legs will also be covered.
• A compensation of ₹2 lakh will be paid in case of accidental death or permanent total disability. Whereas, in case of partial disability, a compensation of ₹1 lakh will be paid.

Benefits of PMSBY

Here are some benefits of the Pradhan Mantri Suraksha Bima Yojana:

• Affordable Premium: Just ₹20 per annum, ensuring cost-effective coverage.
• Financial Security: Helps families cope with financial stress in case of accidents.
• Easy Enrolment: Can be linked to any bank account with minimal paperwork.
• Nationwide Availability: Open to all eligible individuals across India.
• Supplement to Family Health Insurance: Complements existing family health insurance plans by covering accidental risks.

How to apply for PMSBY?

The PMSBY scheme will be administered through public sector general insurance companies and private insurance companies such as ICICI Lombard. You can apply with any of these insurance companies through SMS or Net Banking to become a beneficiary under this scheme.

All you need to do is download the PMSBY form the Government website and approach a bank or insurance company with the duly filled form.

Steps to enrol for PMSBY through SMS

• Step 1 – Send a message on the onboarding organisation’s toll-free number
• Step 2 – You will receive an activation message
• Step 3 – Reply to the activation message with “PMSBY Y”
• Step 4 – You will receive an acknowledgement message
• Step 5 – The bank will process your request as per the information in your savings account

Steps to enrol for PMSBY through Net Banking

• Step 1 – Log in to your net banking account
• Step 2 – Click on “Insurance”
• Step 3 – Select the bank account to be used for premium payment
• Step 4 – Verify the details and click on “Confirm”
• Step 5 – Download and save the acknowledgement receipt for future reference

Documents required under PMSBY Scheme

Give below is a list of documents needed for PMSBY scheme-

• Aadhaar Card (linked to the bank account).
• Bank Account Details (for auto-debit of premium).
• Application Form (available at banks and online portals).
• Nominee Details (to ensure smooth claim settlement).

How to file a claim under PMSBY?

In case of accidental death or disability of the beneficiary, he/she or his/her nominee can file a claim under the PMSBY insurance scheme. Here’s what needs to be done:

• Step 1 – Reach out to the bank or insurance company from where the scheme was purchased.
• Step 2 – Obtain a claim form and fill it. It may ask for your name, address, contact details, and accident details. You can download the PMSBY claim form Jansuraksha
• Step 3 – Submit the duly filled claim form with relevant supporting documents, including the death certificate or disability certificate.
• Step 4 – After verifying the documents submitted by you, the insurer will transfer the claim amount to the specified bank account.
  

FAQs

1. Does PMSBY cover hospitalisation costs for accidents leading to death or disability?

No, PMSBY does not reimburse hospitalisation expenses. The scheme only provides financial assistance in case of accidental death or permanent disability.

2. Who can receive the insurance payout if the insured person passes away?

The nominee mentioned in the enrolment form will receive the insurance amount. If no nominee is registered, the legal heir can apply for the claim.

3. How is the insurance claim amount paid?

For disability claims, the insured person receives the amount in their bank account. In case of death, the payout is transferred to the nominee’s or legal heir’s account.

4. Will the insurance cover apply if the policyholder dies by suicide?

No, PMSBY does not provide benefits in case of suicide.

5. Is a police report necessary to file an insurance claim for an accident?

Yes, for accidents such as road mishaps, drowning, or criminal incidents, an FIR is required. However, in cases like snake bites or falls, hospital records can serve as proof.

6. If a person goes missing, will their family receive the insurance payout?

No, the claim is approved only when death is confirmed with valid documentation proving it was due to an accident.

7. What compensation is given for partial disability?

The scheme only covers complete and irrecoverable loss of sight in one eye or total loss of function in a hand or foot. Partial disabilities that do not meet these criteria are not covered.

8. Can someone claim benefits from multiple banks if they have enrolled in PMSBY through different accounts?

No, even if an individual has registered through multiple banks, they can claim the benefit only once.

9. Is it possible to enrol in PMSBY through multiple bank accounts?

No, a person can enrol only once, even if they hold multiple bank accounts.

10. What is the eligible age range for joining PMSBY?

People aged between 18 to 70 years can enrol in the scheme.

11. How is the insurance premium paid?

The premium is automatically deducted from the insured person’s bank account every year.

12. If I missed enrolling in the first year, can I join later?

Yes, if you didn’t enrol initially, you can join in later by providing consent and ensuring your bank account has sufficient funds for premium deduction.

13. Can someone rejoin the scheme after leaving it?

Yes, individuals who exit the scheme can re-enrol in the following years by paying the premium again.

14. Can PMSBY benefits be claimed along with other insurance policies?

Yes, PMSBY benefits are independent of other insurance plans and can be claimed even if you have additional coverage.

15. Does PMSBY cover accidents due to natural disasters? What about cases of murder or suicide?

Yes, PMSBY covers accidental death or disability caused by natural disasters like floods and earthquakes. It also covers murder cases, but it leaves out suicide cases from ts coverage.

16. Can all members of a joint bank account enrol in PMSBY separately?

Yes, all joint account holders can individually register for the scheme, provided they pay the premium separately.

17. What types of bank accounts qualify for PMSBY enrolment?

Any savings bank account with an auto-debit facility is eligible for enrolment.

18. Can NRIs enrol in PMSBY?

Yes, NRIs can join the scheme, but claims are payable only in Indian currency and will be given to a nominee or legal heir residing in India.

Conclusion

The essence of the PMSBY scheme is to provide social security to the citizens through personal accidental cover at a much lower price than the prevalent market rate. It is a yearly scheme that needs to be renewed every year through auto-debit of the premium amount of ₹20. The policyholder or his/her nominee will get a fixed sum of ₹1 lakh or ₹2 lakhs upon filing a claim. With its affordable premium, easy enrolment and significant benefits, it is a valuable addition to your health insurancepolicy. Enrolling in PMSBY is a simple yet effective step toward securing your family’s financial future against accidental risks.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the Insurance industry and products. It is advised to verify the currency and relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.