Over time, alcohol has become more prevalent in people's lives, especially among younger generations. Consuming it in moderation is not an issue, but if it becomes a habit, that is cause for concern. It can lead to various illnesses, including liver cirrhosis and cardiac disease. Many people today are unsure of insurance for alcohol consumers and the benefits of a policy that provides coverage to such people. Also, many believe their insurance providers will reject their claims because of their consumption of alcohol.

If your insurance provider learns you regularly consume alcohol, the insurer might deny or reject your claim. This is because greater alcohol use may result in health risks that your insurer may not be willing to pay for. The catch is that your insurance provider might ask you to shell out a higher premium because your chance of contracting diseases may increase. As a result, drinking alcohol affects your insurance cost in many ways.

Are Alcohol Consumers Eligible to Buy Health Insurance?

A person can apply for a health insurance plan if he/she infrequently drinks or consumes alcohol moderately without adverse effects on the person’s health. Therefore, those who consume alcohol can buy health insurance.

• The insurer might request an examination when someone starts drinking after obtaining health insurance. To avoid paying a higher premium, you must always drink alcohol cautiously.
• You must inform your insurer even if the insurance provider does not evaluate you on this count. If you hide the fact that you consume alcohol regularly and subsequently experience health issues, the insurer might reject your health insurance claim.
• Insurance companies can request the medical case file to analyse the alcohol consumption problem of a policyholder. If that happens, you could be obligated to pay for the therapy. Many people hide this to avail of a policy at a lower premium. However, if the insurer finds out, the monetary consequences of a denied claim are much worse.
• Significant health problems brought on by a high level of alcohol consumption result in a higher premium as it increases the insurance company's liability to provide coverage. If you drink, choose “alcoholic” when getting health insurance estimates. Try ticking off non-alcoholic beverages to see the difference in the premium.

The premium will also depend on you, and your drinking practises if you are the oldest family member considering a family floater health insurance plan.

Is It Important to Declare if You Are an Alcohol Consumer to an Insurance Company?

It's important to understand that your drinking practices may affect the perks of any health insurance plans you buy or already have. So, this may not severely impact those who drink alcohol infrequently; it might significantly affect extreme drinkers and could even lead to insurers denying or rejecting their claims.

When buying a life insurance policy, you must fill out a declaration form so that the insurer is aware of any existing medical conditions. Furthermore, one must reveal whether or not they consume alcohol because failing to do so could result in the life insurance policy being affected by pre-existing medical problems like cirrhosis of the liver.

Drinking too much alcohol can cause several illnesses, such as liver disease, cancer, stroke, diabetes, and pancreatitis, which generally shorten a person’s expected lifespan. The insurance companies see it as a risk and request an advance declaration from the prospective policyholder. Your insurance provider may raise your premium if your blood alcohol level exceeds the permissible limit.

Your risk of denied claims increases manifold if you withhold facts when buying a health insurance policy. As a result, it is wise to be completely truthful about your health status when applying for an insurance policy.

Why Is Insurance Premium High for Alcohol Consumers?

Moderate alcohol consumption is acceptable, but excessive drinking may raise red flags for prospective insurers.

• Excessive alcohol consumption may lead to illnesses like high blood pressure and liver, kidney, and coronary diseases. In addition, it may cause problems with a person’s mental health and issues related to substance abuse. Therefore, your alcohol intake significantly impacts your premiums when determining your suitability for the finest term insurance policies.
• Your medical documents may also show that your routine alcohol consumption is above a threshold. Additionally, becoming a higher risk for prospective insurers will directly raise the cost of your insurance premium.
• You will probably be eligible for a standard rate if your binge drinking happened in the past and you have refrained for 5-7 years, for instance. On the other hand, if you've been sober for one to five years, you probably count on rated insurance, which has higher rates. But the insurer will limit the scope of coverage. However, your application has a high chance of being rejected if you sought therapy, relapsed, or remained sober for less than a year.
• Purchasing life insurance coverage may be extremely harder if you have a criminal record for driving while intoxicated (DUI).

Suppose the insurance provider determines that the policyholder died in an accident due to intoxication and the person's blood alcohol level was higher than the legal limit. In that case, the insurer has no obligation to provide coverage to the policyholder's family. You must be mindful of these factors when you think in terms of insurance for alcoholics. You must be aware of these factors when you think in terms of insurance for alcoholics.

Importance of Buying Health Insurance for Alcoholics

While it might be challenging for an alcoholic to obtain health insurance, it's not unattainable. An insurance company might issue a policy, but the payment might be higher; a medical test can reveal whether an individual drinks heavily or moderately. A person may be eligible for a basic health insurance plan if he/she has only been a moderate drinker for a brief period. Below is a list of factors that show the significance of purchasing health insurance for alcoholics.

• Hospitalisation as an inpatient: Medical expenses accrued while receiving treatment in the hospital will be covered. However, the co-pay provision or clause may require the policyholder to foot a portion of the bill.
• Co-payment and deductibles: Health insurance providers may have a co-payment provision requiring the insured to pay a portion of the expenses incurred. In most instances, the policyholder can choose the percentage of the co-payment. One of the elements affecting the cost of health insurance is the co-payment proportion selected. Similarly, a person who chooses a high deductible can get the benefit of a relatively cheap premium.
• Cashless facility: If a person decides to get treatment in a network hospital, he/she can get the advantage of cashless transactions. The insurer will pay for the expenses incurred at the point of discharge.
• Lifetime renewability: This is a standard feature of health insurance plans. The policyholder must renew the insurance plan on time to continue receiving the benefits.

Many reputable insurance companies require you to undergo certain medical tests when you seek health insurance coverage. These pre-medical exams are necessary for obtaining health insurance because they play a significant role in establishing your eligibility for coverage. However, it does not entail that you cannot get health insurance without a medical test. 'Insurance providers that require you to take a health insurance test are the most accommodating when filing a claim.

However, it is crucial to remember that even if the insurance company has not requested that you undergo these tests, this does not suggest that you conceal a pre-existing medical condition. Fraud is intentionally misrepresenting facts, resulting in the insurer denying or rejecting your claim. Therefore, before your insurance provider determines your premium amount, you must declare any pre-existing medical condition to avoid the chances of your claim being denied or rejected in the future.

What are the Pre-Medical Tests?

Pre-medical inspections, or pre-medical tests, are a set of medical assessments performed by licenced medical professionals to determine the applicant's current health status. Before issuing a healthcare policy, most insurers insist on pre-medical tests as they want to assess the prospective policyholder’s medical condition. Also, the premium for a policy depends on the results of the pre-medical tests that you have to undergo.

In most cases, the insurance provider's coverage and the number of tests doctors perform are correlated. Additionally, most testing is done based on the applicant's age and the plan's benefits. According to the general tendency, most people seek insurance without medical exams.

The age of a potential customer and the scope of the insurance coverage determines how many pre-policy medical examinations are required. For example, if the beneficiary is older than 45, most health insurance firms demand a pre-policy medical assessment, including several parameters.

The world has seen one of the most dreadful pandemics in human history. As a result, how people generally live their lives in the present has undergone a complete transformation due to COVID-19. In addition, many sectors, along with the health insurance sector, have been impacted by this pandemic. As a result, how the health insurance market works has undergone considerable change.

Nowadays, most insurers insist on a pre-medical investigation for prospective policyholders. Although it is not mandatory, pre-policy medical tests are gaining popularity.

Is Pre-Medical Examination Compulsory for Buying Health Insurance?

A prospective policyholder with a pre-existing condition views medical exams as a barrier as they can lead to higher premiums or even coverage denial. However, most individuals over 45 undergo regular medical examinations to be aware of any dormant health issues. Insurance providers advise them to give accurate information when applying for insurance to guarantee a smooth claims procedure. Furthermore, most policies have a waiting period for pre-existing conditions. Insurance providers usually reject claims related to pre-existing health issues made during this tenure.

Regular medical exams are always advisable because they give you an update on your health condition and act as a benchmark for medical professionals. Without medical exams, disputes over whether policyholders concealed or misrepresented their illnesses could arise when claims get settled. Your insurer can reject your claim if the insurance provider finds you have concealed information about a pre-existing illness.

The premiums for plans that cover pre-existing ailments are comparatively high than a standard policy. They also have more stringent restrictions than plans with standard coverage. However, you will still have to give detailed information even though buying a policy without a medical exam may seem simple.

A comprehensive medical evaluation will establish your actual degree of fitness. If there are any possible health problems, you will be in a position to opt for medical intervention and timely treatment.

Although it is not mandatory, you should go for a medical examination before buying health insurance coverage.

A cashless Mediclaim policy is a progressive new way to manage medical expenses. Traditionally, when someone falls ill or requires medical attention, they must pay for the costs upfront and then submit a claim to their insurance provider for reimbursement. However, with a cashless Mediclaim policy, the entire process is streamlined and simplified.

What is cashless health insurance?

A cashless Mediclaim policy allows you to walk into any of your insurance provider’s network hospitals and receive the necessary medical treatment. The payment for the treatment is then directly settled between the insurance provider and the hospital without the need for you to pay any money upfront. This arrangement eliminates the burden of arranging for funds in times of medical emergencies while also allowing for a seamless and hassle-free medical experience.

How does cashless mediclaim work?

Cashless Mediclaim insurance works in the following manner.

• Choose medical insurers that provide coverage for the majority of diseases.
• Provide information about your current and previous medical conditions and then pay the premium.
• Review the network hospitals in your area.

If you become ill, you can go to any accredited hospital listed on the insurer’s network and get treated without having to pay anything out of pocket.

Benefits of cashless health insurance

Here are the major advantages of opting for a cashless health insurance plan:

• Immediate access to medical care without upfront payment.
• Peace of mind during emergencies.
• No need for reimbursement paperwork.
• Wider network of hospitals ensures accessibility.
• Helps manage finances better, especially during high-cost treatments.

For families, opting for a health insurance policy for family with cashless benefits ensures that each member is protected without added financial pressure.

Types of cashless health insurance plans

Cashless mediclaim is available in various types of insurance plans to suit individual needs:

• Individual health insurance plans: Covers one person with cashless hospitalisation.
• Family floater plans: Offers shared coverage for the entire family under a single sum insured.
• Senior citizen plans: Tailored for older adults with specific health conditions.
• Critical illness plans: Offers cashless treatment for predefined life-threatening illnesses.
• Group health insurance: Common in corporate sectors; employees get cashless treatment benefits.

Inclusions and exclusions of cashless health insurance

Understanding what’s covered and what’s not is crucial when choosing any health insurance plan, including cashless Mediclaim-

Common inclusions:

• Hospitalisation expenses (pre and post)
• Daycare procedures
• ICU charges
• Ambulance fees
• Some diagnostic tests and medicines

Common exclusions:

• Cosmetic treatments
• Dental and vision not related to accidents
• Self-inflicted injuries
• Pre-existing diseases during the waiting period
• Non-network hospital treatments (unless reimbursed later)

Things to consider when buying cashless health insurance

Before purchasing a cashless health insurance plan, keep these points in mind:

• Hospital network: A wide hospital network increases accessibility.
• Claim settlement ratio: A higher ratio means better reliability.
• Pre- and post-hospitalisation coverage: Look for comprehensive benefits.
• Inclusions and exclusions: Read policy documents carefully.
• Waiting period for pre-existing diseases: Shorter waiting periods are better.
• Customer service support: Quick claim assistance is crucial during emergencies.
• Top-up options: Useful when you want to extend your coverage.

Especially for families, evaluate the health insurance policy for family based on the number of members, age, and existing health conditions.

FAQs

• Is cashless health insurance available in all hospitals?

No, cashless benefits are available only at network hospitals listed by the insurer.

• Can I convert a reimbursement claim into a cashless claim?

No, cashless claims must be pre-authorised. Reimbursement is a separate process.

• What should I do if a cashless claim is rejected?

You can pay the hospital bill yourself and then file for reimbursement with valid documents.

• Is cashless mediclaim available for pre-existing diseases?

Yes, but only after the waiting period as mentioned in your policy.

• How can I check the list of network hospitals?

Visit your insurance provider’s website or app to check the latest network hospital list.

Conclusion

Cashless mediclaim insurance brings convenience and peace of mind when you need it most. Whether you’re buying an individual health insurance plan or a health insurance policy for family, ensuring it offers comprehensive cashless benefits can significantly ease the burden during medical emergencies. Do thorough research, compare policies, and choose what aligns best with your family’s healthcare needs.

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.

Today, where medical costs are skyrocketing and can drain one’s finances, a Mediclaim policy has become an essential shield to safeguard against unexpected medical expenses. It offers financial assistance during medical emergencies, ensuring you and your loved ones receive the best medical care without any economic burden. However, with various payment options available, people are often uncertain about the payment methods for their Mediclaim premiums. Let’s explore whether Mediclaim premiums can be paid in cash and understand the answer in detail.

Before delving into the topic, it is essential to understand the basics of Mediclaim. A Mediclaim policy covers the expenses incurred during medical treatment, consultation charges, and pharmacy bills. It provides financial assistance to you, ensuring you do not face any economic burden due to unexpected medical emergencies. To avail of these benefits, you must pay a premium to the insurance company at regular intervals, as specified in the policy document.

Can you make a cash payment for the Mediclaim premium?

Yes, most health insurance companies will accept cash payments for Mediclaim premiums. However, checking with the specific insurer about their preferred payment methods is always a good idea. You should make cash payments directly at the insurer’s branch office and remember to obtain a valid receipt for future reference. For added convenience and security, you should use electronic payment methods such as online transfers or debit/credit card payments.

No tax benefit when you pay cash for Mediclaim Premium

If you pay the premium for your Mediclaim insurance policy in cash, you will not be eligible for any tax benefits. Under Section 80D of the Income Tax Act, tax deductions are available only on premiums paid through digital modes of payment like Net Banking, credit cards, or debit cards. Therefore, choosing a suitable payment method to maximise your tax savings while purchasing a Mediclaim policy is essential.

• You are eligible for a tax break of up to Rs 25,000 for Mediclaim insurance premiums paid for yourself, your spouse, and your dependent children.
• An additional benefit of up to Rs 25,000 is available for Mediclaim insurance premiums paid for your parents.
• If you or your parents are senior citizens (age 60 years or above), the deduction limit increases to Rs 50,000.
• If you and your parents are both senior citizens, the deduction limit increases to Rs 1,00,000.
• It is important to note that the total deduction for Mediclaim insurance premiums, including those paid for parents, cannot exceed Rs 1,00,000.

However, you can still get a tax benefit if you spend money on preventive healthcare, such as routine health tests, and pay for it in cash. In this case, the maximum allowable deduction is Rs 5,000, and the benefits are limited to a cap of Rs 25,000.

When it comes to healthcare expenses, medical insurance is a saving grace for many people. However, even with insurance, the costs can add up quickly, leaving many policyholders struggling to pay their medical bills. That is where hospital discounts come into play.

A hospital discount is a reduction in a hospital’s total bill amount for medical treatment, surgery, diagnostic, or any other healthcare service provided to you. Typically, insurers offer these discounts to help you reduce your out-of-pocket expenses. Insurance companies provide hospital discounts in collaboration with their network hospitals.

The Insurance Regulatory and Development Authority of India (IRDAI) issued an order in 2015 requiring all insurance providers to make it mandatory for hospitals to disclose any and all discounts on the final hospitalisation bill. This move aimed to increase transparency and ensure that policyholders are aware of any discounts offered by the hospital on their medical treatment bills.

Now that you are aware of hospital discounts, it is time to look at some methods for obtaining them.

Why do hospitals offer discounts?

Hospitals offer discounts for several reasons, many of which are tied to maintaining positive relationships with insurance providers and ensuring timely payments. Here are a few common reasons:

• Negotiated rates with insurance companies:

Hospitals often have agreements with health insurers to provide services at discounted rates. In return, they receive quicker payments and a steady stream of insured patients through referrals.

• Encouraging early or cash payments:

For patients who are not using insurance, some hospitals offer discounts for early or full payments. This helps make healthcare more affordable and simplifies the billing process.

• Minimising outstanding balances:

Offering reasonable discounts can encourage timely payments. This helps the hospital maintain steady cash flow and continue providing high-quality care.

• Strengthening patient relationships:

Discounts can make healthcare more accessible and show that the hospital is committed to patient well-being. This helps increase trust and long-term relationships with the community.

• Supporting preventive care:

In some cases, hospitals offer discounts on check-ups or health screenings. This promotes early diagnosis and helps patients stay healthy, reducing the need for more complex care later.

• Partnering with employers or organisations:

Hospitals may work with companies or community groups to provide health packages or discounted services. This improves access to care while expanding the hospital’s reach.

• Offering package deals for common procedures:

Fixed-price treatment packages for surgeries or other procedures make costs clearer for patients and help them plan better, while ensuring affordability.

How hospital discounts work in mediclaim policy

Hospital discounts play a crucial role in Mediclaim, which is a type of health insurance policy that reimburses medical expenses or provides cashless treatment. Here’s how it works:

• Cashless claims:

If you're admitted to a network hospital, you may receive treatment without paying upfront. The hospital bills the insurance provider directly at a pre-negotiated, discounted rate.

• Reimbursement claims:

If you visit a non-network hospital, you can still claim reimbursement. The final bill may reflect standard hospital charges, but any discounts you receive will reduce the amount you're eligible to claim.

• Impact on family health insurance:

If you have a health insurance policy for your family, these discounts can help conserve the overall sum insured.

• Helps stay within sub-limits

Some policies have sub-limits (for room rent, surgery or doctor’s fees). Hospital discounts make it easier to stay within these limits and avoid extra out-of-pocket costs.

• Supports faster claim settlement

Discounted and itemised bills are easier for insurers to process, leading to quicker claim approvals and reimbursements.

How to avail of a hospital discount while billing?

To make sure you don’t miss out on hospital discounts, follow these simple steps:

• Spot billing errors: Be vigilant about billing errors to save money on your medical bills. If you notice any discrepancies, connect with the hospital billing department immediately. Requesting an itemised bill can also help provide a detailed breakdown of charges for various services, pharmacy bills, inpatient stays, and other factors.
• Go for a health card: A health card with a No-Cost EMI option can help you pay your medical bills in convenient monthly instalments, reducing your financial stress. This benefit is available at all network hospitals affiliated with your insurer. Furthermore, various insurers provide hospital bill discounts when you swipe their health card.
• Negotiate: You can negotiate with the healthcare provider for a discount on your medical bill. Explain your financial situation and ask if they offer any discounts, payment plans, or other options to help reduce the cost.
• Upfront payment: Depending on the hospital, medical bills can also provide benefits similar to other cash payment discounts. This can be particularly helpful if you are dealing with expensive medical bills. Certain hospitals may offer a substantial discount if you settle the entire treatment cost upfront but remember that this offer requires immediate payment.

Tips to maximise hospital discounts

Hospital bills can add up quickly, but the good news is that there are ways to reduce costs without compromising on care. By having the knowledge and making smart decisions, you can take full advantage of the discounts available. Here are some handy tips:

• Choose network hospitals: These facilities often have pre-negotiated discounted rates with your insurer.
• Keep medical records organised: It helps in quicker processing and reduces disputes during claim settlements.
• Understand your family policy coverage: If you hold a health insurance policy for your family, know who is covered, the sum insured and any sub-limits, if applicable.
• Check for cashless treatment options: Many network hospitals offer cashless services, where the insurer pays the hospital directly. This saves you from having to pay out of pocket first.
• Ask about hospital packages: Some hospitals offer fixed-price packages for certain treatments or surgeries. These can be cheaper than paying for each item or service separately.
• Use preventive health check-ups: If your insurance offers free check-ups, take advantage of them. Early detection can help you avoid big hospital bills later on.
• Be aware of waiting periods: Some treatments, like dental or maternity, may have a waiting period. Knowing this can help plan better and avoid surprises.
• Negotiate when paying yourself: If you're paying without insurance or for anything not covered, you should ask for a discount or payment plan. Many hospitals are open to discussion.
• Know what’s not covered: Understand what your policy excludes, for example, cosmetic procedures or alternative therapies, so you’re not caught off guard.
• Use your insurance helpline: If you’re unsure about something, call your insurance provider’s helpline. They can guide you on how to get the most value and avoid unnecessary costs.

Conclusion

Hospital discounts in mediclaim policies are a valuable tool for reducing medical expenses and preserving your insurance benefits. Especially when you have individual health insurance, every rupee saved through discounts helps in making the plan more sustainable and beneficial.

When you understand how hospital discounts work and take proactive steps during hospitalisation, you can ensure a smoother, more affordable healthcare experience. Whether it's a routine check-up or an emergency, being informed puts you in control financially and otherwise.

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 your general physician or another certified medical professional for any questions regarding a medical condition. 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.

Mediclaim is basically health insurance that covers your medical expenses. It includes costs related to hospitalisation, diagnostic tests, consultation fees, and OPD treatments. Pre-hospitalisation expenses cover costs, such as medical tests like blood tests, urine tests, or X-rays. Post-hospitalisation expenses cover those tests prescribed by the physician to ascertain the recovery or progress of the patient. Not all therapies, like physiotherapy, are covered under post-hospitalisation expenses. Nonetheless, you can claim and obtain coverage for physiotherapy prescribed by the doctor after hospitalisation under post-hospitalisation expenses. The policyholders have the option to claim both pre- and post-hospitalisation expenditures by submitting authentic invoices, pertinent duplicates of the doctor's certification and discharge summary.

Comprehensive health insurance plans usually offer coverage for physiotherapy. It's good to check what your policy covers. The financial strain during medical emergencies is reduced with health insurance or Mediclaim plans, making them an essential component of fundamental financial planning.

Having health insurance or Mediclaim is essential as it covers medical costs during emergencies. These plans include annual health check-ups and day care treatments. It also offers a no-claim bonus (NCB) and domiciliary hospitalisation. It's essential to check the list of inclusions in your policy to get maximum benefits from them. Standard policies may not cover physiotherapy expenses, but you can make a claim if the policy covers OPD expenses. Comprehensive health insurance plans usually offer coverage for physiotherapy, which is beneficial in case of unexpected injuries or medical conditions that require physiotherapy treatment.

Add-on for Covering Physiotherapy Sessions

• To cover Physiotherapy in your policy, you can also buy add-ons by paying a little extra premium. E.g. ICICI Lombard’s Befit add-on covers several out of hospital medical services which allow you to talk to a general physician, specialist, or super-specialist doctor online or at a clinic or via teleconsultation, 24/7.
• These add-on usually cover everyday health needs that don't require hospitalisation, including physiotherapy sessions.
• The benefits of such add-ons include access to medical practitioners through audio, video, online portal, chat, or mobile application, 24/7 e-consultation, and coverage for laboratory tests and minor procedures recommended by the network medical practitioner.
• You can acquire cashless coverage for medications and medical supplies.
• You can receive coverage for the evaluation, diagnosis, and treatment of ailments related to bones and joints from physiotherapists within the insurer’s network.
• When buying add-on covers, you should consider factors such as the scope of coverage, the waiting period, and the additional premium amount.

When it comes to safeguarding our well-being, we often seek refuge in things that give us comfort, be it our family or our hobbies. But what about the unexpected twists that life throws our way? Illnesses and accidents can often leave us stranded in the face of physical and financial uncertainty. During these times, we realise the true importance of having a safety net that can catch us when we fall. The concept of the Mediclaim policy kicks in here.

Mediclaim Meaning

A Mediclaim policy is a type of health insurance policy that provides coverage for medical expenses incurred due to illness or injury.

• This policy typically covers hospitalisation costs, medical treatments, and other related expenses.
• The policyholder pays the insurer a premium in exchange for this coverage.
• The coverage and benefits offered by a Mediclaim policy can vary depending on the policy provider and plan chosen.
• Mediclaim insurance plan offers both cashless and reimbursement claim options.

How does Mediclaim work?

When you buy a Mediclaim policy, you pay a premium to the insurance company. In exchange, the insurance company agrees to pay for all or a portion of your medical expenses up to the coverage limit specified in the policy.

• In a medical emergency, you can seek treatment from an affiliated hospital to receive cashless treatment or if you want reimbursement for your treatment bills from another healthcare provider.
• The third-party administrator (TPA) is responsible for assisting you with documentation issues and taking care of the rest of the procedures to ensure a smooth claim settlement for cashless hospitalisation.
• In the event of a reimbursement claim, the insurer will first review all the bills you have provided and determine how much of the medical expenses are covered by the policy.
• You must remember that Mediclaim policies do not cover a wide range of ailments and may include a waiting period for some or all of the covered diseases. As a result, before making any decisions, always read the policy wording.

Features of buying Mediclaim policy

• Financial protection:

The primary benefit of a Mediclaim policy is financial protection. It can help you pay for expensive medical treatments and hospitalisation costs, which can put a strain on your wallet.

• Cashless hospitalisation:

With a Mediclaim policy, you can get cashless hospitalisation at network hospitals. That means you can get treatment without having to pay cash upfront. The insurance company will settle the bills directly with the hospital.

• Tax benefits:

You can claim a tax deduction for the premium paid towards your Mediclaim policy under Section 80D of the Income Tax Act.

• Pre- and post-hospitalisation expenses:

Mediclaim policies also cover pre- and post-hospitalisation expenses, including doctor's consultation fees, medicines, and diagnostic tests.

• No-claim bonus:

Mediclaim policies offer a no-claim bonus if you do not make any claims in a policy year. This can be in the form of a higher sum insured or a reduction in premium.

• Critical illness coverage:

Many Mediclaim policies offer coverage for critical illnesses, such as cancer, heart attack, and stroke. 

Mediclaim policy is an essential part of financial planning. It provides financial protection against unexpected medical expenses and ensures that you and your family can access quality healthcare without worrying about the cost. Before purchasing a Mediclaim policy, ensure you compare the features and benefits of different policies and choose one that meets your specific requirements.

Medical emergencies are uninvited guests that bring financial woes with them. And to help you avoid the consequences, Mediclaim products on the market are there. Mediclaim is an insurance policy that covers hospitalisation, medical treatments, and other related costs. But did you know that there are several jargons that you must decode when filing a claim for treatment expenses? CCN is one such terminology.

CCN, which stands for claim communication number, is a unique identifier a health insurance provider generates for each claim request submitted by the policyholder. This number serves as an acknowledgement of receipt of the claim request and also allows the policyholder to track the status of his/her claim.

The concept of CCN number kicks in once you submit a duly filled claim form with all the necessary documents, such as medical bills, doctor’s prescriptions, and other related documents. The insurance provider verifies these documents and processes the claim. Once the claim is processed, the CCN number is generated and shared with you via SMS or email.

You cannot overstate the significance of CCN numbers in mediclaim. In addition to serving as a unique identifier, CCN also helps to streamline the claims process, making it faster and more efficient. With the help of CCN numbers, insurance providers can quickly retrieve the details of the claim request.

Steps to identify CCN number

Identifying the CCN number is an important step in the mediclaim process, as it allows policyholders to track the status of their claims. Here are the steps to identify the CCN number:

• Check your email or SMS inbox: Insurance providers usually send the CCN number to policyholders via email or SMS once the claim is processed. Check your inbox for any communication from the insurance provider.
• Check the physical documents: Policyholders can find the CCN number written on the physical copies of the claim documents. Look for the CCN number on the top of the claim form or the reimbursement receipt.
• Check the insurer’s website: Most insurance providers have an online portal or mobile application that allows policyholders to track the status of their claims. Log in to the portal and enter your policy details to check the status of your claim and find the CCN number.

If you are unable to identify the CCN number, contact the insurance provider’s customer service for assistance.

Women are often considered the backbone of their families, the caretakers, and the decision-makers. In a world where women's voices are becoming more prominent and powerful, they now play an even more important role in household decisions, especially the financial ones. It's a startling number: Globally, when women can earn an income, they typically reinvest 90% of it into their families and communities to provide better nutrition, health care and education to their family & children.

In India, according to the fifth National Family Health Survey fact sheet in 2022, nearly 88.7% of currently married Indian women tend to participate in the critical household decision about healthcare for themselves and are decision-makers in major household purchases, including those related to insurance. They are researching, comparing, and choosing policies offering comprehensive coverage and flexible payment options.

Whether it's a health policy that covers their specific medical needs, a vehicle policy that protects them while driving or riding on the road, or a travel policy that provides comprehensive coverage on the go, women in India are making intelligent and informed decisions about their insurance needs. Below are a few key takeaway points from our initial sample study on understanding women's behavioural preferences when purchasing health, vehicle & travel insurance online.

What does insurance mean to women?
Insurance is a financial product that protects against unforeseen risks. For women, insurance means financial security and peace of mind.

How do women decide on buying insurance policies?
Most women prioritise their family's financial safety, and they believe insurance is a helpful tool for achieving this goal. Healthwise, women are more exposed to specific health conditions, including breast cancer and gynaecological-related complications requiring specialised medical care. Therefore, women favour health insurance that covers these healthcare expenses so that they do not add additional costs to their family budgets.

While deciding on an individual health policy, women prefer health insurance policies that offer cashless hospitalisation and a wide network of hospitals. The need for convenience and ease of access to medical facilities drives this preference.

When it comes to vehicle insurance, women have different preferences compared to men. While they believe that the person using the vehicle most should be making the insurance purchase decisions for a family-owned vehicle. However, for their own car or bike, they prefer affordable, comprehensive vehicle insurance policies that cover their personalised needs, such as vehicle damage due to rat bite—indicating their preferences for customised coverage & add-ons. Add-on covers provide additional protection and help women feel more secure while driving & maintaining their vehicles.

For travel insurance, most women prefer to avoid getting involved in the purchase decision as they believe it's insurance for only a short duration and is not a major investment. Most are strapped for time and trust the travel agent's recommendation.

Vitamins are essential to keep the body going. For the normal functioning of the body and a top-notch immune system, you must include vitamins and minerals in your diet. Vitamin deficiency can cause several health issues and trigger bigger health problems with serious consequences. Most body functions need direct and indirect vitamin support for execution. For example, vitamin D is essential for calcium absorption in the body. It means not having enough vitamin D can lead to issues related to calcium deficiency as well. Today, we will look at how vitamin D helps in maintaining good health and run you through a detailed list of Vitamin D food for vegetarians and non-vegetarians.  You can get a health insurance to avoid any circumstances.

What is vitamin D?

Vitamin D is a fat-soluble nutrient that helps the body to absorb as well as retain calcium, phosphate, and magnesium—minerals essential for a healthy skeletal system. Vitamin D also controls cancer cells, checks infections, reduces inflammation, and boosts immunity. The daily amount needed to sustain healthy calcium metabolism and strong bones is referred to as the Recommended Dietary Allowance for vitamin D. They are:

• UL: The Tolerable Upper Intake Level (TUIL) is the largest daily intake that is unlikely to have a deleterious impact on health (UL). The UL for vitamin D in children aged 9 years and above is 4,000 IU (100 mcg).
• RDA: For people aged 19 years and above, the recommended daily allowance is 600 IU (15 mcg). For those over 70 years, it is 800 IU (20 mcg).

Benefits of vitamin D

Vitamin D can reduce inflammation, restrict the growth of malignant cells, and assist in preventing infections. Besides supporting bone health, vitamin D is a major requirement in the normal functioning of many organs and tissues. Some benefits of vitamin D include:

• Fights bone diseases:

Vitamin D is an essential component for calcium absorption. Without vitamin D, you cannot have calcium in your body in active form. Absorption of calcium allows the body to maintain the required amount of phosphate in the body which is again essential for bone health and development.

• Helps maintain good mental health:

While it is not clear how essential vitamin D is in checking clinical depression, it is highly effective in managing seasonal depression. Since there is less sunlight in winter, the body absorbs relatively much lesser vitamin D. This adversely affects the neurotransmitter serotonin.

• Fights respiratory infections:

If you have a significantly low vitamin D level, chances are high that you may suffer from more respiratory issues such as cold and flu. Research shows that deficiency of Vitamin D can worsen the post-COVID consequences.

• Protects against heart ailments and diseases:

Adequate amount of vitamin D reduces the risks of heart failure, stroke, and several heart diseases. Medically, it is not clear if Vitamin D is solely responsible for the prevention of heart diseases, but it definitely helps.

• Keeps the risks of diabetes in check:

Cell-based observational studies show that vitamin D augments insulin sensitivity, improves beta cell function, and reduces inflammation. All these factors are extremely important in controlling Type 2 Diabetes.

• Reduces cancer risk:

More and more scientific sample studies are reinforcing the role of vitamin D in managing and reducing the threat of cancer. The potential correlation between vitamin D and colon cancer, ovarian cancer, breast cancer and prostate cancer is evident. Vitamin D helps in controlling the growth of cancer cells.

• Guards against autoimmune conditions:

Vitamin D plays a very important role in regulating the immune system, thus preventing autoimmune disorders. Studies show that people who intake or absorb sufficient vitamin D are less prone to autoimmune disorders such as arthritis, thyroid etc.

• Helps check cognitive inefficiency and dementia:

Our brain tissues have vitamin D receptors. This indicates the role of vitamin D in cognitive development and health. Since vitamin D enhances cognitive function, it also helps in preventing conditions such as dementia.

Top vitamin D-rich food items for vegetarians

Now that you are well aware of the importance of including vitamin D in your diet, it is only obvious that you would want to know about vitamin D foods. Given below is a list of vitamin D food for vegetarians. To ensure an adequate amount of vitamin D in your body, include these vitamin D-rich foods:

• Fortified orange juice:

Most store-bought fortified orange juice is supplemented with calcium and vitamin D, making it a reliable source of nutrition for lactose-intolerant people. One cup of enhanced orange juice has 100 IU of vitamin D.

• Mushrooms:

Similar to humans, mushrooms can produce Vitamin D when exposed to sunshine. With 2300 IU of vitamin D2 per 100g, they are rich in vitamin D. However, professionally raised mushrooms have very little vitamin D2. Although, some varieties receive UV light treatment, making them a good source of vitamin D. These mushrooms contain 130 to 450 IU of vitamin D2.

• Fortified soymilk:

For vegans and vegetarians, soymilk is a nutritious meal alternative because it contains the same nutrients as cow's milk. Each cup of soy milk contains 120 IU of vitamin D. However, before purchasing soy milk, read the label to determine whether it contains vitamin D. Little vitamin D is present in non-fortified brands.

• Cheese:

Cheese makes one of the best vitamin D-rich food for vegetarians. Cottage cheese has particularly higher amounts of vitamin D. Other cheeses with vitamin D include Cheddar, Fontina, and Monterey. Any type of cheese has about 24 IU of vitamin D per 100g serving.

• Yoghurt:

Because yoghurt is fortified with vitamin D, dairy and non-dairy yoghurts have high levels of this vitamin. It contains around 120 IU of vitamin D per cup.

• Fortified almond milk:

Each serving of fortified almond milk has 2.4 mcg (96 IU) of vitamin D. Numerous almond milk brands also add calcium to enhance its nutritional value.

Top vitamin D-rich food items for non-vegetarians

There is equally a wide range of vitamin D-rich food options for non-vegetarians as well. While non-vegetarians can eat all that has been listed above as vitamin D food for vegetarians, many non-vegetarian food items are also good sources of Vitamin D. Some of the vitamin D foods for non-vegetarian people are:

• Salmon:

Salmon is an oily fish that has a lot of vitamin D. According to the Food Composition Database of the United States Department of Agriculture (USDA), 100g of Atlantic salmon contains 526 IU of vitamin D per serving. When compared to farmed salmon, wild salmon has greater vitamin D. The amount of Vitamin D in a 100g plate of wild salmon is 988 IU compared to 25% in farmed salmon.

• Tuna:

Canned tuna has 268 IU of vitamin D which makes it a superior source of the vitamin. In addition, it is less expensive than purchasing fresh fish. Consuming canned tuna also increases the amount of niacin and vitamin K in the body. However, avoid overconsumption of this food item as it contains the toxic metal methylmercury. High levels of methylmercury in the body can cause serious health conditions.

• Cod liver oil:

If you are not too fond of eating fish, then include a cod liver oil supplement in your diet. Cod liver oil contains 448 IU of vitamin D per teaspoon. This can be easily given to kids who need more vitamin D. It is also a rich source of omega-3 fatty acids and vitamin A. However, avoid consuming excessive amounts of cod liver oil because high levels of vitamin A in the body can be harmful.

• Sardine:

Sardine is an excellent vitamin D food. It contains 177 IU of vitamin D. Fatty fish like halibut and mackerel are also good sources of vitamin D.

• Herrings:

Whether it is served canned, smoked, pickled, or raw, herrings are a great source of Vitamin D. It has 216 IU of vitamin D per 100g serving. Additionally, pickled herring contains salt and 112 IU of vitamin D, both of which are essential to human health.

• Fortified cow milk:

Cow milk has phosphorus, calcium, and riboflavin. With 115–130 IU of vitamin D per cup, it is a fantastic source of vitamin D.

• Egg yolk:

You can get 37 IU of this vitamin from eggs. Note, the chicken’s exposure to the sun and the vitamin D concentration of chicken feed determine the vitamin D content of eggs. Eggs from chickens that have access to pasture and sunlight are three to four times more vitamin D-rich. They have 6000 IU of vitamin D.

Tax Benefits On Preventive Health Check-ups

Life, today, is only getting faster and faster. Long working hours, a sedentary lifestyle, unhealthy eating habits, and stress are harming your health far more than you realise. Hypertension, thyroid problems, diabetes, and high cholesterol are among common health issues among young and middle-aged people. While you must try to develop healthy habits to steer clear of these and similar conditions, you should not ignore the importance of regular preventive health check-ups.

Preventive check-ups not only help you monitor your health status, but they also allow early detection of major illnesses. To top it all, they come with tax benefits, thus, offering an edge to your financial planning.

Preventive health check-up income tax benefits can help you reduce your tax liability significantly. Section 80D of the Income Tax Act allows preventive health check-up deduction from your income tax liability even if you do not have a health insurancepolicy.

Read on to know all about preventive health check-up income tax relief under Section 80D of the Income Tax Act.

What is preventive healthcare?

Several factors contribute to maintaining a fit and healthy body and mind. These include proper nutrition, a balanced diet, regular exercise, good and proper sleep, and healthy recreational activities, among others. Although these things help you in living a healthy life, they offer no assurance that you will never fall sick. Therefore, it is essential to monitor your health closely and take all sorts of preventive measures to avoid any health complications. These measures include:

Periodic health check-ups, shots and immunisation.

Go for periodic blood tests for common conditions such as diabetes, thyroid, and high cholesterol.

Going for other sets of preventive healthcare tests such as cancer screening, HIV tests and more.

The need for preventive healthcare becomes even more important after the age of 40 years. This is when the body's immune strength starts decreasing.

Nowadays, almost all insurance providers offer preventive healthcare check-up coverage. In case your insurer does not cover health check-up costs, you can always buy a separate add-on or a preventive healthcare insurance package. There are different types of preventive healthcare insurance packages such as the family package, cancer package, dental package, package for children and likewise.

What is Section 80D of the Income Tax Act?

Under Section 80D of the Income Tax Act, you can get preventive health check-up income tax benefits. Section 80D allows tax benefits against the medical insurance premium that you pay for yourself, your spouse, children and your parents. The benefit can go up to Rs 25,000-Rs 50,000 depending on the age of the insured person. In addition, you get tax deductions up to a certain limit on the expenses incurred over preventive healthcare check-ups. The preventive health check-up ITR benefit amounts to Rs 5000 under the overall limit of Rs 25,000-Rs 50,000.

You can avail of tax deductions for preventive health check-ups for yourself, your spouse, children and dependent parents. This benefit applies even if the payment for preventive health check-ups is paid in cash.

Features and benefits of preventive health check-ups

These features of preventive health check-ups make them highly beneficial:

• Early detection of diseases:Preventive health check-up allows early detection of disease, thus, helping you against major financial and mental stress.
• Assists in the diagnosis of other medical conditions:It is possible to have some underlying medical condition that has no symptoms to show. Preventive health check-up allows the identification and diagnosis of the same.
• Better chance at prevention of health risks:With early detection of a dormant medical condition, you can do the needful on time.
• Reduces healthcare costs:Pursuing treatment for a medical condition becomes easier and cheaper if the disease is diagnosed at an early stage.
• Control the risk of complications: Diagnosis of a medical condition at an early stage reduces the risk of complications as you can take necessary steps on time.
• Tax benefits:A part of the expenses incurred for preventive healthcare check-up limit is eligible for tax deduction under Section 80D of the Income Tax Act. Therefore, health check-ups help not only in monitoring your health but also support your financial planning.

Deduction under Section 80D for health insurance premiums paid for parents

Section 80D allows tax relief for the insurance premium paid for yourself, your spouse, children, and parents. Read the table below to understand how tax deduction works for each category:

Who can claim a deduction for preventive health check-ups under Section 80D?

Anybody with valid health insurance who undergoes preventive health check-ups can avail of a tax benefit of Rs 5,000. Note, this tax benefit for preventive healthcare comes under the overall limit of Rs 25,000 medical insurance tax benefit as per Section 80D of the Income Tax Act.

If you pay a premium for the health insurance of your spouse, children and dependent parents, and incur preventive health check-up expenses for them, even that is eligible for claim deduction under Section 80D. However, the preventive health check-up deduction limit is Rs 5000 only.

The unique feature of this preventive health check-up ITR relief is that even if you do not have a health insurance plan for your parents, you can still avail of the claim deduction of Rs 50,000 which is inclusive of the Rs 5,000 for preventive health check-up expenses.

What is the maximum amount you can claim?

Following the outlines of Section 80D of the Income Tax Act, you can get a maximum claim deduction of Rs 25,000 in your tax liability if your and your family are less than 60 years of age. You may avail of a claim deduction worth Rs 50,000 if the insured person’s age is more than 60 years. Now, if you, your spouse, and your children are less than 60 years old, but your parents are above 60 years, you can claim a deduction of Rs 25,000 for your family and Rs 50,000 for your parents.

Refer to the table above to understand the claim norms under Section 80D.

The maximum limit of Rs 25,000 or Rs 50,000 includes expenses incurred on preventive healthcare check-ups as well. Remember, the maximum amount that you can claim against preventive healthcare check-ups is Rs 5,000.

So, how does this work? Let us use an example:

Suppose you are 35 years old and your parents are in the age bracket of 52-57 years. In this case, you are eligible for a maximum claim deduction for your medical insurance up to Rs 25,000. Suppose you paid Rs 20,000 toward your health insurance premium and incurred Rs 7,500 for preventive healthcare check-ups. Since your claim deduction limit is Rs 25,000 and you paid out Rs 20,000 for the premium limit, you are left with a balanced deduction limit of Rs 5,000. You can claim this Rs 5,000 for preventive health check-up limit for a deduction. The remaining Rs 2,500 (7500-5000) must be borne by you.

Tax benefits on cash payment

The Section 80D preventive health check-up tax benefits can be availed of even if the preventive healthcare payments are made in cash. Unlike the payment of the health insurance premium amount, which must be made through a proper banking process to make claims, there is no rigid financial process requirement for claims on preventive healthcare check-ups. This means when you go for a preventive healthcare test or diagnosis - be it a blood test or any other monitoring test - you can pay the charges in cash. Just keep a record of the bill payment to claim the deduction from your tax liability.

Deduction under Section 80DDB: Treatment of specified illness

Chapter VI A of the Income Tax Act specifically lays down the various provisions of deductions that can be availed of by a taxpayer. A wide range of tax claim deductions is explained in different sub-sections ranging from 80C to 80U.

Apart from Section 80D, some other sections and sub-sections offer tax claim benefits on expenses made on healthcare and healthcare insurance.

Under Section 80DDB, individuals and Hindu Undivided Families (HUFs) who are residents of India can claim a tax deduction against the expenses incurred for the treatment of specified diseases or ailments. They can claim an amount up to the actual expense or a maximum amount as capped under Section 80DDB.

• If you are less than 60 years of age, you will get a deduction amounting to Rs 40,000 or the actual expense, whichever is less.
• If you are more than 60 years of age, you will get a deduction amounting to Rs 100,000 or the actual expense, whichever is less.

Remember, the deduction is based on the age of the person undergoing treatment and not the one bearing the expenses. Also, the deduction is not related to health insurance or premium payment or preventive health check-up. This is an additional provision crafted to help people get tax relief if they or their dependents suffer from some specified diseases as mentioned in Rule 11DD of the Income Tax Act. The specified diseases include:

Neurological disorders where the damage is at least 40% or more. The same has to be corroborated by a designated specialist.

• Chronic renal failure
• Malignant cancer
• Critical haematological disorders
• AIDS

The deduction can be availed of only by the person who is actually bearing the expenses. However, you could be paying for yourself and/or your dependents such as spouse, children, parents, and/or siblings. In the case of HUFs, the deduction can be claimed if expenses are incurred for the treatment of any family member of the HUF.

Deduction under Section 80DD of the Income Tax Act: Treatment of a dependent with a disability

Under Section 80DD of the Income Tax Act, individuals or HUFs who take care of disabled dependents can claim a tax benefit. The tax relief deductions are essentially based on the expenses of the disabled dependent. However, this deduction cannot be claimed by the dependent but by the one who takes care of the disabled dependent.

Disabilities include conditions such as blindness, loco-motor disability, mental disability, hearing impairment and leprosy affected.

Under this section, deductions can be claimed for the insurance premium paid for the disabled dependent. However, this benefit is restricted to some insurers. You will have to check if your insurance company offers this benefit or not. If the disability of the dependent is 40% or more or there is more than one disability, then you can claim a deduction of up to Rs 75,000. If the disability of the dependent is 80% or more, then as a caretaker you are entitled to a deduction of Rs 125,000 per annum.

Documents Required for Claiming Tax Deduction for Preventive Health Check Up

You don't have to submit any documents to claim tax deductions for preventive health checkups under section 80D of the Income Tax Act. However, it is recommended that you maintain a record of the bill payment made during the policy year on doctor consultations, diagnostic tests, etc. The reason is that your employer may ask for proof of all deductions when issuing Form 16 for filing income tax returns. The second reason is if you are filing on your own, maintaining the bills can simplify the process of claiming deductions. For preventive checkups, you can make the payments in cash, unlike the payment of health insurance premiums, which must be made in any mode but not in cash.

Claim settlement ratio (CSR) is one of the most important factors that you should consider when buying an insurance policy. It is one of the best parameters to check the credibility and integrity of the insurance company that you are planning to buy your insurance from.

What is a claim settlement ratio?

The claim settlement ratio is a percentage figure that shows how many claims have been settled by the insurance company in a financial year against the total number of claims received in that financial year. Every year, the Insurance Regulatory and Development Authority of India (IRDAI) publishes the claim settlement ratio of all the registered insurance companies.

You can easily check an insurance company’s credibility by checking its claim settlement ratio using the IRDA Claim Settlement Ratio 2022 annual report.

Importance of the claim settlement ratio

Your insurance company’s claim settlement ratio is important for two reasons:

• Insurer’s credibility:

A higher claim settlement ratio implies that the insurance company has honored a higher number of claims. This is an indicator that the company is committed to settling the claims raised by its policyholders. This shows their credibility.

• Security for you:

The purpose of buying insurance is to be financially protected in times of crisis. If you cannot get the required financial cushion when you need it the most, the whole purpose of investing in an insurance plan gets defeated. A good and healthy credit settlement ratio ensures financial security for you and your family.

When you claim insurance—be it a health insurance policy or motor insurance—in the face of an emergency, your choice of claim settlement method plays a key role in determining how you feel about your policy. You invest in insurance for the assurance of financial support in your time of need. Cashless claim settlement takes the relief a notch higher by letting you focus on the crisis at hand rather than worrying about arranging for funds at the moment. Confused? Don’t be. Here’s all you need to know.

What is cashless health insurance?

Cashless health insurance refers to policies that offer the cashless claim settlement feature. Under such policies, when a policyholder is admitted to a network hospital, the insurer and the hospital coordinate to settle the medical expenses directly. To avail of this facility, the policyholder must inform the insurer within a specified timeframe—usually at least two days before planned hospitalisation and within 24 hours in case of emergencies. The hospital administration then contacts the insurer, sending a pre-authorisation form to initiate the claim settlement process.

What is cashless claim settlement?

As a policyholder, there are two ways you can make a claim—cashless claim settlement and reimbursement claim settlement.

• Cashless claim settlement

Remember, you can avail of this benefit only at a network hospital or garage for health and motor insurance, respectively. Based on your policy terms, with cashless treatment, you can seek treatment at a network hospital or get your vehicle repaired at a network garage without paying anything out of your pocket. All you need is your insurance card and policy details. Your bills will be settled by the insurer with the hospital or garage directly.

• Reimbursement claim settlement

Reimbursement claim settlement is primarily used in cases where the insured either cannot access or wish to seek service at a network hospital or garage. Most insurance policies allow you to utilize the services of a network hospital or garage of your choice. However, in such situations, you must pay the bills upfront and later claim reimbursement from the insurer. To claim reimbursement, you will have to submit the original documents, bills, reports, etc. along with the duly filled-up claim request form. Once your documents are verified, the reimbursed amount is transferred to your bank account by the insurer.

Is cashless better than reimbursement?

When comparing cashless claim settlement to the reimbursement process, several advantages of the former become evident:

1. Immediate financial relief: In cashless settlements, the insurer directly pays the hospital, eliminating the need for the policyholder to arrange funds during emergencies. In contrast, the reimbursement process requires the insured to pay the medical bills upfront and then claim the amount from the insurer, which can be financially burdensome.
2. Simplified process: Cashless claims involve coordination between the hospital and the insurer, reducing paperwork for the policyholder. Reimbursement claims, however, require the insured to collect all bills, reports, and relevant documents to submit to the insurer for claim processing.
3. Time efficiency: The cashless process is generally quicker, with approvals often granted within a few hours. Reimbursement claims can take longer to process as they involve document verification and approval procedures.
4. Reduced stress: Knowing that the insurer will handle the expenses directly allows the insured to focus on recovery without worrying about financial matters.

How does cashless claim settlement work?

Given below is the cashless claim settlement process for health insurance:

• In case of a medical emergency, get admitted to a network hospital.
• Every network hospital has an insurance desk. You can get all the information regarding claim settlement here.
• Ask for a pre-authorization at the insurance desk. Or, get a declaration from the Third Party Administrator (TPA). Get a printout of the same.
• Submit the necessary form along with the pre-authorization letter or the TPA declaration.
• You will get an email confirming coverage and the maximum sanctioned amount.
• Once the treatment is completed, if the bill incurred is within the limits of the sanctioned amount, you will not have to pay a rupee. If the bill exceeds the limit, you will have to pay the extra amount.

Steps for cashless claims

To effectively utilise the cashless claim facility, policyholders should follow these steps:

1. Choose a network hospital: Ensure that the hospital where treatment is sought is part of the insurer's network. This information is typically available on the insurer's website or through customer service.
2. Inform the insurer:
• Planned hospitalisation: Notify the insurer at least two days before the scheduled admission.
• Emergency hospitalisation: Inform the insurer within 24 hours of admission.
3. Provide necessary documentation: At the hospital, present your health insurance card and a valid ID. The hospital will assist in filling out the pre-authorisation form and submitting it to the insurer.
4. Await approval: The insurer will review the pre-authorisation request. Upon approval, the treatment can proceed without any upfront payment from the policyholder.
5. Post-treatment process: After discharge, ensure that all original documents, bills, and discharge summaries are retained, as the insurer may require them for their records.
6. Settlement: The insurer will directly settle the approved amount with the hospital. Any non-covered expenses or exclusions will need to be paid by the policyholder.

Conclusion

Before choosing the cashless claim settlement method, look for your options for network hospitals and garages. When buying a health insurance policy, make sure your insurance company has a wide network of these facilities.

Furthermore, check the health insurance claim settlement ratio of the company as well. Every year the IRDA publishes the claim settlement ratio of all insurance companies registered under it. Always choose an insurance company such as ICICI Lombard that has a long record of consistent financial credibility. You can check the ICICI Lombard Claim Settlement Ratio either on its official website or the list of IRDA Claim Settlement Ratio 2022 report.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the topic featured in the article. 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.

Vitamin D is key when it comes to maintaining healthy bones, supporting immune function and regulating mood. Our body makes it from sunlight but food sources also matter, especially if sun exposure is low. Finding the right foods can be challenging, as vitamin D is naturally present in relatively few items.

In this guide, you'll find the best vitamin D foods for vegetarians and non-vegetarians. It’s a simple way to choose what works for your lifestyle.

Benefits of vitamin D

Some benefits of vitamin D include:

1. Fights bone diseases: Vitamin D is an essential component for calcium absorption. Without vitamin D, you cannot have calcium in your body in active form. Absorption of calcium allows the body to maintain the required amount of phosphate in the body which is again essential for bone health and development.
2. Helps maintain good mental health: While it is not clear how essential vitamin D is in checking clinical depression, it is highly effective in managing seasonal depression. Since there is less sunlight in winter, the body absorbs relatively much lesser vitamin D. This adversely affects the neurotransmitter serotonin.
3. Fights respiratory infections: If you have a significantly low vitamin D level, chances are high that you may suffer from more respiratory issues such as cold and flu. Research shows that deficiency of Vitamin D can worsen the post-COVID consequences.
4. Protects against heart ailments and diseases: An adequate amount of vitamin D reduces the risks of heart failure, stroke and several heart diseases. Medically, it is not clear if Vitamin D is solely responsible for the prevention of heart diseases, but it definitely helps.
5. Keeps the risks of diabetes in check: Cell-based observational studies show that vitamin D augments insulin sensitivity, improves beta cell function and reduces inflammation. All these factors are extremely important in controlling Type 2 Diabetes.
6. Reduces cancer risk: More and more scientific sample studies are reinforcing the role of vitamin D in managing and reducing the threat of cancer. The potential correlation between vitamin D and colon cancer, ovarian cancer, breast cancer and prostate cancer is evident. Vitamin D helps in controlling the growth of cancer cells.
7. Guards against autoimmune conditions: Vitamin D plays a very important role in regulating the immune system, thus preventing autoimmune disorders. Studies show that people who intake or absorb sufficient vitamin D are less prone to autoimmune disorders such as arthritis, thyroid, etc.
8. Helps check cognitive inefficiency and dementia: Our brain tissues have vitamin D receptors. This indicates the role of vitamin D in cognitive development and health. Since vitamin D enhances cognitive function, it also helps in preventing conditions such as dementia.

Top vitamin D foods for vegetarians

Given below is a list of vitamin D foods for vegetarians. To ensure an adequate amount of vitamin D in your body, include these vitamin D-rich foods:

1. Fortified orange juice: Most store-bought fortified orange juice is supplemented with calcium and vitamin D, making it a reliable source of nutrition for lactose-intolerant people. One cup of enhanced orange juice has 100 IU of vitamin D.
2. Mushrooms: Similar to humans, mushrooms can produce Vitamin D when exposed to sunshine. With 2300 IU of vitamin D2 per 100g, they are rich in vitamin D. However, professionally raised mushrooms have very little vitamin D2. Although some varieties receive UV light treatment, making them a good source of vitamin D. These mushrooms contain 130 to 450 IU of vitamin D2.
3. Fortified soymilk: For vegans and vegetarians, soymilk is a nutritious meal alternative because it contains the same nutrients as cow's milk. Each cup of soy milk contains 120 IU of vitamin D. However, before purchasing soy milk, read the label to determine whether it contains vitamin D. Little vitamin D is present in non-fortified brands.
4. Cheese: Cheese makes one of the best vitamin D-rich foods for vegetarians. Cottage cheese has particularly higher amounts of vitamin D. Other cheeses with vitamin D include Cheddar, Fontina and Monterey. Any type of cheese has about 24 IU of vitamin D per 100g serving.
5. Yoghurt: Because yoghurt is fortified with vitamin D, dairy and non-dairy yoghurts have high levels of this vitamin. It contains around 120 IU of vitamin D per cup.
6. Fortified almond milk: Each serving of fortified almond milk has 2.4 mcg (96 IU) of vitamin D. Numerous almond milk brands also add calcium to enhance its nutritional value.

Top vitamin D foods for non-vegetarians

Some of the vitamin D foods for non-vegetarian people are:

1. Salmon: Salmon is an oily fish that has a lot of vitamin D. According to the Food Composition Database of the United States Department of Agriculture (USDA), 100g of Atlantic salmon contains 526 IU of vitamin D per serving. When compared to farmed salmon, wild salmon has greater vitamin D. The amount of Vitamin D in a 100g plate of wild salmon is 988 IU compared to 25% in farmed salmon.
2. Tuna: Canned tuna has 268 IU of vitamin D which makes it a superior source of the vitamin. In addition, it is less expensive than purchasing fresh fish. Consuming canned tuna also increases the amount of niacin and vitamin K in the body. However, avoid overconsumption of this food item as it contains the toxic metal methylmercury. High levels of methylmercury in the body can cause serious health conditions.
3. Cod liver oil: If you are not too fond of eating fish, then include a cod liver oil supplement in your diet. Cod liver oil contains 448 IU of vitamin D per teaspoon. This can be easily given to kids who need more vitamin D. It is also a rich source of omega-3 fatty acids and vitamin A. However, avoid consuming excessive amounts of cod liver oil because high levels of vitamin A in the body can be harmful.
4. Sardine: Sardine is an excellent vitamin D food. It contains 177 IU of vitamin D. Fatty fish like halibut and mackerel are also good sources of vitamin D.
5. Herrings: Whether it is served canned, smoked, pickled or raw, herrings are a great source of Vitamin D. It has 216 IU of vitamin D per 100g serving. Additionally, pickled herring contains salt and 112 IU of vitamin D, both of which are essential to human health.
6. Fortified cow milk: Cow milk has phosphorus, calcium and riboflavin. With 115–130 IU of vitamin D per cup, it is a fantastic source of vitamin D.
7. Egg yolk: You can get 37 IU of this vitamin from eggs. Note that the chicken’s exposure to the sun and the vitamin D concentration of chicken feed determine the vitamin D content of eggs. Eggs from chickens that have access to pasture and sunlight are three to four times more vitamin D-rich. They have 6000 IU of vitamin D.

What is vitamin D deficiency?

A shortage of vitamin D in the body or its inadequate absorption is called vitamin D deficiency. This usually happens if a person does not consume adequate vitamin D-rich foods or has very little exposure to the sun.

Tips to increase the intake of Vitamin D

If you're looking to improve your vitamin D levels, here are some effective ways to do it:

• Get sun exposure

Spending time in sunlight is the most natural way to boost vitamin D. Aim for 10-30 minutes of midday sun exposure, thrice a week, depending on your skin tone and location. Be cautious of overexposure to avoid skin damage.

• Incorporate vitamin D-rich foods

• Fatty fish: Salmon, mackerel and tuna are among the richest sources of Vitamin D.
• Egg yolks: A single egg yolk contains a small amount of Vitamin D.
• Fortified foods: Many dairy products, orange juices, cereals and plant-based milks are fortified with Vitamin D.
• Mushrooms: Some varieties, like shiitake and maitake, can provide Vitamin D when exposed to sunlight.

• Consider supplements when necessary

Vitamin D supplements are a reliable option, especially for those with limited sun exposure. Take it with a fat-containing meal to improve absorption. Always consult a healthcare provider before starting any supplement.

• Utilise UV lamps or bulbs

For people living in regions with little sunlight, especially during winter, UVB lamps can help the skin produce vitamin D. Make sure the lamp emits UVB rays, not just UVA. Use them in moderation, as overuse can damage the skin and eyes.

• Engage in outdoor activities

Regular physical activity outdoors helps increase your sun exposure naturally. Walking, gardening, or exercising outdoors not only supports general wellness but also encourages your body’s vitamin D production.

Conclusion

Maintaining healthy vitamin D levels is important to support bone strength, immunity and overall well-being. It’s also important to remember that proactive health habits go hand-in-hand with financial security. Having the right health insurance ensures you're covered in case of deficiencies or related health issues that may require medical attention. For older adults, investing in a comprehensive senior citizen health insurance plan can provide added peace of mind and support in managing age-related health needs.

FAQs

• Which fruits and vegetables contain Vitamin D?

Among fruits, oranges contain Vitamin D. Apart from that you can eat mushrooms, tofu, cheese, cereals and yoghurt. All these food items are good sources of vitamin D.

• What does Vitamin D do?

Vitamin D is a fat-soluble nutrient that helps the body absorb calcium, magnesium and phosphate, which are essential for bone development.

• What are the different forms of vitamin D?

There are primarily two types of vitamin D—vitamin D2 and vitamin D3 which are also called ergocalciferol and cholecalciferol, respectively.

• What is vitamin D toxicity?

Too much consumption and/or absorption of vitamin D, much more than required by the body, can cause calcium accumulation in the body. This overabsorption of vitamin D can damage kidneys and bones. Excess vitamin D in the body is called vitamin D toxicity.

• How can vegans get sufficient vitamin D?

Vegans can get vitamin D from plant-based milk yoghurt, tofu, mushrooms, almond milk, rice milk etc. Many vegetarian and non-animal dairy food items are good sources of vitamin D.

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 your general physician or another certified medical professional for any questions regarding a medical condition. 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 Insurance Regulatory and Development Authority of India(IRDAI) is the insurance sector regulatory body in India. The IRDAI’s objective is to optimise the existing insurance industry and make sure the operations and conduct of the sector are fair. The insurance market is undergoing constant changes, upgradation, and high competition. Consequently, the role of the IRDAI is essential.

Who is IRDAI and its role in health insurance?

The IRDAI is the topmost organisation in India responsible for the smooth operation of its vast insurance sector. Among its primary responsibilities are regulating the insurance companies (both government and private), protecting the rights and interests of the policyholders and creating conditions for fairness and transparency. In the field of medical insurance, IRDAI sets rules for the claim settlement process and makes sure that insurance providers properly handle the claims and provide the needed financial support to people.

IRDAI guidelines for claim settlement

The IRDAI has laid down some rules for health insurance claim settlement for all insurance providers registered under it. These rules are laid down to help both the insurer and the insured. Listed below are some of the rules for health insurance claims laid down by the IRDAI:

• A health insurance may not have an exit age if the policyholder renews it on schedule without any interruptions in renewal.
• A Group Health Insurance policy comes with a validity of a maximum of one year.
• The insurer is responsible for providing the policyholder with information regarding the terms and conditions of the policy concerning receiving care at a hospital in India.
• The insurance provider must give the policyholder the choice to switch to another plan after meeting the exit conditions for their health insurance policy. Additionally, insurers must award appropriate credits if the policy was renewed without any gaps.
• The insurance provider must give the applicant a fair, justifiable, and open explanation in writing if their request to purchase health insurance is declined.
• A policyholder will receive rewards if they renew their coverage on time, purchase it early in life, or have a positive claims experience with an insurance provider. The prospectus and policy document should include explicit references to the benefits as agreed by the board.
• Before issuing the policy, the insurance company should give the policyholder a list of medical facilities, government or otherwise, from whom the firm will accept the medical reports.
• Particularly for senior individuals, the premium amount should be reasonable, equitable, and clear. Additionally, the total sum should be made clear to the potential policyholder.

IRDAI’s protection for policyholders

IRDAI has rules for claim rejection and settlement as well. Some of them are:

• If the policyholder maintains the coverage for 8 years without a break, the health insurance provider cannot deny a claim. These 8 years are called the moratorium period.
• Except in cases of fraud and/or a claim brought against the exclusion of the health policy after the moratorium period, the insurance company cannot appeal to the IRDAI against the settlement of such a claim.
• A claim cannot be denied by the insurance company due to misrepresentation or non-disclosure.
• A claim cannot be denied on that basis since IRDAI has allowed the insurance company an 8-year window for validating the information provided by the policyholder.
• The insurance company is responsible for paying interest on the claim amount at a rate that is 2% higher than the bank rate if the insurer's claim payment is delayed.
• The claim should be resolved within 30 to 45 days of the date the policyholder received the last necessary document.

How to ensure a smooth claim process?

Policyholders can facilitate efficient claim settlements by:

• Understanding Policy Terms: Familiarize yourself with coverage details, exclusions and claim procedures.
• Maintaining Records: Keep all medical bills, reports and related documents organized for easy access during claims.
• Timely Intimation: Inform your insurer about hospitalizations or treatments promptly, adhering to specified timelines.

If you understand the details of your medical insurance plan, it can ease the claim process, particularly when you are managing medical insurance for parents.

FAQs

What is the time frame for claim settlement as per IRDAI?

Insurers are required to settle or reject a claim within 30 days of receiving all necessary documents as per the rules set by IRDAI.

Can insurers ask for additional documents after the initial submission?

Insurers needed to ask for all the required documents at once. In case any additional requests need to be made, they should be exceptional and justified.

What if my claim is rejected unfairly?

You can approach the insurer's grievance redressal cell. If unresolved, escalate to the Insurance Ombudsman or IRDAI.

Conclusion

IRDAI's regulations aim to create a transparent and efficient health insurance claim settlement process. In this blog, the guidelines set by IRDAI have been explained, which will help you understand and make better decisions regarding your medical insurance plan, which will go a long way in securing your overall health.

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.

You must always check the claim settlement ratio (CSR) of a health insurance company before buying a policy from them. In fact, you should compare different insurance providers, their plans, terms and conditions, coverage, and waiting period for pre-existing diseases before paying the premium amount. Also, compare their health insurance claim settlement ratio. This is because a medical emergency would already put you under immense mental stress. In such a situation, the last thing you would want to do is follow up through a complex claim settlement process, and worse, face claim rejection. An insurer with a good claim settlement ratio will help you with a seamless and hassle-free claim settlement process.

What is a claim settlement ratio?

The Claim Settlement Ratio (CSR) is the percentage of health insurance claims settled by an insurer compared to the total claims received in a given period. It indicates the insurer’s efficiency in processing claims and honouring policyholder benefits.

Formula for Claim Settlement Ratio:

For example, if an insurer receives 10,000 claims and successfully settles 9,500, its CSR would be 95%.

Types of health insurance claim ratio

There are different types of claim ratios used to assess an insurance company’s performance:

1. Claim Settlement Ratio (CSR): Measures the percentage of claims successfully settled.
2. Incurred Claim Ratio (ICR): The ratio of total claims paid to total premiums collected by the insurer.
3. Claim Rejection Ratio: Percentage of claims rejected by the insurer.
4. Claim Pending Ratio: The proportion of claims still under process.

Why is the claim settlement ratio important when buying health insurance?

The CSR is crucial when selecting a health insurance plan because:

• It reflects the insurer’s credibility and efficiency in claim settlement.
• A higher CSR indicates a greater probability of claim approval.
• Helps policyholders avoid insurers with a high claim rejection rate.
• Ensures health insurance for senior citizens offers financial security without unnecessary claim delays.

What is considered as a good claim settlement ratio?

A good CSR is generally considered to be above 95%, meaning the insurer successfully settles a vast majority of claims. However, a very high CSR (near 100%) might indicate relaxed claim processing, leading to financial instability for the insurer.

How does claim settlement ratio help you choose the right health insurer?

When selecting a health insurer, a high CSR indicates:

• Faster claim processing.
• Fewer claim rejections.
• Financial stability of the insurance provider.
• A more seamless claim experience for policyholders.

Is the claim settlement ratio enough for evaluation?

Besides the claim settlement ratio, consider the following factors to ensure a smooth claim settlement of your health insurance:

• While it is suggested that you should always opt for an individual health insurance provider with a high claim settlement ratio, it is equally important to check the settled claim amount. If the average amount is low, the company may settle a large number of claims for a smaller sum insured.
• You also need to check the claim settlement process of the insurance company you are buying your health insurance The process should be easy and hassle-free.
• Go for insurers with a good digital presence and equally good online customer service.
• While checking the claim settlement ratio, check the company’s CSR for the last 4-5 years. A one-time high CSR does not ensure consistent performance. Choose a company like ICICI Lombard that has been consistently performing well. You can check the ICICI Lombard Health Claim Settlement Ratio from the IRDA Claim Settlement Ratio 2022 annual report.

Importance of claim settlement ratio

Understanding the claim settlement ratio is important because it-

• Helps in choosing a reliable insurer.
• Provides assurance of claim approval.
• Reflects the efficiency of the insurance company.
• Prevents financial distress during medical emergencies.

Required documents for claim settlement

To file a claim, policyholders must provide:

• Duly filled claim form.
• Medical bills, hospital discharge summary and doctor’s prescription.
• Policy document and insurance ID.
• KYC documents (Aadhaar, PAN, etc.).
• Pre-authorisation form (for cashless claims).

How to check health insurance claim settlement ratio?

Before zeroing in on a health insurance plan, run through the following steps:

• Every year, the Insurance Regulatory and Development Authority (IRDA) publishes the claim settlement ratios of all insurance companies registered under it.
• Visit the official website of the IRDA and check the IRDA health insurance claim settlement ratio of your preferred insurance company. Look for the IRDA Annual Report and download the PDF for the latest financial year.
• Make a list of insurance companies with a high IRDA Claim Settlement Ratio in 2022. The higher the claim settlement ratio, the better your chances of getting the sum insured in times of medical emergency.
• Now, compare the coverage benefits of the available health insurance plans of companies with a high claim settlement ratio.

Where to check the claim settlement ratio of a health insurance company?

To check the CSR, you can use the following platforms-

• IRDAI official website.
• Insurance provider’s website.
• Insurance aggregators provided by insurance providers online

How is the health insurance claim ratio calculated?

The CSR is calculated annually by dividing the total claims settled by the total claims received, then multiplying by 100 to get the percentage.

Types of claim settlement processes

These are the types of claim settlements you will see in the insurance claim process-

1. Cashless Claim Settlement: The insurer directly settles bills with network hospitals.
2. Reimbursement Claim Settlement: The policyholder pays the bills first and later claims reimbursement.
3. In-house vs. Third-party Claims Processing: Some insurers handle claims internally, while others outsource them to Third-Party Administrators (TPAs).

FAQs

1. What is a good claim settlement ratio for health insurance?

A CSR above 95% is considered good, ensuring a higher probability of successful claim settlements.

2. Does a high claim settlement ratio guarantee a hassle-free process?

Not necessarily. Other factors like customer service, hospital network and turnaround time should also be considered.

3. Where can I find the claim settlement ratio of my insurer?

You can check the IRDAI website, the insurer’s official website, or insurance comparison platforms.

4. Is CSR relevant for health insurance for senior citizens?

Yes, CSR is crucial in health insurance for senior citizens as they require higher medical coverage and faster claim processing.

5. Can I trust an insurer with a 100% claim settlement ratio?

A 100% CSR may indicate relaxed claim approvals, potentially leading to financial instability. A ratio between 95-98% is ideal.

Conclusion

Remember, a health insurance plan may come with good coverage and several additional benefits at a competitive price. But, if the claim settlement ratio of that health insurance provider is not good, you may face a hard time getting your claim settled when you need it the most. This would defeat the whole purpose of getting health insurance. While a high CSR increases the likelihood of claims being settled, it should be evaluated along with other factors like network hospitals, customer service and financial stability. Whether purchasing a health insurance plan for individuals or health insurance for senior citizens, choosing an insurer with a strong claim settlement record ensures peace of mind during medical emergencies.

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.

Dental hygiene is essential for overall health. Ignoring your oral health can cause cavities and tooth decay. For example, if you ignore dental plaque and do not visit your dentist to have it removed from your tooth enamel, you may develop an oral bacterial infection. Dental procedures, like any other medical treatment, can consume a month's or two's salary. Still, in most cases, they are not part of standard health insurance, and there are no riders available to take care of your teeth. Have you ever wondered why dental procedures are not covered by health insurance? To know the answer, read on. 

What is Dental Insurance?

Dental insurance is a type of medical insurance that covers dental procedures and treatments. In India, most insurers cover dental procedures if the need for medical treatment arises due to a severe accident. Furthermore, if some oral ailments have become life-threatening and dental procedures were done on the recommendation of registered medical practitioners, then you may be able to settle your related claims.

Why Is Dental Insurance Necessary?

Investing in dental insurance is important for the following reasons-

1. It is an effective way to manage the costs of surgical procedures that are otherwise expensive.
2. It also covers preventive care, which reduces the likelihood of surgeries.

What Do Dental Insurance Plans Typically Cover?

Dental insurance plans typically provide coverage for the following:

1. Preventive Care

This includes routine cleaning, regular tests, and X-rays.

1. Basic Procedures

Cavity fillings and basic extractions are covered.

2. Major Procedures

Crowns, dentures, bridges, and root canal treatments are a part of major procedures. 

Some premium plans also cover orthodontic treatments and cosmetic procedures, which standard insurance does not include.

What Are the Common Exclusions in Dental Insurance?

While several important treatments are included in dental insurance, there are also a few exclusions that you should know about-

1. Cosmetic procedures such as veneers and teeth whitening are not covered.
2. Pre-existing conditions are not covered by certain health insurance plans.
3. Most dental insurances have an upper limit, and any cost beyond that is not covered by the plan.

Who Should Buy a Dental Insurance Plan?

Dental insurance plan can be especially useful for-

1. Families with Kids: Children may often need dental visits for issues like cavity and treatments such as braces which are covered by dental insurance.
2. People with Chronic Dental Issues: Individuals who have cavities, or gum disease or need regular visits to dentists should consider dental insurance.
3. Aged People: Senior citizens experiencing deteriorating oral health with age.

Why is Dental Work Not Included in Health Insurance?

Dental work is often not included in general health insurance plans. The reasons for this exclusion are-

1. Historical Context: While health insurance covers serious illnesses and emergencies, dental care has been traditionally seen as a luxury and not a necessity.
2. Cost Containment: Dental work as a part of insurance policies increases the premium, making health insurance costly.
3. Preventive Nature: Dental care is still treated as a preventable procedure through good oral hygiene and regular checkups.

FAQs

1. Can I get health insurance that covers dental care?

A few comprehensive health insurance plans offer the option of including dental care, but it is not included in standard health insurance policies.

2. Is dental insurance expensive?

Dental insurance plans are typically affordable, offering various budget-friendly options to suit the policyholder's needs.

3. How can I reduce dental care costs?

Maintaining oral hygiene, regular checkups, and making use of discounts available at dental hospitals and medical camps are some of the ways of managing the cost of dental care.

4. Are dental emergencies covered under health insurance?

Yes, dental emergencies caused due to accidents are covered by health insurance. However, longer procedures, the cost of hospitalisation, and other dental care expenses are usually not covered by general health insurance.

5. Are root canals covered by health insurance?

While some insurance providers offer coverage for root canals, others do not. Consult your insurer for more details on inclusion and exclusions under your medical insurance.

Conclusion

Dental procedures are subject to policy exclusions as they are considered cosmetic procedures. Even if your insurer provides coverage for this, you should try to understand all the provisions associated with dental-related issues and the claim process. Read all the policy guidelines and choose dental insurance that covers any surgery or dental care you plan to avail.

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 your general physician or another certified medical professional for any questions regarding a medical condition. 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.

As the name implies, a family floater health insurance covers the entire family under a single policy. The policy benefits apply to your spouse, dependent children, and dependent parents. Sometimes, siblings are also covered by this plan, but you must check this with your insurer. In this blog, we will discuss the important features, benefits, and process of buying family health insurance to assist you in making the right decision.

What is family floater health insurance?

In a family floater health insurance policy, each covered member can use the sum insured up to the full amount. However, if one member uses the entire amount, the other member will be denied benefits. To overcome this, you can supplement your policy with a reinstatement add-on. It will restore the sum insured, allowing other covered members to benefit from the coverage.

Key features of family floater health insurance

Some important features of family floater health insurance are-

1. Single sum insured for whole family-

   A single sum insured is shared among all insured family members without needing individual policies.

2. Cashless hospitalisation-

   Many plans offer cashless treatment facilities at network hospitals, eliminating the need for upfront payments during emergencies.

3. Tax benefits-

   Under the tax laws of India, a tax deduction can be claimed for the premium of a family floater health insurance policy.

4. Wide coverage-

   Includes hospitalisation charges, pre- and post-hospitalisation expenses, daycare treatments, ambulance costs, and more.

Benefits of family floater health insurance

The benefits of a family floater health insurance are-

• The policy reimburses for pre and post-hospitalisation expenses.
• This family health insurance covers daycare procedures such as minor surgeries and anaesthesia.
• There is also a provision for medical expenses related to organ donors for a specific time.
• You can also raise medical bills related to in-patient and domiciliary expenses.
• Under the Tax laws (Income Tax Act Section 80D), premiums paid for this kind of health insurance policy are eligible for tax deductions.

How does a family floater health insurance work?

Assume you have a Rs 1,000,000 worth family floater insurance policy. Along with you, the plan covers your spouse and children. Your spouse and child became severely ill within a year of purchasing the policy. The treatment bill for your spouse is approximately Rs 800,000, and that for your child is around Rs 200,000. In this case, the sum insured of Rs 1,000,000 will cover both sets of bills. This structure provides flexibility but requires careful consideration of the family's healthcare needs to ensure suitable coverage.

What does a family floater health insurance plan cover?

Given below is a list of inclusions under a family floater health insurance policy -

• In-patient hospitalisation:

  Expenses related to hospital stays, including room rent, nursing, and associated costs.

• Daycare procedures:

  Treatments that do not require extended hospitalisation, such as certain surgeries and medical procedures.

• Ambulance charges:

  Costs incurred for transporting the insured to the hospital.

• Pre and post-hospitalisation:

  Medical expenses incurred during a specified number of days before and after hospitalisation.

• Preventive health check-ups:

  Some policies offer coverage for routine health examinations.

What family floater health insurance does not cover?

There are a few things that family floater health insurance does not cover. These are-

• Pre-existing diseases:

  coverage is typically excluded during the initial policy period but commences after a waiting period.

• Cosmetic procedures:

  Expenses related to aesthetic treatments not medically necessary.

• Alternative treatments:

  Expenses for non-allopathic treatments may not be covered unless specified.

• Treatment of certain medical conditions:

  such as sexually transmitted diseases and issues arising from substance abuse.

Things to consider before buying a family floater health insurance plan

Careful planning and discussion among the family members is important before going for a family floater health insurance.

Key things to consider are-

• Assessment of coverage needs:

  Evaluate the medical history and healthcare requirements of all family members to determine an adequate sum insured.

• Network hospitals:

  Check the insurer's list of network hospitals to ensure accessibility to cashless treatments.

• Inclusions and exclusions:

  Thoroughly read the policy document to understand what is covered and what is not, including any sub-limits or co-payment clauses.

• Waiting periods:

  Be aware of waiting periods for specific treatments or pre-existing conditions.

• Renewability:

  Opt for policies with lifetime renewability to ensure continued coverage as the family ages.

How to apply for family floater insurance plans online?

Buying a family floater insurance plan online is a quick and easy process. Follow the guide given below-

1. Visit official websites:

   Access the insurer's official website or a reputable insurance aggregator platform.

2. Use premium calculators:

   Provide details such as name, gender, contact information, date of birth, and location PIN to get a quote on the policy.

3. Choose the insurance:

   From the list of policies, choose the family health insurance and check the policy term, premium, and amount insured.

4. Fill application form:

   Provide necessary details, including personal information and details of all family members to be covered. Answer questions related to health, marital status, and information about all the family members.

5. Upload documents:

   Submit required documents such as identity proof, address proof, and medical records if necessary.

6. Payment:

   Pay the premium online through secure payment gateways.

7. Confirmation:

   Upon successful payment, receive the policy document via email or download it from the insurer's portal, usually in 5 to 7 business days.

FAQs

1. Who is eligible for buying a family floater health insurance?

The minimum age for getting family floater health insurance is 18 years, and the maximum is 65 years. Children between 3 months to 25 years dependent on the elders are also included in this plan.

2. How many members can be covered by a family floater health insurance plan?

Up to 6 members can be covered under a family floater health insurance policy, including the couple, their children, parents, and in-laws.

3. Who cannot be covered under the family floater plan?

Extended family members such as aunts, uncles, cousins, or grandparents are usually excluded under the family floater health insurance policy.

4. What are the disadvantages of family floater health insurance?

High premiums and the possibility of the coverage being exhausted by one person only are some of the main drawbacks of a family floater plan. Limitations on the number of members can also be seen as a downside of this type of health insurance.

5. Which is the better option- family floater or individual health insurance?

The value of a health insurance policy, be it a comprehensive plan for one person or medical insurance for the whole family, depends upon the needs and financial situations. While individual plans offer complete and personalised coverage, family floater health insurance is shared amongst family members.

Conclusion

A family floater plan is essential today. However, before choosing an insurer, you should consider the coverage scope, renewability options, ease of adding new members, and claim settlement process. Review the benefits and limitations of buying insurance for the whole family, and decide to ensure a tension-free and secure future for you and your loved ones.

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.

Related Article:-

• Who Cannot Be Covered Under a Family Floater Policy
• Top-Up Insurance Plan for A Separate Family Floater Plan
• Family Floater Critical Illness Plan: Coverage & Benefits
• Average Cost of Health Insurance for a Family of 3
• Understanding family health insurance deductibles

Owing to ever-rising inflation, a huge sum of money that appears sufficient today may prove inadequate for the smallest of your needs in the future. In India, everything is becoming more and more expensive, whether it is groceries or the cost of treating minor ailments. In such a scenario, insurance products come in handy.

However, purchasing medical insurance without first assessing your needs is pointless. You must account for today's doctor consultation fees, critical illness treatment costs, and more. How much health insurance do I need? is a valid question and today, we will look into it in detail.

Importance of health insurance in India

Healthcare expenses in India have been rising steadily, making health insurance plans essential. Medical emergencies can deplete savings, and treatments for critical illnesses can be costly. A well-chosen health insurance policy:

• Provides financial protection against medical expenses.
• Covers hospitalisation, surgeries, and critical illnesses.
• Ensures access to quality healthcare without financial worries.
• Reduces tax liability under Section 80D of the Income Tax Act.

What is the ideal health insurance coverage in India?

 The answer majorly depends on your age. Most adolescents are free of major or minor illnesses. If you are young and work for a company that offers group health insurance, you may choose to insure yourself for a lower sum.

However, if you are over 40 years, your sum insured should be at least 3-5 times your annual income. It means that if you earn ₹6 lakhs per year, coverage ranging from ₹18 lakhs to ₹30 lakhs is ideal.

How to choose your ideal health insurance coverage amount?

You should decide on coverage after considering your age and the number of dependent members. If you have a spouse over the age of 40 years, dependent children, and dependent parents, the total sum insured should be on the higher side. Other factors to consider include:

• Determine potential medical risks. For example, if you have diabetes, you are more prone to heart disease, strokes, and other complications. Always factor in these uncertainties before deciding on the best coverage.
• Check to see if the insurer you are considering has network hospitals in your city.
• Evaluate the benefits provided by the group health insurance through which you are covered.
• Check with your insurance company to see if advanced medical treatments are covered. Read the fine print in the policy brochure to see the provisions relating to the policy's inclusions and exclusions.

All of these parameters not only aid in the selection of the best sum insured, but also in the selection of the best insurer.

How much health insurance is enough in India?

The ideal health insurance plan should cover hospitalisation, doctor fees, pre- and post-hospitalisation expenses, and critical illnesses. Here’s a breakdown:

• For individuals: ₹5-10 lakh
• For families: ₹10-20 lakh (family floater plans)
• For senior citizens: ₹10-25 lakh (including critical illness cover)

Factors to consider while choosing the right health insurance coverage amount

• Rising medical inflation: Medical costs increase yearly, so select a relevant plan.
• Critical illness coverage: Ensure coverage for diseases like cancer, kidney failure, and heart ailments.
• Hospital network: Choose a plan with a wide cashless hospital network.
• Co-payment and sub-limits: Check if the plan restricts claims or co-payment clauses.
• Waiting period for pre-existing diseases: Look for a plan with a shorter waiting period.

How much health insurance do you need in India for family?

If you are your family's sole breadwinner, it is your responsibility to look after your loved ones. If your family consists of your spouse and two children, you can choose a family floater plan with a sum insured of 3-5%. If you have family group health insurance, you may choose lower coverage if you are on a tight budget.

How much health insurance do you need for parents/senior citizens?

People in their old age are more vulnerable to illness. There is also a chance that they have a pre-existing disease or have had major surgery such as a heart bypass in the past. Consider their medical history, current lifestyle, and personal income when deciding on the amount of coverage in a health insurance for senior citizen. Remember, the premium for senior citizens is slightly higher than for young people.

Health insurance plan at ICICI Lombard

ICICI Lombard offers comprehensive health insurance policies with the following:

• High-sum insured options.
• Cashless hospitalisation in a vast network of hospitals.
• Coverage for critical illnesses, pre- and post-hospitalisation expenses.
• There is no co-payment for senior citizens in select plans.

FAQs

1. When is the best time to purchase health insurance?

Buying health insurance early is advisable when premiums are lower and you are less likely to have pre-existing conditions. This ensures continuous coverage and financial security in case of future medical emergencies.

2. Can I modify my health insurance coverage later?

You can adjust your health insurance plan according to your financial situation, family size, or healthcare needs change. Many insurers offer the flexibility to enhance coverage, add riders, or switch plans to suit your evolving requirements.

3. Do health insurance plans cover pre-existing medical conditions?

Most health insurance policies cover pre-existing conditions, but there is usually a waiting period before you can claim these ailments. The duration of this period varies by insurer and policy type.

4. What is the ideal health insurance coverage amount in India?

The right coverage depends on age, lifestyle, medical history, and location. For individuals, a sum insured of ₹5-10 lakh is generally recommended. Families, especially those in metro cities, may require higher coverage to accommodate rising healthcare costs.

5. How much health insurance is necessary for parents and senior citizens?

Given the increased medical expenses associated with ageing, a minimum coverage of ₹10-20 lakh is advisable for senior citizens. A comprehensive plan that includes pre-existing disease coverage and critical illness benefits is an ideal health insurance for senior citizen.

6. What is the recommended health insurance coverage for families in India?

A family health plan with a coverage of ₹5-10 lakh is a good starting point. However, larger families or those in metro cities should opt for higher coverage to ensure complete financial protection against medical emergencies.

7. Is one crore health insurance a good option?

A high-coverage health insurance plan, such as one crore, can benefit individuals seeking extensive medical protection, particularly against critical illnesses or advanced treatments. While it may not be necessary for everyone, it provides financial security against major medical expenses.

Conclusion

Opting for the right health insurance plan depends on factors like your needs, lifestyle, and family structure. A minimum coverage of ₹5-10 lakh for individuals, ₹10-20 lakh for families, and ₹10-25 lakh for senior citizens is advisable. Investing in a comprehensive policy ensures financial security against medical emergencies. Always compare plans, check inclusions, and opt for adequate coverage to safeguard your health and finances effectively.

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 your general physician or another certified medical professional for any questions regarding a medical condition. 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.

Health insurance is essential and the most widely purchased insurance product. The rising cost of medical care combined with a sedentary lifestyle makes it a must-have. Health insurance covers different medical conditions and allows you to lead a stress-free life.

 Health insurance is usually available as an individual plan and a family floater policy. The scope of coverage for both is identical except for the use of the sum insured. Let us proceed and learn

How does health insurance work in India?

Health insurance is specifically designed to provide financial protection against various illnesses. In exchange, the insurer requires you to pay a premium. The cost of this product is determined by several factors, the most important of which is your age and medical history.

 As a policy owner, you are entitled to benefits up to the sum insured. In general, medical insurance policies cover the following expenses:

 Pre and post-hospitalization expenses
Daycare procedures
AYUSH treatment recognized by government institutions
In-patient expenses
ICU charges
Indoor expenses

However, keep in mind that the scope of coverage may differ between insurers. Every policy has a waiting period, and benefits are available once that period is over. As a result, thoroughly reviewing the policy wording is critical.

Deductibles are another important factor to consider. It is the amount you must pay out of pocket at the time of settlement. There are two types of deductibles - mandatory and voluntary. If you increase the latter, your premium will be reduced while your liability will increase.

How does health insurance renewal work?

 Health insurance benefits are available for a fixed time frame. After this period expires, you will have to renew your policy by paying the required premium. During renewal, you can add riders to expand the scope of coverage. If you don't make any medical claims, your insurance coverage will increase up to a certain limit.

 Nowadays, insurers allow both online and offline renewal.