Health expenses are often unpredictable and can strain your finances. A mediclaim policy helps ease that burden by covering hospitalisation costs. But what exactly is a mediclaim policy, how does it work and how is it different from regular health insurance? This blog breaks down its features, types and benefits to help you make an informed choice.

What is a mediclaim?

Mediclaim is a type of health insurance that pays for hospital expenses if you fall ill or get injured. In simple words, if you have a mediclaim policy, the insurance company will help pay your hospital bills, either directly to the hospital or by reimbursing you after treatment. This gives you peace of mind and protects your savings during medical emergencies.

Features of a mediclaim policy

Mediclaim policies come with some important features:

• 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.

How mediclaim insurance works?

When you buy a mediclaim policy, you select the sum insured, which is the highest amount an insurer will pay for hospital expenses. If you fall ill and need treatment, you can either choose a network hospital for cashless treatment or go to any hospital and claim reimbursement later.

Types of mediclaim policy

There are different types of mediclaim policies to suit various needs:

• Individual mediclaim policy: Covers one person for a fixed sum insured.
• Family floater mediclaim: Covers the entire family under a single sum insured. Anyone in the family can use it as needed.
• Senior citizen mediclaim: Specially designed for older people, usually with higher premiums and different benefits.
• Group mediclaim policy: Usually offered by employers to their staff.
• Critical illness mediclaim: Offers coverage if diagnosed with major illnesses like cancer, heart attack, or stroke.

Each type of mediclaim policy has different features, limits and costs. It is a good idea to compare them before deciding which suits you best. For those looking for personalised coverage beyond hospital expenses, individual health insurance can be a better option as it offers wider protection compared to a basic mediclaim plan.

Inclusions and exclusions of mediclaim coverage

Mediclaim policies usually include:

• Hospital room rent
• Doctor’s consultation fees
• Nursing charges
• Surgery expenses
• ICU charges
• Anaesthesia and operating theatre costs
• Pre- and post-hospitalisation expenses for a certain period
• Day-care treatments that do not need long hospital stays

However, there are also exclusions you should know about. Mediclaim policies typically do not cover:

• Cosmetic surgery (unless needed due to an accident)
• Dental treatments (unless caused by injury)
• Pregnancy and childbirth-related expenses (some policies may offer maternity cover as an add-on)
• Pre-existing diseases until the waiting period is over
• Alternative treatments like Ayurveda, unless stated otherwise
• Injuries from war, self-harm, or substance abuse
• Costs above the sum insured

Tips for choosing the right mediclaim policy

Selecting the right mediclaim can feel confusing, but here are some simple tips to help:

• Look at the sum insured: Choose enough coverage to handle expensive treatments. Medical costs are rising, so do not pick a very low sum insured.
• Check network hospitals: Make sure your preferred hospitals are part of the insurer’s network to benefit from cashless treatment.
• Understand the waiting periods: Know the waiting periods for pre-existing diseases and other conditions before buying.
• Look at co-payment clauses: Some policies ask you to pay a small part of the bill yourself. Understand these terms to avoid surprises later.
• Review sub-limits: Policies sometimes have caps on certain expenses, like room rent. Check these limits.
• See renewal conditions: Prefer a policy that offers lifelong renewability.
• Compare policies: Do not buy the first policy you see. Compare benefits, exclusions, premiums and customer reviews before choosing.
• Check claim settlement ratio: This tells you how reliable the insurer is in paying claims.

Mediclaim health policy vs health insurance

Let’s look at the differences between mediclaim policy vs health insurance:

Conclusion

Mediclaim policies are a vital part of financial planning. They protect you and your family from the high costs of hospital treatment and medical emergencies. By paying a yearly premium, you get peace of mind knowing that you can access good healthcare without draining your savings.

Not sure which mediclaim or health insurance cover is right for you? We can help. Just fill out the form on this page to get simple, clear advice based on your needs. Let us guide you in finding the right health insurance plan for yourself or your family.

FAQs

• Can I buy mediclaim for my family?

Yes, family floater mediclaim plans cover your spouse, children and sometimes parents under one sum insured.

• Does mediclaim cover pre-existing diseases?

Mediclaim policies cover pre-existing diseases after a waiting period of usually 2–4 years.

• Is mediclaim the same as health insurance?

Mediclaim is a type of health insurance that mainly pays for hospitalisation expenses. Broader health insurance can cover more than hospital bills.

• What happens if I cross my sum insured limit?

If your medical bills are higher than your sum insured, you must pay the extra amount from your own pocket.

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.

When you or a loved one is admitted to the hospital, dealing with medical costs can be stressful. This is where a mediclaim policy helps. It offers financial support to manage hospital bills. But to get your claim processed smoothly, you’ll come across a term called CCN, which stands for Claim Communication Number. It’s a very important part of the mediclaim process. Let’s understand this in detail.

What is the CCN in mediclaim policy?

The Claim Communication Number (CCN) is a special number given to you when you raise a claim under your mediclaim policy. Think of it as a unique ID for your claim.

Every time you talk to the insurance company or third-party administrator (TPA) about your claim, they will ask for your CCN. It helps them find your file quickly and give you updates.

What is the purpose of CCN in mediclaim?

The main purpose of the CCN is to track and manage your claim easily. Here are some of the things it helps with:

• Faster processing: Your claim file is linked to the CCN. When you mention it, the staff can pull up your file quickly, which saves time.
• Status updates: Whether your claim is approved, needs more documents or is under review, all updates are shared based on your CCN.
• Clear communication: If there is any confusion or issue, giving your CCN helps avoid mix-ups. It ensures you’re getting information about your claim and not someone else’s.
• Record keeping: The CCN is useful for keeping a record of your claim. If you want to refer back to it in the future, this number will help locate the correct details.

Whether you’ve opted for a basic mediclaim policy or a more comprehensive health insurance plan, having a CCN ensures your claim is properly identified and processed without confusion.

How to get a CCN from mediclaim policy?

Getting your CCN is quite simple. Here’s how the process generally works:

1. Cashless claim

If you are going for a cashless hospitalisation, the hospital sends a pre-authorisation request to the insurance company or TPA. Once the request is verified and accepted, you will receive a CCN via SMS or email.

1. Reimbursement claim

If you have already paid the hospital bills and are claiming reimbursement, you will need to submit documents such as:

• Hospital bills
• Medical reports
• Discharge summary
• Doctor’s prescriptions
• Identity proof

After submitting these, the insurance company or TPA will review your documents. Once the claim request is registered, they’ll send you your CCN.

In both cases, it usually doesn’t take more than 24–48 hours to get your CCN once the initial claim is submitted. If you’ve taken a family health insurance, each member's claim will still receive a separate CCN, even though they’re all covered under the same plan.

When can you expect to get your CCN?

The CCN is usually shared soon after you raise a claim. The timing depends on the type of claim and how quickly the documents are submitted:

• Cashless hospitalisation: If the hospital has tied up with the insurer, you might receive your CCN within a few hours after admission, once the pre-authorisation form is sent.
• Reimbursement claim: You will usually get your CCN within 1-2 working days after submitting all the necessary documents.

Importance of CCN in mediclaim

Here’s why the CCN matters:

• Reduces confusion

Imagine two people with the same name submitting a claim on the same day. Without a unique number like the CCN, their files could get mixed up. The CCN prevents this kind of confusion.

• Required for all follow-ups

If you call or email to ask about your claim status, the first thing they’ll ask is your CCN. It helps them find your claim file instantly.

• Faster settlements

Since your claim is linked to the CCN, all documents and updates are stored under one reference. This makes it easier for the insurance company or TPA to process your claim quickly.

• Used in all records

If you need to check your past claims, your CCN will help pull up the right records. It’s also helpful during audits or tax filing if needed.

Conclusion

The Claim Communication Number (CCN) is a vital part of the mediclaim process. It’s a unique ID that keeps your claim details safe, organised and easy to access.

Taking care of medical bills can feel confusing, but you don’t have to figure it all out alone. If you’re thinking about getting health cover or have questions, fill in the form on this page. We’ll help you choose the right health insurance based on your needs.

FAQs

• Is CCN and Claim Number the same thing?

Yes, CCN (Claim Communication Number) is often called a claim number. It’s the unique number used to identify your specific claim.

• Can I get a CCN without submitting documents?

No. The CCN is given only after you submit a claim request with at least the basic required documents.

• What if I lose my CCN?

You can contact the insurer or TPA with your policy number and other details. They will help you retrieve your CCN.

• Is CCN needed for both cashless and reimbursement claims?

Yes, it is required for both types of claims. For cashless claims, you get the CCN after hospital admission. For reimbursement, you get it after submitting your documents.

• Can I track my claim using CCN?

Yes, most insurers and TPAs allow you to track your claim status online using the CCN.

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.

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.

A medical emergency can be a frightening situation. It not only renders you unable to work for the duration of your hospitalisation but makes it difficult to pay the treatment bills. To protect yourself and your loved ones from such occurrences, purchase comprehensive health insurance. The policy covers in-patient care, ICU expenses, pre and post-hospitalisation charges, consultation fees, and more. But, your health insurance will be useful only if your insurer has a streamlined claim process and high claim settlement ratio. 

When purchasing medical insurance for yourself or a loved one, always check the list of network hospitals provided by the insurer. Check to see if you can file your claim online or if the sole option is to visit the insurer with a stack of documents and wait for days for your bill to be reimbursed.

ICICI Lombard health insurance claim process

ICICI Lombard is noted for its instant coverage and speedy claim settlement process. ICICI Lombard is one of the best insurance providers in the medical insurance industry. You can file a claim with ICICI Lombard by following these three simple steps:

• Initiate

Contact our claim executives as soon as a medical emergency occurs by dialling 1800 2666. You can also request via the IL Take Care App.

• Verification

Our claims team will verify the medical documents you shared. If everything checks out, your request will be processed further. 

• Tracking

You can track the real-time claim status with just a few clicks on your mobile device.

Claim procedure for cashless hospitalisation

ICICI Lombard has over 6700+ network hospitals across India, reducing your financial burden during the medical crisis.

• Visit the nearest network hospital. Keep a list of network hospitals handy to avoid the last-minute hassle.
• Go to the health desk counter and show the third-party administrator (TPA) your health card.
• TPA will complete the pre-authorisation request application and submit it on your behalf to the ICICI Lombard claim team.
• The claim executives will review the request form and verify the medical reports before approving the request.
• Once the request is approved, you can avail of treatment for free. 
• Post-treatment, the bills will be settled directly with the hospital.

Note: If the cashless claim is rejected due to missing information or another insignificant reason, you must pay the bills from your pocket before filing the reimbursement claim.

The immune-evading BF.7 variant of Covid-19 is wreaking havoc in China. According to various media reports, the disease is currently affecting millions daily. Given the severity of new strains and potential mutations, the Indian government has increased surveillance of people flying from China and its neighbouring countries. If the necessary measures are not put in at the right time, India may face the same fate as China. Furthermore, when Covid strikes, the healthcare infrastructure is overburdened, increasing the cost of disease treatment. Thus, in the interest of health & financial security, it is advisable to not just get a health insurance but also practice preventive measures against the spread of the virus.

Let's go over some precautionary measures that you may follow to avoid infection from this lethal virus.

Use masks & follow hygiene habits

When going out in public, make sure to wear a mask. For added protection, use a K95 or N95 mask. If at all possible, avoid going out in public places or crowded areas. However, because there is no lockdown and offices are open, the only way to prevent the virus is to

• Practise social distancing
• Isolate in case of symptoms (fever, cold, cough, or breathlessness)
• Sanitise regularly

Get vaccinated

The government's previous massive vaccination campaign aided India in reducing the virus's threat. However, if you have not yet been immunised with any of the authorised vaccines, you should do so right away. Those who have been vaccinated must make an appointment to receive a booster dose or a nasal spray that has recently been introduced to boost immunity against the virus.

Get Health insurance

Insurance does not prevent the virus from infecting you, but it does come into play if you are infected. The cost of treating covid cases can be high because, once severe, it can affect other parts of the body. To deal with covid, the IRDAI implemented the Corona Kavach policy.

Corona kavach is an indemnity plan that covers the cost of covid treatment if you are hospitalised for more than 24 hours after being diagnosed with this ailment. The sum insured under this policy ranges from Rs 50,000 to Rs 5,00,000. The policy includes pre and post-hospitalisation expenses, comorbid conditions, ICU charges, and domiciliary treatment.

Final Words

Covid prevention is always preferable to cure. A reliable medicine to treat this virus has yet to be developed. Remember - the preparation to protect yourself against this virus begins with the purchase of health insurance, which is followed by precautions such as wearing masks, getting vaccinated, and practising social distancing.

The Union Budget 2024’s decision to apply an 18% GST on health insurance premiums has a major impact on all of us. It also changes our attitude to our insurance choices and financial planning. Let’s explore this decision further:

Impact of 18% GST on Health Insurance Premiums

The effect of introducing GST on health insurance premium is larger than what we think.

Here is how:

• Higher premiums: The rise in health insurance rates is the most direct and obvious effect of the increased GST rate. For many homes, financial stability mostly consists of health insurance. It guards against unanticipated medical costs that could otherwise exhaust savings. The 18% GST has clearly added to the financial weight of maintaining health coverage. This rise in premium costs makes it more difficult to balance home budgets, particularly for those already dealing with other growing expenses.
• Policy decision-making: Many customers have to make difficult decisions about their health insurance as premiums rise. While some defer buying insurance completely, others may choose to cut their coverage level to keep their policies reasonable. Inappropriate coverage can result from this uncertainty or scaling back. It leaves people and families more exposed to the financial effects of medical problems.
• Reduced affordability: The increased cost directly affects the affordability of health insurance. Health coverage is becoming a luxury for some rather than a basic protective measure. This shift could decrease the number of people who can afford comprehensive health insurance, which is contrary to the broader goal of universal health coverage. Reduced affordability also begs questions regarding long-term health effects for those who choose not to have required coverage because of financial restrictions.
• Insurance penetration: The healthcare industry has always aimed to raise the insurance penetration rate. It wanted to ensure that more people are covered with healthcare free from financial difficulty. Nonetheless, the higher GST on health insurance is probably going to hinder these initiatives since more expenses would discourage potential new policyholders from getting coverage. This is especially alarming in a country like India, where many people still lack insurance and are thus susceptible to financial shocks connected to their health.

What You Can Do: Tips for Managing Increased Health Insurance Costs

There are several ways you could control and maybe lower your health insurance expenses. These include:

• Shop around: Comparing health insurance plans from several providers is more crucial than it has ever been. Searching around will help you to find the best deal for your budget. This does not only imply searching for the least expensive choice. It means striking a balance between coverage and affordability that fits your family or personal health requirements.
• Customise your coverage: Make your health insurance plan fit for your particular situation. Review the kind of medical treatments your family and you usually require and modify your coverage accordingly. Steer clear of purchasing extraneous items that raise your premiums. For instance, if you are young and healthy, you might not need a plan including comprehensive aged care services.
• Opt for higher deductibles: Your premium might be much reduced by agreeing to pay a larger deductible. If you seldom see a doctor and can control little medical costs out-of-pocket, this is a sensible approach. But be sure you have the money to pay the deductible should a significant health problem arise; this sum is paid before your insurance starts to pay.
• Tax deductions: Take advantage of the tax deductions under Section 80D of the Income Tax Act. Health insurance premiums qualify for tax deductions, which help to somewhat mitigate the financial effects of the GST increase.
• Group insurance options: These types of plans are generally more reasonably priced than individual policies, and many companies provide them. Because of the mass negotiation done by companies, the plans frequently come with reduced premiums and better terms. Think about enroling if your company provides such a plan. It can be a reasonably affordable choice.
• Review your plan annually: Policy specifics and health insurance needs vary yearly. Reviewing your health insurance coverage annually is essential. Given current tax rules and market conditions, this is to ensure it still satisfies your demands.
• Use health savings accounts (HSAs): Without central tax obligation, funds in these accounts can be accessed for eligible medical costs. This can be another approach to control expenses, particularly when coupled with a high-deductible health plan.

Conclusion

As a policyholder, you must be careful when going for health insurance coverage. Comparing several insurance packages before deciding on one is crucial. It guarantees that you choose a plan that offers sufficient coverage and your financial situation. 

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 New Features of ICICI Lombard Health Insurance

We have upgraded our health insurance policy to make it more comprehensive and inclusive. With this new version, you can avail a host of new benefits:

• Zone-based pricing - premium advantage in line with the treatment costs in your zone
• Pneumococcal Vaccine discount
• Guaranteed No-Claim Bonus of 20% of sum insured for every claim-free year (with a maximum of 100% bonus)
• Unlimited reset up to 100% of sum insured for unrelated illness and once for same illness
• Medical procedure expenses for organ donor up to the sum insured
• Home care cover up to 5% of sum insured (max up to `25,000)
• Limit for Cataract cover up to 10% of sum insured (maximum up to `1 Lakh per eye)

The company has also introduced a variety of complimentary services on the IL TakeCare app to help its customer stay healthy, safe and informed about their health

Click here to download IL Take Care App

Zone-based pricing

With our new zone-based pricing, you can get premium advantage in line with the treatment cost prevailing in a particular zone.

Zone definition

Based on your pincode, if you fall in zone A, you will continue to have the freedom to get treatment across India without zone based co-pay (Co-pay is a share of claim amount that you’d have to bear). For other zones, you will need to share a part of the claim amount for treatments at a hospital in higher zone.

Having an insurance policy may not cover you entirely during a medical emergency. This is because of a mostly overlooked aspect of health insurance called deductibles. A health insurance deductible is the amount payable by the policyholder while raising a claim. This amount is predefined in the policy plan. For example, if you raise a claim of Rs 1 lakh and the deductible mentioned in the policy is Rs 40,000, the insurer will approve payment of Rs 60,000 only after adjusting the deductible amount. It is the amount that you need to pay before the insurer starts to pay against the claim. In other words, you must pay medical insurance deductibles out of your pocket.

What is deductible in health insurance?

Deductibles are included in health insurance policies to discourage policyholders from making trivial claims. This also ensures that people don’t misuse their health covers to avail of hospitalization for minor medical concerns.

How do deductibles work in health insurance?

The risk burden of the insurer reduces when there is a deductible amount in the health insurance policy. Therefore, health policies with high deductibles amount generally have a low insurance premium amount. If the amount of the deductible is low or non-existent, the premium amount will be higher.

Types of deductibles in health insurance

Common deductibles in medical insurance are:

• Policyholders can select voluntary deductibles amounts as per their budget and affordability. and decide their premium amount accordingly.
• A compulsory deductible is pre-decided by the insurer at the time of policy purchase. While buying a health policy with a compulsory deductible, the deductible becomes just another point in the list of policy terms and conditions. The compulsory deductible doesn’t have any impact on the premium amount.
• A cumulative deductible is applicable in family floater plans. In these policies, the insurance cover is a cumulative amount applicable to all the members of the family floater policy. Accordingly, the deductible amount is also applicable to all members cumulatively.
• A comprehensive deductible keeps on adding till you pay the amount applicable in your health policy. It is a single deductible that applies to all health covers, but it is not available in India at present.
• Non-comprehensive deductibles apply to specific parts of the policy and not the entire policy. Thus, it is deducted only when you raise a claim against such medical treatments to which the deductible is applicable. For any other claims, the deductibles clause is not triggered.

How to choose a deductible under your health insurance policy?

The applicability of the medical insurance deductibles and the payment terms are the two key factors that you must consider while buying a health cover. You must check the portions of the cover to which the deductible is applicable. Similarly, also find out the covers against which no deductible cover is required. For health deductibles payment, check how much you need to pay towards the health insurance deductibles and how often.

What is the difference between deductible vs co-payment in health insurance?

Co-payment is a predetermined and fixed amount paid by the policyholder each time a claim is made. While deductible is the amount that the policyholder pays before the insurer settles the claim, co-pay is a specific percentage of the claim that has to be paid by the policyholder. Nonetheless, both are expenses in the hands of the policyholder.

Factors impacting the deductible amount in health insurance policy

Several factors influence the deductible amount in your medical insurance policy:

• Age: Older individuals may face higher deductibles due to increased health risks.
• Health Status: Pre-existing conditions can lead to higher deductibles.
• Lifestyle Choices: Habits like smoking or excessive alcohol consumption may result in higher deductibles.
• Policy Type: Comprehensive plans might offer lower deductibles compared to basic coverage plans or critical illness insurance.

Why should you opt for an insurance deductible?

With deductibles, your propensity to raise claims is reduced, particularly the trivial ones. This protects your sum assured so that it can be used to the fullest if a significant medical emergency arrives. Raising no claims also earns you the No Claim Bonus, reducing your premium cost or considerably increasing your sum assured.

As mentioned earlier, the inclusion of a deductible also reduces your premium amount, so that you can buy a better health cover in the same budget.

One may note that the presence of deductibles means that you have to pay a portion of the hospital bill. In the case of smaller medical bills, you may end up paying most or all of it yourself. Nevertheless, medical insurance deductibles offer you the flexibility of rearranging your premium amount as per your affordability. A well-balanced health cover with your preferred deductible amount can safeguard you financially in your hour of need.

FAQs

1. Can I change my deductible amount during the policy tenure?

Deductible amounts are set at the inception of the policy and cannot be changed mid-term. However, you can adjust the deductible when renewing your policy.

2. Does a higher deductible affect claim settlements?

No, a higher deductible does not impact the claim settlement process but determines the portion of expenses you must pay before the insurer covers the remaining costs.

3. Are deductibles applicable to all types of medical expenses?

Deductibles usually apply to most medical expenses, but some preventive services might be exempt. It's essential to review your policy details for specific information.

Conclusion

Deductibles in medical insurance are a major component that impacts premiums and the cost of the policy. Understanding how it works is important for properly managing medical expenses. Select a deductible that goes with your financial limits and medical needs. Most importantly, review the terms and conditions and stay in touch with the insurance advisor or customer care of the insurance company to make smart decisions for your health and finances.

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.

Experts say the mutant variant of coronavirus, which is believed to have originated from the UK, is even more infectious and dangerous.

2020 was a tough year. The rapid spread of the novel coronavirus disrupted the lives of millions of people across the globe. While some lost loved ones to the disease, many had to face financial turmoil as they lost their jobs due to the global lockdown.

However, just when the lockdown restrictions began to ease around the world, and everyone started believing the calamity is over, the Government of the United Kingdom (UK) announced that it had found a new strain or variant of the coronavirus. According to doctors and scientists, the mutant coronavirus variant is more contagious and even more dangerous than the original strain.

Citing this new coronavirus's danger, the UK Government imposed the most stringent lockdown in the country from January 5. Now, the questions that arise are, "What are the symptoms of this new COVID variant?", "Does India need to worry?", "Are the current vaccines going to be effective?", etc.

In this article, you will find information related to the new strain of coronavirus, including its symptoms, threats, associated dangers, and precautions you need to take. Read on.

The new coronavirus strain: What is it?

The new strain of the coronavirus was first identified in a man living in the south-east of England. The variant was named "VUI 202012/01" by the UK scientists. It includes a genetic mutation in the 'spike' protein, which is the reason for its highly contagious nature. According to researchers, this strain of the coronavirus has a minimum of 17 changes of mutation.

How harmful is the new Covid strain?

As per early reports, the coronavirus's new variant is highly contagious and can spread up to 70% faster than the original strain. In fact, in the UK, more than 60% of COVID patients are found to be infected with this new strain of coronavirus. What's more worrying is the fact that this variant is mostly infecting the people between 30 to 60 years of age.

Keeping in mind the threat this Covid strain poses to the population, several countries have temporarily suspended UK citizens' arrival on their shores. Few cases of infections have also been reported from Denmark, South Africa, Netherlands, Australia, France, and Italy.

What's the situation in India?

The new variant of coronavirus has entered India as well. However, the spike in the number of cases isn't too alarming, and the situation is mostly under control. As per government data, the total number of people who have tested positive for the UK strain of coronavirus stood at 165 on January 28.

Keeping in mind the safety of its citizens, the Indian Government has extended the temporary restrictions on the arrival of flights originating from the UK till February 14. Several states such as Maharashtra, West Bengal and Kerela have also taken various steps to control the spread of the mutant COVID-19 variant.

What are the common infection symptoms?

The Office of National Statistics (ONS) conducted a survey to identify the most common symptoms in new covid positive cases. According to the ONS reports, some of the new COVID variant's symptoms include cough, sore throat, muscle pain, joint pain and fatigue.

The reports also suggested the differences between the new coronavirus strain symptoms compared to the old one. It pointed out that the people infected with the latest COVID-19 variant are less likely to experience the loss of smell and taste, which was a common symptom of the original strain.

What are the precautions that you need to take?

The precautions you need to take to avoid getting infected from the new coronavirus's new strain are no different. You should frequently wash your hands with soap or use hand sanitisers to keep your hands clean and germ-free. Also, you should always wear a mask and follow social distancing norms in public places.

In case you experience any of the symptoms, consult a doctor immediately and get yourself tested for the infection. In case you're found to be positive, obey the existing isolation rules and abide by the restrictions till you recover completely.

Will the current vaccines work against the new variant?

As per the scientists, there is no evidence that the current vaccines, including the ones developed by Pfizer and BioNtech in the UK and Covaxin or Covishield in India, will be ineffective against the new coronavirus strain. In fact, a study by the Indian Council of Medical Research (ICMR) and the National Institute of Virology (NIV) has found that Bharat Biotech's Covaxin is entirely effective against the mutant variant.