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Comprehensive Health Insurance

Explore the significance of comprehensive health insurance, covering benefits, coverage details, eligibility criteria, and frequently asked questions. Understand why it's crucial.

  • 22 Feb 2024
  • 4 min read
  • 22 views

You might have heard—health is wealth. But what if your health is affected by an unforeseen illness or injury that requires expensive medical treatment? How will you cope with the financial burden of hospital bills, medicines, tests, and other expenses? That is where a comprehensive health insurance policy can come to your rescue.

 

What is Comprehensive Health Insurance?

A comprehensive medical insurance plan covers many medical emergencies and can be renewed for life. It differs vastly from a regular health insurance policy that only covers hospitalisation expenses. A comprehensive health insurance policy covers hospitalisation and other medical costs that may arise before, during, or after the hospital stay. It also offers additional benefits such as outpatient treatment, organ donor expenses, maternity benefits, and a few more.

 

Benefits of a Comprehensive Health Insurance Policy

Some of the benefits of buying a comprehensive health insurance policy are:

  • It protects you and your family from the financial impact of medical emergencies by covering a wide range of medical expenses.
  • It provides you access to advanced healthcare services at a plethora of hospitals without paying any cash.
  • You can receive tax advantages under Section 80D of the Income Tax Act, 1961, for the sum you spend on medical insurance premiums for yourself, your spouse, your kids, and your parents.
  • It allows you to choose the sum insured, policy term, and add-on covers per your needs and budget.
  • It provides peace of mind and security by ensuring you are prepared for any unforeseen medical situation.

 

Why is Having a Comprehensive Health Insurance Plan Important?

Getting comprehensive health coverage is important for many reasons, some of which are:

  • Healthcare costs are rising rapidly in India due to inflation, technological advancements, and lifestyle diseases. This medical plan can help you cope with these increasing costs without compromising your health or savings.
  • Sudden medical emergencies can strike anyone at any time without any warning. A comprehensive medical plan can help you deal with these emergencies on time.

 

What Does a Comprehensive Medical Plan Cover?

A complete health insurance plan covers:

  • In-patient hospitalisation: This covers the expenses incurred for more than 24 hours on account of illness, injury, or accident. It includes room rent, nursing charges, doctor's fees, medicines, tests, surgeries, etc.
  • Pre-hospitalisation: It covers the expenses incurred up to 60 days before the hospital admission date. It includes consultations, tests, medicines, etc.
  • Post-hospitalisation: It covers the expenses incurred up to 90 days from the hospital's discharge date. It includes follow-ups, tests, medicines, physiotherapy, etc.
  • Daycare treatment: It covers the expenses incurred for certain procedures that do not require 24 hours of hospitalisation. It includes cataract surgery, dialysis, chemotherapy, radiotherapy, etc.
  • Organ donor expenses: It covers the costs incurred for organ harvesting from a donor for transplantation into the insured person.
  • Domiciliary hospitalisation: It covers the expenses incurred for treatment at home under certain conditions when hospitalisation is not possible or advisable.
  • Outpatient treatment: It covers the expenses incurred for consultations and treatments that do not require hospitalisation. It includes dental treatment, eye care, vaccinations, etc.
  • AYUSH treatment: It covers the expenses incurred for alternative therapies such as Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
  • Emergency ambulance: Some medical plans with a rider also cover the expenses incurred for transportation by ambulance to the nearest hospital in case of an emergency.

 

Eligibility Criteria for Buying Comprehensive Health Insurance

The eligibility criteria for buying a comprehensive health insurance policy may vary from one insurer to another. However, some of the common criteria are:

  • Age: The minimum age for buying a comprehensive health insurance policy is usually 18 years, and the maximum age is usually 65 years. The minimum age for covering dependent children is usually 91 days.
  • Health status: The insurer may ask you to undergo certain medical tests or declare your medical history before issuing a comprehensive health insurance policy. 

 

How is a Comprehensive Health Insurance Premium Calculated?

The cost of a comprehensive health insurance policy is calculated based on various factors such as:

  • Sum insured: It is the maximum sum your insurance company will cover for your medical bills in one year. If you choose a higher sum insured, your premium (the money you pay for the insurance) will also be higher.
  • Age: The insured person's age is an essential factor affecting the premium. The older the insured person, the higher the premium.
  • Health status: The health status of the insured person is another factor that affects the premium. If you have pre-existing health conditions or specific illnesses, the insurance company might make you pay a higher premium or an additional charge called a loading.
  • Policy term: It is the duration for which the policy is valid. The longer the policy term, the lower the premium.
  • Add-on covers: The add-on covers are optional benefits to enhance your coverage. The more add-on covers you opt for, the higher the premium.

 

Things to Keep in Mind While Purchasing a Comprehensive Health Insurance Policy

Some of the things that you should keep in mind while buying a comprehensive health insurance policy include:

  • Review different plans from different insurers based on their coverage, benefits, exclusions, limitations, premiums, claim settlement ratio, customer reviews, etc. 
  • Before buying a plan, go through the policy document carefully and comprehend all the terms and conditions, exclusions and inclusions, waiting periods and sub-limits, co-payments and deductibles. You should also check the insurer's claim process and procedure and contact details.
  • Review your needs and requirements periodically, and update your comprehensive health insurance policy accordingly. You should increase or decrease your sum insured, add or remove members, opt for or cancel add-on covers, etc., per your changing needs and life stage.
  • Renew your comprehensive health insurance policy on time before it expires to avoid any lapse or discontinuation of your coverage.

Also read:

Frequently Asked Questions on Comprehensive Health Insurance

 

Q.1. Does a comprehensive medical plan provide 100% coverage?

Ans. No, a comprehensive health plan does not provide 100% coverage for all your medical expenses. It does not cover certain costs, such as cosmetic surgery, experimental treatment, self-inflicted injuries, etc. There are also certain limits and restrictions that apply to a comprehensive health plan, such as sub-limits, co-payments, deductibles, etc., that reduce your coverage. Therefore, please ensure that you always read the policy document carefully and understand what your comprehensive health plan covers and does not cover.

 

Q.2. What is the key distinction between a comprehensive and a regular health insurance Policy?

Ans. The significant distinction between a comprehensive and a regular health insurance plan is that the former covers hospitalisation expenses and other medical expenses that may arise before, during, or after the hospital stay. A regular health insurance policy only covers hospitalisation expenses and does not cover any other medical costs. A comprehensive health insurance policy also offers additional benefits such as outpatient treatment, organ donor expenses, maternity benefits, etc., which are not available in a regular health insurance policy. Therefore, a comprehensive health insurance policy provides more extensive coverage than a regular one.

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