Working women in India face numerous challenges. Maternity leave plays a vital role in ensuring the overall well-being of the mother and newborn child and allows women to adjust to their new role as mothers.

Maternity benefits are necessary to protect women’s economic rights, ensure job security, and support their social function of childbearing and rearing. The Indian Maternity Benefit Act of 1961 provides comprehensive maternity benefits, including paid leave, medical bonuses, and nursing breaks. Additionally, having adequate health insurance coverage is crucial for working women to address any medical expenses related to maternity.

Let’s learn more about the eligibility criteria, why it is essential for women, the rules of the Leave Policy, HR’s role in granting you leave, and more.

Maternity Leave Benefits in India

1. The Maternity Benefit Act in India provides maternity benefits such as paid leave for women employees who need to fulfil their maternal obligations and duties.
2. For first and second-time mothers, the leave is for 6 months or 26 weeks, while every subsequent child entitles the mother to 3 months or 12 weeks of paid maternity leave.
3. Many companies offer maternity health insurance to their employees under their group health insurance policies. However, that depends on the insurance provider that the company is buying from.
4. The Act also ensures the holistic well-being of mothers and their babies by providing childcare provisions.
5. Employers cannot fire or dismiss women employees solely because they are pregnant, in labour, or recuperating post-childbirth
6. The Act mandates that pregnant women have access to amenities, such as hygienic restrooms, comfortable seating, and safe drinking water in their workplace.
7. The Act entitles pregnant women to additional leave days if they are unable to return to work after the maternity leave period.
8. The payment for maternity leave is at the rate of the average daily wage for the period of absence, with an additional medical bonus of Rs 3500 and a benefit of a minimum amount of Rs 6000 under the National Food Security Act 2013
9. Employers must not give pregnant employees difficult tasks or long working hours ten weeks before delivery to ensure the health and safety of both the mother and child.
10. HR departments can incorporate measures to support pregnant employees, including:

• flexible working arrangements
• counselling services
• wellness programs

Important Rules of Maternity Leave Policy in India

1. The Maternity Benefit (Amended) Act 2017 in India provides full compensation to women employees during their maternity leave
2. Compensation via the maternity leave policy is calculated based on their salary or daily wages in the three months before their maternity leave request
3. A minimum of 80 days of work at their workplace in the 12 months before their delivery or adoption date is required
4. Depending on whether the woman is expecting her first or subsequent child, she can take up to a maximum of 26 weeks off for her maternity leave, with up to 8 weeks off before delivery
5. Maternity leave is payable, and the amount payable to the mother is equal to the rate of average daily wage for the period of her actual absence
6. Various statutes as the following prescribe different procedures and compliances for employers while dealing with the maternity health of their employees, such as:

• Employer State Insurance Act, 1948
• the Maternity Benefit (Mines and Circus) Rules, 1963
• the Central Civil Service Rules, 1972
• the Mines Act, 1952

Sugarcane has been a part of human life for thousands of years, celebrated for its sweet taste and versatility in culinary and medicinal applications. Its juice, extracted through a process of pressing and filtering, has been consumed as a refreshing drink in many cultures around the world.

From the bustling streets of India to the tropical beaches of Brazil, the sight of vendors selling freshly squeezed sugarcane juice is common. And with good reason — this humble drink offers a myriad of potential health benefits, making it not just a tasty treat but a possible elixir of vitality. 

Nutrition Value of Sugarcane Juice

It is important to note that the nutritional content of sugarcane juice may vary depending on factors such as the variety of sugarcane, the plant's maturity, and the extraction method. Additionally, the nutritional content may be affected by any added ingredients or processing methods used in the preparation of the juice. 

10 Health Benefits of Sugarcane Juice

Following are the top 10 health benefits of drinking sugarcane juice-

• Blood sugar regulation:

The low glycaemic index of sugarcane juice means that it slowly gets absorbed by the body, preventing a sudden increase in blood sugar levels.

Moreover, the high fibre content in sugarcane juice regulates blood sugar levels by slowing down glucose absorption into the bloodstream.

• Antioxidant properties:

Sugarcane juice contains antioxidants, such as flavonoids and phenolic compounds, which protect against oxidative stress and inflammation. These compounds may help prevent chronic diseases, such as cancer, cardiovascular disease, and neurodegenerative disorders.

• Anti-inflammatory effects:

Sugarcane juice has anti-inflammatory effects, which may help reduce inflammation in the body and prevent chronic diseases. The anti-inflammatory effects of sugarcane juice may be due to its high antioxidant content.

• Digestive health:

The high fibre content of sugarcane juice may promote digestive health by preventing constipation, promoting regular bowel movements, and reducing the risk of gastrointestinal diseases. Additionally, sugarcane juice may boost the growth of beneficial gut bacteria as it has prebiotic effects.

• Immune system boost:

Sugarcane juice contains vitamin C, essential for maintaining a healthy immune system. Vitamin C may also help reduce the duration and severity of colds and other viral infections. Additionally, sugarcane juice with lemon and ginger benefits may have immunomodulatory effects. This tangy drink helps regulate the immune system.

• Hydration:

Sugarcane juice is a natural source of hydration and can help prevent dehydration, especially in hot and humid climates. Additionally, sugarcane juice may have a diuretic effect, which promotes urine production and helps remove toxins from the body.

• Kidney health:

Researchers have found that sugarcane juice protects the kidneys by lowering the risk of kidney stones and other renal diseases. The high antioxidant content of the juice helps to prevent oxidative stress and inflammation in the kidneys.

In a world where traditional hospital stays can be financially and emotionally draining, many people are opting for alternative solutions to receive quality medical care. One option gaining popularity is the idea of bringing the hospital to the patient, creating a seamless and personalised healthcare experience in the comfort of one’s own home. Patients can recover in familiar surroundings, surrounded by loved ones, with access to top-notch medical equipment and personnel. This concept transforms healthcare and brings hope and comfort to patients worldwide. However, seeking medical care at home can sometimes be costly if insurers refuse to cover the expenses, which is where the concept of domiciliary hospitalisation cover comes into play.

What is domiciliary hospitalization?

Domiciliary hospitalisation cover refers to the medical treatment provided to a patient in their home, which otherwise would have been provided in a hospital. This type of cover aims to provide financial protection to patients who are unable to get admitted to a hospital or prefer to receive medical care at home.

For instance, let's consider a patient who is bedridden due to a chronic illness and needs constant medical attention. If this patient requires admission to a hospital, the expenses would be astronomical. However, with domiciliary hospitalisation cover, the patient can receive the necessary medical treatment at home without needing hospitalisation. This type of cover is especially beneficial for patients who need long-term medical care and for whom hospitalisation is not convenient.

Domiciliary hospitalisation cover includes medical expenses, such as nursing care, medical equipment, and prescription drugs required for the treatment of the patient at home.

When is domiciliary hospitalization covered in health insurance?

Most health insurance plans cover domiciliary hospitalisation under specific conditions, such as:

• The patient is critically ill and cannot be moved to a hospital.
• The required treatment is available but hospital admission is not possible due to the unavailability of beds.
• The treatment is for a condition that requires hospital-level care but can be effectively managed at home.

However, coverage terms may vary depending on the medical insurance provider.

How does domiciliary hospitalization work?

Here are the steps that typically take place in the domiciliary hospitalisation process:

• <h3>Diagnosis: The patient visits a doctor and receives a diagnosis that requires medical treatment. The doctor will determine if the patient is eligible for domiciliary hospitalisation based on the nature and severity of the condition.
• <h3>Treatment plan: Once the patient is deemed eligible for domiciliary hospitalisation, the doctor will prepare a treatment plan that outlines the necessary medical interventions and the required duration of treatment.
• <h3>Insurance coverage: The policyholder or his/her family member will notify the insurer that the insured is planning to undergo domiciliary treatment. The insurance company will then provide the patient with the necessary forms and documents.
• <h3>Medical equipment: If required, the patient will be provided with the necessary medical equipment, such as oxygen cylinders, nebulisers, etc., to facilitate the treatment process.
• <h3>Healthcare provider: The patient will choose a healthcare provider specialising in domiciliary hospitalisation. The healthcare provider will assign a nurse or caregiver who will visit the patient's home and provide the necessary medical care.
• <h3>Treatment at home: The assigned nurse or caregiver will provide medical treatment to the patient at home following the treatment plan, monitoring the patient's progress, and reporting it to the doctor.
• <h3>Follow-up: After treatment completion, the patient visits the doctor for a follow-up to determine the success and need for further treatment.

Why should you choose domiciliary hospitalization cover in health insurance?

Opting for domiciliary hospitalisation coverage in your health insurance policy provides:

• Financial assistance for hospital-like treatment at home.
• Uninterrupted medical care when hospitalisation is not possible.
• Coverage for essential medical expenses, reducing out-of-pocket costs.
• Additional benefits in critical illness insurance plans that cater to long-term illnesses requiring extended care.

What is covered under domiciliary hospitalization?

Domiciliary hospitalisation offers several benefits and inclusions. It is typically less expensive than traditional hospitalization. This is due to the fact that it eliminates the need for hospitalisation expenses like room charges and medical equipment rental. Patients can receive medical care in the comfort of their own homes, which is especially beneficial for those with mobility issues or chronic illnesses.

Patients receive one-on-one attention from their assigned nurse or caregiver, allowing for personalised medical care.
 The inclusions of domiciliary hospitalisation may vary based on the insurance policy. However, inclusions may include doctor consultation fees, nursing charges, the cost of medical equipment, and medication costs.

What is not covered under domiciliary hospitalization?

The domiciliary hospitalisation coverage may not cover any medical condition that existed before obtaining the insurance policy. Experimental or unproven medical treatment may be subject to exclusions under domiciliary hospitalisation coverage. Several medical procedures or treatments, such as cosmetic surgery, infertility treatments, and weight loss surgery, are usually not covered. The domiciliary hospitalisation cover excludes any medical treatment received outside of the country.

Several medications, such as prescription drugs not approved by regulatory authorities, are excluded from this coverage. A domiciliary hospitalisation policy does not cover injuries caused intentionally by the policyholder.

A domiciliary hospitalisation plan may not provide coverage for substance abuse or addiction treatment. Treatment for mental illness is also not covered under domiciliary hospitalisation coverage. Injuries sustained during hazardous activities, such as extreme sports or actions involving weapons, may not be covered under domiciliary hospitalisation cover. One cannot make a claim for treatment expenses incurred for alternative therapies, such as acupuncture or chiropractic treatments.

Difference between home care treatment and domiciliary treatment

How to claim domiciliary hospitalisation in health insurance?

To claim domiciliary hospitalisation benefits under your health insurance policy, follow these steps:

1. Notify Your Insurer: Inform the insurance provider about needing domiciliary treatment.
2. Obtain a Doctor's Prescription: Ensure the treatment is medically justified and documented.
3. Keep Medical Records: Maintain prescriptions, diagnostic reports, and bills.
4. Submit a Claim: Provide the required documents for reimbursement or cashless treatment.
5. Await Approval: The insurer will verify the claim and process payments accordingly.

7 things to know about domiciliary hospitalization cover

In order to claim the domiciliary hospitalisation expenses, you must keep the following things in mind.

• When evaluating the domiciliary hospitalisation benefit, you should consider the medical conditions covered and the specific services provided.
• It is also crucial to assess the eligibility criteria for the benefit, such as the patient's medical condition, the availability of a suitable home environment, and the requirement for frequent monitoring or specialised equipment.
• When evaluating the domiciliary hospitalisation benefit, you must consider the duration of the benefit and any limitations or restrictions on the number of visits or treatments it covers.
• The cost of the domiciliary hospitalisation benefit should also be evaluated, including any co-payments or out-of-pocket expenses that may be necessary.
• Domiciliary hospitalisation is possible if the policyholder can demonstrate to his/her insurer that the person was unable to obtain a bed in a hospital where the treatment is available.
• When claiming such expenses, keep all necessary treatment bills and doctor's prescriptions in one place so that you can easily provide them if your insurer wants documentary evidence.
• Not all health insurance policy offers domiciliary hospitalisation; check your insurance policy details for more insights.

All treatments must be doctor-approved and meet the insurer's guidelines to be claimed under domiciliary hospitalisation cover.

FAQs

1. Can I avail domiciliary hospitalisation for any illness?

No, domiciliary hospitalisation only applies to conditions requiring hospital-like care and continuous medical supervision. Minor ailments such as fever, cold, or flu are generally not covered.

2. Does domiciliary hospitalisation cover post-surgical care?

Some medical insurance policies cover post-surgical care under domiciliary hospitalisation if a doctor prescribes home-based treatment instead of hospitalisation.

3. Is domiciliary hospitalisation covered under all health insurance policies?

No, not all health insurance policies offer domiciliary hospitalisation benefits. It is essential to check the policy details before purchasing a plan.

4. What type of expenses are covered under domiciliary hospitalisation?

Expenses such as doctor visits, medications, nursing care, oxygen therapy, and medical equipment like IV drips and ventilators are typically covered.

5. Can I get domiciliary hospitalisation coverage under critical health insurance?

Yes, many critical illness insurance plans include domiciliary hospitalisation, especially for chronic illnesses that require long-term home-based care.

6. How long can I avail of domiciliary hospitalisation benefits?

The duration depends on medical necessity and policy limits. Some insurers set a maximum limit, such as 10-15 days per hospitalisation instance.

7. Do I need prior approval from my insurance company for domiciliary hospitalisation?

In most cases, prior approval is required for cashless treatment, while reimbursement claims require proper documentation after the treatment is completed.

Conclusion

When a patient cannot get hospitalised because of a medical condition or a doctor suggests that a policyholder receive treatment at home, this is known as "domiciliary hospitalisation." It is a valuable option for patients who require medical treatment but prefer to receive it in the comfort of their own homes. This type of care offers several benefits, including reduced costs, personalised attention, and improved emotional support from family members. Additionally, domiciliary hospitalisation eliminates the risk of acquiring infections commonly found in hospitals, making it a safer option for patients with compromised immune systems. While the inclusions of domiciliary hospitalisation may vary depending on the insurance policy, it typically covers medical treatment, necessary medical equipment, and the services of a trained nurse or caregiver.

There are numerous comprehensive health insurance policies offering domiciliary hospitalisation coverage. If you invest in a policy where domiciliary hospitalisation is covered, you may claim reimbursement for domiciliary care. However, not all health insurance policies cover at-home care, so you must be careful when shopping for a policy that meets your needs. When an insured person has a medical emergency, the option of receiving care in the comfort of his/her home may be a lifesaver. It is a feature that allows access to proper medical assistance when essential medical facilities are absent.

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.

While the excitement of parenthood may require some time to subside, if you have adequate maternity insurance, you won't have to stress about the associated costs. Couples should consider several other things before and after the baby is delivered. The best insurance plan for pregnancy will also cover the newborn child up to a specific time. Financial protection during pregnancy, pre- and post-natal care, pre- and post-hospitalisation costs, ambulance fees, and delivery costs, regardless of whether you have a normal delivery or a caesarean section, are all advantages of maternity insurance. Therefore, one of the best ways to deal with such costs is to purchase maternity insurance, which many health insurance companies provide.

What is maternity insurance?

Maternity insurance is a specialised health insurance plan that is designed to cover expenses related to pregnancy and childbirth. This includes costs associated with both normal and caesarean deliveries, prenatal and postnatal care, and sometimes extends to cover the newborn's medical needs for a specified period.

What is pregnancy insurance so important?

The following list includes maternity insurance benefits in India:

• Acting as a Financial Backup:

Maternity insurance is a safety net for the family’s finances by covering the expenses related to normal and caesarean birth. You need not worry regarding the payment of treatment. Some plans include pre- and post-hospitalisation expenses, paying all associated costs up to 30 days before admission and related expenses up to 60 days after admission.

• Expensive delivery in an intimate setting:

People today prefer private clinics because they want high-quality healthcare. Caesarean delivery may cost an additional Rs 50,000 to Rs 1 lakh in a private hospital, while a normal birth may cost Rs 50,000 to Rs 70,000. Your insurer provides all these costs.

• Coverage for the newborn from Day 1:

Typically, health insurance begins to cover infants once they’re at least 90 days old. A maternity insurance policy, however, starts to pay benefits as soon as the child is delivered. In addition, some plans will pay for the newborn's immunisations until the end of the policy year.

• Prepares the couple for complications:

A newborn requires an incubator for a specified time for complications like premature birth. The price of such treatment can reach Rs 10,000 per day. However, if you have a good maternity insurance plan covering most expenses, you can find respite from the financial pressure.

Features of maternity health insurance

The benefits of purchasing pregnancy insurance online include the following:

• Cashless hospitalisation:

Leading insurance companies offer maternity plans to provide cashless hospitalisation services at hospitals nationwide. At network clinics, you can access medical services without paying for them.

• Claim-free Bonus:

If you do not make a claim during a policy year, some insurance companies will reduce the insurance payment for the following year or increase the amount covered at the same premium. Moreover, insurance companies provide an online application facility to make the process straightforward for policyholders.

• Choice of the covered amount:

Policyholders can choose the insured amount. When purchasing a maternity insurance policy, they can select the desired amount insured.

• Tax benefit:

Section 80D of the Income Tax Act of 1961 allows policyholders to receive tax benefits for insurance premiums paid for pregnancy coverage.

When you are ready to become a parent, maternity insurance coverage is an excellent addition to your healthcare plan. Growing medical inflation and the possibility of unpredictably high hospitalisation costs typically make it challenging to pay for medical expenses and can interfere with parenting pleasure. Therefore, buying maternity insurance is advised for an economically secure pregnancy. You can purchase these insurance policies online, as the process is seamless and easy.

Key benefits of maternity health insurance

The key benefits of maternity health insurance are-

• Financial Security: Reduces the financial burden of maternity-related medical expenses.
• Quality Healthcare: Facilitates access to better medical facilities and services.
• Comprehensive Coverage: Encompasses a wide range of maternity-related expenses, ensuring holistic care.

What is covered under a maternity insurance plan?

Inclusions are circumstances in which an insurer will accept a maternity benefit claim. The coverage extends to both the woman and the newborn child's related costs and those associated with delivery and childbirth. The following are the standard benefits of maternity health insurance:

1. Support for both pre- and post-hospitalisation

• Delivery and Labour Costs:

The maternity add-on insurance covers all birth-related expenses. However, the insurance may only cover a certain number of pregnancies due to the coverage limit.

• C-Section:

Your insurer will cover all costs if the doctor recommends a C-section for the mother's or the child's health.

• Hospitalisation and Room Rent:

All hospitalisation costs and room rent incurred while receiving medical care are covered by your health insurance policy with maternity benefits. This also includes the cost of natural and c-section births and pregnancy termination in a life-threatening, medically essential scenario.

• Newborn baby coverage:

Up to 90 days after birth, a newborn will receive coverage at no extra expense. The infant must be added to the basic plan as an insured individual after 90 days.

• Vaccination coverage:

A newborn infant needs to receive vaccinations frequently. The maternity advantages of a medical insurance policy cover the expenses of routine vaccinations, such as:

• Measles
• BCG
• Tetanus Toxoid
• OPV+IPV-B1/OPV
• Hib
• Hepatitis B-1
• MMR-1
• Typhoid
• DTPw booster-1 or DTPa booster-1
• HPV (female child)
• Meningococcal

What is not covered under maternity insurance plan?

Maternity insurance has several exclusions too. First, one should increase the coverage or amount insured under the plan to pay maternity expenses. The typical range of coverage offered by health insurance plans with maternity benefits is between Rs 20,000 and Rs 70,000, which needs to be revised to cover delivery expenses.

Second, there may be circumstances where the insurance company chooses not to settle the claim even though you think the policy covers all expenses. For example, an insurer may reject a claim in the event of a delayed pregnancy (for women aged 35 and more). Let’s have a look over the critical exclusions that apply to maternity insurance policies:

• Spending on vitamins and tonics listed in the plan as well as other dietary supplements
• During the pregnancy, costs associated with diagnostic procedures and medical visits.
• Costs associated with treating infertility
• Price of collecting and preserving stem cells, including the possibility of doing so as a preventative step.

The list above includes some factors; additional exclusions may be relevant depending on your selected maternity health insurance plan. Maternity insurance coverage plans vary, and it would be wise to read the terms and conditions related to the exclusions before you decide on one.

Is there an option to buy maternity health insurance while you are pregnant?

Typically, insurers do not provide maternity coverage as a part of your standard healthcare plan. Insurance companies consider pregnancy and it-s related expenses as a pre-existing condition. However, you can still buy maternity coverage as an add-on with your regular healthcare insurance policy. You might be wondering why you should buy maternity insurance. You might have to wait between 9 months and six years to make a claim for expenses related to becoming a mother. Therefore, purchasing pregnancy insurance after getting pregnant is not a good plan. Instead, consider buying it much ahead in preparation to avoid having to wait.

Unfortunately, inflation has increased the expense of healthcare and will probably continue to do so in the future. This includes maternity-related costs too. Women must buy pregnancy insurance as quickly as they can afford it. By doing this, you can enjoy the arrival of your kid without worrying about expensive medical bills. You can leave that in the care of your insurance provider.

Waiting until the very last minute when attempting to conceive will only lead to unnecessary worry. So, we suggest that you invest in a comprehensive maternity insurance policy well in anticipation. This will also help you complete the waiting period and help you to receive coverage when you start planning for a family.

One can have a medical emergency at any time, irrespective of age. Additionally, the stress associated with finding a work-life balance and our lifestyles is taking a toll on most of us. While medical services constantly improve, newer diseases like COVID-19 are becoming more prevalent. The exorbitant cost of medical services such as hospitalisation or treatment procedures adds to our woes. There is no right age for health insurance; investing in one as early as possible ensures coverage and lets you avail of the best treatment, particularly in medical emergencies.

Therefore, purchasing a comprehensive health insurance policy and ensuring your peace of mind is the best way to combat the rising cost of healthcare.

When is the Right Age to Buy Health Insurance?

In India, one can buy an individual health insurance policy as soon as he/she turns 18. Anyone who invests early in a healthcare plan will be better prepared for medical emergencies as well as enjoy financial security. Buying health insurance at the age of 26 or in your 30s could be a sensible decision with an eye on your future as well as your loved ones.

When your age falls in the bracket of 20 to 30 years, you can plan ahead and purchase maternity coverage if you want to start a family soon. If you are in your 40s or 50s, you could opt for a family health insurance policy. But you will need more add-on coverage as you could be at risk for diabetes, high blood pressure, and other hereditary health concerns or lifestyle-related issues.

Purchasing a health insurance policy post-retirement can be expensive as senior citizens are prone to severe health issues and may require hospitalisation and prolonged therapy. Moreover, one might need to purchase more add-ons like critical illness coverage.

Whether you are considering purchasing health insurance for students under 26 or looking at plans customised for senior citizens, the earlier you invest in one, the more benefits you can enjoy. Investing in a healthcare plan in your 20s is prudent as the premium is lower. You can easily cover the waiting period that comes with purchasing a new healthcare policy. If you don’t make a claim, you can enjoy the benefit of cumulative bonuses. You can opt for a family floater plan at a later age with a low premium, but it's still more expensive than a policy bought at a younger age.

Reasons Why Health Insurance is Important Irrespective of Your Age

Let's look at some reasons why we should invest in getting a health insurance plan as soon as possible:

• Creating a compelling claim history:

The best moment to purchase a health insurance policy is when one is physically healthy. Young and healthy people pay cheaper premiums and are less likely to make a claim.

• Earning Bonus:

One benefits from the no-claim bonus (NCB) incentive if there isn't a claim in any given year. A policyholder receives supplemental coverage each year without a claim at no additional expense. The extent of coverage continues to expand over time.

• Coverage for pre-existing conditions:

The most significant benefit of purchasing earlier in life is completing the waiting period associated with pre-existing conditions. There are waiting periods in health insurance policies before some or all of the policyholder’s pre-existing diseases will be covered. While some health issues have a waiting period of 12 to 24 months, typically, insurers cover pre-existing conditions after 48 months.

• Tax benefit:

There is an additional advantage to purchasing a health insurance plan if you are young and employed. The 1961 Income Tax Act states that if you pay a premium for health insurance, you are eligible for tax advantages up to Rs 25,000 in a financial year. Additionally, the tax benefit for the premium paid for a health insurance plan bought for your parents can increase to Rs 50,000 if they are dependent on you.

Benefits of Buying Health Insurance at A Younger Age

Health insurance is there for us when we require it the most. It is sensible to purchase a health insurance policy as early as feasible, although there is no set age for health insurance for investing in a healthcare plan. Let's examine the benefits of buying health insurance online at a young age:

• Lower quotations & premiums:

The likelihood of developing a medical problem is lower if an individual is young. For instance, you can purchase a policy with INR 5 lakh as the sum assured for INR 5000 if one purchases health insurance coverage before age 30. The premium becomes costlier as you get older. The same coverage may cost between INR 6000 and INR 8000 when you are in your 40s.

• Financial alignment:

Buying a healthcare plan earlier in life ensures that a person has coverage for multiple illnesses, including diabetes, renal failure, cancer, and heart disease. These ailments begin to affect individuals as they turn older. You will be left dealing with significant financial woes if you purchase health insurance benefits at a later age when diagnosed with an ailment or hereditary illness. The premium for a policy will be much higher, or you may even have to purchase add-on covers for an additional premium.

• Renewability:

According to the Insurance Regulatory and Development Authority of India (IRDAI), one can always renew a health insurance plan. However, 65 to 70 is typically the upper age limit for health insurance coverage extension. Lifetime renewability is available if you purchase a policy earlier.

Health insurance is becoming increasingly important in India, with rising medical costs. Every health insurance policy carries a premium, which you need to pay to avail of the benefits of the healthcare plan. And this premium is determined by various factors. The amount one needs to shell out is a major concern, particularly if you are considering a senior citizen insurance premium.

The amount of the premium you must pay for this coverage is a crucial factor to consider, as it can act as a financial safety net in the event of unanticipated medical problems. Your health insurance premium will be determined based on numerous variables and specific situations. Knowing the variables that will affect the cost of your premiums will empower you to make the most of your insurance plan.

What is senior citizen health insurance?

Senior citizen health insurance is a specialised policy created for people aged 60 years and above. It provides coverage for medical expenses incurred due to illnesses or injuries, ensuring that healthcare costs do not become a financial burden during the golden years.

How do senior citizen health insurance plans work?

These plans function by offering coverage for hospitalisation expenses, pre-existing conditions (after a waiting period) and sometimes even domiciliary treatments. Policyholders pay a premium, which is decided at the beginning, and in return, the insurance company covers eligible medical expenses up to the sum insured.

Key features of medical insurance for senior citizens

The main features of a health insurance policy for senior citizens are:

• Hospitalisation Coverage: This covers expenses related to hospital stays, including room rent, doctor's fees and medical procedures.
• Pre and Post-Hospitalisation: Expenses incurred before and after hospitalisation, such as diagnostic tests and follow-up consultations, are covered.
• Daycare Procedures: These cover treatments that do not require prolonged hospital stays.
• Pre-existing disease Coverage: After a specified waiting period, pre-existing conditions are covered.
• Cashless Treatment: Access to a network of hospitals where treatments can be availed without upfront payments.
• Domiciliary Treatment: Some policies cover treatments taken at home under medical supervision.

Benefits of senior citizen health insurance

The key benefits of buying a senior citizen health insurance policy are: 

• Financial Security: Protects savings from being depleted by high medical costs.
• Access to Quality Healthcare: Ensures timely medical attention without financial constraints.
• Tax Benefits: Premiums paid are eligible for deductions under Section 80D of the Income Tax Act, offering health insurance tax benefits.
• Peace of Mind: Reduces stress related to potential healthcare expenses.

How to calculate the premium for senior citizen health insurance?

Premium calculation considers factors like the insured's age, medical history, chosen sum insured, policy tenure and any add-on covers. Utilising online premium calculators provided by insurers can offer a quick estimate, aiding in budget planning and policy comparison.

Things to consider when buying a medical policy for senior citizens

Your health insurance premium will depend on the type of healthcare plan you choose. A family floater plan, for instance, is usually less expensive than an individual health insurance policy. But remember that the age of the oldest family member will determine the cost of the premium for a family floater plan.

• Coverage Scope: The scope of coverage and the sum insured will also impact your health insurance premium. A lesser insured sum can lead to the lowest premium health insurance for senior citizens, while a higher premium will ensure a greater sum insured. Your insurance will only pay you up to the amounts insured in reimbursement for medical costs. However, you will be responsible for covering additional expenses if your total medical bills exceed the amount specified as the sum insured in your healthcare policy.
• Renewability: Remember to choose a plan that offers lifetime renewability and not just the lowest premium health insurance for senior citizens. Look for a plan that covers pre-existing diseases, adequate pre- and post-hospitalisation expenditures, a minimal waiting period after which one can avail of coverage for pre-existing disorders, add-ons, top-ups, family floater policies and benefits and other discounts. Also, opt for a plan that provides adequate coverage for critical illnesses, as with age, there can be a higher risk of senior citizens being diagnosed with such ailments.
• Waiting Period: When you search for a healthcare plan, look for one that provides coverage for a maximum number of pre-existing diseases. Check the waiting period and select one with the least time so that you can easily complete it. Sometimes insurers waive the waiting period for an additional fee. Consider this option if you are aged over 60 or purchasing a policy for your senior citizen parents. You can calculate the premium with a senior citizen health insurance premium calculator and get an idea of the plan’s cost.
• Policy Requirements: Many people think that skipping the tests or not disclosing any pre-existing medical conditions will let them get a healthcare policy for a lower premium. It is sensible to opt for a policy requiring medical tests so that the insurer can customise the right plan for you. It is better to pay a slightly higher senior citizen insurance premium than be denied a claim in times of need.
• Payment Options: Understand the available payment options for the health insurance you are planning to choose. Although opting for co-payment is optional for people aged less than 60, it is mandatory for senior citizens. Anyone can find the co-payment value with the help of a senior citizen health insurance calculator.
• Network Hospitals: It is also important to consider the network hospitals, especially in case of critical illness or senior citizen health care plans, to see if they are located in an area that can be easily reached in case of emergency.

Key factors affecting senior citizen health insurance premium

Some significant factors that affect a senior citizen’s health insurance premium include pre-existing diseases or health issues, add-on covers, co-payment, habits and lifestyle and family medical history. Moreover, if you live in an area where there is a high level of pollution or severe climatic conditions, you might have to pay a high premium. Environmental issues play a crucial role in determining the premium of healthcare policies, as senior citizens are prone to health issues arising from living in such regions.

Age of the Insurer

A comprehensive health insurance policy for people aged over 60 years is a must-have as it provides financial security as well as peace of mind. Age is one of the most significant factors that affect senior citizens’ health insurance premiums. The reasons behind this are listed below:

• As we age, the risks for increased hospitalisations, hereditary illnesses and the need for medical supervision increase.
• As it gets harder to anticipate risk factors and medical expenditures as people age, some insurance companies do not reimburse pre- and post-hospitalisation expenses.
• Several health insurance plans include the option of lifetime renewals, but some insurers only permit renewal until age 80.

Pre-Existing Illness

Let’s look at how pre-existing diseases affect the premiums for health insurance plans, particularly for senior citizens.

• If a person has a history of medical conditions which affect his/her health in the long run, he/she is more likely to spend more money on consulting doctors and specialists, hospital care and other healthcare services.
• You cannot avail of any benefits until you complete the waiting period for pre-existing conditions as stated in your policy documentation.
• The amount of your premium will increase depending on the severity of the pre-existing health condition, as evaluated by a professional.
• If your close family members have a medical history of a pre-existing condition like heart disease, diabetes, hypertension, etc., you are more likely to have a risk of acquiring it at a later stage in life.

Medical Test Results

Medical tests enable the insurance company to learn as much as possible about an individual's health. The insurer may tailor a term policy just for you, down to the details like the length of coverage you need, the cost of premiums and other perks. The findings of the examinations that your insurance provider requests will decide the inclusions and exclusions of your healthcare plan, especially if you're applying for senior citizens' health insurance. The factors listed below may change based on the outcomes of a medical exam for a health insurance policy:

• The insurance company’s main objective is determining the premium you'll have to pay for your healthcare plan. Based on an applicant's perceived level of risk, the insurer will provide a quote for the plan's premium. Your premium will be minimal if you are in excellent health. If you have any pre-existing problems revealed in the test results, the insurer will consider you a greater risk and you might need to pay a higher premium. But it will reduce the chances of your claim being denied or rejected.
• If your medical tests come out reasonably healthy, you may be eligible for a larger sum assured.

Co-Payment Option

The part of the sum insured you'll be obliged to pay for your medical insurance is a co-payment. In other words, you and your insurer share the expense of your healthcare. Health insurance coverage for those aged over 60 or senior citizens includes a compulsory co-pay clause due to the exorbitantly greater medical care costs faced by the elderly compared to younger individuals.

• Some insurers let you choose the size of your co-payment. Opting for a co-payment reduces the amount you pay as a premium for your healthcare policy. It's important to remember that a larger co-pay will result in a lower overall premium, but you will still be responsible for paying a higher amount for claims.
• The insurer will pay the majority of the claim, but the insured will be responsible for paying a certain amount. Co-insurance varies in proportion based on the kind of medical care received.
• Typically, a co-pay clause mandated the policyholder to pay 50 per cent of the cost for a claim due to a pre-existing condition and 25 per cent for hospitalisation.

Why should senior citizens buy a health insurance policy?

It has become crucial for every person to purchase suitable health insurance coverage for their loved ones, especially for parents who are senior citizens. Even if you have an employer-sponsored group health insurance plan that covers your parents, a separate health insurance policy customised to meet the needs of senior citizens is a sensible investment. The premium for senior citizen health insurance can offer your parents the appropriate coverage.

Senior citizens are more vulnerable to various diseases and hereditary medical conditions with age and may even require hospitalisation and domiciliary care. A majority of insurers provide annual health check-ups at no cost to the policyholder. This could help diagnose any ailment that a senior citizen may have developed in its early stages and help the person seek timely medical intervention. As healthcare policies for senior citizens are customised, keeping their needs in focus, they provide adequate coverage. Spending a little more on a senior citizen’s health insurance premium could provide add-ons that could help the person in cases of chronic diseases or critical illnesses.

When one obtains health insurance, particularly for senior citizens, he/she may relax knowing that in the event of a medical emergency, most of the financial commitments will be taken care of by the insurer.

FAQs

1. Can pre-existing conditions be covered under senior citizen health insurance?

Yes, but typically after a specified waiting period as defined by the policy.

2. Are there tax benefits associated with paying premiums for senior citizen health insurance?

Yes, premiums paid can be claimed as deductions under Section 80D of the Income Tax Act.

3. Is there an age limit for purchasing senior citizen health insurance?

While policies are designed for those aged 60 and above, the maximum entry age varies among insurers.

4. What is a co-payment clause?

It is a provision where the policyholder agrees to pay a certain percentage of the claim amount, with the insurer covering the rest.

5. Can I avail cashless treatment with senior citizen health insurance?

Yes, if the treatment is taken at a network hospital associated with the insurer, you can choose for cashless claim settlement.

Conclusion

Timely purchasing a comprehensive health insurance policy for senior citizens is one of the most important steps for ensuring a healthy and stress-free time for the person insured as well as their family. By understanding the factors that have an impact on policy premiums and evaluating policy features, you can select a plan that best suits your needs or the needs of their 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.

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

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

Are Alcohol Consumers Eligible to Buy Health Insurance?

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

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

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

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

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

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

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

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

Why Is Insurance Premium High for Alcohol Consumers?

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

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

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

Importance of Buying Health Insurance for Alcoholics

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

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

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

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

What are the Pre-Medical Tests?

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

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

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

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

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

Is Pre-Medical Examination Compulsory for Buying Health Insurance?

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

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

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

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

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

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

What is cashless health insurance?

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

How does cashless mediclaim work?

Cashless Mediclaim insurance works in the following manner.

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

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

Benefits of cashless health insurance

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

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

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

Types of cashless health insurance plans

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

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

Inclusions and exclusions of cashless health insurance

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

Common inclusions:

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

Common exclusions:

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

Things to consider when buying cashless health insurance

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

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

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

FAQs

1. Is cashless health insurance available in all hospitals?

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

2. Can I convert a reimbursement claim into a cashless claim?

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

3. What should I do if a cashless claim is rejected?

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

4. Is cashless mediclaim available for pre-existing diseases?

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

5. How can I check the list of network hospitals?

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

Conclusion

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

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

Picture this: you wake up one morning feeling unwell, and the only thing on your mind is getting medical attention. But as you navigate the maze of healthcare options available, you are left wondering — what is the best choice for my health insurance needs? Choosing the right health insurance plan can be overwhelming in a place where healthcare is a top priority. And with multiple options available, it is easy to get confused about which plan to go with. One of the most common debates in the Indian insurance sector is whether a private health insurance plan can replace a government-run scheme. 

What is ESIC?

The Employees’ State Insurance Corporation (ESIC) is a statutory organisation responsible for the Employees’ State Insurance (ESI) management and administration. The scheme was introduced in India in 1948 under the Employees’ State Insurance Act to provide social security benefits to employees in the organised sector, such as medical perks that include benefits pertaining to sickness, maternity, disability as well as death.

The ESI is a self-financing social security and health insurance scheme for workers earning a monthly wage of up to Rs 21,000 and Rs 25,000 if a person has a disability. ESI is funded by employers and employees, with the employer contributing 4.75% of the employee’s salary and the employee contributing 1.75%.

The ESIC has a multifaceted role in managing and administering the ESI Scheme. Its responsibilities include collecting contributions, providing medical and cash benefits to employees and their dependents, and managing hospitals, dispensaries, and other medical facilities. Additionally, it serves as a regulatory body to ensure compliance with the ESI Act and other related laws. 

Difference Between ESIC and Mediclaim

Below are the primary distinctions between ESIC and Mediclaim.

ESIC:

• It is a government-run health insurance scheme for employees in the organised sector, earning up to a certain limit. 
• The ESIC sees contributions from both employers and employees.
• It provides a range of benefits; this includes medical, cash, disability, maternity and dependent benefits.
• ESIC also manages and runs its network of hospitals and dispensaries.

Mediclaim:

• It is a private health insurance policy that individuals can purchase from insurance companies.
• It is available to anyone willing to pay the premium, regardless of their employment status or income level.
• It provides coverage for hospitalisation expenses, including medical bills, room charges, surgery costs, and more, up to the sum insured.
• Mediclaim policies have broader coverage and more flexible options but come at a higher cost than ESIC.

Benefits of Switching to Mediclaim from ESIC

Switching from ESIC to Mediclaim can have several benefits, including:

• More comprehensive coverage: Mediclaim policies offer a broader range of benefits than ESIC, including coverage for pre-existing conditions, outpatient expenses, and non-allopathic treatments.

• Greater flexibility: Mediclaim policies offer more flexibility in terms of choosing the sum insured, adding riders or endorsements, and selecting hospitals and doctors.

• Higher coverage limits: Mediclaim policies have higher coverage limits than ESIC, which means that you can get higher coverage for hospitalisation expenses, including room rent, medical bills, and surgery costs.

• Tax benefits: Premiums paid towards Mediclaim policies are tax-deductible under Section 80D of the Income Tax Act, 1961, whereas ESIC contributions are not tax-deductible.

• No dependency on employment status: Unlike ESIC, which is only available to employees in the organised sector, Mediclaim policies are available to anyone willing to pay the premium, regardless of their employment status.

Mediclaim cannot replace ESIC as ESIC is a mandatory social security scheme for employees in the organised sector, whereas Mediclaim is a private health insurance policy. However, employees not covered under ESIC can opt for Mediclaim for health insurance coverage.

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

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

Can you make a cash payment for the Mediclaim premium?

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

No tax benefit when you pay cash for Mediclaim Premium

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

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

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

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

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

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

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

How to avail of a hospital discount while billing?

• Spot billing errors: Be vigilant about billing errors to save money on your medical bills. If you notice any discrepancies, connect with the hospital billing department immediately. Requesting an itemised bill can also help provide a detailed breakdown of charges for various services, pharmacy bills, inpatient stays, and other factors.

• Go for a health card: A health card with a No-Cost EMI option can help you pay your medical bills in convenient monthly instalments, reducing your financial stress. This benefit is available at all network hospitals affiliated with your insurer. Furthermore, various insurers provide hospital bill discounts when you swipe their health card.

• Negotiate: You can negotiate with the healthcare provider for a discount on your medical bill. Explain your financial situation and ask if they offer any discounts, payment plans, or other options to help reduce the cost.

• Upfront payment: Depending on the hospital, medical bills can also provide benefits similar to other cash payment discounts. This can be particularly helpful if you are dealing with expensive medical bills. Certain hospitals may offer a substantial discount if you settle the entire treatment cost upfront but remember that this offer requires immediate payment.

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

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

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

Add-on for Covering Physiotherapy Sessions

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

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

Mediclaim Meaning

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

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

How does Mediclaim work?

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

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

Features of buying Mediclaim policy

• Financial protection:

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

• Cashless hospitalisation:

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

• Tax benefits:

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

• Pre- and post-hospitalisation expenses:

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

• No-claim bonus:

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

• Critical illness coverage:

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

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

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

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

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

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

Steps to Identify CCN Number

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

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

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

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

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

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

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

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

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

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

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

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

What is vitamin D?

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

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

Benefits of vitamin D

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

• Fights bone diseases:

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

• Helps maintain good mental health:

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

• Fights respiratory infections:

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

• Protects against heart ailments and diseases:

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

• Keeps the risks of diabetes in check:

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

• Reduces cancer risk:

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

• Guards against autoimmune conditions:

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

• Helps check cognitive inefficiency and dementia:

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

Top vitamin D-rich food items for vegetarians

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

• Fortified orange juice:

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

• Mushrooms:

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

• Fortified soymilk:

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

• Cheese:

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

• Yoghurt:

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

• Fortified almond milk:

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

Top vitamin D-rich food items for non-vegetarians

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

• Salmon:

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

• Tuna:

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

• Cod liver oil:

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

• Sardine:

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

• Herrings:

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

• Fortified cow milk:

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

• Egg yolk:

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

Tax Benefits On Preventive Health Check-ups

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

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

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

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

What is preventive healthcare?

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

Periodic health check-ups, shots and immunisation.

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

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

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

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

What is Section 80D of the Income Tax Act?

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

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

Features and benefits of preventive health check-ups

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

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

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

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

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

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

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

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

What is the maximum amount you can claim?

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

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

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

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

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

Tax benefits on cash payment

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

Deduction under Section 80DDB: Treatment of specified illness

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

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

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

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

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

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

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

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

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

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

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

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

Documents Required for Claiming Tax Deduction for Preventive Health Check Up

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

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

What is a claim settlement ratio?

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

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

Importance of the claim settlement ratio

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

• Insurer’s credibility:

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

• Security for you:

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

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

What is Cashless Health Insurance?

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

What is Cashless Claim Settlement?

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

• Cashless claim settlement

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

• Reimbursement claim settlement

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

Is Cashless Better Than Reimbursement?

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

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

How Does Cashless Claim Settlement Work?

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

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

Steps for Cashless Claims

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

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

Conclusion

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

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

Disclaimer: The information provided in this blog is for educational and informational purposes only. It 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.