Understanding the claim settlement process and the Claim Settlement Ratio (CSR) is an important step before selecting a health insurance plan. It is a factor that provides insights into whether the insurance provider is a reliable one and how efficient they are when it comes to settling a claim- things that are crucial when you need your health insurance claim in case of an emergency.

What is a claim settlement ratio in health insurance?

A claim settlement ratio or CSR is a percentage figure showing how many insurance claims were settled by an insurance company compared to the total number of claims raised by the policyholders during a financial year.

Importance of claim settlement ratio (CSR) in health insurance

CSR is a critical metric for policyholders because:

1. Reliability Indicator: A high CSR signifies that the insurer has a consistent track record of settling claims, indicating trustworthiness.
2. Financial Stability: It reflects the insurer's financial health and ability to pay claims.
3. Informed Decision-Making: Prospective policyholders can compare CSRs to choose an insurer that is more likely to settle claims promptly.

Types of claim settlement processes

1. Health insurance companies typically offer two main types of claim settlement processes:
2. Cashless Claims: Policyholders receive treatment at network hospitals without paying upfront; the insurer settles the bills directly with the hospital.
3. Reimbursement Claims: Policyholders pay for the treatment initially and later submit the necessary documents to the insurer to get reimbursed.

How do you calculate a claim settlement ratio?

The claim settlement ratio of an insurance company is calculated using the following formula:

CSR = (Total number of claims settled in a year) / (Total number of claims in a year) x 100

The CSR of an insurance company serves as an indicator of the overall financial health and credibility of the company. The higher the claim settlement ratio, the higher the chances of your claim being settled smoothly.

Every year, the Insurance Regulatory and Development Authority (IRDA) publishes the claim settlement ratio of all the registered insurance providers. You can easily check the credibility of an insurance company by going through the list of IRDA Claim Settlement Ratio for FY 2023-24.

What is the claim settlement process?

The claim settlement process involves several steps:

1. Notification: Inform the insurer about the hospitalisation or treatment as per the policy's stipulated time frame.
2. Documentation: Submit the required documents, including claim forms, medical reports and bills.
3. Assessment: The insurer evaluates the claim against the policy terms.
4. Approval/Rejection: Based on the assessment, the claim is either approved and paid or rejected with the reasons provided.

Timely communication and accurate documentation are important for a smooth claim settlement process.

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

A high CSR indicates the insurer has a strong track record of honouring claims, suggesting reliability. When selecting a health insurance plan or critical illness insurance, considering the CSR helps ensure that you choose an insurer likely to provide timely financial support during medical emergencies.

FAQs

1. What is considered an ideal claim settlement ratio?

A claim settlement ratio (CSR) above 90% is generally considered good. It indicates that the insurer has a high rate of settling claims, making them a reliable choice for policyholders. A higher CSR suggests a smoother claims experience, increasing the chances of claim approval.

2. Where can I find the claim forms and the list of required documents for submission?

Claim forms and the list of necessary documents can be found on the official website of your insurance provider. You can also get them by visiting the insurer’s branch office or by contacting their customer support. Many insurers also provide digital forms that can be downloaded and submitted online for convenience.

3. Why is it important to submit all the required documents when filing a claim?

Submitting all the necessary records and documents ensures that your claim is processed without delays or complications. Insurance companies require specific paperwork to verify the claim’s authenticity, assess the coverage and determine the amount payable. Incomplete or missing documents may lead to claim rejection or prolonged processing time.

4. How many health insurance claims can be made in a year?

There is no fixed limit on the number of claims a policyholder can file in a year, as long as they stay within the sum insured under their policy. However, specific policies may have sub-limits or restrictions based on the nature of the treatment, so it's advisable to check the policy terms before making multiple claims.

5. What is the average time taken by a health insurance claim to be processed?

The time taken to settle a health insurance claim varies based on the insurer and the type of claim. Cashless claims at network hospitals are typically approved within a few hours to a day. Reimbursement claims, where policyholders submit documents after treatment, may take anywhere between 7 to 30 days for processing, depending on the insurer’s verification process.

Conclusion

Among several factors that help one choose the ideal health insurance plan is the CSR or claim settlement ratio. A higher CSR reflects an insurer's reliability and efficiency in handling claims, providing policyholders with confidence that their legitimate claims will be processed on time. In addition to CSR, you should check the features of the policy, ICR or incurred claim ratio, rates of premium to be paid and the quality of customer support to make sure that the insurance provider has the best overall services that will come in handy in time of need.

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.

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.

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.

The Insurance Regulatory and Development Authority of India(IRDAI) is the insurance sector regulatory body in India. The IRDAI’s objective is to optimise the existing insurance industry and make sure the operations and conduct of the sector are fair. The insurance market is undergoing constant changes, upgradation, and high competition. Consequently, the role of the IRDAI is essential.

Who is IRDAI and its role in health insurance?

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

IRDAI guidelines for claim settlement

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

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

IRDAI’s protection for policyholders

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

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

How to ensure a smooth claim process?

Policyholders can facilitate efficient claim settlements by:

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

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

FAQs

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

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

2. Can insurers ask for additional documents after the initial submission?

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

3. What if my claim is rejected unfairly?

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

Conclusion

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

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

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

What is a claim settlement ratio?

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

Formula for Claim Settlement Ratio:

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

Types of health insurance claim ratio

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

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

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

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

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

What is considered as a good claim settlement ratio?

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

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

When selecting a health insurer, a high CSR indicates:

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

Is the claim settlement ratio enough for evaluation?

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

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

Importance of claim settlement ratio

Understanding the claim settlement ratio is important because it-

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

Required documents for claim settlement

To file a claim, policyholders must provide:

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

How to check health insurance claim settlement ratio?

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

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

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

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

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

How is the health insurance claim ratio calculated?

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

Types of claim settlement processes

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

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

FAQs

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

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

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

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

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

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

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

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

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

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

Conclusion

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

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

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

What is Dental Insurance?

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

Why Is Dental Insurance Necessary?

Investing in dental insurance is important for the following reasons-

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

What Do Dental Insurance Plans Typically Cover?

Dental insurance plans typically provide coverage for the following:

1. Preventive Care

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

1. Basic Procedures

Cavity fillings and basic extractions are covered.

2. Major Procedures

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

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

What Are the Common Exclusions in Dental Insurance?

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

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

Who Should Buy a Dental Insurance Plan?

Dental insurance plan can be especially useful for-

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

Why is Dental Work Not Included in Health Insurance?

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

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

FAQs

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

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

2. Is dental insurance expensive?

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

3. How can I reduce dental care costs?

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

4. Are dental emergencies covered under health insurance?

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

5. Are root canals covered by health insurance?

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

Conclusion

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

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

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

What is Family Floater Health Insurance?

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

Key Features of Family Floater Health Insurance

Some important features of family floater health insurance are-

1. Single Sum Insured for Whole Family-

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

2. Cashless Hospitalisation-

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

3. Tax Benefits-

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

4. Wide Coverage:

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

Benefits of Family Floater Health Insurance

The benefits of a family floater health insurance are-

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

How Does a Family Floater Health Insurance Work?

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

What Does a Family Floater Health Insurance Plan Cover?

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

• In-Patient Hospitalisation:

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

• Daycare Procedures:

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

• Ambulance Charges:

  Costs incurred for transporting the insured to the hospital.

• Pre and Post-Hospitalisation:

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

• Preventive Health Check-Ups:

  Some policies offer coverage for routine health examinations.

What Family Floater Health Insurance Does Not Cover?

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

• Pre-Existing Diseases:

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

• Cosmetic Procedures:

  Expenses related to aesthetic treatments not medically necessary.

• Alternative Treatments:

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

• Treatment of certain medical conditions

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

Things to Consider Before Buying a Family Floater Health Insurance Plan

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

Key things to consider are-

• Assessment of Coverage Needs:

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

• Network Hospitals:

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

• Inclusions and Exclusions:

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

• Waiting Periods:

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

• Renewability:

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

How to Apply for Family Floater Insurance Plans Online?

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

1. Visit Official Websites:

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

2. Use Premium Calculators:

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

3. Choose the Insurance:

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

4. Fill Application Form:

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

5. Upload Documents:

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

6. Payment:

   Pay the premium online through secure payment gateways.

7. Confirmation:

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

FAQs

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

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

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

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

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

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

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

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

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

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

Conclusion

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

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

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

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

Importance of health insurance in India

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

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

What is the ideal health insurance coverage in India?

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

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

How to choose your ideal health insurance coverage amount?

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

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

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

How much health insurance is enough in India?

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

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

Factors to consider while choosing the right health insurance coverage amount

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

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

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

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

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

Health insurance plan at ICICI Lombard

ICICI Lombard offers comprehensive health insurance policies with the following:

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

FAQs

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

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

2. Can I modify my health insurance coverage later?

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

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

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

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

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

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

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

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

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

7. Is one crore health insurance a good option?

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

Conclusion

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

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

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

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

How does health insurance work in India?

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

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

 Pre and Post-hospitalization expenses

Daycare procedures

AYUSH treatment recognized by government institutions

In-patient expenses

ICU charges

Indoor expenses

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

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

How does health insurance renewal work?

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

 Nowadays, insurers allow both online and offline renewal.

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

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

ICICI Lombard health insurance claim process

ICICI Lombard is noted for its instant coverage and speedy claim settlement process. With a settlement ratio of 99.7%, ICICI Lombard is one of the best insurance providers in the medical insurance industry. You can file a claim with ICICI Lombard by following these three simple steps:

• Initiate

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

• Verification

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

• Tracking

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

Claim procedure for cashless hospitalisation

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

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

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

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

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

Use masks & follow hygiene habits

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

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

Get vaccinated

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

Get Health insurance

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

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

Final Words

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

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

Impact of 18% GST on Health Insurance Premiums

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

Here is how:

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

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

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

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

Conclusion

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

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

The New Features of ICICI Lombard Health Insurance

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

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

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

Click here to download IL Take Care App

Zone-based pricing

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

Zone definition

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

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

What is deductible in health insurance?

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

How do deductibles work in health insurance?

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

Types of deductibles in health insurance

Common deductibles in medical insurance are:

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

How to choose a deductible under your health insurance policy?

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

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

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

Factors impacting the deductible amount in health insurance policy

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

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

Why should you opt for an insurance deductible?

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

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

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

FAQs

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

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

2. Does a higher deductible affect claim settlements?

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

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

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

Conclusion

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

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

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

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

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

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

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

The new coronavirus strain: What is it?

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

How harmful is the new Covid strain?

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

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

What's the situation in India?

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

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

What are the common infection symptoms?

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

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

What are the precautions that you need to take?

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

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

Will the current vaccines work against the new variant?

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

Group health insurance plan along with individual health insurance provides adequate health coverage to your parents

The depth of love your parents have for you can never be measured. They have always been your backbone but at a ripe age, health is probably the first companion that starts deserting them and may take away their hard-earned savings along with it. The exponential rise in treatment and medicine costs compounded with limited scope of income can ruin their ‘golden days’.

The best gift you can provide to your aging parents is securing their healthcare expenses through a health insurance plan. You can buy a separate health insurance policy for your parents or you can include them in the Group Health Insurance (GHI) plan provided by your employer.

What is a Group Health Insurance?

Companies often provide group health insurance coverage to its employees and their family. The premium for this scheme is borne by the employer to create a loyal and motivated workforce. The employee may add his/her spouse, children and parents to this group health insurance plan.

Since the risk is spread across the group, the premium for group health insurance plan are less than individual plans. The organization may design a self-insured plan or may select a pre-planned group insurance policy provided by general insurance companies.

How is it Beneficial for My Parents?

Separate health insurance plans for your parents at a ripe age may cost you much more since they are highly prone to illnesses. The best way is to include them in the group health insurance (GHI) plan provided by your employer. Here’s how it can benefit your parents:

• They cannot be denied the health coverage on the basis of their medical history. No medical examination is required under GHI plan and the claim settlement is also smoother.
• There is no waiting period for any disease and you can claim the health cover for your parents right from the first day.
• Pre-existing diseases are not excluded from the health cover. So, if your parents are already diagnosed with certain ailments, they are also covered under the GHI plan.
• You can even customize the GHI plan provided by the employer by adding a top-up to increase the coverage amount for your parents.

When Arun went to the doctor for his routine check-up, he was quite amused to know that his blood pressure was found higher than normal and he was diagnosed with hypertension. He recognized its high risk factors could lead to cardiovascular diseases and kidney failures, and therefore immediately decided to buy an individual health insurance plan for himself because he knew it can ruin his finances.

High blood pressure or Hypertension is ranked as third most risk factor for attributable diseases in India. Research also shows that overall prevalence of hypertension in the country to be around 30%, with more than 320 lakh people being affected. Although you cannot control contracting the disease amid sedentary lifestyle and work pressure, you can always look to stay protected against hefty medical emergencies that could empty all your savings.

Hypertension Can Prove Fatal

Hypertension can arise due to several reasons and stress tops the list. Modern lifestyle and events from your personal or professional life can give rise to stress which leads to high blood pressure. It can cause many severe health conditions like heart attack, brain haemorrhage, kidney problems, etc. Even a slightly high blood pressure can lead to a stroke.

The rising inflation in medical sector makes it really hard to take care of hefty medical bills for treatment of such diseases. People are also willing to switch to private hospitals in order to get quality treatment but incur very high expenses for doctor’s fees, medicines, diagnostic tests, and hospitalization charges etc.

As the world is still reeling under the COVID-19 pandemic and is struggling to attain normalcy, health insurance has become even more significant in ensuring peace of mind. Health insurance provides a cover of assurance that you will be taken care of in the face of a medical crisis. Healthcare, today, is very expensive and a little something can cost you lakhs of rupees in the name of quality treatment and hospitalization costs. However, just getting any health insurance is not enough, what you need is the right cover that meets your needs without going over your budget. Here are some things to know before buying health insurance, including the important health insurance terms and conditions, to help you make an informed decision.

Health insurance conditions

Most insurance companies have their own set of conditions laid out for policy seekers. You must meet these conditions to be able to enjoy the policy benefits. Some of them are:

- Pre-policy health checks:

• At times, health insurance companies ask you to undergo several pre-policy health checks at their cost. These health checks help them assess your health risk profile so that they can offer a policy that best suits your needs. As an added advantage, you also get to know if there is something to look out for in terms of your health conditions.

- Waiting period:

The waiting period is a very important aspect of c. When you buy a health insurance plan, in the first month, the insurance companies only cover an accidental injury. This is considered a cooling-off period in which the insurance company can check if some problem might not have been missed in the health checks.

- Deductibles:

Deductibles are very important in terms of health insurance conditions. Deductibles are meant to help insurance companies while preventing misuse of medical insurance policies through frivolous claims. A deductible is the percentage amount of your medical bills that you are required to pay out of your pocket—generally 15% or 20% of the total bill amount as well as non-medical and administrative expenses. One good thing about deductibles is that for people who lead a healthy lifestyle and are at low risk, adding a higher voluntary deductible helps in bagging a higher discount on policy premiums.

Investing in medical insurance not only ensures financial security during medical emergencies but also offers substantial tax benefits. The Indian Income Tax Act allows policyholders to claim deductions on various healthcare-related expenses, reducing overall tax liability. Keeping track of tax-reducing bills and receipts is essential for maximising these benefits. This blog explores the tax benefits available on medical insurance for parents, key bills that help reduce tax liability and the process of maintaining and submitting these documents correctly.

Tax benefits on health insurance

Health insurance policyholders can claim tax deductions under Section 80D of the Income Tax Act. The deductions are as follows:

• ₹25,000 deduction for self, spouse, and dependent children (below 60 years).
• ₹50,000 deduction if the insured person or parents are senior citizens (above 60 years).
• Additional ₹5,000 for preventive health check-ups (within the overall limit).

These tax benefits apply to medical insurance for parents, individual policies and family floater plans.

Bills and receipts that help reduce tax liability

There are several ways to reduce the income tax payable, and out of these, most are unknown to us or often forgotten. Invoices and receipts of various expenses are examples of such commonplace items that can help reduce your tax liability.

Here are 8 invoice-related tax deductions in accordance with The Income Tax (IT) Act 1961, which you can claim to save more this year:

1. Health Insurance Premium Receipts

Payment of medical insurance premium for yourself, your spouse and dependent children qualifies for tax deduction under Section 80D. Likewise, payment of medical or health insurance premium for your parents, whether dependent or not, qualifies as a deduction under this section.

1. Preventive Health Check-up Bills

If you have not yet exhausted your deduction limit under Section 80D and you have a bill for a preventive health checkup, you can claim this bill and get a maximum of Rs. 5,000 as a deduction. This deduction is included within the overall limit of Rs. 25,000 of Section 80D (Rs. 30,000 in case of senior citizens) for the financial year 2014-15.

1. Medical Expenses for Senior Citizens

If parents are above 60 years old and do not have health insurance, medical expenses up to ₹50,000 can be claimed under Section 80D. Bills for doctor consultations, medicines and treatments should be properly maintained. Ensure the receipts contain details like patient name, date and service provided.

1. Critical Illness & Medical Treatment Bills

Tax deductions under Section 80DDB can be claimed for specified critical illnesses like cancer, kidney failure and Parkinson’s disease. The deduction limit is ₹40,000 (for individuals below 60 years) and ₹1,00,000 (for senior citizens). Bills must be supported by a doctor’s certificate from a specialist.

How to maintain and submit tax-reducing bills and receipts?

These simple tips will help you better manage and submit tax-reducing bills on time: 

1. Organise Documents Properly: Keep both digital and hard copies of medical bills and insurance premium receipts.
2. Ensure Receipts Are Valid: Bills should include essential details like provider name, patient name, date and expense breakdown.
3. Use Tax Filing Software: Platforms like ClearTax or official IT portals allow easy submission of scanned receipts.
4. Submit Before the Deadline: Ensure all documents are submitted before the financial year-end to claim deductions.

Common mistakes to avoid while claiming tax deductions

These are some of the mistakes to avoid while claiming a tax deduction:

• Paying Insurance Premium in Cash: Only non-cash transactions qualify for tax deductions.
• Claiming Invalid Expenses: Cosmetic surgeries, alternative treatments (not covered under AYUSH) and over-the-counter medicines do not qualify.
• Failing to Maintain Proper Receipts: Ensure bills are itemised and legible.
• Not Including Medical Expenses for Senior Citizens: Even if your parents do not have insurance, their medical expenses can be claimed.

FAQs

1. Can I claim a tax deduction for my parent’s medical insurance?

Yes, under Section 80D, you can claim up to ₹50,000 if your parents are above 60 years.

2. Are cash payments eligible for tax deductions?

Cash payments are eligible only for preventive health check-ups (₹5,000 limit). Insurance premiums must be paid digitally.

3. What documents are needed to claim tax benefits?

You need premium payment receipts, medical bills, doctor’s certificates (for critical illnesses) and diagnostic reports.

4. Can I claim both insurance premiums and medical expenses for my parents?

Yes, if your parents are above 60 years old and do not have insurance, their medical expenses (up to ₹50,000) can be claimed.

Conclusion

Claiming tax benefits through medical insurance and related healthcare expenses can significantly reduce your tax liability. By maintaining valid receipts and understanding the applicable deductions, taxpayers can maximise their savings. Whether it’s medical insurance for parents or personal health expenses, strategic tax planning ensures financial security while complying with income tax laws.

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

The ongoing COVID-19 pandemic has changed the way we live. The new normal includes wearing masks, sanitisers, social distancing, restricted movement, work from home, online shopping and more. Another important aspect of this new normal is getting vaccinated against COVID-19 and get covered with good health insurance. While doctors believe that getting the covid vaccine may not be enough in avoiding infection, but it can certainly contain the severity of the condition. In India, the two most popular options for COVID-19 vaccines are—Covaxin and Covishield. Are you finding it difficult to choose one?

Covaxin

Made by Bharat Biotech, a Hyderabad-based biotechnology company, Covaxin is the first Indian vaccine against the COVID-19 causing coronavirus. It is made from an inactivated virus; the virus was killed before incorporating it into the vaccine. When introduced to a healthy human body, the inactivated virus triggers an immune response, developing antibodies to fight it. These antibodies prove useful in preventing a severe case of COVID-19 when the person is exposed to live coronavirus. The vaccine, stored between 2 to 8 degrees Celsius, is taken in two doses with a gap of four to six weeks between the two shots.

The common side effects of Covaxin include fever, nausea, headache, pain and swelling at the site of injection, muscle ache and even fatigue in some cases.

Covishield

Covishield was developed by Oxford-AstraZeneca and its Indian variant is manufactured by Serum Institute of India (SII), Pune. While Covaxin is made using an inactivated coronavirus, Covishield is made from a viral vector obtained from a different virus usually found in Chimpanzees. The viral vector is modified to imitate the novel coronavirus. Covishield can be stored for up to six months at a temperature of 2 to 8 degrees Celsius. This too is taken in two doses at a gap of 6 to 8 weeks. Moreover, Covishield is claimed to develop more antibodies in the human body, thus needing a longer time gap between the two shots.

Covishield’s side effects are more or less the same as Covaxin and include pain and tenderness at the injection site, fever, nausea and weakness.

In May, the Indian government had expressed confidence in achieving 100% COVID-19 vaccination of adults by the end of 2021. While India is running a global race to achieve complete vaccination to beat the novel coronavirus, there are four types of Covid vaccine in India that are being used to contain the pandemic among the masses. It is important to get covered with good health insurance which covers corona related expenses in this pandemic. Let us take a look at these vaccine options, their similarities and differences, and cost.

Covishield

Manufactured by India’s largest vaccine maker, the Serum Institute of India, Covishield was developed by Oxford University, in collaboration with Cambridge-based pharma and biotech company AstraZeneca.

Covishield has been developed on the viral vector platform using a modified version of a common cold virus. The vaccine is taken in two doses and is found to have an efficacy of 76%, which increases up to 82% with a gap of 12 or more weeks between the two shots. Covishield has been cleared for vaccination by 117 countries so far. Many countries have opened their international borders for Covishield-vaccinated people, including 10 countries from the European Union.

In India, Covishield is being offered free of cost at government vaccination centres. However, if you get the jab in a private hospital, you may have to pay up to Rs 780 per dose—Rs 600 as the price of the dose, Rs 30 as GST and Rs 150 as the service charge.

Covaxin

Covaxin is developed by Hyderabad-based Bharat Biotech in association with the Indian Council of Medical Research and the National Institute of Virology. Covaxin contains dead coronavirus, which prompts the immune system to develop antibodies against it. Covaxin is administered in two doses that should ideally be four weeks apart. Phase 3 trials of Covaxin showed a 77.8% efficacy. Although 13 countries have approved the use of Covaxin, the World Health Organization (WHO) is yet to give its nod to the vaccine.

In India, Covaxin is offered free of cost in government medical centres, while private hospitals can charge not more than Rs 1,410, which is inclusive of Rs 1,200 as the price of the dose, Rs 60 as GST and Rs 150 as the maximum service charge.