For rudimentary understanding it provides financial cover-up in case of illness, health issues. For same one needs to be in agreement with the insurer to invest premium amount for tackling unforeseen health issues for self and family.
Medical coverage is important for every individual as in this dynamic and fast growing scenario, people are compromising with the physical capabilities to excel more and more in their career, they usually ignore the health factors in a day to day life which cumulates to the major health problems down the line. Gradually body starts losing the immunity to fight with the internal and external agents causing health issues. Hence it becomes mandatory to prepare oneself for the upcoming health challenges to ensure the financial assistance at the time of crisis.
Medical coverage plans comes with the flexibility of both types of payments cashless and reimbursements in case of in-network and out of network respectively. For in-network, one can avail the facility by showing the medical cards and expenses to be taken care by the insurance company itself through the TPA (Third party administrator) which depends upon the entitlement. In case of out-of-network, upfront payments should be done by the user and the amount would be reimbursed upon the submission of bills. To avail these facilities one should be hospitalized for 24 hours. However in certain cases like a disease diagnosed after converge and which is to be treated in near future, tests pertaining to surgery/operations, same could be provided without the former condition. In addition, few policies give benefits for routine check-ups also. Coverage in limited to Contact lenses, hearing aids and spectacles are also not covered. Also, there are no short term policies available for health cover for less than a year.
Sum insured can be on individual or floater basis for self and dependent. It also offers an arrangement called Cumulative Bonus, which says that for every claim free year; there will be increase in sum insured by certain percentage(with capping). For any claims, it will be reduced by certain % for next year. Premium depends on certain factors like age, medical history. For older people, premium rates would be on higher side so as in case of bad medical history.
IRDA has taken a major step i.e.Health Insurance Plan Portability which allows a user to switch the policy from one provider to another (subjected to sum insured). IRDA is playing a active role by not only doing the vigilance on existing policies but also by providing as ear to the grievances and concerns related to services offered by the insurance providers. For same one can register their complaints through IGMs website and can connect via Toll free 155255. After registration of a complaint companies got 15 days time to work-upon and to resolve the issues.
Above all, medical covers provide opportunity to save tax and to lessen pressure on one’s pockets.