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Beginner's Guide To Health Insurance

Get clarity on health insurance basics. Learn about coverage, terms, and why it's crucial for your financial security.

  • 14 Jan 2015
  • 3 min read

Well, whatever the case maybe, not any longer. This handy guide helps you to address your basic doubts about health insurance.

Let's Start

So, what are mediclaim, health insurance and medical insurance? Well, all refer to the same thing - an insurance plan that protects you against medical emergencies, monetarily, of course. These plans cover expenses related to hospitalization, including eligible pre as well as certain post-hospitalization expenses.

Summarizing Quickly The Indian Scenario

Insurance Regulatory and Development Authority (IRDA) regulates the insurance sector in India. Any person seeking to insure himself/herself against medical expenses needs to buy a mediclaim policy by paying the requisite insurance premium on the policy. On incurring hospitalization expenses, he/she can then make a claim to the health insurance company.

Apart from the standard policies that cover expenses right from ambulance charges to operation theatre charges, a number of diverse policies are designed that cater to certain unique requirements of each person. Some of these innovative policies are as follows:

Family Medical Insurance Policy

These are family floater health plans that cover all family members under a single policy instead of individual policies for each member.

Upside: Flexibility of utilizing the sum insured by any member of the policy. E.g. If the sum insured is Rs.3 lakhs for Mr. Sharma and Mrs. Sharma; Mrs. Sharma alone can utilize the entire limit of Rs. 3 lakhs.

Downside: Members prone to illness may exhaust the cover leaving other family members with no cover or an insufficient cover.

Also read:

Learning the Lingo

Moving ahead, let's get acquainted with a few terms used in common parlance:

1. Cashless Claims

Availing treatment in an approved hospital (list uploaded regularly by the insurance company) without having to pay money to the hospital is termed as cashless mediclaim. In such claims the Health Insurance Company directly settles the amount with the hospital. The insured is given a Health Card which has to be shown to the hospital for availing such cashless facility during hospitalization.

2. Reimbursement Claims

Under reimbursement claims, the insured actually pays the medical expenses related to hospitalization. Subsequently he/she claims the amount from the Insurance Company, by submitting relevant documents like hospital bills, doctor's certificates, etc.

3. Sub-limit

Sub-limit refers to the maximum limit on the amount that can be claimed under certain ailments. However, you can choose to buy plans that raise or waive off these sub-limits.

4. Third Party Administrator (TPA)

Hired by the Insurance Company, a TPA agency processes claims including cashless facility.

5. Exclusions

Certain diseases excluded from health insurance are termed as exclusions. E.g. Cosmetic surgery is generally excluded from health insurance.

6. Deductible

It is the amount of loss that is borne by the policyholder. Always remember, higher the deductible, lesser is the premium payable.

We hope this has been an eye-opener for you. Availing mediclaim policies help you steer clear of the financial burden during medical emergencies. Do make an informed choice; after all, a huge benefit in exchange for a small premium is always a win-win deal.

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.  

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