Health insurance, mediclaim or medical insurance...Do these terms sound intimidating? Or do these leave you grappling for words in a discussion amongst friends and colleagues? 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.
Learning the Lingo
Moving ahead, let's get acquainted with a few terms used in common parlance:
 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.
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.
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.
Third Party Administrator (TPA)
Hired by the Insurance Company, a TPA agency processes claims including cashless facility.
Exclusions
Certain diseases excluded from health insurance are termed as exclusions. E.g. Cosmetic surgery is generally excluded from health insurance.
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.
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