A health insurance policy is a contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization). The contract can be renewable ( annually, monthly) or lifelong in the case of private insurance. It can also be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or “Evidence of Coverage” booklet for private insurance, or in a national (health policy) for public insurance.
Health care in India
In India, provision of health care services varies state-wise. Public health services are prominent in most of the states, but due to inadequate resources and management, a major population opts for private health services.
To improve the awareness and better health care facilities, (IRDA) Insurance Regulatory and Development Authority of India and The General Corporation of India runs health care campaigns for the whole population. In 2018, for underprivileged citizens, Prime Minister Narendra Modi announced the launch of a new public health insurance fund called Ayushman Bharat Yojana and the government claims that the new system will try to reach more than 500 million people.
In India, Health insurance is offered mainly in two Types:
*Indemnity Plan basically covers the hospitalization expenses and has subtypes like
(2)Family Floater Insurance
(3)Senior Citizen Insurance
(5)Group Medical Insurance
(6)Top Up/Super Top Up Health Insurance policy.
*A Fixed Benefit Plan pays a fixed amount for pre-decided diseases like
(3)Heart disease, etc.
It also has its sub types like (1)Preventive Insurance, (2)Personal Accident.
Depending on the type of insurance and the company providing health insurance, coverage includes
(1)Pre-and post-hospitalization charges,
(4)Health Checkups, etc.
It is pivotal to know about the exclusions which are not covered under insurance schemes:
(1)Treatment-related to dental disease or surgeries
(2)All kind of STDs(Sexually Transmitted Diseases) and AIDS(Acquired Immuno Deficiency Syndrome)
Few of the companies do provide insurance against such diseases or conditions, but that depends on the type and the insured amount.
Some important aspects to be considered before choosing the health insurance in India are
(1)Claim Settlement Ratio
(2)Insurance limits and Caps
(3)Coverage and network hospitals
(3) Incurred Claim Ratio
(4) Waiting period for Pre-existing Diseases
(5) Cost of Premium
- Claim Settlement Ratio(CSR)It is the ratio of the total number of claims settled by the insurance company to the total number of claims received in the same duration of time. Expert tip: A high CSR indicates that the company is more likely to settle a claim without any hassles.
- A cap on the benefits your insurance company will pay in a year while you’re enrolled in a particular health insurance plan. These caps are sometimes placed on particular services such as prescriptions or hospitalizations.
- An insurer should have a good number of hospitals in its network in each city, which cater to various classes of people. Network hospitals should include nursing homes, day-care centers, and multi-specialty hospitals.
- A longer waiting period for pre-existing illnesses can mean that you cannot make a claim for hospitalization, even though you are paying the premium.
- It is the ratio of the total amount of all claims received by a company to the total premiums collected in the same duration of time.
The benefits of employer health insurance will end the moment a job is left or changed. So, it is better to have own health cover early in life, instead of buying an expensive health cover post-retirement. Smokers, obese individuals and people with inactive lifestyles have higher health risks and need higher cover. Do not opt for plans which have a copay option. Choose a policy that offers lifetime renewability. For aged parents policy should cover cataract and knee surgery along with a list of illnesses.
Following are the top health insurance products in India
- Bajaj Finserv Health Aarogyacare Offers one of the best health insurance packages with pre-hospitalization OPD cover. You can get free consultations with doctors, Free Lab tests and much more. It has built a hassle-free claim process through the app and your health claim is just a few clicks away. Check more on their website.
- Star Health Insurance also offers very good health insurance packages and some of them are very comprehensive
- Tata AIG Health Insurance
- Aditya Health Insurance
- SBI General Health Insurance- Arogya Plus Insurance Policy
- Care Health Insurance
- HDFC Ergo Health Insurance
- Niva Bupa Health Insurance
- ICICI Lombard Health Insurance etc