Everything you need to know about Health insurance

Health Insurance: Health insurance is a contract or agreement between the insurance company and the insured customer in which the insurance company agrees to settle the hospitalization claim amount of the insured in case of any accident, disease or illness as per the terms and conditions mentioned under the policy, in return for a considerable amount known as premium. 

The health insurance premium is paid by the customer for the health insurance coverage and the health insurance claim is settled by the insurance company. The validity of a health insurance policy may range from 1 year to 3 years. Customers can purchase health insurance policy for a longer period known as long term health insurance wherein the premium can be paid at once and coverage would be for longer periods. 

The health insurance coverage depends on the sum insured option chosen by the customer. The sum insured in health insurance policies range from ₹50k to ₹1Crore for pre underwritten products. Pre underwritten health insurance plans are those which have the fixed sum insured and fixed premiums. If there is a demand from the customers for a higher sum insured i.e. more than the available sum insured, then the proposal would be underwritten by the underwriter of the insurance company after taking into consideration all the factors. 

Customers can avail tailor made health insurance policies on individual level as well as group level. Group health insurance policy is a tailor made health insurance policy that is offered to the organizations. The premiums of health insurance policies depend on the age of the customer as well as the coverage chosen by the customers. Higher the age, higher would be the premium. Likewise higher the sum insured, higher would be the premium. 

The awareness of health insurance is on the rise in the past couple of years due to the COVID-19 virus, there have been many discussions and health insurance was the top search word during the pandemic period. Due to the rising healthcare costs many people are inclined to take health insurance plans to protect their financial and mental health. As we say, middle class people are just a hospitalization away from becoming poor. Only 70% of the Indian population is covered under some kind of health insurance. Almost 49 crore individuals are covered under the State and Central government sponsored health insurance schemes such as Ayushman Bharat etc. Nearly 14 crore individuals are covered under the Social Health insurance schemes such as Employee state insurance scheme etc. 

Private voluntary health insurance schemes cover only 11.5 crores of population which would roughly translate to 10% of the population. Most of the people who do not meet the eligibility set by State and Center sponsored schemes would be left out and those who do not take private health insurance are under the remaining 30% population without health insurance coverage. 

  • Retail Health Insurance: Private retail health insurance is an individual health insurance policy which covers the individual and their family members. Retail health insurance policy is taken by an individual for himself and or his family members. The retail health insurance covers the inpatient treatment, day care treatment, outpatient treatment and other alternative treatments. 

The retail health insurance policy premium depends on various factors such as Age of the members in the policy, sum insured/ coverage required, add-ons required etc. It is important to note that there would be no claim bonus in the form of increased sum insured for every claim free year. Every claim free year, certain percentage of sum insured would be added to the existing sum insured under the retail health insurance policy. 

There are certain waiting periods in the retail health insurance which are mentioned below:- 

  1. Initial waiting period or 30 day waiting period is the time in which the insured customer has to wait for a period of 30 days after taking the policy to make any claim. The initial waiting period is not applicable for accident related hospitalization. 
  2. Specific waiting periods may vary from 1 year to 3 years during which the customer cannot claim for certain illnesses or diseases as specified in the policy period. There are certain diseases such as knee replacement, hernia, etc for which a waiting period of at least 2 years is applicable. 
  3. Pre pre-existing waiting period is the period in which the customer cannot make a claim for any pre existing diseases that were existing before the inception of the policy. The pre-existing waiting period ranges from 1 year to 4 years based on the insurance company and the type of insurance policy. 
  4. Maternity Waiting period is the time period in which the insurance company will not settle any maternity related claim under the health insurance policy. 
  • Group Health Insurance: Group health insurance is a type of health insurance policy which covers a group of members under a single health insurance policy. The members would usually be employees or members of an organization or association. The group health insurance policy is taken by the employer to provide health insurance cover to employees as a part of employee benefits. 

Group health insurance policy covers the inpatient treatment, outpatient treatment, day care treatment, Alternative treatments, room rent and surgeon charges etc. Group health insurance policy can be given if there are a minimum of 7 employees who are to be covered. 

The major advantage of group health insurance policy is that there would be no requirement to satisfy the waiting period. Pre-existing waiting period, initial waiting period, specific disease waiting period and maternity waiting period. All the waiting periods can be waived off under the group health insurance policy and the members of the policy can avail benefits from day 1 of purchasing the group health insurance policy. 

The members of the group health insurance policy would be given physical health cards or Ecards which can be used to avail cashless claims at any of the network hospitals. Network hospitals are those hospitals which tie-up with the insurance companies to offer cashless claim settlement facilities to the health insurance policy holders. Customers can also avail reimbursement facility by submitting all the required documents to the insurance company to process the claim. 

Group health insurance policies do not have the concept of no claim bonus which is available in retail health insurance policy. Group health insurance policy can be renewed with any of the insurance companies without the need for porting from one insurer to another. It is to be noted that the additions and deletions of members in a group health insurance policy can be done by payment of additional premium at any point of time during the policy period. 

Group health insurance policy is a tailor made policy as it can be customized according to needs and requirements of an organization. Group health insurance is not a pre underwritten product like retail health insurance which would help the customers to opt for the add-ons and other features as per their requirements. 

To avail group health insurance policy please book a call with Ethika insurance broking to get assistance from the health insurance experts on selecting the best health insurance policy.