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Here’s how health insurance works in India

Health Insurance policy is not just a necessity in the present era but an integral part of financial planning. It helps in protecting from heavy bil

Health Insurance policy is not just a necessity in the present era but an integral part of financial planning. It helps in protecting from heavy bills that are incurred while treating any kind of illness. Just like planning finances for the future, there is also a need and necessity for planning health insurances.

Why buy health insurance?

With time, there is an enormous demand for health insurance plans. It is because of increasing diseases and deteriorating health conditions. Therefore, having it is very crucial in the present times. Here are a few reasons why you should buy health insurance for sure.

  1. An uninsured person is likely to receive less and untimely medical care, that may result in a lack of proper treatment.
  2. Also, an uninsured person has to bear the fiscal burden on themselves and their family. 
  3. Insurance results in cashless treatment or reimbursement of medical expenses and also pre- and post-hospitalization expenses.
  4. An insured is also liable for tax deduction under section 80D of income tax for the premium paid to insurance company.
  5. The policies also provide health check-ups that are cashless or at some discount on a regular interval.
  6. The premium paid also covers the room rent of the hospital.
  7. The insured also gets a bonus element if he has not filed any claim in the previous year.
  8. The policy also covers the ambulance expense

Thus, in simple words, taking health insurance is a beneficial investment that a person makes for himself and for family. Along with that, the insurance policy helps the insured in gaining tax benefits as well.

Working on health insurance in India

In a country like India, health insurance is a must. It is due to the fact that with the increase in pollution and degradation of health conditions, people often fall sick. And the medical expenses act as a direct hit in the pocket. In this scenario, insurance policies act as a perfect helping hand that not only saves you from ongoing medical bills but provides reimbursement of pre and post hospitalization as well. In India, there are mainly four types of health insurance plans.

  • Mediclaim 
  • Critical illness cover
  • Hospital cash plan
  • Personal accident insurance 

Every type of insurance plans come with its own pros and cons, and hence it is important to understand all the aspects of plan to understand the compatibility with your requirements.

How health insurance works in India?

  • The health insurance plans are valid for a year and must be renewed every year to keep getting the benefits.
  • During the term of coverage, the insured can claim for health care needs.
  • In case, the insured does not make any claim in the year, then he is liable for a bonus.
  • To get the claim, the insured firstly have to check if the hospital he has opted for the treatment comes in the insurance company network
  • The hospitals that are within the network of the insurance service providers offer cashless hospitalization benefits via TPA.
  • TPA verifies the details of the medi-claim policy and then deducts the amount of bill by the sum insured. If there is some balance, the insured is needed to pay to the hospital.
  • If the hospital opted is not in the insurance company network, then the insured has to collect all the medical bills and submit to the insurer for the purpose of reimbursement
  • The insurer after deducting the amount of reimbursement with co-pay amount reimburses to the insured.
  • Sometimes there comes a situation, where the particular disease is not included in the insurance policy, in such case the company is unable to assist the insured with the healthcare needs.
  • The insured also has an option of porting from one insurance company to another if he is not satisfied with the terms and conditions of the insurance company. The process of porting is completely free and cashless opportunity.
  • The insurance coverage can also be upgraded to ensure sufficient claim at the time of emergency.

Final words

Health insurance is an agreement in which the insurer agrees to pay off the medical expenses that includes hospital bills, pre and post medical expenses, etc. The insurance company have tie ups with the hospital that helps in getting cashless services.

The health insurance policy is a needfulness of life in present time. It saves both you and your family from burning a hole in the pocket. Also, derail your finances and prepares you for the future outcomes.

An ideal health insurance plan would cover all the medical expenses like doctor consultation fees, cost towards medical tests, etc. Also, the premium paid towards health insurance is also subject to tax benefit.

The working of health insurance includes steps to avail the health insurance either in the form of cashless treatment or in cash reimbursement of medical expenses. But both of these act as an helping hand that saves the family and insured from medical bills and expenses.