It is a type of insurance product that helps individuals be prepared for sudden medical expenses. Analysing the illness pattern of the individuals, their
hereditary medical issues and age, insurance companies formulate different products for the applicants. Health insurance policies also provide tax
incentives under section 80D in India. Health insurance policies cover the cost of medical treatments. Dental insurance, like medical insurance protects
policyholders for dental costs.
Popularly known as Mediclaim in India these kinds of policies cover hospitalization, expenses incurred during medical tests and for medicines. One can also
get coverage for medical expenses by opting for the Critical Illness rider available with life insurance policies. Therefore as per the rules of the
contract it means that in case of a critical illness during the policy tenure, one will be paid the amount as proposed in the policy. In case of health
insurance the benefits are regulated by the regulatory body, IRDA.
Types of Health Insurance:
This is the simplest form of health insurance product that is available and is known as the Individual Mediclaim policy covering the hospitalisation
expenses for the individual up to the sum that is assured by the contract of the policy. The extent of the coverage depends on the premiums paid earlier and
also on the duration of the policy.
For example if there are say 3 family members, there can be three independent policies for each of them independently covering them up to say 2L inclusive
of the hospitalisation and other medical expenses.
Family Floater policy:
These are the extended versions of the Mediclaim policy. The sum assured value can be utilized by anyone of the family members. i.e. Each of the family
member comes under the policy, and it covers expenses for the entire family up to the sum assured limit. The premium for family floater plans is typically
less than that of a separate insurance cover for each family member.
For example suppose a family has 3 members and there is a combined policy of 6L on which any one of the members can lay claim. Now suppose one person gets
hospitalised and requires say 4L then the amount in the fund for that year goes down by that amount. So now if any other member wants to lay claim only 2L
will be available in that case. Next year again however the policy will start with 6L again. These plans are suited for families as each member is covered
for a large amount and usually the probability of more than one member getting hospitalised in a family at the same time is very low.
Unit Linked Health Plans:
Different health insurance companies have introduced Unit Linked Health Plans. These plans are still a new concept and are in the development phase. This
kind of product is recommended for those who actively invest in equities and have a high risk taking capacity as the quantum of returns is directly linked
with the prices of the equities in which the money gets invested. These plans integrate health insurance with investment and pay back an amount at the end
of the insurance term depending upon the performance of the market.
HDFC ERGO Health Insurance FAQs
Do I really need health insurance?
Yes, No one knows when a medical emergency might strike. It is best to buy health insurance, to save money when an emergency strikes.
Is Health Insurance the same as Life Insurance?
No. Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely death/or if something happens to
you. The payout is made only post the death of the person insured or at the maturity of the policy. Health Insurance protects you against ill health/diseases
by covering the expenses you might incur (for treatment, diagnosis etc.) in case you are affected by disease or injury. There is no payout made at maturity.
Health insurance also needs to be renewed annually.
Are Maternity/Pregnancy related expenses covered under Health Insurance plans?
No. Maternity/Pregnancy related expenses are not covered in a Health Insurance plan. However, employer provided group insurance plans often cover maternity
Is there any tax benefit that one can avail of while purchasing Health Insurance?
Yes, there is a tax benefit available under Section 80D of the income tax act 1961. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable
income for payment of Health Insurance premium for self and dependants.
Is a medical checkup necessary before buying a policy?
A medical checkup is necessary for a new health insurance policy for customers above the age of 40 or 45 years depending on the health insurer's norms.
Medical checkups are usually not needed for renewal of policies.
What are the minimum and maximum policy durations?
Health insurance policies are general insurance policies usually issued for a period of 1 year only. However, some companies also issue a two year policy. At
the end of your insurance period you must renew your policy.
What is coverage amount?
Coverage amount is the maximum amount payable in the event of a claim. It is also known as “sum insured” and “sum assured”. The premium of the policy is
dependent on the coverage amount chosen by you.
Who is a Third Party Administrator?
A Third Party Administrator (commonly referred to as TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care
service provider. A TPA provides the insurance company with a variety of services like networking with hospitals, arranging for cashless hospitalization as
well as claims processing & timely settlement.
What is Cashless Hospitalization?
In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle
the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the Third-Party Administrator (TPA) on behalf of the
health insurer. This is for your convenience.
Can I buy more that one Health Insurance policy?
Yes, you can have more than one Health Insurance policy. In case of a claim, each company will pay proportion of the loss.
What are the factors which determine the premium payable for health insurance?
Under health insurance, the age and the amount of cover are the factors that decide the premium. Usually, younger people are considered healthier and thus
pay lower annual premium. Older, people pay a higher health insurance premium as their risk of health problems or illness is higher.
Is Mediclaim the same as health insurance?
Yes, it is the same.
What do you mean by coverage amount? Is there is a minimum or maximum limit?
Coverage amount is the extent to which the insurance company will reimburse you for the medical expenses incurred by you. Usually, Mediclaim policies start
with a low coverage amount of Rs 25,000 and go to a maximum of Rs 5,00,000. (There are also high value insurance policies especially for critical illness
available from some providers)
HDFC ERGO Health Insurance Benefits & Coverage
Health Insurance Benefits
Save tax under sec 80D of Income Tax Act.
Get pre and post hospitalization coverage of expenses
Cashless facility across various network hospitals
What does Health Insurance not cover?
Pre-existing condition(s) as defined in the policy and declared by Insured during policy purchase will be covered only after few years from the
time of inception.
Diseases contracted by the Insured persons within 30 days
Diseases such as Congenital Internal Disease, Stone in urinary and biliary systems, Migrane/Vascular headaches etc., are not covered during
first few year of insurance.
Diseases such as Cataract, Benign Prostatic Hypertrophy, Knee/Hip Replacement, Heart Disease, Chronic Renal Failure/ End Stage Renal Failure
etc., are not covered during first couple years of insurance.
You must read the policy exclusions & the limitations in various covers properly before buying a Health Insurance plan because you should know what all covers your policy include & exclude.
HDFC ERGO Health Insurance Claim Process
What is the Claim Process?
You should walk into a network hospital & get the treatment done & the bills paid through the Health Card. In case of hospitalization you need to give the
card number to the network hospital, you must pre-authorize from the TPA (Intermediary between the Insurance Company & the hospital) & will process the
cashless settlement after the verification of your policy details. You should know the formalities required for cashless settlement as some insurance
companies are required to be notified 48 hours before hospitalization.
If you don’t opt for cashless settlement, you need to settle bills at the hospital and get them reimbursed later.
Health Insurance Articles
IRDA’s health insurance guidelines – a review Insurance Regulatory and Development Authority (IRDA), the watchdog of insurance industry, has taken many policy initiatives in recent past which have potential to impact the insurers as well as insured. Not only these guidelines help the policy holders but they will also improve the transparency of agreement between policy holders and insurance providers. Health insurance was in news for last couple of years for all the bad reasons.
Why health insurance? The most neglected is health insurance. Most often this tax saving instrument is brushed aside with the logic that after all it’s an expense (no monetary gains) and well we all save for the “rainy day”. So why incur an additional expense? The moot point – Is it truly an additional expense? It’s soon going to be time for filing income tax returns.
Health insurance plans – new types for tax benefits! Health insurance plans get benefit under section 80D in the form of deduction from taxable income upto Rs.15,000/- for non-senior citizens and upto Rs.20,000/- if senior citizens are covered. But many a times for a normal household with parents under the age of 45 and 2 children, the premiums may not come upto the levels at which one can maximise the Section 80D benefits.
Employer sponsored health cover. Is it enough? One very important aspect we need to understand is that after the age of 45 no insurance company will provide a health policy without medical check examination. Once the medicals are done and the individual is prone to even 0.001% of any disease, that particular ailment will be excluded from the policy and he/she cannot claim the expense.