#Health Insurance in India and Career Opportunities 31 January 2019


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Health Insurance in India and Career Opportunities: People generally invest in Health insurance Generally to claim the future medical expenses of a person. If someone takes a health insurance plan the insured expects a certain amount of medical expense to be there in future which help him to pay his medical bills. The main motto of a health insurance plan is to safeguard that the person should have enough money to take care of their emergency medical requirements when they get old.

Mainly the general health insurance policy does not always cover the entire health problem, but someone might encounter in the future. There are some terms and conditions accepted by the insured, and the insurer and the entire procedure happens according to the contract signed.

Health Insurance in India and Career Opportunities

The appropriate time to take health insurance

According to experts the best time to get a health insurance plan is when the insured is in a good physical condition.
The general logic among young people is that since they are rarely distressed by physical disorders they do not need such a plan.

In reality, people fall prey to a disease or other physical problem at any point of time – nobody can predict the life fully free of such issues. As people get older the problems increase and the possibilities of some major disease are always there.

Health Insurance & its Types

There are two types of health insurance plans in India  – Critical illness insurance and Medical insurance.

Medical insurance: This insurance provides hospitalization cover and pays back medical costs that have been there for paying for diseases or surgery when the insured was admitted to a healthcare facility.

We have listed some of the forms of medical insurance as follows:

  • Individual medical insurance
  • Overseas medical insurance
  • Group medical insurance

There are some health policies which pay actual expenses of hospitalization for all diseases – these programs are mainly provided by nonlife insurance providers and are normally called Mediclaim policies.

The accidental insurance policies secure a person against the risk of any form of accident. There are some health insurance providers such as Apollo Munich who provide medical accident insurance facilities too. Besides this, there are many other insurance providers that provide accidental insurance policies. we have listed some of them as follows:

  • Royal Sundaram
  • HDFC Ergo
  • ICICI Lombard

Critical illness insurance: this type of health insurance provides cover for the treatment of major ailments. With this type of program, the insured can be sure that he or she will be receiving a prefixed amount in case the individual is diagnosed with a critical illness that comes under initial agreement.

Under these plans, the payment is done within a few days of the diagnosis and once the payment is done the policy is no longer in operation. Under normal conditions these plans cover the following:

  • Aorta graft surgery
  • Significant organ transplant
  • Cancer
  • Multiple sclerosis
  • Coronary artery bypass surgery
  • Paralysis
  • First heart attack
  • Primary pulmonary arterial hypertension
  • Kidney failure
  • Stroke

How to file health insurance claims?

We have listed some of the important documents necessary to claim the insurance policy.

  • Properly filled and signed the claim form
  • Reports and receipts of diagnostic tests accompanied by doctor’s notes
  • Discharge certificate of the hospital
  • Collected Receipts and bills from consultants, professional with diagnosis certificate
  • Disease-related documents right from the time when the disease was known – this will consist of consultations with the physician and the insured’s medical history and reports
  • Doctor’s certificate that specifies the complete recovery of the insured
  • Bills and receipts from the health care ease – this needs to be backed up with proper prescriptions
  • Providing previous policies’ details to the third party admin

If the hospitalization is not planned the processes mentioned below have to be stuck to:

  • The TPA has to be informed that claim form has to be collected and filled up properly as early as possible.
  • The claim form along with necessary documents has to be submitted within seven days of the insured’s recovery
  • Obtain all the treatment-related documents from the hospital once treatment is completed
  • Bills have to be paid by the insured initially – the insurance company will only compensate them
  • The policy document has to be read thoroughly to understand which costs are included

There is a probability that the claim may be rejected if the disease is not covered by the plan. In such conditions, the claimant needs to send a letter to the organization within 15 days to file a complaint. If the payment is not done the claimant needs to contact the TPA and find out the reasons for the same. In the majority of such cases, it has been seen that if additional papers are provided the remainder of the claim is settled.

Health Insurance Policy Benefits

The major advantages of a health insurance policy are as follows:

  • Helps to  safeguard the future through premiums
  • Assistant in Payment for medical and hospitalization bills
  • Saves huge future financial losses due to expensive medical and post-treatment expenses
  • Protective and disability bills
  • Enforce a sense of security
  • Helps in Tax benefits as per Indian Income Tax Act’s Section eighty D
  • Greater financial security
  • These policies can even be availed after crossing sixty years

How to Choose a Health Insurance Policy?

There are different modes to judge the viability of insurance policy we have listed some of them as follows:

  • Compare features and prices before accepting a policy is important. Aggregate sites can be used for this purpose.
  • For brokers, it is suggested to get their license numbers and verify the details from the IRDA website. Hence the brokers operate independently they will offer the best advice instead of preferring a particular company as is done by the agents.
  • For families, it is better to avail a family floater policy, which is cheap and provides better coverage for every family member. It also provides a family member to use any part of the policy – this facility comes in handy as the instances of an entire family falling sick are rare.
  • It is advised to provide complete and true information in the declaration form. This will make sure the proper payment of claims Thorough comparison of policy terms – brokers normally provide the best suggestions in this case.
  • It is better to eat healthily and work out Daily. Smoking and drinking should be avoided completely. These will help you to pay your premium on time.
  • It is best to avoid such policy that is cashless arrangements with a nearby hospital or nursing home. It is recommended to go for a policy that provides adequate fulfillment of requirements.
  • If an insured has a disease already it is better to take most care and not think about the insurance while deciding on lifestyle and habits. This will be helpful in the long term.
  • Do detailed research on the hospitals covered by a particular plan and know their respective areas of specialty.

Parameters of a Good Medical Insurance Policy

A health insurance policy must have the following criteria to be observed as a possible option:

  • pay for fees of hospital rooms, surgeons, and doctors
  •  provide basic protection
  • Pay for medicines, medical tests, and relevant expenses
  • The specific health plans must  add crucial ailments like kidney failure and heart attack or cancer and diabetes
  • The critical illness plans must provide tax benefits.

We hope that our article about Health Insurance in India and Career Opportunities will surely help you to get to know about the carrier options and info about the company.


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