It is said that “Health is wealth”. With chaotic and hectic schedules, working up to late hours, increase in pollution, food contamination and fast-paced lifestyles among others, health has become a major concern like never before. As the overall life expectancy has increased in India, courtesy to advanced medical facilities, the number of diseases adversely affecting the people have also been on the rise in the past decade or so. While the causes for a decline in the overall standard of health may be varied and debatable, there’s no denying the need for Health insurance across various age groups. With medical inflation, many citizens are increasingly turning to health insurance policies to avoid huge medical bills during emergencies.
What is the best Time to Buy Health Insurance Policy?:
Time and tide wait for no one, goes the old adage. The right time to buy a health insurance policy is the moment you realize that your health costs may only escalate in the future owing to the overall rise in the cost of living among other factors. The sooner you realize this, the better it is for you. In other words, you should buy a health insurance policy at a young age to avail of many benefits with lesser premium.
Family Health Plan Coverage.
Family Health plan also known as FLOATER Health policy which covers the whole family comprising of self, spouse, children, parents under a single Fixed sum Insured by paying a single premium.
a. This policy covers persons in the age group 91 days onwards.
b. Children below 5 years would be covered provided both the parents are covered under policy.
c. The policy offers option on covering on individual sum insured basis and on family floater basis.
d. This policy can be issued to an individual and/or family.
e. The family includes spouse, dependent children and dependent parents.
Salient Features & Benefits
a. In-patient Treatment – covers hospitalisation expenses due to an illness or accident. Insurance Company will pay for the medical expenses for Room rent, boarding expenses, Nursing, Intensive care unit, Medical Practitioner, Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, Medicines, drugs and consumables, Diagnostic procedures, Cost of prosthetic & other devices or equipment if implanted internally during a Surgical Procedure.
b. Pre- Hospitalisation - The Medical Expenses incurred due to an Illness in 30 days immediately before the Insured Person was hospitalized.
c. Post-Hospitalisation - The Medical Expenses incurred in 60days immediately after the Insured Person was discharged post Hospitalisation.
d. Day care procedures – The Medical expenses for various Day care procedures which do not require 24 hours hospitalization due to technological advancement.
e. Domiciliary Treatment- The Medical Expenses incurred by an Insured Person for availing medical treatment at his home which would otherwise have required Hospitalisation.
Optional Benefits (Available in selective Plans on additional premium payment)
a. New-born baby – Coverage for new-born from birth.
b. Maternity Expenses – Medical Expenses for maternity including pre-natal and post-natal expenses after a waiting period of 4 years.
c. Opinion in respect of a Critical Illness.
d. Convalescence Benefit- Lump-sum payment of 1% of the sum insured up to a maximum of Rs. 10,000 in an event of hospitalisation exceeding 10 continuous and completed days.
e. Critical Illness –.Insurance Company will pay the Insured person the sum insured as a lump-sum amount for the identified 11 critical illness subject to same have been diagnosed during the Policy Period and the Insured survives 30 days after the diagnosis.
f. Hospital Daily Cash – Daily allowance for the each and every continuous and consecutive 24 hours as an inpatient hospitalisation. Maximum up to 30/60 days. If mentioned in the policy schedule this benefit will be applicable to the eldest member of the family.
g. Regain Benefit –Automatic availability of the basic sum insured, if the basic sum insured inclusive of the no claim bonus has been exhausted during the policy year. Basic sum insured will be re-instated only once in a policy year. Regain sum insured can be used for only future claims made by the Insured Person and not against any claim for an illness/disease (including its complications) for which a claim has been paid in the current policy year. If the Regain sum insured is not utilised in a policy year, it shall not be carried forward to any subsequent policy year. The Regain benefit is applicable on sum insured of Rs. 3 lacs and above. The insured can choose either Regain benefit or Co-pay Option and not both. Once the Regain benefit is availed, it cannot be withdrawn by the Insured at subsequent renewals.
h. Enhanced Cumulative Bonus- The cumulative bonus shall automatically increase to 10% and the maximum cumulative bonus shall not exceed 100% of Base Sum Insured. Cumulative bonus thus applied would automatically decrease by 10% of the Basic Sum Insured in that following Policy Year in case of a claim. Once the enhanced cumulative bonus benefit is availed, it cannot be withdrawn by the Insured at subsequent renewals
All claims payable will be subject to the waiting periods specified below except if any Insured Person suffers an Accident:
i. General waiting period for first policy of 30 days for all claims payable under the Policy. This is not applicable for renewal of the Policy.
ii. 48 months waiting period for all Pre-existing Conditions declared and/or accepted at the time of application. Pre-existing Condition means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer
I. War or any act of war, invasion, act of foreign enemy,
II. Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self -injury or attempted suicide or suicide while sane or insane.
III. Any Insured Person's participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing in a professional or semi-professional nature.
IV. The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.
V. Treatment of Obesity and any weight control program.
VI. Psychiatric, mental disorders (including mental health treatments) and, sleepapnoea, Parkinson and Alzheimer's disease, general debility or exhaustion (“run-down condition”);
VII. Congenital external diseases, defects or anomalies, genetic disorders.
VIII. Stem cell implantation or surgery, or growth hormone therapy. Venereal disease, sexually transmitted disease or illness; “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human immunodeficiency virus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS related complex), Lymphomas in brain, Kaposi's sarcoma, tuberculosis.
IX. Save as and to the extent provided for under Maternity Benefit, pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth (including caesarean section) except in the case of ectopic pregnancy in relation to a claim under In-Patient Treatment for in-patient treatment only.
X. Sterility, treatment whether to effect or to treat infertility, any fertility, sub-fertility or assisted conception procedure, surrogate or vicarious pregnancy, birth control, contraceptive supplies or services including complications arising due to supplying services.
XI. Save as and to the extent provided for under Outpatient Dental Treatment Benefit, dental treatment and surgery of any kind, unless requiring Hospitalisation.
XII. Expenses for donor screening, or, save as and to the extent provided for in Organ Donor Benefit, the treatment of the donor (including surgery to remove organs from a donor in the case of transplant surgery). xiii. Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure or for muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities).
XIII. Circumcisions (unless necessitated by illness or injury and forming part of treatment); treatment for correction of eye due to refractive error, aesthetic or change-of-life treatments of any description such as sex transformation operations.
XIV. Expenses for donor screening, or, save as and to the extent provided for in Organ Donor Benefit, the treatment of the donor (including surgery to remove organs from a donor in the case of transplant surgery).
XV. Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure or for muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities).
XVI. Circumcisions (unless necessitated by illness or injury and forming part of treatment); treatment for correction of eye due to refractive error, aesthetic or change-of-life treatments of any description such as sex transformation operations.
XVII. Plastic surgery or cosmetic surgery or treatments to change appearance unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an Accident, cancer or burns.
XVIII. Conditions for which Hospitalisation is NOT required.
XIX. Experimental, investigational or unproven treatment devices and pharmacological regimens.
XX. Admission primarily for diagnostic purposes not related to illness for which Hospitalisation has been done.
XXI. Save as and to the extent provided for under Convalescence Benefit, any Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care.
XXII. Save as and to the extent provided for under AYUSH Benefit, any non-allopathic treatment.
XXIII. Preventive care, vaccination including inoculation and immunisations (except in case of post- bite treatment), any physical, psychiatric or psychological examinations or testing; enteral feedings (infusion formulas via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements, unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
XXIV. Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for admission, discharge, administration, registration, documentation and filing.
XXV. Items of personal comfort and convenience including but not limited to television (wherever specifically charged for), charges for access to telephone and telephone calls (wherever specifically charged for), food stuffs (except patient`s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service as well as similar incidental services and supplies, and vitamins and tonic sunless vitamins and tonics are certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
XXVI. Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed; treatments rendered by a Medical Practitioner who is a member of an Insured Person's family, or stays with him, however proven material costs are eligible for reimbursement in accordance with the applicable cover.
XXVII. Save as and to the extent provided in Spectacles, Contact Lenses, Hearing Aid benefit, the provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.
XXVIII. Any treatment or part of a treatment that is not of a reasonable cost, not medically necessary; treatments or drugs not supported by a prescription.
XXIX. Artificial limbs, crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively).
XXX. Any specific time bound or lifetime exclusion(s) applied by Us and specified in the Schedule and accepted by the insured, as per our underwriting guidelines.
XXXI. Any non-medical expenses mentioned in the policy document.
If you are insured continuously and without interruption under a plan issued by an Indian general insurer and you want to shift to any other Insurance Company on renewal of Health policy then there will be transfer of accrued benefits and make due allowances for waiting period etc., as per regulations & guidelines on portability issued by IRDA. If the insured person transfers from any other insurer and enhances coverage, then the portability benefits will be offered only in respect of the previous sum Insured.
Terms of renewal
a. Some companies offer renewal up to 65 years and some offer Lifelong Renewal unless the Insured Person or any one acting on behalf of an Insured Person has acted in an improper, dishonest or fraudulent manner or any misrepresentation under or in relation to this policy or the Policy poses a moral hazard.
b. Grace Period - Grace Period of 30 days for renewing the Policy is provided under the Policy.
c. Maximum Age – different insurance company has different maximum age and cover ceasing age in the policy. For Additional benefit of Critical Illness and Hospital Daily Cash will be provided with a life-long renewability or as per the terms of the policy.
d. Waiting Period - The Waiting Periods mentioned in the policy wording will get reduced by 1 year on every continuous renewal of your Health Insurance Policy.
e. Renewal Premium – Renewal premium are subject to change with prior approval from IRDA. Any change in benefits or premium (other than due to change in Age) will be done with the approval of the Insurance Regulatory and Development Authority and will be intimated at least 3 months in advance.
f. In the likelihood of this policy being withdrawn in future, intimation will be sent to insured person about the same 3 months prior to expiry of the policy. Insured Person will have the option to migrate to any health insurance policy available with existing Insurance Company at the time of renewal with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period etc. provided the policy has been maintained without a break as per portability guidelines issued by IRDA.
g. Sum Insured Enhancement –The Sum Insured can be enhanced only at the time of renewal subject to no claim have been lodged/ paid under the policy. The increase in sum insured is allowed subject to underwriting acceptance. In case of increase in the Sum Insured waiting period will apply afresh in relation to the amount by which the Sum Insured has been enhanced.
h. Any Insured Person in the policy has the option to migrate to any health insurance policy available with existing insurance company at the time of renewal subject to underwriting with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period etc. provided the policy has been maintained without a break as per portability guidelines issued by IRDA.
The premium amount paid under this policy qualifies for deduction under Section 80D of the Income Tax Act.
Key Points to Remember when Comparing Health Insurance
Sum Insured by the policy
Premium to be paid for the coverage
List of network hospitals and Claim Settlement Ratio
Sub-limits (if any) and Waiting Period (for PEDs)