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Health Insurance

health insurance

What is Health Insurance?

According to the World Health Organization (WHO), it is expected that chronic and infectious diseases will see a rise by 57%. We all have been witnessing the spread of chronic diseases such as coronavirus, which are expensive in treatment as well. Therefore, it is crucial to have some financial shield against unexpected medical emergencies. 

This is where health insurance plays an important role.

A health insurance plan is a commitment undertaken by the insurance company such that if the insured person is hospitalised for any illness or disease or even injury, then all agreeable expenses would be paid by the insurer. To avail this benefit, the insured would have to pay a price at the beginning of the policy term, called “premium”.

For example, say you have a fixed deposit of INR 2 lakhs in savings and you get coronavirus and need to be hospitalised. You need to undergo treatments the total costs of which amount to INR 3.5 lakhs. Now consider the following scenarios –

Without a Health Insurance PlanWith a Health Insurance Plan of INR 5 lakhs
  1. You might have to withdraw your fixed deposit to pay for the hospital bills up to INR 2 lakhs
     
  2. You would also have to arrange for additional funds to cover the remaining INR 1.5 lakhs
     
  3. You might have to get a loan to cover the total bill for which you would have to incur additional interest cost
  1. Your hospital costs would be covered by the health insurance policy
     
  2. Your fixed deposits would remain safe for the future
     
  3. You would not have to avail a loan for medical bills

What is Covered?

As mentioned in the benefits that health insurance plans offer a wide scope of coverage, here’s a look into the standard coverage benefits which you can find under a standard health insurance plan –

Coverage benefitMeaning
In-patient hospitalisationThe costs incurred on hospitalisation and treatments are covered if you are hospitalised for 24 hours or more
Pre-hospitalisation expensesThe costs incurred before being hospitalised are covered for up to a specific duration which is usually between 30 to 90 days
Post-hospitalisation expensesThe costs incurred after being discharged from the hospital are covered for up to a specific duration which is usually between 60 and 120 days. These costs are incurred for monitoring your recovery after treatments
Daycare treatmentsThose which do not require hospitalisation for 24 hours due to advanced medical techniques. Such treatments are also covered under health insurance plans
Domiciliary hospitalisationIf you are hospitalised at your home its expenses would be covered if such hospitalisation is because of non-availability of hospital beds or because you cannot be shifted to the hospital
Organ donor expensesIn case you undergo an organ transplant surgery, this feature would cover the expenses incurred on harvesting an organ from a donor
Ambulance costsFor hiring an ambulance to transport you to the hospital is covered up to a specific limit
AYUSH treatmentsNon-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy are also covered under many plans
Free health check-upsHealth insurance plans allow you the benefit of monitoring your health through free preventive health check-ups. This facility is allowed once in 1-4 policy years depending on the policy you choose
Sum insured restorationIf you use the sum insured on a previous claim, this feature restores the sum insured to its original amount so that you get complete coverage for subsequent claims which occur within the same policy year
Maternity benefitUnder this benefit the costs associated with pregnancy, childbirth and pre- and post-natal care are covered up to specified limits. Maternity cover is beneficial if you are planning a family
OPD expensesOPD expenses are those which are incurred on an outpatient basis on doctor’s consultations, medicines, diagnostic tests, etc. Many health plans allow coverage for such expenses up to specified limits
No-claim bonusNo-claim bonus (NCB) is a reward for you if you don’t make a claim in a policy year. You are either allowed an increase in the sum insured free of cost or a premium discounts on renewal through no claim bonus

What is Not Covered?

Though health insurance plans allow a comprehensive scope of coverage, there are some medical costs and treatments which are not covered. These are called policy exclusions and some of the most common exclusions include the following –

Pre-Existing IllnessesWhich already exist at the time of buying the plan. Usually, it is either not covered or not covered at least in the initial 2-4 years (waiting period)
Specific IllnessesLike hernia, joint replacement surgeries, fistula, cataract, etc. are not covered within the first one or two years of the policy
Illnesses contracted right after buying the policyIllnesses suffered within the first 30 to 90 days of buying the policy are usually not covered, other than accidental injuries, which is covered from the first day itself
Cosmetic TreatmentWhich are not medically necessary would not be covered
Dental TreatmentOther than resulting from an accident
STDVenereal diseases and sexually transmitted diseases like HIV or AIDS are not covered under health insurance plans
War and allied perilsInjuries or illnesses suffered due to war, mutiny, civil unrest and other similar reasons, including nuclear contamination, would not be covered
Overuse of drugs/alcoholHealth complications due to overuse of intoxicating substances would not be covered
Experimental TreatmentAn unproven and experimental treatment is usually not covered
Other Exclusions
  • Self-inflicted injuries and attempted suicide
  • Participating in hazardous activities or adventure sports
  • Criminal activity
  • Deliberate injuries, etc.
  • Are also not covered under any health insurance plan.

You should know these policy exclusions to know the instances when your claims would not be paid by the insurer.

Health Insurance FAQs
  • Paytm Insurance Broking Private Limited. Address: 136, 1st Floor, Devika Tower, Nehru Place, NEW DELHI, South Delhi, Delhi, India, 110019
  • Registration No. 700. IRDAI Direct Broker Code - IRDA/DB 795/19. Valid till 16/02/2023
  • CIN - U66000DL2019PTC355671