Health Insurance is a crucial financial tool that covers a range of medical expenses and treatment. It protects you and your family against high medical costs, ensuring access to necessary medical care when you need it.
Buying Health Insurance is a simple proposition: you pay a small premium to an insurance company, which then makes good any costs that arise if you get hospitalised subject to the maximum promised and the conditions outlined in the policy.
Also read: What is a Health Insurance Policy?
Benefits of Health Insurance cover
In an age where medical costs are soaring, Health Insurance coverage is a no-brainer. Here are a few reasons why:Financial protection
A Health Insurance policy helps you cope with the financial burden of hospitalisation. When insured, your policy covers all planned and unplanned hospitalisation expenses and other related costs.Access to quality healthcare
The hospital network under your Health Insurance plan ensures you can select the best hospital and access timely and quality medical care. It includes access to specialists, diagnostic tests, and specialised treatments that may be expensive or inaccessible.Tax friendliness
Any amount you pay as Health Insurance premium is tax deductible. If your annual salary is ₹ 9.5 lakhs, and you pay ₹ 50,000 as a premium, your taxable salary will be ₹ 9 lakhs.The maximum deduction limit is up to ₹ 25,000 per year if you are below 60 years of age. If you are above 60 years, the limit increases to ₹ 50,000. You can even claim additional deductions of up to ₹ 25,000 if you pay premiums for your parents below 60. If your parents are above 60, the limit increases to ₹ 50,000.
OPD treatment
Some Health Insurance plans cover outpatient department (OPD) treatment, including fees for doctor's consultations, follow-ups, and prescribed medications. However, this benefit may require an additional premium.Free annual check-ups
Complimentary annual check-ups provided by many Health Insurance plans allow you to access health assessments, preventive screenings, and diagnostic tests every year and help you in the early detection of potential health issues.Preventive care and wellness
Many Health Insurance plans cover preventive services such as vaccinations, health screenings, and wellness programs. The measures promote early detection and prevention of illnesses, leading to better health outcomes and reduced medical costs in the long run.Family coverage
Health coverage often provides options for family coverage, ensuring your loved ones are protected. It includes coverage for your spouse, children, and dependents, providing comprehensive medical benefits for your family.Peace of mind:
Health Insurance offers peace of mind, knowing you have protection against unforeseen medical emergencies. It allows you to focus on your health and well-being without stressing over the financial consequences of medical treatments.Read the terms of your plan thoroughly to understand the benefits of Health Insurance. It offers essential benefits that help you manage medical expenses and access quality care, making it indispensable coverage against rising medical expenses. Overall, Health Insurance is a vital tool that provides financial security and access to quality treatment and promotes preventive measures, ensuring you and your family can prioritise your health and well-being.
What are the common inclusions in a Health Insurance Policy?
Hospitalisation expenses
Health Insurance typically covers expenses related to your hospitalisation, including room charges, nursing charges, doctor's fees, surgical procedures, anaesthesia, and operation theatre charges.Pre-and post-hospitalisation expenses
Many policies cover medical expenses incurred before and after hospitalisation, including diagnostic tests, medications, follow-up consultations, and rehabilitation services.Daycare procedures
Health Insurance often includes coverage for specific daycare procedures that don't require 24-hour hospitalisation, such as cataract surgery, chemotherapy, dialysis, and certain surgeries.Ambulance charges
Some policies cover road ambulance services, including transportation to the hospital in emergencies.Pre-existing conditions (during the waiting period)
Your policy may cover pre-existing conditions, but they may have a waiting period before the coverage becomes effective.Maternity benefits
Certain Health Insurance plans offer maternity coverage, including expenses related to prenatal care, delivery, and postnatal care. However, the benefits may have waiting periods and specific limitations.Also read: Health Insurance Cancellation Policy - All You Need To Know
What are the common exclusions in Health Insurance policy?
Cosmetic Procedures
Health Insurance rarely covers cosmetic procedures or surgeries done specifically for aesthetic purposes.Experimental and unproven treatments
Treatments considered experimental or not medically proven are not covered.Non-medical expenses
Expenses that are not directly related to medical treatment, such as personal comfort items, telephone charges, and television fees, are usually not covered.Certain high-cost medications
Some high-cost medications, such as drugs for lifestyle enhancement or non-life-threatening conditions, may be excluded from coverage.Self-inflicted injuries
Injuries resulting from self-inflicted harm or attempted suicide are not covered.It is important to review your Health Insurance policy's specific terms and conditions to understand the inclusions, exclusions, waiting periods, and coverage limitations.
Other Health Insurance cover features you must consider
Health Insurance policies in India are evolving to cater to your individual needs, providing customised coverage options. Regardless of your age, health status, or marital status, knowing about the benefits of health insurance available for everyone is essential.Riders
Health Insurance companies offer various riders such as Critical Illness coverage, accident cover, and maternity cover. While the riders increase the policy premium, they expand your coverage and provide additional benefits.No Claim Bonus
One of the best benefits of being insured is the no-claim bonus, which rewards you with a discount on your premium for every claim-free year. It incentivises maintaining good health and avoiding unnecessary claims.Lifetime renewability
Your insurance company offers policy renewability throughout your lifetime with no age restrictions. Paying the premiums on time and ensuring the timely renewal of your Health Insurance policy is essential.Restoring sum assured
Insurance companies can restore your coverage amount when you have utilised the entire sum assured for medical treatment. It is essential to understand the policy terms regarding coverage restoration.Benefits on deductibles
Deductibles are the amount a policyholder pays before the insurance provider covers the claim. They may include individual and family deductibles in the plan. Look for benefits in your health insurance plan that do not require payment of deductibles, such as coverage for doctor's visits.Daycare treatment
Domiciliary hospitalisation refers to receiving medical treatment at home under medical advice and supervision. It is applicable when a hospital room is unavailable or due to the patient's weak condition. Familiarise yourself with the ailments covered, the limitations of availing of the medical insurance benefit, and other policy terms related to home treatment.Daily cash allowance
In case of hospitalisation of you or your family member, the insurance company may offer a daily cash allowance to cover expenses like food and hospital visits. The insurer determines the allowance duration, which is not applicable after hospital discharge.Attendant allowance
Some insurance companies may offer a provision for covering the expenses of an attendant or a person responsible for taking care of you. It provides an allowance to cover your attendant's expenses, including food and refreshments.How to choose the right Health Insurance plan
- Assess your healthcare needs and medical history
- Compare coverage, benefits, and network hospitals of different policies
- Choose an adequate sum insured and consider waiting periods
- Check for co-payment and sub-limits
- Compare premiums and claim settlement ratio
- Read customer reviews for customer service feedback
- Understand policy exclusions and limitations
- Consider add-on riders for enhanced coverage
Documents needed when buying a Health Insurance plan
- Government-issued photo ID, such as an Aadhaar card, passport, voter ID, or driving license, for identity proof and address.
- Usually, two recent passport-sized photographs are required.
- Birth certificate, school leaving certificate, passport, or any government-issued document that mentions your date of birth.
- Permanent Account Number (PAN) card is required for tax purposes, as insurance premiums are eligible for tax benefits under Section 80D.
- Medical reports may be required for underwriting purposes, especially for senior citizens or those with pre-existing conditions, medical reports may be required for underwriting purposes.
- You need to fill out the proposal form provided by the insurance company when opting for Health Insurance.
- In certain cases, the insurance company may require income proof to assess your eligibility, especially for high-sum insured amounts.
- Provide your bank account details for premium payments and claim settlements through electronic transfers.
- You may also be required to mention details of the nominee who will receive the policy benefits in case of your unfortunate demise.
Also Read: Can I Port My Health Insurance Policy?
Health Insurance claim process
- Inform the insurance company about the hospitalisation or medical treatment for which you seek coverage.
- You may need to show your Health Insurance Card or policy details at a network hospital to avail cashless claim facility.
- Fill out the claim form provided by your insurer and attach all the relevant documents.
- Submit the claim form to your insurer within the specified time frame.
- The insurance company will review your claim application and the supporting documents.
- Once the claim is processed and approved, the insurance company will settle the claim amount. The insurer will pay the hospital if it's a cashless claim. You will receive the approved claim amount in their bank account with reimbursement.
- You can contact the insurance company's grievance redressal cell if there are any disputes or issues regarding the claim settlement. If the matter does not get resolved, you can escalate it to the Insurance Ombudsman or seek legal recourse.
Also Read: Learn Why Health Insurance Claims Get Denied
Key Takeaway
- Health Insurance protects against high medical costs and unexpected medical expenses, reducing the burden on you and your family.
- Health Insurance ensures access to a network of hospitals, enabling you to receive timely and quality medical care, including specialists, diagnostic tests, and treatments.
- Many Health Insurance plans cover preventive services and wellness programs, promoting early detection, preventive care, and overall well-being.
- Having Health Insurance offers peace of mind, knowing that you are protected against unforeseen medical emergencies and can focus on your health without worrying about financial implications.
- One benefit of having Health Insurance is family coverage, extending protection to your loved ones and ensuring comprehensive medical benefits for your family.
- Health Insurance may offer tax advantages, allowing you to claim deductions on premiums paid, reducing your overall tax liability.
- You need to understand the exclusions and limitations of coverage, including specific treatments, pre-existing conditions, and non-medical expenses, to make informed decisions about your Health Insurance plan.
FAQs – Frequently Asked Questions
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What are additional benefits of Health Insurance ?
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What is the importance of Health Insurance in our life ?
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Is it necessary to have Health Insurance ?
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What benefits will not be covered under Health Insurance ?
DISCLAIMER
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
About Aditya Birla Capital
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MoneyForLife Planner
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Financial Solutions
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Compliance with the Law
You agree that you will not:
- Use any robot, spider, scraper, deep link or other similar automated data gathering or extraction tools, programme, algorithm or methodology to access, acquire, copy or monitor the Website, or any portion of the Website.
- Use or attempt to use any engine, software, tool, agent, or other device or mechanism (including without limitation, browsers, spiders, robots, avatars or intelligent agents) to navigate or search the Website, other than the search engines generally available by third party web browsers
- Post or transmit any file which contains viruses, worms, Trojan horses or any other contaminating or destructive features, or that otherwise interferes with the proper working of the Website or the facilities.
- Attempt to decipher, decompile, disassemble, or reverse engineer any of the software, comprising or in any way making up a part of the Website or the facilities.
- You agree not to use the facilities for illegal purposes or for the transmission of material that is unlawful, harassing, libelous (untrue and damaging to others), invasive of another's privacy, abusive, threatening, or obscene, or that infringes the rights of others.
Restrictions on Commercial Use or Resale
Your right to use the facilities is personal to you; therefore, you agree not to resell or make any commercial use of the facilities. In addition, the Website welcomes your feedback as a user of the facilities. Any feedback you provide will become the confidential and proprietary information of the Website, and you agree that the Website may use in any manner and without limitation, all comments, suggestions, complaints, and other feedback you provide relating to the Website. The Website shall have a worldwide, royalty-free, non-exclusive, perpetual, and irrevocable right to use feedback for any purpose, including but not limited to incorporation of such feedback into the Website or other Website software or facilities.
No Endorsements
All product and facilities marks contained on or associated with the facilities that are not the Website marks are the trademarks of their respective owners. The Website would require you to respect the same. References to any such names, marks, products or facilities of third parties or hypertext links to third party sites or information does not imply the Website’s endorsement, sponsorship or recommendation of the third party, information, product or facilities.
Promotional Offers
You may receive from time to time, announcement about offers with intent to promote this Website and/or facilities/products of ABC Companies (“Promotional Offers”). The Promotional Offer(s) would always be governed by these Terms of Use plus certain additional terms and conditions, if any prescribed. The said additional terms and conditions, if prescribed, would be specific to the corresponding Promotional Offer only and shall prevail over these Terms of Use, to the extent they may be in conflict with these Terms of Use. The Website reserves the right to withdraw, discontinue, modify, extend and suspend the Promotional Offer(s) and the terms governing it, at its sole discretion.
Charges for use of Website
There are no charges or fees to be paid by you for use of this Website. However, you are responsible for all telephone access fees and/or internet service fees that may be assessed by your telephone and/or internet service provider. You further agree to pay additional charges, if any levied by Third Party Service Provider(s), for the facilities provided by them through the Website (Additional Charges).
No Endorsement
You are advised to be cautious when browsing on the internet and to use good judgment and discretion when obtaining information or transmitting information. From this Website, users may visit or be directed to third party web sites. The Website makes no effort to review the content of these web sites, nor is the Website or its licensors responsible for the validity, legality, copyright compliance, or decency of the content contained in these sites.
In addition, the Website does not endorse or control the content of any other user and is not responsible or liable for any content, even though it could be unlawful, harassing, libelous, privacy invading, abusive, threatening, harmful, vulgar, obscene or otherwise objectionable, or that it infringes or may infringe upon the intellectual property or other rights of another. You acknowledge that the Website does not pre-screen content, but that the Website will have the right (but not the obligation) in their sole discretion to refuse, edit, move or remove any content that is available via the facilities.
Electronic Communications
These Terms of Use and any notices or other communications regarding the Facilities may be provided to you electronically, and you agree to receive communications from the Website in electronic form. Electronic communications may be posted on the Website and/or delivered to your registered email address, mobile phones etc either by Facilities Provider or ABC Companies with whom the services are availed. All communications in electronic format will be considered to be in "writing". Your consent to receive communications electronically is valid until you revoke your consent by notifying of your decision to do so. If you revoke your consent to receive communications electronically, the Facilities Provider shall have the right to terminate the facilities.
Assignment
You shall not assign your rights and obligations under this Agreement to any other party. The Website may assign or delegate its rights and/or obligations under this Agreement to any other party in future, directly or indirectly, or to an affiliated or group company.
Legal Disclaimers
The information provided on or through the Website is for general guidance and information purposes only and they do not in any manner indicate any assurance or opinion of any manner whatsoever. Any information may be prone to shortcomings, defects or inaccuracies due to technical reasons. Certain information on Website may be on the basis of our own appraisal of the applicable facts, law and regulations in force at the date hereof.
The information (and opinions, if any) contained on the Website may have been obtained from public sources believed to be reliable and numerous factors may affect the information provided, which may or may not have been taken into account. The information provided may therefore vary (significantly) from information obtained from other sources or other market participants. Any reference to past performance in the information should not be taken as an indication of future performance. The information is dependent on various assumptions, individual preferences and other factors and thus, results or analyses cannot be construed to be entirely accurate and may not be suitable for all categories of users. Hence, they should not be solely relied on when making investment decisions. Your investment or financial decision shall always be at your own discretion and based on your independent research; and nothing contained on the Website or in any information would construe ABCL/ABC Companies or any of its employees/authorized representative as having been in any way involved in your decision making process. Any information and commentaries provided on the Website are not meant to be an endorsement or offering of any stock or investment advice.
Nothing contained herein is to be construed as a recommendation to use any product, process, equipment or formulation, in conflict with any patent, or otherwise and Facilities Provider / ABCL/ABC Companies makes no representation or warranty, express or implied that, the use thereof will not infringe any patent, or otherwise. Information on this Website sourced from experts or third party service providers, which may also include reference to any ABCL Affiliate. However, any such information shall not be construed to represent that they belong or represent or are endorsed by the views of the Facilities Provider or ABC Companies. Any information provided or sourced from ABCL Affiliate belongs to them. ABCL is an independent entity and such information from any ABCL Affiliate are not in any manner intended or to be construed as being endorsed by ABCL or Facilities Provider. The information does not constitute investment or financial advice or advice to buy or sell, or to endorse or solicitation to buy or sell any securities or other financial instrument for any reason whatsoever. Nothing on the Website or information is intended to constitute legal, tax or investment advice, or an opinion regarding the appropriateness of any investment or a solicitation of any type. Investment in the securities market and any financial instruments are inherently risky and you shall always assume complete and full responsibility for the outcomes of all the financial or investment decisions that you make, including but not limited to loss of capital. You are therefore advised to obtain your own applicable legal, accounting, tax or other professional advice or facilities before taking or considering an investment or financial decision.
No Solicitation
No Information at this Website shall constitute an invitation to invest in ABCL or any ABC Companies. These are meant for general information only or to meet statutory requirements or disclosures. ABCL or any of its employees are in no way liable for the use of the information by you, when making any decision or investing or trading through any investment vehicles or ABC Companies, or any other third party which may be engaged in offering of these services.
The information contained on this Website does not represent and should not be used to construe (i) the terms on which a new transaction would be entered into by ABCL or ABC Companies, (ii) the terms on which any existing transactions could be unwound by ABCL or ABC Companies, (iii) the calculation or estimate of an amount that would be payable following an early termination of any past/existing transactions or (iv) the valuations given to any transactions by ABCL or ABC Companies in their books of account for financial reporting, credit or risk management purposes.
Statutory Disclosure
ABCL and ABC Companies are engaged in a broad spectrum of activities in the financial services sectors. You understand and acknowledge that Aditya Birla Money Limited (‘ABML’), Aditya Birla Finance Limited (‘ABFL’) and Aditya Birla Sun Life Asset Management Company Limited and trustees and sponsor of Aditya Birla Sun Life Mutual Fund (‘ABSLMF’) are group companies and ABML / ABFL also acts as a distributor of ABSLMF. Any recommendation or reference of schemes of ABSLMF if any made or referred on the Website, the same is based on the standard evaluation and selection process, which would apply uniformly for all mutual fund schemes. You are free to choose the execution facilities in the manner deemed fit and proper and no commission will be paid by ABSLMF to ABML / ABFL if you choose to execute a transaction with ABSLMF on the Website, unless otherwise agreed by you and ABML/ABFL separately. Information about ABML/ABFL, its businesses and the details of commission structure receivable from asset management companies to ABML/ABFL, are also available on their respective Website.
Similarly Aditya Birla Money Insurance Advisory Services Limited and Aditya Birla Insurance Brokers Limited are insurance intermediaries and engaged in the distribution of Insurance Products and it may services may include products of Aditya Birla Sun Life Insurance Company Limited and Aditya Birla Health Insurance Company Limited. However there is no conflict on these services and commissions if any payable are in accordance of the extant regulations.
Force Majeure
The Facilities Provider, ABC Companies and any of its Third Party Service Providers shall not be liable for any delay or failure in performance resulting directly or indirectly from acts of nature, forces, or causes beyond their reasonable control, including, without limitation, Internet failures, computer equipment failures, telecommunication equipment failures, other equipment failures, electrical power failures, strikes, virus, other malicious computer code, hacking, labour disputes, riots, insurrections, civil disturbances, shortages of labour or materials, fires, flood, storms, explosions, acts of God, war, earthquake, governmental actions, orders of domestic or foreign courts or tribunals, non-performance of third parties, or loss of or fluctuations in heat, light, or air conditioning.
Indemnification
You agree to protect and fully compensate Facilities Provider, ABCL, ABC Companies, subsidiaries, licensors, suppliers and facilities providers, employees, officers and directors, from any and all third party claims, liability, damages, expenses and costs (including but not limited to reasonable attorneys fees) caused by or arising from your use of the facilities, your violation of the Terms of Use or your infringement, or infringement by any other user of your account, of any intellectual property or other right of anyone.
No Waiver
The Facilities Provider, ABC Companies or any of its third party service providers and processor bank/merchants etc. shall not be deemed to have waived any of its/their rights or remedies hereunder, unless such waiver is in writing. No delay or omission on the part of Facilities Providers and ABC Companies, in exercising any rights or remedies shall operate as a waiver of such rights or remedies or any other rights or remedies. A waiver on any one occasion shall not be construed as a bar or waiver of any rights or remedies on future occasions.
Exclusive Agreement
You agree that these Terms of Use are the complete and exclusive statement of agreement supersede any proposal or prior agreement, oral or written, and any other communications between you and the Facilities Provider and its Third Party Service Providers or processor bank/merchants relating to the subject matter of these Terms of Use. These Terms of Use, as the same may be amended from time to time, will prevail over any subsequent oral communications between you and the Website and/or the processor bank.
Termination
Either party can terminate this Agreement by notifying the other party in writing. Upon such termination You will not be able to use the facilities of this Website.
Governing Law and Jurisdiction
The Website specifically prohibits you from usage of any of its facilities in any countries or jurisdictions that do not corroborate to all stipulations of these Terms of Use. The Website is specifically for users in the territory of India. In case of any dispute, either judicial or quasi-judicial, the same will be subject to the laws of India, with the courts in Mumbai having exclusive jurisdiction.
These Terms and Conditions are governed by and to be interpreted in accordance with laws of India, without regard to the choice or conflicts of law provisions of any jurisdiction. You agree, in the event of any dispute arising in relation to these Terms and Conditions or any dispute arising in relation to the Website whether in contract or tort or otherwise, to submit to the jurisdiction of the courts located at Mumbai, India for the resolution of all such disputes.