How health insurance plan works in India?
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How health insurance plan works in India

Livewell: Health Insurance & Wellness Blogs | Max Bupa

How health insurance plan works in India?

Max Bupa

30 June 2020

Did you know that in just one year, over 5.5 crore people were driven into poverty in India because of medical bills? In fact, it is one of the biggest reasons for bankruptcy around the world. Even the smallest of health issues can cost you tens of thousands of rupees, and if it ends up being severe, it can set you back by lakhs.

Is there a way around it? Of course, there is - health insurance. Even you must have heard from countless people that having a health insurance plan is a must. So 'How does a health insurance plan actually work in India?' Let's understand that.

 

Understanding health insurance

Health insurance can be best defined as an arrangement between you and an insurance provider where in exchange for relatively smaller premiums, the insurer guarantees to offer financial coverage for much larger healthcare expenses. In other words, health insurance protects your finances against medical emergencies, for nominal instalments of premiums.

The insurer determines this premium amount for your health insurance plan depending on your personal information such as your gender, age, medical condition, location etc. You may also need to get health check-ups as most insurance companies ask applicants to assess their health if they are 45 above.

NOTE: If you want to get a better idea of the premium, you can also estimate your premium on Max Bupa's website with the help of the premium calculator.

 

What is 'coverage'?

Basics covered under your health insurance plan

1. In-patient care (hospitalisation): for individuals/families

2. Pre and post-hospitalisation expenses

3. Hospital accommodation

4. Day-care treatments

5. Periodic health check-ups

The coverage of your health insurance plan refers to all the services you can avail without having to incur the financial burden, i.e. that insurance provider pays for it. Plans in India typically cover hospitalisation expenses, ambulance charges, day-care procedures, doctor's consultation fees, pre and post hospitalisation expenses, etc. To fully understand the scope of your plan, it is important to read your policy documents. It tells you what all benefits you are entitled to along with exclusionsthat are not covered under your plan.

To make your health insurance more robust, you can also opt for add-ons, which essentially are added features and coverages that can be availed for an additional premium. For example, to truly cover yourself against critical diseases like cancer and heart disease, you either need to opt for a critical illness add-on or a critical illness health plan. The same goes for accidents that may lead to disability (temporary/permanent) or death. You will need to opt for a personal accident care add-on in order to cover such incidents. It is suggested because such diseases and accidents can completely disrupt your livelihood and the coverage from a basic health insurance plan might not be enough.

 

How to avail these services?

When it comes to using the benefits of your plan, in most cases, it happens through claims. If you are going to go through a medical procedure, or already have gone through one, you inform the insurance provider about it through the claims form. After analysing the situation and processing the claims form, the insurance provider pays for the covered expenses through cashless payments, reimbursements, or both.

Cashless payments: In this case, the insurer directly settles the medical bills with the hospital without you having to do anything.

Reimbursement: In this case, you pay the hospital first, and then get the amount reimbursed or paid back by the insurer.

Note: In either case, make sure you keep all the medical bills, prescriptions, and other medical documents safe with you.

Max Bupa provides you with a range of health insurance plans to pick from that best suit the needs of you and your family. Benefits such as health check-ups, organ transplant, mental disorder treatment, bariatric surgery, etc. are already included in the health insurance plans to give you extensive and comprehensive coverage. Max Bupa Health Insurance Plans also include several valuable benefits such as international coverage and e-consultations so that you and your family are well-covered as you go through life.

Sources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405940/

2. https://thelogicalindian.com/story-feed/awareness/medical-debt-india/?infinitescroll=1