Health Insurance Plans: Buy Best Medical Insurance Policy in India | Max Bupa
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Types of health insurance plans in India

Buying health insurance is an inexpensive way to secure medical care for individuals and their families during emergencies. There is a multitude of health insurance plans available in India, which aim to provide coverage against various health risks along with a host of other benefits. However, in order to choose a plan that is best suited to you, you must know all the options available to you.

 

Here is a quick look at six of the most popular health insurance plans available in India.

 

Individual Health Insurance plans

 

As the name suggests, an individual health insurance policy provides coverage to an individual during medical emergencies, as stated in the policy wordings of the plan. 

There are many types of individual health insurance plans available in India which are suitable for every need and can be easily customized as well with add-ons such as accident covers, critical illness covers, etc.

Note: The sum assured of the policy is directly dependent on the age, health and income level of the insured individual.

 

Family floater health insurance plans

 

A family floater policy is specially designed to cover the needs of your entire family. Most importantly, a family floater policy is significantly cost-effective and hassle-free when compared to an individual policy as it saves a lot of time, effort and money. Plans such as Max Bupa's Heartbeat plan can even cover 19 relationships under a single policy.

Keep in mind though that the premium of a family floater policy is heavily dependant on the age of the oldest family member covered under the plan.

 

Employer-sponsored group health insurance plans

 

To safeguard the well-being of employees and provide an additional benefit/incentive, employers may buy group health insurance plans. While the premium for a group insurance cover is much lower than an individual policy, the terms of the health insurance policy are standardized and offer the same benefits to all employees.

For certain types of businesses that employ more than a specified number of people, purchasing a group insurance policy is compulsory for the employer. However, many times these policies prove to be inadequate due to multiple exclusions which makes it necessary to supplement it with a personal policy of your own.

 

Senior citizen health insurance plans

 

As you age, health issues become more common, and consequentially, treatments also tend to get complicated and expensive. Thus, these health insurance plans are specifically designed, keeping in mind the needs of senior citizens. Anyone above the age of 65 can opt for such a cover. 

The insurer may also introduce a co-payment clause in the insurance contract premiums under these plans tend to be more expensive as senior citizens are more susceptible to health issues. With the help of this option, you have to pay anywhere between 10% and 30% of the medical costs during hospitalization (as agreed upon by the insurance company and the individual). This helps bring down the cost of coverage, making the insurance affordable for retired senior citizens.

 

Critical illness health cover

 

Potentially life-threatening diseases such as cancer, diabetes, coronary issues, strokes, paralysis, kidney failure, and other organ failures are considered critical illnesses. Treatment for these always ends up being emotionally and financially exhausting. With the help of a critical illness health insurance policy, the policyholder is awarded a lump sum amount upon the diagnosis of any such illness covered through the policy.

This makes it easy to fast track treatment and not lose critical time due to a shortage of funds. Unlike individual health plans and family floaters, the insured person does not have to be hospitalized to claim benefits; just the diagnosis is enough.

 

Additional top-up policy

 

The easiest way to increase your health insurance coverage is by opting for a top-up policy. A top-up policy comes at a fraction of the cost of a full-fledged health insurance cover.

The other advantage of a top-up policy is that the coverage you seek can be increased or decreased on every renewal basis your individual needs. Max Bupa offers Health Recharge to allow policyholders to avail additional benefits for themselves or their families.

It is important to assess your individual needs and your family's needs before investing in a health insurance plan. It is also equally important to review your insurance coverage and make changes to accommodate new dynamics in your life. For more information on health insurance plans, head on over to https://transaction.maxbupa.com

What are the types and benefits of a Mediclaim policy?

The average insurance buyer in India is often unaware of what Mediclaim exactly means. Several people assume it to be the same as a regular health insurance policy.

However, this assumption is only partially right. Mediclaim is a type of a health insurance policy, but it is not interchangeable with health insurance. Let us explore this further.

 

What is Mediclaim?

 

If you have a Mediclaim policy, your insurance provider will reimburse you for any medical expenses that you may incur during the policy period.

Having said that, it is necessary to note that for the claim to be passed, you will need to stay a minimum of 24 hours in the hospital. The aberration to this rule is daycare procedures such as cataract or chemotherapy, among a few others where overnight medical supervision is not required.

The hospitalisation expenses covered by Mediclaim in India extend to doctor’s fees, consultant fees, diagnostics, medicine bills, costs of medical supplies like saline drips and even nursing charges.

However, the policy only allows for reimbursement of expenses that you rake up during your hospital stay; it also extends to specified periods before and after hospitalisation, depending on the policy you have chosen.

Usually, this period ranges from 30 days to 90 days and the usual expenses reimbursed are doctor’s charges, diagnostic costs and follow-ups.

 

Who qualifies for Mediclaim?

 

You can enjoy the benefits of a Mediclaim policy as an individual or as a family. 

However, for this particular health insurance plan, there is an age-related condition – it usually has an entry age of 18 years and an exit age of 65 years. Some health insurance companies in India though offer the Mediclaim policy to consumers from the age of five years up to the age of 80 years.

Keep in mind though that certain medical conditions, procedures and medical aids are not covered under a Mediclaim policy, these being:

Pre-existing diseases

Sexually-transmitted diseases

HIV/AIDS

Pregnancy and childbirth

Dental procedures and aids

Vaccination

Cosmetic, plastic and obesity-related surgeries 

Obesity-related treatments

Hearing aids

 

Mediclaim Benefits

 

At the end of the day, what matters are the benefits of a Mediclaim policy. This can be summed up in one simple line: with Mediclaim, you buy yourself a financial cushion for a medical emergency.

According to estimates of the World Health Organization (WHO), the out-of-pocket expenditure on health in India is one of the highest globally – more than 60%. Further, this is on account of the low level of health insurance coverage in the country and the skyrocketing fees charged by private hospitals. For example, the commonplace gallstone surgery can often cross even one lakh rupees; for critical diseases, costs can be high to the point of being unaffordable for most.

With a Mediclaim health insurance policy, that burden can be taken care of. Plus, it also covers pre- and post-hospitalization expenses along with expenses on medical services at home.

Another benefit is that you can avail of the benefit of covering your whole family with just one policy.

And finally, there are the tax benefits – of up to ₹ 25,000 for yourself and up to ₹ 75,000 for your family and parents, with at least one parent being over the age of 60 years.

 

Types of Mediclaim

 

Health insurance companies in India offer several types of Mediclaim plans, such as:

Individual Mediclaim: This policy covers only the policyholder, and the number of hospital stays doesn't matter if the cost is within the insured amount

Family floater: Here, a master premium is paid to cover all family members including parents, and can be availed of separately or individually as per the unused sum insured

Group Mediclaim: This is handy for people with a group of employees, and is a great plan for a country like India where insurance penetration is so low

Senior citizen Mediclaim: Specifically designed for the elderly (age 60 years and above), it carries special terms and conditions

Critical illness Mediclaim: Unlike the usual Mediclaim policy that covers only sudden illnesses and accidents, this plan covers critical illnesses like cancer, kidney failure, etc

Overseas Mediclaim: This Mediclaim policy allows you to make claims for medical expenses that were incurred outside India as given in your policy wordings.

Low-cost Mediclaim: This is a Mediclaim policy with a low premium that addresses the more underprivileged sections of society and is usually bought by SME owners for employees.

 

Mediclaim Policy

 

Mediclaim policies allow you to make claims through one of two ways: the cashless process or through reimbursement of payments made for the treatment, the costs, in either case, being no more than the sum assured.

1. Cashless: If you visit any of the hospitals or clinics included in the insurer’s hospital network, you are entitled to cashless facilities at that center. What this means is that it is the health insurance company, and not you, who settle the entire claim or a part of the claim provided you seek treatment at an approved hospital.

For a smooth cashless experience, however, you have to follow certain procedures laid down under the policy. For instance, you need to fill out a pre-authorization form and submit it to the insurance company or its third-party administrator. This can be done before or during the admission process.

2. Reimbursement: If you are unable to access any network hospital and seek treatment outside the insurer’s approved list, you have to first clear your hospital dues like anyone else, and then submit the relevant bills for reimbursement. 

You will be reimbursed even if the hospital concerned is located outside India provided you have the overseas Mediclaim policy, but the reimbursement will not be more than the sum assured.

You also have to inform the health insurance company or an authorized representative that has sold you the Mediclaim policy about your hospitalization before or at the time of getting admitted.

If any medicine and supplies required for the treatment are bought from a chemist outside the hospital precincts, your Mediclaim policy covers that purchase as well.

Thus, it is imperative that you pick your mediclaim policy based on your needs. It is a sound investment that you simply can't do away with in today's day and age.

How to buy health insurance online

Earlier, health insurance companies had to make infrastructure investments and take the help of various brokers, agents and financial consultants to sell health insurance plans in India. The procedure was arduous and time consuming with reams of paperwork to boot. 

However, in today's digital age, buying a health insurance plan is almost as easy as ordering a pizza online. The internet can provide you with a wealth of information regarding various health insurance plans, their features, benefits and also quick and simple tips on how to buy a health insurance plan online.

The process has evolved to become extremely efficient, transparent and cost-effective with minimal paperwork and intermediaries. So, the only question left is, how to apply for health insurance plan in India?

 

We are going to answer this question with a few steps that are guaranteed to help you select a plan that suits your needs.

 

Do your research

Most people who are looking to buy a health insurance plan either speak to family and friends or go online to look for the best-rated health insurance providers. There are also many forums on social media where real customers post their experiences regarding their interaction with health insurance companies, service quality, etc.  which should give you a fair idea of which health insurance companies you should consider. 

Visit the website

The websites of insurance providers are one of the best sources of information available about health insurance plans in India. All you need to do is take a look at the plan that suits your needs and take notes. After that, you can compare one policy with another to see which ones offer you more comprehensive coverage at a lower premium.

If this gets too confusing, many independent online agencies allow you to compare a plan before you zero in on a policy. Thus, you can access information about all prominent insurance providers and their plans in one place!

Provide personal details

An important thing to keep in mind before comparing plans is that each health insurance provider will ask you for your personal information such as your age, income, health status, area of residence, etc. to assess your eligibility online. This will also help you estimate your health insurance needs and which plan suits your needs and pocket best.

Make comparisons

With the internet, it is easy to get the exact quote for any health insurance plan from various insurers online and compare them.

To make thorough comparisons, you may want to download the brochure and go through all the policy details and terms and conditions carefully. Some key factors to keep in mind include- the reimbursement/cashless benefits, the critical cover (if any), exclusions etc. Many aggregator sites can help you compare policies of different providers before you finally buy a policy

Finalise the plan 

Once you zero in on a policy, double-check the plan's reviews online. Things to look for include the final cost after-tax, the renewability clause of the plan and the loyalty benefits. For instance, MaxBupa offers some plans which give you loyalty benefits and discounts upon opting for a longer tenure. If you still have any doubts, call the provider's helpline number available online or shoot them a mail. 

Note: Some health insurance providers may ask you to upload basic documents online to verify your details. 

 

Purchase your health insurance policy

 

You can purchase your plan directly from the insurer’s website or through the website of an intermediary. Sometimes, there can be a slight difference in the price of the same plan when purchased from different places. Some insurance companies also have tie-ups with banks and credit card companies that offer additional discounts or cashback offers on using their facility. Another thing to remember is keeping important documents such as age and address proof handy as you may be asked to provide these to complete your purchase.

The best part when you buy a health insurance plan online is that you don’t have to deal with pushy salespersons and you can also save yourself a lot of time and money during the process.

Want to know more about buying health insurance online? Go to www.maxbupa.com to find out more.    

Who are third-party administrators (TPA) in health insurance?

If you are planning to buy a health insurance policy anytime in the near future, the third-party administrators (TPA) for the health insurance sector will have a direct bearing on you. This is because they are the agency that you will be dealing with directly while making your claims.

Want to know the exact role they play in passing your health insurance claims? 

Keep reading to know more.

 

Explaining TPA

 

The third-party administrator, or the TPA, is not an employee of any health insurance company but an independent and separate entity that acts as the bridge between you and your insurance provider. 

The TPA is licensed by the IRDAI to execute this task for insurers across categories, and not just for players engaged in health insurance. It can be an individual, an agency or could be a company that is retained by the insurer to perform several administrative services such as managing customer services on its behalf. Typically, it receives a fee of 5.5% of the premium amount.

However, for the customer, the services provided by the third-party administrator are for free – there is no hidden cost in the contract.

 

Scope of work- TPA

 

The tasks that make TPA a key cog in your relationship with your health insurance provider is primarily customer service. This includes claims processing which makes it necessary for you to interact with a TPA. 

Insurers across verticals, including health insurance companies, outsource their claims process (a portion of it or entirely) to a TPA of their choice. 

In the case of health insurance-related claims though, the third-party administrator also coordinates with the network hospital or any other hospital where the policyholder has undergone treatment before filing their claim.

In India, many health insurance companies have their own dedicated departments for claims processing. For instance, MaxBupa health insurance processes your claims without any TPA, which significantly reduces the time taken to process your claims.

Role/Importance of TPA

While some of the functions of the third-party administrator have been touched upon earlier, let’s get into further details for a better insight. Broadly, the TPA is supposed to-

Promote cashless facilities

Provide customer service

Process claims

 

Customer Service

The work of the third-party administrator – vis-à-vis you – begins the day the policy is sold to you,i.e. when you enter your health insurance provider’s database. Whatever service is your due, is now the responsibility of the TPA. Some of these services include- delivery of the health/identity card, attending to your grievances if any and of course, settling claims. 

The TPA streamlines costs and services and keeps you posted on network hospitals and addresses any concern that you may have. The TPA also makes payments to the hospital (in the case of non-cashless cases) and aids the reimbursement process with the help of your provider.

Cashless Service

The TPA is also responsible for building the network of hospitals for the health insurance company. In the process, it brings the cashless facility to you as the insured. It takes the call on empanelling a hospital-based on its service track record, infrastructure and facilities, management background and IT infrastructure.

Claims Processing

This is the role that the TPA is most known for. It coordinates with the hospitals for claim settlements, verifies bills for treatments, checks for false claims and even settles payments with hospitals in case of cashless facilities.

 

IRDAI Amendments

Until recently, a policyholder had to accept any third-party administrator their health insurance provider chose. This changed on December 3, 2019, when the IRDAI announced amended regulations giving customers the right to choose a TPA from the list suggested by their health insurance provider. To be precise, “The policyholder can choose a TPA of their choice from amongst the TPAs engaged by the insurer” as stated in the notification on the website.

Keep in mind though that as a policyholder, you can only choose the TPA from the list suggested at the time of buying or renewing the policy. If you do not choose any of the suggested TPAs, then the health insurance company can allot you a TPA of its own choice. 

IRDAI also allows the health insurance company to limit the TPA list based on the health insurance product and geographical location of the policyholder. Hence, if the insurer engages the services of only one TPA because of those factors, you will have no option but to go along with that particular TPA.

The regulator also says that it is the insurer’s “prerogative” to engage or discontinue the services of a TPA for a particular health insurance product. 

Also, the only time you can choose (an alternate) TPA is if the services of the original TPA are terminated during the period of your health insurance coverage.

How to get health insurance coverage for your newborn?

Becoming a parent is one of the most beautiful things that could happen to you. While celebrating the news with sweets and deciding the name is the first thing you would be inclined to do, there’s another important thing that you can and should do before your baby is born,i.e. figure out the right health cover for them.

Finding the right health insurance for a newborn is not the same as that for an adult since the needs of a newborn are completely different.

Thus, here are some things that you should know in order to get health insurance coverage for your newborn baby:

Policies available for newborns

In India, getting an individual health insurance plan for a newborn is quite tough. However, the newborn can be insured under your new/pre-existing family floater health insurance policy. So, if you already have a family floater health plan, you’ll have to talk to your insurance provider about the procedure.

Additionally, many health insurance plans have started offering maternity benefits and a newborn cover as features. Thus, when you’re looking to get health insurance, look for plans with such coverage, since the waiting period for the maternity cover to kick in is usually 2+ years.

Note: Like family floater plans, if you get health insurance coverage from your company, your newborn can be added to that as well.

Age and waiting period

Most insurers in India don’t insure a newborn baby from day one as there are a lot of complications and risks that could be involved. Usually, there is a waiting period of 90 days after which the baby can be covered under your family floater health plan.

However, some insurance providers like Max Bupa cover your newborn from day one until the end of the policy year. The vaccinations required in the first year for the baby will also be covered. However, this benefit is limited up to your sum insured.

 

Application and documents

The first step to take when your baby is born is to inform the insurance company within the first week of birth. After this, you will have to submit an application to your insurance provider. Based on this, the provider will either add your baby to the policy right away or wait until the time of renewal.

You will also need to submit certain documents such as your newborn’s birth certificate, the maternity discharge report and any other medical reports related to your child’s birth that would be relevant for the insurance company.

Premium

The medical reports of your newborn will be assessed by your insurance provider to see if the baby is subject to any complications. Depending on this, the insurance company will give you an updated premium amount for your policy.

You can also opt for insurance providers like Max Bupa whose plans cover your newborn without any additional premium from day one. You can know more about these plans by visiting https://transaction.maxbupa.com

Lastly, choosing a health insurance policy for your newborn is never easy. After all, once your baby is born, there will be a thousand things to take care of. Hence, an important thing like a health cover mustn't be left for later.