Understanding Health Insurance: A Comprehensive Overview

Explain medical insurance.

The first thing that normally crosses your mind when you enter a hospital is how much money you will have when you get out. In a world where cutting-edge technologies are everywhere, the medical sector is one of the pioneers, but technology has a cost. A protracted hospital stay would most likely cost several lakhs, while a routine check-up might easily run into thousands of dollars. In the very least, when you’re getting medical care in a hospital, having strong and comprehensive health insurance coverage can save your skin—and your money.

health insurance

What is health insurance?

If you select a plan, your health insurance provider will pay for your medical expenses; however, you will have to pay an annual premium, which you can also pay in monthly installments. We refer to this as the premium. Depending on the policy you select and the provider, health insurance helps you avoid financial hardship by covering treatment costs, hospitalization fees, ambulance costs, laboratory prices, and other related expenses. Plans even cover lost income in certain situations.

Why is having health insurance coverage a requirement?

An alarming 68% of medical costs in India are paid out-of-pocket (OOP), according to a WHO report that puts the country’s growing desire for health insurance coverage into context. In addition, just 18% of Indians have access to health insurance and reside in cities, with 14% doing so in rural areas. Purchasing health insurance early is crucial because premiums are significantly lower. It is crucial to keep in mind that many plans do not cover pre-existing ailments or diseases that manifest within 30 days of the policy’s acquisition, with the exception of those originating from accidents.

Whether you are thinking about getting health insurance or you currently have coverage, this list of considerations will help you comprehend its importance.

  • Cashless treatment: Presenting your health insurance card, or even simply your policy number, is all that is required to receive treatment at any of these institutions. After you have completed the required paperwork, the rest will take care of itself. However, if you select a non-network facility, you will be responsible for covering the cost of the care and filing a claim for reimbursement. Since few people can quickly gather large sums of money for medical expenditures, cashless treatment is thus one of the biggest benefits of having health insurance.
  • Rising Health Disorders and Medical Costs: In India, the cancer rate has nearly doubled in the past 26 years. Furthermore, there has been a rise in other severe conditions like diabetes and tuberculosis. When you combine this with the slowly but surely rising expenses of prescription drugs and medical services, you won’t have to look far to see why having health insurance is crucial.
  • Free Annual Health Exam + Additional Benefits: qualified for a No Claim Bonus (NCB), an increase in the overall amount covered. Insurance companies also cover pre- and post-hospitalization expenses, ambulance fees, and other benefits.
  • Benefits with regard to taxes: A policy under Income Tax Act Section 80D. Individuals may deduct up to ₹50,000 in total. All major health insurance companies have a large number of reputable hospitals inside their network, which are referred to as network hospitals.
  •  2019 saw 11,57,294 reported cases of cancer, according to data from India’s Cancer Registry. In
  • Many insurance companies offer their customers a free yearly physical as a bonus (some only do this if you haven’t filed a claim on your coverage in a few years, though). Furthermore, except for outpatient claims, if you haven’t filed any claims with your insurer during the duration of your policy, you might be
  • If your parents are under 60, you can receive tax benefits for the premiums you pay for your health insurance under 60 (₹25,000 for you, your spouse, and any dependent children, and ₹25,000 for the parents); if your parents are over 60, you can receive tax benefits for the premiums you pay (₹25,000 for you, your spouse, and any dependent children, and ₹50,000 for the parents). If both the individual and their parents are older than 60, ₹1,00,000 may be deducted.
  • Peace of mind: Above all, it is quite reassuring to know that you have carefully considered insurance coverage to safeguard your back, especially in view of the alarming increase in major illnesses over the past few decades. It will not only spare you and your loved ones from medical emergencies, but it will also take one more worry out of your already busy daily schedule.

Now that we’ve established the importance of health insurance, let’s examine some considerations for your decision.

Considerations while looking for health insurance coverage

  • It is better to have health insurance when one is young, as was previously said. Along with premiums, the chance of health issues also tends to increase with age.
  • Look for insurance that covers recent medical conditions. Since they are the ones that use up our money the most frequently, it makes sense to include them on the list.
  • Choose an insurance policy that does not have a large co-payment requirement. A co-payment is the portion of the cost that you are required to pay out of pocket if you file a claim. The insurance company pays the remaining amount in accordance with the terms of the policy.
  • To increase the net total coverage of your health insurance policy, choose the right riders or add-on features.

Types of health insurance

A hospital bill would be paid in part by you, and the remaining amount would be paid by the insurance company under an indemnity plan. You get to pick the doctor you see; the insurance company has no control over the hospital or whether the visit was necessary. But the extent of this autonomy is restricted. In the event of an emergency, you still need approval from your insurance company before being admitted to the emergency room, even if you are not incapacitated. In the event that you select the indemnity plan, you must pay the entire sum up front before filing a claim for reimbursement.


Exclusive Provider Organization (EPO): Members of an EPO plan must make use of a pre-established physician network in addition to a primary care physician (PCP), who will refer patients to specialists inside the network for medical attention. However, this condition is not applicable in an emergency. There will also be a little co-payment that you have to make.

Point of Service (POS): Similar to the EPO pan, POS provides a PCP to select from among the network providers. There are situations where your coverage will be increased. However, your coverage can be limited, and you might be required to pay a deductible (co-payment) if you select a hospital that is not in the network. Moreover, you might have to pay in full before asking for a refund.

Add-ons to health insurance

  • Top-ups: By combining a basic insurance plan with a top-up plan, you may be able to obtain adequate coverage at affordable prices. An additional insurance plan known as a “top-up” plan starts to cover medical costs over and above what your primary insurance plan would. Top-ups only cover the cost of one hospital stay; super top-up plans cover the price of medical bills for a full year’s worth of conditions.
  • Riders: For an additional fee, you may add a rider to your standard health insurance plan to increase coverage and tailor it to your requirements. A number of riders are available, such as those for critical illness, maternity leave, and personal accidents.
  • Defined benefit plans: The majority of basic health insurance policies do not cover expenses related to anything other than hospitalization, including prescription medication prices, meals, and charges for treating conditions that do not require hospitalization. Definable benefit plans come to the rescue and ensure that you receive a predetermined payout regardless of your expenses.

What your health insurance policy does not cover

  • Illnesses related to substances: If it is evident that your disease is the result of misusing cigarettes, alcohol, or other illicit drugs, your claim will be rejected.
  • Home treatment: If the patient is not admitted to the hospital, the claim will be void. Certain insurance companies may pay for treatment received at home, but the maximum amount will be less.
  • Certain Prescription Drugs: Insurance companies might not cover every prescription drug required to treat serious illnesses like cancer. Immunotherapy drugs are frequently not covered, as are several oral chemotherapy medications. Intralesional and intra-arterial injections are not covered by certain insurance policies.
  • Charges made by the resident physician: If the resident physician makes separate charges on the bill, such expenses will not be covered. However, in the event that it is part of the accommodation cost, the insurance company might pay for it.
  • Novel or advanced therapies: The insurance does not cover experimental or unproven treatments, such as robotic surgery. Furthermore, stem cell therapies are frequently uninsured.
  • Non-medical costs: The insurance does not pay for the price of other convenience items or toiletries. Kindly consult the IRDAI circular number. See IRDA/HLT/CIR/036/02/2013 for an exhaustive list of items not covered.
  • Pre-existing conditions: Pre-existing conditions are often either fully excluded from coverage or may not be eligible for a claim until a lock-in period that is decided by the insurance carrier.

in summary;

The importance of health insurance cannot be overstated. It’s crucial to get health insurance as soon as possible for your spouse, parents, kids, and yourself. You may access our health insurance plan right here.

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