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What is Health Insurance?

Health insurance is a yearly contractual agreement between the policyholder and the insurer. The health insurance company provides financial coverage to the policy holder/insured up to the sum insured limit. It offers medical coverage incurred on hospitalization along with multiple benefits, like pre & post-hospitalization cover, medical check-ups, wellness program, OPD etc.

Health insurance at a glance

Category Specification
Sum Insured limit From ₹50,000 up to ₹6 crore
Maternity Cover *Available
Pre & Post-hospitalization Expenses *Covered
ICU Charges Covered
OPD Cover Available
Free Health Check-ups Available
Ambulance Cover Covered
Day Care Procedures Covered
Tax Benefits Up to ₹75,000 per financial year
* Available (Optional)
* Covered (In built)

Benefits of Buying Health Insurance Plans Online

Buying health insurance plans online is an easy, convenient, and cost-effective way to protect yourself and your family from rising medical expenses. With the wide range of policies available online, you can compare and select the policy that best suits your needs and budget, and get the policy instantly issued without any hassle. Take a look at some of the top reasons to buy a health insurance plan below:

  • Access to a Wide Range of Policies

    Buying health insurance plans online gives you access to a wide range of policies from different insurance providers. You can compare and choose the policy that best suits your needs and budget.

  • Instant Policy Issuance

    Online purchase of health insurance policies allows you to get instant policy issuance without any paperwork or documentation. You can buy the policy online and get the policy digitally issued instantly and download it on your email and phone.

  • Transparent and Hassle-Free Process

    The online process of buying health insurance plans is transparent and hassle-free. You can read the policy terms and conditions, benefits, exclusions and price comparison before buying the policy. The online process ensures that you get the policy that meets your requirements, and you can make an informed decision.

  • Other Benefits

    Buying health insurance plans from www.bimaleap.com online is a cost-effective option as insurance companies offer other benefits for online purchases.

Key Benefits of Health Insurance Plans in India

Health insurance plans offer a variety of health benefits to the insured depending on the plan. Following are the key benefits of buying a health insurance plan in India:

  • Day-care Procedures

    Certain medical procedures or surgeries that do not require hospitalization for less than 24 hours are also covered under health insurance plans. These procedures include dialysis, chemotherapy, cataract surgery, and others.

  • Ambulance Charges

    Health insurance plans cover the cost of ambulance services to transport the insured from the place of emergency to the hospital.

  • No Claim Bonus

    Health insurance plans provide a no-claim bonus as an incentive to policyholders who do not make any claims during a policy year. It increases the sum insured amount for the next policy year without any additional premium cost.

  • Cashless Hospitalization

    Most health insurance plans offer cashless hospitalization where the insured does not have to pay the medical bills at the time of discharge. The insurer directly settles the bill with the hospital, subject to the terms and conditions of the policy.

  • Tax Benefits

    Health insurance premiums paid up to a certain limit are eligible for tax deductions under Section 80D of the Income Tax Act, 1961. This provides a significant tax benefit to policyholders.

  • Lifelong Renewal

    Most health insurance plans offer lifelong renewal, which means the policy can be renewed every year for the entire lifetime of the insured. It provides financial protection against unforeseen medical expenses even in old age.

  • Coverage for Pre-Existing Diseases

    Health insurance plans also provide coverage for pre-existing diseases after a waiting period, which varies from one policy to another. This ensures that the insured does not have to bear the financial burden of an existing illness.

What is Covered in a Health Insurance Plan?

Most health insurance companies in India cover the following medical expenses under a health insurance policy:

  • In-patient Hospitalization Expenses

    The hospitalization expenses incurred during the treatment of an illness or injury are covered.

  • Pre-existing Illnesses or Diseases

    After the completion of the waiting period, you can file a claim for the expenses incurred on the treatment of any pre-existing illness.

  • Pre and Post Hospitalization Expenses

    Medical expenses incurred on blood tests, x-ray, and consultation fee that are required before hospitalization is taken care of by the insurance company. Similarly, the cost of medicines, any consultancy charges and preventive health check-ups that are done to ascertain your health after the discharge from the hospital is covered under the health insurance plan.

  • Ambulance Charges

    All medical insurance plans cover emergency ambulance charges.

  • Maternity Cover

    Medical expenses incurred during the pregnancy and delivery (C-section or normal) are covered along with new born baby expenses.

*Please read the product brochure carefully to know more details about coverages, premium limits and terms etc.

What is Not Covered in a Health Insurance Plan?

  • Treatment for substance abuse or alcoholism.

  • Costs related to weight loss surgery or obesity treatment.

  • Treatments received outside of India, except in specific cases like emergency medical evacuation.

  • Cosmetic treatments or procedures that are not deemed medically necessary.

  • Any sort of self-harm or suicide attempt will not be covered

*It is important to note that the above exclusions may vary from insurer to insurer and from one policy to another. It is essential to carefully read the policy documents and understand the terms and conditions before buying a health insurance policy.

Key Factors to Consider before Buying a Health Insurance Plan

Important Considerations for Purchasing Health Insurance Before making a decision to buy a health insurance plan, it's important to take into account the following factors:

  • Coverage Scope

    The coverage provided by the policy and the sum insured will determine the illnesses and surgeries that can be claimed during the policy period in case of an exigency. When selecting a health insurance plan, closely examine the benefits offered, such as hospitalization expenses, daily cash benefit, COVID hospitalization cover, critical illness cover, health check-ups, day care procedure and maternity cover. No claim bonus can also be availed in case of claim free year.

  • Adequate Sum Insured

    The sum insured is a critical factor when choosing a medical insurance policy. Due to ongoing inflation, it's advisable to opt for a health insurance plan with a minimum sum insured of Rs 10 lakhs, which can go up to Rs 6 crore. For family floater policies or senior citizen insurance, higher sum insured amounts provide higher coverage.

  • Policy Type

    There are various types of health insurance policies available in India. Depending on your needs, you can choose to purchase individual health insurance, senior citizen health insurance, family floater or critical illness plans. Additionally, you can buy top-up and super top-up health insurance along with your existing health plan to enhance coverage. This is beneficial in case the base sum insured is exhausted during treatment.

  • Waiting Period Clause

    Your health insurance policy only takes effect after the initial waiting period of 30 days has elapsed. Any claim submitted during the initial waiting period, except for accidental hospitalization claims, can be denied by the insurer. Furthermore, the waiting period clause also applies to pre-existing conditions like thyroid, blood pressure, diabetes, etc. It is also applicable to specific illnesses, treatments, and maternity cover. Opt for a plan with minimal waiting period.

  • Co-payment Clause

    Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be paid by you (the insured). The co-payment option does not affect the sum insured. It allows you to reduce your premium to a certain extent but increases your out-of-pocket expenses. Only choose this clause if you can pay off a portion of your hospitalization bills without financial difficulty.

  • Room Rent Sub-limits

    Your medical insurance policy may also have a room rent sub-limit, which places a cap on the amount you can spend on room rent during hospitalization. This limit can vary based on the policy you have purchased. Opt for a plan with room rent sub-limits that match your requirements.

  • Network of Cashless Hospitals

    Check the list of network hospitals for an insurance company where cashless claims can be filed. The more network hospitals you have in your vicinity, the better the chances of availing cashless hospitalization benefits.

How to Calculate Health Insurance Premium?

In order to maintain an active policy, it is essential to make payments of a regular premium. Have you ever wondered about the process of calculating this premium? There are various factors that impact health insurance premiums, such as the medical history of your family, the sum insured, your family definition, your pin code and more.

Taking these factors into account, you may wish to calculate your premium to determine the amount you will need to pay for the policy. This can be accomplished through the use of a premium calculator, which is an online tool that calculates the premium based on the information you provide, including the preferred sum insured, age of the insured, and so on. www.bimaleap.com provides an easy-to-use online platform for calculating your health insurance premium.

Eligibility Criteria to Buy a Health Insurance Plan

The eligibility criteria to buy a health insurance plan depends on a number of factors such as the age of the policyholder, pre-existing diseases, etc. In most health insurance plans, the following eligibility criteria should be met:

Category Specification
Age Criteria for Adults Entry age for adults: 18 years and above
Age Criteria for Dependent Children Entry age for Children: 90 days to 25 years
Pre-existing Disease waiting period upto 4 years

  • Age:

    The age range for adults eligible for health insurance coverage is typically 18 years and above, while dependent children are usually eligible from 90 days to 25 years of age. However, the actual age limits can vary from one insurance policy to another.

  • Pre-existing conditions:

    Insurance companies may require applicants to disclose any pre-existing medical conditions. Depending on the plan, pre-existing conditions may not be covered or may be covered after a waiting period range given in the respective policy documents.

  • Medical history:

    Some insurance plans may require a pre-medical screening, particularly for older applicants or those with a history of certain medical conditions.

  • Lifestyle habits:

    Applicants may be required to disclose information about lifestyle habits such as smoking or alcohol consumption. In some cases, these habits can impact coverage eligibility or premiums.

  • C-KYC:

    As per latest guidelines by IRDA effective from 1st January 2023, C-KYC is mandatory to purchase an insurance policy. C-KYC requires your PAN & Aadhar details linked with your mobile number.

It is important to carefully review the eligibility criteria of any health insurance plan before applying to ensure that all requirements are met. Disclosing of all material facts with utmost faith to the insurance company is also important to avoid any issues with claim settlement in the future.

What is Medical Insurance Claim Procedure & How Does It Work?

A health insurance claim or a medical insurance claim is a request that is raised by the policyholder for compensation of the expenses incurred for the treatment. The insurance company upon verification of the claim either settles the bills directly with the hospital or reimburses the amount you spend, depending on the type of claim procedure you have opted for.

  • Cashless Claim –

    In a cashless claim, the policyholder can seek treatment from any of the network hospitals of the insurance company. On admission, the policyholder must produce the cashless health card provided by the insurer and the expenses incurred for the treatment will be directly settled by the insurance company; you need not pay a single Rupee. For cashless claim, you only need to show your health insurance card at the time of admission in the hospital. Most insurance companies approve cashless treatment 30mins to 4 hours, depending upon the case from the time of admission at the network hospital.

  • Reimbursement claim -

    In a reimbursement claim, you must initially pay for the treatment and then file a claim for reimbursement. When you file a claim, you must produce the bills and showcase other records of the money spent on hospitalisation and treatment. The insurance company, after verifying the bills and documents, will credit the amount to your bank account. In case your request for a cashless claim is rejected, or you or your family member is seeking treatment at non-network hospitals, then you can apply for reimbursement. Remember to start the reimbursement process immediately after patient/insured person discharge from hospital.

Cashless Reimbursement
S no Planned hospitalization Emergency hospitalization
1 Choose a hospital from the network as mentioned in the insurance document NA Get in touch with your insurance company through the toll-free number & provide a membership number
2 Inform insurance company claim team prior to admission & provide a cashless card or policy document Same as planned hospitalization Settle all the hospital bills
3 Fill cashless request form at the hospital Same as planned hospitalization Present the bills, prescriptions, discharge summary and other necessary documents when you request for reimbursement
4 Submit the form and medical records to TPA desk at the hospital Same as planned hospitalization Download & fill the reimbursement form, available on the insurance website
5 TPA/Insurer will verify all the documents Same as planned hospitalization Submit the form along with medical records, ID proof and Cancel cheque of policy holder
6 Once approved, the insurance company will settle the hospital bills Same as planned hospitalization - A cheque will be disbursed or insurer will settle the claim through NEFT in the policy holder’s bank account once the claim is approved. The general turnaround time for the process is 20 days from the date of receipt of all documents
7 In case of disapproval, one can file for reimbursement Same as planned hospitalization

Important Points To Remember For Claims-

  • The forms for reimbursement must be filled correctly, if not, then the claim request might be denied.

  • Claim request must be raised immediately after date of discharge.

Follow these steps carefully to get your medical insurance claim approved. Remember to keep all the documents ready as the insurance company may ask for any documents at any time.