Health Insurance 762 views February 22, 2019

Type of Health Insurance Plan

The age-old adage “Health is Wealth” is now being considered in all seriousness by most Indians. This is evident as an increasing number of the country’s population is queuing up to buy health insurance policies, both online and offline. There are others, however, still unaware of the nuances of health insurance and the types of health insurance policies sold in India.

Health Insurance

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Health insurance companies in India are many. These insurance companies offer a range of health insurance plans suited to every kind of need and budget. Health insurance in India is broadly divided into two categories, each of which is again divided into certain subcategories or specific kinds of health insurance policies that one may buy depending on need and fiscal convenience.

Health Insurance Plan in India

The two broad categories of health coverage plans are:-

Indemnity Plans

Health insurers selling these kinds of health plans are liable to make good for the expenses or compensate for the amount spent on treatment and medical assistance. The idea behind buying insurance is to seek cover or protection in lieu of regular premium payment. These kinds of health insurance policies are bought to ensure that the policyholders find themselves on the same financially secure footing similar to what had been before the loss. Indemnity health cover plans reimburse the amount that the policyholder or the insured may have spent on paying hospitalization bills subject to the amount of the sum assured determined while buying the policy.

The common kinds of indemnity plans include:-

1. Individual health insurance policy

This is the simplest kind of health insurance that covers a single insured person from the brunt of the amount expended on hospitalization and consequently medical treatment. Multiple benefits including that of cashless hospitalization, reimbursement of the amount spent on treatment and medical bills, pre and post hospitalization expenses, in addition, to addon covers. However, the amount of cover is subject to the sum assured limit determined while buying the health insurance coverage.

2. Family health coverage

As the name suggests, this kind of health coverage is bought to secure the lives of all family members covered under the health insurance policy. Many insurance companies sell them as Family Floater Plans, thus, allowing all the members in the family to get health coverage. However, the amount of cover, as in all other health insurance plans, is limited to the sum assured amount determined while buying the healthcare insurance plan. As opposed to theindividual health insurance plans, the premium charges towards family health insurance are much lower.

3. Senior health insurance

This is also called theSenior Citizen Health Insurance and is bought to secure the lives of those aged above 60 years. These kinds of health plans aim to secure the protective cover to senior citizens against nagging old-age health issues. As per the provisions of the Insurance Regulatory Development Authority of India (IRDAI), health insurance companies must include people until the age of 65 years while selling their plans.

4. Maternity health insurance

Many health insurance companies in India also cover additional costs inclusive of the amount spent on prenatal care, delivery of the child, postnatal care in addition to vaccination of the newborn babies as mentioned in the terms and conditions of the maternity insurance plan. Some health insurance plans with maternity coverage also include ambulance fees spent on transporting the mother to the hospital for delivery and cover the expenses on health check-up and treatment of the newborn baby throughout the entire period of the policy.

5. Preventive health coverage

This is unlike other healthcare that involves treatment only on the diagnosis of any illness. As the name suggests, this kind of health plan is aimed at providing preventive check-ups and necessary medical procedures to prevent falling ill or falling prone to serious ailments. The insurer indemnifies the costs of availing regular healthcare including the amount spent on X-Rays, blood tests or consultation fees of the medical practitioners. This plan is created to generate awareness among customers the significance of going through regular checkups in order to remain healthy while aiding in the prevention and early detection of serious health problems.

Defined Benefits Plans

Unlike indemnity plans, these plans do not compensate for the extent spent on hospitalization but pay off the amount predetermined while buying the health insurance policy. The amount of claim paid by the insurer, according to the provisions of this kind of plan, is unbiased of the actual amount spent on hospitalization and medical treatment and does not exceed the amount of sum assured promised at the time of buying the health plan.

Some common defined benefits plans are as under:-

1. Critical Illness insurance

These health insurance policies are different from others in the sense that they are bought to secure against the amount spent on treatment of various critical disorders. Customers may buy this policy either as standalone plans or add-on riders as an effective cover against certain specified chronic diseases including kidney failure, sudden paralysis, cardiac arrest, etc. The list of critical illnesses varies among plans sold by different companies covering health insurance plan in India. On diagnosis of any of the critical illness specified in the list published, the insurer is liable to pay the amount of sum assured in a lump sum to the policyholder irrespective of the costs borne during treatment of the illness.

2. Personal Health insurance

Also called personal accident cover, these kinds of plans are bought as riders, i.e., in addition to the plain and vanilla medical insurance plans and include hospitalization costs in the event of unforeseen and unfortunate events including accidents. These are issued as defined benefit or fixed benefit plans as the amount decided while opting for the rider is paid to the insured in case of death or permanent disability resulting from the accident.

3. Hospital Cash Benefits plans

Also called as Hospital Daily Cash plans, this kind of health plan promises a fixed sum of money towards hospitalization. This health insurance policy ensures that the insured is paid for each day hospitalized. The amount of money paid by the insurer is determined while buying the policy and is irrespective of the amount spent as hospitalization expenses.

4. Unit Linked Health Plans (ULIPs)

These are actually investment cum insurance plans that also act to cover against the health problems of the insured. Offered by only a few insurance companies, this product combines the benefits of both investment and health cover. Continuous and regular payments of premiums towards these kinds of plans not only allow the creation of a corpus amount subject to the market conditions while also ensuring a cover towards the treatment of pre-existing disorders not covered under any other health insurance policy during the waiting period. Some common ULHPs being sold in the Indian market include ICICI Pru’s Health Saver, LIC’s Health Protection Plus, Birla Sunlife’s Saral Health, and IndiaFirst’s Money Back Health Insurance Plan.

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