Health Insurance February 26, 2021

A Micro Health Insurance Plan is specifically designed for low-income individuals wanting a health cover for themselves and their family members against diseases or illnesses. Under a micro health insurance policy, the insured’s hospitalization expenses, medical treatments, surgeries and other such expenses shall be payable by companies and the government. Besides, it can offer you benefits like cashless claims, no claim bonus and other facilities. So if you are earning less and care about your family’s health, purchase a micro health insurance plan. Let’s read this page below and know the importance of micro health insurance plans.

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Micro Health Insurance Features and Benefits

Under micro health insurance, you’ll get the following features and benefits –

Hospitalization Expenses Coverage:- The insured person will be covered for all in-patient treatment or surgery expenses that include room rent, doctors’ fees, diagnostics tests, prescribed medicines, drugs and other consumables, intravenous fluids, blood transfusion, injection administration charges, ICU charges, cost of anesthesia, blood, oxygen, operation theatre charges, surgical appliances, radiotherapy, prosthetic devices, implants, diagnostic materials and X-ray, dialysis, chemotherapy, nursing and boarding expenses.

The maximum coverage limit of hospitalization expenses will be mentioned in your micro health insurance policy bond. So read the policy document of different micro health insurance plans carefully before choosing the one with the optimum cover amount.

Pre-hospitalization and Post-hospitalization Coverage:- If you are suffering from any covered illness or injury before hospitalization for the same, the company shall cover the same for a predefined period, known as the pre-hospitalization coverage. In this, the company shall reimburse the expenses incurred before hospitalization if the insured has been suffering from an illness or injury.

The same benefit is provided to you post-discharge from the hospital if you still require medical assistance for the illness or injury for which you have been admitted previously. But these medical expenses come under post-hospitalization coverage. This benefit also has a predefined limit, and the same will be mentioned in the policy document.

Cashless Claims:- This is the facility through which an insured person can claim his/her micro health insurance benefits. To use the cashless claim facility, you need to follow the instructions shown below.

For Planned Hospitalization

  1. Contact your insurance company and get the list of network hospital
  2. Once you choose your network hospital, proceed for pre-authorization from the company
  3. Once the pre-authorization is done, you can start getting treated at any of the select network hospitals without any hassle

For Emergency Hospitalization

  1. Visit any network hospital
  2. Show your health insurance card at the hospital
  3. Fill the pre-authorization form and submit it to the information desk. However, you should do it within 24 hours of hospitalization
  4. Later, if the company approves the pre-authorization, the hospitalization expenses will be paid directly to the hospital.

Note:- The cashless claim process may vary depending on your insurance company.

No Claim Bonus:- Purchasing micro health insurance doesn’t mean you need to get sick or injured to get its benefit. You can still get the policy benefits even if you don’t make a claim, and this is called the no claim bonus. This benefit will increase your sum insured for the next and will go on until you make a claim. The maximum bonus can be 50% or 100% of your policy sum assured. A no claim bonus will only help you deal with the ever so increasing healthcare costs.

Daycare Coverage:- Medical treatments and procedures that require hospitalization for not more than 24-hours are known as daycare procedures. And your micro health insurance will pay for that as well if such a claim arises during the policy term. Under daycare procedures, the following will be covered and it may vary based on your policy –

  1. Haemo-Dialysis
  2. Parenteral Chemotherapy
  3. Radiotherapy
  4. Eye Surgery
  5. Lithotripsy (kidney stone removal)
  6. Tonsillectomy
  7. Dilation and curettage
  8. Surgery of Hydrocele
  9. Surgery of Prostate
  10. Few Gastrointestinal Surgery
  11. Genital Surgery
  12. Surgery of Nose
  13. Surgery of Throat
  14. Surgery of Ear
  15. Surgery of Urinary System
  16. Treatment of fractures/dislocation (excluding hairline fracture)
  17. Laparoscopic therapeutic surgery

Tax Benefits:- You are also eligible for a tax deduction Under Section 80D of the Income Tax Act (ITA), 1961. The tax benefit will be provided to you for the micro health insurance premium payment. And the deduction could be up to INR 25,000 every financial year. If you are a senior citizen, the maximum deduction limit can go up to INR 30,000 a year.

Popular Micro Health Insurance Plans in India

The following is the list of some popular micro health insurance policy in India, so take a look at their features and benefits below:-

Policy NameType of planPre and post- hospitalization medical expenses (coverage period)Pre-existing disease waiting periodAdditional Benefits
Max Bupa Swasthya Pratham - Micro Insurance ProductPurchase on an individual or a Family floaterUp to seven days before admission and up to 15 days post discharge24 monthsMaternity and newborn cover

Personal accident cover

Out-patient cover
Star Care Micro Insurance PolicyPurchase on an individual or a Family floaterUp to 30 days before admission and up to 60 days post discharge48 monthsCataract

Accidental grievous injuries

Modern Treatments
Pradhan Mantri Jan Arogya Yojana (PMJAY)Family floater planAvailableNot availableSum insured from INR 1 Lakh to INR 5 Lakh

Zero pre-entrance health check-ups

Lifelong renewals
Aam Aadmi Bima Yojana (AABY) schemeIndividualAvailableNot availableHealth insurance for individuals who are in specific occupations like weaving, fishing, handloom, carpentry, etc.

Things to Know About Micro Health Insurance

Before purchasing a Micro Health Insurance, you should know the following:-

  1. This insurance has affordable premium rates
  2. This policy tenure is one year only
  3. This covers all your family members plus you if purchase it on a family floater basis
  4. There are no medical check-ups required before buying this plan
  5. The policyholder age should be 65 years or less at the time of purchase/inception
  6. The policy can be renewed for lifelong without any hindrance
  7. Your hospitalization bills shall be covered only if the hospital stay is for 24 hours or more
  8. The cost of the ambulance will also be covered under the microinsurance plan

Conclusion

The major part of India’s population is rural, so for them, a micro health insurance plan is a suitable solution for their health needs. As you see above, both government and insurance companies are offering micro health insurance policies. They are also affordable plans for the people who live in rural areas. Having a micro health insurance policy means you can get proper medical treatment without putting a strain on your finances.

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