Health Insurance

Introduction
Health Insurance is an insurance that covers you and your loved ones at the time of medical
emergencies by paying for the expenses incurred during the treatment. An insured has to pay
the premium as per the plan selected and the cumulative amount is thus paid during any
medical contingency. In India, it is also called mediclaim. Health insurance also acts as a tax
saving tool by providing tax exemption under section 80D.

Health Insurance can be paid in two ways depending upon the type of Health Insurance
cover. Either the insured can pay the expenses out-of- pocket and reimburse the same later
from the insurer (insurance provider), or the payment can be made directly to the hospital or
medical facility provider by the insurer.

Importance

How many times do you need to visit a hospital to finally realise that you require a health
cover? It just takes one medical emergency to make you understand how vulnerable you are
when you have to foot the hospital bills. Whether you are rich or poor, young or old, being
diagnosed of an illness that requires hospitalisation could be one hell of an ordeal. Diabetes,
stroke, heart ailments, renal failure and similar other lifestyle diseases are increasingly
becoming common these days. Medical science, thankfully, has improved in leaps and
bounds and there are now super-speciality hospitals where many life-threatening diseases can
be treated. But it all involves huge cost. The wealthy may be able to afford these expenses but
what about the average middle-class people? Where do they get the money to meet the costs?
For illnesses that call for surgery or hospitalisation, the medical expenses may easily run into
six digit figures. Now imagine having to pay a huge amount within a few hours' notice. That
surely can make you paranoid. This is exactly where a health insurance policy, commonly
known as mediclaim in India, comes in to cover your expenses to a great extent and help you
retain peace of mind.

Documents Required for Medical Insurance Policy

If you have decided to buy health insurance online, then there are few documents that you
need to provide such as:
 Age proof - Any one of Birth Certificate, 10th or 12th mark sheet, Driving License, Passport,
Voter ID, etc
 Identity proof - Driving License, Passport, Voter ID, PAN Card, Aadhar Card, which proves
ones citizenship
 Address proof - Electricity Bill, Telephone Bill, Ration Card, Driving License, Passport,
should clearly mention the permanent address.
 Some plans require a medical check-up usually for elder people above the age of 45 years in
order to make sure that the insured does not suffer from any chronic illness.
 Passport Size Photo to have a record of the insured person`s identity for future references.
Health Insurance InclusionsSteps
The coverage offered by a health insurance policy is subject to the type of policy and the
insurer. An ideal policy is customizable and suites your requirements in the best way
possible. Following are common health insurance policy inclusions. In-patient hospitalization
expenses Donor, in case of organ transplantation During injuries requiring overnight
hospitalization Pre-existing illnesses or diseases Pre and post hospitalization Ambulance
charges Maternity or newborn Health check-ups Daycare procedures Treatment availed at
home or domiciliary hospitalization
Health Insurance Exclusions
No coverage or reimbursement offered with the waiting period of the policy, usually initial
30 days. Coverage of critical illnesses and pre-existing diseases is subject to a waiting period
of 2 to 3 years. Clear exclusion of expenses incurred for maternity/newborn. Injuries caused
by war/terrorism/ nuclear activity/suicide attempt. Terminal illnesses, AIDS, and other
diseases of similar nature. Cosmetic/plastic surgery, replacement of hormones, sex change
and more.
Dental or eye surgery. Non-allopathic diseases’ treatment. Bed rest/hospitalization and
rehabilitation, common illnesses etc. Treatment/diagnostic tests, post-care procedures.
Treatment in abroad or by an under-quali􀃗ed medical professional. Coverage offered by
health insurance policies vary with the insurer; however, certain points are not covered by
health policies, that fall under the category of policy exclusions. Following are common
health insurance policy exclusions:
Note: It is recommended to explore each plan to ensure the maximum coverage can be
availed.
Health Insurance Eligibility Criteria
Health insurance policy is mandatory for almost everyone, especially for those who have
dependents and/or families since they certainly do not want them to have financial strains.
Buying a medical insurance policy ensures that one's health is secured and medical expenses
are covered across a wide network of hospitals in India. One can opt for the best health
insurance policy with extended coverage on the following two bases Individual Family
Floater
Documents Required for Health Insurance Claim Reimbursement
Discharge card issued by the hospital. In-patient hospitalization bills signed by insured for
authenticity. Doctors’ prescriptions and medical store bills. Claim-form with insured’
signature on it. Valid investigation report. Consumables and disposables prescribed by the
doctors with complete details. Bills of doctors’ consultation. Copies of the Insurance policy
from the previous year and the current year/copy of ID Card of TPA. Any other document(s)
asked by TPA.
Bajaj Allianz Health Insurance
A joint venture of Bajaj Finserv Limited, a comprehensive financial services company based
out of
India and Allianz SE, the global financial services major based out of Munich, Germany,
Bajaj Allianz General Insurance Company focuses on the general insurance space in the
country, including medical insurance. The joint venture seeks to leverage successfully Bajaj
Finserv's in-depth understanding of the local Indian market and its extensive distribution
network across the country with the vast global experience of the Allianz Group. Bajaj
Finserv Limited holds a 74% stake in the general insurance company while Allianz holds the
remainder.
The company has been one of the outperformers in the space as testified by it receiving the
iAAA
rating from ICRA for the 10 year in a row. The rating highlights the company's highest
claims paying ability and its strong position in the general insurance industry. Most recently,
the company was conferred the Economic Times; Best Corporate Brand Award as an
outcome of the newspaper's Best Brands Survey for 2016. Bajaj Allianz General Insurance
was also acknowledged as the Most Admired Health Insurance Company of 2015 by Pharma
Leaders Power Brands Awards. In addition, Indian Market Research Bureau (IMRB) ranked
it second among the top health insurance brands in the country on the basis of customer
loyalty based on a syndicated survey. Bajaj Allianz General Insurance was also recently
awarded a Certificate of Appreciation by Rajasthan High Court, and Punjab and Haryana
High Court for excellence in the field of claim servicing for motor third party claims. Other
awards in 2015 included The Silicon Valley Business Award 2015 under the categories of
Best Financial App and Best Overall App for Insurance Wallet product. In addition, it won
the Claims Award Asia 2015 for the third year running, under the categories of Insurer
Claims Team of the Year for Claim Settlement during the Jammu and Kashmir floods, and
Claims Innovation of the Year for launching pioneering claim settlement practices for health
insurance claims.
SBI Health Insurance
SBI Health Insurance operated as a joint venture between State Bank of India and Insurance
Australia Group. The company offers a range of health plans for both individuals and groups.
Serving a large share of insurance customers in India, it has gained the trust of its existing as
well as prospective customers. Over these years, the company has successfully established its
feet in the vast insurance market of India. The health insurance products of SBI allow its
customers to manage their 􀃗nancial expenses. Based on the health cover required, its
customer can opt for plans with sum assured up to Rs. 50, 000 to Rs. 5, 00,000.

List of Government Health Insurance Schemes in India

Pradhan Mantri Suraksha Bima Yojana (PMSBY)

It is a government-of-India-backed health insurance scheme, which offers coverage against
personal accident resulting in accidental disabilities, or death on account of an accident. It is
offered for a period of one year and requires annual renewals. The policy is available with all
public sector insurance companies that deal in the general insurance sub-domain. All private
sector insurers are open to selling the scheme on a similar set of terms in collaboration with
various banks upon necessary approval. Anyone within the age group of 18 to 70 years, with a
savings account in any of the participating banks can bene􀃗ts from the scheme while the
AADHAR would be the prime KYC for the scheme and bank account.

RashtriyaSwasthyaBima Yojana (RSBY)

A government-run health insurance scheme for poor people in India, it provides them with
the cashless facility at various public and private hospitals across the country. Enrolled in
2008, the scheme already has over 36 million families (as on February 2014) enrolled across
25 Indian states. The operations under this plan started under the Ministry of Labor and
Employment and were transferred to the Ministry of Health and Family Welfare on April 1,
2015. As this plan works for BPL (Below Poverty Line) families, they get a smart-card that is
biometric-enabled to become eligible for inpatient medical care worth Rs. 30, 000 per year at
an empanelled hospital. The coverage for preexistingdiseases is there right from day one for
parents and up to three children.