What is Health Insurance?

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.

Health Insurance And It's 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.

Rashtriya Swasthya Bima 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
preexisting
diseases is there right from day one for parents and up to three children.