Health insurance plans often referred to as medical insurance, offer financial support to policyholders for various medical costs. These expenses can include surgeries, treatments, hospital stays, and bills resulting from illnesses, injuries, or accidents. When you need to use your health insurance, the insurance company will follow the rules outlined in the policy and provide the necessary benefits.
In simple words, a medical insurance or health insurance policy is like an agreement. The insurance company promises to cover the expenses if you need medical care. This could be because you get sick or injured and need treatment. In many cases, health insurance companies work together with specific hospitals, often called network hospitals. This helps you because you can get treatment at these hospitals without having to pay right away.
Benefits for Employers
Understanding the various types of health insurance plans available simplifies the decision-making process when selecting the right policy. In India, there are several distinct health insurance plan categories designed to cater to the diverse needs of individuals. These are elaborated upon below.
Individual Health Insurance Plans
In Individual health insurance plans, a single individual serves as the policyholder and gains all the coverage benefits offered under them. Individual health insurance plans usually cover the medical expenses of insureds based on the sum insured chosen and premium paid. Some of the benefits offered under these plans include hospitalisation expenses on an in-patient basis, pre-hospitalisation and post-hospitalisation basis, daycare expenses, and domestic hospitalization expenses. This is best suited for people who have higher health risks, and individual health insurance plans generally come without any limit on the maximum age for policy renewal which means that the plan offers lifetime renewability benefits to the insured. There are no restrictions on how many claims can be made during the term of an individual health insurance policy.
Family Floater Health Insurance Plans
A family floater health insurance plan offers coverage to the entire family, on a floater sum insured basis. It is advantageous to have family floaters as it makes it easier for an individual to manage his or her health insurance by covering himself or herself as well as family members. A family floater health insurance policy is also an affordable option when you have to include your parents in the policy as compared to a senior citizen health insurance policy. A family floater health insurance policy offers coverage to the following members of your family: legally wedded spouse, parents, brother, sister, dependent children, parents-in-law, and other relations varying from plan to plan, at affordable premiums.
Senior Citizens Health Insurance Plans
Senior citizen health insurance plans are meant to meet the insurance needs of people aged between 60 years and 75 years. It is advisable to get a senior citizen health insurance policy as the most individual or family floater health insurance plans fail to provide coverage to people aged above 65 years and only allow renewals. Daycare expenses, cashless hospitalisation, domiciliary hospitalisation expenses, cover for pre-existing diseases, and cover for specific diseases are some of the coverage benefits of senior citizen health insurance plans.
Critical Illness Insurance Plans
A number of life-threatening illnesses like heart attack, stroke, paralysis, cancer, renal failure, etc. are covered under critical illness insurance plans. These plans offer a lump sum amount on the first diagnosis of the critical illness and the insured can use this amount both in India as well as outside India. The insured can even use this money to clear debts if any, such as for a child’s education, or any other way based on the requirement.
Women-Specific Health Insurance Plans
As the name suggests, Women-specific health insurance plans are specially designed to cater to the insurance-related requirements of women of different age groups. Plans like these protect women from healthcare expenses at the time of maternity, retirement, cover for newborn babies, cover for child education, etc. In addition, they also cover women for specific diseases which they are prone to, after a specific age. Even if a woman already has an individual health insurance policy that the employer has provided to her, it is still better that she should buy a women-specific policy. The reason is that an individual health insurance policy, unlike a women-specific health insurance plan, sometimes fails to meet the specific needs of women and hence they miss out on coverage benefits.
Top-Up Health Insurance Plan and Super Top-up Health Insurance Plans
A top-up or super-top-up health insurance plan lets individuals increase their base policy's sum insured to cover the shortfall in case hospital bills exceed the plan's coverage. A top-up health insurance policy kicks in when the amount of claim exceeds the deductible value and the sum insured of the base health insurance policy during a policy term, in case of single hospitalisation. All claims are treated individually in these plans. Super top-up plans cover medical expenses incurred during a policy term that exceeds the deductible and sum insured limit of the base health insurance plan. They also cover expenses that are not covered by your top-up or base policy. However, the only difference is that the super top-up policy takes into account multiple hospitalisations. One can purchase a super top-up insurance policy from any insurance company irrespective of which insurance company’s base policy one has.
Disease-Specific Health Plans
People looking for wide coverage for a particular disease may be interested in disease-specific health insurance plans, such as cancer, diabetes, heart disease, etc. This plan can also be opted for by those who have a corporate health insurance plan or any regular health insurance plan as such plans may not always offer sufficient coverage for specific diseases. Disease-specific health insurance plans eliminate the waiting period, which otherwise you are required to complete if covered under a regular health insurance plan. The plan however is best suited for people with a family history of a particular disease like hypertension, diabetes, etc.
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.