Health Insurance Benefits And Plans Eligibility Criteria
Health Insurance Benefits And Plans Eligibility Criteria.The significance of health insurance cannot be overemphasized as it has to do with providing financial cushion in the face of such circumstances as illnesses. In the current world, being covered by a good health insurance is not just a luxury but a necessity in equal sense since healthcare costs are rising everyday. This article will focus on the following topics, that is, the advantages of health insurance, the various categories of heath insurance policies and the factors to consider while choosing on the right insurance policy.
Benefits of Health Insurance
1. **Financial Protection**
The first advantage that is accrued under health insurance is protection in terms of finance. Health care costs are even high when it comes to medical treatments as seen in Private Hospitals. When you have a reliable health insurance policy, then you will be relieved of the burden of making a huge amount of money to cater for the costs of your medical bills. The insurer pays for the expense of the hospital, to surgery etc depending on the insurance policy.
2. **Comprehensive Coverage**
The insurance policies not only entail hospitalization expenses that include domiciliary, pre & post – hospitalization, ambulance charges – day-care procedures and even consultation fees. It also includes the coverage for services such as Ayurveda, homeopathy and other known systematic therapies.
3. **Cashless Treatment**
A majority of the health insurance companies have arrangements with a list of hospitals from where policy holders can get their treatment done with reimbursement facilities. This means that instead of the patient having to pay the bill in advance for the treatment to the hospital, the insurer does it on his/her behalf. It helps to avoid the pressure of sourcing for funds whenever there is an emergency.
4. **Tax Benefits**
Premiums of medical insurance policies are allow abate under section 80D of the Income tax Act of 1961. People can also avail up to ₹25,000 exempt limit in respect of payment of premiums for themselves, their spouses, and dependent children. Moreover, for the senior citizens, this limit is higher up to ₹50,000.
5. **Wellness Programs**
Most of the health insurance services available contain some element of the Wellness program. These include things like preventive check-ups, fitness app subscriptions whereby people get to join the gym for a certain amount of money per month, and more.
6. **Critical Illness Coverage**
Of course, a lot of health insurance policies go with critical illness where the life threatening illnesses such as cancer, heart attack, kidney failure, etc. These illnesses often need long term treatment and the costs may be high. Critical illness coverage comes in helpful in that it pays a lump sum to cater for these costs.
7. **No Claim Bonus (NCB)**
In this case, when a policyholder does not you didn’t make any claims within the year covered by the policy, then what is given is a No Claim Bonus. This bonus may either be in the form of a rebate on the subsequent financial year’s premium or the boosting of sum insured free of charge.
Types of Health Insurance Plans
1. **Individual Health Insurance Plan**
This type of plan affords an individual with protection for the different diseases as well as the medical bills. It includes hospitalization, surgery, often even medication. The money being insured is the policy amount which is available for one person and the premium payable varies with the person’s age and medical history.
2. To meet the contingent’s diverse needs, a number of HF offers the most suitable product, the **Family Floater Health Insurance Plan**.
A floater plan is one which offers insurance protection to more than one person within the same family under one specified amount. It is cheaper because the premium is lower than if each member were to take his/her own policy. In the event of sickness or any medical ailment or even accidents any of the family members can come forward and make a claim from the total sum insured.
3. **Critical Illness Insurance Plan**
This plan is designed to help those with major medical conditions such as cancer, stroke, kidney failure and other significant disease. They pay a stated amount on first diagnosis of one of the mentioned serious diseases regardless the expenses incurred on hospital bills.
4. **Group Health Insurance Plan**
Group health insurance plans are common offers which employers make to their employees. These plans are provided to a specific group of people often with a rather standard size of coverage. It is cheap for companies and the employees and gives some extent of health cover.
Health Insurance Benefits And Plans Eligibility Criteria
5. **Health insurance plan for senior citizen**
Such plans are mainly prepared for individuals who are older than 60 years of age. They offer health risks that are prevalent in the old people like cataract, joint replacement, heart ailments, among others. This is due to the fact that people with the advanced age are considered to be a higher risk thus the premium may be higher.
6. **Maternity Health Insurance Plan**
Maternity insurance plan is basically meant to cater for all the expenses that are incurred in the process of child birth right from the time of conception to the time of delivery. This may cover expenses of newborn baby, vaccination costs, and delivery emergency expenses that can protect women who are pregnant or even giving birth.
7. **Top up & Supertop up Health Insurance Policy**
Top-up insurance plan is an insurance policy which complements your existing health insurance policy once the main limit is used up. A super top up plan function in a way similar to this, but it looks at the total Overview We medical expense for the year rather than per claim basis.
Eligibility Criteria for Health Insurance
Every company has its own rules regarding the eligibility of their health insurance policy so one must verify before buying one. Here are some common factors to consider:Here are some common factors to consider:
1. **Age Criteria**
Generally, health insurance policy or plan shall have a set minimum age and maximum; that is ages of application. Most of the individual health insurance policies contain an entry age of 18 to 65 years of age. Depending on the insurer, the family can be floater and the dependents can range from infants for example 90 days and above. The senior citizen plans are for people that are 60 years and above.
2. **Pre-existing Medical Conditions**
The majority of health insurance companies in existence have a principal exclusion period for the pre-existing health conditions, which may take between 2-4 years. If the applicant has such pre existing health conditions as diabetes, hypertension, or asthma the insurer may either decline the application or give a longer period before the medical condition can be covered.
3. **Medical Tests**
Certain companies expect the clients who want to apply for insurance, especially those who are more than 45 or 50 years expect them to under go through some medical examination with a view of determining the health state of the applicant before agreeing to give him or her the policy. This enables the insurer to assess the level of risks that are related to the given individual and thus set a premium to be charged.
4. **Occupation**
Some occupations increase your chances of getting compensation in case of an accident hence they may reduce your chances of getting a health insurance plan or they will charge you a higher premium if you are a miner, constructor or if you work in a very risky environment.
5. **Geographical Location**
There are Health insurance companies who may have restrictions as to where they cover within the country or they may have different charges for the regions. Those residents living in metropolitan cities could be charged higher premiums than those in the rural areas given the fact that the cost of delivering health care services is relatively high in the urban areas than the rural areas.
6. **Waiting Period**
Standard T&Cs of most of the health insurance policies mention a mandatory 30 day waiting period from the date of start of the policy for non accidental hospitalization claims. Also, there is waiting period for taking Maternity benefits, Pre-existing diseases, or specific treatment like Cataract surgery.
7. **Dependents Coverage**
Under family floater plans, the insurance companies cover any number of spouses, dependant children and sometime parents. Regarding dependant children, there is always an upper age limit beyond which the dependant cannot be covered, usually up to 25 years of age and the dependant has to be unmarried and solely dependent on the policyholder.
Conclusion
Selecting a proper health insurance plan depends on the benefits which are to be offered and the criteria that one has to meet. One must evaluate the current state of his/her health, compare the options and read all the requirements and conditions stated on the policy. Whether you want to ensure yourself for a specific amount or your family for a fixed amount, the correct form of insurance will give needed defense and rest in the course of medical crises. It is also for this reason that one should always compare different plans, although consulting insurance advisors is equally important in finding the best health plan.