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How Does Health Insurance Work In India

Health Insurance


Today, being covered by a health insurance policy is vital. It offers protection from the price of medical care and other health-related expenses. Hospitalization costs, pre- and post-hospitalization costs, ambulance fees, room rent, doctor consultation fees, day-care treatment fees, evacuation fees, and severe illness-related costs amongst others could be said to be a few of the frequent items covered by most health insurance policies.

Despite investing in a health insurance policy, most people are often clueless about the workings of these health policies, especially in India.

 How health insurance works in India

  • Choosing a health insurance provider: The insured’s journey starts when he buys a policy. There are various types of health insurance policies. You can choose an insurance policy based on the coverage offered, the inclusions, the exclusions, and the premium. This marks the beginning of your interaction and relationship with your health insurance service provider. *

* Standard T&C Apply

  • Medical tests: A thorough medical examination may be performed to determine your overall health. Your health is a major factor in your health insurance premium calculation.
  • Deciding the  sum assured and premium: Depending on your age, health, and income, the insurance provider shall decide how much you should pay for your health insurance premium. The service provider can establish an annual premium and approve the sum assured based on these considerations. You could compare multiple health insurance plans using the online insurance premium calculator to get an idea of your premium amount.
  • Claims: Any claims that fall under the sum assured cap can be paid out based on additional criteria, like deductibles and co-payments.
  • Cashless hospitalisation: You must determine whether the coverage is a cashless insurance policy in case of hospitalisation. If the insurance is cashless, you must speak with the network hospital’s Third Party Administrator (TPA). Your hospital cost may be directly settled by the TPA. * 

* Standard T&C Apply

  • Non-cash reimbursements: If the procedure requires upfront payment, you may be responsible for paying the bills before your insurance company reimburses you.

If the policy is not cashless, you must submit a claim to the TPA with the hospital bills, reports, doctor’s summary, and discharge report. These TPAs will gather your supporting documentation, check it, and guarantee that your claim application is comprehensive. They may submit the claim to the insurance provider after the application is complete.

Accordingly, the insurance provider may handle the claim and pay the expenses.

There can be a few exclusions, such as having to pay a percentage of the expenses yourself. The term for this is co-payment. There could be a small number of things that the insurance provider pays proportionately. They are referred to as deductibles. The insurance company deducts the remaining costs after paying various expenses in a specific proportion. This sum may be directly credited to your bank account by the insurance company.

  • Smooth process: The process surrounding claims is hassle-free overall. It takes little time, and the majority of insurance providers are helpful in smoothly processing the claims.
  • Cumulative Bonus: Some insurance companies give you a cumulative bonus if you don’t file any claims within a specific year. This might be in the form of an increase in the sum assured.

Before you buy one, always remember to do a thorough comparison of various health insurance plans in India. Investing in these health insurance products requires a thorough understanding of how this insurance market operates. You can only make effective claims and utilise your health insurance coverage to its full potential if you have complete information. *

* Standard T&C Apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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