A good health insurance plan is the biggest gift that you can give to yourself and your loved ones. It provides you with mental and financial support during times of medical emergencies. The rise in the number of diseases and the ever-increasing medical costs associated with them can cause a serious hit to your pocket. To manage your finances, a
health insurance plan can come in handy. But do you know about the common health insurance features? Read this blog to understand them.
Key Highlights
- A health insurance plan protects you and your family during medical emergencies
- There are different types of health insurance plans like individual, family floater, senior citizen, etc
- Understand the waiting period and sub-limits under health plans as they restrict the coverage
- You must check the various policy exclusions and carefully analyse them before making the purchase
Top Health Insurance Features to Know About
A health insurance plan is usually designed to meet your financial needs during emergencies. Hence, they offer various features to suit those needs. You must carefully check all the features and then select the one that is the most beneficial for you.
Some of the top features of health insurance are as follows:
Types of Health Plans
Health insurance plans are categorised into various types, depending upon their coverage. Some of the types of health plans, along with their meaning, are explained below:
Type of plan |
Meaning |
Individual Health Insurance Plans | The plan covers one individual for a single sum insured |
Family Floater | The plan covers the entire family which includes the proposer, spouse, dependent children and dependent parents. The entire family can use the sum insured |
Senior Citizen Health Insurance | The plan is designed to cover individuals aged 60 years and above |
Critical Illness Insurance | The plan covers listed illnesses and pays a lump sum benefit if you are diagnosed with any covered illness |
Personal Accident Insurance | The plan covers accidental deaths and disablements and pays a lump-sum benefit |
Top-up and Super Top-up Plans | These plans offer supplemental coverage and come with a deductible limit. Claims exceeding the deductible are paid, and the premiums are low |
Waiting Period
Full coverage under health plans does start immediately. For some illnesses, you might have to wait for a few days, months or years to avail of the benefits. This period is called the waiting period, during which coverage is not available.
The various types of waiting periods for a health insurance plan are as follows:
Type of waiting period |
Meaning |
Initial Waiting Period | Waiting period of 30/60 days, starting from the issuance of the policy. No claims are accepted during the waiting period. Exceptions are made in case of accidental hospitalisation. |
Maternity Benefit and New-born Baby Cover Waiting Period | Usually 9 months-48 months, depending upon the policy terms |
Pre-Existing Disease Waiting Period | Usually 2 to 4 years of issuance of the policy. Some policies allow reducing the waiting period at an additional premium |
Specific Diseases Waiting Period | Usually, 1-2 years of the policy on listed illnesses and procedures. |
Accidental Hospitalisation Waiting Period | No waiting period. Immediate coverage is allowed |
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No Claim Bonus
The insurance companies offer a no-claim bonus or NCB as a reward for having made no claims in the past year. It means that if you make no claims in a particular year, you will be entitled to receive an NCB from your insurer. An NCB is offered in two ways, which are described below -
Types of NCB |
Benefits/features |
Cumulative Bonus | The amount of your sum insured increases by a certain percentage The premium of the policy remains the same |
Discount on Premium | You get a discount on your renewal premiums up to a certain percentage. |
Also Read -
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Exclusions
There are exclusions under every health plan wherein coverage is not allowed for specified illnesses or treatments. Some of the common exclusions are as follows:
- HIV/AIDS or any other STD
- Cosmetic treatments like plastic surgery, breast enhancement or body contouring
- Dental Procedures, unless the need arises out of an accidental injury
- Deliberate or self-inflicted injury or suicide attempts
- Congenital disease
- Claims due to war or after-effects of nuclear weapons
Sub-Limits
Sub-limits are limits on specific medical-related expenses such as room rent, ambulance costs and consultation fees. Sub-limits are also placed on specific medical procedures such as cataract removal, knee ligament replacement, etc.
Sub-limits dictate the maximum coverage on the specified expenses or procedures. If the expenses exceed the sub-limit, you have to bear the additional costs.
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Pre and Post-Hospitalisation Expenses
Pre and post-hospitalisation expenses refer to the expenses that you incur before and after hospitalisation. Health plans offer these benefits for a certain number of days. The expenses covered include doctor visits, medicines, diagnostic tests, etc.
Understand the Features to Buy the Right Plan
A health insurance plan safeguards your future, protects you from financial problems during medical contingencies and ensures that you and your loved ones receive proper medical care and attention. Hence, you must choose an insurance plan that takes care of all your needs during such emergencies, offers you maximum features and provides you support both financially as well as mentally.
FAQs
Q1 - What features should I look for while purchasing a health plan?
Some of the health insurance features that you must consider before making a purchase are:
- Coverage features
- Premium
- Network hospitals
- Ease of claims (both cashless and reimbursements)
Q2 - What is meant by co-pay in health insurance?
Co-pay is a health insurance feature wherein you undertake to pay a specific percentage of the claim from your pocket while the insurance company pays the rest.
Q3 - Do I need to claim my NCB every year or can it be accumulated?
In the case of cumulative bonus wherein the sum insured increases every claim-free year, the NCB is accumulated. For premium discounts, you can claim the NCB every year.
Q4 - Which health insurance plan is best for me?
There is not a universal health insurance plan which can be best for you. The choice depends on your needs and requirements. You must take into account your requirements, your premium payment capacity, and the various features of the policy and then, select the plan which suits your needs the most.
Q5 - How can I make a health insurance claim?
Health insurance claims can be availed in two ways-
Cashless: Under this facility, you do not have to make any payments from your pocket. All you need to do is locate an empanelled hospital, submit your insurance papers, and the insurance company will directly pay the hospital bills.
Reimbursement: Under this, you are required to pay the bills out of your pocket first. Once, you are discharged from the hospital, you can claim a cashback/reimbursement from your insurance company by submitting all the bills along with supporting documents.