Medical expenses are soaring high day by day and paying for them could dig a deep hole in your pocket. Though availing top notch medical aid was never cheap but with today’s ailments and diseases and our reduced immunity the need has become more frequent. Health insurance comes in handy to meet emergencies of severe ailment or accident and even disability in some cases. Health insurance is an affordable way to safeguard oneself against the unpredictable healthcare requirements in life.

Co- Payment refers to the amount borne by the Insured’s in respect of each and every claim subject to the policy’s terms & conditions. Insurer’s liability to pay the benefit amount is over and above the Co- Payment amount.

Co- Insurance refers to the amount the Insurer would pay before receiving the claim benefit. For example: If the Co- Insurance amount is agreed at 30%, then the insurance benefit in any case would be restricted to the remaining 70 %. In such scenario the Health Insurance Company pays 70% and the Insured agrees to act as a Co Insurer for the remaining 30% of the claim amount.

Pre – Existing Disease refers to any disease or related condition for which the Insured has received Medical advice or treatment before the commencement of the Insurance Policy.

Pre – Existing disease might lead to serious implication in future. As such certain companies completely exclude them while some cover Pre- Existing diseases after a certain period of time.

In case of claim with respect to any medical sickness or injury, all Prescriptions, receipts, original Doctor bills, Hospital admission/ Discharge card, Diagnostic / investigative reports along with the completed claims form needs to be submitted.

TPA stands for Third Party Administrator and is an approved Health Care service provider of the Insurance Company. The insured is supposed to contact the TPA for any claim assistance as it helps the insured in faster claim settlement.

No claim Bonus refers to the premium discount received on Policy renewal. The insured is eligible for No claim bonus, in case of no claim during the previous policy year.

The Premium chargeable for a Health Policy is determined by actuaries of the Insurance Companies based on several factors. In case of an Individual health policy, “adverse selection” is one such factor wherein the insurance company might charge slightly higher premium as compared to a group policy, assuming that there is higher probability of an Individual claiming medical benefits. However in case of a group policy, a certain number of people would never claim any medical benefits. Other such factors determining the cost of an Insurance Policy would be the age of the Insured person, amount of coverage required and other additional benefits.

Health Insurance is an affordable way to safeguard oneself against the unpredictable healthcare requirements in life by offering coverage for most of the medical treatments and procedures. However in case of life Insurance, if the insured dies, lump sum amount is paid to the beneficiary.

Health checkups are necessary for issuance of a health policy if the Insured’s age is above 45 Years subject to the Policy’s Terms & Conditions.

Every Health Insurance Policy has certain exclusions subject to the Terms & Conditions of the Policy. Some of the main exclusions are:

• Any type of Cosmetic or dental Surgery
• Maternity expenses
• Any Pre – Existing disease or condition subject to the policy’s Terms & Conditions.
• Any type of disease or injury contracted during the first 30 days of the policy.
• Certain diseases subject to the policy’s conditions are not covered for the first few years of the Policy.
• Non allopathic treatment
• War, riots, strike, terrorism acts, nuclear weapon induced treatment.
• Diseases such as AIDS, HIV.
• Self inflicted injury, or Injury caused due to intoxicating substances, drugs or misuse of liquor.

In case the insured dies while receiving treatment, the nominee or the next legal heir of the deceased receives the claim amount. In case of cashless Hospitalisation, the treatment expense is settles directly b/w the Insurance Company/ TPA and the Network Hospital.

Cashless Hospitalisation means direct settlement of medical bills by the Third Party Administrator (TPA) on behalf of the insured. Cashless facilities are available only at network hospitals and are subject to prior approval of TPA.

A person can buy more than one health Insurance policy. However In case of claim, each Insurer contributes toward the claim amount restricted to a percentage. In simple words, the Claim amount would be shared amongst all the Insurers.

All health insurance plans/riders are eligible for tax deduction under Section 80D of the Income Tax Act, 1961 .Under section 80 D, premium paid for a Health Insurance policy for self, spouse, dependent children and dependent parents is eligible for a deduction up to Rs.15,000/- per annum. In case both or any one the parent is senior citizen, an enhanced exemption limit of INR 20,000 is available. Section 80D also covers payment of premium exclusively for Critical Illness Rider.

Pre Hospitalisation refers to any expense incurred in relation to injury/illness for which the insured is eventually hospitalised. Most of the Insurance Companies have a 30 day Pre Hospitalisation period covering medical expenses incurred 30 days prior to hospitalisation.

Post Hospitalisation expenses refer to any expense incurred in relation to the medical treatment received by the insured. Most of the Insurance Companies provide 60 Days post hospitalisation cover after being discharged from the hospital.

For example: expenses incurred on medicines, diagnostic test, Doctors consultation fees etc are covered under Pre & Post Hospitalisation.

Daily Cash benefit is also known as Hospital cash allowance and refers to a definite sum of money, paid to the insured in case of hospitalisation. This benefit amount depends upon the type of cover and the coverage amount applied for.

OPD includes diagnostics tests, dental treatment, cost of medicines, drugs, ambulance charges and related expenses.

At times, the insured receives medical treatment at home subject to the following two conditions:

• Due to non availability of beds in Hospital, patient receives the same treatment at home.
• The medical condition of the patient is so critical, that the patient can’t be shifted to Hospital.

In such scenarios the expenses incurred on medical treatment received at home are termed as domiciliary expenses.

Maternity related expenses are not covered under health Insurance.

Waiting period is the duration for which the Insured is not covered for any medical treatment. Most of the Insurance policies have a 30 day waiting period after the commencement of the policy, during which no amount can be claimed for any medical expense as a result of illness.