What is Medical Insurance and its benefits?

Medical Insurance Policy is a contract between the insurer and the policyholder where the insurance company helps the insured to meet the medical expenses. A health policy provides the benefit of reimbursement of medical expenses or cashless treatment for an illness or accidental injury.

What is medical insurance?

Medical insurance is a type of insurance that provides medical coverage against medical expenses arising out of a health emergency. A health insurance plan provides financial assistance to the policyholder to cover hospitalization expenses, day care procedures, ICU charges and critical illness benefits. The policyholder can also buy a health insurance plan to avail tax benefits on the premium as per the Income Tax Act, 1961.

Top Reasons to Buy a Medical Insurance Policy:

The cost of medicine is increasing every day, making the treatment costly. If you get hospitalized for a serious illness or lifestyle disease, you can lose all your savings. Buying a health insurance policy is the only way to afford quality medical treatment during a health emergency. Take a look at some of the top reasons to buy a health insurance plan below:

 Beat Medical Inflation –

 A health insurance policy can help you pay for your medical bills, including pre and post hospitalization expenses, as well as in the future despite rising medical costs.

Afford Quality Medical Treatment –

 It helps you afford the best quality medical treatment and care so that you can focus only on recovery.

Fight Lifestyle Diseases –

 It allows you to pay for long term treatment of lifestyle diseases like cancer, heart attack, etc which are increasing with changing lifestyle.

Protect your savings –

 It helps you to safeguard your hard earned money by covering your medical expenses so that you can avail the necessary treatment without any financial worries.

Avail Cashless Hospitalization Facility – 

It allows you to avail cashless hospitalization facility at any network hospital of your insurance provider by making a cashless claim.

Avail Tax Benefits –

 It enables you to save tax on health insurance premiums paid under Section 80D of the Income Tax Act for better financial planning.

Ensure peace of mind –

 It allows you to get medical treatment with peace of mind as you don’t have to worry about paying huge hospital bills.

Major Benefits of Medical Insurance Policy in India:

Medical Insurance Policy provides many types of health benefits to the insured depending on the plan. Following are the major benefits of buying a medical insurance policy in India:

Hospitalization Expenses –

 A health insurance plan covers medical expenses incurred in case of hospitalization for more than 24 hours. This includes room rent, doctor’s fee, cost of medicine, diagnostic test fee, etc.

Pre and Post Hospitalization Expenses – 

This includes medical expenses incurred on any illness before hospitalization as well as post-discharge treatment expenses. Pre-hospitalization and post-hospitalization expenses are covered for a specified number of days as specified in the policy document.

ICU Charges – 

A health insurance plan also covers the cost of availing treatment in ICU during hospitalization.

Ambulance Cost – 

This covers the cost of ambulance services received to reach the nearest hospital during a medical emergency.

Cashless Treatment – 

All health insurance providers in India offer cashless treatment at their network hospitals. If you get admitted to an out-of-network hospital, you need not worry about arranging money to pay the hospital bills as it will be settled by your insurer under cashless claims.

Day Care Procedures – 

This also includes the cost of availing day care treatment which requires hospitalization for less than 24 hours.

Pre-existing diseases –

 The best health insurance policies offer coverage for pre-existing diseases as well after you complete the waiting period. Usually pre-existing diseases are covered after a waiting period of 2 to 4 years.

AYUSH Treatment – 

​​This includes the cost of getting medical treatment through AYUSH school including Ayurveda, Unani, Homeopathy, Siddha and Yoga.

Medical Check-up –

 Most of the health insurance companies in India provide free preventive health check-up facilities to the insured at regular intervals depending on the terms and conditions of the policy.

What is included in the Medical Insurance Policy?

Most of the medical insurance companies in India cover the following medical expenses under a medical insurance policy:

 Inpatient Hospitalization Expenses – 

Hospitalization expenses during treatment of an illness or injury are covered, provided the hospitalization exceeds 24 hours.

Pre-existing Illnesses or Illnesses –

 After the completion of the waiting period, you can file a claim for the cost of treatment for any pre-existing disease or condition.

Pre and Post Hospitalization Expenses –

 Medical expenses on blood tests, X-rays and other medical tests which are required before hospitalization are borne by the insurance company. Similarly, the cost of medicines and preventive health check-ups to ascertain your health after discharge from the hospital are covered under a health insurance plan.

Ambulance Charges – 

Although the coverage amount varies from insurer to insurer, most medical insurance plans cover emergency ambulance charges.

Maternity cover –

 Medical expenses incurred during pregnancy and delivery are covered along with the expenses of the newborn.

Preventive Health Check-up –

 Regular health check-up facilities are also provided in some health insurance plans in India.

Day-care procedures – 

Daycare treatments where hospitalization is not required for more than 24 hours are covered. This includes eye surgery, dialysis and other common daycare surgeries as mentioned in your policy document.

Home Remedy Cover –

 It also covers the expenses incurred on getting medical treatment at home on the advice of a doctor.

AYUSH Benefit –

 A health insurance plan also reimburses medical costs on Ayurveda, Unani, Siddha or Homeopathy treatment up to a specified limit.

Mental health care cover – 

Many health plans in India provide coverage for medical expenses incurred on treatment of mental illness, such as depression.

 What is not included in the Medical Insurance Policy?

The following medical expenses and conditions are not covered by a health insurance plan:

  • Claims arising during the initial 30 days of purchase of a health insurance plan are not covered, unless there is an emergency.
  • Pre-existing diseases coverage subject to waiting period of 2 to 4 years
  • Critical illness coverage usually comes with a waiting period of 90 days
  • Injuries due to war/terrorism/nuclear activity
  • Self-injury or suicide attempt
  • Incurable diseases, AIDS, and other diseases of a similar nature
  • Cosmetic/plastic surgery, hormone replacement surgery, etc.
  • Dental or eye surgery expenses, bed rest/hospitalization and rehabilitation, general ailments etc.
  • Treatment/diagnostic tests and after-care procedures
  • Claims arising out of adventure sports injuries

Also read: What is Corporate Health Insurance?

Eligibility Criteria for Buying Medical Insurance Policy:

The eligibility criteria for buying a medical insurance policy depends on several factors such as the age of the policyholder, pre-existing diseases, etc. In most health insurance plans, the following eligibility criteria must be met:

Age Criteria- 

The entry age criteria for adults and children varies and can range from 18-65 years and 90 days to 25 years respectively. Actual age may vary from one medical insurance policy to another.

Pre-Medical Screening- 

Pre-medical examination is required for applicants aged 45 years or above 55 years. However, most senior citizen health plans require pre-medical tests before issuing a policy.

Pre-existing diseases- 

Any pre-existing diseases are covered after completion of waiting period i.e. 2-4 years. Most of the health insurers ask the applicant whether they are going through any medical condition like blood pressure, diabetes, heart disease, kidney problems etc while buying a health insurance plan. If you are a smoker or an alcoholic, you must disclose this to the insurance company.

Do not keep it a secret as it can lead to problems at the time of claim settlement. It can also cause your claims to be denied. Based on this criterion, the insurance company decides to provide medical coverage to the applicant.