Medical insurance, also known as health insurance, is a financial product that provides coverage for medical expenses and healthcare services. It helps individuals and families manage the costs of healthcare by paying a portion of their medical bills. People realized it’s benefit during recent Covid times. More awareness observed after this.
Here are some key aspects of medical insurance:
- Coverage: Medical insurance policies typically cover a wide range of healthcare services, including doctor's visits, hospital stays, surgeries, prescription drugs, preventive care, and more. The specific coverage and what is considered "in-network" can vary depending on the policy and provider.
- Premiums: Policyholders pay regular premiums to maintain their medical insurance coverage. Premiums can be paid monthly, quarterly, or annually, depending on the insurance plan.
- Deductibles: Many insurance policies have a deductible, which is the amount the insured individual must pay out of pocket before the insurance company starts covering medical expenses. Deductibles can vary widely. It’s important to get information of these deductibles before we subscribe to any policy.
- Co-Payments and Co-Insurance: After meeting the deductible, policyholders often have to pay a portion of their medical expenses, either as co-payments (a fixed amount per service). The insurance company covers the remaining portion.
- Networks: Many insurance plans have networks of healthcare providers, including doctors, hospitals, and clinics. Staying within the network typically results in lower out-of-pocket costs, while going out of network can be more expensive.
- Preventive Care: Medical insurance often includes coverage for preventive services like health screenings and wellness visits at no additional cost to the insured. This is to encourage preventive healthcare.
- Emergency Care: Medical insurance typically covers emergency medical services such as ambulance transportation – ground and/or air.
- Prescription Drug Coverage: Many health insurance plans provide coverage for prescription medications, either with a fixed co-payment or co-insurance.
- Specialized Care: Some policies cover specialized care, such as mental health services, maternity and childbirth, and dental or vision care, though these are often subject to separate policies or riders.
- Government Programs: In India programs such as Aasyushman Bharat. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a national public health insurance scheme of the Government of India that aims to provide free access to health insurance coverage for low income earners in the country. Roughly, the bottom 50% of the country qualifies for this scheme. People using the program access their own primary care services from a family doctor and when anyone needs additional care, PM-JAY provides free secondary health care for those needing specialist treatment and tertiary health care for those requiring hospitalization.
- Employer-Sponsored Insurance: Many people receive health insurance coverage through their employers, which often subsidize the cost of premiums as an employee benefit.
It's important to carefully review and understand the terms and conditions of your medical insurance policy, including any limitations, exclusions, and the process for making claims. Additionally, it's advisable to regularly review your insurance needs and compare different insurance plans to ensure you have the right coverage for your specific healthcare needs and financial situation.
Various types of Health Insurance policies available in India at present are:
- Individual insurance plans: This is the most common type of health insurance plan in India. Such a policy only covers an individual. It takes care of your medical costs in case you are admitted into a hospital. The premium in such cases will depend on personal factors such as your age, medical history, etc.
- Family floater insurance plans: As the name suggests, this type of health insurance plan covers the entire family. It is similar to an individual policy except that the sum insured in this case is usually higher and is shared between the family members. One of the main advantages of such an insurance plan is that you need not manage different policies. Moreover, such policies are also more cost-effective than buying an individual policy for each member.
- Senior citizen insurance plans: These health insurance policies are specially designed for senior citizens who are usually above the age of 60. Since old people are more likely to make a claim, the premium to be paid is higher in such cases. Also, many insurers don’t stress on a pre-medical screening or exclude pre-existing diseases before granting senior citizen insurance because old age often comes with health issues.
- Critical illness insurance plans: A critical illness insurance plan insures you for fatal diseases such as kidney ailments, heart attacks, cancer, paralysis, etc. In such cases, the policyholder receives a lump sum amount on the diagnosis of the covered illness. Unlike individual policies, no hospitalization is needed for claiming the money. Such a plan is advisable for those who have a history of such illnesses in their family.
- Personal accident insurance plans: Accidents are common and the expenses they bring along can drain all your savings. A personal accident insurance covers the cost of medical treatment needed after an accident. Usually, such a policy offers benefits against 3 events – partial disability, total disability, and death due to accident.
- Maternity insurance plans: These are women-specific health insurance plans. Such plans provide coverage for pre-natal and post-natal expenses along with the delivery and ambulance cost. A baby cover is also provided wherein the expenses related to the new-born baby are covered up to a certain duration. Most maternity plans have a waiting period before they get active. Thus, it is prudent to buy such cover as soon as a woman gets married. These can also be taken as an add on to a basic policy.
- Unit Linked Insurance Plans: Unit Linked Insurance Plans or ULIPs are insurance plans that double up as investments. When you pay the premium, a part of it is utilized for providing cover to you, as usual. The remaining amount of the premium is invested in a mix of equity and debt. With ULIPs, you not only secure your health but also build wealth for the future with the returns.