How Health Insurance Works?

Medical emergencies involving hospitalization are situations that can raise our stress levels. For middle-class families in India, it also means high expenditure. The primary reason for this is the steadily rising cost of quality treatment at private hospitals. Hence, health insurance is highly recommended for everyone, no matter what life stage one is in. From family floater health insurance to customized plans for illnesses, health plans greatly benefit families who are looking to save on their medical expenses.

Also, one should clearly understand how health plans work in order to make the right decision when it comes to buying a suitable plan for one’s family.

How does Health Insurance Work?

Health insurance works to protect a family or individual from a financial burden that could arise during times of medical exigencies. Health insurance plans work by providing coverage for various medical expenses incurred by an individual or family in return for a sum called a premium which is paid to the company on a regular basis.

The first step to availing the benefits of health policy is to assess one’s family healthcare needs. Depending on the coverage required and consideration of any pre-existing ailment, one should opt for the best health cover that will serve as a financial cushion.

Now, let us suppose you opted for a health cover worth Rs 5 lakh and incurred hospitalization expenses of Rs 2 lakh soon after buying the policy. This is when your health policy proves to be beneficial. Since the incurred expenses are lower than the sum insured, your expenses will get covered by your policy after considering deductibles and copayments (if applicable). There are no out-of-pocket expenses to be borne by you.

To avail the health coverage, you are required to raise a claim request. There are two kinds of claim settlement:

• Reimbursement of expenses wherein the insured person is first required to pay from his/her pocket. He/she should then submit the medical bills and hospital reports to get the treatment expenses reimbursed.
• Cashless claim settlement is an option available to the policyholders if they get treatment at a network hospital. Here, your bills will be directly settled with the hospital, subject to policy terms and conditions. 

Important Points to Note about Health Plans

• The premium amount is decided after consideration of various factors such as age, income, type of coverage selected, health conditions, etc.
• At the time of buying cashless health insurance, one should check if the cashless facility is available with the specified plan opted for.
• In case of cashless claims, the policyholder must approach the hospital insurance desk for claim settlement.
• For a successful claim settlement, the insured person must adhere to the time limit set for raising a claim request. For emergency hospitalization, it is usually 24 hours from the time of admission within which the insured person must inform the customer support team. For planned treatment 48 hours before the hospitalization. 
• Health policies offer comprehensive coverage for medical expenses which is not just limited to hospitalization. The expenses may include pre-and-post hospitalization medical expenses, OPD costs, ambulance costs, etc.

From a range of health insurance plans by Care Health Insurance, you can choose the best health cover for your family and lead a stress-free life without worrying about medical costs.