Tuesday, 20 October 2020

What is Family Health Insurance? Know its Types and Claim

Family Health Insurance


Family Health Insurance is just like an Insurance Contract. It is a legal Contract Insurance Company Promise you to pay the amount up to your hospitalization cost. If you keep on paying a premium to the company. This premium depends on your Age, Family Size, and Sum Insured. This premium is fixed for a Year ( Annual premium). In instead that, Company gave you protection against a financial loss. This financial loss is due to Hospitalization. Insurance Company is not accountable Until you admit in a hospital ( In-Patient).

How to Claim Family Health Insurance and How Does it work?


IPD Charges are the expenses incurred due to admission in the hospital as In-Patient. So Company will pay if and only if Admission has happened. It could be Cashless or Reimbursement. In the case of Reimbursement, You pay on your own and then ask the company for a refund. You have to send all Bill and Medical documents to the company office for reimbursement.
What is Family Health Insurance? Know its Types and Claim
Another mode is Cashless, Which is popular these days. The insurance company does tie-up with major hospitals in the country. After this Tie-up, Those hospitals are known as Network Hospitals for Cashless That means, In case of eligible claim after hospitalization in Network Hospital Company will directly pay the eligible amount to the Network Hospital In cashless Claim, All communication is happening between Insurance Company and Hospital. Insurance Company has signed an MOU ( Memorandum of Understanding) with Hospital.

It states that If a Policyholder gets admission to a network hospital, Then Hospital will directly ask the Insurance company for claim amount. If the claim is permissible, then the Company will directly pay the amount to the hospital. In this case, Customers need not pay anything ( except non payable items) to the hospital. { Please note 100% claim is never paid, Customer has to bear the cost of Non-Payable Items) Company will pay the Permissible amount of Bill directly to Hospital.

Note: The amount is not immediately transferred to Hospital. This Transfer of money is as per terms decided between Company and Hospital. It could be 3 days or weeks or months. This transfer is a commercial transaction between hospitals and companies. Policy Holder has no Role in it. Again, The 100 % claimed amount is never paid. Non-payable items under the health policy has to be paid by you, so knowledge of your policy is important.

IRDA Publish this list of Nonpayable items every year. This list is divided into Various Categories For example, the Cost of Diaper is not covered. Now, Whether the cost of a Diaper is included in Hospital Bill, It depends on the hospital. So, there are lots of Non Payable items in the hospital bill. This list is ever-changing as per the interaction of IRDA or other professional

Organization on various Platforms. Who will pay for a particular item, It is decided. Do you know, Bandages, Cotton, Diaper, Mask, etc.are not covered in claim? Most people are not aware of it.

So, Be realistic and expect some deductions depending on the type of hospitalization. Whether it is Cashless or Reimbursement. Extra amount has to be paid by the policyholder. If someone is guiding you that " Simply go to hospital with a card and your claim will be 100% settled ".Please don't believe it. 100% claim may be payable in a very rare scenario. Mostly in real life, a 100% claim is never paid

Different types of health insurance


Individual Health Insurance Plan

An individual health insurance plan is a health coverage only for you. it covers only your hospitalization and medical bills. the premium for this particular plan is based upon your age and your medical conditions. premiums are generally lower because only you are insured in this type of health plan.

2. Family floater health insurance plan

A family floater health insurance plan covers all the family members. For Example, you want to get your spouse and your children insured in one plan and that can be done in a family floater plan. it is meant for families.

So, the insurance premium here is based upon the age and medical condition of the eldest of the senior-most member of the family. so be sure not to include your senior family members say for example your parents who are about 45 years of age into this plan because the premiums will then rise and also chances are that all the sum, in short, will be utilized by them and you all will not be left with any other plan.

Senior citizen health insurance plan

Senior citizens health insurance plan is specially designed for senior citizens. the reason I told that senior citizens shouldn't be included in your family floater is because the premiums will rise drastically and also all the sum insured may be utilized by them that is exactly why this plan has come into existence.

You see the older you grow, there are more risks of contracting diseases and hence the insurance hesitates in granting you a health insurance plan but under this, there is a profit for the insurer what he does? Is the caps the expenses that are copay comes into the picture and the senior citizen who is insured has to pay or bear some amount of hospitalization expenses and he will bear some other expenses. so this was about senior citizen health insurance plan.

Disease-specific health insurance plan


what is a disease-specific health insurance plan

For example, you are in an area wherein you are prone to contract malaria or dengue or such specific diseases so this plan is meant for only that purpose. suppose you fear that you will you are exposed to dengue what you have to do is get this health insurance plan. so if you ever happen to suffer from dengue. what happens is your insurer will cover for all the treatment that is right from diagnosis to treatment to recovery. All these expenses will be covered by the insurer.

Critical illness health insurance plan

These plans are specifically designed to cover for your critical illness expenses. critical illness can be anything from stroke or paralysis, kidney failure, etc. These diseases were supposed to be excluded from health insurance coverage but now by paying certain extra premiums. you will get a whole health insurance plan for this purpose

Group insurance plan

Even if you hadn't heard of the plants that I mentioned earlier this plan must be very familiar to you that is because every organization company nowadays provides this. Every organization or company takes a group health insurance plan for all their employees. Here what happens is the premium is very less and your pre-existing diseases or say your medical tests all these are not taken very strictly because the insurance that not everyone will fall sick frequently that is why this group insurance plan has a higher coverage at a lesser premium.

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