Here is why a Health Insurance Policy essential for you:
A report released by the World Health Organization on non-communicable diseases (NCD) (commonly known as lifestyle diseases) paints a depressing picture of India. 26 percent of Indians aged between 30 and 70 could die from one of the four major non-communicable diseases – diabetes, cancer, stroke and respiratory diseases. The death toll was nearly 2 million in 2012 & the number keeps on adding every year. Medical experts have assigned sedentary lifestyle & physical inactivity to be the leading cause of death. Owing to the rising healthcare costs & inflationary pressures, the cost of treatment of such diseases may run into lakhs of rupees.
So, let me elaborate what the medical experts mean by “sedentary lifestyle & physical inactivity”.
Round the clock you are tied up with official deadlines & keep challenging your limits. You give priority to target accomplishments over balanced lifestyle. You skip meals, ignore workouts & push through late-night work schedules. As a result, your chances of falling sick & getting hospitalised increase manifolds. As you know, these days health care comes at a premium price. To make sure you don’t forego necessary medical treatment due to the inadequacy of funds, health insurance has evolved as a necessary expense.
Health insurance refers to an insurance contract between you & the health insurance company in which the insurer agrees to provide you with a specified health insurance cover at a particular “premium” subject to policy terms and conditions. The health cover may include expenses of hospitalisation, fees of the surgeon, prescription drugs, surgery, etc. subject to overall ceiling of sum insured (for all claims during one policy period).
With the opening up of insurance sector for private players, numerous health insurers have entered the Indian healthcare segment. But still, according to latest IRDA Report, less than one-fourth of the population has health insurance coverage.
Some of the terms used in health insurance policy are as follow:
1. Cashless Hospitalisation
It is a specialised service under which your hospitalisation expenses are paid off by the insurer directly to the authorised network hospital on the approval of the Third Party Administrator (TPA). Here, you need not make any cash payments of hospitalisation expenses to the hospital.
In this scenario, after availing treatment, you make a cash payment of hospitalisation expenses directly to the hospital. Afterwards, you may claim reimbursement for the expenditure incurred by submission of relevant documents to the TPA.
3. Third Party Administrator
It is a specialised health care company/agency/organisation authorised by IRDA to work as linking pin between the insured & the insurance company especially at the time of cashless claims processing & settlement. These agencies also provide value-added services like Ambulance services, 24-hour toll-free help lines, Medicine supplies, etc.
4. Health Card
It is an identity card which, comes with a Health Insurance Policy, is used to avail cashless hospitalisation facility at the network hospital. It contains contact numbers of TPA who can be called to seek clarification of queries.
5. Network Hospitalisation
A hospital which has an agreement with the health insurance company to provide Cashless treatment is called a ‘Network Hospital’.
6. Non-Network Hospitalisation
Non-network hospitals are those with whom the insurer does not have any agreement. If you seek treatment in these hospitals, then initially you shall pay for the treatment and later may claim as per reimbursement procedure.
Now, let me take you through some reasons as to why a comprehensive health insurance policy should form indispensable part of your financial planning:
1. Comprehensive family health cover
When the going gets tough, then health insurance gets you going. A “family floater” plan is a type of health insurance which provides coverage for you & your dependent family members. It is more efficient than getting a separate policy for each family member. Usually, benefits are available in the form of hospitalisation expenses cover, free health check-ups, the inclusion of pre-existing diseases, etc.
2. Tax Benefits
Apart from covering for medical expenses, health insurance also helps you avail tax benefits. Under Section 80D of Income Tax Act, 1961, you may claim a tax deduction of an amount of up to Rs. 25,000 towards the health insurance premium paid to cover health of self, spouse & dependent children. Additionally, the premium amount of Rs 25,000 given to cover health of parents can also be claimed as a tax deduction. If either of your parents is a senior citizen, then the deductible premium limit goes up to Rs. 30000. Following table shows details of Section 80D:
3. Better & timely medical care
Uninsured people have found to receive lesser medical care as compared to the insured ones. Especially, a chronic disease like cancer is diagnosed at a stage when it becomes malignant. Usually, either they do not receive preventive care when it is required urgently or even if they receive, it is of no use because crucial time is already elapsed. Moreover, they are less likely to receive rehabilitative care as compared to the insured ones.
When you & your family get enrolled under a health insurance policy, you can access top-notch health care providers, specialist doctors, hospitals and clinics at the right time & a reasonable cost.
A study has found a correlation between health insurance coverage & longer lifespan. The risk of death was 25% higher in the uninsured people as compared to the insured people. The tendency to end a treatment before complete recovery was greater in uninsured individuals who lowered their health status significantly.
Thus, if you have health insurance coverage, then chances of living a longer & healthier life increase significantly.
5. Financial Stability
When any health insurance policy covers you, you get specialised medical services at a nominal price. In the absence of such coverage, you may have to shell out more to access the same quality of medical services. Moreover, you may have to divert those funds which you have earmarked for some other financial goal to pay medical bills. Such a diversion on a continuous basis could hurt your financial stability & impede accomplishment of overall financial goals.
Thus, you can secure your financial stability as well as achievement of financial plans by getting your health risk covered under health insurance.
6. Support for medical emergencies
Many times, there are emergencies wherein the insured does not have enough time to withdraw cash & then get hospitalised. Health insurance comes handy in such a scenario as it provides the facility of “cashless hospitalisation” wherein you can directly get admitted to a network hospital on showing your health card. The bills would be settled directly by the insurance company on your discharge.
7. Peace of mind
The risk related to the inability to handle medical emergencies causes stress. Stress is the reason for all ailments as it weakens your immune system. Health insurance coverage provides various kinds of benefits that enable you to handle difficult situations confidently. You can, thus, live a peaceful & relaxed life.
Both lack of health insurance and inadequate health insurance may lead to various financial & medical problems. Corporate insurance policies cease to cover risk in the event of job changes or layoffs. Hence, it is important to buy an additional health cover for yourself & family. Health insurance is a function of your annual income, average medical expenditure, family history of NCDs, the number of dependents, lifestyle habits, place of residence, occupation, age, etc.
Suppose if you have a corporate insurance policy, then you may buy an additional cover of Rs 1 lakh each for yourself, spouse and kids. If you don’t have an employer-sponsored cover, then you may hike the cap to around Rs 2 lakh and then buy a family floater for Rs 6 lakh further subject to factors mentioned earlier.
Moreover, if you belong to a higher age bracket, then you may need to shell out a higher premium. These days the underwriting processes of the health insurers have become stringent & rejection of proposal may happen on account of numerous reasons. My advice to you is to disclose all your facts truly & fully & insist on medical examination from a reputed laboratory. Get a health check-up done on your own to rule out minor illnesses. Finally, understand the terms, conditions & exclusions of the health insurance policy clearly & settle for a plan that meets your requirement completely.