Medical Insurance: A Quick Guide
Health issues happen to everyone, from the seasonal colds to life threatening diseases like cancer. While it is easy to manage the costs of seasonal flus, diseases related to heart, brain, lungs, kidneys and other organs of the body may require extensive treatments, tests and in some cases surgery. Health or medical insurance plans are what come in handy at these times.
What Is Health Insurance
As the name suggests, health insurance plans cover health related costs. To explain further, in the event of a medical emergency, health insurance plans will pay for the costs related to medical treatment.
It is a legal agreement between an individual or business and an insurance provider to pay for medical bills that may arise due to an insured’s sickness, accident, or other covered illness.
The insured must pay a specific amount, called a premium, in exchange for health insurance coverage as specified in the agreement. The policy must be maintained by paying the annual premium amount.
The insurer determines the premium using information such as the amount covered, the age of the applicant, any pre-existing problems, additional benefits, etc. In most cases, before verifying the necessary premium payment, the insurer conducts a medical examination of the applicant.
Medical costs that arise from hospitalisation or treatment while the medical insurance plan is active are paid as per the coverage provided.
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Health Insurance: How Does It Operate?
Health insurance plans might function in two ways regarding covered medical expenses: the cashless approach and the reimbursement technique.
In a cashless medical insurance plan, the insured person can get medical treatment at empanelled hospitals and clinics without worrying about paying the in-hospitalisation and other costs upfront. The insured gets in touch with the TPA, they review the files and make the payment directly to the hospital.
The specifics of a health insurer’s cashless treatment network, which includes participating hospitals and clinics, are often available on the insurer’s website.
In this insurance plan, the insured uses their money to pay the hospital bills. They collect all the bills and then submit these to the insurer. The insurer will review the files and then pay the amount directly to the insured’s bank account.
The insured person must submit thorough invoices, treatment records, and other paperwork by their standards.
A cashless medical insurance plan allows the insured to get medical care at accredited hospitals and clinics without having to pay for in-hospitalization or other charges up front. The insured contacts the TPA, who reviews the files and directs payment to the hospital.
A health insurer’s cashless treatment network, which comprises participating hospitals and clinics, is frequently published on the insurer’s website.
Reasons Why Medical Insurance is a Necessity
Medical insurance is more important than ever for a variety of reasons, including: –
The cost of treatment is rising:
Modern medicine has made it possible to treat the majority of serious illnesses. Instead of worrying about the cost, a person who opts for a medical insurance plan is paying a small amount of annual premium. When required the compensation amount is covered by the insurer.
However, it is of utmost importance to read the policy details to know what is covered under a plan before opting for one.
Provides a person peace of mind
Poor diet, lack of exercise, hectic lifestyles, pollution, etc., all contribute to stress. These increase chances of falling ill with issues such as respiratory disorders, stress and others which require long-term treatment and in some cases hospitalisation.
A health insurance plan enables peace of mind as the insured does not have to worry about where the money will come from when they or their family members require treatment.
Helps with unexpected medical issues
One thing we can all agree upon is that medical emergencies can happen at any time of the day or night. It requires instant action and the medical staff needs to start the treatment without delay. If medical insurance plans are opted for, then all they have to do is provide the insurance card to the hospital and without delay treatment will start.
If a person does not have insurance, unfortunately at some private hospitals the treatment may get delayed while trying to arrange money to pay admission and other bills.
It would help if you internalised that medical insurance plans protect you from financial ruin if you incur unexpected medical costs today or in the future. Being ready is the prudent thing to do.
Health insurance plans come with tax benefits. An insured persona can claim their health insurance premium as a tax deduction according to section 80D of the Income Tax Act.
Choosing the right medical insurance plan
There are several aspects to consider while choosing health insurance. The insurance company will ask for test results to determine the health of the person looking for insurance. Based on the test, and other factors such as age, gender, place of stay, family medical history and more, the coverage amount and premium payable is decided.
Evaluate the coverage options offered by different insurance plans. Consider whether the plan covers hospitalization, outpatient services, prescription medications, preventive care, and other essential healthcare needs.
Look for plans that provide coverage for a wide range of medical services and have a comprehensive network of healthcare providers.
Check the list of hospitals, clinics, and healthcare professionals included in the insurance provider’s network. Opting for in-network providers often results in lower out-of-pocket expenses.
Ensure that the insurance plan allows you to access medical facilities and practitioners that are convenient for you, especially if you have specific healthcare preferences or specialists you want to consult.
Understand the deductible amounts and co-payment requirements associated with the insurance plan. A deductible is the amount you must pay out of pocket before the insurance coverage kicks in, and co-payments are fixed amounts you pay for each medical service.
It is important to compare the different health medical plans available to get the right policy. Make sure to invest with a trustworthy insurance company as you need them in emergencies and they should be there to help and not create roadblocks.