Types of Health Plans

Critical illness plans

Critical illness plans are fixed benefit plans which pay a lump sum amount irrespective of the actual costs incurred. These plans cover a list of major illnesses. If you are diagnosed with any of the covered illnesses, you get a lump sum benefit which is the sum insured chosen by you.

Disease-specific plans

There are Health Insurance plans which are designed to cover individuals suffering from specified ailments. These plans provide coverage to ailing individuals who are otherwise excluded from normal Health Insurance plans. Some common ailments covered by these plans include diabetes, heart-related problems, dengue etc.

Group health plans

Indemnity Health Insurance plans which are taken by a group are called group health plans. There is one policy covering all the members of the group. The premiums are low and can be paid by the group, individual members or by both.

Personal accident plans

These health plans cover death and disability arising out of an accident. The sum insured is paid in full in case of death or permanent total disability. However, in case of permanent partial disabilities, a proportion of the sum insured is paid depending on the plan's features.

Top-up health plans

Top-up health plans are Health Insurance plans which supplement your existing Health Insurance coverage. These plans help you in increasing the sum insured at affordable premiums. There is a deductible limit under top-up plans. If any claim exceeds the deductible limit, the plan benefits are paid.

Super top-up plans

These plans are a step above top-up Health Insurance plans. While under top-up plans the deductible is applicable for each claim made, under super top-up plans, the aggregate claims made in a year are considered. If the total claims made exceed the deductible limit, the plan pays the benefits.

Premium calculation in a Health Plan

The premium for a Health Insurance plan is calculated after considering various factors. These factors are mentioned below -

Present Age

Age is the primary factor that determines Health Insurance premium. In family floater, the age of the eldest member is considered when fixing the premium. It's recommended to include parents in a separate senior citizen health plan.

Sum insured

The coverage level you choose also affects your premium level. Higher the coverage greater would be the premium amount and vice-versa.

Medical history

Your existing medical health and previous history also affect the premium rate. If you are suffering from pre-existing illnesses, you have a higher health risk. Due to this high risk, your premiums are higher.

Tenure selected

Nowadays Health Insurance plans come in a 1/2/3 year period. If you choose a longer tenure and pay the premiums at once you can avail discounts in the plan and the premium reduces.

Top 5 Health Checks for Mediclaim Policy

A steady rise in the cost of medical expenses accompanied by high rate of inflation has made hospitalisation and medical treatments associated with it an extremely expensive affair. Hence, many people today consider a mediclaim policy as an integral part of their financial planning.

Here are the 5 common mistakes which you need to watch out:

1. Over dependence on Employer Group Insurance

Most salaried employees rely on the Group Health Insurance provided by the employer to take care of Hospitalisation expenses. If you have dependent parents and/or spouse and children to take care of solely relying on group Health Insurance can be a big mistake which can cost you dear later. It is always advisable to clearly know the extent of coverage provided and if there are any sub-limits and caps on the cost of treatment. Ideally, you should ask your HR department to share the insurance details and depending on the kind and extent of coverage, you need to review your insurance portfolio for Self, Dependents and Parents. As most group plans accept pre-existing diseases, keep it for your parents and take additional coverage with a top up or super top up plan for yourself.

2.Allowing Gaps in Coverage by not adding Add-on covers

Buying a mediclaim policy solely on the basis of premium can affect you adversely at the time of discharge from hospital. There are various add-on covers which can be added to your base policy to enhance the level of protection. For example, a basic plan would have a sub-limit to your room rent which would be linked to all the other treatment expenses in proportion to your room rent limit. Any expense over and above the limit in case of hospitalisation will have to be borne by you. Adding room rent waiver to your insurance plan will cover the room and treatment cost entirely in case of hospitalization. Similarly, you can add critical illness rider which would cover a wide variety of critical illnesses and provide a lump sum in case of any critical illness. Auto restoration of health cover, co-payment clause are some other important things to watch out for in your mediclaim policy.

3. Taking One Size Fit all policy for all

Healthcare needs of each individual are different and therefore various mediclaim plans are formulated keeping in mind the varied healthcare needs. You must choose the policy after taking into consideration your health conditions, specific healthcare needs, dependents health conditions and past medical history. Also, check for the waiting period in case of specific illnesses such as piles, fistula, fissures, ENT disorders, pre-existing diseases, etc. before which a claim cannot be made.

4. Choosing between family floater plans and individual plans

The number of members in the family and their age is critical in deciding whether to opt for a family floater plan or to buy an individual plan. A young healthy family can opt for a family floater plan as it can provide adequate coverage to all members and will be economical. However, in case of a big family with siblings and parents where majority of them are old, taking a family floater plan may not be ideal as the coverage provided would not be sufficient. In such cases, it is better to opt for individual health plans.

5. Porting previous Health Plans that are Vanilla and over-priced

Porting in Health Insurance plans allow policyholders to relook their existing mediclaim policies and move to another policy without having to lose out on the benefits of continuity. Thus, if your existing plans do not offer adequate benefits and are over-priced, you can always port to another insurer to maximise your benefits. With new products introduction in last few years, one should introspect whether to continue with the decade old Policy or smartly move to a new generation Plans.