Category Archives: Health Insurance

Pre-existing Conditions

Posted on May 19, 2013 by
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pre-existing-conditions-300Any health condition or illness which already exists and the insured is under medication for the same while an insurance contract is being signed is known as a Pre existing disease or condition. Such diseases or ailments are covered under the insurance policy only after a waiting period specified by the insurance company.

Coverage of pre existing diseases varies to a great extent depending on the insurance company.  In order to cover the pre existing disease an additional amount along with the regular premium known as extra premium is required to derive the benefits of the policy.

Conditions for claims in case of Pre existing diseases:

There are certain guidelines listed by IRDA in order to settle the claims received for pre existing diseases:

  • Insurance companies cover diseases like hyper tension and diabetes only after a waiting period of four years. During these four years the insured should not have been hospitalized for the same and no claim should be made through any other insurance company.  i.e.  A continuous four claim free years is a pre-requisite to be eligible for the benefit under the clause of pre-existing disease.
  • For a certain pre existing illness to be covered for a particular individual, there is an additional amount to be paid along with the premium amount. This loading on the premium hedges the extra risk of covering the existing disease.

The pre existing diseases have a direct connection with the existing diseases most of the times. The examples of pre existing diseases are: Asthma, hypertension, diabetes, heart ailments, thyroid, thalassemia.

There are times when the pre existing diseases are not covered or permanently excluded from the policy. The conditions could be as under:

  • Disease/ailment may be in existence but the policyholder was unaware of the same. The disease might have been detected at the time of medical check-up required for the insurance contract.
  • The policyholder might have suppressed the information intentionally.
  • The policy was taken soon after detection of the disease.

In case the date of disease mentioned by the patient or medical practitioner is controversial.

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Everything About Cashless Treatment

Posted on May 6, 2013 by
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cashless-claims

Cashless Treatment

We cannot always predict the future episodes of life but if we are alert we can surely prepare ourselves with whatever resources we have. Insurance is one such mode which helps us deal with future financial uncertainties better. It works as a protective layer in times of uncertainties.  One such form of insurance cover is health insurance, which safeguards individual in times of medical emergencies.

Medical emergencies cannot be estimated and so at times, the cost of treatment, hospitalization and medicines could wipe off ones entire savings. With financial limitations one is also deprived of quality medical treatment. Health insurance works as a medium of relief to individuals since such a cover ensures proper medical helps in times of need. To be able to receive hassle free treatment, health insurance policies comprise of a benefit known as CASHLESS TREATMENT. This works as an added benefit to the medical cover.

How does Cashless Mediclaim Work?

Cashless treatment can be availed when the insured gets the treatment done from a medical centre or hospital which is listed on the insurance company’s empanelled list. Under this benefit, one does not need to settle the hospital bills with the hospital himself. The insurance company itself or sometimes represented by the TPA (Third party Administrators) covering the individual co-ordinates with the hospital and settles the bills.

The health insurance companies ties-up with the hospitals after negotiating the rates and medical support quality, such hospitals are called networked hospitals. Cashless facilities can be availed in these hospitals only.

The Third Party Administrators represent the insurance companies and are responsible for settling the claims both to be reimbursed and cashless.  For an individual to be able to avail the cashless facility, the TPA is the final decision making authority.

Process of availing Cashless facility:

Pre Authorization Form:  The insured is required to fill this form available either at the hospital’s help desk or the TPA website. Based on the detailed information filled in this form the TPA decides whether the insured is entitled to cashless claim.

Planned Hospitalization:

In case of planned hospitalization, individual is required to fill in the formalities 3-4 days before the hospitalization. The insured should take care of a few things before hospitalization:

  1. Insured should check the list of networked hospitals offered by the insurance company to select the most convenient one.
  2. Present the filled authorization form at the hospital as a part of communication to the TPA.
  3. The TPA on receiving the form either accepts or rejects the cashless claim and inform the individual and hospital along with the amount approved in case the claim is accepted.

Emergency Hospitalization:

In case of emergency hospitalization, the procedure to avail cashless treatment should be started within 24 hours from the time of hospitalization by producing the health insurance card. In this case, the procedure works on priority basis and so settlement does not take more than 6 hours.

What happens if the cost of treatment exceeds the approved sum?

The TPA approves only a part of the expenses incurred for the treatment. It is only when the complete bills along with discharge summary, all reports are received from the hospital, the TPA settles the entire amount.

Reasons for the claims to be rejected:

There could be cases when the claims could be rejected by the TPA. A few cases could be:

  • The disease for which the insured is hospitalized is not cover by the insurance policy opted for.
  • If the insured has exhausted the total sum assured approved for the policy year.
  • The pre authorization form does not provide all required details.

Expenses not occurred under cashless facility:

There are a few non medical expenses which are not covered under the cashless facility:

  • Registration, admission fee.
  • Charges on the food.
  • Ambulance charges.
  • Documentation charges, service charges.
  • Toiletries and medical support like nebulizers, oxygen masks etc.

Highlights of Cashless Facility:

  • This facility is available only in case of networked hospitals.
  • Individual is required to submit all medical documents along with discharge summary, total medical bill before discharge from the hospital.
  • Cashless facility can be availed depending on the terms and conditions of the insurance company.
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Life Insurance Health Products

Posted on September 3, 2012 by
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health insurance questionHealth Insurance Products are offered by both Life Insurance Companies and Non-Life Insurance Companies. And there’s notable difference between the offerings of the products from both Life Insurance and Non Life Insurance Companies.

The Life Insurance Health Products can be categorized under 2 categories with respect to the policy term. There is one category which has minimum 3 years policy term while the other category has the policy term of 10 or more than 10 years.

Following is a discussion on the generic as well as supplementary benefits provided by the health products of the Life Insurance Companies.

Generic Benefits

  • Daily Hospitalization Cash Benefit: This is the benefit provided to the insured in case, the insured is hospitalized (other than ICU) for treatment of any illness or accidental injury, for a continuous period of more than 24hrs. Under such circumstances a daily cash benefit as per the scale of benefits applicable is paid to the insured.
  • Intensive Care Unit Benefit: This is the benefit provided to the insured in case, the insured is hospitalized to ICU for treatment of any illness or accidental injury, for a continuous period of more than 24hrs. Under such circumstances a daily cash benefit as per the scale of benefits applicable is paid to the insured which is generally double the Daily Hospitalization Cash Benefit.
  • Maturity Benefit: At maturity, the insured receives a guaranteed lump sum amount as maturity benefit. This benefit is provided only when the policy term is 10 or more than 10years.
  • Health Saving Benefit: This benefit entitles the insured to claim reimbursement for health care expenses such as medicines and drugs, diagnostic expenses, dental expenses etc.
  • Critical Illness Benefit: Lump sum benefit is paid, in case the insured contact any of the critical illnesses mentioned in the policy during the coverage.
  • No Claim Discount: A certain percentage of “No Claim Discount” on the initial premium is granted in each subsequent year when the insured has made no claims during each previous policy year as per the Policy Terms and Conditions.
  • Renewal Discount: This is the benefit where in, a certain percentage of discounts are given on the premium applicable at the time of renewal of the policy.
  • Tax benefit: Tax benefits can be availed under Section 80D of the Income Tax Act, 1961.

Supplementary Benefits

  • Pre and Post Hospitalization Cover: These are the coverage provided for the expenses incurred for a certain number of days prior to the hospitalization as well as after the hospitalization i.e. after the date of discharge. Generally Pre and Post hospitalization provide coverage of 30 to 60 days.
  • Day Care Treatment Cover: Apart from Hospitalization cover, few life insurance companies provide Day Care Treatment cover, which requires less than 24hours of hospitalization.
  • Recuperation Benefit: In case of a continuous hospitalization for more than ten days at a stretch, the Policy provides a lump sum amount to the insured as recuperation benefit which is generally equal to three times the Daily Cash Benefit as chosen by the insured subject to a maximum of Rs. 10,000 for the entire policy term.
  • Family Care Benefit: This benefit can be availed when two or more than two members, covered under the same policy, are hospitalized for the same illness or accidental injury for more than 5 consecutive days then a lump sum amount (independent of the Basic Sum Assured) is payable to meet the incidental expenses. This benefit will be payable to a family only once in a Policy Year.
  • Medical Check Ups: This is the benefit where in the life insurance companies provide reimbursement for the medical tests subject to a certain limit.
  • Ambulance Charges: This is the benefit where in the insurance companies pay for the emergency ambulance charges to carry the patient to the nearest medical services.
  • Total Permanent Disability Benefit: In this benefit, a onetime benefit will be paid in case the insured is totally and permanently disabled due to an accident.
  • Congenital Benefit: This benefit is provided by few health products. This will cover the listed Medically Necessary Surgical Procedures required in correcting the congenital defects in a child born / adopted by a mother who is continuously covered for a period of time.

Some of the Health Products Offered by Life Insurance Companies

  • LIC – Jeevan Arogya
  • SBI Life – Hospital Cash
  • Metlife – Met Health Care
  • ICICI – Health Saver
  • Metlife – Met Health Care
  • Birla Sunlife – Universal Health Plan
Categories: Articles, Health Insurance, Insurance 101, Life Insurance

Riders on Health Insurance Policy

Posted on May 21, 2012 by
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Health RiderIf you are willing to expand the benefits of your health insurance policy and for that you are planning to buy another policy. Than think once again as you have another alternative which is easier and cheaper way to maximize benefits of your health insurance policy i.e. riders or add-ons.

What are riders?

Riders or add-ons are attachments that can be attach to your base policy. These riders cover those expenses that are not covered under base policy. These riders provide additional benefits at very nominal cost. These riders can’t be bought stand alone. There are many riders that are available in the market; you can choose them as per your requirements.

How many riders can be added on one policy?

There is no limit on how many riders you can add to your base policy. However, total premiums of all riders should not exceed 30% premium of your base policy.

When you can add riders to your policy

Riders can be added to a base policy at the time of buying a policy or at the time of renewal.

Some important riders

  • Critical illness rider: Regular health insurance policy does not cover some critical illnesses such as cancer, kidney failure etc. however this can vary from company to company. Than instead of buying a stand alone critical illness policy you can add a critical illness rider to your base policy which is a cheaper option.
  •  Hospital cash allowance: This rider cover all the expenses incurred at hospital during treatment, apart from consultation fees and medicine charges.
  •  Home nursing charges: Most of the health insurance policies do not cover home nursing expenses. This rider takes care of your home nursing expenses.
  •  Ambulance charges: Regular policy does not cover ambulance charges. Therefore, in the situation of emergency this rider can prove very beneficial.
  •  In-patient physiotherapy charges: Sometimes patient is advised physiotherapy during the course of treatment which is not covered under plain vanilla policy. This rider helps in covering those expenses.
  •  Accompanying person charges; Regular policy does not cover the charges for the person accompanying the patient at the hospital, this rider covers all these charges.
  • Children education fund: There may be situation when a person may not be in position to work for long time, than in such situation this rider help in paying the education expanses of the insured’s children.

Though riders are becoming popular these days but still awareness about the advantages of riders is very low. These riders not only cover some expenses which are incurred during hospitalization but they also cover expenses of post-hospitalization. Most of us are not aware that post-operation expenses can also go very high.

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Insurance 101: Health Insurance – Can you claim two insurers for single treatment

Posted on December 23, 2011 by
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Health Insurance Policy MantraIn India less than 1% of our population has health insurance or mediclaim. This is miniscule compared to countries like USA where 75% people have mediclaim. One of the contributing factors is the limited knowledge of health insurance in India, even in the metros.

 

Aparna, an unmarried PR Executive in an MNC, with two dependent parents had a group mediclaim cover of Rs 1.5 lacs provided by her company. To secure her family further against any other unforeseen medical exigencies she had also taken a family floater policy from a private insurance company for a sum insured Rs 2 lacs. Unfortunately her mother developed a cyst in uterus and had to undergo hysterectomy surgery which would cost Rs 2 lacs. The total expense including hospitalization and other charges would amount to Rs 3 lacs.  Aparna was in a fix .Will her mediclaim provide cover for the medical expenses of her mother? She had never made a claim under mediclaim.

 

Can she make claim under two different policies to make good her expenses? Of course she can because that is the very purpose of insurance. The first principle of insurance, principle of indemnification, says that the insured should be placed, as far as possible, in the same financial position as he/she was before the loss, provided he/she does not make profit out of it. In the subject case Aparna should first intimate both the insurance companies where she holds mediclaim. All the original bills with the claim form will be submitted to the major insurer and photocopies along with claim form to the other insurer. The total loss (up to a maximum of total sum insured) would be borne proportionately by the two insurance companies and she can meet her medical expenses.

 

Let PolicyMantra.com help you find best health insurance now.

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Health Insurance Portability: Everything you wanted to know

Posted on October 3, 2011 by
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Health Insurance Portability: Portability is the quality of being movable; capable of being moved. In business terms it’s the ability of being transferred from one service provider to another without losing the earned benefits. Like in mobile number portability where you can switch the network provider but you can retain the number, and like in job portability when you switch your employer your PF (provident fund) also get transferred and you retain what you have earned in PF account from previous employer. Likewise, from today, portability in health insurance is available as the insurance companies are finally ready with the long-awaited portability norm.

Let’s see what is there in health insurance portability. Under health insurance portability norm one can change its insurance provider without losing the credit of waiting period and no-claim-bonus. This portability norm has two things:

  • Any person having individual or family floater policy of non-life insurance company can change its insurer at the time of renewal without losing the credit earned.
  • Any person or member of family covered under any group policy of non-life insurance company can opt-out to take individual or family floater policy first with the same insurance company for at least one year and after that policyholder will be accorded with the portability norm as mentioned in first point. In this the person will not lose the earned credit period of waiting clause while moving out from group policy to individual or family floater policy with same insurance company.
    For example: Mr. Ramesh is working with XYZ ltd from last two years and XYZ ltd has its group health insurance policy from Iffco-Tokio general insurance. If Mr. Ramesh wants to withdraw from group cover and wants to buy to individual or family floater policy then he can buy policy from Iffco-Tokio and he will be given due credit for his already spent times with the Iffco-Tokio, which means if there is waiting period of 2 years for some ailment to get covered under the policy he can get the claim from the first year from his newly bought policy. Earlier he had to wait for 2 years to make claim under fresh policy.

The procedure: Policyholder will have to apply with new insurance company 45 days prior to the expiry of existing policy to get the credit. This is the period given to insurance company to seek any information from existing insurance provider. If the complete information and data has been provided to the new insurance company and if the company does not communicates its decision within 15 days then it will lose the right to reject the proposal and has to accept the proposal.

Treatment of waiting period and sum insured under health insurance portability.

  • Waiting period: Credit will be given to the time already spent under policy with respect to pre-existing disease and time bound exclusions. Only the differential time waiting will be required to make claims. For example: If Mr. Ramesh has already spent 2 years with some health insurance policy of one non-life insurance company and any ailment which has 3 years waiting time period he will have to wait only one year with the new insurance company to make any claim, and if the waiting period is 1 year or 2 years he will not have to wait any further.
  • Sum insured: Portability will be applicable only for the sum insured under the previous policy including any enhanced sum insured due to no-claim bonuses acquired from previous insurer under previous policy.
    For example: If Mr. Ramesh had a sum insured of Rs. 2 lakhs and accrued bonus of Rs. 50,000 with Iffco-Tokio general insurance; when he shifts to another insurance company then the new insurance company has to offer him sum insured of Rs. 2.5 lakhs by charging the premium applicable for the same amount. If the new insurer has no product for Rs. 2.50 lakhs, then it has to offer the nearest higher slabs say Rs. 3 lakhs to insured by charging applicable premium for said sum insured but the portability norm will be applicable to only up to Rs. 2.50 lakhs and the incremental sum insured of Rs. 50,000 will be considered as fresh policy. So if the treatment costs Rs. 2.75lakhs and the treatment had waiting period of 2 years then under ported policy only Rs. 2.50lakhs can be claimed. This is also true with when any person opt for higher sum insured after having spent some time of lower sum insured with the same insurance company.

This has been one good move by IRDA as the portability will empower unsatisfied policyholders to move to an Insurance Company of their choice. Portability will bring in more competitive environment and better service experience.  In the current scenario, renewal of health policies is the headache of the customer. In the portability scenario in the long run, Insurance Companies will have to win their renewals through better services, responsiveness and claims experience. This is a good weapon given to customers but customers should be very careful in choosing the new insurers and should always look for the age limit for policy renewals as porting health insurance policy at older age will not be so easy.

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Health cover is better option than Life cover for senior citizens

Posted on August 29, 2011 by
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If you are a senior citizen and wanting to buy a life insurance than give it a second thought whether really you need it or not; if you are 60 years of age or above then you do need an insurance but not life insurance instead you need cover for your health and assets.

Basically there are three objectives behind buying a life insurance they are firstly tax saving secondly living legacy for the heirs and thirdly ensuring financial security for the dependents.

If your objective of taking life cover is that you want to give financial protection to your dependents in the case of something happened to you in other words basically insurance is needed when you have dependents and responsibilities at different stages of life such as marriage, home loan etc; but till you come to the age of retirement than you have fulfilled your financial responsibilities such as your home loan is paid off and your children are settled, it is in rare cases that your liabilities remains even after your retirement.

Another point is that if you want to buy term insurance at the age of 60 than there is limited period for which you are covered as most of the companies provide term plans upto the age of 65-70 years; there are few companies that offers insurance at this age; there are only three companies that offers term insurance at the age of 60 for 15 years; and even if you get insurance then for it you have to go through rigorous medical tests.

And if your objective is that you want to leave legacy behind for your heirs then you might think to buy a whole life plan where you pay premiums for whole life and your nominee gets the sum assured and any additional bonus after your death and there are also some plans which have limited premium paying term.

But if you look it in real sense that does whole life plans are the best way to leave legacy behind; then it is not; as it does not provide enough return as they are usually traditional product hence it invests most of its fund in debt products and costs are also not mentioned explicitly.

And if your objective is tax saving than you can look at other investment option which will also give you assured return take for instance you can invest in Public Provident Fund (PPF) which will not only give you assured return of 8% annually and it is tax free and you can even get deduction on its contribution under section 80C of income tax Act, another option for you is that you can invest in 80C fix deposits for assured return if you are conservative investor and if you are ready to take risk than you can invest in diversified equity-linked saving schemes which will not only help you in wealth creation but it will also save tax.

Hence, not everyone need life insurance specially senior citizens but every one need Health insurance particularly for senior citizens; according to regulations insurers can’t refuse you for health insurance till the age of 65 but it is difficult to get health cover after 65 years of age as very few insurers provide health cover after 65 and those who offer they limit sum assured to 3-4 lakhs.

If you willing to buy health cover then take in considerations some points before buying it such as go for the cover which allows life long renewal specially stand alone companies provide life long renewal; and another point is that most of the policies have co-pay clause according to which a insured have to share part of claim with the insurer at prescribed rate hence go for the cover which have less percentage of co-pay.

You can also opt for critical illness cover to bump up your cover critical illness policies are different from basic health insurance policies as they cover only specific diseases and they are even cheaper than basic health policy; as senior citizens get less sum assured under basic health insurance cover hence critical illness cover can help to increase your health cover.

You also need cover for your assets such as if you have a house than it is must to have house holder’s policy which is basically a fire policy that covers house and its contents in the case of fire, earthquake, lightening, flood storm you can also have terrorism cover for your house as add-on cover for which you need to pay 10 paise for sum assured of Rs 10,000.

Third party motor cover is mandatory and it is also necessary for you to take it for your car as not only covers your liabilities towards third party but it also pays for damages of your car and passengers in case of death.

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Examine subsequent factors before buying a health policy

Posted on July 19, 2011 by
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If you wish to get  health cover just don’t go by the low premiums i.e. do not buy a health policy just because it is cheapest; prior to going for health cover you must keep in mind some other factors as well apart from pricing.

Insurance companies revise premium rates of their products based on factors such as their claim ratios and rising medical expenses.

Following factors should be considered while choosing a right health cover apart from the premium rates:

  • Higher sum insured: It is essential to know that your policy has higher sum insured or not, for instance a man in 30s may find Rs 2,00,000 cover sufficient but as his age progresses and medical expenses increases he might require a higher cover after few years which may not be available in the policy and if he wishes to shift to other insurer than in such case you may loose out all portability benefits and pre existing diseases coverage.
  • Policy that have maximum sum insured can be enhanced: Another factor to consider is many private companies allow a policyholder to enhance his cover by 10-50% of your current sum insured hence see which cover provides you to enhance your sum insured to the maximum.
  • Limits and sub-limits: Few insurers have begin the co-pay for the persons above the age of 60; co-pay means a insured have to pay the part of the claim on his own hence try to avoid the policies that have co-pay in older age;  and also avoid the policies that have sub-limits on doctors fees, room rents and procedures.
  • Exclusions: Insurance companies do not cover the Heart disease, cataract, hernia, fistula, piles, and fibroids in the initial years of the policy whereas health policies have certain diseases which are completely excluded.
  • Waiting period: A person should see the waiting period for the diseases that are hereditary.
  • Renewability: Most of the public sector insurers provide renewability for their policyholders up to the age of 70-75 years however some stand alone insurers provide renewability for the life time.
  • Age of medical test: Insurers do not ask a policyholder to under go medical test if he is below 45 years; hence go for the cover which provide higher exemption for medical test.
  • Number of day care procedure: A person who is going for the health cover must also keep in mind the number of day care procedures; critical illnesses that will be covered in the policy besides the limits on daily expenses.
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Features of Health Policy

Posted on May 26, 2011 by
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In today’s time when our life style has been changed tremendously; in today’s fast moving life we don’t have time to pay attention towards our health we tend to over look our health; when treatments are also getting expensive in such an environment it has become essential for every body to have a health insurance; which can cover our unexpected expenses on it.

Before buying a health policy you must go through it thoroughly; you must be completely aware of the clauses of the policy before buying it; some points to be taken in consideration are given below:

  • Exclusion – Exclusion or ailment is that those ailments which will not be covered under the cashless or reimbursement plans. According to the policies if you get a disease within the 30 days of the policy it is not covered; your pre-existing diseases are also not covered under the policy; although age related disease such as rheumatoid is covered as they have long waiting period.
  • Loading – If you make a claim on your policy than you are liable to pay extra amount or loading on it on your next premium; companies have two different methods to calculate this loading they are – some companies calculate it on the basis of claim ratio slab while some other calculate it on the percentage of sum assured.
  • Sub- limit on ailment – From past few years insurers had introduced a new feature that is sub-limit on ailment this means that they have put on cap on the expenses of certain diseases according to which you can not claim over a limit whether your sum assured is more; insurers have put a cut -off amount on some minor surgery such as cataract; on the other hand United India insurance had  caped their limit on major surgeries such as cardiac, brain, cancer and joint replacement; in such cases they pay either all the expenses or 70% of sum assured which ever is less; if claimant is more than 60 years it deducts 20% of every claim as a co- pay.
  • Co- pay – Companies levy co- pay condition for pre-existing disease or senior citizens; according to it a claimant has to pay certain percentage of the total claim amount; take for instance Bajaj Allianz general health insurance charge you co- pay of 10% of the claim if you approach the hospital which is not in their network.
  • Renewable age – Companies also have cut off rule for policy renewals; most of the private companies limit their renewable age up to 60 or 75 years; whereas there are some companies who offer life time renewable they are Apollo, Munich health insurance, Max Bupa health insurance and PSU insurers. Though they offer life time renewable products they have low sum assured and sub-limit and their waiting period is higher for pre-existing diseases.
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Choosing the Right Health Insurance Cover

Posted on August 14, 2010 by
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When it comes to health insurance, you want to be assured of getting medical attention without causing any financial strain. The possibility of falling ill and undergoing some kind of expensive health treatment during the lifetime is much more than a sudden demise. Given the cost of treatment at private health care facilities, it’s almost beyond reach for the Indian middle and lower income class to meet such expenses. Despite all these facts, penetration of Health Insurance is exceptionally low in India. This is partly because of a lack of understanding of various products and the need for these products. There is a wide range of health products available in the market, each with its own advantages and drawbacks. Understanding them is important to make the right choice.

Policy Mantra helps you learn what to look for when choosing a health insurance product, it’s important to know how these products operate so you can decide which product has all the traits that fit your needs. Whether you already have health insurance or are in the process of changing health insurance providers, being an informed shopper will empower you to compare and choose the right product for you. When choosing your health insurance provider, many plans should be acceptable to you, but you want one with adequate coverage while making the most sense financially. Here is list of few Health Insurance products to choose from.

INDIVIDUAL HEALTH PLAN:

This is the simplest form of health insurance. It covers hospitalization expenses for an individual with a sum assured limit. The insurance premium depends on the sum assured value. There are certain limitations to this type of cover in terms of pre-existing ailments, out-patient treatments, limit on maximum age at entry and other exclusions.

FAMILY FLOATERS:

These plans consist of shared Individual Health Plan. The benefits are mostly the same, but the sum insured limit is shared by all the family members covered under the plan. This reduces the need for you to pay from your pocket. It comes at a lower premium. This type of cover has certain restrictions like, it has an upper age limit of 55 years or 60 years. Moreover, coverage of children under this policy will cease once they reach 25 years. Therefore, a family floater is more suitable for a young family.

CRITICAL ILLNESS:

This is generally provided in addition to the individual or family floater health plan. In India, these plans are sold separately; this is a major flaw in the sales of health insurance. In critical illness cover a lump sum amount is paid for a pre specified set of diseases which are critical in nature such as cancer or a stroke. Restriction: This is not a comprehensive health insurance cover and does not cover all diseases. It covers only specific ailments. Moreover, a diagnosis of a critical ailment like cancer, for example, may not be enough to trigger payment of the policy if the cancer has not spread or is not life-threatening. Other restrictions may include a specific number of days the policyholder must be ill or must survive after diagnosis.

DAILY HOSPITALIZATION CASH BENEFIT:

Hospital Cash Plan is a daily cash benefit insurance policy that assists the policy holder to meet all his/her miscellaneous expenses during the period of their hospitalization generally not covered in the regular health insurance. It acts as a supplement to the health insurance policy. Payment of Rs. 500 to 5000 is paid on daily basis of inpatient hospitalization. Drawback of this type of cover is that these plans are not sufficient in themselves as they only cover hospitalization expenses and not medical costs.

UNIT-LINKED HEALTH PLAN:

These plans are similar to Unit Linked Life Insurance plans except that these cover health insurance instead. Although life insurers are selling these policies, they may not cover life risk. Some portion of premium goes towards medical coverage and the rest is invested in the stock market just like a ULIP. The benefits are defined and the payout is not dependent on the costs actually incurred. Being Linked to the market, they are subject to market risks and also costs like fund management charges.

SENIOR CITIZEN HEALTH PLAN:

This plan is similar to individual health plan but designed for older age people. Most basic health insurance plans has the limitation on entry age at around 60 years while Senior Citizens Health Plans are generally for the people in the age group of 60-80 years. Most can be renewed lifelong or up to the age of 90 years, and have a fixed coverage. Main drawback of this plan is that many ailments are excluded.

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