10 Health Care Benefits Covered in the Health Insurance Marketplace

Take the time to analyze and review health insurance policies available in the marketplace today. Make sure you pick a health insurance policy that has the health insurance benefits you need for your family. The Health Insurance industry has been growing in India since 1986. With the rising costs of medical care and with the prevalence of new and frequent illnesses and diseases increasing, today it is vital for you to have health care benefits covered. Swine flu alone has affected 10,000 people in India leading to more than 2000 deaths. The expenses involved in admitting a critically ill family member can drain your pocket. What are the benefits available in the marketplace today? Read on to understand your options and pick the ones that fit your needs:

Benefits Covered:

  • Discounts for Loyalty:

You may receive loyalty discounts for yourself and/or family by sticking to one insurance company. Make sure that your health insurance benefits include this feature. With the ease of portability of health insurance most insurance companies should have this covered.

  • Health Checkups:

Free health checkups are a part of the health insurance benefits that some companies provide. Yearly checkups are an important part of preventive health care. The health checkups may include immunizations, physical checkups, and preventive screening.  The benefit is available only after 2 to 4 years of claim free years with continued coverage. The block of claim free years varies on plan to plan basis. Some insurers offer it irrespective of the claim history. Wellness may be an important point included in health care benefits covered by your policy.

  • No-Claim Bonus:

One of the many benefits of having health insurance is the no-claim bonus. If you don’t avail any claim in a given policy year, you may receive this bonus (which is subject to terms and conditions). A younger person will gain from this no-claim bonus benefit as chances of you claiming for illness are less than that of an older person.

  • Cashless Healthcare:

If your health insurance covers a particular illness, you may be admitted to a network hospital and treated without having to pay upfront. Your health insurance company will pay for the hospitalisation and treatment. Hospitals with an agreement with the health insurance provider are network hospitals, wherein they agree that your bills will be paid for directly by the insurance company to the hospital. The network hospital will provide your insurance provider the details of your medical treatment and the company will pay them directly. You may have to pay for non-medical expenses. Your health insurance provider will have a list of these non-claimable expenses.

  • Reimbursement of the Claim amount:

If you go to a non-network hospital, you will need to claim reimbursements of your hospitalization after you have paid the hospital yourself. For hassle-free reimbursement of the money spent on hospitalization, apply to the insurance company with the proper documentation including hospital bills. You will get reimbursement for health care benefits covered by your health insurance policy.

  • 24/7 Support:

Many health insurance companies cover the insured’s ambulance fees, pre & post hospitalisation treatment, transporting a family member to the insured patient’s bedside, arranging for medicines, getting blood to the insured, or even cover the charges for transporting the mortal remains of the insured. Analyze whether this aspect of health insurance is important to you and find a health insurance provider who provides this benefit.

  • Online application and renewal:

A convenient and easy way to get insured quickly is through online facilities. Your health insurance benefits may include this 24/7 facility. Renewal also may be done hassle free. It is a quick and accurate method of providing service to customers. The chances of you being cheated are also reduced enormously.


Check out this Articles: Benefits of Health Insurance Portability


  • Renewability:

You may also benefit from lifelong health insurance renewability when you insure. Make sure that your plan has lifelong renewability. As you age you will need health insurance benefits more. Having health care benefits covered will give you peace of mind as you age.

  • Quick Settlement:

A health insurance provider must settle claims quickly. They should also give you frequent updates on the progress of a claim you have made. No one wants to wait for years for a settlement. This is one of the health care benefits covered by a good health insurance provider. Look at IRDAI Annual “Incurred ratio” report on total claims paid versus the number of premiums received by both Public and Private insurance providers. The higher the ratio the less hassle you will have in getting your claims approved.

  • Co-payments and deductibles:

One of the important aspects of health care benefits covered by your policy is the co-pay option. You will pay a portion of your hospitalization bill while the rest is paid for by the health insurance company. If your co-pay is more, the premium will be less and vice versa. A deductible is when you pay up to a certain amount for health care expenses after which the health insurance company takes over. In some policies you also co-pay after the deductibles. Ideally, your co-pay and/or deductible should be nil for you to have complete health insurance benefits

Conclusion

Make sure that the health insurance benefits have most of the above points. You may also want to check the sum assured and the premium you will have to pay. Are they both right for you? Can you make the payment on time and according to the schedule? Also, make sure you check out the pre-acceptance checks required, the medical tests you will have to undergo. Does the insurance cover any pre-existing conditions you have? How long must you wait for coverage to kick in for these pre-existing conditions?

Harjot Singh Narula

Harjot Narula is founder and CEO of ComparePolicy.com, an IRDAI approved insurance web aggregator focussed on selling online insurance for companies. Harjot has more than a decade of experience in software development and has also spent 5 years in US working for the mortgage and risk management industry.

Leave a Reply

Your email address will not be published. Required fields are marked *