The Basics Of Health Insurance And How It Works

This guide explains health insurance policy, factors affecting it, types of health plans, and more.

Health insurance definition:

It is a policyholder-insurance company contract that covers medical expenses from illness, injury, or accident.

Insurance companies reimburse medical expenses in two ways:

  1. Cashless treatment: Policyholders don’t pay network hospitals. Insurance pays the hospital directly.
  2. Reimbursement: The health insurance policyholder must pay medical bills before requesting insurance reimbursement. 

Kinds of health insurance policies

Self-plan and family floater health insurance are the main types. The individual policy would only provide coverage and benefits to the primary policyholder. Family floater plans cover your whole family. All these insurance types can be found on a health insurance app. 

Considerations before buying health insurance: 

Step 1: selecting an insurance company

Consider these factors when choosing a health insurance company:

  1. Available plans: Compare a company’s plans and USPs. To find the right policy, choose a company with various plans.
  2. Hospital network: Hospital networks are crucial for cashless claims. Better insurers have wider networks.
  3. Claim settlement ratio: A higher ratio means the company consistently settles claims. *
  4. Claim-based loading: Some companies would raise your renewal premium if you made claims in the past. Avoid them.
  5. Premium rate: Compare similar plans across companies to check the pricing and choose one that suits you. Do consider all these factors before you buy health insurance online.
  6. Claim settlement ease: Insurers have streamlined their claim process with:
  • WhatsApp notice
  • Digital records
  • Faster approvals
  • App-based
  1. Reviews: Read customer reviews. Talk to family and friends. Ask about their claim experience. 

Step 2: selecting a plan

Selecting a plan is the most crucial step after choosing an insurance company. Be on the lookout for health insurance benefits.

  1. Coverage benefits: Compare coverage benefits. Look for additional features to expand coverage. Select the most comprehensive plan.
  2. Customisation option: Choose plans with customisable coverage features. Add-ons let you customise your coverage.
  3. Premium amount: The premium amount matters. Choose the plan with the lowest premium for the same coverage.
  4. Sub-Limits: Health plans may have sub-limits on room rent, ICU room rent, etc. Sub-limits can increase costs. Choose a policy without sub-limits.
  5. Co-payment clause: Co-payments require paying part of each claim out of pocket. A 10% co-payment means you pay 10% of every claim.
  6. Wait time: Health insurance policies prohibit specific coverage during the waiting period. It is essential if you want coverage right away.
  7. Price cuts: Health insurance offers concessions to attract customers. Choose a plan with the highest concession. Always check for health insurance benefits that you need. 

Step 3: how much coverage is right?

Health insurance is pointless if the sum insured is low. Just consider these factors:

  • Number of policyholders
  • Pre-existing conditions
  • Hospitalisation and medical treatments*
  • Rising medical inflation 

Step 4: Affordable health plans

Insurers also offer various premium instalment options. Super top-up health plans can help you afford a high sum insured. Also, look into cashless health insurance as a feature.

Get insured anytime, anywhere! Check out Bajaj Allianz General Insurance website to learn more and download the app now.

* Standard T&C Apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.