health Insurance

Health Insurance: Eligibility, Costs & Claims

by | Feb 1, 2025 | Personal Finance | 0 comments

Healthcare prices are rising worldwide, making it orders of magnitude more difficult to get medical care.  A single hospitalization can be sufficient depletion of your savings or can force you into financial stress. Health insurance aims to give care in such financial troubles. It should not be viewed only as a financial product but rather as something that ensures advantages such as wellness and financial security.

Health insurance not only assures but also provides quality healthcare to you and your family without the worry of costly bills. It includes services from admission to the hospital, operations, testing, and even check-up care, thus being a fallback safety support in a medical emergency.

Key Benefits of Health Insurance: 

  • Financial protection against high medical expenses.
  • Access to a network of top hospitals and healthcare providers.
  • Coverage for critical illnesses, accidents, and surgeries.
  • Tax benefits under Section 80D of the Income Tax Act.

With the unpredictability of health issues along the way and the soaring expenses of treatments, having health insurance is no longer an alternative option—it is a must. Whatever the case, be it young and healthy or dealing with a family, having a health insurance policy is a preventive approach towards maintaining your health and financial capacity.

health

What is Health Insurance?

Insurance is the cost of the premium which is available for medical expenses in exchange for protection. It is a protecting tool, that helps to compensate the expenses of treatment in the case of accidents.

Types of Health Insurance Plans:

  • Individual Plan: This plan only includes one person.
  • Family Floater Plan: It is a policy under which a single sum insured applies to a whole family.
  • Senior Citizen Plan: A plan designed for elderly people featuring higher coverage limits.
  • Critical Illness Plan: It is in force after diagnosing a critical illness, such as cancer, or a stroke, which needs pricy treatment.

For example, my friend Raj took the family floater plan. When his son suffered an injury to his leg, the insurance paid the ₹1.5 lakh hospital bill in full.

Who is Eligible for Health Insurance?

The great news is that health insurance is eligible for a long list for almost everybody!

Eligibility Criteria:

  • Age: Generally, individuals of 18-65 years are preferred; some plans also cover newborns and seniors above 65.
  • Pre-existing Conditions: Patients suffering from other chronic diseases like diabetes or hypertension can avail of the insurance policy after the waiting period (which usually lasts between 2-4 years).
  • Dependents: You may include your spouse, children, and parents under your health plan.

Don’t skip health insurance even if you are a young and healthy individual. Before becoming sick (due to dengue) my friend Priya thought that she did not need health insurance until she was admitted to the hospital. A treatment fee of ₹50,000 was her wake-up call.

eligibility for health insurance

How to Take Health Insurance?

The process of obtaining health insurance is quite simple.

Steps to Buy Health Insurance:

  • Assess Your Needs: Determine whether you require individual or family coverage.
  • Compare Plans: Use online platforms such as Zerodha, Upstox, or Paytm Money to compare premiums, coverage, and benefits.
  • Check the Sum Insured: Ensure the coverage amount meets your possible medical expenses.
  • Fill out the Application: Enter the details including your age, health history, and lifestyle.
  • Pay the Premium: The payment can be made via online or offline methods.

Pro Tip: Always provide your medical history truthfully to avoid claims being turned down.

What is the Cost of Health Insurance Per Month?

The cost of health insurance per month is considered to change depending on several factors.

FactorImpact on Cost
AgeYounger individuals pay lower premiums.
Sum InsuredHigher coverage means higher premiums.
Medical HistoryPre-existing conditions may increase costs.
Add-onsCritical illness cover adds to the premium.

A basic plan usually costs many ₹500 to ₹2,000 each month. As an example, a 30-year-old has to pay around ₹700 per month, for example, a ₹5 lakh sum insured.

avail health insurance online

How to Avail Health Insurance Online?

The process is fast, straightforward, and trouble-free.

Steps to Buy Online:

  • First, open the site of Alice Blue or Paytm Money.
  • Eventually, select the plan that offers you the best value using their comparison tools.
  • So the new, temporary customers will visit, fill in their particulars, upload the ID proof, and the address proof, and finally the photo (if applicable) to complete, all the documents.
  • After that, the premium online payment via bank transfer, UPI, or credit card will be made.
  • Confirm your email is a record of your policy arrival.

Last year, I bought my policy online, and the process took less than 30 minutes. It is a revolution in terms of time efficiency.

What is the process for claiming health insurance? 

It is determined by the kind of claim.

1. Cashless Claims:

  • Go to a network hospital.
  • Appoint the insurer before entry.
  • Present your health card and ID verification.
  • The insurer pays the bill straight to the hospital.

2. Reimbursement Claims:

  • Clear yourself the hospital bill.
  • Hand in bills, reports, and discharge summaries to the insurer.
  • Then wait for funds to pour into your account.

Pro Tip: Always keep your policy number and documents handy during hospitalization.

Common Mistakes to Avoid Health Insurance

  • Not Comparing Plans: Do not accept what you find first. Look at the premiums, coverage, and benefits of different plans.
  • Ignoring the Waiting Period: The limits and exemptions in the health insurance policy must be mentioned.
  • Choosing Low Sum Insured: Healthcare providers are disbursing money in proportions such that the amount of coverage you obtain is a function of your annual income which, in a sense, becomes a low sum insured.
  • Not Reading the Fine Print: Being aware of exclusions like cosmetic surgeries or acupuncture

My cousin learned the hard way when his claim was rejected due to a pre-existing condition he hadn’t told the insurance company about.

protect health and wealth

Conclusion: Protect Your Health and Wealth

The statement that health care is not an expense but a guarantee of well-being is not just an assertion, but a fact. It protects your bank account and enhances the awareness that you will always get the best treatment. Now is the time to explore your options and buy a policy to secure your future.

Are you aware that health insurance can save you on taxes? Under Section 80D, you can claim deductions. Also, up to ₹25,000 for yourself and your family as well as a limit of ₹25,000 for your senior citizen parents.

To gain detailed knowledge of taxes, read our article concerning Hidden Ways Taxes Affect Your Income and Investments.

FAQs

Can I buy health insurance for my parents?

You can, as most plans let you enroll your parents as dependents.

Is there a waiting period for the claims?

Yes, typically 30 days for general ailments and 2-4 years for pre-existing conditions.

Can I switch my health insurance provider?

Yes, under the portability, the switch can be done without any loss of benefits.

Are maternity expenses covered?

A portion of the mother’s pay covers maternity, but you usually have to go through a waiting period.

What if I miss a premium payment?

Your policy can be terminated, but some insurers offer a grace period.

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