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Sagun Finance Health Insurance

  • Health Insurance :
    • Medical emergencies can strike anyone and anytime. To add to this are the rising medical costs that have the capability to dig a hole in your pocket. One way to overcome such hurdles is to be prepared by purchasing a health insurance plan. This insurance helps reduce economic worries by covering critical illness treatment costs, hospitalisation costs and other such expenses.

  • What is Health Insurance? :
    • Health insurance offers financial protection to meet the expenses incurred due to hospitalisation or treatment of some disease. It is an understanding signed between the insurance company and the policyholder. The company or the insurer agrees to provide the sum insured or the coverage amount to the policyholder (the insured) for meeting the medical expenses. To get this benefit, the insured has to pay a certain amount of money in the form of premium. However, not all kinds of situations and cases are covered by health insurance. These are called exclusions. Let us understand health insurance in detail.

  • What is Health Insurance Premium? :
    • To get the financial protection under a health insurance plan, you need to annually pay certain amount of money in the form of premium. This can be called the cost of the insurance. Premium is an important aspect to be considered before finalising a plan. Always use the premium calculator available on the insurance company website or insurance web aggregators to know the premium amount. This helps to compare different plans and to gauge your affordability of buying the plan. Some of the factors taken into account while deciding the premium amount are :
      Type of insurance plan :The premium for a health insurance plan depends on the type of plan chosen. It is different for a family floater and an individual plan.
      Nature of work of the applicant : The nature of your occupation goes on to decide the premium amount. If your nature of work is riskier, you will pay a higher premium amount. For instance, a truck driver’s job is riskier than that of a teacher. Thus, the driver will pay higher premium compared to the teacher.
      Age : For getting a health insurance plan, age is an important factor. Thus, it also decides the premium amount. Higher the age, higher the premium amount, as older people have higher chance of suffering from any illness
      Current medical condition :Any medical history or rather the current medical situation of the person plays a vital role in deciding the premium amount. In case of any pre-existing illness, the premium might go up.
      Number of family members covered : For an individual health insurance plan, you get the coverage for more than one family member. Thus, the premium amount depends on the number of family members included in the plan.
      Policy term :The duration of the health insurance policy decides the premium amount. So, if the plan is for longer duration, premium amount will automatically increase.

  • Types of Health Insurance Plans :
    • Health insurance is available in various forms. However, all the health insurance policies can be broadly categorised under two types: indemnity plan and fixed benefit plan. Let us understand these two types in detail.
      Individual Insurance
      Family Floater Insurance
      Senior Citizen Insurance
      Maternity Insurance
      Group Medical/Employee Insurance

  • Documents Required to Process Claims :
    • In order to get the claims settled on time, certain specific documents are required :

      • Duly filled in claim form
      • Medical certificate from doctor
      • Discharge summary
      • Prescriptions
      • Investigation report
      • Pharmacy bills
      • FIR (in case of accidents)
  • Claim Process :
    • A health insurance policy helps manage any unforeseen medical expenses. Thus, in case of any eventuality, you need to properly file claims in order to get the benefit. There are two types of claims: cashless and reimbursement claims.
      Cashless claims :To avail this kind of claim, you need to use one of the network hospitals, which is a hospital empanelled with the insurance company. Here, the policyholder does not have to pay the hospitalisation expenses as it is borne by the insurance company.

      • In case of planned treatment, inform the insurance company in advance. This can be done through email or the toll-free number
      • On hospitalisation, provide the health card given by the insurance company to the Third Party Administrator (TPA) desk of the hospital along with an approval from the treating doctor
      • Also submit the required documents
      • Once the insurance company approves the case, it pays the medical expenses directly to the hospital
      • Reimbursement claims:Here, the policyholder makes the payment for the treatment and hospitalisation. However, he/she gets back the money later as per the sum insured amount after submitting the required documents.

      • After paying the medical expenses on your own, submit the bills and other required documents to the insurance company
      • After an evaluation, if the insurance company finds the claim fit, it will make the payment to the insurer
  • Advantages of Buying Health Insurance Policy :
      • A health insurance plan helps manage the unexpected treatment or hospitalisation costs that have the potential of derailing your budget and creating financial burden
      • The plan helps in managing the rising medical costs
      • It offers peace of mind when the financial burden is taken care of by the insurance company during such pressing times
      • Treatment at network hospitals provide cashless facility
      • Premiums paid for health insurance are tax exempt up to the limit of Rs 1 lakh under Section 80D of the Income Tax Act, 1961
      • For individuals below 60 years of age, the premium amount on which you can save tax is Rs. 25,000. This holds true even if you pay the premium for spouse and dependent children