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How Does Health Insurance Work

Very often we hear about the necessity of health insurance in our lives and its importance in financial planning. Challenging times highlight the urgency of having a comprehensive health insurance plan that protects you and your loved ones in case of medical contingencies. Some of the common things covered under a health plan are in-patient hospitalisation costs, pre- and post- hospitalisation expenses, ambulance cost, treatment expenses, daily care procedures, and more.

The insurers provide you with a complete list of health insurance inclusions and exclusions. However, you and your family should be aware of how the health insurance plan works. Understanding its functionality will help you reap maximum benefits and avoid getting your claims rejected in dire times. Keep reading to know how health insurance works.

Know How Health Insurance Works

Here’s a stepwise walkthrough on the working of a health insurance plan in India -

Step 1: Choose the required health insurance coverage

The health insurance coverage begins once you have purchased the policy. Coverage for specific health conditions start after the completion of the waiting period, and the same will be mentioned in your policy documents.

The policy document will also provide you insights on the coverage of your health plan, inclusions, exclusions, add-on health insurance benefits (if any), premiums charged, etc. It is advised to go through these terms and conditions carefully before buying the health insurance plan.

Step 2: Sign the paperwork and pay your first health insurance premium

Once you review your policy paperwork and pay the first premium, your relationship with the insurer begins.

The insurer will calculate your health insurance premiums based on several factors such as your age, income, lifestyle, medical conditions, and coverage needed. In some cases, the insurer might even ask you to undergo a medical checkup before issuing you the health insurance plan. Based on all these factors, the insurer will set annual premiums and approve the sum assured amount.

You can use the health insurance calculator to determine the premiums in advance. Based on the results, you will be able to choose a health policy that is affordable and fulfils your medical needs.

Step 3: Raising a cashless claim request on your health insurance

Now, if there is any medical emergency, it is best to seek treatment from a network hospital. Your insurer will provide you with a list of network hospitals where you can avail cashless treatments. If you are indeed admitted to a network hospital, approach the Third Party Administrator (TPA) desk available there.

The TPA will initiate your claim with the insurer. The insurer will then get in touch with the hospital for further verification. Upon successful validation, the insurer will approve your claim application and pay the expenses incurred directly to the hospital.

Step 4: Raising a reimbursement claim request on your health insurance

In case you do not have any network hospital near you, proceed to seek medical guidance at any hospital and claim for reimbursement later. Make sure that you keep the medical bills and treatment reports carefully so as to make a successful reimbursement claim and inform the insurer well in advance.

Once you discharge from the hospital, fill out the claim registration form available on your insurer’s website. Upload the supporting documents and submit the claim application. The insurer will assess your claim application and make a decision. If your claim is approved, the expenses incurred will be reimbursed into your bank account.

Step 5: Claim settlement support and No Claim Bonus (NCB)

Health insurance claim settlement process is hassle-free and not at all time-consuming. In fact, you can get in touch with the insurer’s customer care service for guidance in submitting the claim application. Moreover, if you do not claim on your health plan in a particular year, most insurers provide a No Claim Bonus (NCB). The NCB can be used to avail discounts on your health insurance premiums at the time of renewal.

Conclusion

Before you buy a health insurance plan in India, understanding the working of the policy will allow you to make a better financial decision. Additionally, you and your dependents will be able to reap maximum health insurance benefits and make a successful claim on it in the future.

We understand that health insurance can be a tricky insurance plan for most people. Because of this, many people in India avoid buying the policy altogether. Therefore, we at Finserv MARKETS make an effort to help our customers understand the product and its related terms and conditions in detail. These insights will undoubtedly help you buy a health insurance plan that protects you and your loved ones during medical emergencies.

You can also read more on health insurance tax benefits by visiting the Finserv MARKETS website.

Moreover, if you are looking to buy the policy, consider buying health insurance at Finserv MARKETS. You can benefit from features such as cashless claim settlements at the network hospitals across India, reinstatement benefits if you exhaust your existing sum assured, hassle-free health insurance renewals, bespoke health plans that best suit your needs, tax benefits, and so much more.

So, don’t wait. Get a health insurance plan at Finserv MARKETS today.  

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