Understanding the need and definitions behind Health Insurance

If you have anybody at home who has health risks, you will know that having a health insurance is the responsible thing to do. Take the case of this family: It is a family of 6 living in one house. The family consists of maternal grandparents, a mother, a father and their two children aged 12 and 15. The family only has one car and only the father knows how to drive. Suddenly, the grandfather falls ill and the father is away on business.

It falls to the grandmother, mother and children to pay the cost of the ambulance and admitting him to the hospital. But where is the money to come from if the husband has all the financial control and the grandfather has his finances limited by his access to it i.e his health? In a case like this, it is best to have a health insurance that offers a cashless facility and covers the ambulance cost. In this case, the family had all these facilities in place so the father could continue his business and the grandfather went on to live another 12 years that doctors said would not have been possible.

So how do you know if health insurance is something that you need? Our friends at Bajaj Allianz have given us a wonderful breakdown of everything you need to know about health insurance. The full article is below.

It’s not enough to just get a health insurance policy. It is also important to know what the different terms in the policy mean and what they do for you. Let’s start with some of the basic terms that you must know about:

• Sum Insured – This is the amount of cover that one can opt for and the maximum amount up to which the insured can get benefits in the event of a claim during a single policy year. 
• Premium – This is the amount paid to the insurance company when you purchase a health insurance policy. The premium to a great extent depends on the sum insured you have chosen. 
• Pre and Post Hospitalization Expenses – Health policies compensate you for expenses that you would incur prior to getting hospitalized for a treatment, as well as for the recovery treatment post being discharged. 
• Deductible – This is a fixed amount which the insured needs to first bear for each claim. The insurance company’s liability starts over and above this amount. 
• Ambulance Charges – This additional benefit compensates you for the charges that you incur when availing an ambulance service in case of an emergency to take the patient from home to the hospital or from one hospital to another. 
• Day-Care procedures – Certain surgical procedures do not require 24 hours of hospitalisation (the basic requirement when one needs to avail a health insurance claim for treatment). These are called day-care procedures. 
• Network Hospitals – Insurance companies tied up with hospitals provide better medical services to their customers during their time of need. These networked hospitals allow you to avail cashless facility. It is necessary that the insurance company is informed of the hospitalisation so that they can authorize the hospital to not charge the customer. 
• In-House Claims Team v/s TPA – The insurance company’s own claim settlement team is called an in-house claims team, while TPA refers to outsourced claims team. An in-house claims team enables the insurance company to directly deal with health insurance claims and provide the customer better service. 

Bajaj Allianz also provides additional benefits. These are called Value Added Services, and are generally meant to help customers enjoy a healthier lifestyle overall by providing discounts on OPDs, medicines, glasses and lenses, gym memberships, etc.

Visit www.insurancebazar.in for a more personalized insurance education experience.