How to Get Health Insurance and How Does Health Insurance Work


Before beginning with the topic related to how the health insurance works and how to get the suitable health insurance, we must first know what exactly is this health insurance. A layman’s knowledge about the health insurance is only good as what they really see in an advertisement or else what they hear from their family and friends. In simple words a health insurance is said to be an agreement between a customer and an insurance company. It is very much helpful in covering one’s medical expenses and other associated spends. Thus, it can be said that a health insurance is very much essential for each and every individual specially in these tough times. According to the agreement of the health insurance the various items that are said to be covered under the process are hospitalization expenses which includes the pre and the post expenses of the hospital, consultation expenses of the doctor, charges of the ambulance and the room rent charges, evacuation charges, the day-care procedure charges and so on. In short, it can be said that a health insurance provides financial coverage in total healthcare expenses of the insurance holder.

Types of Health Insurance

The most popular and the various categories of the health insurance plans are as follows:

  • Family Floater insurance – This particular kind of insurance helps in providing coverage of all family members who are said to be the part of the policy. Generally, in this kind of plan a family that comprises of 4 members which includes 2 adults and 2 dependent children are covered. It does have also other kind of variants as well as some of the insurance providers also add their parents and the also the parents-in-law in the policy.
  • Senior citizen health insurance – This category of insurance generally provides coverage for the senior citizens who are aged 60 years and above. This particular kind does come at a higher premium price as of the higher health risk probability among the older people.
  • Maternity insurance –This particular kind of health insurance helps in providing uninterrupted clinical benefits to the pregnant women. Various plans that comes under this policy covers mother as well as their new-born babies.
  • Specific Illness insurance –This kind of insurance plans are designed in such a way that it only provides coverage for only those of the diseases that are specified under the plan. For example: Covid-19 specific insurance, heart specific health insurance and so on.
  • Individual health insurance –As the name defines, it is a plan for a single individual where the entire sum of money insured is applicable for the one who is only insured.
  • Group health insurance –In this specific kind of insurance the corporate companies and the employers provide insurance for their employees. This are mostly done in group as various individuals are insured under a single insurance plan.

Process of Buying Health Insurance

Before buying a suitable health insurance one must choose the health insurance that is suitable for them. One health insurance policy does not meet all of the requirements that an insurer wants. Thus, buying an insurance is easier said than done. There are various kinds of health insurance policies available in the market and each of them has unique cover benefits. Thus, there are different kind of steps that are essential in ensuring one to buy the best health plan that meets all of his/her family needs.

The first step in doing that is to determine the need of the healthcare. It is been said that a health insurance is an investment but if someone does not purchase that with proper care then it could turn into an expense. Thus, the first and foremost step is to assess yours and the family member of your healthcare needs. The young couple must always consider maternity and family planning health insurance. Those having a larger family group must consider the healthcare needs of each family members and decide individual plans for them. Or else the family floater insurance plan is more suitable in this category.

The next step is calculating the amount of the total sum insured taking into the consideration of the healthcare expenses. In this phase, one must not forget the factor of inflation as it is said to be accounting to be the highest share in the overall inflation.

The third and the most important step is to compare the different health insurance plans along with the different insurance companies. Once the type of the health insurance plan is selected then one must power up their individual finance goals and thus compare different plans. One must differentiate different plans on the following factors such as:

  • Premium
  • Various diseases and illness covered
  • Claim settlement ratio
  • The various network hospitals
  • Waiting period for pre-existing diseases and their clauses
  • Various Add-on that are offered
  • Pre and post hospitalization coverage
  • The insurance companies review and their performance history
  • The facility of the cashless claim
  • Various kinds of sub-limit clauses and the co-payment

The last and the final phase in getting the health insurance plan is when you have noted down all the specific requirements of yours that you need from the insurance plan and disclose all the details of that correctly and completely. Any discrepancies regarding that can create problem during the claim at the time of the medical emergencies and the hospitalization. After noting all these details, one must contact directly to the company that he/she had chosen and directly contact them and get the quote. Or else, if someone needs to apply the health insurance online then he/she must log onto their preferred company’s website and choose the health insurance plan that he/she wants to avail. Soon after that one has to enter the simple details of the insurer as their date of birth, gender, mail address and the sum insured. Soon after that the website will direct to the next page and will get a quote for the insurer according to the details that are filled before. The insurer then can customize their quote instantly by decreasing or increasing the sum insurance. In this phase one must include the add-ones that the individual wants any. Whenever the individual had focused in on the right inclusion soon, they can proceed to the next step that is KYC or Know Your Customer. Once KYC is completed the last and the final stage is to pay for the plan that the insurer selected.

How Health Insurance Works

  • The process of the health insurance for the insured person begins as soon as the individual purchases the health insurance policy. Depending on the coverage and the various exclusions and the inclusions and also the premiums one can choose the insurance policy. That is the moment from when the relationship with the insurance company and the individual begins.
  • Depending on the income and the age of the person the insurance company will be deciding the premium which the individual has to pay for their policy. Soon the company will be conducting a medical test in order to assess the general health of the individual. Depending on those factors the company will soon set and approve the yearly premium and the sum assured.
  • In case of hospitalization, the individual or the insurer needs to check if the policy is cashless insurance policy or not. If it is cashless then one must approach the Third-Party Administrator or TPA in the network hospital. The TPA’s are the one who will be directly reimbursing the hospital bills. On the other hand, if the insurance policy is not cashless then the individual will have to pay the hospital bills and later on it will be directly reimbursed from the insurance company.
  • Some of the insurance policies also includes the hospital cash in their policy which means that the number of days an individual has spent in the hospital will be covered. In simple words the daily expenses that are incurred in the hospital will be covered.
  • If the insurance policy is not cashless then the individual will have to take all the bills and the documents to the TPA’s of the network hospital. Soon after that the TPA’s will be verifying those documents and will ensure that the claim application is completed. The insurance company will soon process and reimburse the bills. Few disallowances can be there as some portion of the expenses will have to borne by the individual which is called as a co-payment. Few items called deductibles are the one that the company will be paying proportionately. Some of it they will deducting and will crediting it into the bank account of the individual.
  • The claim related process is always hassle-free and is not very much time consuming and most of the companies are always helpful in clearing the claims.
  • If someone does not make any claim in a year then it will be in the form of a discount in the premium or an addition to the sum assured.

Hopefully this article will be helping in understanding the basics of the health insurance. Moreover, it is suggested that one must read and understand the terms and condition of the insurance plan completely before purchasing it.

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