How Health Insurance Works

Health emergencies are like uninvited guests, but it is quite easy to tackle them while being covered under a health insurance plans. So let us first understand how health insurance works when push comes to shove.

A health insurance plan works to keep individuals and their families covered against the financial burden that can arise from unanticipated medical events. It offers financial coverage for the medical expenses that an individual or their family might have to incur during medical exigencies.

Individuals can leverage the benefits of health insurance by paying a premium amount at regular intervals over a tenure. You can even choose a health insurance plan with lifetime renewability and stay covered under the same insurance plan throughout your life.

The first step of availing of health insurance is to assess your and your family's healthcare needs. Based on this analysis and your financial capacity, you can estimate your health insurance premium and sum assured. However, it is important to strike a balance between the health insurance policy's premium and coverage, as it is not wise to compromise on the coverage for a lower premium.

During the tenure of your health insurance, if, unfortunately, you catch hold of any disease that is covered under your plan, you can claim your health insurance and keep your savings intact. Let us understand the claim settlement process under a health insurance plan in detail.

For most health-related emergencies, hospitalization is necessary. Generally, your insurance policy includes a number of network hospitals where you can avail of the cashless treatment, meaning you might not have to pay anything out of your pocket as the hospital might directly settle the medical bill with the insurer.

However, if under any circumstance, admission to any of the network hospitals is not possible at that point of time, you can apply for the claim to your insurer and get your treatment cost and other related costs reimbursed. Let's break this down to properly understand how health insurance works when there is a claim to be made.

1. Cashless Facility

Insurance companies have a list of hospitals where an insured individual can make their claim under a health insurance policy without getting into the hassles of payment through the pocket at the time of hospitalization. TATA AIG has a network of 7200+ hospitals across India, making it easier for you to avail of a cashless facility.

This cashless facility works directly between the hospital and the insurance company, subject to your policy terms and conditions. This facility offers ease of access and a hassle-free experience in terms of managing finances.

2. Reimbursement Facility

In case your health insurance plan does not provide a cashless settlement or admission in the specified list of hospitals is not possible, there is always an option of reimbursement. The expenses incurred will be paid by you to the hospital in this case, and you will have to raise a claim request with your insurance provider later on. Direct payment to the hospital will ensure that there is no miscalculation of the total amount, and you will be well aware of the amount that'll be reimbursed according to your policy.

In both the facilities, there is a process that needs to be followed. Firstly, there is a specified timeline within which you will be required to make a claim settlement request which you must adhere to. Secondly, all valid documents and medical bills must be presented when availing of the claim. Lastly, all changes, renewals and updating in the health insurance plan must be reviewed thoroughly. Click on the link to know about both the health claim settlement process in detail.

With such a diverse range of insurance plans available, it might get confusing as to how to go about the entire process. There are a variety of things to consider before choosing an appropriate Individual health insurance plan or family health insurance. In addition, how to avail a plan is an extremely important step that needs to be properly understood. So, here's how to get started:

1. Assess your Healthcare Needs

It is crucial to know that you must assess your healthcare needs when you opt for a health insurance plan. These include considering any pre-existing diseases, vulnerability or predisposition to any medical condition and the role of genetics that might be at play. Other factors that need to be taken into account are age-related issues (if any), dependents in your family, lifestyle habits and others.

2. Sum Insured

After you have carefully assessed your healthcare needs, the choices become clearer and more concise. The next step is to decide on the Sum Insured you want to insure. This is a critical decision where several factors come into play. These factors include the time period of the insurance, the tax-saving benefits it offers, considering any other active insurance plans that you may have, the ailments and benefits that the policy covers and so on. For instance, after carefully analyzing all these factors, you might decide on insuring yourself for a coverage of Rs. 5 lakhs as the policy and its benefits best suits your needs.

3. Settling on a Premium

Premium is the amount fixed as per your chosen plan that you have to pay to your insurance provider on a regular basis. This amount is decided based on a number of factors like age, type of coverage you have opted for, income and other health conditions so as to enable you to pay the amount without fault and as easily as possible.

Now that you have understood the things to consider in the initial phases, the second phase, and perhaps the most important part, comes to action, buying health insurance. After buying it, if, unfortunately, any health emergency arises during your tenure, you need not worry about the finances. You can simply inform your insurer about the same and either avail of cashless treatment or apply for the claim.

Comprehensive health insurance plans provide for an all-rounded coverage that does not stop at hospitalization. It also includes pre-and post-hospitalization expenses such as high-end diagnostics (OPD basis), in-patient treatments, and other consumables as per your active policy. How health insurance works might be a difficult concept in theory, but with a comprehensive understanding, it is easy in practice. At TATA AIG, your health is our top priority. With our MediCare and MediCare Plus Health Insurance policies, we strive to give you comprehensive health coverage to best suit your needs. We have a vast network of 7200+ network hospitals to enable a cashless hospitalization facility for you. Our restore benefits and a considerable claim settlement ratio makes us one of the credible insurance providers. You can visit our website to get your health insurance plan activated for a secure future. For any further queries, contact us via call/SMS/e-mail.