Benefits and Features of Health Insurance Plans

Friday, Aug 04 2023
Source/Contribution by : NJ Publications

As the proverb goes, "Health is Wealth", taking care of your health and the health of your family members is crucial. With the rising expenses of medical care and hospitalization, having health insurance is essential. Health insurance will serve as the safety net for you ensuring that you have access to quality health care and the necessary treatment by removing /reducing the dependency on your personal financial situation. It also acts as a financial safety net for the big, unexpected financial shocks that may arise due to rising medical costs, subject to the amount of coverage available.

We all are aware of the usual benefits and coverage of health insurance policies like hospitalisation charges, pre & post-hospitalization expenses, day care treatments, Ayush and mental health care. However, it would be interesting to note that a health insurance policy may also offer several other benefits. There are plans available today that offer greater flexibility, more comprehensive features and coverage through add-ons and riders. Let’s keep reading to explore some of these useful add-ons/riders that can be attached to your policy to help you gain more benefits from your health insurance plans.

1. Wellness benefit: 

Some plans offer wellness benefits such as Regular/Preventive health check-ups and preventive healthcare services. These benefits encourage individuals to lead a healthy life and prevent the onset of any fatal diseases. Certain plans offer discounts on maintaining good health. For instance, if you walk 10,000 steps, you can avail of approximately a 10% discount on renewal premiums.

2. Non-Payable Items: 

During a hospitalization, certain expenses are not covered by health insurance and need to be paid out of pocket. These are known as non-medical or non-payable expenses. The most common non-medical expenses are food, laundry, thermometer, bandages, nebuliser kit, toiletries, etc; These expenses can account for up to 10% of the total hospital bill that you have to pay from your pocket. By taking this add-on cover, such expenses can also be covered under your health insurance policy. So, you can expect the entire hospitalization claim to be paid without deduction. 

3. OPD (Out-Patient Department /Treatment): 

This feature provides coverage for medical expenses incurred on outpatient treatments, which do not require hospitalization or an overnight stay in a hospital. Depending on the policy, an OPD add-on can provide coverage for a range of expenses, including doctor consultations, diagnostic tests, pharmacy bills, and other outpatient medical expenses in such OPD cases too. An example of OPD is root canal treatment. Instead of being hospitalized, you can visit your dentist regularly for evaluation and treatment. 

4. No claim bonus (NCB) and Cumulative Bonus (CB): 

NCB and/or options CB add-on rider enables you to avail more coverage from your health insurance policy if you do not make any claims in the previous policy year. Companies now offer a 5% to 500% of progressive increase on the sum insured every year under such add-ons/policy features. For example, Rs. 5 lakh base sum insured can increase up to Rs. 20 lakh in 4-5 years with no claim. Some plans give a cumulative bonus irrespective of claims. In such cases, the coverage increases every year even if you make a claim.

5. International benefit: 

Some health insurance policies cover the medical expenses incurred during travelling abroad and while staying there. Under this benefit, you can plan for your treatment abroad (sometimes with the choice of your hospital), without worrying about the treatment costs. Such plans help you to upgrade your affordability to get the best treatments in the world. The global cover is available at a reasonable premium of around Rs. 1.5 -1.8 lakh for a family of 2 adults & 2 children with a sum insured of Rs 1 Crore.

6. Restoration benefits: 

This add-on enables your health policy's sum insured to be restored up to 100% as soon as it is reduced following a claim. It is very useful in the event of a second hospitalisation within a single policy year where you get to enjoy extra coverage. For instance, if you have a SI of Rs.5 lakh, due to a claim on the policy, the cover of 5 lakh is reduced, so on partial or complete utilization of Rs 5 lakh, this benefit restores another Rs.5 lakh for the subsequent claims.

7. Maternity Coverage: 

Under this add-on, the policy covers the costs associated with the pregnancy (childbirth) up to the risk cover or a fixed amount. Both normal and C-section births are covered. Certain insurers offer pre and post-natal expenses and newly born baby coverage for a specific amount of maternity insurance.

The Bottom Line

With the rising cost of healthcare and medical emergencies in India, it has become increasingly difficult for people to pay medical bills, often compromising the quality of medical care received. Moreover, lifestyle-related medical conditions caused by factors such as sedentary life, poor diet, pollution, stress, and other external factors have become more prevalent. Fortunately, health insurance policies have evolved to meet the increasing demand for better and more comprehensive policies. Today, the policies not only cover hospitalization expenses but also offer many other covers and add-ons which can be customised. Additionally, health insurance policies in India offer a tax benefit that can be claimed under Section 80D of the Income Tax Act. While specific features may differ from one policy to another, one can evaluate the options available and select a suitable policy to match their needs.

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