What is a pre-existing condition in health insurance?

What is a pre-existing condition in health insurance?

Pre-existing conditions are ones that already exist, and when we talk about pre-existing diseases, we mean conditions where a person already has a disease such as asthma, hypertension, heart disease, diabetes, thyroid disease, cancer, or pregnancy before actually buying an insurance policy. According to the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing condition is taken into account when an illness or injury is discovered 48 months before enrolling in the policy.

According to the Affordable Care Act (ACA), once you sign up for a health insurance or life insurance policy, no insurance company is allowed to refuse to provide coverage or charge a higher premium due to a pre-existing condition.

Pre-existing illness possibilities

Asthma, hypertension, heart disease, thyroid, acne, anxiety, sleep apnea, and many other conditions. In addition, some diseases, such as diabetes, cancer, depression, epilepsy, and lupus, are chronic, indicating they last for a long period or continue to recur. Pregnancy is also considered a pre-existing condition if it persists previous to the purchase of the policy.

Although there isn’t a specific plan for pre-existing conditions, a policy with a high monthly premium and low deductible may provide the coverage you desire. Purchase is advised if the condition necessarily requires routine medical examinations, treatment, or surgery.

Waiting period for pre-existing disease

The waiting period is essentially the amount of time that the insured must wait before receiving coverage benefits for a specified disease during the term of the policy. A month or a maximum of 90 days serves as the initial waiting period. According to IRDAI, the waiting period for a particular disease can last up to 4 years, but the waiting period for common diseases like diabetes, thyroid disease, hypertension, heart disease, etc. cannot be longer than 30 days. Additionally, the type of waiting period you are subject to varies from insurer to insurer.

Pre and Post Hospitalization

Pre and Post Hospitalization

Pre and post-hospitalization expenses like medical tests, medications, consulting fees, and other costs are typically covered by health insurance. This is understandable given that medical expenses do not only include treatment costs and emergency room costs.

Pre-hospitalization refers to an instance in which coverage is provided prior to hospitalization, whereas post-hospitalization refers to an instance in which coverage is provided following the patient’s hospital discharge.

Pre-hospitalization expense: These costs arise when a doctor orders a number of tests to identify the underlying cause of a condition before treating it. These diagnostic procedures may include CT scans, X-rays, MRIs, ultrasounds, and other types of investigative work. In most cases, pre-hospitalization expenses are paid for up to 30 days before being admitted to the hospital.

Post-hospitalization expenses include costs for medication, follow-up care, additional examinations, consultation fees, and other similar costs. The cost of medical care up to 45 to 90 days after discharge is covered and is regarded as a post-hospitalization expense since treatments typically resume after discharge and recovery take time.

Pre and post-hospitalization coverage advantages

Lessen financial burden: This coverage ensures that the financial fallout from receiving a discharge is well taken care of by the insurance provider, which undoubtedly lessens the financial strain on the wallet.

Peace of mind: When pre and post-hospitalization expenses are covered by the policy, one is at ease and can concentrate on providing the best care.

Prepared for emergencies: Health emergencies can happen out of the blue and without warning, so having a policy that includes pre-and post-hospitalization coverage keeps you ready for such circumstances.

Can preserve savings: helps you keep your savings for the future. Generally, medical treatments have a tendency to deplete your savings if you don’t have a proper health insurance plan.

How to submit a claim for pre-and post-hospitalization expenses?

Within the time frame of the pre-and post-hospitalization coverage provided, the following actions must be taken.

  • Verify that the illness for which the insured person was admitted to the hospital is the same one listed on the claim.
  • Complete the necessary form, attach the hospital bill, prescription, diagnosis confirmation, discharge summary, etc., and submit it to the insurer and the third-party administrator.
  • Submit it between 45 and 90 days after admission to the hospital
  • If the insurer determines that the expense is pertinent to the medical condition after reviewing the supporting documentation, he will accept and approve the claim.

 

Coronavirus Health Insurance

Coronavirus Health Insurance

What is coronavirus?

In December 2019, Wuhan, China was the source of a group of viruses known as the Coronaviridae. Its symptoms and signs include nose infections, sore throats, sinus infections, excessive fatigue, loss of taste and smell, and breathing difficulties.
And in extreme circumstances, can lead to respiratory sicknesses such as pneumonia, renal failure, multiple organ failure, and severe acute respiratory syndrome (SARS). A person with a pre-existing ailment or an older person over the age of 60 has died most frequently from it.
Multiple varieties of COVID-19 has introduced ever since, such as the delta and omicron variants. Additionally, numerous vaccines have been created to combat the virus; in India, these vaccines include Covidshield, Covaxin, and Sputnik V.

What is coronavirus health insurance?

The expense of therapy for a medical problem brought on by the coronavirus is covered by Covid-19 health insurance. It pays for in-patient, out-patient, and hospitalization costs associated with medical care. The variants omicron and delta are also covered by this coverage, which begins to pay benefits the day after a virus is discovered.

Does the current health insurance plan cover coronavirus?

Yes, if you had health insurance before receiving a diagnosis of coronavirus or one of its variants, such as delta or omicron, your current policy will cover the cost of the treatment, unless you contract the virus during the coverage’s initial waiting period. Additionally, if you decide to get health insurance after testing positive for COVID-19, the cost of your therapy won’t be covered.
Since a coronavirus infection is not regarded as a pre-existing condition, it qualifies for treatment coverage, in-patient hospitalization costs, ICU fees, diagnostic test fees, etc.

Inclusion and exclusion of COVID-19 Health Insurance
Exclusion may vary depending on the policy:

 

Benefits of coronavirus health insurance

  • If a doctor recommends home therapy, it is covered.
  • A cashless facility
  • No co-payment clause is mentioned
  • Consumable expenses like PPE kits, masks, and gloves are covered
  • Coronavirus treatment is provided without additional cost
  • Additional coverage options like maternity benefits and newborn baby coverage.

Senior Citizen Health Insurance

Senior Citizen Health Insurance

Senior Citizen Health Insurance

Senior citizen health insurance is a policy that covers the medical costs of citizens over the age of 60. It covers critical illness, pre-existing disease, hospitalization costs both before and after, coronavirus therapy, etc. Medical examinations and a cashless hospitalization service are also available.

Why is senior citizen health insurance important?

As people get older, their health can deteriorate to the point that they need to get regular checkups. Managing the cost of emergency treatment can be a nerve-wracking experience. A senior citizen health insurance policy not only covers the expense of treatment but also includes the following benefits:

Coverage for critical illnesses: As you become older, you’re more likely to develop serious illnesses including kidney problems, cancer, and heart problems, among other things. You can acquire critical illness coverage as part of your standard plan or as an add-on policy with senior citizen health insurance.

Annual health checkup facility: Annual health checkups are covered under this plan. Regular examinations are important for senior citizens to track major health issues and begin treatment early to avert medical crises. As a result, senior health insurance plans include annual health checkups for those over the age of 60.

Help meet the healthcare cost:
As medical inflation rises, it’s more important than ever to safeguard the medical costs of elderly citizens, as this gives them an advantage when it comes to providing the finest medical treatment in times of need.

Stress reduction:
Managing medical expenses may be stressful, especially when the cost of treatment for severe and minor ailments continues to rise. Having a health insurance plan for elderly citizens can alleviate financial concerns.

What is covered by a senior citizen’s health insurance plan?

Hospitalization cost: Expenses such as ICU fees, medicine fees, doctor’s fees, nursing fees, operating room fees, surgical equipment fees, diagnostic tests, orthopedic implants, and so on are covered under this health plan.

Pre-existing disease: After a specific amount of time has passed, the cost of the pre-existing disease is covered.

Day care treatment: Treatments that do not take 24 hours and can be completed in a single day are also covered under a senior citizen’s health plan.

COVID-19: This plan covers the cost of coronavirus treatment for a set period.

Ambulance expense: This covers the cost of transporting the insured from one hospital to another.

Residential care treatment coverage: If a doctor recommends that a senior citizen receive residential care treatment, the insurer will reimburse the costs.

What isn’t covered by a senior citizen’s health insurance plan?

– Cost incurred as a result of self-harm
– Non-allopathic therapy costs
– Plastic surgery
– Lasik surgery
– The cost of AIDS therapy
– Costs incurred as a result of drug and alcohol abuse

One policy’s list of exclusions may differ from another’s.

Family Health Insurance

Family Health Insurance

Safeguard your loved ones with Family Health Insurance! 

Family health insurance is self-explanatory in that it covers the entire family. The policyholder pays a single premium regardless of age, which covers all family members. Individual health insurance, on the other hand, requires you to pay separate rates for each person. This is how a family health insurance policy differs from an individual health plan.

Importance of family health insurance policy

Even with meticulous care, an individual’s health can be unpredictable, therefore health insurance is a must to be able to manage the costs in the event of an unforeseeable health incident. We put forth a lot of effort only to provide for and safeguard the lives of our families. In any case, their presence is our highest priority. As a result, ensuring their health is critical in ensuring the family’s future. The following are the key factors of a family health insurance in India:

Cashless facility: In a cashless facility, the insured receives treatment without having to pay cash. The settlement occurs between the insurer and the hospital in their network.

Maternity coverage: The Family Health plan includes a maternity rider that covers hospitalization costs, delivery expenses, C-sections, terminations, etc. Rider coverage lasts for 30 days before delivery and 60 days following delivery.

Accidental coverage: This plan includes accidental coverage as well as a premium waiver in the event of permanent incapacity caused by an accident.

Critical illness coverage: Under a family health insurance policy, critical illnesses such as diabetes, thyroid, hypertension, and cancer are covered. If you have a stated medical condition, you will be compensated.

Benefits of having the best health insurance plan for Family

As with any other plan, the family health insurance has its own benefits that we should be aware of before purchasing. Please take a look at the following:

Affordable Premium: Health insurance plan for family has a low premium because you only have to pay a single premium for the entire family. Your husband, child, and parents are all covered, but getting an individual health plan for the parents, taking their age into account, might be wise.

Hassle-free: With a cashless facility, the treatment process is expedited because the network hospital and insurer cover the costs. This service is also provided on an individual basis.

Adding a New Family Member to the Health Plan: Adding a new family member to the health plan is as simple as paying an additional premium. This cuts down on the number of steps you have to repeat in each particular plan. Make careful to increase the sum insured amount when adding your parents to an existing plan.

COVID health insurance: To protect your family financially against coronavirus, “Coronavirus health insurance” has been introduced, which covers the cost of Covid-19 treatment on a family floater basis.

Tax deduction: If you pay a premium for an individual or a family’s health insurance, you may be entitled to a tax deduction under section 80D of the Income tax.

Additional benefits: Under family health insurance plans, additional benefits such as critical sickness and pregnancy expense coverage are offered as add-ons. Before choosing the finest health insurance plan, read the policy conditions carefully to learn about the waiting period.

Family Health Insurance

Family health insurance is self-explanatory in that it covers the entire family. The policyholder pays a single premium regardless of age, which covers all family members. Individual health insurance, on the other hand, requires you to pay separate rates for each person. This is how a family health plan differs from an individual health plan.

Why is family health insurance important?

Even with careful care, an individual’s health can be unpredictable, therefore health insurance is a must to be able to manage the costs in the event of an unforeseeable health incident. We put forth a lot of effort only to provide for and safeguard the lives of our families. In any case, their presence is our highest priority. As a result, ensuring their health is critical in ensuring the family’s future.

Factors of health insurance plans for family

Cashless facility: In a cashless facility, the insured receives treatment without having to pay cash. The settlement occurs between the insurer and the hospital in their network.

Maternity coverage: The Family Health plan includes a maternity rider that covers hospitalization costs, delivery expenses, C-sections, terminations, etc. Rider coverage lasts for 30 days before delivery and 60 days following delivery.

Accidental coverage: This plan includes accidental coverage as well as a premium waiver in the event of permanent incapacity caused by an accident.

Critical illness coverage: Under a family health insurance plan, critical illnesses such as diabetes, thyroid, hypertension, and cancer are covered. If you have a stated medical condition, you will be compensated.

Benefits of Family Health insurance plan

Affordable Premium: Family health insurance has a low premium because you only have to pay a single premium for the entire family. Your husband, child, and parents are all covered, but getting a separate health plan for the parents, taking their age into account, might be a wise move.

Hassle-free: With a cashless facility, the treatment process is expedited because the network hospital and insurer cover the costs. This service is also provided on an individual basis.

Adding a New Family Member to the Health Plan: Adding a new family member to the health plan is as simple as paying an additional premium. This cuts down on the number of steps you have to repeat in each particular plan. Make careful to increase the sum insured amount when adding your parents to an existing plan.

COVID health insurance: To protect your family financially against coronavirus, “Coronavirus health insurance” has been introduced, which covers the cost of Covid-19 treatment on a family floater basis.

Tax deduction: If you pay a premium for an individual or a family’s health insurance, you may be entitled to a tax deduction under section 80D of the Income tax.

Additional benefits: Under a family health insurance plan, additional benefits such as critical sickness and pregnancy expense coverage are offered as add-ons. Before choosing the finest health insurance plan, read the policy conditions carefully to learn about the waiting period.

Types of health insurance plans for parents

There are three different types of health plans one can choose from. Look at it to get a better understanding:

Senior health insurance: This provides health insurance to the elderly over the age of 60. In addition to other advantages that basic health insurance lacks, senior health insurance offers a shorter waiting period for pre-existing conditions.

Family health insurance: Every member of the family is protected by family health insurance. which includes the partner, parents, kids, and in-laws. By paying an extra premium, one can add a new member to the insurance plan.

Health insurance for individuals: As the name implies, this plan is intended for a single person and can be modified in accordance with the requirements of the individual. People under the age of 60 and parents under 60 are eligible for this plan.

Inclusions and Exclusions of Family’s health insurance plan:

Depending on the policy, the exclusions list may change:

  Inclusions

  Exclusions

Room Rent

Cosmetic Surgery

ICU Charges

Self-harm /Suicide

Domicile Treatment

Injuries from War/Riot/Strikes

Operation Theater Charges

HIV/AIDS

Daycare Procedure

Dental Treatment

Pre and Post Hospitalisation Charges

Infertility Treatment