How Does Health Insurance for Heart Patients in India Work?

Critical heart conditions like heart attacks, heart failure, valve disease, strokes and transient ischemic attacks (TIAs), peripheral arterial disease, aortic disease, cardiomyopathy, and a long list of other conditions are covered by cardiac health insurance plans. In recent years, heart disease has become so common among younger people. Previously, it primarily affected seniors, people over 60, and people with pre-existing heart conditions, but now both young people and older people are severely affected. To better control the situation, one can adopt healthy lifestyle habits and prepare for medical emergencies by purchasing a cardiac health insurance plan. This will ease the additional stress associated with treatment costs.

There are many different plans that insurance companies offer to their clients. Some examples include critical illness insurance, pre-existing illness insurance, senior citizen health insurance, coronavirus health insurance, etc. There are also heart patient health insurance plans that cover the cost of treating conditions related to the heart.

To better control the situation, one can adopt healthy lifestyle habits and prepare for medical emergencies by purchasing a cardiac health insurance plan. This will ease the additional stress associated with treatment costs.

Knowing that this list is not all-inclusive, let’s examine some of the heart attack warning signs:

  • Pain in the chest that may be described as pressure, tightness, squeezing or aching
  • Headaches or a sudden feeling of unsteadiness
  • Cold sweat
  • Indigestion or heartburn
  • Nausea
  • Lack of breath, etc.

Significance of health insurance for heart patients in India

The need for health insurance for heart patients has increased in India as a result of the sudden rise in health-related ailments and the cost of their treatments. Reduced financial burden and assistance with obtaining the best care to treat the illness are the top priorities of cardiac health insurance plans. Policyholders with pre-existing medical conditions can still benefit from these plans and receive the best care available. The following are some of the advantages provided by cardiac health insurance plans:

Hospitalization costs are covered:Under this plan, the insurance companies provide reimbursement to cover the costs of heart treatment, including pre-and post-hospitalization costs, medications, diagnostic tests, etc.
Lump sum payout:If the policyholder has been diagnosed with a cardiac condition, the insurance companies will offer a lump sum for treatment needs.
Loss of income is covered:The insured is given compensation for the loss of income. During prolonged medical treatment, the patient is typically unable to work, so he is given a payment that he can use to pay for his care or cover other expenses.
Financial protection: Under a cardiac health insurance plan, the insurance company is responsible for covering all treatment-related costs. The insured person can concentrate on receiving the best care without being concerned about the cost.
Oversees treatment: If a policyholder receives treatment outside of the country, the insurer will cover the costs following the terms of his cardiac health insurance plan.
Tax benefit:Following the Income Tax Act of 1961, the premium for cardiac health insurance is tax deductible up to a maximum of Rs. 25,000.

The following coverage is available if you buy a heart insurance policy for a heart patient in India:

Pre- and post-hospitalization expenses are covered under this health insurance plan like as they are under other health plans, along with the cost of the necessary treatments.

Treatment in the outpatient department (OPD): If the course of treatment necessitates frequent OPD visits, the cost of those consultations will also be covered by the cardiac health insurance plan.

Domiciliary care: If a doctor advises a patient to receive care at home, the cost of that care will be covered by the insurance company. However, doctors can recommend it in an emergency, so companies provide the claim taking that into account. Typically, senior citizens choose this type of treatment.

Annual Heart Checkups: To ensure that the illness has been identified early enough to be treated, health insurance for people with heart conditions provides free yearly examinations.

Hospitalization Expense: The Company pays for both treatment costs and hospitalization costs, including ICU fees. According to the terms of the insurance policy and the network hospital, the insured is typically given a lump sum amount instead of reimbursement for the cost.

Coverage for the Initial Heart Attack: The majority of health insurance plans typically provide coverage for medical care following the Initial Heart Attack. When a person has a heart attack, there is a chance that the heart muscle will stop working because of insufficient blood flow. As a result, the treatment is necessary and costly, and insurance pays for those costs. To ensure that the illness has been identified early enough to be treated, health insurance for people with heart conditions provides free yearly examinations.

Heart Failure: If cardiologist reports show this indication, treatment can move forward and the cost is covered by the insurer.

The following are some heart procedures that are typically covered by health insurance for heart patients, though this varies from policy to policy:

– Antithrombotic medication

– The procedure of coronary artery bypass grafting

– The implantation of an artificial pacemaker

– Defibrillation

– Heart valve surgery

– Implanting stents and performing coronary angioplasty

– Less intrusive heart surgery

– Surgery on mazes

– Repair of aneurysms

– Implanting a ventricular assist device, etc.

List of costs not covered by a cardiac health insurance plan:           

– An intentional injury or a heart injury brought on by suicide.

– Pregnancy-related medical care, such as delivery, abortion, miscarriage, etc., is not covered.

– Heart disease was exaggerated by drug and alcohol use.

– Neither infertility testing nor IVF treatment is covered.

– Congenital illness is not covered

– Damage resulting from riots, war, strikes, etc.

How can a heart patient purchase a health insurance plan online?

  • Before purchasing a health insurance policy, it’s crucial to compare the reasonable premiums and add-on benefits provided by the leading insurance providers in India.
  • To receive better help in this regard, get in touch with Policyxplore.com, which offers comprehensive support by offering the best comparison, quotes, and add-on benefits.
  •  Some heart health insurance plans offer supplemental protection like in-home care, personal accident insurance, and fee waivers in critical circumstances, among other things.
  • With help, you’ll be able to determine which cardiac by making a premium payment online, you can buy the health insurance plan that best suits you.
  • The issued policy will be sent to your email address, and you can contact a health insurance expert at policyxplore.com with any questions you may have.

 

You can also send us an email at [email protected]

Why waiting period?

Why waiting period?

The waiting period is necessary to prevent users from buying policies with ulterior motives. As there are cases where customers buy the policy after receiving a disease diagnosis and fail to disclose it when signing up for the policy. A waiting clause regarding pre-existing conditions has been implemented by insurance companies to maintain an ethical approach.

The waiting period clause for pre-existing conditions is followed, but you should read the clause carefully and consider whether it is reasonable for you before purchasing an insurance policy.

There are different waiting periods for health insurance.

Initial waiting period: The insurer must wait a specific amount of time after purchasing a policy before claiming a pre-existing condition by the clause. Standard health insurance has a waiting period of one month or a maximum of 90 days, though this can differ from insurer to insurer.

Pre-existing disease waiting period: For more prevalent diseases like diabetes, thyroid, hypertension, etc., the waiting period typically lasts between one and four years. Additionally, the disease and the health insurance plan that a person purchases come into play.

Waiting period for specific disease: Depending on the insurer, there may be a waiting period of up to 2-4 years for specific diseases like tumors, cancer, stroke, etc.

Maternity waiting period: After a 2 to 4-year waiting period, one can obtain maternity coverage. This coverage is typically included in health insurance plans, but it is also available as an add-on. If a higher premium is paid, the waiting period may be shortened.

Coronavirus waiting period: A 30-day waiting period must be completed before submitting a claim for the treatment of an active coronavirus. It is covered by the typical health insurance plan, but there are also coronavirus-specific insurance plans available.

Waiting period for bariatric surgery: Bariatric surgery, also referred to as weight-loss surgery or obesity surgery, is a procedure for obese people that helps them address the health problems that come with obesity.

 

What is Cashless hospitalization? – Everything you need to know

What is Cashless hospitalization? – Everything you need to know

The word “cashless” itself conveys the meaning: it means not requiring cash. When you combine the terms “cashless hospitalization” and “cashless treatment,” it means neither admission into a hospital nor payment of a treatment’s costs must be made with cash by the policyholder.

How is that even doable? Well, most people are familiar with the reimbursement policy where you submit the bills, the insurance company submits the claim, and you receive full or partial reimbursement depending on the policy. However, with cashless treatment, no payment is necessary. Here, insurance companies have a list of network hospitals where they have agreements with particular hospitals based on their services and treatment costs.

If you receive treatment at one of those hospitals, the insurance company and network hospital will negotiate a price. By using the cashless facility, the policyholder is exempt from payment.

What advantages does cashless hospitalization have?

With cashless treatment, the policyholder need not be concerned about rushing to a bank or ATM or asking a friend or relative for cash in case of an emergency. The goal of cashless treatment is to prevent such situations and lessen the stress associated with making financial arrangements in advance. However, the settlement amount is capped at the maximum amount insured by the policyholder.

The best medical care is provided when you are properly covered because insurance companies evaluate the hospital’s services before signing a contract.

Depending on the severity of the illness, there are typically two situations: either a person needs emergency treatment or plans for future treatment; as a result, cashless treatment is also offered in these two ways:

Planned hospitalization: Under this scenario, the policyholder typically has enough time to choose the best network hospital for their condition. Important things to remember are to let your service provider know about the condition and obtain TPA approval. (TPA, or third-party administrator, is a company that handles payment of bills on behalf of the insurance provider and works with hospitals to arrange payments.)

Then, carry out the subsequent actions:

– Complete the paperwork necessary for hospitalization, such as preauthorization forms. The form is available from the insurance desk of the network hospital or the company’s official website.

– Once completed, turn in the form to the insurance desk. Each hospital in the network has a dedicated Insurance desk that can assist the policyholder.

– Now the application will either be accepted or rejected based on several variables, including the illness’s nature and the policy’s terms and conditions.

– Once it has been accepted, the treatment can start after the third party administrator (TPA) has sent an approval letter.

Emergency hospitalization: Policyholders must follow procedures similar to planned hospitalization, including filling out preauthorization forms, submitting them, and receiving TPA approval. In an emergency, the Third Party Administrator (TPA) must decide whether to reject or approve the request within six hours for the treatment to continue.

– If TPA rejects the request or you are unable to wait for TPA approval, you may pay the bill now and request reimbursement later.

Note:

The policy terms and conditions, including inclusions and exclusions, waiting periods, pre-existing condition exclusions, and many others, should be carefully read by the policyholder before purchasing an insurance policy.

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.