Rising healthcare costs are among the leading causes of financial ruin in I. Individuals exhaust their lifetime savings when diagnosed with a severe Illness or suffer major injuries in an accident. If you are searching for ways to safeguard your finances from healthcare expenditures, purchasing a health insurance plan is your smartest choice. Let’s understand how health coverage operates in Bangalore.

How Does Health Insurance Function in Bangalore?

Health insurance is structured to offer financial support to the insured individual in case they incur an eligible healthcare expense. In exchange, the policyholder must pay a regular premium. The healthcare costs are covered up to the insured sum limit, which is the highest claim amount granted by the insurer.

Not every healthcare cost is included in health insurance.

Typically, a health coverage plan takes care of hospitalization costs, day-care treatments, organ donor charges, ambulance fees, maternity-related expenses, AYUSH therapies, etc. However, the extent of coverage is not identical across all mediclaim plans and differs from one policy to another.

Additionally, health insurance policies also feature optional add-on benefits that can be included in your plan to enhance its coverage. For example, reducing the waiting period for pre-existing diseases (PED), critical illness protection, OPD coverage, and daily hospital cash are some of the most prevalent health insurance add-ons.

Moreover, the premium for every health insurance plan is not uniform.

The cost of a health insurance policy is determined by multiple aspects, such as the policyholder’s age, health history, location, insured amount, coverage scope, deductibles, additional covers, etc. The deductible refers to the portion of the claim amount that you consent to pay during claim settlement.

How Does Health Insurance Renewal Function?

When you purchase a health insurance plan, you pay a premium amount. However, this premium remains valid only for a specific duration. Generally, health insurance policies are offered with annual, bi-annual, quarterly, or monthly premium payment options.

Once the validity of a health plan ends, the insured individual must renew the policy. This is crucial because insurance coverage terminates immediately after the policy lapses. Therefore, if you wish to have uninterrupted medical protection, renewing your health insurance plan before its expiration date is necessary.

To renew your health insurance policy, you must get in touch with your insurer and request policy renewal.

How Does the Health Insurance Claim Process Work in Bangalore?

When you have to pay for a healthcare service, you need to submit a claim request to get your insurer to cover the cost. However, as soon as your insurance provider receives the claim, they will first verify whether the illness/treatment falls within the scope of your health insurance policy.

The medical reimbursement will be provided only if your illness/treatment is included in your policy coverage.

If your treatment/illness is covered under the policy, the insurer will then check the hospital where you are receiving medical care. If it is a network hospital, you are entitled to avail of a cashless hospitalization benefit, where the third-party administrator (TPA) will handle the settlement of hospital bills on behalf of the insurance provider. The TPA will review your medical records and ensure that you clear any applicable deductibles before they pay the hospital charges.

Keep in mind… Every medical insurance provider in India has a network of listed hospitals that offer cashless hospitalization facilities.

However, if you are undergoing treatment at a non-network hospital, cashless treatment will not be available. In this scenario, you will be required to settle the hospital bill at the time of discharge. Afterward, you can submit a claim request to your insurer by providing the necessary documents.

Ensure that you collect all your medical records from the hospital when getting discharged.

Once your insurer receives your reimbursement claim application, they will evaluate your documents to confirm whether your policy covers the illness/treatment. If it does, the claims department will proceed with the reimbursement of your medical expenses.

In a Brief Summary

Health insurance is simple to purchase and beneficial to claim. Just ensure that you comprehend how health insurance functions so that you have a smooth and trouble-free experience.