Insurance cover for individual, family floater health plan, benefits of insurance in india , premium for health insurance

1. HEALTH INSURANCE
Health Insurance is a way to ensure that you and your family’s health
needs are covered.
Products like Individual Health Cover, Family Floater and Senior
Citizen health care are most prevalent
A Health insurance policy is a contract between an insurer and an
individual/ group in which the insurer agrees to provide specified
health insurance cover to the covered individuals at particular price
called “premium”.
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2. FUNCTIONING OF HEALTH INSURANCE
Health Insurance product is designed to protect consumers against
financial ruin that can easily happen through unforeseen, major
medical expenses.
The primary function of health insurance is to shield you from the
cost of medical care. It’s especially important these days when
medical bills for treatment of a serious illness or injury could easily
eat up your savings or push you into bankruptcy.
A secondary function of health insurance is to provide you with access
to discounted medical care.
Without health insurance a doctor’s office may charge you twice as
much for a routine visit (or anything else) compared to someone who
has health insurance.
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3. INDIVIDUAL
An individual policy means a separate health insurance policy for
each person with a defined cover.
Individual health insurance covers an individuals health needs,
medical expenses during sudden illness, surgeries and accidents.
The eligible amount depends on the life style, financial capacity
and health conditions of the individual.
Usually a medical test is undertaken for evaluating the persons
health/ pre existing diseases
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4. FAMILY FLOATER
In contrast, in a family floater, the limit can be utilised by any of
the covered family member.
Eg. If you buy a family floater of Rs 4 lakh, then any member can
utilise this entire limit.
Family Floater plan covers entire family in a single plan.
This acts as an umbrella cover for the entire family.
The policy comparison should be done keeping in mind your
coverage for pre-existing diseases , life style and exclusion during
the first 30 days of the policy
Family Floater plans takes care of the medical expenses during
sudden illness, surgeries and accidents.
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5. GROUP MEDICALIM
Group Medical Insurance is usually taken by companies for their
employees
Depending on the company policy, the GMC may also cover
family members of the employee
Group health insurance is beneficial as it comes at a lower
insurance premium vis a vis individual plan, as the risk is spread
across large number of members.
Family Members covered are usually
The member+ 3 members of the family or
The member + 5 persons ( this includes spouse , 2 children and
either of the parents or in-laws.
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6. SENIOR CITIZEN
 Senior Citizen Health insurance plan is a necessity , specially
at the retirement stage, as the GMC cover ends and growing
age leads to more health issues.
The plan offers comprehensive cover for medical treatment
of illnesses and accidents requiring in-patient hospitalisation.
It also provides cover for Domiciliary hospitalization, which
becomes more frequent at older age.
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7. ELIGIBILITY CRITERIA
Entry Age
FAMILY FLOATER – 18- 60 years
INDIVIDUAL-18-65 years , Children- 3 Months- 25 Years
GROUP MEDICLAIM- 5- 80 years , Children- 3 Months- 5 Years
SENIOR CITIZEN- 60- 80 Years
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8. COVERAGES & BENEFITS
Hospitalization- Medical expenses incurred during hospitalization
including accommodation, boarding , doctor charges etc. These are
those expenses which you reasonably incur on the advice of a
doctor.
Pre and post hospitalization - The policy covers relevant medical
expenses incurred 60 days prior to and 90 days after
hospitalization.
Ambulance Charges - Covers emergency ambulance charges subject
to a limit of Rs 1000.
Organ Donor Expenses – Depending on the company policy the
cover can go up to up to 50% of the base sum insured, subject to
upper limit on the amount.
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9. COVERAGES & BENEFITS
No claim Bonus – the health insurer also provides bonus in terms of
increase in the medical cover for each claim free year, maximum
up to certain % of the total cover.
Medical Test - No medical tests are required up to 45 years of
age , subject to a clean health history of the insured.
Pre policy Check up – Cost of pre-policy check-up is refunded once
the policy is issued.
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10. CASHLESS FACILITY
In a cashless facility the policy holder doesn’t have to pay the
hospital bills as the ailment being treated is paid for by the
insurance company.
 You will have access to cashless facility at various hospitals
across the country.
Its available for Individual , Family and Senior Citizens as well .
Useful in case of critical emergency operations , hospital
admissions.
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11. CASHLESS FACILITY
Conditions for Cash Less Facility
The hospital should have tie up with the Insurance company
The Medical condition being treated should be covered by the
Health Policy.
The expense should be within the limit provided by the
health policy, as any excess will have to be paid by the
individual.
Third Party Administrators
These agencies tie up with the Insurance companies to
process their health claims .
A health policy holder has to connect with the listed TPA for
availing the Cashless policy.
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12. CRITICAL ILLNESS POLICY
Critical Illness is a serious health condition which majorly affects an
individuals Life schedule. It may also lead to loss of income due to
inability to work.
Critical Illnesses Covered
Heart attack
Multiple Sclerosis
Stroke
Cancer
Major Organ Transplantation
Kidney Failure
Coronary Artery Bypass Surgery
Paralysis
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13. CRITICAL ILLNESS POLICY
Advantages
The benefit amount is paid on diagnosis of the diseases
provided it meets the specific criteria and the insured survives
30 days after the diagnosis.
The insured receives the amount as lump sum so that he can
plan the treatment accordingly.
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14. VALUE ADDED SERVICES
Provided by Insurance Companies
Out Patient Department discounts at selected hospitals / doctors .
Discounts on Wellness Test packages at network diagnostics
Many more lucrative health related offers at select outlets under the
below categories
Health Care and related Products
Eye care
Dental Care
Pharmacy
Discount cards to pharmacies, suppliers of agricultural inputs or other
businesses.
Various types of assistance including legal assistance, homework
assistance or assistance with employment issues. www.probusinsurance.in

15. TPA
These are Third party administrators which manage the logistics of the
customer interaction with the hospital and insurance company.
They ensure that the clients are able to get due health care at the tie
up hospitals under the cashless scheme.
Also, in case the customer goes for reimbursement of expenses, it’s
the TPA that manage the operational part of the same. Though the
agreement is between customer and the insurance company.
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16. HEALTH INSURANCE
It has to be a part of your financial cycle
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