Dear all, I am excited to present my project, which is a comprehensive analysis based on the book "What Every Indian Must Know Before Investing" by Vinod. The main focus of my presentation revolves around health insurance. Through an in-depth study of the book, I gained valuable insights into the structure of health insurance and the essential factors that investors must consider to identify the most suitable options from the wide array of insurance available. Drawing from my understanding, I have carefully curated the most crucial points and endeavored to present the content in a simplified and easily understandable manner. It is important to note that I have omitted the tax benefits sections for now, but I may incorporate them at a later stage. I genuinely hope that this presentation, along with the book, proves to be as helpful to you as it was to me in navigating the complexities of health insurance as an investor. Thank you for your attention and consideration.

1. Breaking Down
health insurance
citation and source :What every indian should know before investing ~ VInod Pottayil
By: Ponnappa JN

2. During the period of policy you can make as much claims as possible within the insured
limit
Instead you may :
- Receive a bonus in a way of
-
Premium increases with your age. Insurance companies follow an an age bracket.
At the end of the policy period, If you haven't been hospitalized and therefore do not make
any claim, you will not get back the money you paid.
increased in insurance coverage
Discount in renewal premium
Health insurance policy usually covers
Room and Boarding
expenses
Nursing expenses Anesthesia, blood, oxygen,
operation theater charges,
etc.
Expenses incurred prior
and post hospitalization up
to a certain number of days
(dependent upon policy).
Fees of the surgeon ,
anesthesiologist , Physician,
and consulting physician.
Health insurance policy is valid for a fixed of one or more years at a time.
- At the end of an insurance policy the existing policy may be renewed to continue i
Incase you are hospitalized during this period the company will either
insurance
- Pay the hospital directly
- Reimburse the amount you paid to the hospital
Health insurance is a type of insurance coverage that provides to individuals and their families It works on
the principle of risk pooling, where individuals pay regular premiums to an insurance company, and in return, the company agrees to cover a portion or
all of the medical expenses incurred by the insured.
financial protection against medical expenses.
What is health insurance?

3. Types of Health Insureance
Individual Health insurance policy Family Floater health insureance policy
Add on : (not common) (to pay caution)
Recommended :
To pay caution :
Recommended :
As the name suggests, each individual
has a separate health insurance cover.
depends upon various factors including
age, gender, medical history and
profession,
each member pays a different premiu
Gst 18% applicable on premium
One main policy holder, additional
members get insured under the same
policy with the owner
common cover (premium)
Gst 18% applicable
recharge, reload, reset benefit etc.
For a young family where the chances of
of more that one or two hospitalizations
during the same year will be rare
If bought at different intervals, you may
have to pay individual premiums on
different dates, which can be a hassle.
For senior citizens, that have a higher
chance of needing medical attention.
*Prevents burden on family
*Most health insurance policies offer a grace period of up to 30 days, you should renew the policy before it expires to enjoy any eligible benefits like no-claim
bonus and possibility of your claim being rejected due to non-renewal of policy *

4. Waiting Period
Buying the right Health insurance :
Factors considered by Insurance company :
Whichever may be the type of insurance, You
Only upon the completion of the waiting period can you make a claim.
This is
The where the waiting period is not applicable
There is a that you may have (diabetes, hypertension, ENT
disorders, osteoporosis, etc.). This as
when you eventually make a claim. Although
cannot make a claim immediately on having bought the policy.
The waiting period prevents people from buying a policy after being diagnosed with an ailment and thus
misusing the benefit of health insurance
declaration of existing conditions will
result in a higher premium and add waiting period . ( Waiting period for pre-existing diseases may range
between 1-4 years according to policy and medical history of the patient).
usually 30 days from the date of issue of the policy
exception to this is hospitalization due to accidents
separate waiting period for pre-existing diseases
must be declared during the time of buying the policy non-declaration
will lead to rejection
Ag
Medical Histor
Number of pre-existing Disease
Family’s medical histor
Lifestyle (smoker, non-smoker etc.
Risk in profession
If you are the main and sole earner of the family you
should opt for a high cove
Young and unmarried , could opt for a low cover
(this can be evaluated and increased over the years)

5. The claim process :
Insurance claim
Needs to be part of
hospital network
Option 1 Option 2
User
Claim Reimbursement
TPA/claim process dept.
Cashless Hospitalization
You pay for the expenses and then get the
amount reimbursed by filing a claim
To do this you must provide all documents
related to hospitalization along with bills.
Inform TPA/ Claim process dept. right at
the time of hospitalization.
Verifies all documents and performs due
diligence on the documents submitted.
TPA/claim process dept.
TPA/Claim dept. informs the hospital
about their willingness to bear the
expenses as per policy details
Any paid by
insurer will be
5%-20% attached
with policy also borne by the user if
applicable
Difference in amount
borne by user
Co-Payment clause
Bill
Discharge card
medical report
Laboratory finding
copy of original
Additional documents and bills
Document needed to be stored
* Incase there is more than one insurance policy, You can either claim from one or divide the reimbursements among them *

6. Some of the conditions covered by health insurance :
not
Dental treatment
exception: those arising
from accidents or requiring
hospitalization.
Treatments necessitated
due to participation in
hazardous or dangerous
adventure sports
Expenses to correct
eyesight due to refractive
error less than 7.5 diopters
Expenses related to
infertility , child birth etc
gender change treatments
Cosmetic treatment
Obesity treatment
Unless medically certified
by practitioner.
Spa or nature cure clinics
Treatment for addictions
Injuries sustained during
criminal activity
* Total lists of exclusions have been fixed at 18 *

7. Top up policies :
Types of Top Up Policy :
Top Up policy Super Top Up policy
If You feel the health insurance cover is inadequate, you can opt for a instead of increasing the
cover of your existing policy or buying another health insurance policy.
top up policy
The threshold limit is applied to each individual hospitalization expense
the you incu
Premium is lower than super top up policy
The threshold limit is applied on the sum of all hospitalization expenses
incurred with the year
The premium for a super top up policy is higher
Benefits of choosing a top us policy :
- the premium is lower.
Compared to a new insurance policy or increasing the cover charge
The premium of a top up is 50% lesser than the premium for a new policy of the needed cover.
Considerations for a TOP UP policy :
- Almost all top up
- *Ensure you have a health insurance cover for the threshold limit.
policies accept a claim only after you've paid a certain amount on your hospitalization.
(threshold limit)
* Top up policies can be from an insurer different from whom you had purchased the primary health insurance policy; however buying from the same insurer
makes it easier

8. Fixed benefit plans :
A fixed benefit plan or defined benefit plan is one that gives you a fixed amount of money to overcome your financial liabilities when you face a medical emergency.
There are three main types of fixed benefit plans :
Critical Illness pla
Personal accident insuranc
Hospital cash policy
Many major health diseases are covered in this plan :
cance
coronary artery bypass surger
myocardial infarction (heart attack
Kidney failur
Major Organ transplant
Strok
Permanent paralysis of limb
Heart valve replacement surger
Multiple sclerosi
Deafness
Loss of speec
Major burns
Critical Illness plan
a critical illness plan provides additional protection for the policyholder is she is afflicted with a serious illness.
Benefits of this plan :
The insured is paid a lump sum amount as soon as the disease is diagnosed.
* If the person has both critical illness and health insurance,
The health insurance cover can be used to pay for the hospitalization
While the lumpsum payment from critical illness cover can pay for other expenses during a period of emotional and financial stress

9. Personal Accidental Insurance Plan
Accident :
What is personal Accidental Insurance ?
Personal Accident Policy claim can be made for any of the following reasons:
As per IRDA “an accident is defined as a sudden, unforeseen, involuntary event caused by
external and visible means”
Personal Accident Insurance policy provides complete financial protection to the insured
members against uncertainties such as accidental death, accidental bodily injuries, and
partial/total disabilities, permanent as well as temporary disabilities resulting from an
accident. In the case of accidental death of the policyholder, the nominee gets 100%
compensation from the insurer. There are various other compensations that are offered for
accidental disability such as loss of eyes, limbs, and speech. ~ Policybazaar
*The insured can use the money received to meet their financial obligations or invest the money
to receive a steady income over a period of their disability.
*The premiums for personal accidental policy are comparatively low.
Death due to an accident -
Total permanent disability -
Permanent partial disability -
Temporary total disability -
100% of the insured amount is paid as per policy
100% of the insured amount is paid as per policy if the insured is disabled for life
if the insured is partially disabled, the policy pays a percentage of the sum assured to the
insured. The amount may be paid as a lumpsum (50% of the sum assured) or in parts (1% of
the sum assured over 100 weeks) and so o
If the insured is disabled temporarily due to an accident, the policy will pay a certain part
of the cover to the insured.

10. Hospital Cash Insurance Plan
About :
This type of insurance policy is useful for self-employed professionals and
businesspersons as it compensates for the loss of income incurred during the time the
insured is hospitalized
Hospital cash insurance simply pays a certain fixed amount for the number of days you
spend in the hospital.
Points to consider before buying Health insurance
Premium amoun
How does the policy treat pre-existing diseases? (wait period clause
for newly married users who plan on having a baby, may consider a
policy that covers maternity complications that may arise during
pregnancy. There is a waiting period of 2-4 years to cover expense
no claim bonus can boost the cover by around 5%-10% for every year
that you do not make a claim
some policies reimburse you the cost of your annual health check-up
for a certain number of continuous claim-free years
Senior citizens, may have to pay a higher premium and may have a
co-pay clause, compare terms and conditions before deciding.

11. Health insurance Fixed benefit Plan
Top Up Policy
General Insuranc
an Individual health insurance policy:
Waiting Period
Keep track of all claims made by the insured and show the
remainder of the cover charge
Keep an option to record and store all the medical reports,
Documents and bills incurred
Keep information on subtle clauses more visibl
Inform the coverages and exceptions in the insurance
Set reminders on expiry of policy and track grace perio
Provide space to add pre-existing disease
Provided space for claims , option 1 to store data and
option 2 to report to TP
Warn about co-payment clause during paymen
- A need for reminders to pay premiums is helpful
- Suggest for senior citizen
- Inform about the covers and claims
- Show reset benefit if applicable
- Recommend for young familie
- Track waiting period
- Provide an option to report a claim due to accident
A Family floater health insurance policy:
- Suggest to take this plan as an add on with health
insurance plan
- Show all major illnesses that will be covered with
this plan
Critical illness plan
- Show transparency on the information covered on
the plan.
- Premiums are comparatively low
Personal Accidental insurance plan
- suggest for self employed or business persons
Hospital cash insurance plan
Top up policy :
- Track Premium and remind users to pay on time.
- Ensure that the cover costs as much as the
threshold limit to avoid compensation.
Inform the insured that the claim is applicable
only once
Top Up Policy
The threshold limit is applied on the sum of all
hospitalization expenses incurred with the
year.
Super Top Up Policy
Base Plan Additional Additional
My Understanding :
And their underlying feature selling points
From my understanding , Its always suggestable for users to have a base health insurance plan to cover the hospital costs and have additional plans and policies
to provide further benefits and care for the additional costs that are incurred.

12. Thank you for your time reviewing my presentation “ - from the book
“ by vinod”
If you’d like to see more or get in touch, my contact information is provided below.
Email:
breaking down health insurance
rahulponnap2@gmail.com
what every Indian must know before investing