OneInsure Blog
Post By Joan
How Does Health Insurance Work?
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Health Insurance, mediclaim policy, Health Plans
Medical costs are rising each year. For people who have not saved much, availing medical treatment at any of the country’s top hospitals can prove to be rather difficult. To safeguard and protect the needs of such individuals, insurance companies have designed different kinds of health insurance policies.
Health insurance is a type of policy where the insurance company pays for medical treatments if and when you fall ill. The health insurer pays for the hospital stay, prescription drugs and doctor consultation fees. If any of the covered illnesses is detected during the policy term, the insurer will pay the claim amount according to the terms and conditions of the insurance plan.
Types of health plans and how they work
Health insurance can be classified into individual health insurance plans, family floater plans and group health insurance.
| Types of health plans | What they do |
| Individual health plan | Individual health plan, as the name suggests, covers the financial needs of the policyholder alone. Say you have a family of three and you have availed an individual health plan of Rs. 3 lakhs for each family member. In case of hospitalization, all the members can claim up to Rs. 3 lakhs individually. |
| Family floater plans | Family floater plans can be taken to cover your entire family. Most family floater plans cover the individual, spouse and children. A few plans extend coverage to include dependent parents and in-laws. To understand how a floater policy works, consider this example - Mr. X has taken a floater policy of Rs. 8 lakhs to cover himself, his wife and two kids. One day, his younger son falls ill and gets hospitalized. The medical bills amount to Rs. 4 lakhs, which is covered by the floater policy. For the remainder of the year, the family now has a health coverage of Rs. 4 lakhs. |
| Group health cover | Group health cover is generally taken by an organization for its employees. Here, the inclusions and exclusions for all the employees of a company are alike. The coverage can be extended to include the employee’s spouse, dependent children and dependent parents. The premium on group covers are generally lower compared to individual health plans. |
Procedure for filing claims
When you are admitted in one of your insurer’s network hospitals, you need to submit copy of ID card/policy copy and KYC of proposer to the TPA cell of the hospital. They will give you the pre authorization form, which needs to filled and submitted to the TPA cell. The hospital will then send the request to the insurer. If the claim is found to be valid, the insurance company will co-ordinate with the network hospital directly and settle your bills (cashless hospitalization).
In case of reimbursement claim, the policyholder has to file a claim with the insurance company listing down the amount spent on treatment expense. The insurance company will process the claim according to the terms of the policy and accordingly reimburse the policyholder for the expenses incurred.
Need Assistance with your Claim Process? Install OneInsure App from Google Play Store or App Store and get free claim assistance on all types of insurance policies.
