What Is Best Health Insurance?
Health insurance provides essential financial security against unexpected medical costs. Securing best health insurance plans allows families to safeguard their future through affordable premium payments covering emergency care and hospitalization.
A wide range of Health Insurance products are available in the Indian market and you should choose the best health insurance plan for you/your family so that you can have peace of mind in the future while paying huge medical bills.
Besides helping you with financial security, health insurance also helps you to have quality medical care & tax benefits too.
What Benefits Do Best Health Plans Cover?
Here are some of the standard coverages/benefits covered under the health insurance policy:
Besides the above basic coverages/benefits, the following can also be a part of the policy or as optional coverage:
Types of Health Coverage
Besides the above, some other examples are Cancer Insurance, Cardiac Insurance, Dengue Insurance, Covid Insurance, etc.
What about Sum Insured/Premium/Claims?
Sum Insured offered currently ranges from 3 Lakhs up to 1 Crore and above, premium varies from company to company and is linked with the insured’s age & health condition.
Claims Procedure:
Exclusions in Family Health Insurance Plans
General Exclusion is as under:
In Personal Accident Insurance
For all information change existing to below:
Definition
Personal accident is a benefit policy and covers accidental death, accidental disability (permanent/partial), and Temporary total disability and may also have add-on coverage of accidental medical expenses, funeral expenses, educational expenses, etc. depending on the particular product.
The peril covered under the PA policy is “Accident”.
Definition
An accident is defined as anything sudden, unforeseen, unintentional, external, violent, and by visible means
The personal accident insurance policy provides that, if at any time during the currency of this policy, the insured (person who has taken the policy) shall sustain any bodily injury resulting solely and directly from an accident caused by external violent and visible means, then the insurance company shall pay to the insured or his legal personal representative(s), as the case may be, the sum or sums set forth in the policy if resulting in specified contingencies such as death, permanent disablement, etc.
Important definitions of the bold words mentioned above are:
COMPENSATION/COVERAGES:
In a PA policy, while the death benefit is a payment of 100% of the sum insured, in the event of disability, compensation varies from a fixed percentage of the sum insured in the case of permanent disability to weekly compensation for temporary disablement.
Weekly compensation means payment of a fixed sum per week of disablement subject to a maximum limit in terms of the number of weeks for which the compensation would be payable
Death: If a person dies due to an accident, the risk is covered under the personal accident policy. His legal heirs are entitled to get the sum insured. For example, if the sum insured is Rs 1.00 lakh, in case of death, his legal heirs will get Rs 1.00 lakh as compensation.
Disability: Disability can be classified further as follows:
Permanent total disability (PTD): means becoming totally disabled for a lifetime viz. paralysis of all four limbs, comatose condition, loss of both eyes/both hands/both limbs or one hand and one eye or one eye and one leg or one hand and one leg.
Permanent Partial Disability: means becoming partially disabled for a lifetime viz. loss of fingers, toes, phalanges, etc. The compensation will be based on the percentage of the disability as defined in the policy coverages.
Temporary total disablement: means becoming totally disabled for a temporary period of time. This section of cover is intended to cover the loss of income during the disability period. The temporary period may be days, weeks, months, or even years. The payment will be on weekly basis.
The client has the choice to select only death cover or death plus permanent disablement of or death plus permanent disablement and also temporary total disablement.
Add on Cover (differs for different companies based on respective policy guidelines):-
Carriage of dead body & Funeral expenses: The expenses incurred for the carriage of the dead body of the insured due to an accident to the place of residence are reimbursed. This amount will be over & above the sum insured.
Education amount for children: In case of death or permanent disablement of the insured person, the insurance company also pays the education for two children if their age is below 25 years.
Medical Expenses: The medical expenses cover is as follows:
Premium calculation factors:
The underwriting considerations for personal accident policies are discussed below:
Rating:
In personal accident insurance, the main factor considered is the occupation of the insured. Generally speaking, exposure to personal accidents at home, on the street, etc. is the same for all persons. But the risks associated with a profession or occupation vary in accordance with the nature of the work performed. For example, an office manager is less exposed to risk at work than a civil engineer working at a site where a building is being constructed.
It is not practical, to fix a rate for each profession or occupation.
Hence, occupations are classified into groups, each group reflecting, more or less, similar risk exposure. The following system of classification is simple and found to be feasible in practice. Individual companies may have their own basis of classification.
Classification of Risk:
Based on occupation, the risks associated with the insured person may be classified into three groups:
Risk Group I
Accountants, Doctors, Lawyers, Architects, Consulting Engineers, Teachers, Bankers, persons engaged in administration functions, and persons primarily engaged in occupations of similar hazards.
Risk Group II
Builders, Contractors, and Engineers engaged in superintending functions only, Veterinary Doctors, paid drivers of motor cars and light motor vehicles, and persons engaged in the occupation of similar hazards. All persons engaged in manual labour (except those falling under Group III), cash-carrying employees, garage and motor Mechanics, Machine operators, Drivers of trucks or lorries and other heavy vehicles, professional athletes and sportsmen, woodworking Machinists and persons engaged in occupations of similar hazards.
Risk Group III
Persons working in underground mines, explosives magazines, workers involved in electrical installation with high tension supply, Jockeys, circus personnel, persons engaged in activities like racing on wheels or horseback, big game hunting, mountaineering, winter sports, skiing, ice hockey, ballooning, hang gliding, river rafting, polo and persons engaged in occupations/activities of similar hazard.
Risk groups are also known in the form of ‘Normal’, ‘Medium’, and ‘High’ respectively.
Age Limits:
The minimum and maximum age for being covered and renewed varies from company to company. Generally, a band of 5 years to 70 years is the norm. However, in the case of persons who already have a cover, policies may be renewed after they complete 70 years also, but up to the age of 80 subjects to a loading of the renewal premium.
No medical examination is usually required for renewal or fresh cover.
Sum Insured :
The sum insured in a personal accident policy has to be fixed with caution, as they are benefit policies and not subject to strict indemnity. Care should be taken to consider income derived through ‘gainful employment’. In other words, income that will not be affected by accident to the proposer should not be considered while determining the sum insured.
As practices of fixing the S.I. varies among insurers/underwriters, the exact amount for which the cover could be granted depends on the underwriters. However, the general practice is that the cover granted should not exceed the equivalent of 72 months / 6 years’ earnings of the insured.
This restriction is not strictly applied if the policy is for capital benefits only.
For temporary total disablement cover, however, it should not happen that in the event of compensation payable, the same is disproportionate to his earnings during the same period. If the cover is for weekly compensation for TTD, the sum insured usually does not exceed twice his/her annual income.
While giving cover to persons who are not gainfully employed e.g. housewives, students, etc. the insurers make sure that they provide for capital benefits only and that no weekly compensation is provided.
Types of policies other than individual policy cover
Family Package Cover
For children and non-earning spouse, the cover is limited to death and permanent disablement (total or partial). However, based on individual company’s norms, the Table of Benefits may be considered. Some Companies allow TTD cover to a non-earning spouse also up to a particular limit.
Group Policies
A group discount is allowed off the premium if the number of insured persons exceeds a certain number say 100. Group policy however may be issued when the number is smaller, say 25 but without any discount.
Normally, policies on an unnamed basis are issued only to valued clients, where the identity of the member is clearly ascertainable beyond doubt.
Claim documentation:
Death claim
Permanent Total Disability (PTD) and Permanent Partial Disability (PPD) Claim
Temporary Total Disability (TTD) Claim
EXCLUSIONS (NOT COVERED UNDER PERSONAL ACCIDENT POLICY)
No compensation is payable in respect of death, injury, or disablement of the insured