Medical insurance is a contract between the proposer and the insurance company that mentions the insurance company will pay a portion of medical expenses if the insured is sick or injured and need medical care. The insured is required to pay the insurance company a premium in each month. Some contracts also specify that the insurance company will pay a portion of insured’s medical expenses to make sure that the proposer don’t get sick, such as paying for annual physical exams, wellness visits and immunizations. The amount the insurance company will pay, and under what circumstances they’ll pay is known as coverage and can differ significantly from policy to policy.
Health insurance, which offers protection from increasingly high medical costs, is offered in a variety of policy types and terms. Health insurance is not designed to pay long term health care expenses. It is instead meant to cover the cost of hospital or physician care for illness, injury and surgery, as well as the cost of prescription medications. It can be used partially for the care of chronic illness. The contract spells out what portion of medical expenses the insurance company will pay and how much the proposer is required to pay out of his pocket. The policy may not pay anything until the insured has paid a specified amount out of his pocket, which is known as a deductible. Generally, the higher the deductible, the lower will be the insurance premium.
The policy may also require paying a percentage of the bill by the insured which is known as a coinsurance, in addition to the deductible and copayment. Usually the coinsurance is capped at an annual maximum amount, at which point the insurance company would pay 100% of the insured covered benefits for the remainder of that calendar year. Different types of health insurance schemes with different names are introduced by different insurers. All these schemes have certain common basic features.
Mediclaim Policy (individual)
This policy provides for reimbursement of hospitalization/ domiciliary hospitalization expenses for illness or disease suffered or accidental injury sustained during the policy period. The liability in respect of all claims admitted during the period of insurance shall not exceed the sum insured for the person. The policy pays the following expenses incurred under the following heads.
- Room, boarding expenses in the hospital or nursing home.
- Nursing expenses
- Specialist fees.
- Anesthesia, blood, oxygen, Operation Theatre Charges, Surgical Appliances, Medicines and drugs, Diagnostic materials, and X Ray, Dialysis Chemotherapy, Radiotherapy. Cost of Pacemaker, Artificial Limbs and cost of organs and alike expenses.
Group Mediclaim Policy
It is available to any group or association or institution or corporate body provided it has a central administration point and subject to a minimum number of persons to be covered. The group policy is issued in the name of the group or association or institution or corporate body. The coverage under the policy is the same as under individual Mediclaim policy. But it has certain difference with Mediclaim policy. in group Mediclaim policy cumulative bonus and health checkup expenses are not given. Group discount in the premium is available. Renewal premium is subject to bonus. Maternity extension benefit is available at extra premium.
This policy is given to members of the Cancer Patients Aid Association. The members are required to submit proposal form with a declaration that he is in good health and not suffering from cancer. He has to undergo medical checkup and a certification to that effect has to be made by CPAA in the proposal form. If the insured during the period of the policy suffers from cancer, the policy will pay to the insured medical or surgical or hospitalization or diagnostic expenses actually incurred but not exceeding the sum insured
Critical illness insurance
This policy is designed to pay the sum insured if the insured is found to have a critical illness contracted during the period of insurance and insured survives critical illness for at least 30 days from the date of its discovery. The critical illness may be cancer, coronary artery bypass graft surgery, myocardial infarction, end stage renal failure, major organ transplant, stroke, paralysis, heavy valve replacement surgery, end stage liver disease, loss of limbs, loss of speech, major burns, coma, Alzheimer’s disease, blindness, Parkinson’s disease, deafness or multiple sclerosis.
Overseas medical policy
This policy provides for payment of medical expenses in respect of illness suffered or accident sustained by Indian residents during their overseas trips for specified purposes. Indian residents who undertake the following trips are eligible to insure under this type of insurance policy.
- Business and official purposes
- Holiday purpose
- Accompanying spouse and children of the person who is going abroad
- Foreign nationals who are working in India for Indian employers of Multinational Organization getting their salary in Indian rupees, covering the official visits abroad provided they are undertaken on behalf of their employees.
Corporate Group OMP (Declaration basis)
This policy is a new scheme designed for corporates who regularly send their employees abroad for business, training, project work etc. This policy is given by charging an advance deposit premium for a specified number of days and the insured is required to submit details of the person who go abroad for visit.