Eligibility Criteria for Health Insurance and Mediclaim and Factors that Affect Premiums

This is the era when people are struggling to follow a healthy routine. With a busy life and tight work schedule, people are constantly ignoring health, resulting in rising medical expenditures. To ease the burden, health insurance companies come up with various plans to take care of your healthcare needs. It not only supports you financially but also provides mental peace. This blog will provide you with information regarding healthcare insurance.

 

Healthcare Insurance vs Mediclaim

Many people get confused when it comes to differentiating healthcare insurance and mediclaim. Here are some points which will help you get a better understanding of both terms:

 

Basis	Mediclaim	Healthcare Insurance
Coverage	It provides coverage for hospitalisation, accident-related treatment, and pre-existing diseases.	It offers comprehensive medical coverage against hospitalisation, ambulance expenses, post-hospitalisation charges, etc.
Add-on Covers	It does not involve add-on covers.	Add-ons involve critical illness insurance cover, personal accident cover, maternity cover, etc
Flexibility	It does not offer flexibility.	Policyholders can reduce the premium amount by changing the policy duration.
Sum Insured	In most cases, the sum insured for mediclaim insurance does not exceed ₹5 lakhs.	The sum insured may vary from  ₹50,000 to  ₹6 crores per annum.
Claims	You can file multiple claims till the insured amount is exhausted.	In case of claims related to critical illness or accidental disability, the assured sum is paid in a lump sum.
Hospitalisation	Hospitalisation is mandatory to avail benefits.	There is no need for hospitalisation to avail benefits. E.g., daycare procedures.

 

Eligibility for Health Insurance

As soon as you think about health insurance, the first thing that strikes your head is the eligibility for health insurance. You must consider the below-listed factors to understand the eligibility for health insurance:

 

• Age: The minimum age to avail the benefits of healthcare insurance is as low as 16 days after the child’s birth. The coverage varies as per the age of each beneficiary of the plan.
• Pre-existing Health Conditions: If you are suffering from any pre-existing health conditions like diabetes, heart problems, etc., then the health plan and premium get changed accordingly.
• Medical Testing: Usually, medical tests are mandatory if you are above 40-45 years of age. The insurer requires a medical report to determine your eligibility for the insurance.
  

 

Factors Affecting Premium

Premium is the amount paid by the policyholder against the coverage provided. It is an annual payment by the policyholder, which varies with the plan and the insurance provider. Here are some factors which affect the premium:

 

Sum Insured: It is the maximum amount you can claim from your insurer for medical expenses. A lower sum insured results in a lower premium and vice versa. You must select a plan which offers a sum insured that fulfils your requirements.

 

Type of Plan Chosen: Premium depends on the plan you choose. You must compare the premium of floater vs individual health insurance if you are planning to buy health coverage for your family.

 

Pre-existing Diseases: Pre-existing diseases like diabetes, high blood pressure, asthma, etc., have long-term effects on an individual’s health. This leads to increased medical expenses, which is the reason for the higher premium as compared to what is paid by a healthy person.

 

Nature of Work: People who work at construction sites or factories where the risk of getting injured is higher have to pay a higher premium as compared to people working in offices and less risky places.

 

Benefits of Healthcare Insurance and Mediclaim

Life is not a cakewalk; it comes with both rough and smooth terrains. During tough times like degraded health or accidents, healthcare policy gives financial as well as mental support. Here are some common benefits you can expect if you buy a health plan:

 

Safety against Increasing Medical Costs: Medical costs are increasing at a great pace which has raised the expenses of good healthcare services. Medical insurance safeguards you from out-of-pocket expenditures and helps you save money.

 

Tax Benefits: Besides being your safety net for unfortunate events, insurance also provides tax benefits under section 80D of the Income Tax Act.

 

Peace of Mind: You experience peace of mind after getting your family secured under a health plan. You can enjoy your life without worrying about health expenditures.

 

Affordable Plans for Young Individuals Medical emergencies do not knock on the door before arriving. It is better not to wait to get old to buy a health policy. Buying insurance at a young age will give you enough time to spread the amount of premium over the years to reduce the financial strain.

 

Health is one of the most important pillars on the basis of which every other thing gets decided. Negligence on account of health can cost you a big amount. It is high time to invest in a health plan to protect yourself and your loved ones against any unfortunate event in life. Niva Bupa is one of the leading brands in the medical insurance market, which offers a variety of plans to take. care of the major insurance needs of people. You can visit our website to compare various plans and make a wise buying decision.