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Health insurance is a legal agreement between you and a health insurance company.
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Health insurance plans may cover a wide range of medical care and services. These often include preventive and non-preventive care, as well as emergency care, behavioural health, and sometimes vision and hearing. it is a comprehensive insurance policy that covers medical expenses that arise due to an illness. These expenses could be related to hospitalisation costs, pre-hospitalization and post-hospitalization which includes ambulance costs and related expenses, cost of medicines or doctor consultation fees.
A comprehensive health insurance policy also offers you with a co-payment option. This means that in case of any treatment, the insurance company will bear some of the expenses while the remaining expenses will be paid by the person insured.
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Your employer may offer you a health plan as part of your job.
They work with the insurance company to design the health plans they offer you. Your employer may also choose to add certain programs and services to your benefits, as well.
If you don’t get a plan through your employer you can buy one on your own directly through a health insurance company. You’ll find a variety of plan options to choose for an individual cover or for a family cover for all the family members.
Health insurance and medical insurance are two different words which are often used interchangeably by many people. However, there is a slight difference between them as medical insurance offers limited coverage to hospitalization expenses and treatment towards the pre-specified ailments and accidents. Medical insurance doesn’t offer any add-on coverage like health insurance.
Types of Health Insurance
There are two basic types of health insurance:
Mediclaim / Hospitalisation Plans
Mediclaim or hospitalisation plans are the most basic type of health insurance plans. They cover the cost of treatment when you are admitted to the hospital. The payout is made on actual expenses incurred in the hospital by submitting original bills. Most of these plans cover the entire family up to a certain limit.
Critical Illness Insurance Plans
Critical Illness Insurance Plans cover specific life-threatening diseases. These diseases could require prolonged treatment or even change in lifestyle. Unlike hospitalisation plans, the payout is made on Critical Illness cover chosen by the customer and not on actual expenses incurred in the hospital. The cover gives the flexibility to use the monies for changing lifestyle and medicines. Also it’s a substitute for income for the time you could not resume work due to illness. Payout under these plans are made on the diagnosis of the disease for which the original medical bills are not required.
Third Party Administrator TPA: A third-party administrator is a company that provides operational services such as claims processing and policy benefits management. Insurance companies often outsource their claims processing to third parties. Thus, such companies are called third-party administrators. Other insurance Companies have their in house Claims Administration. Third-party administrators are commonly used by health insurance providers, who outsource many of their administrative functions. Not only claims administration but premium billing, customer enrollment, handling policies, and other day-to-day operations are handled by a TPA.
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Frequently Asked Questions
1.When should you get health insurance?
- If you are offered a health plan through your employer,
- If you have a family to care for,.
- If you would not be able to pay the costs for unexpected illness, or injury you should get health insurance.
- If you just need coverage in the event of a serious accident.
- If you’re between jobs.
2.What is the purpose of Health Insurance?
No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and offers many other important benefits. Health insurance protects you from unexpected, high medical costs. You pay less for covered in-network health care, even before you meet your deductible.
3.What is the deductible / Coinsurance in Health Insurance?
The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.
4.What is the role of TPA?
Role of the TPA : TPAs function as intermediaries between the insurance provider and the policyholder, and its key function is the processing of claims and settlement. The TPA issues ID cards or eCards to policyholders, which have to be shown to the hospital authorities before availing any cashless hospitalization services. TPA sends all the documents necessary for consideration of claims, along with bills, to the insurer. At the time of a claim, the policyholder has to inform the TPA. He will be directed to a hospital the TPA has a tie up with.