What is health insurance- know everything

What is the definition of health insurance?

A health insurance policy provides coverage for medical expenses incurred due to accident, illness or injury. One can avail such a policy by paying premiums for a fixed period i.e. every month or every year.

During this period, if the insured person meets with an accident or develops a critical illness, the cost of treatment is borne by the insurance providing company.



You can also avail several additional benefits to enhance the coverage of the health insurance policy, which are discussed in detail in the section below.

But, first let’s see,

Why do you need a health insurance policy?

  1. As of 2016, life expectancy at birth was 68.7 years for men and 70.2 years for women. The global average is 70 and 75 years.
  2. Non-communicable diseases accounted for about 61% of all deaths in India in 2017
  3. As per 2017 data, about 224 million people in India suffer from high blood pressure.
  4. About 73 million Indians suffer from type 2 diabetes, which can lead to a variety of health problems. This number is expected to rise to 134 million by 2025.

What do these numbers indicate? Potential health issues can arise at any time in a person’s life and with them come the costs associated with treating them.

The healthcare market in India is expected to reach US$372 billion by 2022, indicating that medical expenditure in the country will continue to rise.

These staggering figures, along with rising medical costs, highlight the importance of health insurance policies in India. These policies provide comprehensive coverage of healthcare expenses in exchange for periodic premium payments made by the policyholder.

What are the benefits of a health insurance plan?

Hospitalization Expenses

Any medical condition that requires immediate hospitalization is covered under a standard health insurance plan. However, claims are considered only if the illness is undiagnosed before purchasing the insurance plan.

Major insurance providers also cover hospitalization expenses for the following conditions:

Critical illness treatment – ​​Some insurance providers provide an amount equal to or more than the sum insured to cover all in-house expenses for treatment of critical illnesses. All medical expenses such as hospitalization, diagnosis, and medicines are covered by most companies.

Hospitalization coverage due to accident and illness – Medical expenses incurred due to hospitalization due to illness or sudden injury also fall under these expenses. Major insurance providers also provide comprehensive treatment expenses up to or more than the sum insured. Such comprehensive coverage helps you stay financially secure in case of any emergency.

  1. Pre and post hospitalization expenses
    Pre-hospitalization expenses such as diagnostic expenses and doctor fees etc. can be covered by a health insurance plan.

Post discharge expenses such as medicines, regular checkups, injections etc. are also reimbursed by most insurance companies. The compensation amount can be taken as a lump sum amount or by showing the bill.

  1. No limit on ICU room charges
    Health insurance policies also cover ICU bed charges. The insured can also choose to stay in a private room, the entire cost of which can be borne by the insurance company up to the total sum insured.
  2. Mental illness treatment cover
    Timely hospitalization for psychiatric treatment is also covered under such health insurance policies. With the rising mental health issues in India and around the world, this cover helps every such person to lead a good life in a professional manner.
  3. Bariatric surgery cost
    Only a few insurance companies cover all the expenses incurred in this surgery, which aims to help people overcome obesity problems. Obesity often puts people at risk of other health problems like heart disease, diabetes, high blood pressure, etc. Including this in insurance promotes long-term good health.

These features of a comprehensive health insurance policy can take care of all the major medical expenses faced by any individual. Additional benefits in the form of more coverage features are also provided by leading companies at a slightly higher premium charge.

  1. No limit on room rent
    The hospital room rent is also covered under these health insurance policies, so that the insured can recover comfortably. The total amount to be spent in such cases is determined in advance by the insurance company.
  2. Daycare procedures
    Hospital expenses for daycare treatments like dialysis, cataract, tonsillectomy, etc. are covered under most health insurance plans.
  3. Road ambulance charges
    Standard health insurance policies cover all ambulance expenses incurred during medical emergencies. This is a significant benefit as premium hospitals often charge a hefty amount for transportation.
  4. Refill sum insured
    Under such a health insurance policy, you can claim up to the sum insured twice a year, provided the medical condition is different each time.
  5. No claim bonus
    For no claim every year, insured persons are given extended discounts or higher sum insured (at no additional cost) in subsequent years, which can help reduce the annual premium charges or increase their sum insured.
  6. Daily hospital cash cover
    Daily cash allowance is offered by select institutions to help individuals compensate for lost wages during hospitalisation.
  7. 0% co-payment
    Major insurance companies cover all medical bills of the insured person up to the sum insured. Zero co-pay reduces the financial liability of the patient, allowing him to fully focus on his health.

Learn more about it

  1. Zone Upgrade Facility
    The cost of treatment in India varies from city to city. It is especially expensive in metros like Delhi and Mumbai.

By availing the zone upgrade facility, you can get more expensive coverage for treatment in different city zones. Zones are divided based on the medical expenses of cities. The higher the medical expenses of the zone, the higher the city is in this classification.

By paying a slightly higher premium, you can get premiums using this add-on.

By opting for Zone A, you can get rid of the difference in treatment costs in different areas or zones, but it can save you up to 10%-20% on the total premium.

*Zone upgrade add-on is not available on Digit at this time. However, if you live in Zone B, you can get an additional discount on the premium. Not only this, we do not have any zone-based co-payment.

  1. Home Health Care
    Comprehensive health insurance policy provides coverage for all expenses incurred on home hospitalization. This includes payment for medicines, nurse fees, injections, etc. for the comprehensive treatment of the patient.
  2. Organ Donation Charges
    All medical bills incurred in organ donation can be claimed.
    All major insurance companies maintain all the above provisions on their insurance products. However, different insurance policies are offered for specific diseases, or different age groups.

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