Understanding Comprehensive Medical Policies in India: ACKO General Insurance Limited

The primary characteristic of health insurance in India is that it is decentralised. People would buy health insurance or choose not to buy it. Therefore, this represents a substantial section of the population that remains uninsured. About 40 crore Indians do not have any medical health insurance scheme protection. Private companies are digitalising this process and innovating new insurance products to capture the market share. Medical insurance is comprehensive in protection, so let us find its benefits.

Medical Insurance: Overview

Medical health insurance has been set up to tackle the dangers of rising medical costs, giving access to quality health care without pressure on someone's savings. Medical emergencies will be 100 percent secure, thus causing less stress and allowing for faster healing.

Besides high out-of-pocket health expenditures, low-income growth also necessitates this kind of insurance, making it an absolute necessity for any form of financial security. Typical medical claim policies only cover hospitalisation costs, whereas complete policies provide coverage beyond hospitalisation limits and thus substantially reduce healthcare costs incurred by families.

Benefits of Comprehensive Medical Health Coverage

The best health insurance policy protects you financially against sudden medical expenses. The mentioned benefits include:

• All-round coverage against the different health problems.
• Higher limits for coverage will allow for fewer out-of-pocket expenses.
• Peace of mind and financial security from not depleting personal savings in meeting health costs.

Individuals can tailor their benefits and append riders according to their changing needs or their families' needs for enhanced coverage.

Types of Comprehensive Medical Insurance Plans

The following are some of the main types of insurance offered by leading insurers:

1. Individual Health Insurance

An individual health insurance plan has been chosen by a 52-year-old businessman. His pre-existing hypertension is taken into consideration in this regimen. The strategy consists of:

• Costs of medications
• Bills for diagnosis tests
• The cost of the surgery and the room.

These are ideal for those who need specialised medical treatment and are appropriate for those seeking a targeted healthcare plan.

2. Family Floater Plans

Imagine a set of four people who go for a family floater plan of Rs 10 Lakhs. The unique thing about this arrangement is that instead of every person in the house having to purchase single plans for themselves alone, they could pay a single premium for the whole family.

The plan simplifies costs by establishing a renewal date and premium amount. These types of plans are designed to cover more than one family member under one policy, extending sum-insured benefits to the different family members. It is cheaper with the one premium covering the whole family and can cater to all types of health needs a family may have.

3. Top-up and Super Top-up Plans

A couple opted for a basic health insurance policy for a total sum insured of Rs 5 Lakhs. Unluckily, both individuals ended up undergoing treatment and surgery during the same period, which cost them more than 10 Lakhs from their savings. This is where the top-up and super top-up plans come into play.

Top-up plans come into the picture to add coverage over and above the threshold limit of the base policy. Super top-up plans provide more extensive coverage when expenses covered by the policy exceed the deductible limit in the policy year.

Features of Comprehensive Medical Health Insurance Plans

The all-inclusive coverage of plans includes the following:

• ​Hospitalisation Cover: This consists of all expenses such as room rent, ICU, doctor's fees, and surgeries during the patient's stay in the hospital.
• Daycare Treatments: These treatments do not require 24 hours of hospitalisation, such as dialysis, cataract surgery, chemotherapy, etc.
• Pre- and Post-Hospitalisation Costs: These are all tests, consultations, and drugs before and after hospitalisation.
• Maternity and Newborn Benefits: This part covers expenses incurred during childbirth, during pregnancy, and even after childbirth concerning the newborn's medical care.
• Ambulance Charges: All expenses incurred for an ambulance during any medical emergency.
• Cashless Network Hospitals: Under the cashless hospitals network, a patient can walk into the network hospitals for treatment without paying. The insurer will pay for the treatment and settle bills directly with the hospital.
• Annual Health Check-ups: To promote healthy living and early diagnosis, many insurers offer free health check-ups once a year.

Generally, when someone buys a comprehensive health insurance plan, they are offered similar coverage with respect to all policyholders. Differentiation of premiums, however, comes in between different people. It differs for a 40-year-old and a 25-year-old individual paying premiums for the same insurance policy, availing similar coverage.

• Age and health conditions: Older people or patients having pre-existing conditions are charged extra as there is a greater risk of health issues.
• Sum insured amount: The premium will always be proportionate to the sum insured. The larger the sum insured, the higher the premium because the greater the coverage, the greater the insurer's liability, and hence the cost of the policy increases.
• Policy Terms and Benefits: Plans with added benefits such as maternity cover or wellness programs are costlier.
• Claim History: Policyholders who are habitual in making claims will always be charged a higher premium as these customers are treated as high-risk.

Conclusion

Healthcare costs are projected to soar higher in the coming years. Comprehensive insurance plans protect insured individuals against possible risks and provide them with cashless treatment options. Premiums, though, vary from person to person. Individualised coverage can be configured, and the trick is balancing maximum benefits and affordability.