There are three types of health insurance cover available in the market today. These are:
Mediclaim:
These policies cover you for hospitalization expenses. Actual hospitalization expenses are paid subject to a maximum limit of the sum assured opted for. All insurers offer policyholders cashless treatment in their network of hospitals. Policyholders can also pay upfront and then claim reimbursement from the insurer.
We recommend Mediclaim as a basic “must have” health insurance to our customers. Mediclaim can be individual or a family floater. In individual every person has his or her own individual policy. In a family floater the members of a family pay a single premium and have one insurance policy that covers the family. Sometimes parents and in-laws can also be included in the family cover. A floater cover provides a lot of flexibility for the family and normally works out more economical.
Fixed Benefit Cover
These is a new class of insurance products in the Indian market. These plans pay a pre-determined sum of money depending upon the number of days a person is in hospital and the type of surgery done. This amount may be more or less than the actual expenses you incur. We recommend this as an additional insurance to purchase after you have the basic mediclaim policy. Similar to the indemnity cover, fixed benefit cover has individual and family floater options. Fixed benefit policies will pay you the benefit even if the actual costs are reimbursed by a mediclaim policy.
Critical Illness plans
In these plans a fixed sum of money is paid if the person gets certain pre-specified diseases. Plans can cover anywhere from 9 to 35 diseases. In our view these plans are best bought after one has the basic medicliam and fixed benefit plans. They are ideal for diseases that are debilitating but may not require constant hospitalization - for example cancer or renal failure.
Each of the insurance plans described here can be taken for a single Individual or may include dependents such as the spouse, minor children, parents, parents-in-law, grandparents and grandchildren.
1. There are Three Basic Types of
Health Insurance Policies
Mediclaim Policy
Fixed Benefit Plans
Critical Illness Plans
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2. Mediclaim Policy
It is an Indemnity Policy
Case 2
Your Actual
Insurance Case 1
Actual treatment
Cover, The expense –
Sum treatment
expense – Z (> X)
Insured - X
Y (< X)
Amount Amount
Reimbursed = Y Reimbursed = X
Your insurance payout will be the lower of the two values –
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the sum insured and the actual expenses
3. If the insurer is offering cashless facility at its
approved hospital networks…..
…. You would need to pay only the amount in
excess of the amount being covered
If you are being treated in a hospital outside
the insurer’s network OR the insurer does
not offer cashless facilities, you need to pay
first and then claim reimbursement
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4. Individual and Family Floater Mediclaim
Family Floater
Policy manages Policies
your risks better
In case of individual
policies, 2L for member
than individual 1 and 50,000 for
policies in most member 3 will be paid
circumstances. out. 50,000 of first
Actual Expense member’s expenses
Illustration for a
Individual Family during a year will not be paid
family of 3 (2
Cover Floater
adults, one child)
Total Premium paid
pa – Rs 7,912.
Member 1 2 Lakhs 2.5 Lakhs
4 In case of a
Member 2 2 Lakhs floater policy
Lakhs cover of 4 Lakhs,
the entire
amount will be
Member 3 50 paid out.
2 Lakhs
Thousand
Total Premium paid
pa – Rs 7,702.
5. Fixed Benefit Plans
In the event of hospitalization, the insurer pays a
predetermined amount irrespective of actual expense
A certain amount per day spent in hospital
A certain addl. amount per day spent in ICU of the hospital
A certain addl. amount in the event of surgery at the
hospital
Whether the actual expense is more or less than the actual
expense, the benefit SecureNow a given premium paid.
is fixed for
6. Critical Illness Plans
Similar to fixed benefit plans in structure
Only pre specified diseases are covered – range from 9 to 35
for various insurers
Any disease outside the pre specified diseases are not
covered
Ideal for diseases that are debilitating but may not require
constant hospitalization - for example cancer or renal failure
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7. Our Recommendation
Buy the Comprehensive Medicare Policy first as your basic
cover. It takes care of most of your needs
Every 5 years or so, add a fixed benefit Plan to take care of
added costs of medical care.
Buy a critical illness plan as a rider plan to take care of the
rare but debilitating diseases
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9. Fill in your details on our
inquiry form.
We will call you back!
SecureNow Insurance Broker Private Limited
3rd Floor, 29 Hauz Khas Village, New Delhi 110016
Web – www.securenow.in
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