In today’s busy world people love to use the internet to shop for almost everything. We buy groceries to cars using the internet to find the best prices and research the products. Many people today use the internet to purchase health insurance. There are a few things to know about health insurance prices, they are regulated and they same policy from the internet and from an Insurance broker will be the same price. This is good news for the consumer this makes is easy to compare plans and premium costs via the internet. This can be a great way to go if you are healthy and you know what you want, but it can be a large problem for someone who has some medical issues to find the best plan and company for their particular situation.

The Insurance Agent/Broker can offer you the personalized advice and guidance you need to navigate through obtaining health insurance. To get this personalized service there is no effect in the premium cost, so why would you shop on the internet alone for insurance. The personalized service you will get will save you a lot of time when you need to ask a question or need help. They will know who you are when you call. You will have a person who you know to call if you have a question. If you call an 800 number of one of those internet services to buy insurance, you will be talking to a different agent every time you call. You may even need to call the insurance company and have no one on your side to help you work an issue.

The great advantage of working with an Insurance Broker/Agent is growing a relationship together. They know you and you know them so it will save you time if you need help. The insurance agent has support people in the particular insurance company to help them if your issue has not been resolved through the normal channels.

The Insurance Agent/Broker has something you do not have when you are applying for insurance online is access to the underwriter guide and to underwriters to do a pre-screen before you apply to see if the insurance company can accept you and what your rate up may be. The insurance company has the final word on your premiums, but you will be able to get an estimate with the help of an Agent. Using an insurance agent can save you some frustration and guidance that can help lead you to an approach to saving you on your premiums.

I would suggest you build a relationship with your insurance agent to help you through any personal insurance needs. They will be a good contact for you in the event of any issues and can help you through finding the best solution for your needs. Do not go it alone, find an agent you trust to help you. The best complement for any insurance agent is a referral, so ask around to find one of your friends if they know if an agent.

Help your neighbor not a big company; use an insurance broker/agent.

First of all, it is not only possible to buy health insurance when you’re self-employed, it’s absolutely critical … afterall, your health is one of your most important business assets.

Here are a couple of things to keep in mind as you shop for your best health insurance plan. And remember, when it comes to health insurance, there is no one-size-fits-all policy. You’ll need to consider your individual circumstances as you compare options.

1. If you’re relatively healthy, consider a high-premium policy that covers only catastrophic events, such as surgeries and major injuries. The premiums are much lower than traditional health insurance policies, but that means you’ll be paying out of pocket for check-ups and minor medical care.

2. Take advantage of Section 80D: You get an advantage of an annual deduction of Rs. 15,000 from taxable income for payment of Health Insurance premium for self and dependants. For senior citizens, this deduction is Rs. 20,000.

3. If you want more coverage than the catastrophic policy offers, consider a comprehensive policy and then choose the highest possible deductible that you can afford, even if that deductible would be a financial stretch. The dollars you save on the premiums will likely exceed the deductible in the long run.

4. If you choose to go with a comprehensive policy, make sure it doesn’t include coverage you don’t need like: pregnancy, mental health, chiropractic or unnecessary prescription drug coverage. On the other hand, if any of those coverages are important to you, ask your insurer to include them in your policy.

5. Consider a supplemental insurance policy to help cover your deductibles and out-of-pocket medical expenses that aren’t covered by your primary insurance policy. This type of policy can even pay a cash benefit is you are unable to work because of illness or injury, an important feature for the self-employed.

By deciding up-front what type of insurance is best for your situation, you’ll feel more confident as you shop for the best policy.

If you would like to learn more about health insurance for the self-employed, please visit the website recommended below.

Health is surely one’s wealth indeed. But it is true that one does not think of getting their insurance done against the illnesses until the time comes when they have to face some serious health related problems. Health insurance has become a necessity in the present scenario.

The price of medicinal heed and management has ascended to new tallness in topical years and is predictable to go up still more in the coming years.
What exactly is health insurance:-

Health insurance is actually a protection against medicinal expenses. Non-life insurance corporations propose health insurance. Nevertheless, it could be bought as an extra advantage condition with your life cover plan with few limitations. You have to make your payments in installments or as in the form of lump sum amount.

Health insurance frequently offers either straight expense or compensation for operating cost linked with illnesses and damages. The price and variety of defense given by your health insurance would depend on the insurance supplier and the exacting policy which you may purchase.

Need of a health insurance:-

Suppose for a minute if you face any health problem by tomorrow that might cost a lot of money, then you will get the importance of health insurance in your lives. People who do not get their insurance done live a risky life every day. A good health insurance can guard you against that risk.

Even after having a sound good health you cannot predict what the future holds for you. And therefore the need for health insurance arises. The greater expenses related to medicinal treatments are far above the reach of a common man.

Growing charge of healthcare and rising life duration would force the present age band of functioning class to consider a sensible mix of investment and risk wraps to face future tests. In any of the therapeutic emergency, charge of hospital room, the doctor’s bill, tablets and connected health services would come out to be a massive sum. In similar cases health insurance offers you the financial assistance.

Need to know about Health insurance:-

You should recognize the plan, and become recognizable with frequent health insurance necessities, inclusive of different kind of limitations and conditions. Therefore it is necessary to have knowledge about the coverage that policy offers and to understand how much you have to pay for getting it. Many corporations provide “Mediclaim” for complete health insurance coverage of an individual.

Religare Enterprises plans to roll out its health insurance business by April 2010 even as it continues to scout for a foreign partner for the venture. The company is confident of completing all formalities in the current financial year, said Amit Varma, president for healthcare at Religare Enterprises. We will approach the Insurance Regulatory and Development Authority (Irda) in a couple of months for a licence to start operations, he added.

Religare Enterprises has started hiring for the proposed health insurance business and expects to appoint a CEO shortly. The company is in the process of setting up operations and is likely to appoint a new head by November, Mr Varma said.

The news of a fresh venture comes close on the heels of Religare Enterprises’ aborted joint venture with Swiss Reinsurance for health insurance. The company is now in talks with global health insurers such as Discovery Health, Cigna and Aetna for a possible tie up, learns ET. “We hope to induct a foreign partner in the health insurance venture after our proposed joint venture with the world’s second-largest reinsurer Swiss Re fell through last month,” Mr Varma said.

Religare Enterprises, which has a life insurance joint venture with Aegon of the Netherlands, had signed a non-binding term sheet with Switzerland-based Swiss Reinsurance Co to develop a health insurance joint venture earlier this year.

However, talks between the companies fell through as Swiss Re was already present in the Indian market through a 26% stake in TTK Healthcare Services, a third-party administrator in health insurance, and Religare believed that the new deal could clash with the existing Indian venture.

With a reach of just about 2% of the country’s 1.1-billion population, India offers a huge potential in health insurance market. There are over 30 health insurance products in the category offered by both life and non-life insurers. While ICICI Lombard, Bajaj Allianz and Reliance General are some of the prominent general insurers in the health insurance space, Apollo DKV, Max Bupa and Star Health & Allied Insurance are the standalone players.

Religare is a Delhi-based financial services holding company, led by the former promoters of Ranbaxy, brothers Malvinder and Shivinder Singh. The company is present across retail, institutional and wealth spectrums through its subsidiaries and joint ventures.
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Introduction

Having health insurance is important because coverage helps people get timely medical care and improves their lives and health. Some may believe that people always have access to medical care because they can always go to an emergency room.

But even areas with well supported safety-net care do not remove barriers to access to the same extent as does having health insurance. “Coverage matters,” concluded the Institute of Medicine (IOM) during a recent multiyear appraisal. Indeed, the prestigious IOM estimated that lack of coverage was associated with about 18,000 extra deaths per year among uninsured adults. Several points deserve emphasis.

1. Uninsured people receive less medical care and less timely care.

Overall, uninsured people get about half as much care as the privately insured, as measured in dollars spent on their care—even taking into account free care received from providers. This discrepancy holds true even when spending is adjusted for age, income, health status, and other factors. (This finding and most information presented here do not come directly from District sources, for which data are often lacking. But most patterns are believed to be generally true of all locations.)

Uninsured adults get fewer preventive and screening services and on a less timely basis. Shortfalls are documented for many types of illness or condition, including screening for cervical and breast cancer as well as testing for high blood pressure or cholesterol. Cancers, for example, are more likely to be diagnosed at a later stage of illness, when treatment is less successful.

Uninsured pregnant women use fewer prenatal services, and uninsured children and adults are less likely than their uninsured counterparts to report having a regular source of care, to see medical providers, or to receive all recommended treatment. Shortfalls are particularly notable for chronic conditions. For instance, uninsured adults with heart conditions are less likely to stay on drug therapy for high blood pressure.

Some uninsured people may decide not to obtain insurance precisely because they expect not to need medical care, so simple comparisons of the insured and uninsured can be misleading. However, many studies adjust for factors like age and health status that affect need for care.

One recent study examined people who experienced an unintentional injury or a new chronic condition—times when care is more clearly needed. Uninsured individuals were less likely to obtain any medical care, and if they did receive some initial care, they were more likely to get none of the recommended follow-up care.

Agent

An agent is appointed by the insurer to conduct business on behalf of the insurance company. An agent must hold a license issued by the IRDA.

Claim

The process of applying to the insurer for reimbursement of the expenses incurred for treatment is called “filing a claim”. Usually, this process is handled by a service provider to the health insurance company. This service provider is called a “Third Party Administrator” (See below).

Cashless Claim

As the term suggests, the insured can make a claim without paying any cash upfront.
The insurer or its Third Party Administrator have tie-ups with network of hospitals and nursing homes called a “network hospital”(see below) across the country. The insured can get themselves admitted in these specified network hospitals and take treatment for the disease contracted without any cash payment to the hospital at the time of discharge.
However cashless mediclaim settlement is subject to the limits and sub limits which is subject to the sum insured of the policy.

Coverage Amount

Coverage amount is the maximum amount payable in the event of a claim. It is also known as “sum insured” and “sum assured”. The premium of the health insurance policy is dependent on the coverage amount chosen by you.

Critical Illness Policy

A Critical Illness is a serious possibly terminal disease, which is strictly defined by the insurer. Conditions such as cancer, multiple sclerosis, major organ transplants are deemed as “Critical Illness”. Most critical illness policies provide for the payment of a lump sum benefit if the policyholder is diagnosed as suffering from one of a number of specified terminal conditions.

Cumulative Bonus

Each claim free year ensures that you get a benefit known as “cumulative”bonus – it is similar to “no claim discount”(see below) in concept. The only difference being that instead of giving an upfront discount, the health insurance company adds more benefits for the same premium paid. However, the overall amount of these benefits will not exceed a certain percentage as specified in the policy.

Related Links
Healthcare Insurance-Common Terms and Definitions

Tamil Nadu’s Karunanidhi government has reached out to people with a unique offer: a Rs 517-crore state health insurance scheme for 1 crore poor families. In a grand gesture, the CM also said that his house will be turned into a free hospital. CNBC-TV18’s Meenakshi Madhavan reports.

After free colour TVs and rice at Re 1 per kg, DMK chief K Karunanidhi has another gift for Tamil Nadu’s poor. He’s now giving them health cover! Union Health Minister Ghulam Nabi Azad was in the state to inaugurate the Kalaignar Insurance Scheme for life-saving treatments. The scheme will benefit 1 crore poor families who can now avail of medical services up to Rs 1 lakh. The premium of Rs 500 per year will be paid for by the government.

“If the Kalaignar Insurance Scheme for life-saving treatments reduces the out-of-pocket expenditure of poor households and ensures quality health services for them, it would have alleviated the pauperization of poor households as health expenses are one of the leading causes for families remaining poor,” Health Minister Azad said.

Star insurance, a private insurance provider, will implement the scheme. It has already identified six hospitals in each district and 15 hospitals in each major city where the scheme will be made available.

“The DMK believes in starting schemes that will help the needy,” Karunanidhi has said.

It’s yet another populist measure from a party known for its sops. The CM has said that after he and his wife dies, he wants a free hospital to be built on the land he owns in his native village. He also wants his Chennai house to be converted into a free hospital. This one is sure to take Karunanidhi closer to the masses.

Q. Is a medical checkup necessary before buying a health insurance policy?

A. A medical checkup is necessary for a new affordable health insurance policy for customers above the age of 40 or 45 years depending on the health insurer’s norms. Medical checkups are usually not needed for renewal of policies.

Q. What are the minimum and maximum policy durations?

A. Health insurance policies are general insurance policies usually issued for a period of 1 year only. However, some companies also issue a two year policy. At the end of your insurance period you must renew your policy.

Q. What is coverage amount?

A. Coverage amount is the maximum amount payable in the event of a claim. It is also known as “sum insured” and “sum assured”. The premium of the policy is dependent on the coverage amount chosen by you.

Q. My wife and children are residing at Chennai while I am here in Mumbai . Can I cover all of us in one policy?

A. Yes, you can cover the entire family under one policy. Your health insurance policy is in force across India. You must check whether there is any network hospital near to your as well as your family’s place of residence.

You must check if your insurer has a network hospital close to you or where the rest of your family resides. Network Hospitals are the hospitals that have tied up with the TPA(Third Party Administrator) for cashless settlement for expenses incurred there.

If there are no network hospitals at the place of your residence, you could opt for reimbursement mode of settlement.

Q. Are naturopathy and homeopathy treatments covered under a health policy?

A. Naturopathy and Homeopathy treatments are not covered under a standard health policy. The coverage is available only for allopathic treatments in recognized hospitals and nursing homes.

Q. Does health insurance cover diagnostic charges like X- ray, MRI or ultrasound?

A. Health Insurance covers all diagnostic test like X- ray, MRI, blood tests etc as long they are associated with the patients stay in the hospital for at least one night. Any diagnostic tests which have been prescribed in the OPD are generally not covered.

Q. -I am young and healthy. Do I need health insurance?

A -Yes. You will need insurance. Even if you’re young, healthy and haven’t had to see a doctor in years, you will need coverage against unexpected events like accidents or an emergency.

While your health insurance coverage may/may not (depending on the policy taken) pay for things that aren’t too costly like routine doctor’s visits, the main reason to have coverage is to have protection against the large treatment expenses of serious illness or injury.

No one knows when a medical emergency might strike. It is best to buy health insurance, to save money when an emergency strikes.

Q. Is Health Insurance the same as Life Insurance?

A-No. Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely death/or if something happens to you.

The payout is made only post the death of the person insured or at the maturity of the policy.

Health Insurance protects you against ill health/diseases by covering the expenses you might incur (for treatment, diagnosis etc.) in case you are affected by disease or injury.

There is no payout made at maturity. Health insurance also needs to be renewed annually.

Q-My employer provides me with health insurance coverage. Is it advisable to take another policy on my own?

A_It is strongly advised to have health insurance on your own as well because of reasons of continuity. Firstly, if you change your job, you might not necessarily get health insurance from your new employer. In any case you will be exposed to health costs in the transition period between jobs.

Secondly, the track record that you have built in health insurance at your old employer will not transfer to the new company policy. Covering pre existing diseases might be a problem. In most policies pre-existing diseases are covered only from the 5th year onwards.

Therefore to avoid the above problems, it is advisable to take a private policy in addition to your company provided group health insurance policy.

Q. Is there any tax benefit that one can avail of while purchasing Health Insurance?

A-Yes, there is a tax benefit available under Section 80D of the income tax act 1961. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable income for payment of Health Insurance premium for self and dependants.

For senior citizens, this deduction is Rs. 20,000. Please note that you will have to show the proof for payment of premium. (Section 80D benefit is different from the Rs 1, 00,000 exemptions under Section 80 C)

At present, the Central government employees are covered under the CHGS scheme, being operated by the health ministry.

The government has formulated a novel health insurance scheme that will allow its employees to choose between a health insurance plan provided by an insurer or that from state-run Central Government Health Scheme (CGHS).

“The scheme is already formulated…It will open the choice for government servants,” G C Chaturvedi, Additional Secretary in the Finance Ministry told news agency.

The new scheme explained

The new scheme, which will be placed before the Union Cabinet for approval soon, will immediately benefit at least three lakh Central government employees, he said.

The new scheme, Chaturvedi said, will be more beneficial to the employees who are posted at places where there are no CGHS dispensaries or they are far away from the place of posting.

CGHS dispensaries and hospitals are located only in 26 places in the country.

“Those who are residing outside CGHS dispensaries areas will immediately opt for it… There are over three lakh employees who will immediately opt for it, others will take some time,” Chaturvedi said.

The government had earlier appointed an inter-ministerial committee to work out a health insurance scheme to supplement the CGHS scheme to provide better coverage to its employees.

The fairer sex is not getting a fair deal despite conclusive evidence of higher life expectancy for women.

Life expectancy of males in India is 63.87 years whereas females score 66.91 years, according to data available with the ministry of health and family welfare.

“A majority of women are non-smokers, which contributes to their longer life,” says SK Sethi, vice president and director of the Insurance Brokers Association of India. But while absence of distinction between men and women on premiums is the norm, some exceptions are emerging.

Aviva Life says it offers women lower rates in case of its pure-protection product, Aviva Life Shield Plus, and charges less for certain unit-linked plans too.

LIC has an exclusive insurance product aimed at women — Jeevan Bharathi — and premiums charged are lower in this case than regular policies, says ED Rajesh Kandwal. However, such examples are few and some in the industry say it is also because of poor financial literacy standards.

One insurance broker, who asked not be named, said companies charged both men and women equal premium because most women are unaware that once they reach the middle age, they carry lower risk and, hence, should be charged less.

Health Insurance Covers hospitalization when a patient is in hospital for more than 24 hours due to:

1)  Surgery requirement
2)  Illness
3)  Accident
4)  Symptoms, when diagnosis is been done

According to the Document of Cholamandalam MS General Insurance the costs covered are :

1. Room, Boarding Expenses in Hospital/Nursing Home
2. Nursing Expenses, intensive care unit expenses,
3. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees
4. Anesthesia
* Blood Oxygen,
* Operation Theater Charges,
* Surgical Appliances, Medicines,
* Drugs,
* Diagnostic Materials,
* X-ray,
* Dialysis,
* Chemotherapy,
* Radiotherapy,
* Pacemaker cost,
* Artificial Limbs,
* Cost of Organs.
5. Pre-Hospitalization Expenses
6. Post-Hospitalization Expenses
7. General Health and Eye Examination (Optional with extra premium)
8. Local Ambulance Services (Optional with extra premium)
9. Hospital Daily Allowance (Optional with extra premium)

Admissible Limits:

• Minimum 24 hrs. Hospitalization except Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy, D&C, Tonsillectomy (insured discharged on same day)
• Pre-Hospitalization Expense: Laboratory, X-ray or any other medically necessary diagnostic procedures ordered by a physician (60 days prior to Hospitalization in case of all type of covers)
• Post-Hospitalization Expenses: The medically necessary treatment ordered by a physician and readered (within a time period of the Insured person’s discharge from Hospital or Day Treatment) (90 days after hospitalization in case of all type of covers).
• General Health and Eye Examination: Radiology, Blood Diabetes, Liver, Renal/Kidney, Cardiac Lipid, Phospholids, Lung, Abdomen, Cancer, Optometry, Slit Lamp Examination, Direct Fungus Examination, Indirect Fungus Examination, Color Vision Testing, Prescription of Glasses if necessary.
• Local Ambulance Services; Emergency ambulance road transportation by a licensed ambulance service to the nearest Hospital.
• Hospital Daily Allowance: The Hospital Daily Allowance benefit is payable per day of Hospitalization in India for a limited period per person and policy period.
• Day care Surgeries: Microsurgical operations on the middle ear, other operations on the middle and internal ear, nose and the nasal sinuses, the eyes, the skin and subcutaneous tissues, the mouth and the face, Traumatological surgery and orthopedics, the breast, the digestive tract, the female sexual organs, the male sexual organs, the urinary system. For Applicants aged 45 and above a medical test is mandatory.

Health insurance is not very expensive when compared to the cover it gives you.

Healthcare is increasingly expensive, with technological advances, new procedures and more effective medicines that have also driven up the costs of healthcare.

While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.

The costs payable for a health insurance policy generally depends on various factors like the number of persons insured, their age group, the sum insured opted for, the cost sharing mechanisms like co-payments and deductibles in the policy, health status of the proposed insured persons, and the kind of coverage sought.

The costs thus start from a subsidized premium of Rs 100 under a Universal Health Insurance Scheme policy for a person below the poverty line, and could reach up to tens of thousands for high amounts of comprehensive coverage.

For illustration purposes, the data of the insurance regulator for 2007-08 indicates that the average premium per person was in the range of Rs 1143 per person during the year, which comprised of a mix of group individual policies with varying cover.

Swine Flu -Is it covered or not?

Insurance companies have come out with some clarifications and these are;

1. Cost of Tami flu is not covered as this is being given by the Government on free of cost basis.
2. Private hospitals can charge the patient for facilities like tests, beds and doctors fees. And this will be covered.
3. If admitted in a hospital and the tests are negative then nothing is payable. If positive then it is payable.
4. If it is a new policy then 30 days clause is applicable. Summary of all points is do not wait ,get health insurance policy ,otherwise be prepared to be treated in one of the government owned hospital. Wish you best of luck so that you don’t get affected with this disease.

TPA’s to deduct TDS when releasing payment to Hospitals

Recent news item indicates that this decision is being implemented. We are not going into details but we feel that the impact of this will be increase in rates by hospitals as they will find it a necessity to increase the rates with a view to handle the increased need for working capital.

The normal inflation of health acre in India is 15% per year-should we expect 18% this year. Let us wait and watch.

Medical Mafia Aug 28, 2009 issue of Fortune

It is always a pleasure to read independent articles in publications like Fortune, where unbiased article can be eye opener for all of us.

This article is worth reading – where a group comprising of doctors and lawyers handles the cases and fights with Health Insurance co’s so that the genuine or inflated claims are passed.

They manage the best of doctors assisted by lawyers to appear in the court so that the client gets paid. Ofcourse the agreed % out of this payment goes into their (lawyer/doctors) pocket. Question before us is does it happen because Health Insurance co’s are hesitant in passing of claims?

We do hope that Indian Non Life Insurance co’s as well as Health Insurance co’s will take corrective steps and we can avoid excessive role for lawyers to get the claims passed.