Why Health Insurance Is Important? – An In-Depth Guide (English)

I am startled and astonished at the same time when I have seen a study report published by The Indian Express on 23rd Feb 2021 where it is told that only 27 percent of Indians have health insurance. You can click here to read about it.

On the opposite side, it makes me more surprised when I can see 73 percent of Indians are not covered by medical insurance or health insurance.

Medical emergencies always take us by surprise. I have witnessed from my long experience the fire fighting mindset of people in general which means they will take action at the extreme point only. It is always better to be safe than sorry, and it is no different when it comes to medical insurance. It happens only due to a vast absence of awareness.

For mass, the cost of insurance is an expenditure in the steed of protection. And escaping from the premium amount, most of the common people think to earn great savings. But, a maximum part of this savings goes exhausted due to his lifestyle expenditure only. And as a result, at the time of a medical crisis for himself or his family, all of their hard-earned wealth vanishes at a single moment. I have witnessed people take a loan in high interest or to sell or mortgage their ornaments or to premature their FDs at this high time. I have seen people use it to destroy their long-term savings which are kept for a particular goal due to unwanted medical emergencies.

I have experienced that people have to miss the facilities like to avail a good comprehensive medical treatment from a renowned hospital as it is highly expensive. The cost of treatment in a reputed medical institute is quite enough to make a fit man ill.

A particular saving for medical emergencies cannot be a substitute for the health insurance policy. For instance, you have kept Rs. 5 L aside for your medical expenses. One of your family members gets sick and has been admitted to the hospital. Rs. 3 L is spent. Now it will take time to reform this fund up to Rs. 5 L and in between this time, what will happen if another family member gets sick and hospitalized. But, you can stay more secure and in a peaceful mind availing of health insurance by Rs. 20 K to Rs. 25 K only.

Again, a must in your investment portfolio, the government encourages everyone to buy medical insurance and allows you to avail tax deductions on it under Section 80D.

As it is mandatory for car insurance, I have seen people availing themselves of expensive car insurance rather than availing themselves of health insurance or proper health insurance. I find people are having higher restaurant bills from the cost of health insurance for a particular year.

There are some below-mentioned highlights of why health insurance is inseparable in our life:

  1. To deal with medical cost Inflation
  2. To protect your savings
  3. To fight with lifestyle disease
  4. To protect your family
  5. To secure your family
  6. To ensure better treatment


What Kind Of Costs Are Covered By Health Insurance? 

A health insurance policy provides comprehensive coverage of hospitalization expenses. Here is a small snapshot for you:


1. In-patient Hospitalization Expenses

Health Insurance covers the room charges, ICU charges, the doctor fee, specialist or consultant fee, cost of surgery, oxygen, blood, etc. payable to the hospital unless there is no capping clause in that particular policy

2. Pre & Post Hospitalization Expenses

Medical expenses like doctor consultations, medicines, and diagnostic tests incurred for the injury or illness before you are hospitalized are covered under health insurance. These are called pre-hospitalization expenses.

Similarly, after being discharged from the hospital, doctors recommend follow-up check-ups, consultations, medicines, etc. These costs are called post-hospitalization expenses. The period of pre and post-hospitalization is being determined according to the company and it varies.


 3. Hospitalization at Home

Many health insurance policies cover hospitalization at home. It covers hospitalization where a hospital cannot be used for treatment due to the following two reasons:

A. Non-availability of beds in the hospital and patient is availing treatment in a home according to doctor’s advice.

B. When the patient is so ill or injured that it is impossible to move him/her to the hospital for treatments and the patient is availing treatment at home according to the doctor’s advice.


Why Do We Need To Cover Hospitalization Expenses? 

I have already discussed why we need health insurance. Here’s I am adding some more information on why we should cover hospitalization expenses through a health insurance policy – 


1. Increasing Cost of Health Expenditure

In-country like India, the rate of education inflation and healthcare inflation is the highest. According to a government report, India’s retail healthcare inflation stood at 7.14% in the financial year 2018-19 and after this covid pandemic situation, it increased like anything. If it stands at 8% for example, the medical bill of Rs. 3 L, in 2021 will stand at Rs. 10L in 2030. If you are 30 years old and your medical expenses are Rs. 3 L now, it will be Rs. 30 L at the age of 60 years.


2. Access to Quality Healthcare 

When our family members fall ill, we want to give them supreme healthcare which is the best quality treatment, best doctor’s assistance. Only health insurance with proper coverage can satisfy it.


3. The Surge in Lifestyle Disease

Modern-day lifestyle has changed drastically. We live sedentary lifestyles burdened with pollution, mental stress, and bad eating habits. As a result, we are prone to lifestyle diseases like diabetes, hypertension, high cholesterol, heart-related illnesses even liver-related illnesses including transplantation. These are enough to avail of a health insurance policy.


4. Tax Deduction Under 80 D 

Health insurance premiums also give tax benefits. According to IT Act u/s 80 D, you can claim a deduction of up to Rs.50 K by paying a premium for you and your family in health insurance plans. In case you are paying a premium for your senior citizen parents, you can claim an additional deduction of up to Rs.50 K.


When To Buy Health Insurance? 

It is easy to avail yourself of health insurance when you are fit and normal. If you are suffering from diseases like sugar, blood pressure, hypertension, thyroid, etc, it is really difficult to opt for a new health insurance policy. Many of the insurance companies use to decline your proposal form or put an exclusion for a while and then accept it. In another scenario, the insurance company includes loading of extra premium to accept your proposal. Thus, I advise you to buy health insurance before you run the risk of meeting with an accident or suffer chronic disease. 


What Are The Exclusions In Health Insurance Plans? 

There are medical costs and treatments which are not covered by a health insurance policy. These are called policy exclusions. It might be temporary or permanent. 


Temporary Exclusion

There are some waiting periods in a standard health insurance cover for diseases/treatments. Such as: 

  1. Illness apart from an accident is not covered within 30 days of policy commencement.
  2. Pre-existing diseases are not covered for the first 2-4 years
  3. A specific list of treatments that are not pre-existing like hernia, fistula, cataract, joint replacement, etc. are covered after 2-4 years


Permanent Exclusion

Some illnesses and treatments are entirely excluded from the scope of coverage of the policy. Such as – 

  1. When there is no active treatment carried out. For instance, if the patient is in the hospital only for carrying out medical tests or for monitoring purposes, or recovery, the insurer will not be liable to pay.
  2. Illnesses or injuries suffered under the influence of alcohol, drugs, or any other intoxicants.
  3. Maternity expenses are not covered in standard health insurance policies. Some do cover after a waiting period.
  4. Cosmetic surgeries that enhance your appearance are not covered unless there is a medical need.
  5. Internal Congenital illnesses are not covered.
  6. Illnesses or injuries arising due to self-inflicted wounds or attempted suicide are not covered at any stage.


Some Essential Conditions To Look Out For

All Insurance policies have their terms, conditions, restrictions, wordings. Here are some essential conditions which you should look out for when buying health insurance plans – 


1. Sum Assured

The sum insured of a health insurance policy is the maximum amount that the insurance company will pay in a particular year. Sum insured is also crucial since it determines many other important covers in the policy, such as room charges and treatment limits.


2. Capping Clause

There are many policies in the market which costs on the lower side if I compare with the rest. They have a limitation or cap on room rent, doctor’s fee. It should be checked thoroughly before buying a particular policy.


3. Floater Cover

Individual health plans cover one individual under a single sum insured. Floater plans cover two or more members of the family under a single sum insured. Such type of coverage is beneficial for protecting your entire family under a single plan.


COVID has taught us “N” number of lessons. Pre-protection for a medical emergency is one of them. If you want to know more about “Why health insurance is important”, you may watch the video. If you need more assistance, you can visit our website roysfinance.com or you can mail us at [email protected]. For more, you can reach us at +91-888-12-888-44 for telephonic consultation or Whatsapp.

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