What is the meaning of a waiting period in health insurance plans?

When you buy a health insurance plan, there is a waiting period in the policy that precedes the plan. During this waiting period, you are not covered against certain types of illnesses. The waiting period can last up to four years in health insurance policies in India.

What is Health Insurance - Health Insurance Meaning & Types

Q: What do you mean by pre and post hospitalisation in health insurance plans?

There are two types of hospitalisation expenses that a health insurance plan can cover. Pre-hospitalisation expenses are medical costs incurred before you get admitted in a hospital for treatment. This can include ambulance costs, medicines, medical tests, and other expenses. Post-hospitalisation expenses are medical costs that you incur after you are discharged from the hospital. These can include medical follow ups, nurse care, medicines, and other charges. Both these types of expenses are covered under health insurance plans.

Health insurance is a type of insurance that covers medical expenses that arise due to an illness. These expenses could be related to hospitalisation costs, cost of medicines or doctor consultation fees.

Types of Health Insurance

There are two basic types of health insurance:

1. Mediclaim Plans

Mediclaim or hospitalisation plans are the most basic type of health insurance plans. They cover the cost of treatment when you are admitted to the hospital. The payout is made on actual expenses incurred in the hospital by submitting original bills. Most of these plans cover the entire family up to a certain limit.

2. Critical Illness Insurance Plans

Critical Illness Insurance Plans cover specific life-threatening diseases. These diseases could require prolonged treatment or even change in lifestyle. Unlike hospitalisation plans, the payout is made on Critical Illness cover chosen by the customer and not on actual expenses incurred in the hospital. The cover gives the flexibility to use the monies for changing lifestyle and medicines. Also it's a substitute for income for the time you could not resume work due to illness. Payout under these plans are made on the diagnosis of the disease for which the original medical bills are not required.

Why do you need Health Insurance now?

No one plans to fall ill or get hurt, but a serious illness can strike anyone at any time. The cost of treating the illness can cause severe financial strain on the savings you have accumulated over time. This means that you might have to compromise on providing your child the best quality education or defaulting on your home loan payments. Today, the cost of medical treatment is continuously rising.

For e.g., Herceptin, a cancer medicine costs approximately 1,10,000 for a vial of 440 mg. Depending on the weight, a patient usually requires 17-19 bottles for treatment over a year . That's 18 - 20 lakh just for the medicine^~. Then add hospitalisation costs, doctor consultation fees, chemotherapy costs, etc. and your overall expenses could exceed 25 lakh. These costs which are already very high are increasing every year. Most smart people have taken necessary precautions to insure their health as soon as possible. Health insurance is a living benefit, where you would need monies at the time of dire need. One disease can drain out all the savings you have made for your children's education, marriage, for buying a house or even retirement. You would not want your family's dreams to get shattered just because of an illness, especially when you could have protected yourself financially. It is beneficial to take a health insurance policy when you are young and healthy . As you get older, not only does your premium increase, but you also stand a chance of being denied a health cover by the insurance company.

How to choose a good health insurance plan?

Anybody who has a health insurance policy will tell you that buying one is one of the smartest financial decisions by any earning individual. Now, that you have decided to buy a health insurance policy, you need to know how to select a good health insurance plan that will take care of all your needs. Here is a list of benefits any good health insurance plan should offer you:

Protection against a large number of critical illnesses
Flexibility to choose your health cover
No increase in premiums during the policy term even if your health condition changes
Long policy term that covers you even in your old age
Large hospital network for easy access to medical treatment

Should I buy a Mediclaim plan or a Critical Illness Insurance plan?

A Mediclaim plan will either reimburse all your hospitalisation expenses or settle the hospital bills via a cashless facility. With a Critical Illness Insurance plan, you will receive a lump-sum payout on the detection of a critical illness. You don't have to be hospitalised for the same. If you are unable to work because of the illness, then you can use the amount as a substitute for your monthly income. You can even use the money to cover expenses for doctor visits, medicine purchases, medical tests or any other expense that might arise during this time. That is why you need both – a Mediclaim plan to cover your hospitalisation expenses and a Critical Illness Insurance plan to cover your loss of income and other expenses that arise due to an illness.

Check out the health insurance plans from
ICICI Prudential Life here –

Check out the health insurance plans from ICICI Prudential Life here –

ICICI Pru iProtect Smart - Term Insurance Plan
ICICI Pru Heart/Cancer Protect - Health Insurance Plan

Protection for you
Life cover at affordable rates so that your loved ones are financially protected

Accidental Death Benefit⁺(Optional)
In case of death due to an accident within the ADB term, we will pay your nominee/legal heir the ADB as lump sum

Accelerated Critical Illness (ACI) Benefit
Claim payout on the first diagnosis of covered 34 critical illnesses* (optional).

Protection Against Disability
In case of permanent disability⁷ due to an accident, your policy continues without you having to pay any premiums.

Tax Benefit
Get tax benefits up to `54,600^ u/s 80C & 80D of Income Tax Act 1961

100% Benefit Payout
If diagnosed with a terminal illness⁸, we pay you the complete Sum Assured.

FAQs

1. What things are covered under the hospitalisation benefit in health insurance?

The hospitalisation benefit under health insurance is a cover for expenses, such as room rent, ambulance costs, cost of surgery, doctor’s fee, medicines, and more. It also offers cashless hospitalisation at network hospitals and covers pre and post-hospitalisation expenses.

2. What do you mean by pre and post-hospitalisation expenses in health insurance plans?

Pre-hospitalisation expenses are medical costs incurred before you get admitted in a hospital for treatment. This can include ambulance costs, medicines, medical tests, and other expenses. Post-hospitalisation expenses are medical costs that you incur after you are discharged from the hospital. These can include medical follow ups, nurse care, medicines and other expenses. Both these types of expenses are covered under health insurance plans.

3. What is the meaning of waiting period in health insurance plans?

When you buy a health insurance plan, there is a waiting period in the policy that precedes the plan. During this waiting period, you are covered against only some illnesses as per your plan, not all. The waiting period can last up to four years in health insurance policies in India.

4. Can I buy a separate health plan for my parents and spouse?

Yes, you can buy a separate health plan for your parents and spouse. You can customise the health insurance plan considering the needs of the spouse. For parents, it is suggested that you opt for senior citizen health insurance plan to secure their future.

COMP/DOC/May/2023/195/3075

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Product Brochure

Affordable Health Cover
Get `20 lakh health insurance cover for heart and cancer at less than `176 per month¹

Payout On Diagnosis
Get paid on diagnosis of any of the listed Minor/Major conditions⁴

Family Benefit For Couples
5% discount on first-year premium when you buy health cover for yourself and spouse²

Waiver Of Premium
In the case of a minor/major claim or on the diagnosis of permanent disability due to accident⁵

Existing Customers Discount
5% loyalty discount on first-year premium for all existing customers³

Income Benefit
Get 1% of the Sum Assured as additional income for 5 years on the diagnosis of major conditions⁶

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Documents Required for Health Claim

Disclaimers

^~Source: Dealing with the cost of cancer treatment in India: Are patents the problem?

Link: https://spicyip.com/2012/06/dealing-with-cost-of-cancer-treatment.html

ICICI Pru iProtect Smart

* This benefit is payable, on first occurrence of any of the covered 34 illnesses. The Critical Illness Benefit is accelerated and not an additional benefit which means, the policy will continue with the Death Benefit reduced by the extent of the ACI Benefit paid. Premium payment on account of ACI Benefit will cease after payout of ACI Benefit and the future premiums payable under the policy for death benefit will reduce proportionately. If ACI Benefit paid is equal to the Death Benefit, the policy will terminate on payment of the ACI Benefit. In case of incidences covered under accidental Permanent Disability as well as Critical Illness, benefits shall be paid out under both the options. In case no ACI Benefit is triggered within the ACI Benefit term, then ACI Benefit will terminate and premiums corresponding to it will not be payable. However you would be required to pay premiums for all other Benefits to keep the policy in force. The ACI Benefit for Angioplasty is subject to a maximum of `5,00,000. On payment of Angioplasty, if the ACI Benefit is more than `5,00,000 the policy will continue for other CIs with ACI Benefit reduced by Angioplasty payout. The future premiums payable for the residual ACI Benefit will reduce proportionately.

^{^}Tax benefits of ₹ 54,600(₹ 46,800 u/s 80C & ₹ 7,800 u/s 80D) is calculated at highest tax slab rate of 31.20%(including cess excluding surcharge) on life insurance premium u/s 80C of ₹ 1,50,000 and health premium u/s 80D of ₹ 25,000. Tax benefits subject to conditions under Section 80C, 80D,10(10D), 115BAC and other provisions of the Income Tax Act,1961. Good and Service tax and Cesses, if any will be charged extra as per prevailing rates. Tax laws are subject to amendments made thereto from time to time. Please consult your tax advisor for details, before acting on above.

⁺ Accidental Death benefit (ADB) is up to ₹2 crores(Subjected to underwriting guidelines). ADB is available in Life Plus and All in One options. In case of death due to an accident Accidental Death Benefit will be paid out in addition to Death Benefit. Accidental Death Benefit will be equal to the policy term or (80-Age at entry), whichever is lower.

^*For further details, please refer to the information provided in the product brochure. ICICI Pru iProtect Smart UIN .

ICICI Pru Heart/Cancer Protect

¹The above mentioned premium rate is for `10 Lakh Cancer Cover and `10 Lakh Heart Cover for a 30 year old healthy male for a policy term of 5 years. The total single premium amount will be ` 6,223. If you choose monthly mode, then the premium amount works out to `176.

²A discount of 5% on the first year’s premium will be offered on purchase of ICICI Pru Heart / Cancer Protect when life assured and his/ her spouse is covered under the same policy. The policy benefits of both the Lives Assured shall be independent of each other. The Sums Assured of both the lives could be different. A claim made by one Life Assured under the policy does not affect benefits of other Life Assured. This Family benefit has to be chosen at the inception of the policy only, spouse cannot be added once the policy is issued. This discount is not applicable on Single Pay Policy. With one policy, you can avail either Family Benefit or Loyalty Benefit.

³Existing customer discount of 5% on the first years premium is available only for policies with Regular Premium Payment Option, it is not applicable for Single pay policies. With one policy, you can avail either Family Benefit or Loyalty Benefit.

⁴A lump sum is paid out on diagnosis of any of the listed conditions. This payout is based on the level of the condition. In any case, the total payout in the policy cannot exceed 100% of the Sum Assured of the cover selected. Please refer to the sales brochure to know about the payouts at different level of condition.

⁵The Company shall waive all future premiums on a claim of Minor condition under the chosen cover; or on the diagnosis of Permanent Disability (PD)of the Life Assured due to an Accident. If both Cancer cover and Heart cover are chosen such waiver is allowed on a minor/major condition claim under either Cancer cover or Heart cover; or on the diagnosis of PD. This benefit is available only if the Policy is in force as on the date of diagnosis of the condition/at the time of accident. In case of Minor Conditions, the total payout will be capped at 100% of the Sum Assured.

⁶Under the Income Benefit, the Sum Assured has to be chosen at inception of the plan. An amount equal to 1% of the Sum Assured chosen at inception will be paid to the policyholder each month, for a period of 5 years upon a valid claim under any of the listed Major conditions. Where the Cancer cover and Heart cover are taken together, pay out under Income Benefit will be triggered for only that cover for which a claim of Major condition is registered and all Benefits through other cover remains unaffected.

⁷On diagnosis of Permanent Disability (PD) due to an accident, the future premiums under your policy for all benefits are waived. To know more about definitions, terms & conditions applicable for permanent disability due to accident, kindly refer sales brochure of ICICI Pru iProtect Smart.

⁸A Life Assured shall be regarded as Terminally Ill only if that Life Assured is diagnosed as suffering from a condition which, in the opinion of two independent medical practitioner’s specializing in treatment of such illness, is highly likely to lead to death within 6 months. The terminal illness must be diagnosed and confirmed by medical practitioner’s registered with the Indian Medical Association and approved by the Company. The Company reserves the right for independent assessment.

ICICI Prudential Life Insurance Company Limited. IRDAI Regn No. 105. CIN: U66010MH2000PLC127837. ADVT No: W/II/1798/2020-21. UIN: 105N154V03

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What is Health Insurance ?

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