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15 Lakh Health Insurance

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15 Lakh Health Insurance

Gone are the days when a family floater plan of ₹ 5 lakh would be enough for an individual as well as the family. Individuals could rely on their employer-provided insurance plan to cater to all health issues in the family. However, with the constantly rising cost of medical care in the country, such policies would leave you asking for more.

As a result, more individuals are now looking for ₹15 lakh health insurance or more. A health insurance plan that offers coverage of ₹15 lakh or more offers much better peace of mind and financial protection against most health conditions. If you have been looking for a plan with better coverage than your existing health plan, here is all that you need to know.

What is a ₹15 lakh health insurance plan?

A ₹15 lakh health insurance plan is any health insurance that offers a sum insured of ₹ lakh for the insurance buyer. In other words, it is the maximum amount of claim that you can make during the term of the policy. A health insurance plan with ₹15 lakh coverage will ensure that you and your loved ones are financially protected in the event of a health emergency. And that you receive the best medical treatment out there, without having to worry about the finances. A ₹15 lakh health insurance plan will protect you against accidents, and major and minor illnesses.

Workings of Mediclaim policy for ₹15 lakh sum insured

A Mediclaim policy of ₹15 lakh is designed to help the insured take care of medical expenses. There are different components of a Mediclaim policy, such as coverage, term of the policy, premium and settlement of the policy.

Should you decide to buy a Mediclaim policy of ₹15 lakhs, you will need to pay a certain premium amount to the insurance provider. The policy usually has a fixed term and the premium amount is for the term. On the completion of the term of the policy, you can renew it by paying the policy premium. It is recommended that you continue with a policy for a longer period for coverage against emergency medical needs.

A Mediclaim policy usually covers expenses related to the hospitalisation of an individual due to various reasons such as critical illness, accidents, surgeries, etc. To avail of the benefits, you will need to file a claim.

You can either opt for a cashless claim or a reimbursement claim. In a cashless claim, the insurance provider will directly settle the bill with the hospital, thereby removing any need for you to make payments. On the other hand, a reimbursement claim requires you to settle the bill on discharge and provide all the bills and summaries to the insurance provider. They will assess the documents and on approval, pay you the reimbursements.

Who should buy health insurance plans for ₹15 lakhs?

Purchasing a health insurance plan with a sum insured of ₹15 lakh is recommended for a number of individuals. Here are all the people who will benefit from buying a health insurance policy of ₹15 lakh.

1. Individuals who need a financial cushion against medical emergencies, which can be mostly sudden and out of nowhere.
2. Individuals who have a history of medical illnesses and issues should opt for the policy. Due to a higher possibility of inheriting some medical condition or the other.
3. Individuals who follow a sedentary lifestyle are more prone to lifestyle-based diseases such as high blood pressure, diabetes, heart attacks, etc. and the treatment of these diseases does not come cheap.
4. Individuals who have a high-risk job or a high-pressure work environment should also opt for a larger health insurance plan.
5. Also, individuals who travel a lot should opt for the policy, which can give them the necessary protection, irrespective of the location.
6. If you already have an employer-based health insurance plan but the coverage is not adequate, you should opt for ₹15 lakh health insurance, for better protection against the rising cost of medical treatments.

It is important that you factor in the need for the right coverage and the right premium amount based on your budget. You can look at the medical history of your family before deciding on the policy coverage. If you are not too sure about the perks and benefits of a ₹15 lakh plan, here are all the details that you would want to know before deciding.

Premiums for ₹15 lakh health insurance plan

The last couple of years and a widespread pandemic have made it difficult for a lot of families to cope with the financial needs of medical treatment. In such times, it makes it even more important to opt for the right health insurance plan to safeguard your interests. A health insurance plan of ₹15 lakh can be a sensible choice since it offers the right coverage and the premiums are affordable as well.

The premium of a health insurance plan of ₹15 lakh would depend on a lot of factors such as the age of individuals, the coverage that you are looking for, your current residence, etc. If you are looking for ₹15 lakh health insurance plan, you can get it for less than ₹ 10,000 should you choose to pay the premium annually. However, a lot of insurance providers now offer easy payment options to pay the policy premiums. Thus, you can opt for monthly payments, which makes the policies even more accessible.

Features of ₹15 lahks medical insurance

Choosing a ₹15 lakh health insurance policy offers you a host of features. The following are some features that you must look for while choosing a health plan.

1. Pre and post-hospitalisation
The cost of treatment is not only limited to hospitalisation. A patient might have to undergo medications and therapies before and after admission to the hospital. And these expenses can build up a fair bit. Health insurance plans usually cover pre and post-hospitalisation expenses for a duration of 30 days and 60 days respectively. Thereby assisting the insured to recover quickly.

2. Network hospitals
Insurance providers have tie-ups with hospitals. These tie-ups enable the insured to avail of better benefits from their insurance provider. The insured can visit these network hospitals undergo treatment and even get discharged without having to pay anything. The insurance provider will directly settle the bills in such cases. Thus, going through the list of network hospitals is important before opting for a policy.

3. Co-payment
Some health insurance providers have a clause of co-payment in their plans. If you opt for such plans, you must pay a certain percentage of the insurance claim. For example, if a policy has a co-payment clause of 10%, in a claim of ₹1 lakh, you will end up paying ₹ 10,000 out of your pockets. And the amount can be even higher if the claim amount is high. It is advisable to look for policies that do not have a co-payment clause.

4. Pre-existing diseases
Any medical condition or disease that you have prior to the purchase of a health insurance plan is referred to as a pre-existing disease. Insurance companies normally have a waiting period for some of the pre-existing diseases. In other words, you must see through these periods before filing for a claim. It is recommended that you opt for policies that either cover your pre-existing diseases or have minimal waiting periods.

5. Room rent
Insurance providers usually have room rent limits or sub-limits. Since it is one of the major expenses that patients undergo, it is important to take note of any room rent caps or limits that your policy might have. Policies that do not have any caps on room rent are ideal.

6. No claim bonus
One would not hope to claim a health insurance policy every year. For the years that you do not file for a claim, some insurance providers offer no claim bonus. The bonus can result in either a discount or an increase of the sum insured by the native plan. The bonus can range between 10% to 50% for every year that you do not file a claim.

7. Policy premiums
One of the major factors that one might consider before buying a health insurance policy is the policy premium. However, it should not be the sole criterion for choosing a health plan, or else you might miss out on features and benefits. Thus, you must look for a policy that offers adequate coverage without costing you a lot of money in premiums.

Higher sum insured plans v/s low sum insured with Top-Up plans

A lot of individuals can be confused between buying a health insurance plan with a higher sum insured or buying a health with a lower sum insured and using top-up plans. Here are the major differences between both plans.

ParametersHigh-sum insured planLow-sum insured plan with top-up plan
PremiumsThe policy premiums can be high due to the higher coverageThe policy premiums can be quite pocket friendly, due to the lower base plan
DeductibleThe plan usually has a lower deductible if there is anyThe deductible amount can be a bit high since the top-up will only kick in after the deductible is paid
Claim processThe process is simple and mostly cashlessThe process is also simple but might not always be cashless

If you already have a health insurance plan with a lower sum insured, adding higher top-ups can be a cost-effective way. On the other hand, if you are planning to buy new insurance, a plan with a higher sum insured is preferred. It will give you much better coverage and seamless claims.

Benefits of buying ₹15 lakh health insurance

A health plan with ₹15 lakh sum insured will ensure that you and your loved ones have adequate coverage to face any unforeseen medical needs. The following are some benefits of choosing such a plan.

Cashless payments

A big benefit of buying a health insurance plan for ₹15 lakhs is the cashless benefits. When you visit a network hospital, as listed by the insurance provider, you will not have to pay for the treatment that you undergo. Your insurance provider and the hospital will directly settle the bills.

Family floater

A health plan with ₹15 lakh as the sum insured is ideal for a family floater plan. Everyone in the family can benefit from a higher sum insured and use the amount for any health issues during the year. The higher coverage ensures that most medical emergencies can be covered without you having to take any sort of financial stress.

Comprehensive coverage

A plan with a sum insured of ₹15 lakh will ensure that you and your loved ones have the adequate financial backing to undergo any unforeseen medical challenges in the future. A plan that covers hospitalisation charges, consultation fees, surgery charges, nursing charges, etc. can be a differentiating factor. It will also allow you to preserve your savings since the policy will take care of the expenses.

Tax benefits

Premiums that you pay towards a ₹15 lakh health insurance policy, can also be used to avail of tax benefits. Under Section 80D of the Income Tax Act of 1961, the premium that you pay can be deducted from the total taxable income. For any individual under the age of 60, the maximum cap is of ₹ 25,000 and for any individual above the age of 60, the maximum cap is set at ₹ 50,000.

Critical illness

A health insurance plan with ₹15 lakh coverage gives you better preparation against any critical illness that the insured might be diagnosed with. Critical illnesses such as heart attack, paralysis, cancer, etc. can cost a lot for treatment. A health insurance plan with ₹15 lakh coverage will ensure that you can proceed with the treatment. Alternatively, you can also opt for a critical illness rider with the plan. On diagnosis of any critical illness, the insurance provider will pay a lump sum amount, which can be used for the treatment.

Eligibility & documents required to buy ₹15 lakh health insurance

To be able to buy a ₹15 lakh health insurance policy, insurance companies usually have some eligibility criteria. Here are some of them.

1. Age
The applicant must be in the age group of 18 and 65 years. For children, the age limits are between 90 days and 18 years.

2. Medical tests
Depending on the insurance provider that you opt for, you might have to undergo a medical test prior to the purchase of the policy. These diagnostic tests are usually for blood, urine, and major organs.

The following are all the documents that you must submit to be able to buy a health insurance plan.

◦ Proof of address such as utility bill, driver’s license, Voter’s ID, passport, Aadhar card
◦ Proof of age such as birth certificate, PAN card, Aadhar card, passport, mark sheets
◦ Proof of identity such as Aadhar card, passport, driving license, PAN card
◦ Passport size photograph
◦ Any other existing medical records

What’s covered under ₹15 lakh health insurance?

A ₹15 lakh health insurance plan can cover a lot of ground for you and your loved ones. The following are some of the standard coverages of a ₹15 lakh health plan.

1. Cost of inpatient treatment such as nursing charges, room rent, specialist consultation, etc.
2. Ambulance charges
3. Pre hospitalisation charges
4. Post hospitalisation charges
5. Doctor consultation charges
6. Organ donation expenses
7. Cost of daycare treatment
8. Diagnostic tests
9. Cost of AYUSH treatment

What’s not covered under ₹15 lakh health insurance?

When you opt for ₹15 lakh health insurance, it might not cover all possible scenarios. There are a few exclusions, as is with any other insurance plan. Here are some that you should be aware of.

1. Cost of dental treatments
2. Cost of cosmetic treatments and surgeries
3. Cost of treatment of self-inflicted injuries, attempt to suicide or suicide
4. Medical issues due to abuse of alcohol, drugs, and other intoxicating substances
5. Cost of alternative treatments such as acupuncture or acupressure
6. Cost of treatment of congenital diseases

Before you opt for a health insurance plan, it is highly advisable to go through the policy documents to understand the inclusions and exclusions of the policy. It will ensure that you receive the needed coverage and at the same time, avoid any claim rejections.

How to buy a ₹15 lakh health insurance policy?

You can follow these steps to buy a ₹15 lakh health insurance policy, right from the comfort of your room.

1. Visit the website or smartphone application of your preferred insurance provider or insurance aggregator.
2. Look for health insurance as the primary link.
3. Look for a health insurance plan with a sum insured of ₹15 lakhs.
4. Select the buy option on the website or app.
5. Enter your personal details such as name, contact details, email address and phone number.
6. Scan the list of add-ons to assess if you would like to add any of them.
7. Review the details of the policy and proceed to make the payment.
8. On successfully paying the premium, the insurance provider will provide an acknowledgement and send a digital copy of the policy to your registered email address.

The calculation behind purchasing a 15 lakh health insurance plan

There are quite a few calculations that one must do before one can decide on a ₹15 lakh health insurance policy. The following are some of the major calculations.

1. Calculation of Premium
Insurance providers consider a lot of factors before calculating the policy premiums. Factors such as the age of the applicant, health history, family history, lifestyle, individual or family floater plan etc. Since the sum insured by the policy is a bit high, the insurance premium will also be a bit higher than a standard health plan with lower coverage.

2. Calculation of Tax deductions
You can receive tax deductions under Section D for the purchase of a health insurance plan. The maximum deduction is ₹25,000 for an applicant, spouse or children provided everyone is under 60 years. And if you have dependent parents under the age of 60, you are eligible for another ₹25,000 deductions. The same amount increases to ₹50,000 for senior citizens. Thus, the maximum deduction is set at ₹1 lakh for someone who is a senior citizen and so are their parents.

3. Calculation of deductible
A deductible is a factor that can reduce the policy premium of health insurance. A deductible is an amount that you must pay on each claim. A higher deductible amount will help you reduce the premiums. However, one must be careful, since a higher deductible might offset benefits on a lower claim amount.

4. Calculation of co-payment
Some insurance providers require the insured to pay a certain percentage of the claim amount as co-payment. Having a co-payment clause will aid you in reducing the policy premiums. However, you must be comfortable paying the amount on each claim.

How does the 15 lakh health insurance plan work?

When an insured is admitted to a hospital, the ₹15 lakh health insurance policy will come into effect. It will cover all medical expenses of the insured up to a maximum of limit ₹15 lakhs. If the insured informs the provider about a medical procedure or treatment before admission, they can avail of cashless payments.

The insured can also submit all the bills and the insurance provider will assess and accept them accordingly, on a visit to a non-network hospital. It is important to note that only conditions covered by the policy are eligible for a claim. The conditions mentioned in the exclusion list will not be covered by the provider.

Factors influencing the 15 lakh health insurance premium

Insurance providers consider the following factors to decide on the policy premiums of a ₹15 lakh health insurance plan.

1. Age
The age of the applicant is one of the major factors that insurance providers consider. Buying a policy at a younger age will help you save on premiums considerably.

2. Deductibles
Opting for a deductible means that you will have to pay that amount every time you file for a claim. On the other hand, it can lower the premiums bit a small margin.

3. Coverage
Since the sum insured is ₹15 lakh, the premium of the policy will be more than a policy with a lower policy coverage.

4. Medical history
If you do not have any medical history and pre-existing diseases, you can secure a policy at a lower premium.

5. Lifestyle
If you are someone who likes to smoke and drink, it can have an impact on your policy premium.

How to pick the perfect 15 lakh health insurance plan?

There are a few things that you need to keep in mind, to be able to pick the perfect ₹15 lakh health insurance policy.

1. Coverage
It is of paramount importance to understand the coverage and benefits on offer when you choose a health insurance plan. Look for expenses that are covered apart from inpatient treatment.

2. Co-payment
Look for policies that do not have a co-payment clause in their documents.

3. List of network hospitals
A quick look at the list of network hospitals will ensure that you receive the necessary treatment at your preferred hospital or a nearby hospital.

4. Pre-existing conditions
Make sure that you appraise your insurance company for any pre-existing conditions and that you are aware of the waiting period for the diseases.

5. Exclusion list
Going through the exclusion list will help you avoid any unwanted claim rejections.

To Sum Up!

A ₹15 lakh health insurance plan can be an ideal purchase that can safeguard you and your loved ones against medical conditions and inflation. You can use the factors mentioned above to choose a plan that offers the right coverage at the right price point.

Frequently Asked Questions

Hospitals that are affiliated with the hospital and you can avail of cashless benefits are network hospitals.

Not all insurance providers offer maternity coverage. If you are explicitly looking for maternity coverage, it might be wise to choose a similar plan likewise.

A medical check-up prior to issuing a health insurance plan entirely depends on the insurance provider and the plan that you want to buy.

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