5 Lakh Health Insurance
5 Lakh Health Insurance
In this era of uncertainty, having a comprehensive health insurance plan is an essential investment for protection against unforeseen medical expenses and rising medical costs. Health insurance coverage provides a sense of security and financial stability during a medical emergency because even a minor sickness or injury can result in heavy medical expenses today. A 5 lakh health insurance policy is gaining popularity due to its extensive coverage. This blog will provide a comprehensive overview of the features of a 5 lakh health insurance policy. Keep reading to learn all about it.
What is a ₹5 lakh health insurance plan?
A 5 lakh health insurance policy is a policy that provides coverage up to the sum insured value of ₹ 5 lakhs. The policy provides a maximum medical coverage of ₹ 5 lakhs to the insured, which is adequate to provide comprehensive coverage for hospitalisation due to an injury or illness, other related medical expenses like pre and post-hospitalisation, daycare procedures, ambulance charges and much more.
How does a mediclaim policy for ₹5 lakh sum insured work?
When you buy a 5 lakh health insurance policy, you are provided coverage for the policy term, which is generally 1 year. The policy has to be renewed at the end of the policy term for continuous coverage. If during the policy term, the insured is hospitalised, he can file a claim for hospitalisation expenses up to ₹ 5 lakhs. The insurer, on receiving the claim request, checks if the treatment is covered or not. The insurer also verifies the doctor’s prescription and medical reports to see if the treatment is required or not. After the verification is complete, the insurer approves or rejects a claim request.
If the insured avails treatment in a network hospital, he is eligible for cashless settlement of the claim. The third-party administrator (TPA) will assist in documentation and claim settlement. If there is a deductible clause in your policy, you will have to bear the deductible amount from your own pocket. If you get a hospital bill exceeding your sum insured value, you will have to pay the excess amount. In case you are getting treated in a non-network hospital, then you have to file for reimbursement of the claim after getting discharged from the hospital. In such a case you have to provide the discharge summary and all the medical documents related to the treatment. If after the verification process, your claim is approved, it will be directly reimbursed to your bank account.
Who should opt for a health insurance plan for ₹5 lakhs?
A 5 lakh health insurance plan provides coverage for essential medical care at a pocket-friendly cost. Let us look at some scenarios where such a plan is suitable.
1. Young adults
Youngsters who are just starting their careers and are physically fit should buy a 5 lakh health insurance plan to avail of medical coverage at an economical cost. Waiting periods will be over when you will actually need to file a claim.
2. Low-income families and individuals
Families or individuals with low incomes should buy a 5 lakh health insurance policy as the premiums are low and it covers all essential medical expenses a family or an individual may need.
3. Individuals with no medical conditions or history
If you don’t have any pre-existing condition or a medical history of any critical illness, you can opt for a 5 lakh health insurance plan as you may not need high medical coverage.
4. Retired individuals
If you are a retired senior citizen without any serious health issues, this plan is suitable to provide basic medical coverage at a budget-friendly premium.
5. Premiums for ₹5 lakh health insurance plan
Before purchasing a health insurance plan, it’s important to calculate the premium for the coverage you desire. This will help you determine the actual cost and choose a plan that fits your budget. The premium for a 5 lakh health insurance plan differs from insurer to insurer. However, there are certain other factors that influence the premium of a health insurance plan.
6. Age of the insured
The premium increases as the age of the insured increases because the risk of falling sick also increases with age. Hence if you buy a policy at a young age you can get a good average at a low premium.
7. Medical history
A medical history of pre-existing diseases or critical illnesses in the family also increases your premium. Always disclose your medical history to the insurer to avoid claim rejection in future.
8. Lifestyle
Your habits and lifestyle also play a role in determining your premium value. If you are a smoker or tobacco consumer or you lead a sedentary lifestyle, you are at high risk of critical illnesses in future. Hence, you are charged a high premium.
9. City of residence
The city you live in determines the cost of medical care and as a result, affects the cost of health insurance coverage. For instance, if you reside in a top-tier city like Mumbai or Bengaluru, the cost of medical treatment is typically high, which means that the premium for insurance coverage will also be high.
Key features of a ₹5 lakhs medical insurance
It is crucial to do proper research before you buy a health insurance plan. Carefully understand and compare features of different policies. Many new-age insurers are offering plans with unique features. So understand your own healthcare needs and look for policy features that fulfil all your requirements. Here are some useful features of a 5 lakh health insurance policy.
1. Cashless claim settlement
When you take treatment at a network hospital, you can file for a cashless claim settlement. Almost all insurance companies offer cashless treatment with their network of hospitals. Look for an insurer that has a broad network and hospitals near you.
2. Pre and post-hospitalisation coverage
It is an important feature to have in a health insurance policy. However, the number of days for which pre and post-hospitalisation charges are covered depends on the insurance company.
3. AYUSH treatment
Because of the side effects of allopathic treatments and harsh medicines, most people now prefer alternative treatments which are more natural and safe. Hence, coverage for these treatments is an important feature of a 5 lakh health insurance policy.
4. Domiciliary treatment
Many health insurance companies now cover treatments taken at home provided certain terms and conditions are met as specified by the insurance company.
Which is better high sum insured plan or low sum insured plan with a top-up plan?
If your existing health insurance coverage is not enough and you are not able to decide which is a better option for you; a high-sum insured plan or a top-up plan to supplement a low-sum insured plan, here are scenarios explaining when to opt for which option.
When to opt for a high-sum insured plan?
High-sum insured plans are easier to claim but come at a high cost. You can get the entire sum insured for a claim easily. Such plans are easier to port also. So you should buy a high sum insured plan when,
1. You want to enhance your overall coverage with more benefits included and do not just want an increase in the sum insured value.
2. You want coverage without any limits or capping. A high sum insured offers coverage without sublimits.
Some important points to note
A top-up plan adds to the sum insured of your existing plan and increases your overall sum insured value. It is an economical way to increase the sum insured of your base policy compared to buying a policy with a high sum insured. The premiums for top-up plans are lower because these plans come with deductibles. You should opt for a top plan,
1. If you don’t have the budget for a high-sum insured plan.
2. If you just want to increase your sum insured value.
3. If you have an employer’s health insurance and want to increase your sum insured value.
When to opt for a low-sum insured plan with a top-up plan?
1. You can file a claim under a top-up plan only if the claim amount is more than the deductible in your top-up.
2. You can choose the deductible amount.
3. Your deductible amount should be the same as the sum insured by your base policy so that you don’t have to pay anything from your own pocket.
4. It only increases the sum insured value and does not enhance the overall coverage or benefits of the base policy.
5. Ensure that your top-up plan is from the same insurer as your base plan to avail of cashless claim settlement.
A high sum insured of ₹ 1 crore will have a higher premium compared to a ₹ 5 lakh health insurance plan with a top-up of ₹ 95 lakh. However, the latter may not provide the same coverage benefits as a ₹ 1 crore plan. So which is a better choice for you depends on your healthcare needs and budget.
Benefits of Buying ₹5 Lakh Health Insurance
Health insurance coverage offers many relevant benefits considering changing lifestyles and rising medical costs. A 5 lakh health insurance policy offers solutions for all your healthcare needs.
1. Wide range of coverage
It covers a range of medical expenses like hospitalisation fees, doctor’s consultation charges, cost of medical tests, ambulance charges, pre and post-hospitalisation expenses and much more.
2. Helpful during medical emergencies
A 5 lakh health insurance policy is helpful during medical emergencies, providing timely medical attention. The insured can focus on his recovery peacefully without worrying about the finances.
3. No claim bonus
A no-claim bonus is given when the insured does not make any claims in a policy year. This bonus is either added to the sum insured or is given as a discount on the renewal premium.
4. Tax benefits
The premiums paid for a 5 lakh health insurance policy are eligible for tax deductions U/S 80 D of the IT Act. If you pay the premium for your senior citizen parents’ health insurance, you get claim tax benefits for that as well.
5. Flexible tenure
While purchasing a 5 lakh health insurance policy, you have the flexibility to choose a policy term you want. You can have a policy term of 1, 2 or 3 years. If you choose a term of more than 1 year, you don’t have to renew the policy every year.
6. Free annual health check-ups
Most insurers offer free annual health check-ups once a year either through reimbursement or on a cashless basis if done at a network hospital.
7. Wellness benefits
Many health insurers offer wellness benefits with their policies such as discounts on gym membership, dietary and nutritional consultation, rewards for staying active and fit and much more. These benefits help you maintain good health.
8. Rider benefits
Riders are additional benefits you include in your health insurance coverage at an additional cost. These benefits help you customise your health insurance plan according to your unique medical needs. For instance, maternity benefits, critical illness cover, increase in room rent limit, reduction in waiting periods, etc.
Eligibility & Documents Required to Buy ₹5 Lakh Health Insurance
When you apply for a 5 lakh health insurance plan, you need to fulfil eligibility criteria and provide some documents for your application to be accepted by the insurance company. Eligibility criteria include your age and medical history.
1. Age
Any individual with age 18 years or above is eligible to apply for a health insurance plan. Some policies have an upper age limit beyond which you cannot apply for health insurance. It is generally 65 years but may vary across insurers. However, there are some policies which do not have an upper age limit to apply.
2. Medical history
It is required that you disclose your medical history honestly so that you get the right coverage. If you have any pre-existing disease, a habit of smoking or a family history of critical illness, do not hide from your insurer. Hiding information may lead to claim rejection or cancellation of a health insurance policy.
Documents you need to furnish while purchasing a health insurance policy
Following are the documents you need to provide at the time of purchasing a health insurance policy.
1. Proof of age – Voter ID, PAN card, Aadhaar Card, Driving license, passport, birth certificate, high school/intermediate marksheet. Any of these documents can be provided as an age proof
2. Proof of address – Ration card, rent agreement, utility bills, driver’s license, passport, voter ID, PAN card, and Aadhaar card are all accepted as address proof.
3. Passport Photos – You will need to provide your and your family member’s passport photos, which will be covered under the plan.
4. Medical reports – As per the plan you choose and your medical history, you may also be required to provide medical reports as asked by the insurer.
5. Proposal form – Submit a filled and signed proposal form to the insurer.
Inclusion Under ₹5 Lakh Health Insurance
Every insurer offers its own set of inclusions and exclusions, so you should compare plans and understand the terms and conditions to find out the most suitable plan for your medical care needs. Here are some common inclusions offered by most 5 lakhs health insurance plans.
1. Medical expenses incurred due to hospitalisation of a minimum of 24 hours are covered.
Pre and post-hospitalisation expenses before and after a hospital stay are also covered for the number of days specified in the policy.
2. Daycare procedures that do not require more than 24 hours of hospitalisation are also covered as specified under the policy.
3. Ambulance charges for the transportation of the insured to the hospital are also covered up to the limit specified in the policy.
4. Alternative treatments such as AYUSH treatments are also covered under health insurance plans these days. Some insurers provide these plans as in-built coverage and some offer it as an add-on cover at an extra cost up to the limits specified under the plan.
It is recommended that you read the terms and conditions of the policy and understand the inclusions well to avoid any last-minute surprises.
Exclusions Under ₹5 Lakh Health Insurance
Every health insurance policy has certain exclusions for which no coverage is provided. Here are some common exclusions.
1. Any medical expense during the waiting period.
2. Cosmetic surgery
3. Treatment for obesity
4. Treatments for substance abuse or rehabilitation treatment
5. Injuries caused by participation in adventure sports.
For more details read the policy document and check the exclusions under your policy.
How to Buy a ₹5 Lakh Health Insurance Policy?
You can buy a 5 lakh health insurance policy both online and offline. To purchase a policy online, follow the steps given below:
1. Visit the insurer’s website and go to the health insurance section.
2. Choose a health insurance product as per your requirements.
3. Select the Buy Now option and you will get a form.
4. Fill out the form with your personal information and contact details.
5. After submitting all the information and documents, make the payment online.
6. The policy document will be mailed to your registered email ID.
Reasons to purchase a 5 Lakh Health Insurance in India
Here is why you should consider purchasing a 5 lakh health insurance policy.
1. Medical inflation
With rising medical costs, even a simple medical procedure and hospitalisation for a few days can cost you your savings. Having a 5 lakh health insurance policy can help you cover hospitalisation costs without affecting your savings, protecting you against medical inflation.
2. Financial Protection
A 5 lakh health insurance plan protects you from financial burden in case of unexpected medical emergencies and provides timely medical care at the best of hospitals.
3. Comprehensive coverage
A 5 lakh health insurance plan offers comprehensive coverage for a range of medical expenses including hospitalisation costs, daycare procedures, domiciliary treatment, organ transplant expenses, modern treatments and much more.
4. Pre-existing diseases
If you have a pre-existing disease, you can customise your coverage to include benefits to suit your healthcare needs, such as a reduction in waiting periods for pre-existing diseases.
Selecting the perfect 5 lakh health insurance plan
Selecting the perfect 5 lakh health insurance plan requires you to look for certain important factors that will help you find suitable coverage.
1. Coverage matching your needs
Always look for a plan that provides coverage according to your needs. Make sure that if you have a family floater plan, it should be able to cover the healthcare needs of each family member. Compare plans with different benefits and pricing until you find one that best suits you.
2. Budget-friendly
Look for a plan that provides comprehensive coverage at a price that suits your budget. However, it is important to note that you should not compromise on coverage just to fit your budget. Try to get a health insurance cover that is adequate and reasonably priced.
3. Plan type
The type of plan you need depends on whether you are seeking health insurance for yourself or you want coverage for the entire family. Individual health insurance plans are best if you want coverage for yourself only. On the other hand, family floater plans are suitable to cover the entire family.
4. Claim settlement ratio
This ratio indicates the number of claims settled by the insurer out of the total claims received. This ratio shows the insurer’s ability to pay claims to the policyholders. Hence, it is important to check the claim settlement ratio of an insurance company before purchasing a health insurance policy.
5. Network of hospitals
Check the network of hospitals, and see if there are any near your location. Always select an insurer with a wide network of hospitals, so that you can easily get a cashless treatment.
6. Lifetime renewability
A policy that can be renewed for your lifetime is the best option to have as it will cover you in your old age and you will not have to worry about getting coverage in old age or about waiting periods to file a claim.
3. Comprehensive coverage
Conclusion
Purchasing a 5 lakh health insurance policy is a necessary investment everyone should make for protection from sudden medical expenses. It not only protects your savings from medical expenses but also provides quality medical care when you need it the most. The policyholder also has the flexibility to customise your health insurance coverage.
Frequently Asked Questions
A 5 lakh health insurance policy provides comprehensive coverage at an affordable premium with an option to customise coverage with add-on covers.
Young professionals at the beginning of their career, low-income families, retired individuals or anyone who does not require a high sum insured coverage.
You can file any number of claims in a year until your sum insured is exhausted.
The initial waiting period may range from 30 to 90 days depending upon the insurer.
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