#HEALTH INSURANCE BULLETIN

Week -2

When we are going to purchase Health Insurance, we are coming to know that there are two types of policies.

First Indemnity Plan basically covers the hospitalisation expenses and has subtypes like Individual Insurance, Family Floater Insurance, Senior Citizen Insurance, Maternity Insurance, Group Medical Insurance.

Second Fixed Benefit Plan pays a fixed amount for pre-decided diseases like critical illness, cancer, heart disease, etc. It has also its sub types like Preventive Insurance, Critical illness, Personal Accident.

Most of the Policies that we are purchasing and using are first type of policies. What is main difference between first and 2nd type of policies is payment amount. In Indemnity Plan payment is based on what doctors giving estimates while in 2nd type of policies payment is fixed at the time of taking policies.

I will explain it in simple language like this: For example A took type 1 policy Means Indemnity Plan with SI 5 Lakhs. After 2 months S/he got hospitalized and hospital gave estimate of 1.57 lakhs. S/he informed that I have Health Insurance with Company XYZ Ltd. Hospital started treatment and at the end of 3rd day given final bill of 1.60 lakhs. S/He submitted it to Company representative in hospital and they made payment 1.50 lakhs and told you have to make payment of 10,000 from your own pocket. We came to know that even S/he having policy of 5 Lakhs they got payment of 1.50 lakhs instead of hospital bill of 1.60lakhs. Why S/he got only 1.50 will explain next week. Now back to 2nd type of plan call it Type 2 policy. Same person took type 2 plan from the same company for the same SI of 5 Lakhs but when they submitted a bill of 1.60 lakhs comapny given her/his account payment of 5 lakhs. Why it happen like this we will come to know like this:

2nd type of Plan is Fixed Benefit Plan, where payment is based on the disease type, not treatment taken. In this type of policy once company will come to know you have one of disease mentioned in the policy you will get fixed amount without taking into consideration what you spent in hospital.

Now more details why s/he got 1.50 lakhs instead of 1.60, why first time we paid 10K and only 10K from her/his pocket? Why that time payment goes to hospitals directly? for today this much ok.

Thanks

Ajeet