Monthly Archives: December 2015

Know more about Health Insurance portability

Health Insurance Policies

When it comes to health insurance, IRDAI has made the customer the king. With health insurance portability, you can carry forward your benefits accrued from Insurer A to Insurer B.

What this simply means is – if you are unhappy with your current insurer, you can port (not just transfer) your policy to another insurer. Where earlier transferring meant being tagged as a new policyholder, now you can transfer credits for pre-existing conditions. This is applicable not only when you switch between two insurers but also between two plans by the same insurer.

The Procedure

The procedure of portability is a simple do-it-yourself task. The application form to port your health insurance policies should reach Insurer B, 45 days before to the last date of renewal of your existing policy.

Once you receive the proposal from Insurer B, select the product that matches your needs and submit the form to Insurer A.

Insurer A is bound to provide all the details to Insurer B within 7 working days. Once Insurer B receives the information, it is obliged take a decision within 15 days.

Word of Caution

  • Insurer B is allowed to decide premiums based on its underwriting norms. This means the premiums you pay could be higher even for a similar cover.
  • Your request can be denied if there was a break in the policy – ensure you port your policy before the expiration of your existing one. If your acceptance is still pending on the last day of renewal, you could request your existing policyholder to extend your coverage.
  • Waiting period levied by Insurer B can be different compared to Insurer A even for the same disease. In addition, terms and conditions vary from insurer to insurer; confirm the inclusions and exclusions in the policy before you make the decision to port.

If you are a part of a group health insurance by Insurer A, you will have to switch to an individual plan from the same insurer and apply for portability to Insurer B only after one year.



Health Insurance Advantages Plan


New Medicare Supplement strategy will present a collection of options ranging from widespread coverage that bridges Medicare gaps, to the availability of packages presenting reasonably priced monthly premiums and more unsurprising co-payment structures that promote wellness by making doctor’s visits more reasonable for beneficiaries
“The updates to the Medicare Supplement health advantage plans are salutation news for Medicare beneficiaries during these harsh economic times because the policy align the payback with the fresh updates made to the Medicare program,” said Krista Bowers, president of BCBSGA Senior Business.

“The new efficient Medicare Supplement plans offer peace of mind, practicality and affordability that is in tune with today’s Medicare landscape.”
The new Medicare complement plans are a result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 that endorsed a new set of Medicare Supplement insurance plans to replicate the requirements of today’s Medicare beneficiaries.
A Medicare Supplement policy is a supplemental health insurance plan sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medicare Supplement policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover.

If an individual is enrolled in the Original Medicare Plan and has a Medicare Supplement policy, then Medicare and Medicare Supplement will pay both their shares of covered health care costs
Although as of June 1, 2010 the current Medicare procedure referred to as “standardized” plans will no longer be open for new sales or new association, Medicare beneficiaries who are at present enrolled in a “standardized” or “pre-standardized” Medicare Supplement plan can preserve their recent plans as long as their premium expenditures are recent.


Individual & Family Plan Health Insurance

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Insurance Options for People Without Coverage or Needing Better Coverage

Individual and family health insurance coverage differ from employer-sponsored health insurance coverage in a variety of ways. For example, pricing is based on an individual or family’s specific needs and their medical history.

This health insurance plans pricing can vary from state to state. The number of health insurance plan options is another key difference. While employer-sponsored health insurance may offer only one or two options, individual and family plan options can be in the dozens. The rates for individual and family choices may differ widely from one another.

Individual and family health insurance plans also provide you with the freedom to maintain your coverage regardless of whether you stay with the same employer. However, if you choose to move to another state, it is likely that you will be need to change insurance plans.

In most states, it is currently possible to be denied coverage for an individual or family plan based on your medical history. However, anyone may apply for individual health insurance coverage. Before applying for coverage, you should take the following steps:

  • Evaluate the key needs you have for a health insurance plan based on past experience and knowledge of your health circumstances
  • Determine the amount of money you can pay each month for a health insurance premium
  • Use ourtools to compare the coverage and costs of plans against one another

Our parent company, e Health, provides assistance in finding affordable health insurance for individuals and families.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage.

Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the “gaps” in original Medicare coverage.


Seven Secrets to Choose the Best Health Insurance Plan

health insurance

Medical costs and the complexity of diseases keep increasing by the day. A minor surgery can cost you anywhere between Rs 30,000 and Rs 60,000, while a cardiac treatment can cost you Rs 5 lakh, depending on the city and hospital you choose. One way to handle this rising cost is by taking a medical insurance policy in your name.

In India, there are more than 25 companies offering various medical insurance policies. However, most of these policies are complex in nature and one plan never fits all. Hence, it is very important to note that you have to understand your individual needs in order to choose the right insurance plan. Here are a few points that will help you do this.

1.Company– There are 28 general insurance companies in India that offer health insurance plans. It is very important to know the company’s background, management, network of hospitals, claim process (in-house or third party) and claim settlement ratio before choosing the right plan. It is best to choose a general insurance company for your health insurance, rather than a company that offers life and general insurance. This is because the cost for health insurance policies is higher when life insurance companies offer them.

Inclusions and Exclusions – It is very important to note that pre-existing diseases are not covered during the initial years of the policy. Also, there are a few medical procedures like dental surgery, hernia, etc. which are excluded in the first few years.

Tip 2: Take a close look at the list of excluded diseases before finalizing your health insurance plan.

Sublimit – To tackle the rise in health care costs, insurance companies have introduced sublimit clauses. The most common sublimits are room rent, doctor’s fees and diagnostics. For example, if you are taking a plan for a sum assured of Rs 2,00,000, the insurer may cap the room rent to the extent of 1%-1.5% of the sum assured, or Rs 2,000 per day, whichever is higher. If it exceeds the specified limit, then you have to pay the balance.

Tip 3: While most companies have sublimits in their policy, do talk to your insurance advisor to find out which companies offer health insurance plans without any sublimits.

Co-payment – Co-payment means the fixed percentage of the total bill which you have to pay in case of a claim. This percentage is already defined in the policy document. The co-payment clause is around 10% or 20% for such policies. For some policies, it can go as high as 40%.

Tip 4: Identify those diseases that come under the co-payment clause before you opt for a health insurance policy.

Renewal age – Most PSU companies and certain public insurance companies provide medical insurance policies with a renewal age of up to 70 or 80 years. It is to be noted that diseases may increase with old age and so, medical costs may be higher. Hence, it is important to have medical insurance at an older age.

Tip 5: Few companies offer senior citizen policies with lifetime renewal, for which the entry age itself is 60 years. For non-senior citizens, it is advisable to look at a policy that offers lifetime renewal to you.

Coverage  If you are unmarried, it is better to take an individual policy. Health insurance policies offer a provision to add new family members at a later stage. If you are married with kids, then it is best to opt for a family floater policy that will cover you, your spouse and your kids. It is ideal to have a separate senior citizen policy for your parents, if they have crossed 60 years of age. This is because the cost of a family floater would be decided on the basis of the highest age of the person in the family and hence, taking such a policy with a senior citizen in it would skyrocket your cost.

If you are living in Tier-1 cities, it is ideal to have a coverage of not less than Rs 10 lakh as a family floater, while if it is Tier-2 cities, you can have a coverage of not less than Rs 5 lakh.

Tip 6: No claim bonuses will be offered by insurance companies in two different ways. Few of them will offer it to increase the sum assured every year, while few companies offer it as a discount in premium. Choose the one which increases the coverage instead of the discount in premium as the cost of medication increases on a yearly basis.

Cost – Ideally, the cost of the policy should be given least importance while buying medical insurance. If the policy provides you all the benefits and if the cost is a little higher, it is ideal to look at the cost benefit analysis and to take the same as it is worthwhile to pay the cost for the benefit you get.


Is your Health Insurance plan adequate to cover critical illness?


It was a late Sunday afternoon and I was feeling perplexed.

Researching the best antivirus software, I got so confused about various terminologies that I closed my laptop and went to a friend’s house, an IT guy, for a cup of coffee. In the course of our conversation, while he was enlightening me on the antivirus bit, I came to know he had a similar woe, except that it pertained to insurance.

He was planning to buy insurance for his family, but was all confused between health and critical illness insurance: whether to combine both, buy them separately, or not buy them at all.

I decided to help my friend and enlighten him on the difference between both policies and what is right for him. Here’s what I told him.

Health and mediclaim policies: How similar, how different?

First of all, let us understand the fundamental point that within the broad non-life segment of insurance, health and critical illness are different categories of insurance. Both kinds of policies are sold by non-life insurance companies.

Speaking first of healthcare insurance, it is an “indemnity” based insurance which reimburses the actual cost of hospitalisation expenses in case you are admitted to a hospital. When we speak of indemnity based cover, it means that for whatever amount of policy (sum assured) you have taken, your insurer will reimburse you only to the extent of the actual cost or expense that you’ve incurred & nothing more.

As against this, critical illness insurance is a “fixed benefit” insurance cover. Unlike health insurance, here there is no mandatory requirement of hospitalisation to make a claim. As soon as you are diagnosed with a specified critical illness having a specific severity level as defined in the policy terms and conditions, your insurer is bound to release the sum assured to you in one go, irrespective of whether you’ve spent even a single rupee on treatment of illness or not.

Also, there is no restriction on the usage of the money: it can be used to pay off any outstanding loans, fund financial goals or create an investment income stream to meet future household & living expenses.

As a consumer, what should be your approach?

First things first, since health and critical illness address different needs of a policyholder, there is a place for both in a person’s insurance portfolio. Having said that, given that hospitalisation is far higher on a probability scale than a critical illness, especially  assuming the policyholder is young and fit, while having your own health insurance is a “must have”, a critical illness can be said to be a “good to have”.

IRDAI Health Insurance Regulations in 2013 standardised a lot of the terms, conditions and clauses used in these policies across insurers, which is a big plus for the consumer and makes the task of choosing policies offered by various insurers a lot easier.

It is also observed that some life insurance policies offer critical illness cover as a rider. Generally, the premium for a Critical Illness rider is lower than the premium for a standalone Critical Illness policy. This is because the standalone policy generally offers more features and more comprehensive coverage than the rider, though it may differ from insurer to insurer.

Some health insurance policies available in the market bundle a critical illness cover with health insurance. While it seems like a good idea to buy one policy covering both requirements, that should not be the only deciding factor: policy features and premium should be compared thoroughly before signing up for such policies.


Health and critical illness are separate categories and each policy has its own place in a family’s overall insurance requirement. It is a wise approach to first define your familial requirements, then compare across insurers and select the best available policy in each of the categories of insurance to help secure you and your family’s future from unforeseen medical contingencies.


How Are You Feeling, HealthCare insurance


HealthCare insurance is up! Well, for some users.

After a Nov. 30 deadline was announced as the end of the site’s major reconciliation period, it’s looking slightly healthier than it was a few weeks ago.

Checking in on the federal website, now identified by its glitches, after month-long repair efforts shows that not much has changed for consumers. Whether young or old, tech-savvy or still figuring out why you would want to “pin” or “+1″, modern web users expect a seamless experience from beautifully designed apps, sites, and software that HealthCare insurance has yet to deliver.

That’s not to say the site doesn’t exhibit smoothness in some areas, such as the front end created by Development Seed, which is fully functional. Visitors are able to get informed on coverage and view hundreds of pages specifics and get clear explanations of the health law.

But the site’s informative face doesn’t get people enrolled in coverage, unfortunately, and the federal health portal could still use some intensive care.

I tried applying on Black Friday, one day before the stated deadline for the site to function again, and was able to get as far as an electronic signature that didn’t seem to go through.

My application through the federally facilitated exchange is still incomplete, and I have yet to see any available health plans in my area, what kinds of subsidies I qualify for, and how much coverage is going to cost me: all the essentials running through every uninsured and curious marketplace applicant’s mind since Oct. 1.

Federal officials publicly stated there would be noticeable improvements to the site by the end of November, though it wouldn’t be perfect. Monday marked the first business day since the self-imposed deadline for repairs, and the site is getting mixed reviews.

Repairs will be ongoing for HealthCare insurance, which means one day the site will run as effortlessly as any other high-traffic site — likely when open enrollment season 2015 arrives. But for year one, the enrollment process is still haphazard, requiring diligence and even some back-up methods, like direct enrollment through insurers.

Not all experiences with the site are rocky or unsuccessful. According to the Washington Post, brokers and application counselors in Utah said three of every four applicants were able to enroll within the hour of logging into their account.


Does health insurance cover addiction treatment?

Before you make the decision to undergo addiction treatment, it’s important to determine whether it’s covered under your current health insurance policy. If it’s not, you could end up with a large bill or even have your treatment cut short due to non-payment. You can learn more about your insurance coverage for addiction treatment by reading through your benefits guide or contacting your insurance company directly.

Insurance coverage for addiction treatment: What’s covered?

Your addiction treatment may or may not be covered by your insurance. Insurance coverage for addiction treatment usually depends on your insurance company as well as the type of treatment you decide on. Not all insurance companies cover addiction treatment, for instance. Those that do may not cover certain types of treatment.

Generally, traditional detox services are covered by health insurance; however, insurance companies will not usually cover rapid detox or ultra rapid detox, since these are still considered to be experimental treatments that aren’t medically necessary. Outpatient addiction treatment is typically covered by most health insurance plans, but not all insurance companies will cover inpatient treatment.

Does insurance cover addiction treatment?

Even if your insurance covers addiction treatment, there’s still a good chance that you’ll have some out-of-pocket costs. The majority of health insurance companies require policyholders to pay a small co-pay, or coinsurance, in order to receive addiction treatment. This may be a percentage of treatment costs or a fixed rate. Fixed co-pays can range from $10 to $150 per day of treatment.

If your insurance company denies your addiction treatment claim, there are a couple actions you can take. First, you can appeal this decision. In order to do this, you’ll need to investigate the appeals process and possibly gather evidence that addiction treatment is a medical necessity for you. You can then write an appeal letter or fill out an appeals form and send it to your insurance company along with any supporting documentation.

If your appeal is denied and your insurance company refuses to cover addiction treatment, you may qualify for reduced cost addiction treatment under sliding scale fees. Most addiction treatment facilities also offer financing options, in which you’ll make payments over time to cover the cost of addiction treatment.

Addiction treatment with no insurance

Even if you have no health insurance, addiction treatment is possible. There are a number of resources that you can use to help cover the costs of rehab.

  1. Public government insurance covers the cost of addiction treatment with no insurance. This includes programs such asMedicareand Medicaid. Medicare is a government insurance program that covers taxpayers over the age of 65 and some younger individuals with disabilities. Medicaid is an assistance program that covers the medical bills of low-income individuals.
  2. Likewise, the federal government sends money to state agencies every year to offset the cost of addiction treatment. This money, administered as a Block Grant by SAMHSA, goes to treatment centers directly. To learn where to go to access this low cost addiction treatment, call 1-800-662-HELP or visit the SAMHSA treatment locator website.
  3. Sliding scale fees are also offered by many addiction treatment facilities. These are reduced fees primarily based on a person’s income. Other factors, such as the size of a person’s household and monthly expenses, may also be taken into consideration. If you don’t qualify for reduced cost addiction treatment, certain facilities may offer financing to help you pay for treatment.

Medical insurance for addiction treatment questions

Navigating the world of insurance can be frustrating, confusing, and time consuming. The good news is we’re here to help! If you have any questions about medical insurance for addiction treatment, feel free to leave them in the comments section below. We look forward to helping you make sense of every aspect of your addiction treatment.