5 Lakh Health Insurance
5 Lakh Health Insurance
According to the proverb, health is wealth. Therefore, medical insurance coverage is required to cover unexpected treatment expenditures, particularly during the COVID-19 pandemic. Many of us buy it yearly, not only for the stated cause but also because of associated health insurance tax benefits.
A 5 lakh medical insurance policy has traditionally been the most prevalent sort of protection taken up by Indians working in the organised sector.
Being a prominent player in the Indian insurance industry for more than 20 years, it is the responsibility of Tata AIG to provide clear and concise information about the 5 lakh health insurance policy to its customers - what the policy covers and what the policyholder can expect in terms of benefits and coverage.
So, for a good reason, we have penned this informative post to help you understand the ins and outs of the 5 lakh mediclaim policy. Continue reading to learn more about the same in detail and depth.
5 Lakh Mediclaim Policy: What Exactly Is It?
A 5 lakhs health insurance plan is a policy that provides the policyholder with a ₹5 lakhs sum insured. It implies that the insured individual is covered for ₹5 lakhs in healthcare expenses, according to the terms and conditions of their plan.
A 5 lakhs health insurance policy protects you and your family from the financial burden of medical costs incurred due to a mishap, minor injury, sickness, or other unforeseen circumstance. A decent health insurance policy ensuring a suitable sum will help you deal with unanticipated medical crises.
Perks of Having a 5 Lakh Medical Insurance Policy
Having a 5 lakh medical insurance policy can provide several benefits and perks to the policyholder. Here are some potential perks of having a 5 lakh medical insurance policy:
- Adequate Coverage: A 5 lakh medical insurance policy provides a decent amount of coverage for medical expenses, which can be pretty helpful in sudden illness or accidents.
- Cost Savings: Medical treatments can be expensive, and having a 5 lakh medical insurance policy can help to offset some of these costs, thus providing cost savings for the policyholder.
- Cashless Treatment: Many insurance companies offer cashless treatment facilities to their policyholders. It means the policyholder can avail of medical treatment at network hospitals without paying any cash upfront.
- Comprehensive Coverage: 5 lakh medical insurance policies often cover a wide range of medical expenses, including hospitalisation, surgery, doctor's fees, medicines, and other related costs.
- Tax Benefits: The health insurance premium for 5 lakhs that you pay can also provide tax benefits. Under section 80D of the Income Tax Act, policyholders can claim tax deductions on their premium payments.
- Peace of Mind: Having adequate medical insurance coverage can provide peace of mind and reduce stress. It can be vital during illness or injury when you need to focus on your recovery.
The Mathematics behind Purchasing a 5 Lakh Health Insurance Plan
To understand the mathematics behind purchasing a 5 Lakh health insurance plan, we need to consider a few factors, such as:
- Premium: The premium is the amount of money you pay the insurance company to purchase the health insurance plan. It depends on several factors, such as age, medical history, pre-existing conditions, etc.
- Sum Insured: The sum insured is the maximum amount the insurance company will pay in case of hospitalisation or medical treatment. In this case, the sum insured is 5 lakh.
- Deductibles: A deductible is an amount you agree to pay before the insurance company covers your medical expenses. Generally, the higher the deductible, the lower the premium and vice versa.
- Co-pay: Co-pay is the percentage of the medical expenses you agree to pay out of your pocket while the insurance company covers the remaining percentage.
- Coverage limit: The coverage limit is the maximum amount of money that the insurance company will pay for your medical expenses. In this case, the coverage limit is 5 Lakh rupees.
Now, let's assume that the premium for a 5 lakh mediclaim policy is ₹10,000 per year. Choose a deductible of ₹50,000 and a co-pay of 10%. You will have to pay the first ₹50,000 of your medical expenses. The insurance company will cover 90% of the remaining costs up to the coverage limit of ₹5 lakhs.
So, if you have a medical expense of ₹1 Lakh, you must pay the first ₹50,000, and the insurance company will cover the remaining ₹50,000.
However, suppose you have a medical expense of ₹7 Lakh; in that case, you must pay the first ₹50,000, and the insurance company will cover 90% of the remaining ₹6.5 Lakh, which is ₹5.85 Lakh (90% of ₹6.5 Lakh), up to the coverage limit of ₹5 lakhs.
Reasons to Go for 5 Lakh Health Insurance in India
There are several reasons to consider purchasing a 5 lakh health insurance plan in India, including:
- Rising Healthcare Costs: The cost of medical treatment in India is increasing rapidly, and hospitalisation expenses can quickly accumulate. With a 5 lakh health insurance plan, you can get coverage for hospitalisation expenses, doctor's fees, and other medical costs.
- Comprehensive Coverage: A 5 lakh health insurance plan can offer comprehensive coverage for various medical procedures, including surgeries, diagnostic tests, and ambulance charges.
- Financial Security: Medical emergencies can occur unexpectedly, and they can also put a significant strain on your finances. A 5 lakh health insurance plan can provide financial security and ensure you receive quality medical care without worrying about costs.
- Pre-existing Medical Conditions: If you have any pre-existing medical conditions, such as diabetes or hypertension, a 5 lakh health insurance plan can provide coverage for medical expenses related to those conditions.
Things Included and Not included under a 5 Lakh Health Insurance Plan
The coverage offered under a 5 lakh health insurance plan may vary depending on the insurer, the specific policy, and the terms and conditions mentioned in the policy document. Generally, a 5 lakh health insurance plan covers the following:
- In-patient hospitalisation expenses: In-patient hospitalisation expenses refer to the medical expenses incurred during a hospital stay for a minimum period of 24 hours. These expenses are usually covered under health insurance plans, including a 5 lakh plan.
- Pre and post-hospitalisation expenses: Pre and post-hospitalisation costs refer to the medical expenses incurred before and after a hospitalisation. These expenses are also typically covered under a 5 lakh health insurance plan.
- Day-care treatments: Day-care treatments refer to medical procedures or treatments that can be completed within a few hours and do not require an overnight hospital stay. These treatments are also covered under a 5 lakh mediclaim plan.
- Ambulance charges: Ambulance charges refer to the expenses incurred for transporting the patient from the location of the incident to the hospital or between hospitals. These expenses are also typically covered under a 5 lakh health insurance plan.
- Room rent expenses: Room rent expenses refer to the charges incurred by the patient for occupying a room or ward in the hospital during their stay. These expenses are typically covered under a 5 lakh health insurance plan.
- Surgeon fees, doctor fees, and other medical practitioner fees: Surgeon fees, doctor fees, and other medical practitioner fees refer to the charges incurred by the patient for medical consultations, diagnosis, and treatment provided by medical practitioners. These expenses are typically covered under a 5 lakh health insurance plan.
- Diagnostic tests and imaging: Diagnostic tests and imaging refer to medical tests conducted to diagnose or evaluate a medical condition. These tests are typically covered under a 5 lakh health insurance plan.
- Organ donor expenses: Organ donor expenses refer to the expenses incurred by the organ donor for donating an organ for transplantation. These expenses may include medical, hospitalisation, and other related costs.
- Some health insurance plans provide coverage for organ donor expenses under certain conditions. The coverage for organ donor expenses may vary based on the specific health insurance policy and plan.
- Alternative treatments such as Ayurveda, Unani, and Homeopathy: Alternative treatments such as Ayurveda, Unani, and Homeopathy are not typically covered under a 5 lakh health insurance plan. Most health insurance plans only provide coverage for allopathic treatments, which are based on conventional western medicine.
However, some health insurance plans may offer coverage for alternative treatments as an add-on benefit or rider to the base health insurance plan. The coverage for alternative treatments may vary based on the specific health insurance policy and plan.
It's essential to check the policy document to understand if the health insurance plan covers alternative treatments like Ayurveda, Unani, and Homeopathy. If the policy does not provide coverage for alternative treatments, then the patient would need to bear the expenses for these treatments themselves.
Things Not Included:
- Cosmetic and plastic surgery
- Maternity and childbirth expenses (unless specified in the policy)
- Treatment for obesity and weight management
- Treatment for mental illnesses, psychiatric or psychological disorders, and de-addiction programs
- HIV/AIDS treatment
- Treatments for infertility and related expenses
- Non-allopathic treatments not specified in the policy
- Expenses related to self-inflicted injuries or attempted suicide
- Expenses incurred outside the geographical limits specified in the policy
Note: It's important to carefully read and understand the terms and conditions mentioned in the policy document to know exactly what is covered and what is not covered under a 5 lakh mediclaim policy.
Who Requires a 5 Lakh Medical Insurance Policy?
A 5 lakh medical insurance policy can be suitable for individuals and families who want basic health insurance coverage at an affordable premium. Here are some examples of individuals who may require a 5 lakh medical insurance policy:
- Young adults and individuals starting their careers: Young adults who are starting their careers and do not have any major health concerns may opt for a 5 lakh health insurance policy as it provides basic coverage at a lower premium.
- Individuals with limited budgets: Individuals with limited budgets who cannot afford higher coverage may opt for a 5 lakh health insurance policy.
- Individuals with no family history of major illnesses: Individuals with no family history of major illnesses or pre-existing medical conditions may opt for a 5 lakh health insurance policy.
- Senior citizens: Senior citizens who have retired and do not have any major health concerns may opt for a 5 lakh health insurance policy.
However, it's important to note that deciding to opt for a 5 lakh health insurance policy should be based on individual needs and circumstances. It's always advisable to assess your health needs and choose a health insurance policy that provides adequate coverage based on your medical history, age, and other factors.
How Does the 5 Lakh Health Insurance Plan Work?
A 5 lakh health insurance plan works like any other health insurance plan. Here are the basic steps of how a 5 lakh health insurance plan works:
- First, you purchase the health insurance you choose. Medical insurance is often given annually and must be renewed each year after it expires. Now, if an insured person is hospitalised within the policy year, it is evident that you will file a claim for your medical expenditures. In the event of a claim, the insurance company first determines if the treatment sought by the insured is covered under the health plan.
- The insurer then determines whether or not the hospital where the insured is receiving treatment is in its network. If you opt to be treated in a network hospital, you will be eligible for cashless hospitalisation, and the Insurer (directly) or an appointed Third Party Administrators will be responsible for settling your hospitalisation payments.
- The insurer/TPA will evaluate the specifics of your health insurance plan, and if it contains a deductible clause or the entire amount of your costs exceeds the sum insured, you will only have to pay the difference. And if no such provision applies, you have nothing to worry about.
- If you want to be treated at a non-network hospital, you must first pay the hospital, but remember to gather all your medical bills, including pre and post-hospitalisation costs. These bills must be filed with your insurance company.
Again, the insurer/TPA will review your policy provisions and compute the total amount to be paid after subtracting any co-pays or amounts that exceed your insurance coverage. The insurance provider will directly refund you for the balance or the whole amount of your invoices, whichever is greater.
Factors Influencing the 5 Lac Health Insurance Premium
Several factors can influence the 5 lakhs medical insurance premium. Here are some factors that may impact the premium:
- Age: Age is one of the most significant factors that impact the premium amount. Younger individuals may have to pay lower premiums compared to older individuals as the risk of illness and medical conditions increases with age.
- Medical history: The policy premium may also depend on the individual's medical history. Individuals with pre-existing medical conditions may have to pay higher premiums as they are more likely to make claims.
- Lifestyle habits: Lifestyle habits such as smoking and alcohol consumption can increase the risk of health problems and may lead to higher premiums.
- Location: The policyholder's location can also impact the premium amount. Individuals residing in cities may have to pay higher premiums than those living in rural areas.
How to Pick the Perfect 5 Lakh Health Insurance Plan?
Choosing the right 5 lakh health insurance plan requires careful consideration of various factors. Here are some tips that may help you select the right plan:
- Suitable Coverage: It is best to acquire a medical insurance plan that protects you against a wide variety of medical problems and includes perks such as daycare expenses, pre and post-hospitalisation fees, and so on. If you are obtaining family health insurance coverage, be sure that it satisfies the needs of each member of your family. Specify your criteria, compare plans based on benefits and pricing, and then select a plan that meets your needs.
- Type of Plan: Individual health insurance policies are feasible if you are single and do not have family responsibilities. But, if you want to include your family members in your medical insurance policy, getting a family health plan is preferable to enjoy maximum advantages at a lower cost.
- Keep It Affordable: While money cannot be equated with health care since individuals want to treat themselves and their loved ones at whatever cost, it is critical to get a health plan that is reasonable for you. When purchasing health insurance, the budget is critical. But, before you pay for mediclaim coverage, you should review the advantages listed in it. The best advice is to purchase a reasonably cost health insurance policy at the outset to guarantee that you are adequately insured and that the premiums are also cheap. So, in the future, you may evaluate your plan and enhance the coverage as your income, family size, and needs change.
- Claim Settlement Ratio: The claim settlement ratio is an essential factor to consider when buying health insurance because it represents the percentage of claims settled by the insurance company against the total number of claims received in a particular period. It is a reliable indicator of the insurer's ability to settle claims and honour its commitments to policyholders.
- Network Hospital Coverage: While purchasing a health insurance policy, reviewing the list of network hospitals is essential. The finest health insurance in India offers a vast network of hospital alternatives. Check the number of network hospitals around your home as well. With Tata AIG health insurance policies, you may select from approximately 7,200+ cashless networks for rapid, simple, and cashless claim settlement!
- Choose a Policy with Lifetime Renewability: When purchasing a health insurance policy, check to see whether the policy includes a lifetime renewability provision. Because you are more likely to be impacted by health issues as you age, obtaining mediclaim insurance with the option of lifetime renewability is more practical and useful. As a result, select health plans that provide lifelong renewability.
While looking for health insurance, the guidelines mentioned above will help you get the most out of it. Purchasing health insurance is a significant investment to protect yourself from the financial burden of excessive healthcare expenditures. As a result, you must invest in the appropriate plan and with the appropriate insurance provider.
How to Purchase a 5 Lakh Health Insurance Policy via Tata AIG Online?
You can purchase a health insurance policy from Tata AIG online by following these simple steps:
- Visit the Tata AIG General Insurance website and navigate to the “Health Insurance” section under the ‘All Products’ tab.
- Choose the type of health insurance plan that suits your needs, such as individual or family floater, and select the required coverage amount (in this case, you need to select a sum insured of ₹5 lakhs).
- Click on the "Buy Now" button and fill in the necessary details, such as your personal information, contact details, and medical history.
- Review the policy details, terms and conditions, and the premium amount.
- Make the payment online using your credit/debit card or internet banking.
- After payment, you will receive a confirmation email with the policy document and other necessary details.
Before paying, it is essential to carefully review the policy details, coverage, exclusions, and other terms and conditions. If you have any doubts or queries, you can contact the customer support team of Tata AIG General Insurance.
Benefits of Purchasing a 5 Lakh Health Insurance Policy from Tata AIG
It isn't easy to maintain a healthy habit today. Along with other aspects, age is significant in determining your health. Medical emergencies can occur at any time during a worldwide pandemic. As a result, protecting your and your loved ones' health becomes critical, and the only sure method to do so is to have Tata AIG health insurance in place. Tata AIG’s 5 Lakh health insurance policies have various advantages. Here is a list of advantages that Tata AIG puts forward:
- Hospitalisation Expenses: We cover your hospitalisation charges, such as ICU, room rent, investigations, doctor consultations, surgery, and so on, just like any other health insurance plan.
- Pre- and Post-Hospitalisation Expenses: Apart from basic hospitalisation, there are additional charges classified as before and post-hospitalisation. It includes diagnostic, blood tests, medications delivered by a qualified medical practitioner before and after hospitalisation, patient-care procedures, OPD expenditures, consultations, and ambulance charges, among other things. All these are covered by a Tata AIG 5 lakh health insurance plan, helping you save money.
- AYUSH Benefit: With the introduction of new and sophisticated kinds of medicine, insurance policies have expanded to include allopathic and alternative forms of care. For example, Ayurveda, Unani, Siddha, and Homoeopathic therapies are included under AYUSH and paid for by Tata AIG as in-patient care.
- COVID-19 Cover: Regarding health and well-being, the coronavirus epidemic has created a tsunami of anxiety, uncertainty, and widespread panic. Every time we leave the house, we run the chance of catching the virus, and the rapid mutation has increased that risk. In these unique times, the most critical benefit one can ask for in a health insurance plan is coverage for COVID-19 therapy, and Tata AIG’s 5 lakh health plan ticks the box in this matter too.
- Cashless Hospitalisation: Tata AIG’s 5 lakh health insurance policy provides cashless hospitalisation benefits to its policyholders, which means that they can avail of medical treatment at network hospitals without paying cash upfront for the expenses covered under the policy.
What Our Clients Say
"I recently purchased a mediclaim policy from Tata AIG and am extremely happy with my decision. The policy covers a wide range of medical expenses, and the customer support team was very helpful in answering all my queries. The cashless hospitalisation facility is also a great feature, which gives me peace of mind knowing that I won't have to worry about the expenses while getting medical treatment."
~ Rakesh Chaubey
"I had to make a claim under my mediclaim policy with Tata AIG, and I must say that the process was very smooth and hassle-free. The claim was settled within a few days, and I was able to get the required medical treatment without any financial burden. I am very impressed with the high claim settlement ratio of Tata AIG and would definitely recommend their policies to others."
~ Gurinder Arora
"I have been a policyholder with Tata AIG for a few years and am very satisfied with the coverage offered under their mediclaim policies. The policy covers a wide range of medical expenses, and the premiums are very reasonable. The customer support team is also very helpful and has assisted me in making changes to my policy as per my requirements."
~ Roshni Bansal
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Disclaimer / TnC
Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.
Frequently Asked Question
1. Does Tata AIG's health insurance plans cover COVID-19?
Yes, Tata AIG's health insurance plans cover COVID-19-related medical expenses, subject to the terms and conditions of the policy. The coverage includes hospitalisation, pre and post-hospitalisation, diagnostic tests, and other related medical expenses. However, checking the policy document or contacting Tata AIG's customer support team is always recommended for detailed information on COVID-19 coverage and exclusions.
2. What are some of the payment options that Tata AIG offers its policyholders for premium payments?
Tata AIG offers several convenient payment options for paying the premium for their health insurance policies. Here are the different ways to pay the premium:
- Online payment - UPI, debit/credit card, or net banking
- Auto-debit facility, where your payable premiums get automatically deducted from your bank account on the due date
- Demand draft or cheque by visiting the nearest Tata AIG branch office or by sending it through post/courier Choose a payment option that is convenient and secure for you.
3. What's the grace period for the 5 lakhs medical insurance plan?
The grace period for the 5 lakh health insurance plan from Tata AIG is usually 30 days. It means that if you cannot pay the premium on the due date, you have a period of 30 days from the due date to pay the premium and keep the policy active. During the grace period, the policy remains in force, and you can avail yourself of the benefits covered under the policy.
However, it is essential to note that the coverage will only be available for claims arising during the grace period once the premium is paid in full. If the premium is not paid within the grace period, the policy may lapse, and you may lose the coverage benefits. Therefore, paying the premium on time to avoid any inconvenience.