Health Insurance or medical insurance is a contract between the insurer and policyholder where the insurance company offers medical coverage to the insured up to the sum insured limit. Multiple benefits on health plans are available, like coverage for pre & post hospitalization, medical check-ups, room rent coverage, cashless facility, etc.

If not any health issue, it could be hospitalisation due to an accident. Meeting medical expenses which appear out-of-the-blue is not in the reach of everyone. At least not at present times, when the Medical treatment cost is increasing every day making treatments expensive.The product that covers the expenses that arise out of such emergencies is Health Insurance. The insurance company either pays the medical expenses incurred directly to the hospital or will reimburse the expenses to the insured individual. 
 

Health Insurance:

1. It. covers pre and post hospitalisation expenses including the hospitalisation cover.
2. Expenses incurred for ambulance services and lost income cover is provided by some of the insurance companies.
3. Cover for critical illness for over 30 plus ailments like cancer, kidney failure, paralytic stroke, heart-related problems etc. is available.
4. The maximum sum assured is Rs. 6 Crores

Mediclaim: 

1. Mediclaim covers only the hospitalisation expenses.
2. It takes care of only hospitalisation cover.
3. Critical illness not covered.
4. The maximum sum assured is Rs. 5 Lakhs.

To avail cashless treatment, you should take treatment in the hospital that is in the network list of the policy for cashless treatment. If so, then a pre-authorisation 48 hours before admission to the hospital for a certain treatment has to be obtained from the insurance company or if it is an emergency then, at least 24 hours after admission the pre-authorisation has to be obtained. Your mediclaim service provider reviews the documents submitted by the hospital while you are being treated. These include discharge summary, hospital bills, pharmacy bills, investigation reports, payment receipts and doctor's consultation papers. The claim, if approved, is settled by the insurance company directly. All you need to do is sign on the relevant papers before getting discharged!

Pre-existing disease is a medical condition that already exists when one is purchasing a health insurance policy. Medical conditions such as high blood pressure, diabetes, thyroid, asthma, depression, etc., are considered pre existing ailments. Pre-existing diseases are covered by Health Insurance policies but there is a certain waiting period from the effective date of the policy usually the waiting period is between 2 to 4 years. Some insurance companies offer the option to remove the waiting period clause on the receipt of some extra premium. Under this option, the duration of the waiting period is either reduced or the waiting period is entirely removed.

When treatment is taken in a hospital which is not included in the cashless treatment hospital list, the claim settlement will by reimbursement only. You will have to initially bear the medical expenses and then claim for reimbursement from the insurance company usually within 7 - 30 days of discharge. On approval of admissible claim amount, insurance company will directly credit your bank account with the net payable amount thru NEFT.