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Retail health insurance is a type of health insurance policy available to the general public, whereas the group health insurance policy is only available for a group of people. Retail health insurance policy covers the cost of claims that are incurred by the insured customer during the policy period in return for a considerable amount known as “Premium”. Retail health insurance policy is also known as a personal health insurance policy. Retail health insurance policy covers the cost of inpatient hospitalization, daycare procedures, and alternative treatments like Ayurveda, Yoga, Unani, Homeo & Siddha. In addition to these, the personal health insurance policy also covers the room rent expenses incurred by the insured customer, pre and post hospitalization expenses as a result of inpatient treatment. The personal health insurance policy is available to all segments of people. The minimum entry age is 18 years for Adults and 91 days for newborn babies, the maximum entry age being up to 80 years. In addition, most personal health insurance policies are offered with a lifelong renewal option to the customers.
Let us understand the different types of retail health insurance policies available in India:-
1. Individual Health insurance: Individual retail health insurance policy is a type of policy that is offered on an individual basis. As the name suggests, the policy is meant for a single person. There will be only 1 person as insured under the individual retail health insurance policies. The minimum and the maximum entry age of the individuals would be the same as that mentioned above. It is not possible to add family members under the individual health insurance, and hence separate individual policies are to be taken for each family member. The premium under the individual health insurance policy will be calculated based on the age of the prospect as well as the coverage required.
2. Family floater health insurance: As the name suggests Family floater health insurance policy is a policy in which the sum insured would float among the family members covered under the policy. The sum insured under the policy can be utilized by any or all of the family members without any restriction on per person usage. All the members or a few members of the family can be added under the family floater retail health insurance policies. The basic structure of family floater health insurance policies would be:
Adult + Child
Adult + Child + Parents
Adult + Child + Parents-in-law
3. Critical illness insurance: Critical illness is a form of illness that is life-threatening and incurs a huge amount of money for treatment. A critical illness health insurance policy covers the expenses related to the hospitalization of the insured due to any of the mentioned critical illnesses. The critical illness policy covers illnesses like heart attack, cancer, paralysis etc. If the insured is diagnosed with any of the listed critical illnesses, the insurance policy will settle the sum assured mentioned under the policy. There is no requirement for hospitalization under the critical illness policy, as the diagnosis with any critical illness would be sufficient to settle the lump sum amount under the policy.
4. Senior Citizen health insurance: As the name suggests, senior citizen health insurance policies are offered to senior citizens who are above 60 years old. There are certain personal health insurance policies that are designed keeping senior citizens in mind, and these policies provide coverage to senior citizens. The policy covers pre and post hospitalization, inpatient hospitalization, alternate treatments etc., up to the sum insured available under the policy.
5. Top up health insurance policy: A top-up health insurance policy would benefit a person with an existing health insurance policy. A top up health insurance policy would have a “deductible” or “excess” which is the predefined amount that the insured customer should bear at the time of claim settlement. Claim amount over and above the deductible would be settled by the insurance company under the top up health insurance plan.
6. Hospital Daily Cash policy: Hospital daily cash policy is given as an add-on or as an individual policy. The hospital daily cash policy provides a certain amount of daily cash to the insured customer in case of hospitalization. There are various plans in the hospital daily cash policy in which the sum insured ranges from Rs.500 to Rs.10k per day.
7. Disease-specific health insurance: There are certain retail health insurance policies which are offered to customers that cover certain diseases such as Covid-19, Mosquito bite etc. These policies cover the medical expenses of the insured customers only if they are admitted to the hospitals for the mentioned diseases. The Corona kavach health insurance policy covers the hospitalization expenses of the customer only if he/she is admitted to the hospital due to Corona. Similarly, the mosquito bite policy covers the expenses due to hospitalization in case of diseases resulting from mosquito bites such as Dengue, Malaria, Chikungunya etc.
8. Maternity insurance: Maternity health insurance policy is generally given as an add-on or rider in the existing health insurance plan. These plans cover the pre and postnatal expenses and expenses arising out of childbirth. The newborn baby expenses are also covered under the maternity retail health insurance policies. The maternity health insurance policies have a waiting period of 1 to 3 years before making a claim.
9. Personal Accident insurance: Personal accident insurance is offered as an add-on in a health insurance policy and also as an individual product. Personal accident insurance compensated the insured customer in case of death or disability. In case of accidental death of the insured, the sum insured would be paid to the nominee of the insured. In case of disability of the insured, a particular amount would be paid to the insured under the policy. The personal accident policy covers the total and partial disability of the insured due to an accident. Personal accident policies are benefit policies where the entire sum insured would be paid to the nominee in case of the death of the policyholder.
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