Catastrophic health insurance refers to health insurance plans that provide coverage for emergencies. These policies cover all the basic benefits and come with low monthly premiums. A sudden medical crisis could incur extremely high medical expenses, which are often paid straight from their pocket. If you want to safeguard yourself and your family from any such medical emergency, purchasing catastrophic health insurance could be beneficial.
But before you do so, learn about the coverage it provides, benefits, eligibility, exclusions, claim settlement process and more. Read on!
Catastrophic health insurance provides coverage for medical emergencies as well as preventative care. They usually come with a low monthly premium. Catastrophic plans were first introduced in the United States in 1973 for workers and Medicare beneficiaries. In India, top-up, and super top-up plans are the most appropriate health plans to protect oneself from catastrophic events.
Top-up plans increase the base coverage of an existing health plan and can be very helpful for a single event of hospitalisation. In addition, super top-up plans provide coverage for cumulative medical expenses providing adequate financial cushioning throughout the year. These catastrophic health insurance plans provide coverage after one’s medical expenses cross a certain threshold limit called the deductible.
Let us say that you have a base plan with an insured sum of Rs.10 lakh and a deductible of Rs.4 lakh. Now, if your medical expense is around Rs.6 lakh, the super top-up plan will pay Rs.2 lakh.
Most catastrophic health plans will cover essential benefits such as:
All Hospital-Related Expenses
It includes fees for doctors, surgeons, anaesthetists, nurses, surgical appliances, blood bags, oxygen, etc.
It will cover room rent, ICU (Intensive Care Unit) charges, nursing expenses, etc.
This includes treatments that require a one-day stay at a hospital.
Complementary Health Screenings
A catastrophic medical insurance policy offers free annual check-ups as well as a few complimentary health screenings.
Besides paying for emergency medical costs, catastrophic insurance policies may also account for the following expenses:
These are among the most important reasons to get a catastrophic insurance policy:
The following eligibility criteria are applicable for purchasing catastrophic health insurance policies:
Follow the given tips to choose the optimal catastrophic plan for your needs.
Tip 1: Select the Right Deductible
This is the amount you will have to pay from somewhere else before the catastrophic health plan takes effect. Select a deductible amount close to your current health insurance coverage to avoid paying out-of-pocket.
Tip 2: Stick with the Current Insurer
If someone gets this policy from the current insurer, they may waive off the waiting period for pre-existing diseases. This could allow long-time customers to get coverage as soon as they buy the top-up policy.
Tip 3: Check the Terms and Conditions
You should carefully check the terms and conditions to ensure that the insurance policy covers all sorts of treatment one may undergo.
Tip 4: Upgrade Base Cover
Since these health plans provide the same benefits as a base plan, you may want to upgrade your existing plan to get more benefits.
Tip 5: Work Out the Costs Saved
These insurance policies are meant for people who cannot afford more expensive health plans. Hence, it is advisable to calculate the premium costs to select a policy that facilitates the most savings. One can use the Navi insurance premium calculator to determine quotes and plan purchases accordingly.
Also Read: What Is Mental Illness Cover In Health Insurance? What Are Its Benefits?
The following are the two ways one can claim a Catastrophic health insurance plan:
To avail the cashless facility, you will need to take the following steps:
To claim reimbursement, follow the given steps:
Remember to check the terms and conditions of your health insurance plan before filing for claims.
Your catastrophic health insurance policy will not offer coverage till you have met your deductible. There are also some limits on preventive health care besides standard exclusions.
The following are some of the standard exclusions of catastrophic health insurance plans:
Also Read: Managed Care Plans: What Is It & How Does It Work?
The following people may want to avoid opting for a catastrophic health insurance plan:
These health insurance policies often have very high deductibles, which kick in only when the medical bills are too high. Anyone who wants health insurance coverage below this limit will want to opt for other plans.
A catastrophic health insurance policy provides a safety net that can cover medical expenses for serious illnesses. These are ideal for those with a basic health plan but cannot afford a high premium.
Navi Health Insurance offers comprehensive policies with a hassle-free claim process that takes only 20 minutes for approval. Download the Navi App and get an insurance policy cover of up to Rs.1 crore for you and your family.
Ans: The major features of a catastrophic health insurance policy include:
– High-cost deductible
– Low-cost premium
– High sum insured
– Given to insured people with a base policy
Ans: Top-up and super top-up health insurance plans are the closest thing to catastrophic insurance in India. Both come with a cheap premium and come into effect when the medical bills cross the deductible.
Ans: Yes, one can set their deductible to an appropriate amount, depending on the policy.
Ans: No, although high deductible health plans (HDHP) carry higher deductibles, these are a special type of health insurance policy. These have standardised limits for the deductible and out-of-pocket maximum. Moreover, they have less stringent age limit requirements, unlike catastrophic health insurance policies.
Ans: Long-term health insurance policies usually have a tenure of 2-3 years, unlike regular health policies which have a tenure of 1 year. This allows you to benefit from discounted premiums. Moreover, you can renew the policy less frequently.
In contrast, the main advantage of a short-term catastrophic plan is that it provides coverage for extremely high medical bills. People who do not have high medical bills throughout the year may want to opt for these plans.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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