Health insurance is a contract where an insurance company pays for some or all of your medical expenses in exchange for a premium.
It protects you from high healthcare costs due to illness, injury, hospitalization, surgeries, and sometimes preventive care.
Reduces your medical costs during emergencies
Covers major hospital bills, surgeries, and treatments
Protects your savings from unexpected expenses
Provides cashless treatments in network hospitals
Offers preventive care (vaccinations, annual checkups)
Helps manage chronic illnesses (diabetes, hypertension)
Gives peace of mind and financial security
Covers a single person for hospitalization and medical expenses.
One policy covers the entire family (spouse, children, parents) with a shared sum insured.
Specialized plans for people aged 60+ with coverage for age-related illnesses.
Pays a lump sum amount if diagnosed with serious diseases like cancer, heart attack, or stroke.
Offered by companies to employees; often includes dependents.
Covers childbirth, prenatal and postnatal care.
Provide additional coverage once your base insurance is exhausted.
Medical bills are settled directly between the hospital and insurer (in network hospitals).
If you visit a non-network hospital, you pay first and get reimbursed later.
Covers expenses for tests, diagnosis, and medicines before and after hospitalization.
Coverage for treatments that don’t require 24-hour hospitalization (e.g., cataract surgery).
Covers emergency ambulance expenses.
Increase in sum insured for every claim-free year.
Many plans offer free preventive health checkups.
Health insurance protects you from paying the full cost of medical care out of pocket. Even a simple emergency visit can be expensive. Insurance:
Reduces your costs for routine and emergency care
Helps you access preventive services
Provides financial protection against unexpected illnesses or injuries
A premium is the amount you pay every month to keep your insurance policy active—similar to a subscription fee. Even if you don’t use medical services, you must pay this to maintain coverage.
A deductible is the amount you must pay each year for medical services before your insurer starts covering costs.
Example:
A fixed fee you pay for a service (e.g., 500 for a doctor visit).
A percentage of the cost you pay after your deductible is met (e.g., you pay 20%, insurance pays 80%).
This is the most you will pay for covered services in a year.
Once you reach this limit, insurance pays 100% of covered costs for the rest of the year.
Requires a primary care doctor (PCP)
Requires referrals to see specialists
Usually cheaper, but limited provider network
No referral needed for specialists
Larger provider network
Higher premiums, more flexibility
No referrals required
Must use in-network doctors
Middle ground of cost and flexibility
High deductible, lower premiums
Often paired with a Health Savings Account (HSA)
A Health Savings Account allows you to save money tax-free to pay for qualified medical expenses.
Benefits:
Contributions are tax-deductible
Funds roll over each year
You own the account even if you change jobs
Providers who have agreements with your insurance. Costs are lower.
Providers without an agreement. Costs are usually higher, and some plans don’t cover them at all.
Most plans cover preventive services at no additional cost (no copay/deductible), including:
Annual physical exams
Vaccines
Screenings (blood pressure, diabetes, cancer, etc.)
Coverage details vary by plan.
Common factors include:
Your age
Location
Tobacco use
Plan type (HMO, PPO, etc.)
Coverage level (bronze, silver, gold)
Whether you’re adding dependents
Yes, once coverage starts.
However, some plans may have:
Waiting periods for certain services
Preauthorization requirements
