Health Insurance | Understanding
What is Health Insurance?
Health insurance or medical insurance is an agreement wherein an insurance company agrees to compensate the insured for the medical and surgical expenses incurred during the policy tenure. The medical expenses may incur if the insured falls ill, or meets an accident that leads to hospitalization of the insured. To be eligible to avail coverage benefits under the policy, the policyholder is required to pay a specific amount periodically, known as premium. Health insurance premium is decided by an insurance company and policyholders are required to pay the same on a monthly, quarterly, half-yearly, or yearly basis, without any lapse, to avoid losing the renewal benefits.
Importance of Health Insurance Plans in India;
With rising healthcare expenses, access to the required and quality medical treatment can be financially draining. So, to protect yourself and your family against these expenses, you must get everyone insured under a reliable health insurance plan in time. Here are top reasons why you should consider buying health insurance today:
To Protect Your Savings: One hospitalization has the potential to drain entire savings of lifetime. But if you get hospitalized with a comprehensive health insurance plan, you can save this hard earned money. There are different health insurance plans in the market to cater to different requirements of individuals. But most commonly, they cover the insured for in-patient hospitalization expenses, pre-hospitalization and post-hospitalization expenses, daycare expenses, health check-up, ambulance expenses, domiciliary expenses, organ donor expenses, and so on
To Deal With Medical Inflation: An unforeseen illness can put anyone in stress. And the rising cost of medical treatment in such times only makes the situation worse. And the healthcare expenses are not only limited to hospitalization expenses, but also include pre-hospitalization and post-hospitalization expenses. These include ambulance expenses, expenses related to medicines, diagnostic tests, doctor’s consultation, room rent, etc. All these expenses can be saved by purchasing an affordable health insurance policy timely.
Lifestyle Changes: Another reason to get health insurance cover is that it helps you fight lifestyle diseases such as cancer, kidney failure, stroke, paralysis, heart diseases, etc. These diseases are most common in people above 45 years of age but due to sedentary lifestyles, stress, pollution, etc. these are now affecting youngsters as well. A comprehensive health insurance plan that covers you for regular medical check-up not only helps you identify the diseases, but also offers financial protection in case of their treatments.
To Secure the Health of Your Family Members: A single health insurance policy can cover your entire family. Many insurance companies offer health insurance plans that allow you to cover oneself, legally wedded spouse, dependent parents, dependent children, dependent parents-in-law, brother, sister, aunt, uncle, brother-in-law, sister-in law, etc. It reduces the hassle of maintaining multiple health insurance plans and keeps you stress free by keeping your entire family protected at all times. Also, purchasing health insurance plans on a family floater basis prove to be more affordable.
Timely and Good Quality Medical Treatment: With a reliable health insurance plan, one can avail of timely and good quality treatment without draining their entire life savings. To avail the treatment, all the insured has to do is visit the nearest network hospital and avail the required treatment as per the terms and conditions mentioned in the policy document. The insured can avail treatment for up to the sum insured, at these hospitals, without paying anything from his/her own pocket. The facility can be availed in case of planned hospitalization as well as emergency hospitalization.
Key Features of Health Insurance Plans;
Following are the key features of medical health insurance plans. It is recommended to compare these features with similar health insurance plans before shortlisting one online.
Sub-Limits on Room Rent - Some insurance companies come with a feature of sub-limits on room rent. This means that there is a maximum amount that an insurance company shall pay in case of a claim. Generally, this limit is up to 1% of the sum insured and a maximum of 2% in case of ICU expenses. But there are several general insurance companies that offer health insurance plans without any sub-limit on room rent. Hence, it is recommended to go for such plans.
Pre-Existing Diseases - Pre-existing diseases are those which you already have been suffering from before buying a medical insurance policy. This is why health insurance plans come with a waiting period instead of offering cover since day 1. During this waiting period, no claims are admissible. Hence, you should choose a health insurance policy with a minimum waiting period.
Co-Payment - Co-payment is when the insurance company and policyholder share the cost in case a claim arises. A co-payment can be decided in percentage or in amount. So, to take care of your savings, you must choose a health insurance policy that comes without any co-payment.
Network Hospital - Network hospitals are the hospitals that have tie-ups with health insurance companies where the insured can avail treatment without paying anything at the hospital. The benefit of availing cashless treatment comes with this feature. If a policy does not offer this feature, then you will be required to pay the expenses incurred at the hospital, from your own pocket, and the insurance company will reimburse you for the same later.
So, when choosing a health insurance company, make sure you go with the one that has a high number of network hospitals nearby your place of residence.
Key Factors To Consider Before Buying Health Insurance Plans;
In order to make the best buying decision, you must consider the following factors before shortlisting a health insurance policy:
Claim Process - The smoother the claim settlement process of a medical insurance company is, the better it will be for the insured. This is because if the insurance company is not good at handling the claims of the insured, then it fails the entire purpose of having a health insurance policy. Good customer support is an additional benefit that you must look for.
Family Members to be Covered - You must consider the family members for whom you want coverage. Under family floater health insurance plans, you can seek cover for yourself, your legally wedded spouse, children, parents, and grandparents. You must also keep their age, present ailments, and family medical history in mind. Also, you must be aware of any pre-existing conditions that they have and share with the insurance company, before buying the policy. So, choose a health insurance policy that covers all of them at an affordable premium.
Sum Insured - Sum insured should be chosen wisely as it covers you and your loved ones for medical expenses incurred during the entire policy term. You should look at the income as well as your age to decide the sum insured that you should opt for under your medical insurance policy. Make sure to choose a sum insured that is not insufficient as well as the one for which the premium is not too high.
Add-on Benefits - Add-ons are additional benefits that you can include in your health insurance policy, for extensive coverage. You can choose them voluntarily by paying an extra premium at the time of policy purchase.
Network Hospitals - Availing treatment at network hospitals is very convenient as they allow cashless treatment to the insured. This is why you should check the number of network hospitals an insurance company has. It is recommended to choose an insurance company that has a high number of network hospitals. Also, make sure to select the one nearby your place of residence in order to save time in case of an emergency.
Coverage Benefits - One of the most important factors to consider is coverage benefits. Different health insurance plans come with different coverage features which you should choose as per your requirement. Common coverage benefits under health insurance plans include in-patient hospitalization expenses, pre-hospitalization and post-hospitalization expenses, road ambulance expenses, daycare expenses, domiciliary expenses, etc.
Lifetime Renewability Benefit - The chances of getting ill in old age are higher and hence if you buy a new health insurance policy at that time, it would cost you comparatively more. Therefore, you must choose a health insurance policy that comes with a lifetime renewability benefit.
Free Medical Check-Up - Many health insurance plans cover you for free medical check-ups. You must check the same before shortlisting a policy.
Waiting Period - The waiting period is the time at which an insurance company does not cover you. This is why you should choose a health insurance policy that comes with the least waiting period. There are different types of waiting periods such as initial waiting period, waiting period for pre-existing illnesses, waiting period for specified illnesses, etc., which you should be informed about, before shortlisting a health insurance policy.
Premium - It is recommended to choose a health insurance policy that comes at an affordable premium so that you are able to continue with the policy for a long period of time without any financial strain. However, choosing a medical insurance policy with a low premium is not always advisable as it may not get you enough coverage in case of an emergency.
Type of Policy - To identify which type of health insurance policy you want for yourself or your loved ones, you must evaluate your needs thoroughly. After that, you can choose from different types of health insurance plans available in the market such as individual health insurance plans, family floater health insurance plans, senior citizen health insurance plans, critical illness insurance plans, maternity insurance plans, children health insurance plans, disease-specific health insurance plans, etc.
Exclusions - Exclusions are the conditions for which you cannot make a claim, under your health insurance policy. Hence, when choosing a policy, you must opt for the one with the least number of exclusions. Some common exclusions under health insurance plans are treatment required due to self-harm, treatment required due to participation in adventure sports, etc.
Popular Health Insurance Companies;
At present, there are 29 insurance companies which offer health insurance plans in India. Of them, 20 are private general insurance companies, 4 are public general insurance companies, and 5 are standalone health insurance companies.
Top Health Insurance Companies in India 2022;
Here is a list of the best health insurance companies compiled on the basis of Claim Settlement Ratio (CSR) registered by them for the financial year 2019-2020.
Rank Health Insurance Company Health Claim Settlement Ratio FY20
1 IFFCO Tokio General Insurance 96.33%
2 Care Health Insurance 95.47%
3 Magma HDI Health Insurance 95.17%
4 The Oriental Insurance Company 93.96%
5 New India General Insurance 92.68%
6 Bajaj Allianz General Insurance 92.24%
7 Max Bupa Health Insurance 89.46%
8 Navi General Insurance 86.98%
9 HDFC ERGO General Insurance 86.52%
10 Manipal Cigna Health Insurance 85.72%
11 Edelweiss General Insurance 85.57%
12 National Insurance Company 83.78%
13 Future Generali General Insurance 82.96%
14 Royal Sundaram General Insurance 81.50%
15 Liberty General Insurance 81.03%
16 ICICI Lombard General Insurance 78.67%
17 Star Health Insurance 78.62%
18 United India Insurance Company 78.03%
19 Reliance General Insurance 76.43%
20 Tata AIG General Insurance 76.04%
21 Kotak Mahindra General Insurance 75.45%
22 Acko General Insurance 74.09%
23 Aditya Birla Health Insurance 70.81%
24 Universal Sompo General Insurance 70.75%
25 SBI General Insurance 66.08%
26 Go Digit General Insurance 63.56%
27 Cholamandalam MS General Insurance 56.25%
Choose a Health Insurance Plan For;
Family Health Insurance: A health insurance plan for a family is meant for the entire family. The policy can cover all the family members under a single sum insured, which is divided among all the members and can be availed by all of them or one member of the family, as per the need arises. Apart from self, a family floater insurance policy can include a legally-wedded spouse, dependent children, parents, parents-in-law, etc., and other relationships, varying from one insurance policy or insurer to another.
Senior Citizen Health Insurance: Senior citizen health insurance plans are designed for senior citizens, parents, or individuals aged more than 60 years to protect them against financial expenses arising because of health issues during old age. Some common coverage benefits offered under senior citizen health insurance plans include expenses related to daycare procedures like chemotherapy, cataract; pre-existing disease cover, cashless hospitalization, in-patient hospitalization expenses, pre-hospitalization expenses, etc.
Individual Health Insurance: Individual health insurance is a type of health insurance plan wherein only an individual, i.e. the policyholder is entitled to receive coverage benefits, in return for the premium that he/she has paid. Under this type of policy, the policyholder is covered on an individual sum insured basis, where he/she can claim up to the sum insured in case of hospitalization of at least 24 hours. An individual health insurance policy covers the insured for most healthcare needs and is hence, a wise choice.
Personal Accident Health Insurance: Personal Accident health insurance covers the insured in the misfortune event of an accident (rail/road/air) that may be lethal or cause disability or mutilation. These plans not only cover the insured for healthcare expenses, but also for loss of income, in some cases, that occurs due to accidents. Common benefits offered under these plans include accidental death cover, permanent/total disability cover, temporary total disability, hospital cash benefit, transportation of mortal remains, etc.
Health Insurance for Parents: Health insurance for parents offers them the required coverage for several healthcare expenses in their old age. Some of these include in-patient hospitalization expenses, pre-hospitalization and post-hospitalization expenses, daycare treatments, etc. It is important to have health insurance for parents as it saves them from burning their life savings in meeting medical expenses in old age.
Maternity Health Insurance: Maternity insurance plans cover all expenses up to a specific predefined limit in case of delivery. These plans protect you for financial expenses incurred due to normal as well as C-section deliveries. Maternity insurance plans offered by some insurance companies also cover you for prenatal and postnatal expenses and newborn baby expenses. Maternity insurance plans usually come with a waiting period, thus you should not delay their purchase if you are planning your family.
Children Health Insurance: As children have weak immune systems, they are more prone to illnesses. Therefore, it is important for them to be covered under reliable health insurance plans. Not many insurance companies offer standalone health insurance plans for children. But they can seek cover under an individual health insurance plan or a family health insurance plan. These plans cover them for major healthcare expenses like hospitalization expenses, ambulance expenses, daycare treatments, critical illnesses, etc.
Newborn Baby Health Insurance: New born babies require extra care and attention when it comes to their health. Therefore, they need adequate health insurance cover that covers them for basic healthcare expenses. One can add newborn babies on an individual basis or family floater basis, under individual health insurance plans or family floater health insurance plans. These plans cover the newborn babies for hospitalization expenses, pre-hospitalization and post-hospitalization expenses, vaccination expenses, amongst others.
Self-Employed Health Insurance: Health insurance for self-employed professionals offer financial protection in case of accidental emergencies requiring medical treatment and hospitalization. As self-employed individuals do not work in a public or private sector, therefore they cannot get group health cover. These workers include farmers, retailers, freelancers, small traders, domestic workers, etc. Hence, they need separate cover under individual or family floater health insurance plans.
Women Health Insurance: Women's health insurance plans cater to the varied health insurance needs specifically of women. There are, however, not many health insurance plans designed especially for women but there are many insurance companies that have attempted to create them. These plans can be purchased at affordable health insurance premiums for the sum insured as per the requirement and budget of the potential policy buyer. These plans cover women against several medical expenses including critical illnesses.
Group Health Insurance: A group health insurance policy is especially designed for a group of employees who work together. Provided to the employees by their employers as a benefit, a group health insurance policy comes at a low premium. Under a group health insurance policy, you get covered for hospitalization due to an illness, sickness, accident, critical illness, as well as maternity. Note that the employees are covered under a group health insurance policy only until they are working for a particular organization.
Explore Health Insurance terminologies;
COVID-19 Insurance: Covid-19 health insurance policy is a customized insurance policy aimed at covering hospitalization, pre-hospitalization and post-hospitalization expenses, and other medical expenses arising due to the treatment of COVID-19. There are two types of COVID-19 plans namely Corona Kavach Policy and Corona Rakshak Policy, varying in terms of features.
Critical Illness Insurance: Critical illness plans are especially designed to treat critical illnesses such as cancer, stroke, major organ transplant, kidney failure, heart attack, paralysis, etc. Critical illness plans pay the insured in lump sum in case he/she gets diagnosed with a critical illness that is covered under the policy. As the treatment for critical illnesses is high, therefore the premiums for these plans are also relatively high.
Health Insurance Renewal: Every health insurance plan comes with a validity of 1, 2, or 3 years, after which it needs to be renewed. It is imperative to renew your plan so that you don’t lose the accumulated benefits including waiting period benefits as well as No Claim Bonus.
Cashless Network Hospital: A network hospital is a hospital that has a tie-up or agreement with an insurance company to provide cashless treatment. This means that the insurance company directly settles the bills at the hospital and you are not required to pay anything for the medical treatment availed, if the policy offers coverage for the same.
Mediclaim Policy: Most insurers offer cashless mediClaim policy benefits to the insured. This means that the insured can avail cashless treatment provided the treatment is availed at a network hospital. The insurance company directly settles the bills as per the policy terms and conditions, at the network hospital and the insured is not required to pay anything.
Health Insurance Claim Settlement Ratio: Claim Settlement Ratio in health insurance refers to the percentage of the claims settled by a health insurance company against total claims received during a financial year. CSR tells how well an insurance company manages claims. The ideal CSR lies between 80-90%. But note that CSR may change from time to time.
Best Health Insurance Plans: Buying the best health insurance online is easy only when the buyer is aware of the different types of plans available in the market, along with their features and benefits. Health insurance companies in India offer 7 types of health insurance plans that cater to the varied needs of people in different age groups and with different health conditions.
Health Insurance Companies: In India, there are currently 30 insurance companies that offer health insurance plans to their customers. Of these, 25 are general insurance companies and 5 are standalone health insurance companies. The former offers other insurance products as well like car insurance, bike insurance, whereas the latter offers health insurance plans only.
Health Insurance Calculator: Health insurance premium calculator is an online tool that helps calculate the premium you will be charged for a particular health insurance policy. The tool not only helps you calculate premium, but also allows you to compare and analyze different health insurance plans so that you are able to make an informed buying decision.
Health Insurance Tax Benefit: A health insurance plan acts as an efficient tax saving tool. When you buy a health insurance policy, you pay the premium for the same. On that premium, you can avail tax benefits of up to Rs. 50,000, under Section 80D of the Income Tax Act, 1961. The maximum tax benefit can be availed when you and your parents both are senior citizens.
Health Insurance Benefits: Health insurance covers the insured for medical and surgical expenses arising during the policy term. It prevents the savings of the insured from getting wasted in case of a health emergency. Other benefits include tax benefits, cashless treatment, portability benefits, lifetime renewability benefits, cover for critical illnesses, and so on.
Grace Period in Health Insurance: Grace period is that time span that an insurance company provides you to pay the required premium for a particular health insurance plan. You can pay the premium during this period to renew or continue a policy without losing the accumulated benefits, such as waiting period benefits.
Aarogya Sanjeevani Policy: Aarogya Sanjeevani Policy is a standard health insurance policy that can be purchased on an individual or family floater basis for a sum insured from Rs. 1 Lakh to Rs. 5 Lakh. It covers the insured for in-patient hospitalization expenses, pre-hospitalization and post-hospitalization expenses, AYUSH treatment, daycare treatment, etc.
Benefits of Health Insurance;
Health insurance offers a wide array of benefits to the insured. Following are some of the key benefits of a health insurance plan -
Comprehensive Coverage: A health insurance policy keeps you covered for major healthcare expenses incurred in case of medical emergency. Usually, health insurance plans keep you protected for in-patient hospitalization expenses pre-hospitalization and post-hospitalization expenses, ambulance expenses, domiciliary hospitalization expenses, daycare procedures, organ donor expenses, treatments taken under AYUSH systems of medicines, etc.
Lifetime Renewability: As per the guidelines issued by Insurance Regulatory and Development Authority of India (IRDA), the insurance companies offering health insurance plans are supposed to offer lifetime renewability benefits to the policyholders. It allows you to renew your health insurance policy without any upper restriction on the maximum age limit. The feature is most beneficial for parents and senior citizens as they can renew their insurance plans without any pressure of looking for new health insurance plans in old age.
Cashless Treatment: Insurance companies have tie-ups with certain hospitals, known as network hospitals, where the insured can avail cashless treatment. If you avail treatment at these hospitals, the insurance company will directly settle the bills at the hospital, and you will not be required to pay anything for the treatment availed, except for non-medical expenses incurred.
Portability: Health insurance portability allows the policyholders to switch from their existing health insurance company to another, in case they are not satisfied with their existing health insurance plan, or find a more suitable plan. Portability feature saves the policyholders from being taken for granted and offers them flexibility to switch in case of dissatisfaction.
Tax Benefits Under Section 80D of the Income Tax Act, 1961: The government of India promotes health insurance by offering tax exemptions of up to Rs. 1.5 Lakh on the premium paid for health insurance plans, under Section 80D of the Income Tax Act, 1961. An individual can also claim a deduction of up to Rs. 25,000 for insurance cover for self, spouse, and dependent children. You can also avail a tax deduction of up to Rs. 25,000/Rs. 50,000 for health insurance plans purchased for parents aged 60 years/ more than 60 years.
Coronavirus Health Insurance;
Standard health insurance plans provide coverage for the treatment of coronavirus (COVID-19). However, the treatment of coronavirus involves numerous types of pre-hospitalization, hospitalization, post-hospitalization, and treatment expenses during quarantine. Thus, it is wise to opt for short-term health insurance policies, namely Corona Kavach and Corona Rakash, especially designed to provide coverage only for coronavirus treatment expenses.
Corona Kavach Policy;
Corona Kavach Policy is specially designed to provide for medical expenses that may arise due to Coronavirus. Insurance Regulatory and Development Authority of India (IRDAI) has launched this policy making it mandatory for all general and health insurance companies in India. In case the insured is tested positive for COVID-19, the Corona Kavach Policy will cover hospitalization, pre-hospitalization, home treatment expenses or AYUSH treatment for Coronavirus. This policy can be purchased individually and for families as well. Corona Kavach Policy covers Covid hospitalization expenses, Ambulance cover, home treatment expenses, pre and post hospitalization expenses, AYUSH (non allopathic) treatment and ICU expenses. Corona Kavach Policy provides financial aid to an individual in case he/she is diagnosed with COVID-19. This policy has a waiting period of 15 days. For the initial 15 days after the policy has been purchased no expenses shall be covered that may arise due to Coronavirus.
Below mentioned are some things which are not covered under a Corona Kavach Policy;
Diagnostic expenses
Dietary Supplements
Unproven treatments
OPD or Day Care treatments
Vaccination
Unauthorized Testing
Diagnosis Outside India
Corona Kavach Policy also covers Comorbid conditions which may be triggered due to COVID-19 during the hospitalization for the treatment. However, this policy does not cover any other treatment other than treatment for COVID-19.
Corona Rakshak Policy;
Corona Rakshak Policy is a single premium, standard benefit health insurance policy that provides financial protection to an individual in case he/she is diagnosed with COVID-19. 100% of the sum assured shall be provided in lump sum in case the insured is tested positive for COVID-19 and requires hospitalization. This policy was also launched by Insurance Regulatory and Development Authority of India (IRDAI). This policy helps individuals ensure financial aid for themselves and their loved ones to seek treatment without worrying about funds for the treatment of COVID-19. Corona Rakshak Policy provides coverage for hospitalization expenses, ICU cover, ambulance cover, home treatment, AYUSH (non allopathic) treatment and pre/post hospitalization expenses. Pre-medical screening is not required while purchasing Corona Rakshak Policy. This policy also has a waiting period of 15 days under which any expenses for the treatment of COVID-19 shall not be covered.
Below mentioned are some expenses and aspects which are not included in a Corona Rakshak Policy;
Tests conducted by unauthorized testing centers or labs.
Diagnosis outside India
Travel to restricted countries during the travel ban.
Any other diagnosis other than COVID-19.
One unique feature of this policy is that 100% of the sum assured shall be provided as a lump sum to the insured in case he/she is diagnosed with COVID-19 during the policy tenure.
Does Your Medical Insurance Policy Cover COVID-19 Treatment?
As per the mandate of the Insurance Regulatory and Development Authority of India (IRDAI), all the general insurance companies and health insurance companies offering health insurance plans cover expenses related to COVID-19 treatment, in the existing plans. The regulatory authority issued a circular on March 4 that directed insurance companies offering health insurance plans to include cover for COVID-19, irrespective of which policy the insured is covered for.
If you already have a medical insurance policy, then you must note the following;
An initial waiting period is applied, which is 30 days in most health insurance plans.
The claim process for COVID-19 is the same in regular health insurance plans like any other medical condition.
Cover for pre-hospitalization and post-hospitalization expenses is offered as per the terms and conditions of the policy selected.
Apart from COVID-19 cover in existing health insurance plans, the IRDA had also launched COVID-19 health insurance policies namely Corona Kavach and Corona Rakshak policies. Both are short-term health insurance plans that cover families and individuals, wherein the former is an indemnity-based health insurance policy, and the latter is a benefit-based health insurance policy. Both the plans help you feel financially secure in case of a positive diagnosis of COVID-19.
Aarogya Sanjeevani Health Insurance Policy:
Aarogya Sanjeevani Policy is a standard health insurance product which aims to simplify health insurance for people by providing them with a basic and standard plan. An Aarogya Sanjeevani Health Insurance-Policy is offered by all health insurance companies with exactly the same benefits.
An Aarogya Sanjeevani Health Insurance Plan comes with the following features -
No medical check-up up to the age of 45 years
Sum insured between Rs. 1 Lakh to Rs. 5 Lakh
Policy tenure of 1 year with lifetime renewability benefit
No claim bonus of up to 50% of the insurance premium
Waiting period of 30 days for all illnesses except accidents.
What Is The Difference Between Health Insurance And Mediclaim Policy?
In case of medical emergencies, you can avail of medical insurance coverage benefits by either having a health insurance policy or with a mediClaim policy.
What is Mediclaim?
Mediclaim is a health insurance policy that gives you specified financial protection only for expenses arising due to hospitalization. It covers you for hospitalization required due to an accident, in case of sudden illness or surgery, or in case of any surgery during the policy term. Mediclaim is of two types, viz., cashless and reimbursement.
What is Health Insurance?
Health insurance is an insurance cover that provides you complete protection for medical and surgical expenses in case of emergencies. With a health insurance policy, you can avail of cashless treatment or get reimbursement for the amount paid to avail of the treatment covered.
To understand the difference between a medical insurance and mediClaim policy, kindly refer to the table below:
Mediclaim Policy;
It covers you only for hospitalization expenses
It does not offer an add-on cover
It comes with a limited hospitalization cover of up to Rs. 5 Lakh
It is not flexible
Health Insurance Policy;
It offers a comprehensive cover more than the only hospitalization. For example, AYUSH treatment expenses, in-patient hospitalization expenses, pre-hospitalization, and post-hospitalization expenses, daycare expenses, etc.
You can choose from different add-on covers as per your requirement, such as hospital cash, critical illness, room rent waiver, etc.
It comes with an extensive hospitalization cover that may exceed Rs. 5 Lakh, which is decided on the basis of several factors such as age, the number of members covered, pre-existing conditions, etc.
It is flexible and can be customized as per your budget and requirements
When choosing between a health insurance policy or a mediClaim policy, you must consider the following factors:
Your financial condition
Your and your family members’ pre-existing conditions if any, age,
Add-on covers
Sum insured
Policy term
Members to be covered under a health insurance policy
Health Insurance Coverage;
What is Covered?
In-Patient Hospitalization Expenses; Expenses incurred due to hospitalization of 24 hours or more, like nursing and boarding expenses, Nurse’s /Surgeon’s/ Doctor’s/Anesthetist’s fees, cost of blood, medicines, oxygen, ICU/ICCU expenses, etc.
Pré-Hospitalization And Post-Hospitalization Expenses; Expenses arising before and after hospitalization, for a specific number of days as per the policy terms and conditions. These include expenses related to tests, doctor’s fee, medical reports, etc.
Daycare Procedures; Treatments that do not require hospitalization of at least 24 hours, are known as daycare treatments. These include cataract, sinusitis, chemotherapy, radiotherapy, etc.
Organ Donor Expenses; Expenses arising due to harvesting the organ from the donor and for the transplant surgery as covered under the policy. The hospitalization expenses include room rent, doctor’s fee, and other expenses.
Domiciliary Hospitalization Expenses; Treatment taken at home because of unavailability of hospital beds, or when the insured cannot be shifted to hospital due to health conditions. It covers for treatment that exceeds three days, for any injury or illness
Road Ambulance Expenses; Expenses incurred due to transportation of the insured to the nearest hospital in case of a medical emergency are covered up to a specific limit. The ambulance has all the facilities required to transfer the patient.
AYUSH Treatments; It covers in-patient treatments taken under AYUSH systems of medicines which includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy. The expenses are covered for up to a specific limit.
What is Not Covered?
Cosmetic Treatments; Plastic surgeries, face lifts, nose jobs, cosmetic implants, botox, etc. are not covered under most health insurance plans.
HIV/AIDS; Most health insurance plans do not cover expenses related to treatments for HIV or AIDS.
Self-Inflicted Injuries; Any injury due caused due to self-harm including suicide or attempt of suicide is not covered.
Injuries Due to Alcohol or Drug Abuse; Injuries due to alcohol or drug abuse, or other addictive substances are not covered.
Participation in Adventure Sports; Any treatment required due to participation in adventure sports like mountain climbing, etc. are not covered.
Injuries Due to War, Riots; Injuries due to war, riots, nuclear contamination, and related perils are not covered.
Unproven And Experimental Treatments; Treatments which are unproven, experimental or done solely for the purpose of investigation.
Rest Cure, Rehabilitation, And Respite Care; Expenses related to admission for enforced bedrest and not for treatment.
Health Insurance Riders;
Health insurance riders are extra coverages which help you customize your plan and extend its coverage as per your requirements.
Critical Illness Cover; With this add-on, you become eligible to receive a lump sum amount on diagnosis of serious and long-term illnesses such as cancer, stroke, kidney failure, etc. With the amount received, you can make up for the loss of income resulting due to critical illness, pay for debts, if any, or even avail treatment abroad. Some insurance companies provide cover for critical illness as a part of standalone policy, whereas others offer it as an add-on cover, for up to 50 critical illnesses.
Maternity Cover; Maternity add-on cover can be opted under an individual or family floater health insurance policy. If planning a child, then maternity add-on cover works best for you. It provides financial protection against medical expenses arising due to childbirth. Some insurance companies also provide coverage to newborn babies for several healthcare expenses such as vaccination, etc. the add-on cover comes with a waiting period, which may differ from one insurer to another, but generally ranges between 2 years to 4 years.
Hospital Cash; The add-on cover of hospital cash provides you cover all the non-medical and out of pocket expenses arising during hospitalization, that are not covered under the health insurance plan. The policyholder gets daily cash allowance as per the limit specified in the policy document, for a particular policy year. Different insurance companies offer different coverage amounts for daily hospital cash benefits, but it generally ranges between Rs. 500 to Rs. 5,000 per day.
Room Rent Waiver; The type of room you choose at the time of hospitalization, reflects majorly in your hospital bills. A standard health insurance plan comes with a limit on the per day charges of the room. This means that the extra charges incurred due to change in the type of room, let’s say from general room to a deluxe room, will have to be borne by the insured. But with the room rent waiver add-on, you can opt for any room of your choice and you will not be charged anything extra, as it provides you with extra cost during your stay.
OPD Cover; OPD (outpatient department) refers to that department of a hospital wherein a patient is required to simply visit it to avail the required treatment and pay the consultation fees to the doctor, instead of getting admitted as a daycare patient. Generally, health insurance plans do not cover you for OPD expenses, but with this add-on cover, you can secure yourself from expenses arising due to the same. The add-on covers you for the cost of medicines, consultation fees, pathological tests, etc
Personal Accident Cover; Considering the rising number of road accidents in India, personal accident add-on cover is a good choice as it offers financial protection in case the insured meets an accident, which results in outcomes such as permanent total disablement, permanent partial disablement, total disablement, or in case of death due to accident. You can opt for this add-on along with a base health insurance policy voluntarily, by paying an extra premium at the time of policy purchase.
International Second Opinion Cover; International second opinion add-on cover provides you the option to consult international doctors before availing the required treatment. You can use this add-on cover in case you are not satisfied with the diagnosis. Choosing this add-on is an empowering method for the insured as they can review the treatment advice and recommendations offered for a particular illness. It will help the insured get insights on additional treatment options and be doubly sure of the treatment they require.
Air Ambulance Cover; This add-on cover helps transfer the sick/injured insured person, to the nearest hospital, in case of domestic as well as international emergency, as per the terms and conditions specified by the insurance company. This add-on cover saves lives in different scenarios like if you require specialized medical treatment during transportation, if you require to be transported in a swift manner on getting injured when visiting a remote area, or require transportation for medical treatment, if cannot be transported via road.
Reduction in Pre-Existing Diseases Waiting Period; Health insurance plans usually come with a waiting period for pre-existing diseases of 48 months. But with add-on cover of reduction in pre-existing waiting period, you can get the waiting period reduced, from let’s say 48 months to 24 months. The reduction of the waiting period may vary from one insurance company to another. You can get this add-on by paying some extra premium. It does require pre-medical check-up though, to be eligible for this add-on cover.
Which Health Insurance Plan Should You Buy?
There are several medical health insurance plans in India that you can choose from, at the time of policy purchase. These are individual health insurance plans, family floater health insurance plans, senior citizen health insurance plans, critical illness insurance plans, maternity insurance plans, hospital daily cash etc.
If you have a big family or one with senior parents, then an individual health insurance policy is recommended as a family floater policy might not be sufficient for you. You can also buy a separate senior citizen health insurance policy for parents in this case.
Whereas a family floater medical insurance policy is recommended for a young couple or a small family. Kindly note that when going for a family floater health insurance policy, you must choose a higher sum insured so that it is sufficient for all family members.
When choosing which type of health insurance policy you should buy, you must consider a few things other than just the premium. The right approach will be to seek maximum coverage for all the family members at the most affordable premium. It is recommended to do enough research in order to zero down the most suitable health insurance policy for yourself and your family.
Also, once you decide which health insurance policy to buy, you can also add add-on covers to it for extensive coverage. It is not mandatory to buy add-on covers but you can include them in your policy voluntarily at the time of policy purchase, by paying an extra premium. Some popular add-ons offered under health insurance plans are room rent waiver, hospital daily cash, second e-opinion, critical illness cover, air ambulance cover, etc.
Why Buy A Health Insurance Plan at An Early Age?
Following are the reasons why it is recommended to buy medical insurance at an early age:
Lower Premium: As you age, you are required to pay higher health insurance premiums. This is because, in old age, you have a higher possibility of getting ill, due to a weaker immune system. For instance, a person aged 20 years will be required to pay a lesser health insurance premium than someone aged 52 years, due to lesser health issues involved.
Lesser Exclusions: Many medical insurance plans come with restrictions on coverage offered, due to which you may not be able to avail full-fledged cover on buying a policy in later years of life. But if you buy a health insurance policy at an early stage in life, when you do not have any health condition, then you will be able to enjoy a full-fledged health cover.
No Health Check-Up: Another reason why buying health insurance at an early stage in life is recommended is because you would not be required to undergo a medical check-up then. But if you buy the policy in old age, let us say 50 years, then most health insurance companies will ask you to undergo the same. Also, in case there is a health condition in the medical test results, then you might be required to pay a higher premium due to higher chances of hospitalization involved.
No Claim Bonus: You will be able to start accumulating No Claim Bonus early on by buying a health insurance policy timely. You can use this NCB in the later years of life when you might be more vulnerable to illnesses and may need to make a claim. But if you buy the policy during later years of life, then you would not be able to enjoy such increased coverage.
Aligned Finances: If you buy a health insurance policy at a young age, then you have time to plan your finances for a long term. But if you buy it in later years of life, then financial planning may go haywire. Hence, it is recommended to buy a health insurance policy when young so that financial planning can be started early, and also that you are prepared for emergencies irrespective of their magnitude.
Waiting Period: Health insurance plans come with waiting periods for specific conditions, cover for some of which you may require in old age. The advantage of buying health insurance plans when young is that you can complete the waiting period early and avail of the coverage benefits when you actually require them.
Rejections: As you will be more prone to illnesses in your old age, therefore there are higher chances of your health insurance application getting rejected then. Therefore, buying health insurance plans when young is recommended so that there are lesser chances of your application getting rejected.
Pre-Existing Conditions: When you buy a health insurance policy in later years of life, then there are chances that you may already be suffering from pre-existing diseases. But then, you will be required to complete a waiting period to get coverage benefits for the same. On the other hand, if you buy the policy when young, then by the time you may need cover for pre-existing illnesses, you would already have completed the waiting period and will be able to avail the required coverage.
Tax Benefits of Health Insurance;
Every HUF (Hindu Undivided Family) can claim tax benefits, under Section 80D of the Income Tax Act, 1961, on the premium paid for medical health insurance plans. You can avail of tax benefits on the premium paid for yourself and your family members including spouse, dependent children, or parents.
The deduction from the total income can also be availed on the premium paid for top-up health insurance plans as well as critical illness plans, apart from regular health insurance plans.
Understand Terms Included in Your Health Insurance Policies;
Explained below are terms that you must know in order to understand your health insurance policy better:
Co-Payment: Health insurance plans reimburse you for the healthcare expenses during a treatment that is covered under the policy. But if the insured, as well as the insurance company, share the expenses at the time of claim, then it is a case of co-payment. Generally, health insurance plans with a co-payment clause come at comparatively lesser premiums. Mostly, this feature can be seen in senior citizen health insurance plans.
No Claim Bonus: It is a reward that a medical insurance company gives to the insured for not making a claim in a particular year. For instance, an increase in the sum insured by a fixed percentage according to the policy, not more than 50% of the sum insured, if the policy has been renewed continuously.
Deductible: Deductible is similar to co-payment. It is a fixed amount in rupee terms that are shared by the policyholder, and not the insurance company, at the time of claim. It is, however, decided by the insurance company if the insured is required to pay this amount per year, per life, or per event.
Dependents: Dependents are family members of the insured who are financially dependent on him/her. These can be a legally wedded spouse, and unmarried children (natural or adopted).
Exclusions: Every health insurance policy comes with a list of conditions that the insurance company will not cover the insured for, during the policy term. These are known as exclusions. Some common exclusions under health insurance plans are treatments required due to participation in adventure sports, Injuries due to self-harm, insured committing a breach of law, etc.
Grace Period: The grace period is a specific period starting immediately after the expiry of the due date or premium payment, given to the policyholder to pay the premium to continue availing coverage benefits under the policy. If the premium is paid during this period, then you can continue availing of the policy benefits. But if the premium is not paid even during the grace period, then your policy will lapse and you will lose all the accumulated benefits. Hence, it is recommended to keep renewing health insurance plans when the premium is due.
Insurer: The insurance company.
Premium: A fixed amount to be paid periodically in order to keep availing of health insurance policy benefits.
Policy: It is a legal contract between an insurance company and the insured, that contains all the terms and conditions of the insurance.
Pre-Existing Disease: It is any condition, ailment, or injury for which the insured already had symptoms, within 48 months prior to buying a health insurance policy. Generally, pre-existing conditions are covered by the policy after a specific waiting period. Hence, it is recommended to disclose pre-existing diseases, if any, to avoid any hassle at the time of claim settlement.
Network Hospital: Every insurance company has a tie-up with hospitals wherein the insurer can avail cashless treatment. These hospitals are known as network hospitals. It is recommended to choose an insurance company with a high number of network hospitals, for utmost convenience in case of an emergency strike in the future.
Portability: Portability is an individual health insurance policyholder’s right that allows him/her to switch from one insurer to another or from one health insurance policy to another of the same insurer if the policy was maintained without any lapse. Portability allows you to transfer the accumulated benefits as well such as waiting for period benefits, NCB, etc.
Sum Insured: It is the payout amount that an insurance company is liable to pay to the insured in case of a claim. For instance, if the sum insured of a health insurance policy is Rs. 5 Lakh and the hospitalization expenses incurred are Rs. 2 Lakh, then the insurance company will cover the expenses. But if the expenses exceed the sum insured limit, then the insured will have to bear the remaining expenses.
Waiting Period: This is a fixed time period for which the medical insurer does not cover you, even after the commencement of the policy term. Waiting periods can be of different types such as initial waiting period, waiting period for specific diseases, waiting period for pre-existing diseases, etc. The waiting period is calculated from the date of commencement of the policy.
Free Look Period: Free look period is the time that an insured gets to understand his/her health insurance policy better. During this period, if not satisfied, the insured can cancel the policy.
What Are The Factors That Affect Health Insurance Premium?
There are several factors that decide the health insurance premium for an individual for a particular health insurance policy. These are explained below:
Age: Generally, companies offering medical health insurance plans follow the rule-higher the age, the higher the premiums. This is because, in old age, people are more vulnerable to illnesses, which increases their chances of making health insurance claims. Hence, the higher the age, the higher the premiums, and vice versa.
Past Medical History - If you have a history of any medical condition, then you will have a higher chance of hospitalization and hence you will be required to pay a higher health insurance premium. But if there is no history of a medical condition, then you will be charged a comparatively lesser premium.
Lifestyle Habits: Lifestyle habits such as excessive smoking or drinking deteriorate your health and make you more prone to illnesses. If you follow this lifestyle, then you may be at higher health risk and hence will be more likely to make a claim. This is why your health insurance premium will be higher as compared to someone who does not smoke or drink regularly.
Policy Term: Policy term is another crucial factor that decides the premium for a health insurance policy. You can choose from different policy terms such as 1 year, 2 years, or 3 years, according to its terms and conditions. The higher the policy term you opt for, the higher premium you will be required to pay, due to the higher coverage offered.
Add-On Covers: You can include add-on covers to your health insurance policy for extensive coverage. For this, you will be required to pay an extra premium at the time of policy purchase. The greater the number of add-ons covers you buy, the higher premium you will be required to pay for it.
Co-Payment: Premiums for medical insurance plans that come with a co-payment clause are generally low, due to the cost-sharing involved. Therefore, if you choose a health insurance policy with a co-payment option, then you will be required to pay a lesser premium and vice versa.
Body Mass Index: If your Body Mass Index is higher than normal, then you will be at higher risk of suffering from health issues. This is why your premium will be high. But if it is normal, then you will be charged a lesser premium.
How To File A Health Insurance Claim?
Claims under a health insurance policy can be made in two ways - in a cashless manner and in a reimbursement manner. A cashless claim is when you receive treatment at a network hospital of the insurance provider who is servicing your policy. If the claim request is accepted, the insurance company directly settles the bills at the hospital. Whereas in reimbursement claims, you are required to pay for the hospital bill from your own pocket first, and make a claim request with the insurance company later. The insurance company will process your claim and reimburse you for the same after accepting the claim.
You can make a health insurance claim by following the simple steps given below:
Step 1: Visit the network hospital or the hospital of your choice and inform the insurance company about the hospitalization.
Step 2: Fill the pre-authorization form at the hospital’s TPA (third-party administrator) desk.
Step 3: You will receive an approval letter by the claim management team.
Step 4: Respond to the query raised by the claim management team, if any.
Step 5: Avail the required medical treatment.
Step 6: The insurance company will directly settle the bills at the network hospital as per the terms and conditions mentioned in your policy.
Documents Required For Health Insurance Claim Reimbursement;
Listed below are the documents required in case of reimbursement claim:
Valid identity proof.
Duly signed and completed original claim form.
Doctor’s prescription recommending hospitalization.
Original pharmacy bills.
Original prescription for medicines, consultation, and diagnostic tests.
Indoor case papers.
Ambulance receipt.
First Information Report (FIR), if applicable.
Policy details with the insured person(s) name, policy number, illness, and address.
Any other document if required by the insurer.
Listed below are additional documents required in case of a cashless medical insurance claim:
Pre-authorization form.
Valid identity proof along with a photograph.
Documents like voter ID card, driving license, PAN card, and Aadhar card.
Am I Eligible to Buy a Health Insurance Plan?
Eligibility Criteria to Buy Health Insurance;
Buying a health insurance policy is essential because medical care, especially in the private sector, is expensive and can burn a hole in your pocket. To avoid a tough situation during a medical emergency or illness, paying a small annual premium can certainly help to lessen your stress.
You can easily purchase a good insurance plan online that usually covers expenses incurred towards doctor consultation fees, ambulance services, hospitalization to a certain extent. Here are the eligibility criteria-
Entry age for adults; 18-65 years (exclusive plans are provided for people above 70 years of age.)
Entry age for children; 90 days-18 years.
Buying a health insurance policy during early age can be cost-effective as one might not necessarily have to undergo medical tests conducted by the insurers.
Documents Required to Buy Health Insurance Online;
There are a few documents that you must be able to show to buy a health insurance policy online.
These are;
Age proof: Either of the following-Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter’s ID, etc.
Identity proof: Either of-Passport, Driving License, Voter ID, PAN Card, Aadhar Card, which proves one’s citizenship.
Address proof: Either of-Electricity bill, Ration Card, Telephone Bill, Passport, Driving License with your permanent address clearly mentioned on it.
Medical check-up: Some plans require a health check-up to ensure that the individual is not suffering from any chronic illness.
Some Myths About Health Insurance;
Due to lack of knowledge and understanding, people in India have a lot of misconceptions when it comes to health insurance plans. These misconceptions should be cleared in order to make the best buying decision. Here are some common myths and reality behind them:
Myth 1: Health insurance plans is not required when young and healthy
Reality: The ideal time to buy health insurance is when you are young and healthy. This is because if you buy a health insurance policy at a young age, then you will be able to get the cover at an affordable premium as the risk of getting hospitalized then is minimum. Also, health insurance plans come with waiting periods during which no claims are admissible. On buying health insurance when healthy, you can complete this waiting period without any worries as you may not need to make a claim then.
Myth 2: I will only be covered for hospitalization
Reality: It is true that health insurance plans cover you for hospitalization expenses only when the hospitalization of at least 24 hours takes place. But it is not true that the plans only cover you for these expenses. In most cases, they also cover you for daycare procedures such as sinusitis, radiotherapy, chemotherapy, etc, which do not require hospitalization of at least 24 hours. Other expenses covered are OPD expenses, road ambulance expenses, second medical opinion, medical check-up, etc.
Myth 3: People who smoke cannot be covered under any health insurance policy
Reality: You can still buy a health insurance plan even if you are a smoker. But medical insurance companies are concerned about pre-existing conditions, which may even lead to the cancellation of your health insurance application form. So, if there is any pre-existing condition due to smoking, then you must disclose the same to your insurer. It will not deny you the policy but may charge you a higher premium because as a smoker, you will be more prone to illnesses.
Myth 4: Health insurance plans are bought to save taxes
Reality: Health insurance plans do not only help you save taxes as per the prevalent tax laws but most importantly, cover you for healthcare expenses, which may help you save even more in the long term.
Myth 5: It is not safe to buy health insurance plans online
Reality: It is completely safe as well as quick to buy health insurance plans online at reliable platforms. All you need to do is fill a quote, compare the most suitable health insurance plans from the ones displayed on the screen, shortlist the one you wish to buy for yourself and your family, and pay the premium online via a secured payment gateway. These are different premium payment modes like Credit card, Debit card, or e-wallets that you can choose as per your convenience.
Use this link for Frequently Asked Questions [FAQ’s] on Health Insurance policies.
Terms and Conditions:
*Standard T&C Apply. For more details on risk factors, terms and conditions, please read the sales brochure of respective insurers carefully before concluding a sale. Tax benefits are subject to changes in applicable tax laws. For detailed communication on sales contact below authority.
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Insurance Advisory Club
IRDAI Licensed Agent
- Mr. Dheeraj Bodduna
Financial Advisor
Contact: 85220 66133
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