Health Insurance is a type of insurance that offers financial coverage for medical expenses, in the case of policyholder hospitalization. Health insurance plans provide health coverage to the insured with multiple benefits including cashless hospitalization, day-care facility & reimbursement of the incurred expenses and many more.
What is a Health Insurance Policy?
A health insurance policy is a contract between the insurer and policyholder in which insurance company provides financial coverage for medical expenses incurred by the insured. A health policy provides benefit of reimbursement of medical expenses or cashless treatment mentioned in the health policy.
Apart from the medical coverage, a Health Insurance Policy also offers tax under section 80D of the Income Tax Act, 1961.
Medical expenses are sky-rocketing! Get health insurance plans for your medical outlay. With a cashless facility, stay tension-free. Approved by IRDAI, Policy Bazaar helps you compare and find the best health plan.
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Top Health Insurance Plans in India 2020
These health insurance companies are ranked based on their Incurred Claims Ratio. All the insurance companies provide this ratio, which is basically the ratio between the total premium earned in a year and the total claims incurred by these insurance companies. ICR determines the performance of these insurance companies. And the higher this ratio is the better is the claim settlement track record. And it might be better to just opt for an insurer with a higher ICR.
Listed below are some of the top health insurance plans from some of the best insurance companies:
|Insurance Companies||Health Plans||Sum Insured (Rs.)||Network Hospitals||Incurred Claim Ratio|
|Aditya Birla Health Insurance||Activ Assure Diamond Plan||10-30 lakhs||5850+||59%|
|Bajaj Allianz Health Insurance||Health Guard Insurance Plan||1.5-50 lakhs||6500+||85%|
|Bharti AXA Health Insurance||Smart Super Health Insurance Policy||5 lakhs- 1 Cr.||4300+||89%|
|Cholamandalam Health Insurance||Chola MS Individual Healthline Insurance Policy||2- 15 lakhs||6500+||35%|
|Digit Health Insurance||Digit Health Insurance Plan||2- 25 lakhs||5900+||11%|
|Edelweiss Health Insurance||Edelweiss Health Insurance Plan||5 lakh- 1 Crore||2578+||115%|
|Future Generali Health Insurance||Future Health Suraksha Individual Plan||5-10 lakhs||5000+||73%|
|HDFC Ergo Health Insurance||Optima Restore Plan||3-50 lakhs||4721+||62%|
|IFFCO Tokio Health Insurance||Family Health Protector Policy||1.5- 30 lakhs||5000+||102%|
|Kotak Mahindra Health Insurance||Kotak Health Premier||–||4800+||47%|
|Liberty Health Insurance||Health Connect Supra Top-up||up to 1 Crore||3000+||82%|
|Max Bupa Health Insurance||Health Companion Individual Plan||3 lakhs-1 Cr.||4115+||54%|
|ManipalCigna Health Insurance||Prohealth Plus Insurance Plan||2.5-50 lakhs||4000+||62%|
|National Health Insurance||Overseas Mediclaim Business and Holiday Plan||USD 50,000- USD 5 lakh||6000+||107.64%|
|New India Assurance Health Insurance||New India Assurance Mediclaim Policy||1-15 lakhs||3000+||103.74%|
|Oriental Health Insurance||Individual Mediclaim Plan||1-10 lakhs||4300+||108.80%|
|Religare Health Insurance||Care Health Plan||4 lakhs-6 Crore||4987+||55%|
|Raheja QuBE Health Insurance||Health QBE||1-2 lakhs3-50 lakhs||2000+||33%|
|Royal Sundaram Health Insurance||Lifeline Supreme Plan||5/10/15/20/50 lakhs||5000+||61%|
|Reliance Health Insurance||Reliance Critical Illness Plan||5, 7 & 10 lakhs||4000+||14%|
|Star Health Insurance||Family Health Optima Plan||1-25 lakhs||9800+||63%|
|SBI Health Insurance||Arogya premier Policy||10-30 lakhs||6000+||52%|
|Tata AIG Health Insurance||MediPrime Health Insurance||2-10 lakhs||4000+||78%|
|United India Health Insurance||Family Medicare Plan||1-10 lakhs||7000+||110.95%|
|Universal Sompo Health Insurance||Loan Secure Insurance Plan||Up to 10 lakhs||5000+||92%|
See More Plans
Source: IRDA Annual Report 2018-19
Disclaimer: The ranking of the insurance companies in this content is not in any particular order. The list is not compiled as per the IRDA ranking.
Why Do You Need Health Insurance?
Health insurance comes at your rescue when you need any medical assistance at any point in time. In case, when you fall sick or ill, meet with an accident and so forth having a health insurance policy provides cover for the expenses incurred and provides additional benefits as well.
A health insurance plan essentially protects you from any health-related perils. It safeguards in case of any unexpected high medical expenses. A medical emergency can happen anywhere, anytime and it can easily put you in stress and drain you both financially and emotionally. In the hustle-clamor of life and the lifestyle we are leading today, it, therefore, becomes important for every individual to be insured under a health insurance policy.
Besides, the constant rise in the number of diseases and healthcare prices in our country, make it essential to have health insurance coverage as it offers a financial backup in case of medical emergencies. Unfortunately, only 20% of the total population in India has health insurance coverage. Additionally, only 18 percent of the total population residing in urban areas and 14 percent of the total population residing in rural areas had any form of health insurance coverage.
Everyone must buy a good health insurance policy that includes benefits such as hospitalisation expense cover, medication and laboratory test costs, including critical illness and many. Some health plans also cover OPD expenses up to a certain limit.
Does a Health Insurance Policy Cover Coronavirus (COVID-19)?
The recent coronavirus outbreak has recently shaken everyone. More than 118,000 cases in 114 countries and 4,291 have already lost their lives. Besides, thousands more have been fighting for their survival in hospitals.
In India, 110 confirmed cases have been tested positive with coronavirus including non-Indian citizens (COVID-19) as per the data provided by the Ministry of Health and Family Welfare on 15 March 2020.
The increase in the number of cases related to coronavirus, the policyholders of health insurance are in a state of dilemma. The insured are in a quest that will a standard health insurance policy cover coronavirus (COVID-19).
Listed below are some important pointers that you should not miss as per IRDA’s circular:
- On March 4 2020, Insurance Development and Regulatory Authority of India has advised on the handling of claims under the coronavirus wherein the claims of coronavirus need to be handled expeditiously and the health insurance companies need to provide cover for the medical expenses incurred during the treatment and the quarantine period. As per the applicable terms and conditions of the health insurance plan.
- Any claim reported under the coronavirus will be thoroughly reviewed by the claim review committee.
- IRDA has also advised the health insurance companies to design health insurance plans for coronavirus, which can cover the expense of treatment of coronavirus.
Understanding the spread and the severity of the coronavirus (COVID-19), the World Health Organization (WHO) has characterized as a pandemic, which can be controlled on 11 March 2020.
Now, COVID-19 has been declared as a pandemic therefore, you need to check with the health insurance company as they might be unable to settle the claim under the health insurance policy under such a situation. However, most of the health insurance companies do provide a cover under pandemics or epidemics depending upon the health insurance plan you choose.
Now, let us understand the following situations wherein claims for the treatment of coronavirus will get rejected:
- In case, if an individual is affected with coronavirus and then intending to buy health insurance policy most likely it will not be covered under the newly bought health insurance policy.
- The policyholder will not get a claim filed if the treatment of coronavirus falls within the waiting period of the health insurance policy.
- If an individual is diagnosed with coronavirus within the waiting period of the health insurance policy it will not get covered.
- Any claim will not be settled if an individual gets infected with coronavirus from any of the family members who recently travelled to coronavirus affected countries such as Italy, China, Republic of Korea, Japan, Macau, Taiwan, Kuwait, Singapore, South Korea and Hong Kong.
Types of Health Insurance Plans in India
To ensure that the health insurance plan meets your insurance needs, it is important to know the different types of health insurance plans, to decide the right policy.
Mentioned below are the different types of health insurance plans you can choose as per your insurance requirement:
- Individual Health Insurance
- Family Health Insurance
- Senior Citizen Health Insurance
- Critical Illness Health Insurance
- Maternity Health Insurance
- Accident Health Insurance
- Group Health Insurance
- Unit Linked Health Insurance
Now, let us understand each type of health insurance policy.
Individual Health Insurance
An individual health insurance plan offers insurance coverage to an individual with benefits such as cashless hospitalisation, reimbursement, compensation for expenses incurred on pre-hospitalisation and post-expenses along with various add-on coverage benefits.
Family Health Insurance
Family health insurance is designed for the entire family where insurance coverage is offered against a single premium annually. A fixed sum insured is divided among the insured policy members, which can be availed either by one or all members of a family for one or more claims during the tenure of the policy.
Senior Citizen Health Insurance
Senior Citizen health insurance offers insurance coverage to the age group between 60 and above. The policy covers hospitalization expenses including in-patient expenses, OPD expenses, Daycare procedures, pre, and post-hospitalisation expenses along with tax deduction benefit u/s 80 D.
Critical Illness Health Insurance
Critical illness health insurance plan offers a lump sum amount in case the insured is diagnosed with a critical illness such as kidney failure, paralysis, cancer, heart attack, etc.
Usually brought as a standalone policy or as a rider, the sum insured is pre-defined, where the insured has to survive a particular survival period after being diagnosed to avail the policy benefits.
Maternity Health Insurance
The maternity health insurance plan offers coverage for maternity expenses incurred during both pre and post-natal care, child delivery (normal or cesarean). Some providers also include expenses incurred on vaccination of newborn babies in a maternity plan. The list of coverage also includes the transportation fee for ferrying the mom-to-be to the nearest network hospital of her choice.
Personal Accident Insurance Cover
Personal Accident Insurance is a rider cover that offers insurance coverage in case of an accident leading to disability or death. The policy coverage includes hospitalization and bears the medical outlay in the event of an accident. A fixed monetary benefit is offered in the case of an unfortunate event leading to loss of income.
Group Health Insurance
More than 80% of employers these days provide health coverage to their employees. The health insurance offered by an employer covers hospitalization expenses of the employee and his/her family including spouse, children or parents. It is a wise decision to opt for the mediclaim offered by your company as you need not pay any premium. This comes under a group health insurance policy and the premium is paid by the employer, based on the group size and the benefits offered.
Unit Linked Health Insurance
Unit- Linked Health Plan (ULHP) has been introduced recently, which offers a unique combination of health insurance and investment. Apart from giving health protection, ULHPs also contribute to building a corpus that can be used to meet expenditures that are not covered by health insurance plans.
Among the ULHPs available in the Indian market, ICICI Pru’s Health Saver, LIC’s Health Protection Plus, Birla Sunlife’s Saral Health, and India First’s Money Back Health Insurance Plan are a few big names.
Key Benefits of Health Insurance Plans in India
The cost of healthcare in the modern days is increasing at a crazy rate while one’s earnings do not seem to match up that level. A patient looking forward to availing frequent health check-ups may no longer be able to bear the associated expenses. Comprehensive health insurance plans come packed with features that can assist a person in managing expenses associated with medical emergencies and also with preventive healthcare check-ups. Some health insurance plans also offer add-on cover for OPD expenses.
Following are the key benefits of a health insurance policy that one can consider:
Cashless Medical Treatment
Every medical insurance company has tie-ups with various nursing homes and hospitals across the country called ’empanelled hospitals’. If you are admitted to one of these, you don’t need to pay anything. You only need to mention your policy number and everything else will be taken care of by the hospital and your insurer.
These types of health insurance plans are preferred because there is no stress of claim reimbursement and documentation. However, if your expenses go beyond the sub-limits specified by the insurance cover or marked as not covered by the provider, then you will have to settle it directly with the hospital. Another important thing to remember is that cashless mediclaim is not available if one gets hospitalized which is not a part of the hospital network of the insurance company.
Coverage of Pre and Post-Hospitalization Expenses
This feature of a health insurance policy takes care of expenses incurred on both pre and post-hospitalisation. It takes into account the costs incurred during a certain number of days both prior to and post hospitalization as part of the claim, provided the expenditures are related to the covered disease/illness.
Once hospitalized the person is free from the burden of transportation fees as it is borne by the insurer.
No Claim Bonus
NCB (or No Claim Bonus) is a bonus provided to the insured if no claim has been filed for any treatment in the previous policy year. The reward can be offered either as an increment in the sum assured or as a discount on the premium cost. You can avail this advantage on policy renewal.
Medical Check-Up Facility
A medical plan entitles the insured to receive regular medical check-ups. A free check-up facility is provided by some insurers, or you can get it as an add-on benefit.
Room Rent Sub-limits in Your Health Insurance Plan
A health insurance policy may have various sub-limits associated with it; room rent is one of those sub-limits. General Insurance Companies provide you with maximum coverage up to the sum assured. However, they can deliberately trim down their liability by introducing the sub-limit clause in the coverage for hospital room rent.
Once the insured is hospitalized the sub-limit on room rent coverage is applicable on a per day basis. For instance, if your medical insurance policy covers your daily room rent up to a maximum of Rs. 3,000 and your room cost incurred is Rs. 5,000 per day, then you will have to pay the remaining Rs. 2,000 from your own pocket. Besides, room charges are directly associated with the type of hospital roomyou are availing, i.e. a single room or on a sharing basis. Everything else is calculated accordingly.
If the total cost incurred on treatment at the hospital is Rs. 5, 00,000, the table shown below illustrates the expenses that are expected to be borne by your insurer and you, respectively.
Policy Sum Assured (in Rs.) 5,00,000
Room Rent as per Sub-Limit (in Rs.) 3,000
Room Rent Per Day (in Rs.) 5000
Room Availed at the Hospital (in Days) 10
Actual Hospital Bill (in Rs.) Reimbursed Amount (in Rs.) To be Borne by You (in Rs.)
Incurred Room Charges (in Rs.) 50,000 30,000 20,000
Doctor’s Fee (in Rs.) 20,000 12,000 8,000
Medical Tests’ Cost Incurred (in Rs.) 20,000 12,000 8,000
Operation/Surgery Cost (in Rs.) 2,00,000 1,20,000 80,000
Incurred Medicine Cost (in Rs.) 15,000 15,000 0
Total Expenses Incurred (in Rs.) 3,05,000 1,89,000 1,16,000
In this case, the total cost borne by you is Rs. 1, 16,000 out of the total expenses incurred, i.e. Rs. 5, 00,000. Thus, make sure you choose wisely if you want any such sub-limits in your medical insurance policy.
According to this feature, you can lower the cost of your health insurance. Medical insurance plans offer a co-payment option that pre-defines the voluntary deductibles, which have to be borne by the insured. So, in the event of a medical exigency, some amount is paid by the insured and the rest, by the provider.
Co-payment is a cost-sharing requirement under a health policy, which states that the organization or the person will bear a certain share (in percentage) of the total admissible cost incurred. However, the co-payment option does not have any effect on the sum assured. It allows you to reduce your premium to a certain extent (subject to the insurer and insurance policy).
Tax Benefits of Health Insurance Plans
Health insurance policies entitle you to receive tax benefits under section 80D of the Income Tax Act, 1961. The premium you pay towards health insurance plans for yourself or your family members, get you a tax rebate, irrespective of whether they are dependent on you or not. The tax deduction offered, with respect to the premium, is subjected to the age of the insured and the maximum tax deduction limit that is available. You can save up to a maximum of Rs. 25, 000 in a financial year if you are below the age of 60 years. If your age is above 60 years, then this cap of maximum tax benefit increases to Rs. 50,000.
If you are paying the medical insurance premium for your parents and for self, then you are eligible for tax exemption up to Rs. 55, 000 in a year under section 80D, provided your parents are senior citizens.
Third Party Administrators
The TPA concept is the brainchild of the Insurance Regulatory and Development Authority of India (IRDA), to assist both the insured and the insurer. While it benefits the insurer by reducing their overheads or administrative costs, fake claims, and claim ratios, the insured, too, enjoys improved and fast insurance services.
TPAs are important players in the health insurance sector. They have the capacity to handle all or a portion of the claims related to health insurance plans. They have tie-ups with health insurers or self-insuring companies to manage services such as premium collection, enrollment, claim settlement and other administrative services.
Often, hospitals and health insurers outsource medical insurance-related responsibilities to lower their burden.
Pre-Existing Disease Cover
After 2-4 years of policy inception, various policies begin considering pre-existing diseases, e.g. diabetes, hypertension, etc., for claims. Coverage for pre-existing diseases is offered for specific illness (es) that the insured had before purchasing the policy.
Undoubtedly, healthcare is very expensive and nobody wants to get hospitalized. So, now we have preventive health carecheck-ups that take care of you before you fall sick. Preventive care, such as regular health check-ups, concession in X-ray fees, consultation fees, etc., is offered by this policy. By offering various healthcare provisions, this plan aims at keeping you healthy. Preventive care is medical care rendered not for a specific complaint but for prevention and early-detection of ailments.
Health Insurance Inclusions
The coverage offered by a health insurance policy is subject to the type of policy and the insurance provider. An ideal policy is customizable and suites your requirements in the best way possible.
Following are some common health insurance plans inclusions:
- In-patient hospitalization expenses
- Donor expenses, in case of organ transplantation
- During injuries requiring overnight hospitalization
- Pre-existing illnesses or diseases
- Pre and post hospitalization
- Ambulance charges
- Maternity or newborn
- Health check-ups
- Daycare procedures
- Treatment availed at home or domiciliary hospitalization
Health Insurance Exclusions
Coverage offered by health insurance policies varies with the insurer; however, certain points are not covered by health policies and fall under the category of policy exclusions.
Following are common health insurance plans exclusions:
- Unless an accidental emergency, no coverage or reimbursement offered with the waiting period of the policy, usually initial 30 days.
- Coverage of critical illnesses and pre-existing diseases is subject to a waiting period of 2 to 4 years
- Clear exclusion of expenses incurred for maternity/newborn unless a maternity rider has been added on
- Injuries caused by war/terrorism/ nuclear activity/suicide attempt
- Terminal illnesses, AIDS, and other diseases of similar nature
- Cosmetic/plastic surgery, replacement of hormones, sex change and more.
- Dental or eye surgery
- Non-allopathic treatment
- Bed rest/hospitalization and rehabilitation, common illnesses, etc.
- Treatment/diagnostic tests, post-care procedures
- Treatment abroad or by an under-qualified medical professional
Note: It is recommended to explore each plan to ensure maximum coverage
Which Health Insurance Policy Should You Buy?
|Your Requirement||What You Should Get|
|Coverage for hospitalisation expenses including surgical bills||Medical insurance offering cashless facility and claim reimbursement|
|A fixed amount daily while you are hospitalised||Hospital Cash Plan|
|If diagnosed/hospitalized with a critical illness or if the illness leading to loss of income||Critical Illness Plan|
|When an accidental disability leading to loss of income||Personal Accident Insurance|
|Coverage for expenses in the event of caesarean and normal delivery||Maternity Insurance|
|Insurance coverage for the entire family in a single plan||Family Floater Health Plan|
|Coverage for senior citizens||Senior Citizen health Insurance|
Why Compare Health Insurance Plans?
It is vital that you compare health insurance plans online in order to choose the best one to meet your healthcare needs. It can get confusing to select the best health insurance plan as so many insurers offer different health insurance plans with varied features.
It is no wonder that sometimes, people end up with a plan that, though costs less, has contradictory clauses, and they practically get nothing when a claim is filed. On the other hand, you end up buying a health insurance plan with a higher cost just to find out later that it has features that you did not use or might never need.
Amid the increasing cost of treatment, a Health insurance policy prevents a medical emergency from turning into a financial emergency. It makes sure that one’s healthcare needs are taken care of without depleting his/her savings or compromising on one’s future goals
How to Compare Health Insurance Plans?
With more than 25 insurance companies’ providers and more than 200 health insurance products in the Indian health insurance market, comparing health insurance plans and finding the best one is not an easy task. Listed below some of the tips to help you make an informed decision:
Select the Appropriate Sum Assured
The healthcare inflation in the country is skyrocketing and is increasing at the rate of 17% to 20% annually. To cover this inflation, it is important to look for the maximum available sum assured at the best possible rate of premium.
Provide Complete & Correct Details
Provide accurate information regarding your health in the proposal form, as any sort of inaccurate or mismatched information can make the insurer reject your claim form.
Keep in Mind the Factors That Influence the Premium
A few factors that influence the premium of a health insurance plan include the proposer’s life history, family health history, lifestyle, smoking habits, etc. These factors are taken into account before the premium amount is determined.
Check the Credibility of the Health Insurance Company
Do go through the history of the health insurance company you are planning to buy the medical insurance plan from. It is recommended that you select the health insurance company on the basis of the following parameters:
- ICR: Incurred Claim Ratio or ICR, is one of the most important parameters to check while comparing health insurance companies in India. When taking into account the ICR of a health insurance company, look for the average ICR of all the health insurance companies online on Policy Bazaar and go for the one that is closest to this average for a period of few years.
- Customer Experience: You should always take heed to the mass opinion. Look for customer reviews online. If a large number of customers of an insurance company are unhappy, it may be because their customer support or after-sales service isn’t up to the mark.
- Find out the Claim Process: Though the health insurance claim process is pretty generic over providers, knowing the nitty-gritty of the process can help save a lot of hassle at the eleventh hour.
Benefits of Comparing Health Insurance Plans Online
Due to tight and hectic schedules these days, it has become quite impossible to visit different offices or branches of different health insurers in order to compare various medical insurance policies.
Thankfully, Policy Bazaar understands the dilemma of the customers and hence, has offered a platform where you can compare different health insurance plans online.
Enlisted below are some of the major advantages of buying a health insurance plan online:
Access to Accurate Information:
It offers easy access to every medical insurance policy available in the market. It also saves the buyers from dealing with the agents who are known to provide unreliable and biased information most of the time.
Time Efficient and Convenient:
By comparing health insurance plans online, the users are able to save their time as they don’t have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing the health insurance plans, etc., are also easier via online mode.
If a customer buys a health plan via an online channel, he/she will be able to compare health insurance plans and opt for the one that fits in the budget. Also, no brokerage or agent fees are levied and hence, the buyer ends up saving a significant amount of money.
Availability of Provider/Plan Reviews:
Doing so will help you get an overall idea of an insurer’s reputation, enabling you to make an informed decision.
List of Government Health Insurance Schemes in India
The government health insurance scheme refers to the health insurance programmes that are backed by the Indian Government. The motive of launching government health schemes is to make health insurance accessible to the economically deprived section of the society.
Mentioned below are some of the health insurance schemes owned by the government of India:
- Ayushman Bharat Scheme
- Pradhan Mantri Suraksha Bima Yojana
- Rashtriya Swasthya Bima Yojana
- Universal Health Insurance Scheme
- Aam Aadmi Bima Yojana
- Employment State Insurance Scheme (ESIS)
- Central Government Health Scheme (CHGS)
Ayushman Bharat Scheme
The governments’ Ayushman Bharat Scheme aims to offer medical insurance coverage to at least 50 lakh Indians. The insurance programme focuses on two aspects: One focus is to ensure health insurance cover of Rs. 5 lakhs to each family, including in-patient hospitalization expenses and tertiary care. Another focus is to develop health and wellness centers for these people. The scheme has already benefitted 10 lakh Indians. Moreover, 1.5 lakh wellness centers would be set up by December 2022.
Pradhan Mantri Suraksha Bima Yojana (PMSBY)
It is a government-of-India-backed health insurance scheme, which offers coverage against personal accidents resulting in accidental disabilities, or death on account of an accident. It is offered for a period of one year and requires annual renewals. The policy is available with all public sector insurance companies that dealwith the general insurance sub-domain. All private sector insurers are open to selling the scheme on a similar set of terms in collaboration with various banks upon necessary approval. Anyone within the age group of 18 to 70 years, with a savings account in any of the participating banks can benefits from the scheme while the AADHAR would be the prime KYC for the scheme and bank account.
Rashtriya Swasthya Bima Yojana (RSBY)
A government-run health insurance scheme for poor people in India, it provides them with the cashless facility at various public and private hospitals across the country. Launched in 2008, the scheme already has over 36 million families (as on February 2014) enrolled across 25 Indian states. The operations under this plan started under the Ministry of Labor and Employment and were transferred to the Ministry of Health and Family Welfare on April 1, 2015.
As this plan works for BPL (Below Poverty Line) families, they get a smart-card that is biometric-enabled to become eligible for inpatient medical care worth Rs. 30, 000 per year at an empanelled hospital. The coverage for pre-existing diseases is there right from day one for parents and up to three children.
Universal Health Insurance Scheme (UHIS)
Aimed at improving the health standards of people at or below the poverty line, four of the public sector general insurers implemented UHIS in India. Under this scheme, the eligible families can get reimbursement for medical expenses up to Rs. 30, 000 and accidental death benefit of Rs. 25, 000 to the breadwinner in the family.
The loss of income of the family is also compensated with Rs. 50 per day up to 15 days in a month. The scheme was revised later, thereby increasing the premium subsidy from Rs. 100 to Rs. 200 for an individual and Rs. 300 for a family of 5 members and Rs. 400 for a family of 7 members.
Aam Aadmi Bima Yojana (AABY)
A government-of-India-run scheme for people from rural regions of India, who are landless, was launched in October 2007 and covers the prime earner in the family with the benefits. An annual premium of Rs. 200 is payable by the family, which is divided between the Central Government and State Government, while the age of the insured lies between 18 and 59 years. Below are the coverage benefits:
|Rs. 30,000 payable||In the case of Natural Death|
|Rs. 75,000 payable||In case of death or total permanent disability because of an accident causing the loss of both eyes or 2 limbs|
|Rs. 37,500 payable||In case of partial permanent disability because of an accident causing the loss of one eye or 1 limb|
Employment State Insurance Scheme (ESIS)
Employment State Insurance Scheme or ESIS is designed for workers who work in non-seasonal factories with an employee strength of at least 10 employees. The insurance coverage under this scheme is extended for self and dependents. The policy or act now applies to around 7.83 lakhs factories across the country with 2.13 cr insured persons/families. The total beneficiary stands at approx. 8.28 crores. The list of coverage under this scheme includes hospitalisation expenses along with daily cash benefits in case of sickness and disablement. Under ESIS, the offered cash
- Illness Benefit at 70% of total wages for 91 days
- Disablement benefit for the insured
- 90% of last wages in case of temporary disability
- Cash benefit on pro-rata basis for loss of earning capacity for lifelong in case of permanent disability
- Maternity benefit equal to 100% of wages for 12 weeks
- RGSKY for unemployment at 50% of last wages for 1 year
- Dependent benefit at 90% of wages
- Funeral Expenses cover Rs 10,000/-
- Vocational rehabilitation
- Physical Rehabilitation
Central Government Health Scheme (CHGS)
Central Government Health Scheme is one of the popular health schemes owned by the Indian government where health care benefits are provided to Central Government employees. The scheme also covers the pension holders, in fact, it covers all four pillars of a democratic state such as Legislature, Judiciary, Executive and Press. The scheme is unique of its kind due to the comprehensive health insurance benefit. At present, around 35 lakh beneficiaries are covered by CHGS in 71 cities in India. Under CHGS, health coverage is provided for treatment availing under allopathic, homeopathic, Ayurveda, Unani, Siddha and Yoga.
Factors to Consider Before Buying Health Insurance Plans
There are a few factors that you should consider closely to make the right decision:
Caps and Sub-limits
Caps and sub-limits are the thresholds set on various policy-covered expenses. If a health policy has impositions of co-payments, sub-limits, and other caps, this would mean that there will be a policy-stated coverage offered for various expenses. At times, the co-pay clause and caps help in reducing the premium of the plan. These, however, would alter the benefits in the long run. To make the most of your health insurance policy you must understand these factors before you pay for a health insurance plan.
Claim settlement Record
This is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. Thus, you can ensure that your medical insurance claims would not be wrongly withheld. Always ask for the company’s claim settlement ratio before purchasing their health insurance plans and save yourself from unnecessary harassment in the future.
Scope of Coverage
Don’t buy a health insurance plan by just comparing health insurance premiums. Less cost does not necessarily mean a good medical insurance plan. On the contrary, such a health plan might not consider your coverage needs properly. Closely look at what the plan includes. Buying a comprehensive plan is a better option comes to your rescue when you need it the most.
It is important to see how many years the plan proposes to protect you. Mediclaim policies are usually annual contracts. Once the policy term ends, in order to continue the insurance coverage, the insured has to pay the insurance premium. This recurring process is called health insurance renewal. The policy should be renewed continuously, because if there is a break, then, the person will lose the benefits of medical insurance.
Cashless Hospital Network
Check if a hospital around you is included by the medical insurance company you are considering to buy the plan from. You and your family won’t be required to run around collecting documents and filling reimbursements. The provider or its Third Party Administrator should have a tie-up with a range of network hospitals. The insured can get admitted to any of these nursing homes/network hospitals without paying anything from the pocket. However, cashless claim settlement is subjected to limits and sub-limits, which, in turn, are subjected to the sum assured of the medical insurance policy.
Premium Loading refers to the increase in standard premium applicable when the medical insurance company perceives a person to be more at risk (of claiming the insurance) in comparison to others. It is strongly recommended that you check the terms and conditions pertaining to premium loading. This will save you from paying an extra premium after making a medical insurance claim. This aspect, though ignored in the beginning, usually becomes a bone of discontentment later.
Internal Claim Settlement Team
Check the health insurance plans from insurers that have a dedicated internal claim settlement team. This expedites the claim settlement process. Most of the medical insurance players use a third-party administrator to process the claims and do the paperwork. Even though most of these Administrators provide great services, the fact that they are a third-party slows down the process. There are certain rules and regulations to be followed when an administrator processes a medical insurance claim before it is handed over to the medical insurance company, which in-turn affects the turnaround time.
Everyone has a different family size, so you should always look for the family size allowed under the medical insurance plan before purchasing it. If you are in your late 20s and your parents already have a health insurance cover, then purchasing insurance only for yourself does make sense. Alternatively, if you are married with or without kids and have dependent parents, parents-in-law, siblings, etc., then a family health insurance plan is best for you. Checking the premium cost, family size covered, critical illnesses or other benefits will ensure that you are able to purchase the plan you need.
Health Insurance Portability
It is wise to choose a health insurance company that offers health insurance portability. Earlier, policyholders had to stick to a policy just to retain the advantage. Now, you are allowed to switch from one insurance company to another without losing the waiting period advantages earned in your current policy. Moreover, with the insurance landscape changing so regularly, insurance providers regularly come up with better policies and it may make sense to opt for health insurance policy portability.
Although health insurance portability is free, some companies may charge you a certain fee if you are to port out of their plans to those of some other players. Therefore, make sure you do not pay any charges for medical insurance portability. Health insurance portability is a good thing to check when you are finding the best health policy or mediclaim.
With the ‘restore benefit’ facility in your health care plan, you can restore your basic sum assured in case you have already spent the same or the multiplier advantage during your policy tenure. Mostly, the benefit cannot be obtained on the same ailment if you have exhausted the existing sum limit.
Restoration assistance proves to be helpful for a family floater health plan, where if the entire sum assured is used in the treatment of only a single family member, the other members are not left uncovered. In such a case, the other family members can avail policy coverage for the illness other than the one for which the expenses have already been compensated by the insurer.
Well, while finalizing your health insurance plan, you should consider other important factors such as waiting period, sub-limit, claim settlement procedures, etc. You can replace restore benefit with a super top-up plan at an affordable price. Moreover, top-up health insurance plans are more comprehensive since they come with few or no restrictions.
Top up Health Insurance Plans
With the rise of medical inflation, it is prudent to increase the medical insurance coverage amount. But, not all can afford it due to the high cost of the premium. This is where a top-up medical insurance plan comes into the picture. A top up health plan reduces the deductibles cost i.e. the portion of a claim you pay willingly for the damages before the insurer compensates the rest or up to the sum assured. With a top up medical policy, you don’t pay until a hospital breaks its defined limit. A top up plan is considered far cheaper than a standalone medical insurance policy.
For instance, if the medical bill is Rs. 6 lakhs with a deductible of Rs. 2 lakhs, you are required to pay only the latter amount and the remaining 4 lakhs will be paid by the insurer. But, you can utilize your health policy to pay the liable amount. Again, the blending of a top-up plan with a medical cover is helpful as the premium you pay is much more affordable than an individual health plan. For example, if you pay 6,500 as a premium for Rs. 5 lakh regular cover, a top up coverage of Rs. 15 lakh will entail an additional premium of 5,000, which is anyhow cheaper than a separate policy.
As per the medical insurance norms, every insured must serve a defined waiting period to get coverage for any pre-existing illness. It is usually a 30-day period from the day your health insurance plan is initiated. If any claim falls during the waiting period, the insurer has the right to reject the claim for any hospitalisation, except in the case of an emergency. A hospitalisation that arises out of an accident can be registered as a claim and the insurer will compensate for the hospitalisation cost. However, the insured is not required to serve the waiting period for subsequent years.
Health Insurance Eligibility Criteria
Health insurance policy is mandatory for almost everyone, especially for those who have dependents and/or families since they certainly do not want them to go through financial stress. Buying a medical insurance policy ensures that one’s health is secured and medical expenses are covered across a wide network of hospitals in India. One can opt for the best health insurance policy with extended coverage on the following two bases:
- Family Floater
The following criteria must be fulfilled without failure:
- Entry age for Adults: 18 to 65 years (70 and above, based on the plan and insurer)
- Entry age for Children: 90 days to 18 years
- Policy renewability: Lifelong and subject to medical clearance
Health Insurance Portability Explained
You do not have to stick to your current insurer any longer if you do not want to since IRDA now allows you to change your current insurer without losing any of the existing benefits. Previously, if you changed your insurer, then you had to compromise on the benefits, viz. coverage for any pre-existing disease offered by your existing medical insurance policy.
According to the new rules, IRDA allows you to switch from one insurer to another while the new insurer will have to consider the credits you gained from your previous insurer, where credits refer to the waiting period under pre-existing conditions. The same applies if you switch from one plan to another with the same insurance company.
What you can do
- Switch from one health insurance company to another
- Any family floater or individual policy can be switched from/to.
- Avail insurance cover by your new insurer up to the sum assured by the previous policy.
- Both the insurers should mutually complete the formalities as per the IRDA timeline.
Criteria to meet
- A policy can be switched only at the time of renewal.
- With the new policy, the terms and conditions, including the premium are at the discretion of the new insurer.
- Submit a formal shifting request to your current insurer at least 45 days before the due date of the renewal.
- Make sure you specify the name of the new insurer you are willing to switch to.
- There should not be any break between policy renewals.
Health Insurance Premium Calculator
In order to keep the policy in force, regular payment of a fixed premium is essential. Did you ever think about how this premium is calculated? There are certain factors that affect health insurance premium such as the medical background of your family, your personal medical history and so on.
Based on that, you might want to calculate your premium to figure out how much you would have to pay for the policy. It can be done through a health insurance premium calculator. Premium calculator is an online tool that calculates the premium to be paid as per the information provided by you. At Policybazaar.com, you can calculate your health insurance premium easily.
Factors Affecting Health Insurance Premium
With the advancement in medical facilities, health care costs have also increased. The main benefit of health insurance is that it takes care of the healthcare expenses. It offers financial security to you and your family in the event of an unanticipated serious illness or accidental injuries that could drain all your savings. And here is how the cost of your insurance premium is determined:
1. Medical History
Your medical history is one of the major determinants of the health insurance premium. Almost all the ‘ health insurers in India make pre-medical tests mandatory (after a certain age) before buying a health insurance policy.
While, some insurance companies don’t make medical screening mandatory but do consider your current medical conditions, lifestyle-related health risks and medical background of your family.
That is why medical insurance premium for smokers is higher than other people.
Gender and Age
Age is another important determinant of the medical insurance premium. The premium varies based on the age of the insured person.
That is why it is recommended to buy a policy at a young age because the cost of the premium is low for young applicants.
Elderly people are vulnerable to cardiovascular diseases, and other critical illnesses such as cancer, kidney problems, etc. For this reason, senior citizen medical insurance premium is usually on a higher side.
Also, the cost of the premium for women’s health insurance is lower in comparison to the male candidates due to lower risk of stroke, heart attack, etc.
The premium for a 2-year health insurance plan will be higher than a 1-year plan. However, almost all insurance companies offer a discount on long-term medical insurance plans.
Type of Health Insurance Plan
The type of health insurance policy you select also affects the cost of the premium. The higher the risks involved the higher will be the premium and vice-versa.
With the help of an online health insurance premium calculator, you can compare the premium for different health insurance plans.
If you have not made any claim during your policy term, then you can earn NCB or No-claim-bonus ranging from 5 to 50 percent. It is also one of the most important factors that are taken into consideration while calculating the cost of the premium.
If you drink or smoke regularly, chances are high that you will be charged more premium amount. In that case, the insurer can also reject your medical insurance policy request.
Health Insurance Claim Procedures
Health insurance plans come with additional benefits of cashless treatment and expense reimbursement by the insurer. One can file a claim against an event that is covered by the insurance policy. Following are two claim processes:
Health insurance plans provide the insured with the benefit of getting their medical expenses reimbursed by the insurer. The cost of various hospital charges such as bed charges, medicines, lab tests, surgeon’s fees, etc. are paid back to the insured if the claim for reimbursement is filed. The insured pays the (hospital) expenses but gets reimbursed by the insurance company.
Insurance companies provide policyholders with a wide range of network hospitals to get medical treatment without having to make upfront payments. No payment is required to be done by the insured since the clause involves a mutual agreement between both the parties, i.e. the insurer and the network hospital. Availing cashless benefit requires TPA approval.
The insured can also show the insurer-issued health card at the particular hospital as proof of medical insurance cover along with a valid government ID. Following cases are considered for cashless treatment:
In case of planned hospitalization, in order to avail health insurance benefit the insured needs to have TPA approval in advance along with other mandatory documents. Fill the pre-authorization form at the network hospital signed by the treating doctor(s).
Show the health card issued by the insurer at the hospital along with the appropriately-filled pre-authorization form to get TPA approval for emergency hospitalization. If you fail to get TPA approval, you would need to file for reimbursement later. The insured might have to show the itemized bill, proof of medical expenses, discharge bill, etc., as the proof of the treatment availed to avail claim reimbursement.
Documents Required for Health Insurance Claim Reimbursement
In the event of hospitalization, the policyholder needs to submit certain documents as mentioned below:
- Discharge card issued by the hospital/network hospital
- In-patient hospitalization bills signed by insured for authenticity
- Doctors’ prescriptions and medical store bills
- Claim-form with insured’s signature on it
- Valid investigation report
- Consumables and disposables prescribed by the doctors with complete details
- Bills of doctors’ consultation
- Copies of the Insurance policy from the previous year and the current year/copy of ID Card of TPA
- Any other document(s) asked by the TPA
Some Myths about Health Insurance
Before relying on the information it is imperative to check the facts and then buy a health insurance policy. Mentioned below are some popular myths that most people believe about medical policies:
I am Healthy, and I Don’t Need Medical Insurance
Despite taking good care of your health, there are numerous unforeseen circumstances like seasonal illnesses, dengue, malaria, or an accident that can hit anyone anytime. Nowadays, hospitalization expenses are not easy to pay off. Even 2-days of hospitalization expenses would cost you somewhere between INR 60,000 to INR 1 lakh and even more (depending on the type of illness).
My Health Insurance will Cover all the Medical Expenses
As per the IRDAI regulations, all the health insurance plans come with a set of exclusions/limitations. It is required that you check all the policy details and the coverage that is mentioned in the plan. The insurer will only compensate for the expenses that are covered in the policy and up to the specified limit.
Declaration of Pre-existing Diseases
It is essential to declare all the pre-existing diseases in the proposal form. One must mention pre-existing diseases clearly before buying a health insurance policy. Inadequate information can lead to rejection of the claim and can cost more than the expected amount.
Smokers are not Eligible to Buy a Health Insurance Plan
As per the survey, nearly 49% of the applicants who consume alcohol are perplexed to buy a health insurance policy. But there are health insurance companies that offer medical insurance coverage to them as well. But taking into consideration the risks, alcohol consumers, and smokers would need to undergo a stringent pre-medical examination procedure and pay a higher premium to get health insurance coverage.
Medical Insurance will only Cover Hospitalization Expenses
Though most of the health insurance plans cover medical expenses for hospitalization more than 24-hours, there are plans that have a capping on the duration of hospitalization as well. But most of the insurers these days cover daycare procedure as well, where it is not required to be hospitalized for 24-hours. It includes cataract surgery, varicose veins surgery and similar medical procedures.
I am Covered Under a Group or Corporate Health Insurance Plan!
Most people rely on the health insurance plan that is provided by their employer. It is important to know that a group health insurance policy comes with a set of limitations. It will not offer coverage to your family members in most of the cases, the sum assured will not be sufficient, it will not cover critical illnesses. Also, getting health insurance coverage after retirement or losing a job can prove to be an expensive affair.
List of Health Insurance Companies in India
In order to help you with the best and convenient buying experience, we have compiled a list of General Insurance Companies in India providing health insurance in India. This list is prepared based on the Incurred Claim Ratio (ICR) and the overall health insurance policy benefits that they are offering:
Let’s discuss these Health Insurance Providers in detail.
Aditya Birla Health Insurance
Aditya Birla health insurance plans are designed to meet the diversified needs of the customers. The insurer offers a range of comprehensive plans with a sum assured limit up to Rs. 2 Crores. It is known for its individual, family, critical illness, and group health insurance plans. With more than 17,000 advisors, the insurance provider has presence in more than 650 Cities.
Health Insurance Plans by Aditya Birla Capital
|Activ Health Platinum||Activ Care||Activ Assure Diamond|
|Activ Secure||Global Health Secure||Group Activ Health/Secure|
Bajaj Allianz Health Insurance
A joint venture of Bajaj Finserv Limited, a comprehensive financial services company based out of India and Allianz SE, the global financial services major based out of Munich, Germany, Bajaj Allianz General Insurance Company focuses on the general insurance space in the country, including medical insurance. The insurance company has received the iAAA rating from ICRA for the 10th year in a row. With more than 6500 cashless hospitals in India, the insurer offers supreme healthcare with high sum insured options. As of 2019, Bajaj Allianz continues to be one of the robust general insurers in India with a profit of Rs 780 crore and revenue of Rs. 11,097 crore with a growth of 17%.
Health Insurance Plans by Bajaj Allianz Insurance Company
|Health Guard Family Floater Plane||Critical illness Policy||Extra Care Health Plan|
|Hospital Cash Daily Allowance Plan||Silver Health Plan||Star Package Health Plan|
|Tax Gain Health Plan||Critical illness for Women||Individual Health Guard Insurance|
|Health Care Supreme Plan||Health Ensure Plan||Silver Health Plan for Senior Citizens|
Bharti AXA Health Insurance
Bharti AXA claims to have settled 98.27% claims in a year, 1.3 million policies issued, 101 branch offices all over India and PAN India network hospitals to avail cashless treatment and these figures are enough to prove the reliability of the insurer. Health insurance offered by Bharti AXA offers extensive coverage maximum up to Rs. 1 Crore.
Health Insurance Plans by Bharti AXA Insurance Company
|Smart Health Insurance Plan||Smart Super Health Insurance Policy- Value, Classic and Uber Plan|
Cholamandalam MS Health Insurance
Cholamandalam MS General Insurance Company Limited, established in 2001, was set up by the India-based Murugappa Group, a multi-business conglomerate, and the Japan-based Mitsui Sumitomo Insurance Group as a joint venture to address the general insurance market in India. The company provides both individual and corporate insurance solutions through its 105 branches and 9000 plus agents in the country.
The insurer has received many accolades in a form of numerous awards for being perfect in its niche. The Pride of Tamil Nadu Award for BFSI, Golden Peacock Award in 2017 for best risk management, named as dream company to work to name a few.
Health Insurance Plans by Cholamandalam MS Insurance Company
|Chola Swasth Parivar Insurance||Chola Tax Plus Healthline||Chola MS Family Healthline Insurance|
|Chola Topup Healthline||Chola MS Critical Healthline Insurance||Chola Accident Protection|
|Chola Hospital Cash Healthline||Chola Classic Health – Individual||Chola Classic Health – Family Floater|
|Chola Super Topup Insurance||Individual Healthline Insurance||Hospital Cash Healthline Plan|
Digit Health Insurance
Digit Insurance as the name suggests is a digital friendly health insurance provider that offers customized plans that can be easily purchased online. The policies are designed for individuals, families, and senior citizens, who can avail cashless claims in more than 5900 partner hospitals PAN India.The Insurer has bagged a couple of awards such as – ‘ Top Indian Startup 2019’, and Asia’s General Insurance Company of the Year 2019.
Health Insurance Plans by Digit General Insurance Company
|Health Insurance||Corporate Health Insurance|
Edelweiss Health Insurance
Edelweiss medical insurance plans offer coverage to Individuals, Families, and Groups. It comes in three variants- Silver, Gold, and Platinum. The Platinum plans offer comprehensive coverage upto sum assured of Rs. 1 Crore. Coverage for Critical Illness is provided in both Gold, and Platinum plans.
Health Insurance Plans by Edelweiss General Insurance Company
|Edelweiss Health Insurance||Edelweiss Group Health Insurance|
Future Generali Health Insurance
A joint venture of the Indian Conglomerate Future Group, and the Generali Group, one of the world’s largest international insurance companies, Future Generali an Insurance Company has a PAN India presence with its 137 branches. The company provides a range of insurance solutions and intends to exploit the expansive network and local experience of the Future Group and the in-depth insurance expertise of Generali Group.
Health Insurance Plans by Future Generali Insurance Company
|Future Health Suraksha – Individual Plan||Future Health Suraksha – Family Plan||Future Hospicash – Hospital Cash|
|Comprehensive Plan – Health Total||Accident Suraksha – Personal Accident||Future Criticare – Critical Illness|
|Future Vector Care||Future Advantage Top up||Future Health Surplus – Top-Up|
|Surakshit Loan Bima|
HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance)
With a promise of 90% health claims get settled within 20 minutes, HDFC Ergo is one of the leading General Insurance Companies in India. With 10,000+ network hospitals across the country, where quality healthcare can be availed cashless, the insurer offers indemnity-based health insurance with affordable premiums.
Apart from health, the insurer also has expanded its business over other domains such as travel, motor, home insurance, commercial vehicle, property, and miscellaneous insurance. HDFC ERGO Health (formerly known as Apollo Munich Health Insurance) focuses on being a trusted leader in the health insurance space with its innovative solutions.
Health Insurance Plans by HDFC ERGO Insurance Company
|Optima Restore – Our Bestselling Plan||Easy Health – An Affordable Plan||Optima Cash – Daily Hospital Cash Plan|
|Maxima – Our Comprehensive Plan||Optima Super ñ Aggregate Top up Plan||Optima Vital- The Critical Illness Plan|
|Easy Health – Our Plan For Young Family||Easy Health – Our Premium Plan||NEW iCan Cancer Insurance – Covers Cancer Treatment Costs|
|Optima Plus – A Top Up Plan||Energy for Diabetes Health Plans||Dengue Care Plan – Comprehensive & Exclusive Cover for Dengue Fever|
Iffco Tokio Health Insurance
IFFCO Tokio Health Insurance is one of the most sought after insurance products in the market offered by IFFCO Tokio General Insurance Company. Formed in December, 2000, the provider is one of the most renowned insurance providers with maximum customer satisfaction that promises transparency and a hassle-free claim settlement. The health insurance company caters to the rural population as well and offers cashless treatment in more than 5000 network hospitals across India.
Health Insurance Plans by Iffco Tokio General Insurance Company
|Family Health Protector Policy||Critical Illness Health Insurance||Individual Medishield Policy|
|Swasthya Kavach Policy||Individual Health Protector Policy||Personal Accident Insurance Policy|
Kotak Mahindra Health Insurance
The insurance company is a subsidiary of one of the leading private sector banks in India i.e. Kotak Mahindra Ltd. In addition to the basic coverage, the insurer also provides add-on covers and discounts on premium. In more than 4000 network hospitals, the policyholders and the insured members in a plan can avail cashless hospitalization facility.
Health Insurance Plans by Kotak Mahindra Insurance Company
|Kotak Secure Shield||Kotak Health Super Top-up|
|Accident Care Health Plan||Kotak Health Premier|
Liberty Health Insurance
Liberty General Insurance was commenced in the year 2013 and has been providing diversified health insurance products catering to the needs of different customers. The insurer has more than 5000 partner hospitals where the insured can avail cashless treatment. For it services in the insurance sector, Liberty General Insurance has been awarded Employer of Choice by the Excellence Awards.
Health Insurance Plans by Liberty General Insurance Company
|Health Connect Policy||Health Connect Supra|
|Secure Health Connect||Individual Personal Accident|
Max Bupa Health Insurance
Max Bupa Health Insurance has a presence in more than 190 countries and offers direct claim settlement without Third-party Administrator. To ensure convenience to its policyholders and seamless claim settlement the insurer offers cashless claim pre-authorization in 30-minutes
Health Insurance Plans by Max Bupa General Insurance Company
|GoActive Family FloaterHealth Insurance||Heartbeat Family Floater Health Plan|
|Max Bupa Health Recharge Plan||Criticare Health Insurance Plan|
ManipalCigna Health Insurance
ManipalCigna Insurance Company Limited (formerly known as CignaTTK Insurance Company Limited) is a joint venture between the Manipal Group and Cigna Corporation; both are global market leaders with a huge customer base. ManipalCigna Health Insurance offers a full suite of insurance solutions ranging from health, personal accident, major illness, travel and global care to individual customers, employer-employee, and non-employer-employee groups to meet their diverse health needs.
Health Insurance Plans by ManipalCigna Insurance Company
|ProHealth Insurance||Lifestyle Protection Critical Care||Lifestyle Protection Accident Care|
|Lifestyle Protection Group Policy||ProHealth Group Insurance Policy||ProHealth Select|
|Global Health Group Policy||ProHealth Cash|
National Health Insurance
It is one of the most renowned and oldest fully government organizations providing insurance cover In India. It was started in 1906 and now has nearly 1998 offices across India. It is one of the leading insurers providing customized health plans with comprehensive coverage to individuals, families, groups and senior citizens. Cashless hospitalization is provided in more than 6000 network hospitals across India
Health Insurance Plans by National Insurance GI Company
|National Parivar Mediclaim||Overseas Mediclaim Business and Holiday Plan|
|National Mediclaim Policy||National Critical Illness Plan|
New India Assurance Health Insurance
New India Assurance GI Co. was founded in 1919 and has its headquarters in Mumbai and has its presence across 28 countries. In addition to other insurance products, New India Assurance Health Insurance is one of the most trusted products among its customers. Most of the health plans do not require pre-medical check-ups up to the age of 50 years
Health Insurance Plans by New India Assurance
|New India Assurance Senior Citizen Mediclaim Plan||Asha Kiran Health Insurance Plan|
|Asha Kiran Health Insurance Plan||New India Assurance Mediclaim Policy|
Oriental Health Insurance
The Oriental insurance company offers a range of comprehensive general insurance products. In addition to India the insurer offers services in Nepal, Kuwait, and Dubai. People can easily compare, buy and renew health insurance policies online. It offers some of the best medical insurance plans promising an enhanced coverage at an affordable price. The insurance provider also offers insurance products for chemical and petrochemical industries.
Health Insurance Plans by the Oriental insurance Company
|Happy Family Floater Plan||Oriental PNB Health Plan|
|Individual Mediclaim Health Insurance||OBC Oriental Mediclaim Plan|
Religare Health Insurance
With a wide network of over 4,100 hospitals across the country, Religare General Insurance Company is promoted by the founders of India’s leading private hospital chain, Fortis Hospitals. The insurance claims are directly entertained by the company executives and there is no third–party involved in the claim processing. Based on the coverage offered by individual health plans, customers can opt for riders for protection enhancement. Recently, the insurer was awarded MCX Award in 2019, Best Claims Service Provider of the Year for 2018 by Insurance India Summit & Awards 2018 and many more.
Health Insurance Plans by Religare Insurance Company
|Care (Comprehensive Health Insurance)||Enhance (Super Top Up Insurance)||Care Freedom (Health Insurance with Medical Check-up)||Joy (Maternity & New Born Cover)|
|Group Care (Group Health Insurance)||Secure (Personal Accident Insurance)||Cancer Mediclaim (Lifelong Cancer Protection Cover)||Heart Mediclaim (Health Cover for 16 Types of Heart Ailments)|
|Critical Mediclaim (Critical Illness Cover)||Operation Mediclaim (Surgery/Operation Expenses Cover)||Group Secure (Group Personal Accident Insurance)|
Reliance Health Insurance
Reliance is one of the most renowned general insurance providers in India. The insurer has 139 offices PAN India to where you easily reach out to them and avail their seamless services as per your own convenience. With online purchase and renewal services, they are even more accessible.
Moreover, Reliance health insurance has its presence across India and abroad. Reliance provides both Individual and family floater plans. Moreover, Independent women can avail a discount of 5 percent on the premium
Health Insurance Plans by Reliance General Insurance Company
|Reliance Health Wise Plan||Reliance Health Gain Plan||Reliance Health Gain Installment Plan|
|Reliance Wellness Plan||Reliance Critical Illness Plan||Reliance Personal Accident Plan|
Raheja QuBE Health Insurance
QBE Insurance belongs to the Rajan Raheja Group. It is one of the most popular general insurers in India. The insurer offers health insurance policy and cancer insurance policy with comprehensive policy features. Even the non-medical expenses are covered like attendants and hygiene in case of cashless claims. The Cancer Insurance policy offers coverage to individuals in the age group of 1 day to 70 years.
Health Insurance Plans by Raheja QuBE General Insurance Company
|Cancer Insurance||Health QBE|
Royal Sundaram Health Insurance
Royal Sundaram GI Co. Ltd is recognized as one of the most popular general insurance companies in India. The insurer also offers cashless hospitalization facilities in nearly 5000 network hospitals in India itself. Royal Sundaram health insurance offers a lifelong renewability option.
Health Insurance Plans by Royal Sundaram Insurance Company
|Family Plus Health InsurancePlan||Elite Lifeline Health Plan|
|Supreme Lifeline Health Plan||Classic Lifeline Health Insurance
Star Health Insurance
Star Health is the first standalone insurance company. Founded in the year 2006 Star Health and Allied Insurance Co Ltd. initially the company focused on Overseas Medicliam Policy, Health Insurance, and Personal Accident Plan but the vision has now expanded. Since then, there has been no stopping and today Star Health is being counted among the top insurance providers in India. With more than 9800 network hospitals across the country, the insurer was awarded the best BFSI Brand Award by Economic Times in 2019.
Health Insurance Plans by Star Health Insurance Company
|Family Health Optima Plan||Senior Citizens Red Carpet||Star Comprehensive Insurance Policy|
|Star Health Gain Insurance Policy||Super Surplus Insurance Policy||Diabetes Safe Insurance Policy|
|Star Criticare Plus Insurance Policy||Star Family Delite Insurance Policy||Medi-classic Insurance Policy (Individual)|
|Star Cardiac Care Insurance Policy|
SBI Health Insurance
SBI Health Insurance operated as a joint venture between State Bank of India and Insurance Australia Group. The company offers a range of health insurance plans for both individuals and groups. Serving a large share of insurance customers in India, it has gained the trust of its existing as well as prospective customers.
Over these years, the company has successfully established its feet in the vast insurance market of India. The health insurance products of SBI allow its customers to manage their financial expenses. Based on the health cover required, its customers can opt for health insurance plans with sum assured up to Rs. 50,000 to Rs. 5,00,000.
Health Insurance Plans by SBI Insurance Company
|Health Insurance||Group Health Insurance – SBI||Critical Illness||Hospital Daily Cash|
|Loan Insurance||Arogya Premier||Arogya Plus||Arogya Top Up|
Tata AIG Health Insurance
Tata AIG General Insurance is a collaboration between TATA Group and the American International. The insurer has tie-ups with more than 4000 network hospitals in India where cashless treatment is available. The insurance provider ensures a seamless settlement of claims so that the insured can focus on the treatment.
Health Insurance Plans by TATA AIG General Insurance Company
|MediPrime Health Insurance Plan||Tata AIG Wellsurance Family Plan||MediSenior Plan||Tata AIG Wellsurance Women Plan|
|MediPlus Plan||MediRaksha Plan||Wellsurance Executive Plan||Critical Illness Policy|
United India Health Insurance
United India Insurance is one of the most popular general insurance companies in India. It was formed as a merger of 22 companies with their headquarters in Chennai. The insurer facilitates cashless medical treatment in more than 7000 hospitals PAN India. Also, the insurer has been accredited by ICRA for its high claim paying ability and high solvency margin ratio.
Health Insurance Plans by United India Insurance Company
|MediPrime Health Insurance Plan||Tata AIG Wellsurance Family Plan||MediSenior Plan||Tata AIG Wellsurance Women Plan|
|MediPlus Plan||MediRaksha Plan||Wellsurance Executive Plan||Critical Illness Policy|
Universal Sompo Health Insurance
Universal Sompo GI Co. is a private-public undertaking, which was founded in 2007. It is a joint collaboration between Dabur Investment Corporation, Indian Overseas Bank, Karnataka Bank, Allahabad, and Sompo Japan. Universal Sompo health insurance plans are designed in a simple and affordable manner to meet the most of the insurance needs of its customers. Moreover, cashless treatment is available in more than 5000 network hospitals across India. Diversified plans available for individuals, families, groups, NGOs, students and the likewise.
Health Insurance Plans by Universal Sompo
|Individual Health Insurance||Janta Personal Accident Insurance||Complete Healthcare Insurance|
|Senior Citizen Health Insurance||Aapat Suraksha Bima Policy||Hospital Cash Insurance Policy|
|Sampoorna Suraksha Bima||Group Personal Accident Policy||Critical Illness Insurance|
Health Insurance Network Hospitals
Network hospitals mean a group of hospitals associated with a particular insurance company. The best part is that insurance holders cab avail cashless services at a network hospital, which is not the same as a non-network hospital.
Health Insurance vs Mediclaim
Though are used interchangeably, there is a slight difference between mediclaim and health insurance. A medicliam policy is a type of health insurance that offers hospitalization expenses owing to an accident or illness. The sum insured is pre-specified which doesn’t exceed Rs. 5 lakh. On the other hand, health insurance is more comprehensive than a mediclaim plan, where the coverage is extended towards hospitalization expenses, pre and post hospitalization expenses ambulance cover, OPD cover, daycare, etc. as inbuilt benefits.
Health Insurance vs Critical Illness
An ordinary health insurance policy may not suffice your requirement when it comes to treating a critical illness. Here comes Critical Illness Insurance into the picture which is specially designed to cater to the specific needs of an illness. The basic difference between health insurance and a critical illness plan is given below:
|Health Insurance||Critical Illness Insurance|
|Health insurance mainly covers hospitalisation expenses owing to an accident or illness||A critical illness plan offers a lump sum amount in case the insured is diagnosed with a critical illness such as cancer, kidney failure, etc.|
|Loss of income can be availed only with a rider called Personal Accident Cover||With a critical illness policy, the loss of income due to the illness can be mitigated|
|The sum insured amount is restored after a claim||The sum insured amount is paid in a lump sum and is not restored|
Health insurance vs Life Insurance
Both health and life insurance is important, depending on their offerings. However, the major differences between health insurance and life insurance include:
|Health Insurance||Life Insurance|
|Health insurance doesn’t offer death benefit or maturity benefit as an inbuilt benefit||Death and maturity benefit is the major attraction in a life insurance policy|
|Hospitalisation expenses covered due to an accident or illness||No hospitalization expense cover|
|NCB benefit for not claiming the insurance||No NCB benefit|
Health Insurance vs Term Insurance
Term insurance is a type of life insurance, where the insured can avail death benefit where the beneficiary gets the insurance amount in case of the sudden demise of the policyholder. The basic difference between the two are:
|Health Insurance||Term Insurance|
|No death or maturity benefit is offered||The insured can avail death benefit where the beneficiary gets the insurance amount in case of the sudden demise of the policyholder|
|Medical expenses including hospitalisation expenses, OPD, day care, pre and post hospitalisation expenses tec. Are covered||No such cover except death benefit is covered|
|Based on indemnity where hopsitalisation expenses are reimbursed||Pure protection plan and is an absolute must plan|
Buy Top Health Insurance Policy Online
Buying health insurance can be easy if you approach the right channel. Having said this, Policybazaar.com can be a good platform for choosing the right insurance policy. Policy Bazaar has made the process of comparing & buying a health insurance policy easier in comparison to earlier days. One has easy access to the complete details of almost all the health insurance plans available in the Indian insurance market at a competitive price.
Policy Bazaar helps you sieve through numerous mediclaim and health insurance plans and zero down on the one those measures up to your needs. Moreover, the post-sale services are extended to the customers online as well even at the time of medical insurance claim.
PolicyBazaar Facilitates you to do the following:
- Explore and figure out the best health insurance plans
- Read quality articles and news of various insurance companies in India
- Compare multiple health insurance plans
- Find the best health insurance plan for you
- Read user reviews and decide which insurer to go with
- Get expert advice from a well-versed customer support team.
Q: How can I exercise portability procedure on my current health insurance?Ans: Health insurance portability can be exercised only at the time of renewing a policy, not at any time during the policy term. Switching to a new firm can be easy if you follow below simple steps.An insured needs to send an application to port the policy to the new firm which should reach at least 45 days prior to the last day of renewal of the current policy. Though the insurance company is free to consider a proposal even if the person fails to approach them before 45 days of policy renewal, but in that scenario it will not be legally bound to consider your application. So, chances are high that your application will be rejected. Once your request is received by the new firm, they will send proposal and portability forms along with details of different products offered by it. Choose the insurance product which suits you most and fill up the proposal and portability forms and submit them to the new firm. After receiving both the forms, insurance company will approach your current firm seeking details like medical history and claim history. The data will be received through a common data sharing portal developed by IRDA for all insurance companies. The current firm will have to furnish all details about your policy within seven working days. After the new firm receives all details regarding your previous policy, he has to take a decision on underwriting your insurance application within 15 days. If the new firm fails to abide by this duration, he will be bound to accept your application.
Q: Can I cancel my health insurance? If yes, will I get my premium back?Ans: Yes, you can cancel your health insurance. A free look period of 15 days from the date of policy receipt is available to you to review terms and conditions of the policy. If you are not satisfied with the terms of the policy, then you may seek cancelation of it. In such an event, insurance company allows refund of expense done after adjusting underwriting costs, cost of pre-acceptance medical screening, etc.
Q: What do you mean by waiting period?Ans: The waiting period is a defined time-period that the insured has to serve to cover the pre-existing illness. No claim during this period will be accepted by the insurer except the case of an emergency hospitalisation. If I increase my policy Sum Insured at the time of renewal, do any waiting periods apply? With the increase of the Sum Insured, waiting periods will be applicable afresh. Let’s say if the waiting period is 3 years, a claim for the cover can be claimed only after serving 3 years from the date of inception of the policy. Read more about waiting Period in details
Q: Does a health insurance plan cover maternity?Ans: One can add maternity benefits as an add-on or a rider with his/her main health insurance policy. However, some corporate organisations offer maternity benefits with their group health insurance, while some prefer to offer maternity as an add-on cover. But some best health insurance plans that cover maternity include 1. Royal Sundaram Master Product – Total Health Plus 2. Apollo Munich Insurance – Easy Health Family Floater 3. Cigna TTK Health Insurance – ProHealth Plus Plan 4. Star Health Wedding Gift Pregnancy Cover
Q: Do insurance policies cover outpatient expenses also?Ans: Most of the insurance companies have a mandatory requirement of 24 hours hospitalization. However, insurance companies like ICICI Lombard, Apollo Munich, Cigna TTK and MAX Bupa cover OPD (outpatient department) expenses in their base mediclaim policy, while companies like National Insurance offer an OPD cover as a rider at an additional premium.
Q: When should I make a claim?
Ans: Much like car insurance, you need to assess your medical cost and compare it with bonus amount to decide whether it would be wise to make a claim or not. For instance, if you have been hospitalized for one day and total medical bills comes to Rs 5000 only. Calculate the no claim bonus (NCB) for which you are eligible. If the bonus amount is more than Rs 5000, it is advised to pay for medical bills yourself and then earn NCB.
Q: How will the no claim bonus be affected in Apollo Optima Restore plan if the claim has been made after few years?Ans: If you get a no claim bonus in your Apollo Optima Restore plan and a claim is made in the subsequent policy year, the company will decrease the multiplier bonus by 50% of the basic sum insured in the following policy year. However, this reduction will not be below basic sum insured.
Q: What do you mean by no claim bonus?
Ans: No claim bonus (NCB) is a discount on the base premium if no claim on the health policy is made during the policy term. This bonus is usually given in the form of a discount or enhancement of sum assured. Some insurers also add to the total at a pre-defined rate. However, more commonly NCB is offered in the form of discount on the payable total. NCB is quite attractive for a healthy person who has bought health insurance policy for emergency situations. He/she doesn’t need to make small claims at regular intervals and thus, he can enjoy NCB. However, for a person who is suffering from chronic heart ailment, NCB is almost not applicable.
Q: Why do I need Health Insurance?
Ans: Health insurance policy ensures that you would not have to bear medical bills and hospitalization expenses out of your own pocket. It comes with the dual-benefit of coverage against medical emergencies and assured tax benefit under section 80D of Income Tax Act, 1961. With increasing risk of medical contingencies and its corresponding rise in hospitalization cost, medical insurance is quite important for your family and you. It safeguards your loved ones against financial troubles, thereby assuring you for best medical facilities
Q: How much does health insurance cost?
Ans: Buying a health policy is not an easy task. There are various factors that collectively play an important role in deciding the total cost which you need to shell out to get cover. Young, healthy people need to pay far less for insurance than their old counterparts. Similarly, if you are buying a single policy then total payable would be low in comparison to a family health plan as the latter is a comprehensive plan that includes protection for the entire family, whereas the former covers only one. Similarly, corporate health insurance is cheap as it is similar to buy policies in bulk. The cost of medical insurance also depends upon total assured. If you opt for a higher assured total, your premium rates will increase. Similarly any rider attached with the plan increases its cost. For instance, premium rates of a basic health policy offering Rs 3 lakh to a person aged 30 years would vary between Rs 3000-4000/annum. But if you take a critical illness rider, you have to spend more 1500-2000/annum. The cost of health insurance also varies on the basis of the health condition of a person. For example, an unhealthy person who is already suffering from any pre-existing condition may need to pay higher total in the form of loading as compared to a healthy person who doesn’t need to pay the loading fees. Also, in certain scenarios, the total payable may vary from the city to city. For example, a person living in metro city may need to pay the higher cost as compared to the other person of same age and family size living in the remote area, for the same assured total.
Q: What are the various riders and benefits available in a health insurance policy?
Ans: A rider is an add-on option that can be added to a current health policy to get additional cover. There are various riders available in medical insurance sector and some of the major ones are listed below- Critical illness rider= There are certain critical ailments, such as heart attack, paralysis, cancer, etc; for which medical expenses are too high to be covered under a regular health policy. Under critical illness rider, mostly lump-sum is paid to the person and this total is substantial for massive expenses which are involved due to critical illness. Hospital Cash= Insurer provides fixed cash on a daily basis to compensate the loss of income & meet petty expenses of the person during hospital stay Top-ups= If there is a change in the inclusion needed or paying ability increases, then it is better to opt for a top-up insurance plan than buying an individual plan. It helps in expanding the current health insurance cover. Attendant allowance= Some insurers are giving attendant allowance to accompany the insured person who is hospitalized. Co-Payment= It is the portion of the claim that a policyholder agrees to pay in the event of a claim. For a policyholder, main benefit comes in the form of low premium. The higher the ratio, the lower is the premium. A healthy person whose chances of being hospitalized are low can consider buying a policy with this deductible. Deductible= Also known as ‘excess’, deductible is the uninsured part of the claim amount which the person has to pay before the insurance company takes over and pays remaining expenses as per the policy. Since the firm shifts the small portion of risk on you, he gives you discounts on the payable total. Unlike co-payment, the person has to first pay his portion and then only firm settles the remaining portion.
Q: What are pre-existing diseases or conditions?
Ans: Any health problem faced by one prior to seeking insurance policy is called pre-existing diseases. Insurance companies are reluctant to cover such diseases as it is a costlier affair for them. The problem is that people with such conditions usually do not get warm welcome from insurance companies. But it should not deter you from buying a health plan even if you have any such ailment. Every insurance company has its own conditions regarding such illnesses. Some firms prefer to check a person’s entire medical history to know pre-existing condition status, while other insurers will look for medical records over the past four years. So while choosing a policy, you should also need to compare waiting period stipulated in policies for covering such ailments.
Q: What are the fine prints which I should know before buying health policy?
Ans: Buying health insurance can be a painstaking process, so you should make sure you keep below things in mind before buying a health insurance policy. B) What’s covered and what’s not covered in the policy= No health policy includes all illnesses, so it is important to know the list of covered illnesses c) Pre-existing diseases= Be upfront about your current health state and pre-existing diseases. Concealing information may become the reason of claim rejection. d) When does it start= No medical insurance includes starts covering from Day 1. So it is important to know when your inclusion will start. If you will undergo medication before that time, you will not be entitled to get a claim. e) Family or individual policy= A family insurance plan considers entire family under one plan and is cheaper than individual policy. However, it is crucial to check what happens if the main insured of the plan dies. Some policies may lapse while some won’t. Also, taking a family plan with your ageing parents would mean that most of your inclusion would go in their treatment and less inclusion would be available for the rest of the family. f) Understand the premium= Costs of healthcare services are rising exponentially. Thus, it is important to have comprehensive health inclusion so that timely medication could be made. However, before you buy a plan, it is crucial to compare costs with the total assured total and cover. There is no sense in taking up low priced plan if it includes only a few sicknesses.
Q: What if the insurance company refuses to settle my claim and I want to file a complaint? Or I am not happy with processed claim amount.
Ans: In order to monitor grievances and turnaround times of policyholders, IRDA has implemented the Integrated Grievance Management System (IGMS). It is a platform where policyholders can register their complaints with insurance companies first and if required, it can be escalated to IRDA Grievance Cells. You can reach IRDA Grievance Call Centre (IGCC) through- Call – Toll free number 155255 for voice calls Email – [email protected]
Q: What do you mean by health card?
Ans: It is a card that comes along with health insurance policy. Similar to the identity card, this card will allow you to avail cashless hospitalization.
Q: What is the right time to buy health policy?
Ans: ASAP- As soon as possible is the perfect answer to this question. By buying at a younger age, you can enjoy low premium rates. Moreover, for critical illnesses, every firm has its own waiting period. By buying it at the young age means you get access to health inclusion when the need actually arises. So don’t wait for any accident or a medical condition to occur before you hit a panic button and buy a health insurance policy.
Q: What is personal accident insurance?
Ans: Personal accident insurance is an annual policy that offers compensation in the event of injury, disability or death due to an accident caused by external and violent means. An accident may include events like rail/road/air accident, injury due to cylinder burst, injury due to collision, burn injury, drowning, etc.
Q: Why should I buy critical illness cover?
Ans: A critical illness benefit complements the health insurance benefits. While mediclaim takes care of hospitalization expenses, critical illness cover is used to cover extra costs that may arise while seeking treatment for critical diseases like cancer, stroke, coronary heart disease, major organ failure, paralysis, etc. Under critical illness, insurer agrees to pay a lump sum amount on diagnosis of dreadful diseases listed in the policy document. The lump sum amount that you get can be used for different purposes like paying for expensive treatment or recuperation aids, make up for the loss of income due to fall in the ability to earn, etc. Imagine an individual who has been diagnosed with coronary heart disease and the patient has a health plan of Rs 5 lakh. In a regular health plan, payment is usually associated with hospitalization but what happens if total expenses connected with treatment are Rs 8 lakh, out of which hospitalization expense is Rs 5 lakh? Now who will bear Rs 3 lakh expenses (8-5) related to innumerable diagnostic pre & post hospitalization? Having a critical illness plan would give an additional amount to cover Rs 3 lakh expenses. A critical illness plan supplements your medical insurance portfolio. The purpose of a critical illness cover is to pay for costly treatments. The scope of coverage is much wider as it covers up to 20 critical illnesses. Moreover, general insurance companies offer a critical illness cover for 1-5 years. It means, you have ample coverage for a longer duration.
Q: What is sum assured?
Ans: Sum Assured is a pre-determined benefit paid by the insurance company. In case of an accidental death of the policyholder, the insurer pays the nominee the sum assured and the policy ceases right away. Let’s say, you buy a policy with health coverage of Rs. 5 lakh. At the time of buying, the insurer guarantees to pay, a pre-decided amount of 2 lakh to the nominee in case of your accidental demise. This 2 lakh is your sum assured. It is one of the determinants, based on which the insurer decides the premium amount payable for a particular health plan.
Q: How to select the best health insurance plan in India?
Ans: Almost all health insurance companies offer different health insurance plans to meet the needs and requirements of its different customers. Here are some of the most important points that you must keep in mind when selecting the best health plan in India. Check the Sum Assured, Coverage limit, Entry Age and renewability clause, co-payment clause, Inclusions & exclusions, waiting Period and the No-claim-bonus. After comparing different plans on the basis of above parameters you can select the right plan.
Q: What is the procedure for reimbursement settlement?
Ans: 1. Inform the insurer and submit the filled reimbursement claim form within 30 days from the date of release from the hospital 2. You are required to submit all the original and duly stamped medical reports, medical bills and hospital bills with the claim form. Registration number of the hospital is required to be mentioned in the hospital bill. 3. A discharge card, which ensures that you are medically fit, is to be submitted to the insurer as well. 4. Doctor’s follow-up prescription should also be submitted at the time of filing a claim. For a post-hospitalization expense to be covered, you can submit the bills within 60/90/120 days from discharge, as per your insurer’s norms. 5. Keep copies of all submitted documents for future reference and retain them all. The insurer will follow you once the claim is registered and he/she will further guide you. Usually, a claim is settled within 2-3 weeks after it is registered.
Q: How much coverage do I need?
Ans: The term coverage in reference to health insurance means the sum assured by the policy, and the degree of coverage you need is subject to your existing lifestyle, medical background of your family, annual income, place of residence, and age.
Q: Is individual plan better than family floater health insurance plan?
Ans: An individual health insurance plan only provides coverage for an individual, whereas a family floater plan ensures coverage for the entire family in case of a medical emergency. However, an individual plan costs more than a family health insurance floater plan, which is why most individuals opt for family floaters. Family floaters also offer a higher sum insured than individual health insurance plans, in case of only one claim in a year.
Q: How does smoking affect health insurance premiums
Ans: The cost of getting a Health Insurance plan can be significantly higher for those who are regular tobacco users. This is because smoking predisposes an individual to various diseases like heart complications, hypertension, respiratory issues, cancer, etc. Though the number of smokers is higher for men, women who smoke are also prone to osteoporosis. As a result, the premiums for health insurance are higher for smokers and tobacco users are higher than those who do not smoke.
Q: What is covered by health insurance?
Ans: Health Insurance provides all essential health benefits, including doctors’ consultation fee, inpatient and outpatient expenses, while some insurers also cover pregnancy and childbirth-related expenses.
Q: What is Health Insurance?
Ans: Health Insurance Policy is a kind of insurance offering coverage for surgical and medical expenses incurred by the insured when s/he is hospitalized during the policy term. Various health insurers also offer coverage for pre-hospitalization, post-hospitalization, critical illness expenses and day care procedures to its policyholder.
Q: What are the documents required for purchasing a health insurance policy?
Ans: There are no documents required as such for purchasing a health insurance policy. You may have to undergo a pre-policy medical check-up if you are a senior citizen. However, you must have a valid proof of your identity, address, age etc. when you need to file a claim with your insurer. Note: You can always check on your insurer’s website about the documents required for purchasing a health insurance policy.
Q: Is medical checkup necessary before buying a policy?
Ans: Pre policy medical checkup is mostly applicable on higher age bracket or people having past medical history and opting for high sum insured. However, it is in our best interests to undergo medical test at the time of buying a policy to ensure the fast and efficient claim settlement.
Q: What are the minimum and maximum policy durations?
Ans: You have the option to buy medical insurance either for 1 year, 2 years or 3 years. Buying it for 2 years entitles you to get discounts.
Q: Can my friend buy a health insurance policy if he/she is not an Indian National but living in India?
Ans: Yes, foreigners living in India can apply for health insurance policy. However, coverage would be applicable within India only.
Q: Do health insurance policies cover diagnostic charges like X- ray, ultrasound or MRI?
Ans: A health insurance policy covers diagnostic charges like X ray, ultrasound, blood tests or MRI, only if a patient stays in a hospital for at least one day. Any diagnostic test which doesn’t lead to treatment or those tests which have been prescribed to outpatients are not covered.
Q: What happens to the policy after the claim is filed?
Ans: After a claim is filed and settled, the coverage amount would be reduced by the sum that has been paid. For instance, in January, you start a health policy with Rs 10 lakh coverage and in May, you make a claim of Rs 5 lakh. The coverage available to you for June-December would be the balance amount i.e. Rs 5 lakh.
Q: Can I take policy for my kid who is 3 years old?
Ans: Usually children are not covered individually in a policy but can be covered by either of the parent in their own health policy.
1. Health Insurance Renewal Extended till April 21: IRDAI
In a recent circular, Insurance Regulatory and Development Authority of India, IRDAI has asked the health insurance companies in India to extend the health insurance renewal dates of the policyholders whose renewal fall due during the COVID-19 lockdown. The Department of Financial Services, Government of India, issued a notification in this regard on April 1, 2020.
As per the circular, the Central Government has directed that the customers who are not able to renew their health insurance policy between March 25 and April 14, 2020 and considering the current situation due to COVID-19 lockdown, for them the renewal date has been extended till April 21, 2020 to ensure continued health insurance benefits.
IRDAI said that the insured person shall be required to pay the health insurance renewal premium for the entire year from the date it was due till April 21,2020. In addition to that the regulator has also mentioned that the customers should be communicated by the insurers regarding this renewal grace period via mail, telephone, sms, and online on their website.
Once the premium is paid and the policy is renewed on or before April 21,2020 the period of insurance cover will be in continuance from the last renewal date without any gap provided the renewal falls during the lockdown period.
IRDAI has also asked the insurance providers to make necessary arrangements ensuring easy premium payment by the insured persons during the week after the lockdown period ends.
2. 1 Month Grace Period for Paying Renewal Premiums”, Says IRDA
When all news channels are swamped with news of Corona pandemic and its deadly effect globally, IRDA’s announcement for an additional window of 30 days to pay the life insurance renewal premiums is a big relief.
In a recent circular IRDA has notified that even the health insurers may overlook delay in renewal payments up to a period pf 30 days without deeming this delay as a break-in insurance policy. In case of a life insurance policy, the insurance providers are asked to enhance the grace period if needed up to an additional 30 days.
With this IRDA has also confirmed that there will be no change in the benefits offered under a particular policy, including no claim bonus if applicable.
Written By: PolicyBazaar – Updated: 27 April 2020