• Fixed Benefit and Indemnity Based Health Insurance

    Buying a health insurance policy has become a necessity nowadays, with the rising cost of health care and a sedentary lifestyle leading to more frequent trips to the emergency room. While there are a lot of options when it comes to picking a health insurance plan from both private as well as public insurance companies, the type of coverage and premium amounts play a key role in choosing a health insurance policy.

    With health insurance being an additional expense, many of us would hesitate to buy a high premium plan that offers wide-ranging health coverage. For those of us who would like to benefit from extensive without having to pay a high premium regularly, fixed and indemnity based health plans come to the rescue.

    What is a Fixed Benefit Health Insurance Plan?

    A fixed benefit health plan is one where a fixed amount of funds (the sum insured) is paid out to cover expenses for a predetermined illness or condition that has been insured. The fixed benefit plan can be used as a supplement to a regular health insurance plan that provides an additional source of funds during a pre-insured health incident.

    Benefits of Fixed Benefit Health Plans:

    A fixed benefit plan can be used to cover a wide range of services, such as hospital cash policy, critical illness cover or personal accident cover. An individual can choose the provisions of the fixed benefit health plan based on the provisions of their existing health insurance plan. Thus, the fixed benefit health plan works as a filler to cover any possible expenses that are not covered by the regular health insurance plan.

    A fixed benefit plan, unlike a regular insurance plan, does not have stipulations that govern the pay-out. Thus, expenses like post-hospitalisation and medicines which are not covered by regular health insurance policies can be covered by the fixed benefit plan.

    Fixed benefit plans do not require the reams of documents and papers that are required when filing an insurance claim. Depending on the type of pre-defined illness, a diagnosis report from a physician or the policyholder contracting the specific illness is enough for the pay-out from a fixed benefit plan to be released in full.

    Drawbacks of Fixed Benefit Health Policies:

    While a fixed-based health plan offers a fixed pay-out for a pre-insured occurrence, there is a possibility this could negatively affect the policyholder as well. For example, a policyholder chose hospital cash cover as the fixed-benefit health plan and stipulated a limit of Rs.2,000 per day towards expenses. In the course of this policyholder’s hospitalisation, a total of 4 days were spent in hospital and the total bill was Rs.30,000. However, under the plan, only Rs.6,000 will be released due to the limits put on the plan at the outset (each day being Rs.2,000).

    What is an Indemnity Based Health Insurance Plan?

    An indemnity-based plan is a health insurance plan that reimburses the policyholder the cost of medical expenses. These plans will reimburse the policyholder with the actual amount incurred as expenses during a hospitalisation stay up to the sum insured under the policy. For example, if a policyholder chooses a sum insured amount of Rs.4 lakh and is presented with a hospitalisation bill amounting to Rs.1.5 lakh, the insurance company will pay out Rs.1.5 lakh to the policyholder. The balance amount will be left unutilised for a future claim during the policy term.

    In the case of an indemnity plan, the policyholder is required to submit hospital bills detailing the expenses incurred during the hospital stay. An example of an indemnity-based health plan is the ‘Mediclaim’ insurance plan, a popular health insurance product.

    Indemnity-based health plans generally have a deductible, which is a fixed amount that is pre-decided. The deductible amount has to be paid by the policyholder for hospitalisation expenses, with the remainder amount being paid for by the insurance company up to the sum insured amount. Some indemnity-based plans do not have a deductible, with the insurer paying the full cost of the hospitalisation expense (up to the sum insured limit).

    Benefits of Indemnity Based Health Plans:

    Indemnity-based health plans allow flexibility when it comes to the hospital and health care professional, as they generally have tie-ups with a number of partner hospitals and medical centres. Thus policyholders can choose to visit a particular hospital or medical centre based on the type of treatment they are undergoing without having to worry about medical expenses. These plans also cover a wide range of treatments and illnesses and cover the actual amount of the hospital bill.

    Drawbacks of Indemnity-Based Health Policies:

    While indemnity-based health plans cover the cost of hospitalisation, there are a number of expenses they do not cover. These include the cost of post-operative care and medicines. Indemnity plans have a deductible (unless specified), resulting in the policyholder having to meet some portion of their expenses on their own.

     In conclusion, when buying a health insurance plan, it is imperative to have an indemnity-based plan to cover the cost of hospitalisation. For those who wish to extend their insurance coverage, opting for a fixed-benefit plan is a good idea as this plan will reimburse the policyholder for pre-decided incidents or illnesses up to the amount decided at the time of buying the plan.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Health Insurance Reviews

  • Page 1 of 50 1 2 3 4 5
    • Star Health Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the Star Health. I have claimed this policy for 2 lacs. The whole claim process was easy, after discharge. The service was very good. I am really happy about the service of Star Health and it is a recommendable health insurance policy to have.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 20, 2018
    • ICICI Lombard Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the ICICI Lombard . I pay a premium of 5500 per year for this policy. I do not have any claim experience with the policy. They offers 5 lacs coverage for the entire family and the network list of hospitals are also pretty solid with their services.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 20, 2018
    • Cigna TTK Health Insurance
      "Good Service"
      0.5 3.0/5 "Satisfactory"
      I've a health insurance provided by the Employer from the Cigna TTK . I do not have any claim experience , Company is paying the premium. It offers an annually coverage of 2 lacs for me and 1 lac for my wife and 50000 for my children. So far it has been a smooth experience and I'll have to wait and see how they respond to my claim in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 20, 2018
    • HDFC Ergo Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      Got the health insurance policy from the HDFC ERGO around a year ago. The customer support service and the response is good with the HDFC ergo . This policy covers only one member in my family. I have the medical coverage up to Rs,3,00,000 and I am satisfied having the health insurance policy.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jun 20, 2018
    • Star Health Health Insurance
      "Excellent"
      0.5 4.0/5 "Great!"
      I am having the health insurance policy with the Star health insurance company. Customer service is good one and their response too. Coverage value is fine one too with the Star health insurance company. I have not faced any such claims with them till now.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 20, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with MAX BUPA from last 3 years and it is one of the good policy. It is a family coverage where spouse and children are covered. I pay a premium of Rs 18000 for this health insurance. My claim experience was good and they covered 70% of the billed amount.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 19, 2018
    • Religare Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I was using health insurance policy with Religare from last 2 years, i am happy with the coverage value of this insurance policy. I am satisfied with the claim experience and it was a cashless treatment. I have a coverage value of Rs 3 lakhs for this insurance policy.
      Was this review helpful? 0
      , navi mumbai
      Reviewed on Jun 19, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 5.0/5 "Blown Away!"
      I took health insurance from Icici health insurance . I have choose this insurance mainly because of convincing premium with too many benefits . This policy covers Cashless hospitalization. Pre diseases coverage . Overall am satisfied with customer care and service. Am getting income tax benefits
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 19, 2018
    • New India Health Insurance
      "Very good service"
      0.5 5.0/5 "Blown Away!"
      New India Assurance was the first health insurance provider with the Employer provided health insurance, They've partnered with the many hospitals in Pan India and also offered protection for the entire family. They were also offering cashless treatment facilities. Overall it has been a smooth experience.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 18, 2018
    • SBI General Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with SBI general insurance from last 2 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance company. I pay a premium of Rs 50 per month for this insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 18, 2018
    • Star Health Health Insurance
      "Good to have insurance policy"
      0.5 3.0/5 "Satisfactory"
      Idon't have any experience of claim hence i never get a chance to call their customer care. They used to call me for renewing the policy. I can claim about 3.5 lakhs per annum. If i use 10% or not claim the policy, they wont give additional benefits for the next year. Their is a insured amount by 10%. My premium amount will be same but the claim amount they will increase by 10% next year. Cashless treatment is available in this policy
      Was this review helpful? 0
      , noida
      Reviewed on Jun 18, 2018
    • National Insurance Health Insurance
      "Very late back policy"
      0.5 3.0/5 "Satisfactory"
      My company people have taken health insurance policy to the employees. Once i have claimed the policy for my mother. The service is not good as per experience. They have a separate hospital list, in that they have mentioned cashless facility is available but when i went for those hospital, they said their is no cashless facility for this insurance. They will not response from the National Health insurance. The number will keep on ringing. After that my company asked me to send the bill. But i never done to this company. The claim is very low which is less than 20000.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 18, 2018
    • Religare Health Insurance
      "BEST"
      0.5 4.0/5 "Great!"
      From past 7months i am using this health insurance. Documents i have done through the on line. The coverage is for 10k. Per annual i pay of rupees 7-8k. Disease coverage is there. Free medical checkup once in a year is also available in my insurance.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 17, 2018
    • New India Health Insurance
      "Chatting with customer at clamp time"
      0.5 0.5/5 "Unacceptable"
      This is a type of fraud company.This does not pass the claim.When they go to the customer to make a claim, it only rotates it, this time of direction can be more than 8 months.thay do not have any response anymore, only you have to call them these times and you have to consider the information.Out of which it does not raise your phone more than half the time. Each time they constantly ask for something new, they never tell you once and after 8 or 9 months of the final, you cancel your claim according to the new rule.They do not deliberately describe the whole processor, either by either losing the customer tired or in the last. I will request all individual personal and special corporate offices to never do any bonding with this type of company.Because the new rules which it says in 8 or 9 months, how will the customer know at first sight, they deliberately conceal the rules so that the customer does not get disturbed and do not claim.
      Was this review helpful? 0
      , neemuch
      Reviewed on Jun 16, 2018
    • National Insurance Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy from the National Insurance. I am paying the premium of 1400 per year. You can claim this policy at any network hospitals in the country. The need to nofity the customers about the partnered hospitals. If they have tie up with the a new hospital they need to send updates to the customers or publish it on their website.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Star Health Health Insurance
      "Average Service"
      0.5 2.0/5 "Expected more"
      I'm using the Star Health insurance policy. I do not have any claim experience yet. I pay a premium of 8000 Per year. They don't send any renewal notifications. Their Service is good. The coverage is 1 lac for whole family per year. They need to improve their notifications and keep the customer posted about important dates.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've been using the health insurance policy from Royal Sundaram for a while. I am paying the premium of 8000, many of my friends recommended Royal Sundaram. I never had any claim experience with the policy. Overall it has been a smooth experience. I'll have to wait and see how they respond to my requirement in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Apollo Munich Health Insurance
      "The Best"
      0.5 5.0/5 "Blown Away!"
      Since I'm working with health insurance. It is easy to claim in Apollo Munich. The best hospital list covered in this policy. The best health insurance company in PAN India. In my company, they are paying the insurance premium for me and my family.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 14, 2018
    • HDFC Ergo Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've a health insurance policy with the HDFC Ergo. I pay a premium of 6100 Per year, I do not have any claim experience with the policy and it offers full coverage for my entire family. They offer a coverage 2 lacs annually which is pretty good for me. Overall it has been a good experience with the features of the policy. .
      Was this review helpful? 0
      , ghaziabad
      Reviewed on Jun 14, 2018
    • Bajaj Allianz Health Insurance
      "Good Health Insurance policy"
      0.5 5.0/5 "Blown Away!"
      So far i have never claim the health insurance. I can claim upto 7 lakhs. I have taken this insurance policy for me and dependent. The employer take care of the premium amount. I have never contact the customer care. Almost most of the hospital has been covered in this health insurance
      Was this review helpful? 0
      , coimbatore
      Reviewed on Jun 14, 2018
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