Health insurance today is just one of those necessities that modern Indians can’t afford to ignore. The rate of hospitalizations is on the rise, as are the treatment costs.
Health insurance helps policyholders avoid financial strain during unforeseen and unfortunate circumstances that land them in the hospital. Insurance companies that provide health insurance products pay all or part of the hospitalization and treatment charges that would otherwise have to borne solely by the patient him/herself, in exchange for a one-time or periodic premium payment.
Health insurance companies tie up with hospitals to ensure that the reimbursement and claims processes can be carried out efficiently, and with minimal verification.
Anyone researching health insurance policies in 2016 will have to be aware of their exact requirements before starting their research. Health insurance is available in many forms from many providers – the most common differentiation being between Individual, Family Floater, Senior Citizen, or Critical Illness plans. These four health insurance plan sub-categories have minor differences in their terms, conditions, policies, and wordings that offer additional benefits to those falling under a particular category.
Individual health insurance: This is taken by customers who wish to protect themselves from financial uncertainty in case they are ever hospitalized due to the onset of a sudden and unforeseen illness, or an accident at work or on the road.
Family floater health insurance: This is taken by customers who wish to cover themselves from potential financial uncertainty that could arise from any member of their family requiring hospitalization. Some people, who are unaware of this category, choose to take individual policies for each member of their family – this is an expensive and unnecessary practice.
Senior citizen health insurance: This is taken by and for senior citizens, and has a lot of additional benefits and financial coverage for health issues and injuries that are common among senior citizens. A senior citizen would benefit a lot more taking a senior citizen health insurance plan, than he or she would by taking a regular individual health insurance plan.
Critical illness health insurance: Regular hospitalization and treatment charges, while incredibly expensive, cannot even be compared to the amount charged for treatment of critical illnesses. There are specific health insurance policies that offer huge pay outs on the diagnosis of pre-defined critical illnesses.
Based on the type of insurance policy you need, check out the following list of the best health insurance policies under any category in 2016.
Best Individual Health Insurance Plans in 2016:
If you feel that individual health insurance plans are the best fit for your personal insurance requirement, check the table below:
|Features/Plans||Apollo Munich Easy Health||ICICI Lombard Complete Health – iHealth||Religare Care||Max BUPA Health Companion||Bajaj Allianz Health Guard|
|Minimum Entry Age||18 years for proposer. 5 years for children.||18 years for proposer. 6 months for children.||18 years for proposer. 91 days for children.||18 years for proposer. 3 months for children.||18 years for proposer. 3 months for children.|
|Maximum Entry Age||65 years.||No maximum entry age.||No maximum entry age.||No maximum entry age.||65 years.|
|Minimum Sum Assured||Rs.1,00,000||Rs.1,00,000.||Rs.3,00,000.||Rs.2,00,000.||Rs.2,00,000.|
|Maximum Sum Assured||Rs.50,00,000||Rs.10,00,000.||Rs.60,00,000.||Rs.1,00,00,000.||Rs.1,00,00,000.|
|Waiting Period||3 years for pre-existing medical conditions.||2 years or 4 years for pre-existing medical conditions, depending on the coverage option chosen.||4 years for pre-existing medical conditions.||3 years or 4 years for pre-existing medical conditions, depending on the variant option chosen.||2 years or 4 years for pre-existing medical conditions, depending on the case.|
|Co-Pay||No.||No co-pay.||No co-pay.||No co-pay.||10% co-pay.|
|Sub-limits on room rent||None.||No sub-limits. Allowed on request.||No sub-limits.||No sub-limits. Allowed on request.||No sub-limits.|
|Incurred Claim Ratio of the Insurer||63.03%||87.38%||61.13%||55.16%||73.59%|
|No-Claim Bonus||100% no claim bonus.||10% increase in sum assured for every claim free year. Up to 50%.||50% to 150%.||100% in 5 years.||10% each claim free year.|
- Apollo Munich Easy Health:
Apollo Munich Insurance Company’s individual health insurance plan offers excellent benefits at a very affordable rate. A part of the plan’s benefit payout is in the form of paying off the expenses incurred pre-hospitalization, in-patient hospitalization, and even post-hospitalization. Over 144 pre-listed day care procedures are covered even if no hospitalization is needed. Free health check-ups, coverage of expenses for domiciliary treatment, and coverage even for Ayurvedic, Homeopathic, Unani, and Sidha treatments make this a versatile and affordable plan.
- ICICI Lombard Complete Health – iHealth:
ICICI Lombard’s Complete Health – iHealth individual health insurance solution incorporates the best of features from its competitors. It incorporates features like policyholders below the age of 46 years have no requirement for a medical check-up, the policy has lifetime renewability, etc. With a massive hospital network of over 4,500 partner hospitals, this health insurance policy is as usable as it is efficient. Medical expenses incurred up to 30 days prior to – and 45 days post hospitalization are also covered in addition to hospitalization and treatment expenses for hospitalization over 24 hours. Expenses for day care procedures that do not require hospitalization are also covered.
- Religare Care:
As far as health insurance plans go, very few offer the bang for buck that Religare Care does. With coverage for day care procedures, room rent, ICU charges, Ambulance charges, domiciliary expenses, pre-and-post-hospitalization expenses, annual check-ups, and even second opinions, the plan pretty much covers your entire healthcare expenses requirement. The level of coverage offered under each heading varies depending on the sum insured option chosen. There are no sub-limits on the amounts that can be claimed as doctor’s fees, or other medical charges. The plan also has a no-claim bonus, the details of which also vary depending on the sum assured option chosen.
- Max BUPA Health Companion:
The Max BUPA Health Companion plan has 3 variants which basically alter the total scope of coverage and amount of coverage offered under various different heads. Across all variants, however, there are no sub limits on room rent, a full 100% no-claim bonus if there are no claims by the policyholder for 5 years, and no co-pay and the option to extend the scope of coverage to support up to 4 dependant family members. Depending on the variant, the coverage under the plan varies between Rs.2,00,000 to Rs.1,00,00,000. Max BUPA also processes all claims in-house and does not make policyholders deal with TPAs. Emergency ambulance charges, organ donation charges, hospital cash, medical professionals’ fees, etc. are all covered under the plan. The plan also has renewal benefits and cashless treatment.
- Bajaj Allianz Health Guard:
A well balanced policy from the insurer with the highest claim settlement ratio, this individual insurance plan covers the expenses incurred during hospitalization, doctor’s fees, treatment, pre and post hospitalization, taking emergency ambulances, etc. and also covers around 130 day care procedures that do not require hospitalization. Cashless hospitalization facilities can be availed at over 4,000 network hospitals. No medical test are required, and free health check-ups become available after 4 claim-free years at any recognized diagnostic centre. The regular exclusions apply, as they do with all the above plans as well, and any disease contracted within 30 days from the date of coverage will not be covered.
Best Family Floater Health Insurance Plans of 2016:
For those who wish to bring their parents, spouse, and children under the coverage of an effective health insurance product – consider these 5 plans in addition to your research:
|Apollo Munich Optima Restore||Star Family Health Optima||Religare Care||Max BUPA Health Companion||Royal Sundaram Lifeline Elite|
|Minimum Entry Age||18 years for proposer. 5 years for children.||18 years for proposer. 16 days for children.||18 years for proposer. 3 months for children.||18 years for proposer. 3 months for children.||18 years for proposer. 91 days for children.|
|Maximum Entry Age||65 years.||65 years.||No maximum entry age for adults. 25 years maximum entry age for children.||No maximum entry age for adults. 21 years maximum entry age for children.||No maximum entry age for adults. 21 years maximum entry age for children.|
|Minimum Sum Assured||Rs.3,00,000.||Rs.2,00,000.||Rs.3,00,000.||Rs.2,00,000.||Rs.25,00,000.|
|Maximum Sum Assured||Rs.50,00,000.||Rs.15,00,000.||Rs.60,00,000.||Rs.1,00,00,000.||Rs.1,50,00,000.|
|Family Members Covered||6 total.||5 total.||6 total.||4 total.||5 total.|
|Waiting Period||3 years for pre-existing diseases or medical conditions.||4 years for pre-existing diseases or medical conditions. 2 years for specified ailments.||4 years for pre-existing diseases or medical conditions. 2 years for specified ailments.||4 years for pre-existing diseases or medical conditions. 3 years or 2 years for specified ailments depending on the variant chosen.||2 years for pre-existing diseases or medical conditions.|
|Co-Pay||No co-pay.||20% co-pay.||No co-pay.||20% co-pay, depending on the situation.||No co-pay.|
|Sub-limits on room rent||No sub-limits on room rent.||No sub-limits on room rent.||1% of the cover amount per day.||No sub limits.||No sub limits.|
|Incurred Claim Ratio of the Insurer||63.03%.||63.96%.||61.13%.||55.16%||52.89%|
|No-Claim Bonus||50% of basic sum assured for every claim free year.||Up to the pre-specified limits.||50% to 150% based on NCBS.||100% in 5 years.||20%, subject to a maximum of 100%.|
- Apollo Munich Optima Restore:
Bring your entire family under the coverage of an excellent and comprehensive health insurance policy with the Apollo Munich Optima Restore plan. The plan is affordable and covers a lot of expenses that one will face in the event of hospitalization or on the diagnosis of a life threatening disease. Ensure peace of mind by resting in the knowledge that a medical emergency will not become a financial hurdle that requires getting trapped by the debt of personal loan, credit card, etc. The plan covers domiciliary treatment, organ donor expenses, pre and post hospitalization expenses, ambulance charges, day care procedures that do not require hospitalization, and even offers a daily cash benefit. There is also a rider available with this plan that provides additional benefit pay outs on the diagnosis of a critical illness. With a wide range of possible coverage from Rs.3,00,000 to Rs.50,00,000, the Family Floater is a plan that can be taken by a wide range of families no matter how high or low their level of income may be.
- Star Family Health Optima:
This plan offers excellent coverage for a wider variety of ailments, diseases, and procedures to treat the same than its competition. Coverage is available for children right from when they are 16 days old. The expenses for domiciliary treatments, ambulance and hospital charges, etc. are all taken care of under the umbrella of Star Family Health Optima’s coverage. A wider range of over 400 day care procedures are covered under this plan, in addition to coverage for expenses incurred as fees and charges for anaesthetists, consultants, specialists, blood and oxygen, OT charges, etc. Pre and post hospitalization charges are also taken care of under this plan. Even donor expenses for organ transplantation are covered under this plan. The company boasts a fast claim settlement process that it runs in-house without any TPA. The company also has over 6,000 network hospitals. Medical and insurance records and forms, etc. can be maintained online with the facility provided by Star Health Insurance Company.
- Religare Care:
Bring your family under the coverage of an excellent health insurance policy with this one plan that doesn’t burn a hole in your pocket. The plan covers the expenses for room rent, pre and post hospitalization expenditure, ambulance charges, domiciliary hospitalization, and a daily cash allowance. The daily cash allowance is capped at Rs.500, and is not available for policies with sum assured options of below Rs.4,00,000. While this plan is affordable and provides a good amount of basic coverage, it does not cover alternative medical practices, medical procedures related to the eye, or offer any outpatient benefits. The plan does not cover maternity expenses, or critical illnesses. This is one of the few plans in the market that provides for private room compensation along with one free medical check-up every year. It should be noted that most of the benefits in this plan apply to those who choose a sum assured option of over Rs.5,00,000 and enter the plan before attaining the age of 60.
- Max Bupa Health Companion:
With features like no limits on room rent, a higher daily cash allowance than most other plans, etc., this plan has all the features of a great family floater while also being easy on your pocket. While not the cheapest plan for the corresponding benefits in the category, this plan offers additional benefits like vaccinations in case of animal bites, a personal healthcare manager, organ donation expenses, up to Rs.2,000 hospital cash per day of hospitalization, etc. There are three plan variants that can be chosen under this policy, with varying sum insured options and their own specific terms and conditions. Pre-existing diseases and medical conditions can be treated after either 4 years (for variant 1), or 3 years (for variants 2 and 3). Annual aggregate deductible options of 1, 2, 3, 4, 5 or 10 lakhs can be chosen when top up is required.
- Royal Sundaram Lifeline Elite:
One of the best insurance plans for a family floater, but ironically being offered by one of the insurance companies which has a slightly less than desirable incurred claim ratio. The company is very strict on its policies, but pays out better than most other plans because of its wide coverage and huge sum insured options. As with most other plans, this plan also covers pre and post hospitalization expenses, expenses incurred due to in patient care, organ donor expenses, ambulance charges, etc. but what sets it apart is the fact that it also covers day care procedures such as chemotherapy and dialysis. Ayurvedic and Homeopathic treatments are also covered under this plan. Expenses incurred in cases where the patient wishes to take a second opinion on the diagnosis of a critical illness are also fully covered. The plan also provides for coverage of all charges related to emergency domestic evacuation, say, from an accident spot to the hospital, or between healthcare centres, etc. This plan covers maternity expenses incurred, and, unlike most other plans, also provides reimbursement for expenses incurred while seeking international expert medical treatment for 11 (pre-defined) critical illnesses. Airfare up to Rs.3,00,000 is also covered in these special international cases.
Best Senior Citizen Health Insurance Plans in 2016:
These plans are specifically designed for senior citizens, keeping in mind their unique requirements and needs.
|Apollo Munich Optima Senior||Bajaj Allianz Silver Health||Star Senior Citizens Red Carpet||Max BUPA Heartbeat Individual Gold||National Insurance Varistha Mediclaim|
|Minimum Entry Age||61 years.||46 years.||60 years.||3 months.||60 years.|
|Maximum Entry Age||No maximum entry age.||70 years.||75 years.||65 years.||No limit.|
|Minimum Sum Assured||Rs.2,00,000.||Rs.50,000.||Rs.1,00,000.||Rs.5,00,000.||Mediclaim: Rs.1,00,000, Critical Illness: Rs.2,00,000.|
|Maximum Sum Assured||Rs.5,00,000.||Rs.5,00,000.||Rs.10,00,000.||Rs.50,00,000.||Mediclaim: Rs.1,00,000, Critical Illness: Rs.2,00,000.|
|Waiting Period||Pre-existing diseases and medical conditions will be covered after 3 continuous policy years.||1 year for all pre-existing diseases and medical conditions.||2 years waiting period for pre-existing diseases and medical conditions to be covered. 1 year in some cases.||1 year.||1 claim free year for pre-existing diseases and pre-existing medical conditions.|
|Co-Pay||15% or 30% co-pay depending on the case.||20% co-pay if treatment is sought at a non-network hospital. Co-pay can be waived off on the payment of additional premium.||50% for claims arising out of pre-existing diseases. 30% for all other claims.||20% co-pay. Can be reduced through renewals and signing up for the plan at an early stage.||10% for all claims other than those arising due to Cataract and Benign prostatic hyperplasia.|
|Sub-limits on room rent||No sub limits on room rent.||None.||None.||None.||1% per day.|
|Incurred Claim Ratio of the Insurer||63.03%||73.59%||63.96%||55.16%||110.2%.|
|No-Claim Bonus||5% every claim free year.||10% for every claim free year.||None.||Up to 100% in 5 years.||5%, up to a maximum of 50%, per year.|
- Apollo Munich Optima Senior:
A plan made specifically to cater to the health insurance needs of senior citizens in India, the Apollo Munich Optima Senior plan incorporates a lifetime coverage policy wherein there is no maximum age where coverage will cease. This plan also incorporates cumulative bonuses, cashless service, enhancements on sum insured, and full portability of an existing insurance plan. The plan also covers expenses incurred as a result of pre and post hospitalization, over 140 day care procedures that do not require hospitalization, organ donor expenses, emergency ambulance expenses, domiciliary treatment, and the cost for a second medical opinion.
- Bajaj Allianz Silver Health:
The Silver Health plan from Bajaj Allianz is a true all-rounder. The plan has one of the lowest waiting period for coverage of pre-existing diseases at 1 year. The plan also allows for co-pay clauses to be entirely waived off on the payment of a small amount of additional premium. With cashless hospitalization over a huge network of participating hospitals and a family discount of 5%, the plan offers a sense of flexibility and security that very few other plans are able to imitate. Although it is necessary to submit medical test results to the company prior to taking on this plan, the company will reimburse you for the cost of the medical examination if you are found to be eligible, and the plan has lifetime renewability. Emergency ambulance expenses (up to Rs.1,000) and over 130 day care procedures are also covered under this plan.
- Star Senior Citizens Red Carpet:
The Senior Citizens Red Carpet health insurance plan from Star Health Insurance Company allows for an incredible amount of flexibility when it comes to choosing the sum assured. Different sum assured options mean that different levels of premium need to be paid, and this plan has the most number of pre-set sum assured options. In-house claim settlement means that there is no waiting or worrying about how the TPA will process the claim. Claims are also processed and resolved in record time at over 6,000 partner hospitals, as Star Health Insurance is one of the most positively reviewed health insurance companies in India. Sub-limits don’t apply on room rent, but apply for the treatment of certain pre-specified medical conditions. Discounts on premium payable are also available if the insured party undergoes a battery of medical examinations.
- Max Bupa Heartbeat Individual Gold:
This plan offers a few benefits that other plans overlook, and also has one of the most flexible sum assured ranges in the market. This is a general health insurance plan that can also be taken up by senior citizens as it has excellent coverage and benefits. The plan has three variants under the individual category, Silver, Gold, and Platinum – each with varying coverage, benefits, and premium cost.
- National Insurance Varistha Mediclaim:
While it may not have the bells and whistles of other insurance policies provided by private health insurance firms, this insurance from National Insurance has the best ratings when it comes to claims processing. This plan offers the basic Mediclaim coverage and coverage for many day care procedures and almost all procedures that require hospitalization. The plan also covers around 7 major critical illnesses. The plan incorporates a cumulative bonus to reward healthy living and not making claims on the policy. The plan also allows for domiciliary hospitalization expenses to be covered under the benefits.
Best Critical Illness Insurance Plans in 2016:
The following list contains 5 of the best critical illness health insurance policies in India in 2016:
|Apollo Munich Optima Vital||Religare Assure||HDFC ERGO Critical Illness Platinum||Bajaj Allianz Critical Illness||Max BUPA Health Assurance Critical Illness Option|
|Minimum Entry Age||18 years.||18 years.||5 years for dependants. 18 years for proposer.||6 years children. 18 years for proposer.||18 years.|
|Maximum Entry Age||65 years.||65 years.||65 years.||65 years.||65 years.|
|Minimum Sum Assured||Rs.1,00,000.||Rs.5,00,000.||Rs.2,50,000.||Rs.1,00,000.||Rs.3,00,000.|
|Maximum Sum Assured||Rs.50,00,000.||Rs.1,00,00,000.||Rs.10,00,000.||Rs.50,00,000.||Rs.10,00,000.|
|No. of critical illnesses covered||37||20||15||10||20|
|Waiting Period||4 years for pre-existing diseases and medical conditions.||4 years for pre-existing diseases and medical conditions.||90 days.||90 days.||Pre-existing diseases and medical conditions will be covered after 4 years of continuous insurance coverage under this plan.|
|Incurred Claim Ratio of the Insurer||63.03%||61.13%.||56.48%||73.59%.||55.16%.|
|No-Claim Bonus||Sum insured can be increased on renewal if no claim has been made in the previous coverage year.||None.||None.||None.||None.|
- Apollo Munich Optima Vital:
The Apollo Munich Optima Vital insurance plan not only provides a wide scope of cover for a wide range of critical illnesses, it also provides benefits that extend beyond the simple pay out of benefits. Once any of the covered critical illnesses have been diagnosed, a lump sum will be paid out, and a second opinion can be sought from among a list of expert medical specialists chosen by Apollo Munich. There is a clause that states that the policyholder must survive for a period of at least 30 days from the date of diagnosis. There are discounts on premium (up to 7.5%) available when the policy has been taken for a tenure of 2 years. The policy can be extended to cover the policyholder’s dependent parents, spouse, and dependent children up to a maximum of 6 members.
- Religare Assure:
One of the most important features of the Religare Assure Critical Illness policy is that there is no survival period before the benefits become payable. Another feature that truly sets it apart from other critical illness policies is the range of sum insured options available – Rs.5 lakh, RS.10 lakh, Rs.15 lakh, Rs.20 lakh, Rs.30 lakh, Rs.50 lakh, Rs.75 lakh, and Rs.1 crore – this range has at least 4 more options than those made available by other insurers. The plan also incorporates a policy of paying out benefits under different headings and categories. Benefit 1 pays out a lump sum on the diagnosis of a critical illness or surgical procedure required. Benefit 2 covers the expenses and costs that arise out of personal accidents. Benefit 3 is unique to Religare, and is called the “Child Education Benefit” which essentially allows for dependent children under the age of 24 to continue their education unhampered by financial constraints that arise out of medical expenses being borne by the parents. Benefit 4 allocates funds towards getting a second opinion on the diagnosis. Benefit 5 allocates funds for health check-ups for the policyholder in order to maintain and track progress / status of the policyholder’s general health. In addition to these sectioned benefits, the plan also offers the advantage of being totally portable, which means that any plan from any other insurer can be changed into this plan on renewal.
- HDFC ERGO Critical Illness Platinum:
One of the more stable critical illness policies in the market today, the Critical Illness Platinum plan is the highest value variant of HDFC ERGO’s critical illness health insurance policies. The plan pays out a lump sum benefit on the diagnosis of any one of 15 pre-specified critical illnesses (after the policyholder survives the 30-day survival period), including benign brain tumour and Parkinson’s disease (which most other policies don’t cover). The plan also does not require a medical check-up for applicants that are under the age of 45. Despite the fact that the plan does not provide as much coverage as other plans out there, covers only 15 critical illnesses, has a survival period clause, and also has one of the lowest incurred claim ratios – people still buy the HDFC ERGO Critical Illness Platinum plan.
- Bajaj Allianz Critical Illness:
While most other plans offer staggered or periodic pay outs on the diagnosis of a pre-defined critical illness, the Bajaj Allianz Critical Illness plan makes one large lump sum pay out after the policyholder survives the 30-day survival period. This is also one of the few plans out there that covers donor expenses in cases of transplant surgeries. This insurer also does not use any TPA to process claims and settlements, but does this in-house, which increases response time and offers an overall smoother experience while processing claims. Sum insured options vary depending on the age of life insured, with a range of options between Rs.1,00,000 and Rs.50,00,000 for policyholders aged between 18-60, and a range between Rs.1,00,000 and Rs.5,00,000 for policyholder aged between 60-65. There is a loading factor that applies in some cases, which can range from a minimum of 10% to a maximum of 150% on the standard premium rates. Overall a stable plan which covers the most common critical illnesses.
- Max Bupa Health Assurance Critical Illness Option:
With a huge scope of coverage and many benefit pay outs for legitimate claims, the Max Bupa Health Assurance Critical Illness option provides one of the most comprehensive and effective critical illness policies on the market today. Under the Health Assurance product line, which offers policyholders a wide range of customizable coverage options and various combinations of the same, Max BUPA has really gone above and beyond the call and provided access to coverage and benefits that other insurers usually shy away from. Under the Health Assurance product line, policyholders can choose a custom combination of policies that cover specific eventualities – for example – customers can take any one of these variants:
- Critical Illness + Hospital Cash + Personal Accident.
- Critical Illness + Hospital Cash.
- Critical Illness + Personal Accident.
- Critical Illness only.
- Hospital Cash + Personal Accident.
- Hospital Cash only.
- Personal Accident only.
This level of customization can be done depending on the policyholder’s individual and specific needs for specific coverage.
Tax Benefits of Health Insurance Plans:
The premiums paid on all health insurance plans can be used to help save tax under Section 80D of the Income Tax Act, 1961.
*Please note that all promotions, amounts, tenures, repayment requirements, time frames, interest rates, other rates, charges, fees, ceilings, requirements, criteria, features, benefits, exclusions, calculations, ratios, ratings, terms and conditions mentioned above are as of April, 2016 (except for the incurred claim ratio data which is as of FY 2014-2015), and are subject to change at any time. All banks / NBFCs / insurance providers / financial service providers / companies, etc. mentioned above retain all rights to modify, replace, or add to or subtract from any of the above, in any way, at any time, and at their own discretion. You are requested to reconfirm the same with your chosen bank / company / NBFC / insurance provider / financial service provider, etc. before making any financial commitments.