A Health insurance policy is a contract between the insurance company and the policyholder, wherein the insurer pays for the medical expenses incurred by the life insured. The insurer will either provide a reimbursement for your medical expenses or ensure you are eligible for cashless treatment for injuries or illnesses covered under the policy at one of the network hospitals. You can also get tax deductions on the premiums paid towards health insurance under Section 80D of the Income Tax Act, 1961.
| Types of Health Insurance Plans | Benefits of Health Insurance | Health Insurance Network Hospital | Mediclaim Policy | Health Insurance News |
|---|
| Insurance Provider | Claim Settlement Ratio | Key Features |
| IFFCO Tokio General Insurance | 99.71% |
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| Bajaj Allianz General Insurance | 98.48% |
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| Care Health Insurance | 96.2% |
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| Navi General Insurance | 97% |
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| Bharti AXA General Insurance | 99.05% |
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Mentioned below are the different types of health insurance plans you can choose to meet your specific requirements:
The following are the documents you will require to purchase health insurance in India:
Age proof: When purchasing a health insurance policy, you will be required to submit the age proof of all individuals who are going to be covered by the plan. The following documents are acceptable as proof of age:
Proof of identity: The following documents can be submitted as ID proof when applying for a health insurance plan:
Proof of residence: A permanent address proof must also be submitted when applying for health insurance. The following documents can be used for this purpose:
Passport-sized photographs
Certain health insurance companies will require applicants to undergo medical examinations in order to qualify for coverage. Also, insurers can also request other documents apart from the ones mentioned above.
The Central Bureau of Health Intelligence presented a report in 2015-16. According to the report, which was supervised by the Ministry of Health and Family Welfare, less than 30% of Indian citizens were covered by any sort of health insurance. This information highlights the poor situation of the healthcare industry in India. India also happens to be one of the most populated countries in the world, where two-third of the populace is poor and has limited access to basic necessities. As such, investing in health insurance is extremely difficult for many people.
Keeping the situation of its citizens in mind, the Government of India has launched a number of health insurance schemes to financially protect those who cannot afford health insurance. These schemes are made available at affordable prices and offer moderate cover against medical emergencies. A lot of people who come from the middle-income group are making the most of these schemes. Government-sponsored health insurance plans can be purchased from web aggregators that allow you to compare various plans before you find one that best suits your needs.
The following are some of the best health insurance policies offered by the Government of India:
Over the past few years, there has been tremendous growth of the health insurance sector in India. Citizens of the country now have access to a large number of options so far as health insurance companies are concerned, so much so that it is quite hard to find the best health insurance company based on your requirements. A few factors must be kept in mind when choosing an insurer. They are as follows:
There’s more in a name than the ancient proverb suggests. A company’s reputation gives an insight into the kind of services as well as the quality of service you can expect from your insurer. A company with a good reputation with a good brand image is a safe bet as you can be assured of a good experience. While you can always consider word of mouth to choose an insurance company, sound research will go a long way towards ensuring you select the best option at your disposal.
Research is crucial to finding the right insurance company. Look for the company’s financial solidity before picking it. The Credit Rating Information Services of India Private Limited (CRISIL) rating can help you assess the financial stability of an insurance company. Companies with AAA ratings are recommended as they have the best financial strength, making it easier for them to meet obligations.
Considering the fact that insurance is a massive industry, products and services are bound to change over time. Along with the changes in the insurance industry, your insurance requirements can also change as you age. It is therefore very important to consider companies that have a wide variety of insurance plans that can cater to the requirements of a diverse customer base.
When you purchase a health insurance plan for emergencies in the future, it is only natural to expect your claims to be settled quickly. The filing of claims is considered a tedious task and the process can take a long time to complete after you submit the form and supporting documents. Approval can take a while if the company is not up to the mark with its settlement process, and there are chances of your claim getting rejected as well. It is therefore crucial to check for the claims settlement ratio along with the simplicity of its claims settlement process to ensure that there are no hassles at the time of making claims.
Lay people often find it difficult to understand insurance. It is for this reason that an increasing number of insurance providers are appointing advisors so that it becomes easier for customers to comprehend the concept of insurance. These advisors offer support when it comes to selecting the right health insurance policy based on your requirements. They also offer assistance with regard to claim-related queries.
Customer service is one of the most crucial factors to consider when purchasing any product. When you buy a health insurance policy, you will have to ensure that you get solutions and support at your fingertips. A reputed company with an efficient customer support team will ensure that all your queries will be resolved at the earliest, be it through email, phone, or online assistance.
Before you buy any product, reading through the customer reviews posted by fellow users of the product will help you gain an insight into their experience. When it comes to health insurance, going through reviews will help you understand how the policy has benefitted other customers. You may also check the website of the Insurance Regulatory and Development Authority of India for the complaints and resolutions of the company.
When you wish to purchase health insurance, the insurance company could ask you to take certain medical examinations. After your age, your health is the second most crucial factor that aids an insurance company in assessing your premiums.
Currently the majority of the health insurance companies in India provide coverage to individuals under 45 years of age without the need for medical exams. However, your pre-existing conditions, if any, will certainly be taken into consideration by the health insurance company. If your insurer does not insist on taking a medical exam, you will be asked to furnish a declaration of good health in addition to disclosing your pre-existing conditions such as hypertension and diabetes. Having no pre-existing conditions and being younger will help you find plans for lower premiums.
Medical examinations usually comprise mainly of physical, urine, and blood tests. Although these tests seem simple, they have the ability to disclose a lot regarding human health. They can detect abnormalities in kidney and liver functions as well as an increase or decrease in blood sugar levels. They can also reveal whether you consume tobacco or alcohol. Those who seek health insurance and are above 55 years of age are generally required to take additional medical exams.
Listed below are some of the top insurance companies offering health insurance policies. The insurance companies have been ranked based on the Incurred Claims Ratio of every insurer. This is the ratio between the premium earned and the total claims incurred by the insurer.
This is the ratio that is generally used to determine how an insurance company is performing. A higher incurred claims ratio means the insurance company has a better track record of settling the claims they receive. It is always good to opt for an insurance company with a high Incurred Claims Ratio.
| Health Insurance Companies | Incurred Claims Ratio (ICR) |
|---|---|
| IFFCO Tokio General Insurance | 99.49% |
| Bajaj Allianz General Insurance | 77.31% |
| Care Health Insurance | 55.15% |
| Navi General Insurance | 26.78% |
| Bharti AXA General Insurance | 65.37% |
| Acko General Insurance | 84.64% |
| Cholamandalam MS General Insurance | 77.35% |
| Edelweiss General Insurance | 111.57% |
| Kotak Mahindra General Insurance | 55.17% |
| Royal Sundaram General Insurance | 67.88% |
The following are the main benefits of being covered by a health insurance policy:
Cashless Treatment:
When you are covered under a health insurance policy, you can avail cashless treatments which essentially means that you can receive medical treatments without having to pay the hospital from your own pockets.
Cover for Pre- as well as Post-Hospitalisation Expenses:
Effective insurance policies offer coverage for pre- as well as post-hospitalisation expenses for a period of 60 days before and after an insured individual is hospitalised.
Transportation Expenses:
In case you hold a health insurance policy and get hospitalised the plan will cover the costs incurred on using an ambulance to transport you from your home to the hospital or vice-versa.
Medical Check-ups:
Most health insurance policies offer free health check-ups. However, most insurance companies only offer these check-ups for free depending on your No Claim Bonus.
No Claim Bonus:
If you hold a health insurance policy and do not make any claims over the course of an entire policy year, you will be rewarded in the form of a No Claim Bonus.
Room Rent:
In case you are hospitalised, you will have to incur costs on room rent. Having a health insurance policy will ensure that these costs are covered to a significant extent.
Tax Benefits:
Having a health insurance policy can offer tax benefits as well. The premium payments you make towards your health insurance plan qualify for tax deductions under Section 80D of the Income Tax Act.
Online Purchasing Facility:
Thanks to the advancements in technology, you no longer need to visit a branch of the health insurance company in order to purchase a plan. You can do so from the comfort of your own home or office.
Renewal:
The renewal of your health insurance policy can also be done online. There is also a lot of flexibility when it comes to renewing your insurance plan. You can alter the terms of coverage based on what you think will work best for you.
Cover for OPD Expenses:
Most of the traditional health insurance plans require the insured individual to be hospitalised for a minimum of 24 hours if they are to be eligible for reimbursements.
Choosing the right insurance plan can be a difficult task, but thanks to advancements in technology, the internet can now grant you access to a large number of options .This can be assessed and compared before you pick the plan that best suits your needs. People tend to make common errors when purchasing health insurance, and avoiding these mistakes can help you make the most of your health insurance policy. The following are the common mistakes you must avoid when purchasing health insurance:
The amount for which you are covered plays a crucial role in determining which policy will best suit your needs. Most people tend to choose plans with lower coverage as it helps them save some money. Lower coverage will help reduce the amount you pay as premium for your insurance policy. While it is important to save money, it is also crucial to ensure that you don’t be too stingy when it comes to buying health insurance as it could prove to be a hassle later.
Many people tend to go with the first insurance company they find. When purchasing a health insurance plan, it is crucial to compare as many plans as possible as it will help you identify which one best suits your needs.
People tend to lie about their medical history when purchasing health insurance as it tends to lower their premiums. When you purchase a health insurance plan, it is essential to be truthful about your past medical health and situations. When you lie about your medical history, there is a chance that your claims could be rejected if the insurer finds out about the same.Ensure that you submit the correct records so that you do not have to encounter a problem later.
The cashless facility is one of the most important things to look for when purchasing a health insurance plan. However, many people tend to even consider this facility when looking for policies. By finding an insurance provider that offers the cashless facility, you can rest assured that you will receive immediate treatment in case of emergencies and the insurer will cover the costs.
When you purchase a health insurance policy, the insurer will provide with an option of co-pay. If you choose this option, you will have to contribute a certain pre-determined amount at the time of making a claim, and the remainder will be paid by the insurance company. The sum assured will not be affected by the co-pay amount.
Health insurance acts as a safety net for an individual's finances in case he/she meets with an unforeseen accident. The insurance policy ensures that the insured gets the best treatment available without worrying about clearing the costs at the time of discharge. Knowing about the claim process is an important piece of information that the insured should be armed with at all times. There are certain procedures that the insured will have to follow at the time of making a claim.
There are two main types of claim process which an individual can choose when making a claim on their health insurance. These are:
For all the illnesses covered under the health insurance policy, the insured can receive treatment from the hospital by providing the details of the health insurance policy along with some proof for the policy.The hospital will then approach the insurance company with the bills. The insurance company will settle the total amount with the hospital after evaluating all the expenses incurred. There is a separate claim process for planned treatments and emergency treatments. In the reimbursement claim process, the policyholder will have to initially pay for the treatment. The money will then be reimbursed by the insurer after the required documents are provided.
Find out more about the claims process to make sure you are aware of all the steps to take at the time of a claim incident.
Cashless facility is available only if you receive treatment in one of the network hospitals of your insurer. A network hospital is a medical facility with which your insurer has a tie-up to provide healthcare to its customers. If you opt for cashless treatment, you don't have to pay the medical bills upfront from out of your pocket. The insurer will pay the network hospital while you receive treatment without any hassle. All you have to do is show your e-card upon arrival at the network hospital to avail cashless treatment.
Check cashless network hospitals nearby your location: Network Hospitals for Cashless Treatment
Portability is the option of switching from one health insurance provider to another. Opting for portability earlier resulted in a loss of all the benefits you may have accumulated with the previous insurer. IRDA made a change to this rule and you can now transfer your insurance from one insurer to another without losing the benefits you gained with the previous insurer. You can also use this option to port from one plan to another plan provided by the same insurer.
Mediclaim covers only hospitalization expenses whereas health insurance reimburses pre and post-hospitalization expenses, pharmacy bills, and ambulance fees besides hospitalization expenses. Often, mediclaim and health insurance are used interchangeably even though they aren’t the same thing.
| Health Insurance Plan | Mediclaim |
| Health insurance plans offer a comprehensive cover against medical expenses incurred by the life insured due to an illness or accidental injury. | Mediclaim provides reimbursement for hospitalization expenses incurred by the life insured. |
| Critical illness cover, personal accident cover, and accidental disability cover are some of the add-ons or riders that can be attached to the base health insurance policy, wherein the life insured is paid a lump sum amount as benefit. | Mediclaim works on the indemnity principle, wherein the life insured is reimbursed his or her hospitalization expenses. |
| Once the claim is made and the sum assured is paid, no further claims can be made under a health insurance plan. | Any number of claims can be made under a mediclaim policy until the sum assured is exhausted or paid in full. |
| The payout in a health insurance plan can be enormous, usually up to Rs.60 lakh. | Medicla.im insurance cover is limited, usually up to Rs.5 lakh. |
To get a health insurance policy, an individual has to pay a premium amount at regular intervals as selected by him/her during the inception of the policy. From the commencement of the policy, if the insured person has any medical expenses to bear, the insurer will be liable to pay them as per the terms and conditions. Please note that few insurers have a waiting period within which no claims will be entertained. The waiting period differs from one insurer to another.
Health insurance is usually included in the benefits offered by an employer to the employees of an organisation. However, the extent of coverage under such a policy may be limited. So, it is advisable to buy a separate individual health insurance policy for extended coverage.
Health insurance plans are available for individuals, families, and senior citizens. The family floater plans protect the entire family under a single insurance policy, covering Out Patient Department (OPD) expenses and much more. Senior citizen health plans usually provide comprehensive health insurance cover for the elderly for treatment of accidental injuries and illnesses.
The following is a brief list of things you should and should not do when buying a health insurance plan:
| Dos | Don’ts |
| Understand your health insurance requirement and choose a customised plan that will meet your needs. The 4 most common kinds of health insurance policies you can consider include mediclaim, surgical benefit plan, hospital cash benefit, and critical illness. Pick a plan that best suits your requirements. | Try not to be over-insured or under-insured. Choose a sufficient health cover that will provide you with the required assistance on time. |
| Go through the fine print of the policy document and ensure that you understand all the inclusions and exclusions of the plan. Customise the plan as per your requirements and make the premium payment only after your proposal has been accepted by the insurer. You can always negotiate the sub-limits and co-payment features in your plan, so make sure you purchase the plan only once you’re certain that your requirements are met. | Don’t settle for a plan because the premium associated with it is cheap. Plans that are offered for low premiums do not provide adequate coverage and may see you incur out-of-pocket expenses in the future. |
| Go through the policy document carefully to understand all the inclusions as well as exclusions of the plan. Look for the waiting period for pre-existing ailments as they vary from policy to policy. Check the fine print in order to avoid shocks later on. | Make sure that your policy does not lapse. Renewing your health insurance plan on time is crucial to ensuring that you will be financially covered in times of emergencies. Delays in renewing your policy can result in the rejection of claims, if any. |
| Look out for the list of network hospitals and the cashless facility. Doing so will ensure that you pick a plan that offers more than just basic healthcare. You will also be able to access quality healthcare in times of emergencies by checking the list of network hospitals. | Be honest about your pre-existing conditions. If you have any illness or condition, it must be disclosed to the insurer as failure to do so or submitting false documents or concealing facts could result in the termination of your health insurance policy. |
Critical illness plan is a rider or add-on that can be attached to your base health insurance or life insurance policy. Under the critical illness rider, the insurer is bound to pay a lump sum amount to the policyholder if the life insured is diagnosed with any of the specified illnesses mentioned in the policy document. On the other hand, medical insurance is an insurance coverage against medical and surgical expenses incurred by the life insured while the policy is active. Insurers will reimburse the policyholder for expenses incurred from accidental injuries or illnesses.
| Health Insurance Plan | Critical Illness Plan |
| It covers hospitalization costs, OPD expenses, and maternity benefits of the life insured. | It offers a lump sum amount on diagnosis of a pre-specified illness of the life insured. |
| Minimum 24 hours of hospitalization is required to claim or receive reimbursement of the medical expenses incurred by the life insured. | Hospitalization of the life insured is not required to receive the critical illness benefit. |
| Policy continues even after a claim is made until the time of renewal. | Policy lapses once the critical illness benefit has been paid by the insurer. |
| Health insurance provides coverage against medical expenses incurred due to an illness or accidental injury. | Critical illness covers only pre-specified illnesses like cancer, heart attack, etc. |
| The waiting period for a health insurance plan is usually 30 days. | The waiting period for a critical illness plan is minimum 3 months. |
Life Insurance offers financial protection to your family at different stages of their lives in your absence whereas health insurance provides insurance coverage against medical expenses incurred by the insured members due to an illness or accidental injury when the policy is active.
| Health Insurance Plan | Life Insurance Plan |
| It provides insurance coverage against medical expenses incurred due to an illness or accidental injury by the life insured. | Sum Assured is paid as death benefit to the nominee or the beneficiary of the life insured. |
| Health insurance plans are not investment products wherein you can save for the future but with a health insurance policy you can receive financial aid at your hour of need in the case of hospitalization due to an illness or injury. | Life insurance companies offer pension and retirement plans to help you secure your future after retirement. |
| The types of health insurance products include mediclaim, critical illness plan, hospital cash plan, and surgical benefit plan. | The types of life insurance products include term plan, Unit Linked Insurance Plan (ULIP), endowment plan, pension or retirement plan, child plan, and annuity plan. |
| No-Claim Bonus and free health check-ups are offered under certain health insurance policies. | Maturity benefit, surrender benefit, and loyalty bonus can be added to the base policy. |
| Get tax deductions on premiums paid towards health insurance under Section 80D of the Income Tax Act, 1961. | Get tax deductions on premiums paid and maturity benefits received under Section 80C and Section 10(10D) of the Income Tax Act, 1961, respectively. |
Term plans are the purest form of life insurance plans which offers optimum life cover upon the death of the life insured without any maturity benefit. Health insurance provides insurance cover against medical and surgical expenses incurred by the life insured while the policy is active. The insurance company will reimburse the policyholder for expenses incurred from accidental injuries or illnesses.
| Medical Insurance Plan | Term Insurance Plan |
| The medical expenses incurred by the life insured due to an accidental injury or illness are reimbursed by the insurer upon hospitalization. | The sum assured is paid to the nominee or beneficiary upon the demise of the life insured. |
| With a health insurance plan, you can avoid taking a loan or using your savings to pay for medical bills. | With a term plan, you can secure the future of your dependents. |
| Premium rates for health insurance plans vary depending upon the policyholder's age. | Insurance premiums for term plans are fixed throughout the policy term. |
| Health insurance plans can be expensive although it offers comprehensive insurance coverage against medical expenses. | Term plans are not only affordable but also offer a comprehensive cover. |
| The reimbursement is only for medical expenses. The payout cannot be used for any other purpose. | The life cover can be used for children’s education, wedding, and the like in the absence of the life insured. |
‘No-Claim Bonus’ is a benefit offered to the policyholder for every claim-free year. It is awarded upon renewal and comes in the form of discounts on premiums or enhancements in the chosen sum assured. Discounts/enhancement range between 5% - 50%.
These are reductions in premiums, awarded to the proposer for covering additional members, usually more than two.
This refers to the number of times an insurer successfully processes claims from admission to pay-out as against the number of times it rejects them. A very high or very low ratio indicates a skewed process. A positive ratio is one where the number of claims processed successfully are higher than those rejected. (This is not a definite indicator but helps a potential customer judge a company’s service levels).
This refers to the number of times an insurer successfully processes claims from admission to pay-out as against the number of times it rejects them. A very high or very low ratio indicates a skewed process. A positive ratio is one where the number of claims processed successfully are higher than those rejected. (This is not a definite indicator but helps a potential customer judge a company’s service levels).
Yes, most insurers feature an online purchasing and renewal facility on their own website. There are, also, a number of financial services portals that provide this service. Leading portals drive business based on trust and security so it’s definitely a safe alternative to traditional methods.
It is cheaper than going through an agent because the middleman viz. the agent does not play a part in the process and the cost of the policy is reduced by the amount of commissions paid (to the agent).
This is when a policyholder moves or ports from his/her current provider to another. Policyholders are allowed to transfer the coverage and benefits from their current policies to a new insurer, subject to certain conditions. Health insurance portability gives policyholders flexibility in case they are not satisfied with their present provider or find more economic options.
Yes, premiums paid on health insurance plans qualify for tax benefits as per Sec80D of the Income Tax Act.
If a policyholder is not satisfied with the policy he/she has taken or the provider of the policy, he/she can cancel and return the policy within 15 days of receiving it. Premiums already paid will be refunded, subject to adjustments.
Yes, service tax and other charges are applicable at rates and conditions as prescribed by the law (subject to change). Consider this aspect when calculating premiums.
Yes, a duplicate can be obtained by following the procedure set in place by the insurer, usually on payment of charges for a copy.
Anyone who depends on the primary member for their livelihood, commonly the proposer’s spouse, children and parents, are considered dependents. Children are often considered dependents beyond 18 years up to the age of 25 years if they are still students (sons) or unmarried (daughters) or mentally challenged. Dependent children are often covered only if a parent is concurrently covered under the same plan.
Premiums are charged based on the age and location of the insured member and the sum assured chosen. In case of plans on a family floater basis, premiums are calculated based on the age of the oldest member. Premiums in this case are also affected by the family size i.e. the number of family members covered under the policy.
This is whereby claimants avail medical services at their network hospitals without making upfront payments (subject to approvals). This is different from reimbursement of claims whereby claimants make upfront payments for treatment and subsequently submit bills to the insurance company for compensation.
Under some plans, the insurer and the insured are jointly liable to meet expenses. The policyholder will pay a certain percentage towards expenses incurred. If policyholders exercise this option, they are often given reductions in premiums.
Sum assured is the overall amount within which all claims have to be made. Sub-limits are caps placed on different kinds of claims. For e.g. only a certain amount of the sum assured can be claimed for room expenses, or, ambulance charges will be reimbursed only up to a certain amount per hospitalisation.
If, during a particular year, a claim was made, the sum assured is reduced by that amount. The amount remaining as sum assured may not be sufficient to cover any future claims. In this case, some companies offer their clients the benefit of restoring the sum assured to the original amount so as to meet a subsequent claim. This is offered once during a policy period as an added benefit to enhance coverage.
Although used interchangeably, mediclaim is technically not the same as health insurance. Broadly, the difference between the two types of health covers lies in the quantum and breadth of coverage offered. Even though it is considered a form of health insurance, mediclaim plans are more specific in their coverage i.e. it is usually only for hospitalisation expenses, particular illnesses and hospitalisation/treatment in case of accidents. Health insurance plans on the other hand can be customised to cover expenses pertaining to pre/ post-hospitalisation, ambulance charges, critical illnesses etc.
Day care procedures ate those medical treatments that do not require the patient to be hospitalised for a minimum of 24 hours. Day care treatments can be done in few hours so it is done as an outpatient procedure. There are many insurers who offer health insurance coverage specially designed for day care treatments.
Thanks to the sophisticated technology we have in the medical field! What took us days now takes us less than 24 hours. Many medical treatments can be given in few hours because of the advancement in the medical industry. If the treatment can be given to the policyholder as an outpatient, it will be termed as day care procedures. Some of the day care procedures are:
More on:day care procedures.
Most of the insurance policy providers cover day care treatments. One has to research well while buying a health insurance plan on the basis of day care procedure. Some of the factors you need to consider are:
Domiciliary hospitalisation means that the policyholder is being treated for a certain ailment within the confinement of his/her home and not in a hospital or a nursing set up. Usually, domiciliary hospitalisation is allowed when they aren’t able to move the patient from home to the hospital or when the patient cannot be taken to the hospital due to lack of accommodation. In other words, domiciliary hospitalisation refers to the treatment given to a patient for a certain disease or injury for more than 3 continuous days due to non-availability of accommodation in the hospitals or because the patient cannot be moved to the hospital.
If you have a health insurance policy that covers domiciliary hospitalisation, some of the treatments they cover are:
Most of the health insurance plans do not cover dental treatments. Dental treatments are one of the common exclusions in India. Please check with your insurance provider if they do.
Check various options here - Dental Insurance Coverage.
Listed below are some tips that you can follow to select the best health insurance plan:
There are no shortcuts when it comes to reading the fine print of your health insurance policy document. However, you can follow the steps below to which will help you read the fine print of your policy document:
There are many myths when it comes to health insurance in India. Some of the myths are as follows:
The below documents are required when you submit a reimbursement claim:
A floater option means that under one single health insurance plan, the sum assured amount can be used by all the members covered under the particular policy. All family floater health insurance plans have this option. Unlike individual health insurance plan, the sum assured is not for a single person under floater option.
Health insurance providers in India offers cashless hospitalisation facility where they settle the medical bill directly with the hospital if the policyholder is admitted in any one of their network hospitals. However, if the policyholder is admitted in a non-network hospital due to an emergency, the policyholder will have to pay the bill and later get it reimbursed from the insurer. Based on the terms of the plan, the insurer will reimburse the amount spent by the policyholder.
An individual insurance plan is designed to cater to the needs of one person. The sum assured is completely used by the individual person. However, in a floater option, the sum assured can be used by anyone of the members under the insurance plan. Floater options are perfect for families where more than one member require insurance coverage.
Some of the expenses included in sub-limit amount are room charges, medical tests, operation theatre expenses, medicines costs, and hospitalisation expenses.
More details on:Sub-limits.
Generally, not all health insurance plans cover homeopathy treatments. You will have to check with your insurer if homeopathy is covered under the plan. However, if you are looking for insurers who offer health insurance plans that cover AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatments, visit - Medical insurance for AYUSH.
The benefits you get when you are hospitalised due to an accident depends on the type of plan you hold. Generally, personal accident covers pays for your hospitalisation bill, over-the-counter drugs, consultations fees, and other such expenses. If the accident has left you permanently disabled, the agreed sum assured amount will be given immediately. In case of the unfortunate death of the insured, the death benefit according to the plan will be payable.
Unfortunately, that is not an option. If you have not submitted a claim in one policy year, you will be eligible to get a no-claim bonus (depending on the insurance provider). A no-claim bonus is a discount given on your premium amount, expressed in terms of percentage, and can be used while renewing your policy. Few insurers also increase the sum assured amount without any additional charge if you do not make a claim in a policy year.
When you switch your existing health insurance policy to a new insurance provider, you are entitled to the following benefits:
If your insurer covers pre-hospitalisation expenses, the following will be covered:
Post-hospitalisation cover usually pays for:
More details on pre and post-hospitalisation expenses.
The premium for a family floater policy is calculated after considering various factors like age of the oldest member of the family, policy term, number of members covered under one plan, the health condition of the insured, type of plan selected, and the sum assured selected. There is no universal formula used by insurance companies to calculate the premium for a family floater plan. It differs from one insurer to another.
Most of the insurers today offer cashless hospitalisation benefit to their policyholders. Under cashless hospitalisation, if the insured is hospitalised in a network hospital for more than 24 hours, the hospital bill will be settled by the insurer directly with the hospital. The policyholder does not have to arrange for funds, pay the bill, and later file a reimbursement claim. The insurer will pay the bill as per the terms and conditions of the policy held by the insured and the policyholder will only be responsible for those items that are not covered under the insurance plan.
The entry age and the maximum age criteria of the insured differ from one plan to another. Generally, a health insurance plan is available for individuals from 3 months old to 65 years. There are few senior citizen plans that cover senior citizens above 65 years as well.
As the name suggests, pre-existing diseases are those medical conditions that an individual suffers from even before buying a health insurance policy. These are not the diseases that the insured developed after buying a health insurance policy. Some of the examples of pre-existing diseases are asthma, diabetes, blood pressure, cancer, or ulcers.
More information on this page - pre-existing diseases.
A family floater health insurance plan, as the name suggests, is a single health insurance policy that covers the entire family. The sum assured, in this case, is used by all the members of the family as and when an issue occurs.
On the other hand, a critical illness insurance plan covers a list of pre-agreed critical illnesses like cancer, heart issues, tumours, or any such diseases. If an insured person is diagnosed with any one of the listed critical illnesses, the sum assured and other benefits under the plan will be paid immediately.
When a family member or loved one is hospitalised, apart from the hospital bills many out of pocket expenses are incurred. Some of the out of pocket expenses are money spent for food, travel, and non-admissible items. To help people meet these expenses, a hospital cash insurance offers a fixed daily cash benefit or allowance if the insured is hospitalised.
Some insurance providers would ask you to undergo a medical check-up before you buy a health insurance policy. However, there are many who do not require it. This differs from one insurer to another.
If you already have a health insurance policy, please check if you have an option to surrender the plan to your insurer. At times, insurers provide certain benefits if a policyholder surrenders the plan after completing a certain number of years.
If you have just purchased a health insurance plan, please check for the free-look period or the cooling-off period. Most insurances give free-look period within which the policyholder can return the policy back to the insurer.
You will also have an option to cancel the policy while renewing it. However, this depends on your insurance.
An increasing number of illnesses, unhealthy lifestyle, and poor health habits have forced many to contemplate buying a comprehensive health insurance plan. No one can predict when an illness will knock us down. That's exactly why having health insurance is very important these days. Some of the other reasons why health insurance is important are:
Some of the illnesses that are usually covered under a critical illness plan are:
Some of the parameters that an insurer considers while calculating the premium for your health insurance plan are:
For a comprehensive list of factors that are considered while calculating premium, please visit this page.
If an insured person is hospitalised in a non-network hospital, they will have to pay the hospital bill and later file a reimbursement claim. Generally, the procedure to file a reimbursement claim is as follows:
To avail cashless settlement benefit, the process is as follows -
In case of planned hospitalisation:
In case of emergency hospitalisation:
Most insurers allow you to reinstate your health insurance policy within 2 years from the date of the first missed payment or the discontinuance date. However, this differs from one insurer to another. Please check the renewal procedure for your policy with your insurer.
A health card is like an identity card given by the insurer to the policyholder. It contains information like the policyholder’s insurance account number, the name of the insured, the age of the insured, gender, policy expiry date, and other such vital information. It is mandatory for an insured person to show the health card at the hospital in case of hospitalisation.
A health card is very important because:
There are many leading health insurance companies in India. However, the best health insurance company differs from one person to another. It depends on the type of insurance coverage you are looking for and who cater your needs better.
If you are looking for a best health insurance plan, please consider the following:
Most insurers have a change request form that you will have to fill to change the address. Some of the insurance also allow you to change the address online by filling a virtual form. Please note that you will have to submit the form along with your new address proof.
Most insurance providers allow you to increase your sum assured at any time during the policy. Insurers these days also offer top-up health insurance plans. A top-up insurance plan allows you to attach additional cover to your existing insurance plan at a nominal cost. Please check with your insurer for this option.
For more details: Top-up health insurance plans.
Yes. A person can have more than one health policy. In case of hospitalisation and claim settlement, each insurer will pay as per the ratio agreed by them.
More details: Claim settlement procedure for multiple health policies.
The policy can be renewed if you pay the premium dues within the grace period which is 15 days from the expiry date. The policy will lapse if the premiums are not paid within the grace period. There is no insurance coverage available during the grace period.
Yes, as per the Health Insurance Portability and Accountability Act, you can transfer your health insurance policy from one insurer to another without losing the policy benefits.
After a claim has been settled, the policy coverage will reduce by the settled amount till the end of the policy term.
'Any one illness' means the continuous period of illness which includes the relapse period within a certain number of days as specified in the policy document. Usually, this is 45 days.
Any number of claims can be made during the policy term unless there is a specific limit mentioned in the policy document. The sum insured is the maximum limit one can claim under the policy.
Once in 4 years, some insurers pay for health check-ups of the life insured. This is called ‘health check’ facility.
Some insurers appoint a Third Party Administrator (TPA) to process all the claims of their policies. The contact details of the TPA will be available on your health card.
Based on the age of the life insured and certain medical conditions, a medical examination may be required.
No, you don't have to undergo a medical check-up every year if you ensure to renew the policy continuously without fail and there are no changes in the policy terms and conditions.
You have to pay for the pre-policy check-up. Some insurer will reimburse 50% of the cost.
A medical practitioner is a person who is registered with the medical council of any state of India and is thereby entitled to practice medicine within its jurisdiction. It can be a physician, specialist, surgeon, etc.
Medical expenses are the expenses incurred by the life insured for medical treatment received during the policy period on the advice of a medical practitioner due to an illness or accident.
The expenses can be indemnified through reimbursement claims or availing cashless services at a network hospital.
Cashless facility is available only at your insurer’s network hospitals.
Use the network hospital locator available on your insurer’s website for the list of network hospitals available in your area.
Cashless facility may not extend to government institutions.
Yes, the insurer will pay the entire amount for the medical expenses incurred subject to the sum insured. You may have to pay for the non-medical expenses and those that are not covered by the policy to the hospital before your discharge from the hospital.
In case of cashless treatments, the cheque will be sent to the network hospital where the life insured availed treatment.
Co-payment is a cost-sharing requirement wherein the life insured will bear a specific percentage of the admissible costs. Co-payment doesn't reduce the sum insured but it reduces the insurance premium.
It is the specified period of time from the date of policy inception, after the completion of which the full or partial insurance cover will begin or become active. The waiting period for a senior citizen health insurance plan is higher, from 1 to 4 years for certain illnesses.
The group insurance provided by your employer will offer only the basic cover. Employers offer group insurance as a liability cover. It doesn’t fully cover your needs. If you were to shift organizations, the insurance cover from the previous employer will cease. In addition to your group insurance policy, it is advisable to have an individual health insurance plan to adequately cover you and your family.
Group insurance package is purchased by an organization for the benefit of its employees. Individual insurance is bought by individuals for themselves or their families. The differences between the 2 insurance are as follows:
Most countries insist on seeing a valid travel insurance policy upon entry. Receiving healthcare in a foreign country can prove to be a costly affair. When you make travel plans, it is advisable to be prepared for unforeseen, unfortunate events like a medical emergency or a personal accident during the duration of your trip.
Be well-prepared by purchasing an overseas travel insurance policy that offers adequate medical cover against medical expenses including ambulance fees, medical treatment, medical evacuation, and hospitalization. The insurer will settle the claim once the insured person has returned to India except in the case of hospitalization.
Lifestyle diseases like diabetes, hypertension, and obesity have become prevalent among the younger generation. Treatment for critical illness is expensive without an insurance cover. A Critical Illness Rider will provide medical coverage against specified illnesses. Most policies cover 10 to 25 critical illnesses. Heart attack, cancer, stroke, and sclerosis are some of the illnesses covered by this rider.
The insured person must survive minimum 30 days from the date of diagnosis to make the critical illness claim. The waiting period is 60 to 90 days under most policies. You can also get tax deductions on premiums paid towards a critical illness rider under Section 80D of the Income Tax Act, 1961.
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.
A unified and fully stacked AI platform known as ALFRED has been launched by Artivatic.AI. The main reasons to launch this platform is to simplify fraud management, risk, and tariff. According to the company, the introduction of the platform will provide access to health financing and bring about end-to-end self-operating. The platform will reduce the burden on health insurance purchasers as well as the insurance industry.
18 February 2022
According to a poll of the top cities, Indian consumers want the government to increase healthcare funding and implement better policies that will minimise their total medical expenditures. A survey by Kantar, an insights and consulting company stated 66% of Indian consumers expect an increase in healthcare budget allocations while 72% want the government to cut down the petrol rates.
Kantar conducted a survey for 1,419 consumers, including males and females in the age of 21-55 years in SEC A and B in 12 Indian cities. Coming to the tax deductions, investments under 80C, which offer a variety of investment alternatives, came out on top, with 60% of respondents requesting an increase in deductions from the same. The surveyed consumers are expecting better benefits related to house purchases, with 39% requesting the tax deductions on their home loan EMIs to be increased.
27 January 2022
According to the IRDAI, Omicron treatment costs will be covered under health insurance policies that cover COVID treatment. A directive has been issued by the IRDAI to health and general insurers after seeing an increase in the number of Omicron cases. The IRDAI has also requested insurers to ensure that an effective mechanism is in place so that cashless facilities are available for all policyholders.
4 January 2022
Amid growing Omicron cases, India activated its share of vaccine doses in the COVAX alliance to produce more doses as the country is now vaccinating children and individuals eligible for precautionary additional doses. India is expecting to receive about 20 crore doses from its share in COVAX in a graded manner.
India continues to provide vaccine doses to the low middle-income countries for free since the pandemic began. Vaccine orders for 20 crore doses placed with Bharat Biotech and SII are in the pipeline. These doses will be ready by February 2022. Zydus Cadila’s ZY-COV-D vaccinations will commence in the first week of January.
Adults from designated states will receive the ZyCoV-D vaccine. The seven designated states are Jharkhand, Punjab, Uttar Pradesh, Maharashtra, West Bengal, Tamil Nadu and Bihar. Last Friday, Biological E submitted data about its phase 3 studies to the drug regulator of India. The vaccine manufacturer has done risk stocking of 10 crore vaccine doses and is awaiting approval.
The health ministry sources said that no orders have been placed for Sputnik V vaccines. The total number of frontline workers and healthcare workers eligible for a precautionary dose is estimated to be 2.6 crore. According to recent health ministry data, 96 lakh healthcare workers have received their second dose while over 1.03 crore received the first dose.
From an estimated total of 2 crore frontline workers, 1.83 crore have received their dose while 1.68 crore received their second dose. Approximately 6 crore people above the age of 60 years with comorbidities are eligible to receive the precautionary dose. As per recent data by the health ministry, 9 crore people above the age of 60 years are fully vaccinated.
About 7.5 crore teenagers are aged between 15 years and 18 years in India. Teenagers falling in this category can receive their first vaccine dose from 3 January 2021. At present, Covaxin and Zydus are available in India for children.
28 Dec 2021
Plum, an employee health insurance platform, announced the debut of Plum-Lite on Tuesday, December 21, 2021, which is a comprehensive group health benefits membership designed specifically for early-stage start-ups, SMEs, and gig workers/freelancer consultants. Plum-Lite membership, according to the insurance platform, would give new-age health insurance covers, doctor consultations, and Covid19 treatment covers for companies with teams as little as two people for a monthly price starting at Rs.85.
24 Dec 2021
Care Health Insurance Ltd has signed a memorandum of understanding (MoU) with Karnataka Gramin Bank (KGB) which is headquartered at Bellari and sponsored by Canara Bank. Both the organisations will market health insurance products to the bank’s customers spread across 22 Karnataka districts.
23 Dec 2021
Plum, a new health insurance start-up has formed a new agreement with payment processing company Razorpay. This collaboration with Razorpay Rize will allow the health insurance startup to provide health benefits to early-stage start-ups. The move will assist new enterprises in providing health benefits to their employees.
20 Dec 2021
As per the statement given by senior public health department officials on Wednesday, Omicron cases are likely to increase across Maharashtra. The Maharashtra Chief Minister Uddhav Thackeray has given instructions to officers to complete the second dose of anti-Covid-19 vaccines to all the applicable people
17 Dec 2021
Digit Insurance has cut down the waiting period for pre-existing and/or specific diseases to one year. The industry average for the waiting period for pre-existing diseases is up to four years while for specific illnesses it is up to two years. The reduction in waiting period to one year makes this the lowest waiting periods in the industry. Some of the specific illnesses include arthritis, cataract, cirrhosis of the liver, duodenal or gastric ulcers, fibroids, fissures, haemorrhoids, hernia, pancreatitis, sinusitis, tonsillitis, ovarian cysts, etc. All applicants for the insurance policy will have to declare any symptoms or pre-existing diseases at the time of purchasing the policy failing which claims can be rejected.
16 Dec 2021
Federal Bank has tied up with Star Health and Allied Insurance Co Ltd. to offer several health insurance schemes for its 8.90 million customers. The bank will act as a corporate agent in the tie-up. Several benefits can be availed by Federal Bank customers on the insurer’s group affinity and retail products. Federal Bank has customers across 1,291 banking outlets all over the country. All the products will be offered by the bank under one roof.
14 Dec 2021
Karnataka Vikas Grameena Bank (KVGB) has signed a memorandum of understanding (MoU) with Liberty General Insurance Co. Ltd. To offer general insurance products. According to the MoU terms, the company offers various general insurance products like car and two-wheeler insurance, fire and engineering insurance and health, commercial insurance, personal accident, employee compensation insurance, and so on at affordable prices.
To meet the financial requirements of different customers, the bank has been putting consistent efforts to enhance its portfolio.
9 Dec 2021
On 2 December 2021, PhonePe announced the launch of a new health insurance plan starting at Rs.999 for young first-time buyers. The plan covers expenses for in-patient and ICU hospitalisation, Ayush treatment, ambulance, daycare procedures and similar expenses.
Young customers can avail of this plan in 7,600 hospitals in the country. The health insurance plan can be purchased in a simple process where customers have to provide their details such as name, gender, age and email address. This year, PhonePe has launched several insurance products under life insurance, accident insurance, insurance for COVID-19 and so on.
7 Dec 2021
According to the reports, the health insurance firm is planning to raise nearly $974.23m through its initial public offering (IPO) at a valuation of around $7bn.
India’s Star Health and Allied Insurance has priced its IPO between Rs. 870 to Rs.900) per share. The subscription will be open 30 November 2021 onwards.
30 Nov 2021
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