Health Insurance

With India’s medical costs surging tremendously, it is time we gave health insurance its due importance. Furthermore, the kind of lifestyle that people have started to lead these days causes additional health problems and that in turn increases expenditure on medical bills and treatment.

In an era of uncertainties and instabilities, a health insurance policy offers a certain financial steadiness that difficult find anywhere else. However, the penetration of health insurance is still not adequate in a country like India. It is always good advice to have yourself and your loved ones covered for any medical emergency that might occur in the future.

What is Health Insurance?

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.

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 health insurance policy for extended coverage.

Broad Classification of Health Insurance Plans in India:

Medical insurance plans in India can be broadly classified into two types, namely reimbursement or indemnity based policies and fixed benefit hospitalization plans.

Reimbursement or indemnity-based health insurance: This type of health insurance plan is commonly known as mediclaim. The insurer will reimburse any medical expenses incurred due to hospitalization, diagnosis, and pre and post-hospitalization treatments. Mediclaim plans have an annual limit which is renewed every year. This type of plan is available as:

• Individual Health Insurance Plan: Under an individual health insurance plan, only one person is covered for the chosen sum insured. Family members can be enrolled under this plan but a different sum insured has to be chosen for each member.
• Family Floater Insurance Plan: This type of plan is customized for families, wherein a fixed sum insured is available for all insured members for one or more claims during the policy tenure. Spouse, dependent children, and parents can be included under this plan.
• Fixed benefit hospitalization plans: This type of plan offers fixed coverage and benefit payouts if the insured member is diagnosed with a specified illness or is hospitalized. It partially covers hospitalization costs and provides a substitute income. Some health insurance add-ons or riders that can be attached to your base policy are:
• Critical illness plans: The insurer will pay a fixed benefit payout if the insured person is diagnosed with any of the critical illnesses specified under the policy. The lump sum benefit can cover hospitalization cost and act as an income supplement.
• Hospital Cash and Surgical benefit plans: This plan covers defined hospitalization and surgery costs. Medical bills will have to be submitted to the insurer to receive the benefits.

Health insurance plans in India can be personalised to suit an individual’s requirements. The insured can decide if they want a health insurance plan that covers out-patient expenses, critical illnesses, maternity expenses, accident-related expenses, or a combination of all.

Statistics of Leading Health Insurance Companies:

Source: IRDA Annual Report 2016-17

Importance of Health Insurance Plans - Why you should buy?

We all have many goals in life like building a new house, buying a car, travelling the world, or start a business. But did you know that one medical emergency has the potential to burn all your savings and make you get into debt if you aren’t prepared? An unforeseen medical expense not only affects your immediate cash flow but also negatively affects your financial health in a long run.

Did you know that according to the WHO statistics, about 47% of admissions in hospitals in rural India are financed by loans and selling the assets they own? That's true! Further, even in urban India, 31% of hospital bills are paid by taking loans and selling assets. The World Health Organisation also states that 3.2% of Indians are still below the poverty line as they pay high medical bills. The shocking news is that about 70% of people in India spend no less than their entire income on healthcare expenses and purchasing medicines and other prescribed drugs. These statistics prove why health insurance is very important now more than ever.

Rising Cost of Medical Treatment in India:

As mentioned earlier, the cost of medical treatment in India is raising day by day. Some of the reasons for the sudden spike in medical treatments in our country are high real estate costs, sophisticated and expensive medical equipment, raise in salaries and overhead costs, competition, and consumer behaviour to find the best treatment available in the country. Refer to the table below to find more details about the cost of medical treatment and the estimated stay in the hospital:

Source: India Healthcare Tourism

Some of the reasons why you should buy an insurance plan are:

• Buying a comprehensive health insurance plan is very important because your employer cover might not be sufficient. Most of us think that the insurance policy provided by our employer is sufficient and an additional plan will not be required but that may not be the case. Most employers in India offer basic health insurance plan to their employees which are not tailor made to suit your needs. For example, a basic health insurance plan will not cover critical illnesses.
• Also, you should buy a health insurance plan as it covers more than just your hospitalisation expenses. Most of the insurance plans that are available in our country cover day care procedure, OPD charges, consultations, and other such expenses. Even if you are not terminally ill or hospitalised, you can make use of your insurance plan for your regular doctor visits.
• A health insurance becomes essential as day by day the cost of medical treatments in India is increasing. An individual's savings will not be sufficient when an illness strikes.
• If you are looking for ways to reduce the tax you pay to the government every financial year, buying a health insurance plan will help you to do that. Most health insurance plans in India comes with tax benefits.

There are several other benefits of buying a health insurance plan. Apart from the emotional turmoil one has to go through when they are sick, they do not have to face financial crisis as well if they have an adequate health insurance coverage.

Thus, Health Insurance!

To summarise, you should buy a health insurance plan because:

• The number of illnesses that a human being can get in contact with is increasing day by day.
• Post-hospitalisation expenses like consultation fees, tests, and doctor visits have increased too.
• One of the very important benefits of having a health insurance plan is the cashless benefit offered by the insurer. Without a health insurance plan, a person will be forced to pay the hospital bills from his/her own pocket. Whereas, when you have a health insurance plan, you can walk into a network hospital, avail the treatment, and the insurer will settle the bill directly with the hospital.
• It gives you a peace of mind as you know you are covered in case of any eventuality.
• A comprehensive health insurance plan also covers your spouse, children, and any other dependents like parents. This protects your family and loved ones from any financial crisis that they might face even if you are absent.

Types of Health Insurance Policies Available in India:

Some of the popular types of health insurance policies are explained below.

Individual Health Insurance Plans:

As the name suggests, individual health insurance policies are designed to protect an individual from emergencies medical expenses. It is an agreement between an insurance company and an individual under which the insurer promises to cover the medical cost incurred by the insured person in return for a premium amount paid by the customer.

Most of the individual health insurance plan covers hospitalization expenses, pre and post-hospitalization expenses, medical examinations charges, laboratory charges, maternity care expenses, and consultation fees.

Advantages of individual plans:

• One policyholder gets all the benefits that are available in the plan under the individual health insurance policies.
• The sum assured amount can be completely used by the insured person without distributing it to anyone.
• The individual policyholder can add their immediate family members to the policy in the future, if the insured person wishes to.
• Unlike a family floater plan, there are no restrictions on the number of claims that can be made in one year as any number of claims can be made by an individual in a year under this plan.

Exclusions of an individual health insurance plan includes:

• Pre-existing diseases are mostly not covered. Some insurance providers offer cover for pre-existing diseases after the completion of the waiting period.
• Non-allopathic treatments are not covered by individual health insurance plans but recently some insurers have started offering insurance cover for AYUSH treatment which includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatments.
• Substance abuse treatments such as alcohol and drugs are not covered.
• Cosmetic surgeries aren’t covered by medical insurance plans.

Benefits of having an individual health insurance include receiving the best healthcare possible at an affordable premium. With the cashless facility, you don’t have to go through the hassle of initiating a claim or providing documents to get reimbursement. You can get tax benefits on premiums paid towards medical insurance under Section 80D of the Income Tax Act, 1961.

Family Floater Health Insurance Policies:

A family floater health plan that is designed to offer insurance coverage to an entire family. Unlike individual health insurance plans, a family floater medical insurance policy does not focus on only the policyholder. These plans are ideal for families. It acts as an umbrella plan as it covers the entire family from unforeseen medical expenses.

Buying a family floater health insurance plan will save you a lot of money, time, and hassle as you don’t have to buy and manage multiple individual health plans. Most of the family floater insurance plans cover the policyholder, spouse, and dependent children.

However, there are few insurers who allow policyholders to include their dependent siblings, parents, and parents-in-laws. Though family floater plans are quiet famous in India, one should do sound research before buying any medical insurance plan. Most of the family floater insurance plans cover up to 15 relationships.

As the entire family is covered under one policy, you don’t have to go through the hassle of purchasing and maintaining different policies for each member. Choose a policy that offers lifetime renewability and covers pre-existing conditions. Some plans can be attached to a critical illness rider that offers coverage against specified critical illnesses. To decide on the right policy, take the following factors into consideration:

• Renewability: Most insurers offer policy renewability option till the age of 60 to 65. There are some health insurance companies that offer lifelong renewability. Choose a family floater health insurance that provides financial protection when it's needed the most.
• Sum Insured: Healthcare costs keep rising every year. Health insurance companies give you the option to increase the sum insured to cover the rising healthcare costs. Also, if you haven’t made any claims in the previous year, you will receive a No-Claim Bonus (NCB) in the form of an increase in the sum insured.
• Cashless treatment: If you choose cashless treatment, you don’t have to go through the hassle of initiating a claim for reimbursement. Just make sure the network hospitals listed in the policy are good ones.
• Addition of new members: If you plan on having a baby, you have the option to opt for maternity and newborn baby cover.

Senior Citizen Health Insurance Plans:

As the name suggests, senior citizen health insurance plans are tailor-made for the senior citizens who are more than 60 years of age. One of the biggest fears that a senior citizen might face when he/she retires is if they will be able to take care of unexpected medical expenses which are sure to arise given the age factor with the limited income they get every month.

With the change in lifestyle and improved healthcare facilities in India, the average lifespan of an Indian citizen has increased from 53 years to 71 years in the last 2 decades. A longer lifespan means a longer retirement period. Senior citizens, especially pensioners and retirees above 60 years of age have to invest in a good medical insurance policy that provides them adequate health cover against medical expenses caused due to an ailment, disability or an accident.

Senior citizen health insurance plans are exclusively for people aged 60 years and above who need financial aid to meet expensive medical costs in the case of a hospitalization. It is not easy to manage medical costs when you are on a fixed income. The premium for a senior citizen health insurance policy depends on the age of the policyholder and the sum insured. The Insurance Regulatory and Development Authority (IRDAI) has mandated that the minimum entry age for senior citizen health insurance is 60 to 65 years and granted lifetime renewability.

Take the following factors into consideration when choosing a senior citizen health insurance plan:

• Co-payment: It is the fixed sum of money that the life insured has to pay for covered healthcare service. Co-payment depends on the hospital where treatment is received, the specified ailments, and specific hospital charges.
• Sub-limit: It refers to the percentage of sum insured that the insurance company will pay for certain hospital expenses and illnesses such as room rent, doctor fee, cataract treatment, cardiovascular treatment, etc.
• Waiting period: The waiting period for a senior citizen health insurance plan is higher, from 1 to 4 years for certain illnesses.
• Pre-existing conditions: Some health insurance plans offer coverage for pre-existing conditions after the completion of a waiting period of 2 to 3 years. Only up to 50% of the claim will be payable in the case of pre-existing conditions.
• Medical check-up: Senior citizens have to provide medical certificates when purchasing a health insurance policy.

Advantages of senior citizen policies:

• A comprehensive senior citizen health insurance plan gives peace of mind to the elderly and helps them lead a peaceful retired life knowing that their medical expenses will be covered as and when they occur.
• Mostly, higher sum assured benefit is given to a senior citizen.
• Senior citizens can make use of the cashless hospitalization facility available under their insurance plan. A senior citizen doesn’t have to arrange for funds in case of an emergency hospital visit as the insurer will settle the bill directly with the hospital.

Critical Illness Insurance Plans:

Critical illness plans are very important as the number of fatal illnesses are increasing day by day. Critical illness is a serious health condition that affects the lifestyle of a person and is often fatal. Apart from the bodily pain and emotional trauma that a person goes through, they also have to face serious financial crisis. To help people with critical illness, health insurance providers in India offer comprehensive critical illness plans at affordable prices in India.

Under a critical illness plan, the policyholder pays a premium and purchases a policy from an insurance provider. If within the term of the policy, the policyholder is diagnosed with one of the critical illnesses mentioned in the policy document, a sum assured amount and the related benefits will be paid. Many insurers also consider the fact that the policyholder with a critical illness cannot work and therefore loses regular income and offer them daily allowance benefit.

An indemnity health insurance policy may not be sufficient to cover a critical illness treatment. Critical illnesses may lead to disability and loss of income. A critical illness rider can be attached to your base policy to give you enhanced financial protection. Most insurers cover 6 to 15 critical illnesses. Choose a critical illness rider with:

• Low waiting period
• Affordable premium
• High number of illnesses covered
• Maximum renewability age of 60 to 65 years
• Sum insured of 4 to 5 times the annual income

Cancer of specified severity, heart attack, aplastic anemia, muscular dystrophy, permanent paralysis of limbs, and kidney failure requiring regular dialysis are some of the critical illnesses covered under this rider. A critical illness claim can be initiated once you are diagnosed with any of the critical illnesses specified in the policy.

Advantages of a critical illness plan:

• This plan comes to your rescue when you are diagnosed with a critical illness and protects your savings which you would have used if you didn't have a critical illness plan.
• Most of the insurers also cover recuperation aid and other expenses which your basic insurance plan would not cover.
• A policyholder with a critical illness plan can avail tax benefits.
• Apart from covering your medical expenses, under the critical illness plan, the policyholder is eligible for regular free health check-ups.

Exclusions of a critical illness rider includes:

• Diagnosis within the first 90 days from the date of policy inception.
• Demise of the insured member within 30 days from the date of diagnosis or surgery.
• Illnesses caused as a result of substance abuse, smoking, pregnancy, childbirth or congenital disorder.
• Illness caused due to HIV/AIDS infection.
• Infertility treatment, and dental or cosmetic surgery.
• Treatment received outside India.

The policy tenure of a critical illness rider can be anywhere between 10 to 15 years with annual renewability option.

Maternity Health Insurance Plan:

One has to be financially prepared to welcome a baby home. During maternity, many consultations, follow-ups, and medical tests are required. To help people cope up with their maternity expenses without breaking their savings, many insurers offer maternity health insurance plan at an affordable price.

A maternity insurance rider can be attached to your base health insurance policy to provide insurance cover for pregnancy and childbirth expenses. Maternity benefits can help reduce the cost of hospitalization, delivery, tests, and medication. Maternity insurance is offered as add-on in group insurance policies offered by employers with a sub-limit of up to Rs.50,000.

Here is a sample list of expenses covered by a maternity insurance rider:

• Pre-hospitalization expenses of up to 30 days before the date of admission.
• Post-hospitalization expenses of up to Rs.5,000 for 60 days from the date of discharge.
• Ambulance fee for emergency transportation, room rent, delivery expense, nursing expense, and consultation fee.
• Treatment costs for childbirth complications.
• Medical cover for infants diagnosed with a critical illness or congenital disorder.

Maternity health insurance has to be bought before conceiving as there is a waiting period of 3 to 4 years before the benefits are activated. Exclusions of maternity health insurance includes:

• Doctor's fee for regular health check-ups.
• Diagnostic tests and consultation fee during the pregnancy period.
• Vitamins and tonics unless mentioned in the plan is not covered.

Advantages of maternity insurance plans:

• A comprehensive maternity health insurance plan keep your savings in place as the insurer settles the bill directly with the hospital.
• Some maternity health insurance plans also cover vaccination expenses for the new-born baby for the first year.
• Maternity health insurance plan also covers post-hospitalization expenses and other complications caused due to the delivery.
• Some plan also covers the new-born baby for the first 90 days if the baby is diagnosed with any congenital disorder or other critical illness.

Group/Employee Health Insurance Schemes:

Group health insurance provides insurance cover to a group of people like employees, members of associations, etc. Employers provide group medical insurance to their employees as an incentive to boost morale and retain personnel. The employees can opt for additional coverage to cover their family members. Employers and employees can get tax deductions on premiums paid towards group health insurance as per the Income Tax Act of 1961. Employee health insurance covers self, spouse, children, and parents. Some insurance companies provide cover for pre-existing conditions and maternity expenses.

With employee health insurance, you can avail cashless treatment at network hospitals of the insurer. This type of health insurance may also cover ambulance fees and provide reimbursement of specialists' fees for follow up health check-up.

Benefits of corporate health insurance plans:

Listed below are some benefits of opting for a group or employee health insurance policy:

• Unlike an individual medical insurance policy, insured members don’t have to undergo tests or provide medical certificates to obtain group health insurance. Employees of the organization are eligible for the group insurance policy automatically.
• The cost of group health insurance is lower compared to individual health insurance as the employer pays a part of the insurance premium.
• Maternity benefits are a part of group health insurance which most individual health policies don’t offer.
• Same goes for pre-existing conditions, group health insurance covers pre-existing illnesses.
• Claims can be made within first 30 days of getting the group insurance policy.
• A relationship manager will be assigned to the company to take care of the employees’ policy-related queries.
• Co-payment is not required for members over 60 years of age in the case of group health insurance.
• Employer health insurance plans offer cashless hospitalization which is very useful.
• Ancillary charges like ambulance costs and other charges are covered under the group health insurance plans.
• One of the important benefits of group insurance plan is that it helps organization retain their employees. Employees feel safe when their employer offers sufficient insurance coverage.

Preventive Healthcare Plans:

Preventive healthcare includes testing, detection, and minimization of disease causing factors in an individual at an early stage. For example, diagnosis of cancer in later stages or a heart condition is ineffectual. Whereas, with prior warning, you can get the treatment required to keep the disease from spreading or becoming fatal. Regular health check-up can keep you aware of your health condition. Health insurance companies in India offer preventive healthcare packages to cover the following expenses:

• Regular health check-up at network hospitals of the insurer.
• Employee health check-up under group insurance plans for various organizations.
• Family preventive healthcare to cover the self, spouse, children, and dependent parents.
• Child preventive healthcare package for children aged 0 to 13 years.
• Diabetes preventive healthcare.
• Specific disease-related plan: Under this type of preventive health care plan, a specific disease like diabetes is covered. Any time a policyholder incurred medical expenses for that specific disease, the insurer covers the bill as agreed during the inception of the policy.
• Preventive health care insurance plans based on age: Many insurers also offer preventive health care insurance plans based on the age of the insured.

Preventive healthcare insurance is beneficial in keeping the insured member aware of his or her health condition and receiving appropriate treatment in a timely manner. Preventive tests include HIV testing, cancer screening, cholesterol and sugar testing, PAP smear, genetic testing, etc.

Personal Accident Insurance:

Accidents, however minor or deadly cannot be predicted. All accidents take your time, money, and attention irrespective of the intensity of the accident. Did you know that the number of road accidents keeps increasing from year to year? Like your motor insurance that protects your vehicle in case of any accidents, a valid health insurance with an accident cover is important to cover your health-related expenses in case of an accident.

Apart from covering your medical expenses caused due to an accident, most of the personal accident covers also gives your family or loved ones a sum assured amount in case of an insured person’s sudden demise. This makes sure that your family is financially safe in case of any eventuality. A personal accident cover is a rider that can be attached to your base insurance policy.

Advantages of personal accident cover:

Imagine what will happen if the earning member in your family is permanently disabled or worst case not there anymore. How would you manage the financial commitments? Here’s when a personal accident cover comes to your rescue. Some of the benefits of a personal accident cover are as follows:

• A personal accident cover ensures family security.
• No medical tests or documentation is required to avail a personal accident cover.
• Personal accident cover is available for both families and individuals.
• Most of the personal accident covers available in India cover legal and funeral expenses.
• The sum assured or other benefits available under a personal accident cover can be personalised to suit one's needs.
• Injuries sustained due to terrorist acts are also covered under this policy.

Exclusions of a personal accident cover includes:

• Suicide and self-inflicted injuries
• Pregnancy or childbirth complications
• Pre-existing disability
• Disability due to abuse of substances such as drugs and alcohol
• Death or injuries due to an unlawful act or war
• Participation in extreme sports

There are 2 types of personal accident plans:

• Individual accident insurance: This plan covers an individual in the event of permanent total or partial disability, dismemberment or demise due to an accident.

• Group accident insurance: Employers provide group accident insurance to their employees as a value added advantage. The employee's family will be safeguarded against financial contingencies. This type of plan usually offers basic cover unlike the individual accident insurance.

Some of the other features that can be included in a personal accident cover are ambulance fee, repatriation cost, burns, daily cash allowance during hospitalization, loan protection cover, children's education costs, etc.

Top 10 Health Insurance Companies in India:

“Based on IRDA Annual Report 2016-17 Segment Wise Gross Direct Premium Income Of Health Insurers"

One can’t be too careful when it comes to insuring one’s health. There are many companies in India that provide health insurance products with various benefits, advantages and coverage options – but only a few truly stand out among the competition in terms of claim settlement ratios, customer satisfaction, and overall industry leading brilliance.

Here’s a list of the top 10 health insurance companies in India:

1. New India Assurance Health Insurance:

   Founded in 1919 by Sir Dorabji Tata, New India Assurance Co. Ltd. is one of India’s most prominent general insurance provider, based in Mumbai. The company was previously a subsidiary under the General Insurance Corporation of India (GIC), but attained autonomy later on as per the IRDA Act, 1999. Operating via a well-penetrating network of over 2300 offices, consisting of branches, regional offices, divisional offices, direct agent branches, micro offices, and more, New India Assurance is not only among the oldest, but also the most trusted insurer in the country. The insurer has further collaborated with some of the country’s leading public sector banks, and financial organizations to further expand its distribution network, and customer base. Under its health insurance arm, New India Assurance offers a number of well-appointed plans for individuals, and families.

2. United India Health Insurance:

   Incorporated in the pre-independence year of 1938, United India Insurance Company Limited, is India’s 2nd largest government-owned general insurance provider, boasting of premium worth more than Rs.16,000 crore. Post nationalisation in 1972, the insurance company has witnessed unbridled growth, and currently caters to a customer base of over 10 million via its network of over 2200 offices and regional branches. Since it’s inception, United India Insurance has consistently made the news with its achievements and innovations in the general insurance space. The insurer has played an integral part in the designing and implementation of insurance solutions for major client like GMR- Hyderabad International Airport Ltd, ONGC Ltd., Mumbai International Airport Ltd., Tirumala-Tirupati Devasthanam, and many more such influential clients. Besides this, the insurer has also made it possible for a large part of india’s rural population get access to insurance with successful implementation of National Livestock Insurance, Vijaya Raji Janani Kalyan Yojana covering over 45 lakh women in MP, Universal Health Insurance Programme of Government of India, Tsunami Jan Bima Yojana covering 4.59 lakh families in 4 states, and other similar schemes.

3. National Health Insurance:

   National Insurance Company Ltd., also known as NIC, holds the honour of being India’s oldest general insurance Company which was founded in December 1906, in Kolkata. Following its nationalisation 66 years later, the insurer was merged with several other Indian, and foreign companies to finally form National Insurance Company Ltd. With years of illustrious experience under its belt, today, National Insurance Company holds the second spot in the Indian insurance space, in terms of gross direct written premium. The insurer carries out operations not only in India, but also Nepal, catering to a large customer base via its 1900+ branch network. Under its health insurance arm, National Insurance sells two types of policies – mediclaim policy, and a Parivar mediclaim policy.

4. Oriental Health Insurance:

   One of top pioneers in the Indian non-life insurance space is Oriental Insurance Company Ltd. Established in 1947 in Mumbai, Oriental Insurance is One of India’s most trusted public sector general insurance provider. The insurer operates via a network of more than 1800 branches and 30 regional offices which are located not just in India, but also in several nations abroad like Qatar, Nepal, Dubai, and Kuwait. The insurer’s product suite comprises of a large variety of insurance products across several categories such as personal accident insurance, motor insurance, shopkeeper insurance, householder insurance, health insurance, etc. Under its health insurance segment, Oriental Insurance offer a wide range of policies which cater to the needs of not only individuals, but also families.

5. ICICI Lombard Health Insurance:

   ICICI Lombard Health Insurance Company offer cashless hospitalization in its massive network of over 3,200 network hospitals. They have one of the fastest claims processing teams among any insurance provider in the game. Cashless claims are handled directly by the company and the hospital, and reimbursement claims are handled within 14 days. With three highly intricate and detailed insurance products that protect you even when you’re overseas, ICICI Lombard has established itself as one of the most comprehensive health insurance providers in the nation. It has issued over 1387 million insurance policies so far.

6. Star Health Insurance:

   As India’s first standalone health insurance company, Star Health Insurance is present all over the country with over 290 branch offices and over 7,000 network hospitals. They have a record cashless claims approval rate of 90%, all done within one hour of the claim being made. No intervention of a TPA has ensured that Star Health Insurance Company has a high rate of customer satisfaction, and prides itself on its hassle-free direct claim settlement process. The Indian Insurance Awards committee awarded Star Health Insurance Company the prestigious “Health Insurance Company of the Year 2015” award in 2015.

7. HDFC ERGO Health Insurance:

   Features like Enhanced No Claim Bonus, flexible payment options, cashless hospitalization and a huge network of over 5,000 partner hospitals have earned HDFC ERGO Health Insurance Company a place on this list. Exclusive benefits like discounts at pharmacies, diagnostic centres, blood banks, OPD / Doctors, ambulance services, salons, spas, clubs, gyms and wellness centres in addition to dental clinics bring HDFC ERGO to the forefront of health insurers who are willing to go the extra mile to keep their customers happy. They also have 7 unique health insurance plan to cater to specific insurance needs that any customer may have.

8. Apollo Munich Health Insurance:

   When two giants in the healthcare industry join forces for the common good, you get a company as brilliantly run as the Apollo Munich Health Insurance Company. The Apollo Hospitals Group, which is Asia’s largest healthcare provider joined forces with Munich Health, a world leader in the health insurance segment. Simple policies with simple wordings and comprehensive coverage have led Apollo Munich Health Insurance Company to become one of the most highly trusted names in insurance today. Over 90% of their cashless authorizations are done within 2 hours of the claim being made. Over 90% of the claims are settled within 30 days, and 80% of their customers renew their policies every year which points to a high degree of customer satisfaction.

9. Bajaj Allianz Health Insurance:

   With a huge partner hospital network of over 4,000 hospitals, and counting, Bajaj Allianz Health Insurance Company has emerged as one of the top players in the health insurance sector in India. The reigning “Best Insurance Company in India” (as awarded by the Asia Insurance Industry Awards, 2014) is also one of the highest in terms of customer satisfaction.

10. SBI Health Insurance:

    The health insurance company with the widest reach across India with over 14,000 official branches, SBI Health Insurance offers individual and group health insurance policies. To say it has earned the respect and trust of its customers would be an understatement, as it has earned the prestigious 'Most Trusted Private Life Insurance Brand 2013' by the Economic Times, Brand Equity and Nielsen Survey. It’s also 3 separate awards that recognise its efforts towards its employees 'Dream Company To Work For 2014 in Private Insurance', 'Dream Employer of the Year 2014' - Ranked 4th, and 'Employer Branding Award 2014' for Talent Management at the World HRD Congress.

Healthcare Insurance Benefits:

A comprehensive health insurance plan with excellent features has various benefits to the policyholder. It is very important for one to know the benefits that are generally available under health insurance plans as they help in selecting the right plan. While the biggest benefit of having the best insurance plan is that you are always financially protected in case you have a medical emergency, there are many other benefits too. Some of the benefits are:

• No-claim bonus (NCB): NCB refers to the percentage of discount that is given to the policyholder from the insurer for every year that the former has made no claims. It encourages the policyholders to not make petty medical claims. Please note that NCB can be given as a discount on the premium payable while renewing the policy or the insurer may choose to increase your sum assured amount. While renewing a health insurance policy, it is very important to check if you have received your no-claim bonus.
• Family/loyalty discounts: Family and loyalty discounts are given to a policyholder who enrols a family member or another person in the health insurance plan. This is a reward paid by the insurance company to the policyholder for referring people to them. The policyholder also benefits from the discount given as insurers usually give 5% to 10% discount on the premium which is payable by the new member.
• Round-the-clock customer support: Most people find insurance plans to be complicated. To help people understand their health insurance plan better and to answer queries if any, all health insurance provide 24/7 customer service.
• Sum Assured Restoration: Most of the time, policyholders with a family floater plan are afraid that the total sum assured amount available under the plan can be exhausted if one person is critically ill. To help people make optimum use of their sum assured, insurers these days offer sum assured restoration benefit. If a policyholder has a health insurance plan with restoration option, once the sum assured amount is completely used, it will be automatically restored at no additional cost. Health insurance plans with restoration benefit are expensive than the regular health insurance policies.
• Cashless facility: India is going digital and so is our healthcare system. Gone are the days you had to carry cash in hand to pay your medical bills. In case of hospitalisation, when you have a health insurance plan, the insurer will settle the bill directly with the hospital. The insured person does not have to pay the bills. This has helped many people significantly as they don’t have to arrange for funds during an emergency medical situation.
• Online application and renewal facilities: Insurance providers these days have a great online presence. All of them keeps their websites updated at all times as it is very important for them to keep in touch with their customers, to gain new ones, to upsell, and to launch new insurance products. As a customer, you will be able to buy or renew your health insurance plan within few seconds from the comfort of your home.
• Free check-ups: To encourage their customers to lead a healthy life, most insurance providers also offer free medical check-up facility once in a while. Depending on the type of policy that a policyholder holds, he/she may be eligible for a master health check-up.
• Lifelong renewability: It is very important to choose a plan that protects you for a very long time, especially during your old age. That is exactly why many health insurance plans these days come with lifelong renewability option. The policyholders will be allowed to renew for a lifetime. To keep the insurance cover always active, the insured has to renew the policy at the end of every policy term.
• Co-payments/deductibles: When it comes to health insurance plan, policyholders will have an option to choose to co-pay. When a claim is made and if the insured has opted for co-payment, then pre-agreed percentage of the claim is paid by the insurer and the remaining is borne by the insured. Please note that the sum assured amount under the plan will not be affected by co-payments.
• Claim updates and quick settlements: Due to competition, the quality of customer service in the health insurance industry has increased by leaps and bounds. To retain their customers, insurers treat their claims professionally and send them updates about the status of their claims via email/SMS/phone call. Also, the claim settlement ratio has gone up in the last few years. The claim settlement ratio of an insurer is very important as it indicates the number of claims that an insurer has rejected versus the number of claims the insurer has settled. This ratio will let you know if the insurer is playing a fair game.
• Tax benefits: Not to forget, all health insurance policyholders can enjoy tax benefits for the premiums paid towards the plan under Section 80D of the Income Tax Act, 1961. If you are filing taxes and are looking for ways to reduce the tax amount you pay, invest in a health insurance plan today.
• Portability: Often we tend to go back to our service providers and switch to another company that caters to our needs better. The same rule applies to health insurance providers as well. One of the benefits that health insurance plans offer today is portability. The policyholder will be allowed to switch from one insurance company to another without compromising on the waiting period or any other features and benefits which were available with the previous insurer.

Which Health Insurance Policy is Best for Me?

When it comes to buying an insurance policy, make sure you buy one that suits your requirements. Refer to the table below to find out which type of policy is ideal for you based on your expectations:

Things to Keep in Mind When Buying Health Insurance:

The best health insurance plan is a plan that suits your requirement. If you are planning to buy a health insurance policy for you or your family, these are the factors that you should consider:

• Know your policy coverage: Before selecting a health insurance plan, understand what your plan will cover and what it would not cover. Always check if your policy will cover pre-existing illness, accident-related expenses, day care procedures, and maternity expenses. Choose a policy that gives you and your family sufficient coverage.
• Keep an eye on the exclusions: After you understand what your health insurance plan covers, it is very important for you to know about the exclusions. The general exclusions under the plan will be printed in the policy document. But often we do not read the fine prints properly. In order to choose the right insurance plan, you will have to read the exclusions. The list of exclusions differs from one plan to another. Some of the popular exclusions are:
  • Dental services
  • Pregnancy
  • Cosmetic surgeries
  • Joint replacement surgery
  • Homeopathy
  • Ayurveda
  • Injuries caused when under the influence of any drug/alcohol
  • Injuries caused by a war, terrorism, commotion, protest, or strike
• Decide if you want to co-pay: When it comes to health insurance plan, policyholders will have the option to choose to co-pay. When a claim is made and if the insured has opted for co-payment, then pre-agreed percentage of the claim is paid by the insurer and the remaining is borne by the insured. Please note that the sum assured amount under the plan will not be affected by co-payments. Before selecting a health insurance plan, understand if it a co-insurance policy or not.
• Check the premium payment frequency: All insurance policy come with a renewal date. The policy will have to be renewed regularly for the policyholder to enjoy the benefits. The premium amount for most of the individual health insurance plans can be made either monthly/quarterly/semi-annually/annually. However, there are one-year renewable health insurance plans as well. Before buying a health insurance plan, analyse if you will be able to pay the premiums and renew the policy on time.
• Claim settlement ratio: The claim settlement ratio for many insurance providers have gone up in the last few years. The claim settlement ratio of an insurer is very important as it indicates the number of claims that an insurer has rejected versus the number of claims the insurer has settled. This ratio will let you know if the insurer is playing a fair game. While choosing a health insurance policy, make sure that you choose an insurer who has high claim settlement ratio.
• Check for insurance policies with portability option: Often we tend to go back on our service providers and switch to another company that caters to our needs better. The same rule applies to health insurance providers as well. One of the benefits that health insurance plans offer today is portability. The policyholder will be allowed to switch from one insurance company to another without compromising on the waiting period or any other features and benefits which were available with the previous insurer.
• Choose lifelong renewability: It is very important to choose a plan that protects you for a very long time, especially during your old age. That is exactly why many health insurance plans these days come with lifelong renewability option. The policyholders will be allowed to renew for a lifetime. To keep the insurance cover always active, the insured has to renew the policy at the end of every policy term.
• No-claim bonus (NCB): NCB refers to the percentage of discount that is given to the policyholder from the insurer for every year that the former has made no claims. It encourages the policyholders to not make petty medical claims. Please note that NCB can be given as a discount on the premium payable while renewing the policy or the insurer may choose to increase your sum assured amount. While choosing a health insurance policy, it is very important to check if the insurer is offering a good no-claim bonus.
• Sum assured restoration option: Most of the time, policyholders with a family floater plan are afraid that the total sum assured amount available under the plan can be exhausted if one person is critically ill. To help people make optimum use of their sum assured, insurers these days offer sum assured restoration benefit. If a policyholder has a health insurance plan with restoration option, once the sum assured amount is completely used, it will be automatically restored at no additional cost. Health insurance plans with restoration benefit are expensive than the regular health insurance policies. Before choosing a health insurance policy, decide if you want the sum assured restoration option or not.
• Portability: Often we tend to go back on our service providers and switch to another company that caters to our needs better. The same rule applies to health insurance providers as well. One of the benefits that health insurance plans offer today is portability. The policyholder will be allowed to switch from one insurance company to another without compromising on the waiting period or any other features and benefits which were available with the previous insurer. While choosing a health insurance plan, check you can port the policy later to a different insurer.

How to Choose the Right Health Insurance Company?

Over the last few decades, the health insurance industry has witnessed a significant rise in both the number of insurance companies that have been established and in terms of sales. In this era, buyers have an ample of options to choose from. They are spoilt for choices when it comes to insurance providers. Thus, it is very important to choose the right medical insurance company. There are certain factors you should keep in mind when choosing an insurer. Listed below are few tips that might help buyers choose the right company:

• The reputation of the insurance company: Always choose a company that has a good brand image. Word of mouth recommendation and a sound research will help you choose the right health insurance provider.
• Financial stability: It is important to do your research on an insurer to ensure the company has the means to make claim reimbursements. One of checking an insurance company's financial solidity is to check the Credit Rating Information Services of India Limited (CRISIL) rating. A company with AAA rating is considered to have the highest financial strength to meet its obligations.
• Experience matters: Do not ignore the number of years the insurance company is in existence. Especially when there are many new insurance companies that are set-up these days, it is very important that you choose an insurance company that knows the industry very well.
• Do not forget to check the product portfolio: Always remember that your insurance needs changes from time to time. It is not the same all the time. While an individual medical insurance plan seems to be perfect for now, you may land up looking for the best family floater insurance plan in the future. Therefore, it is wise to choose an insurance company that offers a wide range of insurance policies that caters to all types of customers.
• Smooth and quick claim settlement process is very important: Submitting a claim to an insurance company is a very tedious job. Nobody loves to fill papers, attach the supporting documents, and wait for the claim to be approved. Things can get ugly if the claim is rejected. When you choose an insurance company, make sure that they are known for simple and easy claim settlement process. The last thing you would want is to hear that your claim has been rejected.
• Don’t ignore their customer service department: You are bound to have a lot of questions and issues after you buy a health insurance plan. You will be required to contact your insurer’s customer service centre from time to time. So, pay attention to the quality of customer service offered by your insurer. Check if services like online chat, email assistance, or phone assistance are available.
• Insurance advisor: Insurance terminology can be difficult to understand for the laymen. Insurance companies make it easier first-time buyers by appointing an insurance advisor to every customer. Insurance advisors can guide the customers in choosing a suitable insurance plan. In the case of claim-related queries, they can offer prompt assistance. Nowadays, most of the insurers offer 24/7 customer support with a toll-free helpline number to resolve customer queries.
• Customer feedback and reviews: Check existing customer ratings and feedbacks of an insurance company. Visit the IRDAI website to check the number of complaints and resolutions against the insurance company. Visit the insurance company’s official website to check for transparency about the operations of the insurer.

Mistakes to Avoid When Buying Health Insurance:

Choosing the right health insurance plan that meets your requirement is not an easy task. Today, when we can buy an insurance plan within few seconds online, it is very easy to be an impatient buyer. Our busy schedule has somewhere made us ignorant that we skip the terms and conditions and make a hasty decision. Due to this ignorant behaviour, many make mistakes while buying a health insurance plan. Some of the most common mistakes that you can avoid while buying a health insurance plan are as follows:

• Insufficient coverage: The cost of premium, that one pays towards his/her health insurance plan in India, plays a vital role in deciding which policy to buy. Thus, in order to save some extra pennies, one often ends up with insufficient insurance coverage. While the cost of premium is an important factor in choosing your health insurance plan, it should not be the only factor.
• Not reading the fine print: While most individuals know about the treatments and expenses that are covered by the policy, they do not pay heed to exclusions mentioned in a medical health insurance plan. Knowing the coverages of a policy is definitely vital, however, understanding the exclusions is equally important.
• Compare insurance providers: Do not get comfortable with one insurance provider. While renewing your policy, compare various insurance providers and the benefits they offer. If you find a good deal, do not shy away from switching your insurer. To beat the competition and to remain on top, many leading insurance providers offer excellent offers from time to time. Make use of these offers as and when they are rolled out.
• Be truthful about your medical history: There are many reasons your claim can be rejected by an insurer. One of the most popular reasons why insurers reject your health claim is because you were not transparent about your medical history. While buying a health insurance plan, be truthful and let your insurer know about your pre-existing illnesses and any health complaints that you may have.
• Cashless hospitalisation: This is one of the most important features that one has to make a note of while buying a health insurance plan. Most of the buyer's compromise on this feature and assume that they can gather the funds required to pay the medical bills and later get it reimbursed. But did you know that many take huge debts to pay medical bills at a high-interest rate? Always choose an insurance plan with cashless hospitalisation benefit so that your medical bills are settled by your insurer directly with the hospital.
• Don’t go wrong with premiums and co-pays: When it comes to health insurance plan, policyholders will have the option to choose to co-pay. When a claim is made and if the insured has opted for co-payment, then pre-agreed percentage of the claim is paid by the insurer and the remaining is borne by the insured. Please note that the sum assured amount under the plan will not be affected by co-payments. Another mistake that we all commit when we buy a health insurance plan is that we pay high premiums to get low co-pay.
• Don’t be over-insured: You don’t have to buy many riders or a comprehensive health insurance plan if it is not required or does not meet your needs. Many buy extra add-ons to protect them which mostly leads to being over-insured. Take few minutes to write down what you expect your health insurance plan to cover and choose a plan that meets the requirements. Make sure you are not over-insured.
• Get insured early: Most of us do not realise the importance of having a health insurance plan early. Most of the insurers offer lower premium and other benefits for young buyers. The older you get, fewer insurance companies are ready to insure you and your premiums would go up as it is assumed that the older people get, the risk of falling sick is high.
• Don't be satisfied with the insurance offered to you by employer: Your employer-provided health insurance plan might not be sufficient as it is not tailored-made for you. You should also realise that the health insurance plan offered by your employer is not valid when you are in between jobs. A supplement health insurance plan is required to back your employer’s cover. You can also use your employer’s health insurance plan to make a claim and enjoy no-claim bonus on your personal health insurance plan.
• Not having the required riders: If being over insured is a mistake, being under insured also is. Like mentioned earlier, take few minutes to sit down and write your expectations and find an insurance plan that suits your needs.

What Expenses do Health Insurance Policies Cover?

The insurance coverage depends on various factors like the type of the policy, the age of the insured, type of treatment availed, and the insurer. Generally, the below expenses are covered:

• Inpatient hospitalisation expenses: As the name suggests, inpatient hospitalisation expenses are those expenses that a policyholder incurs when he/she is hospitalised in a hospital due to a medical condition. Please note that not all expenses and treatments will be covered by the insurer just because you have a health insurance policy with them. The treatments covered will be clearly mentioned in the insurance policy document which will be shared with you during the inception of the policy. Also, inpatient hospitalisation expenses will be paid only if the policyholder is admitted to a hospital for more than 24 hours. Some of the inpatient hospitalisation expenses that most of the insurers usually cover are as follows:
  • Hospital room charges
  • Cost of medicines
  • Operation theatre charge
  • ICU room charges
  • Inpatient lab test charges
  • Cost of X-rays, MRIs, and CT scans
  • Cost incurred to arrange for blood or oxygen
  • Organ transplants
  • Cost incurred to get the surgical equipment and other surgical tools required
  • Any other expenses related to the treatment that the policyholder is receiving

• Other charges: Apart from inpatient hospitalisation expenses, health insurance plans also covers other miscellaneous expenses like ambulance charges and post-hospitalisation expenses.
• Pre-existing diseases: Most insurers cover the medical expenses that are caused due to pre-existing diseases of the policyholder. It covers specified day-care procedures as well. Please note that there might be a waiting period to avail this benefit. Usually, the insurer will have a waiting period of 11 months within which no claims will be honoured.
• Maternity expenses: Most of the health insurance policies offered in India cover maternity expenses. To help people cope up with their maternity expenses without breaking their savings, many insurers offer maternity health insurance plan at an affordable price.

Generally, maternity health insurance plans are offered as an additional rider or an add-on with the base policy at a nominal fee. Usually, there is a waiting period to make a maternity-related claim. Therefore, it is beneficial if it is purchased as early as possible. Some maternity health insurance plans also cover vaccination expenses for the new-born baby for the first year. It also covers post-hospitalisation expenses and other complications caused due to the delivery. Some plans also cover the new-born baby for the first 90 days if the baby is diagnosed with any congenital disorder or other critical illness.

• Pre/post-hospitalisation expenses: Most of the health insurance plans in India cover pre-hospitalisation and post-hospitalisation expenses. While the pre-hospitalisation expenses cover the medical expenses incurred by a policyholder before getting admitted to the hospital, post-hospitalisation expenses cover the medical expenses incurred by the policyholder after being discharged from the hospital.
• Day care procedures: In some cases, the patient does not have to be hospitalised for more than 24 hours to avail a certain treatment. 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:
  • Tympanoplasty
  • Middle ear reconstruction
  • Incision of tear glands
  • Cataract operation
  • ENT treatments
  • Ophthalmology
  • Radiotherapy
• Domiciliary hospitalisation: 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.
• Daily cash allowances: While most of the insurers cover pre and post-hospitalisation expenses, not many offer daily cash allowance if the policyholder is admitted. When a loved one is admitted, the family and loved ones incur a lot of miscellaneous expenses like transportation costs and food expenses. To help customers cope-up with these petty expenses during hospitalisation, few insurers offer daily cash allowance. Also, many insurers extend this benefit when the policyholder is diagnosed with any one of the critical illnesses and in such cases, regular income may be hampered. Daily cash allowance is the pre-fixed amount that an insurer gives to the policyholder for every day spent in the hospital.
• Health check-up costs: Many insurance providers also cover medical check-up costs. It is good that the policyholder undergoes a master health check-up on a frequent basis. A master health check-up may be expensive but not if it covered by your insurer. A policyholder can walk into any one of the network hospitals and undertake a check-up and the insurer will bear the costs. Some of the tests that will be taken during the check-up are blood tests, X-rays, liver function test, vitamin tests, and urine tests.

What is not Covered - Exclusions:

While coverage is at the discretion of individual insurers, there are certain exclusions or conditions that form an important part of the contract. The more common ones are elucidated below -

• The policy comes into effect after a waiting period, usually 30 days from inception.
• Pre-existing diseases and other specified ailments may be covered subject to a waiting period. This usually ranges between 2 to 4 years.
• Some policies specifically exclude maternity/new-born expenses.
• Injuries/ailments arising from:
  • War, civil unrest, terrorism and related acts.
  • Nuclear risks.
  • Suicide attempts, hazardous activities, acts of negligence.
• Ailments such as HIV, STDs and other related illnesses/illnesses of similar nature.
• Alternative/unrecognized treatments that are non-allopathic in nature (some policies cover ayurvedic, unani and similar treatments).
• Procedures like cosmetic/plastic/sex change surgeries, hormonal replacements etc.
• Dental, optical procedures etc.
• Genetic disorders; Psychiatric disorders.
• Expenses for rest and rehabilitation; common illnesses of mild severity.
• Unnecessary diagnostic tests, treatment, post-care procedures.
• Treatment/diagnosis undertaken outside India or by an unqualified medical professional.

Always! Scrutinize the inclusions and exclusions of each plan to ensure adequate and desired coverage is availed of.

What are Eligibility Norms?

Your age and health condition helps the insurance provider set a value on the health risks you may face. Which is why, some insurers ask for medical information when applying for a health insurance plan. The eligibility norms for health insurance is as follows:

• Medical checkup: Evaluating your health condition and risks based on certain parameters helps the insurer set a premium for your insurance policy. Most insurers don't ask individual aged below 35 years to undergo a medical exam to get a health cover. Although you may not be required to go through a medical examination, you will be asked to furnish a good bill of health and disclose any pre-existing condition like hypertension or diabetes. For people ages 45 years and above, you will have to undergo medical tests and furnish medical reports to the insurance company.
• Smoking or drinking: Lifestyle choices such as smoking and drinking is taken into consideration when evaluating the health risks you may face in the future. Be honest about your lifestyle habits to avoid hassle when making a claim.

• Pre-existing conditions: Being honest about pre-existing conditions and undergoing a medical screening not only helps the insurer with determining insurance premium but also helps you in making a hassle-free claim.
• Medical examination for older people: Insured members with a good bill of health will receive competitive insurance premium rates. If you opt for a large insurance coverage or reach 55 years of age, you will be asked to undergo medical examination. Policies which don’t require medical tests come with basic or small insurance coverage.

Most people will find themselves eligible for health assurance products, barring those who pose too much of a risk to the company.

• Entry age for proposers: Usually between 18 years to 65 years; can go up to 70 years or beyond depending on the type of plan and the company offering it.
• Entry age for children: From as young as 90 days till 18 years; can be considered dependents till the age of 25 years.
• Renewability: Usually lifelong, subject to medical screening beyond a certain age.

Health Insurance Claim Process:

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:

• Cashless Claim Process
• Reimbursement Claim Process

Cashless Claim Process:

When the insured provides their health insurance details along with their e-card or any other type of physical proof of the purchased health insurance policy, the insured can receive treatment at a hospital. This holds good if the injury or illness is covered under the health insurance policy. Once the insured is discharged from the hospital, the hospital will forward the medical bills to the health insurance company. The company will then analyze and evaluate the expenses and settle the payment. This process is known as cashless hospitalization. Over here, the hospital settles the bills with the insurance company. This provides a stress free recovery period for the insured.

The process of making a claim on a health insurance at a cashless hospital depends on the type of treatment that the insured has to undergo.

• Claim Process for Planned Treatment: To avail this plan, the insured will have to inform the health insurance company prior to being admitted into the hospital. The insurer should be informed at least 4 days before the policyholder is admitted or before the treatment date. This time frame varies with each insurance company. The insured should inform the insurance company by submitting a cashless claim form to the insurer via email, post or fax. Once the insurance agency receives the form, they will contact the hospital as well as notify the insured regarding about the claim request. The policyholder will have to provide their health insurance card at the time of admission into the hospital. Any medical expenses incurred thereafter are paid for by the insurance company.
• Claim Process for Emergency Treatment: At the time of an unforeseen event that lands the insured in a hospital, either the insured or the next of kin should contact the customer care team of the health insurance company to locate the nearest cashless hospital. Once admitted, the hospital will have to duly fill up a cashless claim request form. Once done, they will have to submit the same to the health insurance company by either email, post or fax. The insurance company will then send an authorization letter to the hospital indicating the converge of the policy. The medical bills incurred by the policyholder will be covered by the health insurance company. If the claim gets rejected, the insurance company will notify the insured and the hospital stating their reasons for rejection.

Reimbursement Claim Process:

In the event that the policyholder or insured has been admitted into a hospital or clinic and pays for their treatment, the policyholder will have to reclaim the money spent from the insurer. The hospital that the insured has been admitted into does not have to be empanelled with the insurance company. In such cases, the cashless claim facility that's provided by the insurance policy cannot be claimed. Once the insurer has paid for their treatment and hospitalization costs, they will have to make a reimbursement claim. The insurer will have to provide the original bills to the health insurance company to make a reimbursement claim. The insurance company will evaluate the claim that will then decide to either approve or reject it. Once the insurance company approves the claim, they will make the payment to the policyholder. The insurance company will notify the insured in case they reject the reimbursement claim.

Documentation:

The various documents* which are required to make a health insurance claim have been listed below:

• Dully filled claim form
• Investigation report
• Original discharge card or summary from the hospital
• Medical certificate or medical form that has been duly signed by the attending doctor
• Cash memos and prescriptions from pharmacies and the hospital
• All original bills and receipts
• FIR or Medico Legal Certificate (MLC) in case of an accident

*Documents needed may vary from one insurance company to another

Read more on: Health Insurance Claims Process

Health Insurance Portability:

An individual who ends up with a bad health insurance deal can have some respite with the help of Health Insurance Portability. The Insurance Regulatory and Development Authority of India (IRDA) have kept these individuals in mind when devising this convenient mode for people to avail when they are on the lookout for a better health insurance option. With the help of Health Insurance Portability, a customer can transfer their current health insurance policy to a new health insurance provider without forfeiting their benefits. Health Insurance Portability ensures that insurance companies do not take their customers for a ride and also ensures that the customer has the freedom to change insurers if they get a better offer.

With Health Insurance Portability, a policyholder does not have to lose any of their benefits when they change from one insurance provider to another. It acts as a safety net for the accrued benefits accumulated by a customer on their current health insurance policy.

Common Reasons for availing Health Insurance Portability:

• Inadequate cover provided for a specific health issue
• Poor service quality
• Late reimbursements
• Slow or incompetent claim settlement
• Lack of transparency
• Co-payment clauses
• Hiked premiums when a claim has been made
• Room rent limit
• Desire to switch to a health insurance provider who offers personalised services that are in sync with the needs and requirements of the customer
• Better deals offered by another health insurance provider
• Hidden conditions and clauses

Health Insurance Portability Guidelines:

There are certain rules that have been set by the Insurance Regulatory and Development Authority of India (IRDA) which helps guide the insured to change their insurer without any hassle. These rules will have to be followed diligently to ensure that the policyholder’s Health Insurance Portability request does not get rejected.

• Similar Health Insurance Policies: Only similar health insurance policies are allowed to be ported. A policyholder can migrate from one reimbursement plan offered by an insurer to another reimbursement plan offered by another insurer.
• Type of Company: A policyholder is entitled to switch from any specialised or general insurance company to any other specialised or general insurance company.
• Renewal Period: A Health Insurance Portability is possible only during the current renewal period. But if there are any types of discontinuity in the policy period due to delays caused by the insurance company, it shall not be considered as discontinuity.
• Acknowledgement: Both concerned insurance companies will have to acknowledge any portability applications which are made by a policyholder in three days.
• Intimation: A policyholder who wishes to opt for a Health Insurance Portability will have to notify their current insurance provider while also mentioning the health insurance company they wish to port with. The policyholder should notify both insurers 45 days before the policyholder’s existing policy is up for a renewal.
• Porting Charges: There are no charges levied on Health Insurance Portability.
• Grace Period: A policyholder is granted a 30-day Grace Period for the renewal of a policy in case the policyholder’s application for porting is still under processing or the new insurer’s decision has not yet been made.
• Porting in the Same Company: Policyholders are allowed to port out of one plan into another plan within the same insurance company.

Advantages of Health Insurance Portability:

• A customer can avail a customised health insurance cover depending on their needs and requirements.
• When a customer opts for portability, the new Sum Assured will comprise of the old Sum Assured, No Claim Bonus (if applicable), and Accrued Bonus.
• The policyholder does not have to worry about any time bound exclusions when applying for Health Insurance Portability.
• Insurance companies have begun to offer health insurance at lower premiums to be a step ahead of their competition.
• A policyholder can avail a better claim settlement procedure with a new insurer.
• A policyholder can opt for a health insurance provider that offers a policy without any hidden clauses or conditions.

Disadvantages of Health Insurance Portability:

• Policyholders are restricted to changing insurers at the time of renewal of the policy.
• Policyholders cannot port to a health insurance policy that is vastly different from their current policy. They have to switch to a similar policy that is offered by a different insurer.
• Additional benefits that come with the new policy can attract higher premiums. This could erase any monetary benefits that a policyholder is entitled to.

Healthcare Schemes by Government of India and Various States:

The central and state governments of India have launched a number of medical insurance schemes in order to improve healthcare access for the unorganized sectors and people in the Below Poverty Line (BPL) category. Here is a list of health insurance schemes provided by the government:

• Rashtriya Swasthya Bima Yojana (RSBY):

  This scheme was launched by the Ministry of Labour and Employment to provide health insurance coverage for BPL families. Beneficiaries under this scheme can avail hospitalization cover of up to Rs.30,000. There is no age limit for this scheme and pre-existing conditions are covered from day one. This scheme provided health cover to a maximum of 5 family members which includes spouse, children, and dependents. Beneficiaries have to pay only Rs.30 as registration fee. The central and state government will pay the premium to the insurance company.

• Pradhan Mantri Suraksha Bima Yojana:

  Accidents are an unfortunate occurrence which do not discriminate between the rich and the poor. However, in India, accident insurance well within the financial reach of the rich and middle class. The ones who suffer are the poor, who are unable to afford the high premiums accompanying accident insurance policies. In an effort to remedy this situation, Indian government has introduced the Pradhan Mantri Suraksha Bima Yojana, a social security scheme which has been designed specially keeping the low spending power of the poor in mind. This scheme features affordable premiums and provides compensation to the family of the deceased or if the insured has been disabled partially or permanently following an accident.

• Central Government Health Scheme (CGHS):

  This scheme was launched in New Delhi in 1954. It is now available in CGHS covered cities like Allahabad, Bhopal, Chandigarh, Ahmedabad, Lucknow, etc. It provides comprehensive healthcare facilities to the central government employees and pensioners. Dependents of these employees are also included as long as they reside in the CGHS cities. The insurance coverage includes domiciliary care, specialist consultation facilities, laboratory tests, hospitalization, and health education to beneficiaries.

• Aam Aadmi Bima Yojana (AABY):

  This is a social security scheme launched on 2nd October 2017 to provide healthcare facilities for rural landless households. The head of the household or the earning member of the family will be covered under the scheme. The insurance premium of Rs.200 per year is paid by the central and state government. The beneficiary should be between 18 to 59 years of age. An add-on benefit under the scheme includes scholarship for children of the beneficiary. The beneficiary will receive Rs.30,000 upon natural death of the insured member, Rs.75,000 upon accidental death or permanent disability, and Rs.37,500 on partial permanent disability.

• Janashree Bima Yojana (JBY):

  This scheme was launched on 10th August 2000. It replaced the Social Security Group Insurance Scheme (SSGIS) and Rural Group Life Insurance Scheme (RGLIS). This scheme targets people falling under the BPL category and slightly above BPL category in 45 occupational groups covered under the scheme. Some of the covered occupations include Beedi workers, carpenters, power loom workers, cobblers, handicraft artisan, agriculturists, construction workers, etc. Aam Admi Bima Yojana and Janashree Bima Yojana have been merged into one scheme and called as Aam Admi Bima Yojana since 2013.

• Employment State Insurance Scheme (ESIS):

  This is a social security scheme designed to provide socio-economic protection to the working class and their dependents. The insured member and his or her family will receive full medical care from day one. Under the scheme, beneficiary will also receive cash benefits in times of sickness and temporary or permanent disablement that leads to the loss of earning capacity. If a dependent of the insured person is disabled on the job, a monthly pension called the dependent benefit is provided under the ESI scheme. The scheme is applicable to non-seasonal factories, theatres, shops, restaurants, hotels, road-motor transport undertakings, and newspaper establishments employing more than 20 people. Recently, private medical and educational institutions employing more than 20 people in certain states and union territories have also been included under the scheme.

• Universal Health Insurance Scheme (UHIS):

  The public sector general insurance companies have implemented this scheme to improve the access of healthcare for poor families. Beneficiaries will receive reimbursement for medical expenses up to Rs.30,000 and accidental death cover up to Rs.25,000. This scheme is applicable only to BPL families. The insurance premium for this scheme is Rs.200 per person, Rs.300 for a family of 5, and Rs.400 for a family of 7. The four public sector/government health insurance companies in India are The New India Assurance Co. Ltd, United India Insurance Company, National Insurance Co. Ltd, and Oriental Insurance.

• Yeshasvini Health Insurance Scheme by Govt. of Karnataka:

  Launched by the former chief minister of Karnataka, the Yeshasvini Co-operative Farmers Health Care Scheme helps provide farmers across the state with inexpensive medical facilities. The scheme, which was operational in 2013, is targeted at workers belonging a co-operative society and falling in the lower middle income and middle income groups. With over 30 lakh beneficiaries, this scheme provides cover against several ailments like angioplasty, neurosurgery, neonatal intensive care, surgical oncology, orthopaedic surgeries, paediatric surgeries, animal bites, drowning, etc.

• Bhamashah Swasthya Bima Yojana by Govt. of Rajasthan:

  The Bhamashah Swasthya Bima Yojana is an innovative scheme which makes cashless medical facilities available to IPD patients in Rajasthan. The scheme is open to all families which are covered under the RSBY (Rashtriya Swasthya Bima Yojana) and NFSA (National Food Security Act). Essentially an insurance scheme, this Bima Yojana is aimed at bringing down the financial burden of surplus expenses of medical care, by providing financial assistance against illnesses. Another objective of this policy is to create a health database which can be used in the future to help make policy related changes. Read on to find out about the benefits which this scheme provides, along with other related information concerning the eligibility and application process for this scheme.

• Mukhyamantri Amrutum Yojana by Govt. of Gujarat:

  The Mukhyamantri Amrutum Yojana is a health coverage scheme introduced by the government of Gujarat to provide medical facilities, including the cost of surgeries and hospitalization, to all families with an income below 1.5 lakh per annum or income of Rs 1.20 lakh per annum. The Yojana has been awarded for making the best use of information technology in the field of healthcare. Fully funded by the government, the Yojana does not carry any enrolment fee and provides cover worth Rs 2 lakh to each family (5 members).

• West Bengal Health Insurance Scheme:

  The West Bengal Cashless Medical Treatment Scheme was introduced in 2014 for all employees and pensioners of the state government. This is an all-round health scheme which will provide cashless medical facilities up to the amount of Rs 1 lakh to all officers, employees, IAS officers and pensioners working under the state government. The facility is extended to the family members of the aforementioned workers as well, across all hospitals which are a part of the panel of this scheme.

• Chief Minister’s Comprehensive Scheme by Govt. of Tamil Nadu:

  To provide the benefits of medical insurance to the economically weaker sections of society in Tamil Nadu, the Tamil Nadu government introduced the Chief Minister's Comprehensive Health Insurance Scheme. The scheme which is offered via United India Insurance Co. Ltd., a public sector insurance provider, has been launched to benefit over 1 crore households. The beneficiaries under this scheme can obtain cashless medical facilities and surgical treatments, not only from public but also private sector hospitals. The scheme itself provides coverage for all expenses arising due to illnesses, follow-up treatments, consequent diagnostic procedures, etc.

• Rajiv Gandhi Jeevandayee Arogya Yojana, Maharashtra:

  The Maharashtra government has understood the insurance needs of the mass public and currently operates the Rajiv Gandhi Jeevandayee Arogya Yojana health insurance scheme. This is a scheme designed for the economically underprivileged. The plan promises free healthcare for those who have the Orange Ration Card or the Yellow Ration Card. Any treatment sought at government hospitals is covered by this medical insurance scheme. The scheme is also an attempt at including more people under the benefits of health insurance.

Compare Health Insurance Plans Online:

By now you are aware of the importance of a health insurance plan for you and your loved ones. It not only offers sufficient health cover but also timely healthcare treatments and services in your hour of need. There are several health insurance policies available on the market in India. So, how do you figure out which is more suited to your health insurance needs?

Comparing various policies can be time consuming if you were to go from one insurer to the next. Which is why, most customers opt for an online comparison of health plans. Here is a quick guide to health insurance comparison online:

• Visit a third-party website to compare various health insurance policies across the top insurance providers in the country from the comfort of your home.
• Enter personal details such as your name, gender, age, lifestyle habits like smoking and drinking, etc, on the comparison tool.
• You will immediately get a list of suitable health insurance policies with its features and benefits.
• Go through the insurance premium cost, sum insured, inclusions, and exclusions of each policy. Choose a policy that adequately meets your health insurance needs.
• Request for an instant quote on your chosen health insurance policy and if you are satisfied with the cost of the insurance, purchase the plan online.

Why You Should Compare Health Insurance Policies Online:

A medical emergency can drain away your savings and hence, we shield ourselves from such emergencies by purchasing a health insurance plan. However, with the health insurance segment offering a lot of choices, it is natural for anyone to get confused about which policy to purchase. The best way to counter the confusion is to research about the various health insurance products offered by the top insurance providers and compare the benefits offered by each of them. Doing a comparison will help you zero in on the ideal health insurance plan that will cater to your healthcare needs.

The comparison process becomes easier when you do it online. You can access the policy documents of various health insurance plans and go through it carefully. This will help you understand the product completely and eliminate any confusion. Apart from this, there are many other benefits of comparing health insurance policies online. We have listed some of them below:

• With just a few clicks of your mouse, you can access a whole lot of information about the features and benefits of various health insurance plans.
• Online comparison eliminates the need for spending unnecessary effort and time on meeting various insurance agents to understand the product.
• Insurance agents and brokers work for commission and hence, the insurance policy will cost you more than when you purchase the policy online.
• You have the luxury of choosing a health insurance policy that suits your needs instead of settling for a policy that an insurance agent offers you.
• All information regarding various health insurance products, including the coverage, network hospitals, claim forms, application forms, etc. will be available at the tip of your fingers.
• While purchasing a health insurance policy online, you can avail discounts and offers that the insurers provide through their official website.
• Comparison and purchase of health insurance plans online requires minimal documentation and is quicker than the traditional methods.

Is it Good to Buy Health Insurance Plans Online?

A traditional offline sale method includes purchasing an insurance policy through an agent who represents the insurance company. The agent is responsible for explaining the features of a health insurance policy to the potential customer, sell the policy, and facilitate the claim settlement process of the policyholder. The agent will remain the sole point of contact between the insurance company and the customer. The agent gets a commission for the sale.

Nowadays, with the growth of e-commerce in India, most everything is available at the click of a button. It includes health insurance as well. Listed below are some reasons why purchasing health insurance online is beneficial:

• Policy information: Information about the various health insurance policies available in the market can be found on the insurer’s website. You can go through the policy brochure available on the website to learn about the features and benefits of a policy.
• Compare policies: You can save time and effort by visiting a comparison website like BankBazaar.com to compare various policies across the top insurance providers in the market. Comparison can be done any number of times for free on the online comparison portal. This is better than making appointments with agents and wondering if the agent is pushing you to buy a policy for the sake of commission.
• Premium calculator: Comparison websites as well as the insurer's website will have online premium calculator where you can get an instant quote on your chosen insurance policy for free. All you have to do is choose a policy from the drop down box, enter your personal details such as date of birth, city, email ID, and phone number, then enter the sum insured, and click on 'Calculate Premium'. The gross premium amount including tax will be displayed on the screen.
• Premium payment: After choosing the policy you want to purchase, you can click on ‘Pay Premium’ on the insurer's website and you will be directed to a secure payment gateway where you can make the premium payment via net banking, debit card or credit card.
• Renewal online: Policy renewal can be done online as well. Visit the insurer's website and enter your policy number and date of birth, you will get your renewal notice with the renewal premium details. Renewal payment can be done through the insurer's website.
• Low premium costs: As the insurance company is saving on administration costs without the involvement of an agent in the online sale, the premium costs will be lower for your chosen policy. Some insurers offer discount on premium for online purchases.

Whether you want to purchase or renew a policy, it can be done seamlessly through the insurer's website using net banking. All you need is a computer and a reliable internet connection to compare various policies and choose one that best suits your needs.

There are few important things to keep in mind when buying a medical insurance policy online:

• Carry a hard or soft copy of your health insurance policy document with you at all times. It will come in handy should you feel the need to make a claim.
• Comparing too many products that don't fall under the same category may confuse you further when choosing a health insurance policy.
• Take the time to read the policy brochure carefully before purchasing. Make sure to go through the inclusions and exclusions offered by the chosen plan.
• If you are unaware of an insurance term, don't hesitate to clarify your doubt with the insurer.
• Avoid buying a policy from an insurance aggregator, but if you can't then ensure that the policy details match the one on the official website of the insurance company.
• Establish the legitimacy of the website by checking the security certificate.
• Take a screenshot of the insurance payment transaction.

Dos and Don’ts of Health Insurance:

Here is a list of dos and don’ts you must keep in mind when purchasing a health insurance policy:

Medical Insurance History in India:

Health insurance was officially launched in India in 1986. By 2010, more than 25% of the population had access to health insurance. The General Insurance Corporation of India and the IRDAI has launched awareness campaigns to reach all segments of the population. Currently, it is one of the fastest growing segments in the general insurance industry in India. Listed below is a general overview of health insurance in India:

• Health insurance companies: Health insurance companies fall under non-life insurance category. There are government sponsored health insurers as well as standalone insurers offering a wide range of medical insurance products to the public. Health insurance providers face a huge challenge despite a steady growth due to the losses faced over rising healthcare costs. In India, assessing health risks and planning for it ahead of time is yet to become a major priority.

• Products and distribution channels: Over 30 different health insurance products are offered by life insurance and non-life insurance providers in India. ICICI Lombard, Reliance General, and Bajaj Allianz are some of the leading general insurers in the country while Star Health and Allied Insurance is a leading standalone player. As the penetration of health insurance products is low in India, the insurers have set up a range of distribution channels which include insurance agents, brokers, bancassurance, direct mailing, and online shopping.

• Need for medical insurance in India: With the steady rise in healthcare costs, health insurance is no longer a luxury but a necessity. In most cases, more than the illness, it's the rising cost of healthcare that takes a toll on the individual. According to a study conducted by the National Sample Survey Organization, 40% of the patients resort to borrowing loans or selling their assets to pay medical bills. There is a significant portion of the population that forgoes treatment as they don't have the means to cover the medical expenses. There is also the increase in number of lifestyle diseases such as hypertension, diabetes, and obesity. Therefore, the need for health insurance is high in India. Health insurance doesn’t cover just the hospitalization costs. It also covers pre and post-hospitalization costs like medicines and consultation fees.

Medical Insurance Age Limit:

Initially insurers were hesitant to provide health insurance for individuals aged 65 years and above. Standalone health insurance companies changed all that by offering health insurance without a limit on maximum entry age. However, insurance premium increases as you get older. Insurance companies ask for your age as it is one of the factors used to set a value on any health risks that you may face. International health insurance plans don't have an age limit. Health insurance in India is available for individuals aged 5 to 80 years. Newborn babies and children up to 5 years of age can be covered under a family floater plan.

You can buy a health insurance policy without any medical examination before the age of 40. This is based on the belief that young people are least likely to have major health disorders. It is advisable to choose a medical insurance plan with a lifelong renewability option instead of waiting till you turn 60 to obtain a senior citizen health insurance plan.

Senior citizen insurance plans are for people aged 60 to 65 years. This type of plan usually comes with co-payment. The plan covers cost of long-term treatments and emergency medical expenses. Most health insurance plans have an upper limit of 60 to 70 years but there are a few that have no upper limit on entry age. ICICI Lombard, Max Bupa and Royal Sundaram are some of the insurers offering medical insurance plans without a maximum entry age restriction.

Health Insurance Terminology and Basics:

Health insurance jargons and terminology can be difficult to understand or the very least confusing. It becomes easier if you were to know at the least some medical insurance basics in order to choose a plan that is suitable to you and your family.

• Insurance coverage: When you read about a health insurance plan with sufficient coverage, it means the policy has to provide a comprehensive set of benefits with affordable premium, and lifelong renewability.

• Tax benefits: You can get tax deductions on premiums paid towards a health insurance policy under Section 80D of the Income Tax Act, 1961.

• Types of medical insurance plans: There are 4 types of health insurance plans available in India:
  • Mediclaim is the most common and basic health insurance plan that provides reimbursement for all the medical expenses incurred during the period of hospitalization.
  • Hospital cash plan offers daily cash of Rs.2,000 to Rs.4,000 per day for the duration of hospitalization.
  • Surgical benefit plan provides cover for certain surgeries undergone by the insured member.
  • Critical illness plan provides insurance cover against diagnosis of any specified critical illnesses covered under the policy like cancer of specified severity or first heart attack.

• Family floater plan: A family floater plan covers all the members of your family from spouse and children to dependent parents and in-laws. It is cost-effective as you get discounts for insuring more members under the same plan. However, it can be inconvenient if just one member uses up the entire cover for one ailment or a long-term treatment.

• Group health insurance: It is offered by employers to their employees as an incentive to retain talent in the company. This type of medical insurance doesn’t require medical examinations or have any age limit as long as the individual is a part of the organization. The cost of insurance is comparatively lower than individual insurance.

• Co-payment: It is the fixed sum of money that the life insured has to pay for covered healthcare service. Co-payment depends on the hospital where treatment is received, the specified ailments, and specific hospital charges.

• Sub-limit: It refers to the percentage of sum insured that the insurance company will pay for certain hospital expenses and illnesses such as room rent, doctor fee, cataract treatment, cardiovascular treatment, etc. Always check the cap or sub-limit on these costs.

• Waiting period: 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.

• Pre-existing conditions: Pre-existing diseases or illnesses mean health conditions for which you may have sought treatment before taking the policy. Some health insurance plans offer coverage for pre-existing conditions after the completion of a waiting period of 2 to 3 years. Only up to 50% of the claim will be payable in the case of pre-existing conditions. Always disclose any pre-existing condition you may have at the time of policy inception to avoid hassle at the time of making a claim.

• Network hospital: Your insurer will have tie-ups with a number of hospitals in different areas of the country where you can avail cashless treatment after receiving approval from the insurer’s TPA. Such medical facilities and hospitals are known as network hospitals. Cashless treatment can be availed only if you have opted for such a health insurance plan.

• Claim process: For cashless facility, you don't have to initiate claim other than receiving TPA approval to get cashless treatment in a network hospital. For indemnity reimbursement claims, you have to initiate the claim within 48 hours of hospitalization and submit relevant documents to support the claim like medical discharge report, bills, pharmacy bills, etc. The insurer will take 15 to 21 days to assess the claim, verify the furnished documents, and settle the claim. A cheque for reimbursement will be sent to the insured member.

Network Hospitals:

Most people prefer getting treated at private hospitals due to their superior quality healthcare and world-class infrastructure but availing healthcare facilities at these private hospitals can be an expensive affair. To receive relief from such high medical expenses, many people purchase a health insurance plan. A health insurance plan offers coverage for hospitalisation expenses for treatments availed at private hospitals. However, for people with health insurance covers, these private healthcare centres tend to charge a higher amount due to which insurance providers lose out on their profit margins. To overcome this, insurance providers partner with several medical centres across the country. These medical centres then become ‘network hospitals’ of the insurance provider where the policyholders can avail cashless facilities.

The insurance providers negotiate the treatment costs at the network hospitals so that their profitability remains intact while also ensuring that the policyholders receive quality healthcare facilities. While partnering with the hospitals, insurance companies take into account the number of policyholders residing in a particular area so that the network hospital is accessible to them. All network hospitals associated with a particular insurance provider forms a part of the wider network of hospitals.

Individuals with a health insurance plan can avail cashless treatment at network hospitals without having to pay the bills out of their pockets. The medical bills will be settled between the network hospital and the insurance provider directly. Health insurance providers usually honor cashless claims for treatments availed only at network hospitals. If the policyholder is admitted to a non-network hospital for an unplanned/emergency hospitalisation, then he or she can’t avail cashless facility, instead, the expenses will be reimbursed by the insurance provider post discharge. Hence, to reap the maximum benefits out of a health insurance plan, policyholders should always choose the network hospital of the insurance provider for treatment.

The complete list of network hospitals of an insurance provider is clearly mentioned in the policy documents. Policyholders are advised to go through this list so that at the time of an emergency, they will have an idea about the nearest network hospital where they can avail the treatment. The list of network hospitals can also be accessed at the official website of the insurance provider. Before purchasing a health insurance plan, it is always recommended that you choose an insurance provider that has a wide coverage of network hospitals and also ensure that the network hospitals of your insurance provider are located in your vicinity.

Health Insurance Incurred Claim Ratio:

ICR (Incurred Claims Ratio) is the ratio of the total value of claims paid to the total premium collected in a year. It shows the insurance company’s ability to pay claims.

Incurred Claim Ratio for Standalone Health Insurance Companies for FY2016-17:

Incurred Claim Ratio for Private Sector Health Insurance Companies for FY2016-17:

Incurred Claim Ratio for Public Sector Health Insurance Companies for FY2016-17:

Medical Insurance Coverage:

Healthcare insurance coverage is the extent of financial protection given against medical expenses to the policyholder. The policy document will contain the limit of healthcare insurance coverage provided by an insurer. The insurance coverage differs from insurer to insurer and plan to plan. Therefore, it is important to read the policy document thoroughly before paying the premium. A good health insurance plan will offer adequate insurance coverage to cover all your medical expenses.

• Cashless treatment: Most insurers offer cashless hospitalization where the insured member can receive quality healthcare at one of the network hospitals without making dent in his or her pocket.

• Reimbursement: You can also make claims for reimbursement of your expenses during the period of hospitalization if the treatment was sought in a non-network hospital.

• Critical Illness cover: You will be paid a lump sum amount if the insured is diagnosed with any of the specified critical illnesses under the policy.

• Hospital cash benefit cover: The life insured will be paid up to Rs,4000 per day for the duration of the hospitalization to meet non-medical expenses.

• Maternity benefit cover: The insurance coverage includes maternity related expenses such as childbirth, tests, etc.

Depending upon the chosen plan, the health insurance coverage is provided for individuals, groups, and families. The range of the insurance coverage depends on the insurance premium, age, and medical conditions. Everyone looks for a health insurance plan that offers a comprehensive set of benefits at an affordable premium. Nowadays, insurers have launched customized health insurance products to meet the diverse healthcare needs of its customers.

Health Insurance Tax Deductions:

Here is a list of important things to know about tax deductions for health insurance premium:

• Premiums paid towards medical insurance qualify for tax deduction under Section 80D of the Income Tax Act, 1961.

• Individual policyholders can claim deduction for premiums paid towards health insurance for self, spouse, children, and dependent parents. Hindu Undivided Families (HUF) can claim tax deductions for insuring members of the HUF.

• Tax deduction of up to Rs.25,000 can be claimed for health insurance premium paid for self, spouse, and children under the age of 65. For members above the age of 65 years, tax deduction can be claimed about Rs.30,000.

• Tax deduction claim of up to Rs.5,000 can be made for expenses incurred for preventive health check-up for each year.

• No tax deductions for group health insurance premiums.

• Insurance premiums paid using cash cannot be claimed for tax deduction. Pay insurance premium using debit card, credit card, cheque or net banking. You can pay in cash for preventive health check-ups and make claims for tax deduction.

• GST paid on insurance services can’t be claimed for tax deduction.

• Tax deduction can be claimed only if the premium is paid by the assesse not any other third-party.

• The maximum tax exemption limit under Section 80D of the Income Tax Act, 1961 is Rs.65,000.

• Under Section 80DD, the insured member can claim benefits up to Rs.75,000 for expenses incurred from nursing, treatment, and rehabilitation of a disabled dependent and Rs.1.25 lakh for serious disability.

• Under Section 80U of the Income Tax Act, 1961, a disabled individual can claim benefits up to Rs.75,000 and Rs.1.25 lakh for serious disability.

Health Insurance EMI:

Medical insurance premium can be calculated using the online premium calculator available on the insurer's website. Reliance General Insurance offers Reliance HealthGain Policy on 4 easy installments for those who can't afford to pay the insurance premium at one go. Nowadays, health insurance policies can be purchased through Equated Monthly Installments (EMI). It is a suitable option for those who prefer a high sum insured but don't have the capacity to pay high premium at one go. However, the total premium in the case of EMI will be higher than paying the full premium upfront.

The EMI facility is available for sum assured above certain amount and long-term policies. You may also lose out on premium discounts in the case of EMI. Future Generali offers the EMI facility for policies with a sum assured of Rs.3 lakh and above. EMI option is available on a monthly, quarterly, and half-yearly basis for Health Total from Future Generali. In the case of a claim made before the entire EMI is paid, the remaining EMIs will be deducted before the claim is paid.

Public Sector Medical Insurance Companies in India:

In 2014, the 5 public sector general insurance companies including General Insurance formed a common in-house health insurance Third-Party Administrator (TPA). National Insurance, New India Assurance, Oriental Insurance and United India Insurance own almost 70% market share in the health insurance sector. The in-house TPA will help the public sector insurers gain more control over claim processing and also bring about transparency in the process.

Health Insurance Grace Period:

According to the IRDAI guidelines, grace period is the specified period of time from the premium due date during which a payment can be made to renew or continue an active policy without losing out on benefits such as waiting periods and coverage of pre-existing illnesses.

Failure to pay the insurance premium before or on the due date will result in the termination of health cover provided by your insurer. You will be given a short grace period from the expiry date to pay the premium to avoid policy lapse. However, no insurance coverage will be available for the duration of non-payment. Here is how medical insurance grace period works:

• Grace period for payment of health insurance premium: Health insurance companies provide a grace period of 15 to 30 days within which you will have to pay all the outstanding premiums to avoid policy lapse. There will be no insurance coverage available for the period for which premium isn't paid. If you fail to pay the premiums due within the grace period then your policy will lapse.

• Grace period for health insurance policy renewal: It is advisable to pay the renewal premium before the due date. Your policy may lapse if you fail to renew it before the expiry date. However, you can take advantage of the grace period given by the insurer to pay the renewal premium. The grace period is usually 15 to 30 days from the expiry date. The policy will lapse if the renewal premium is not paid within the grace period.

Letting your policy lapse will be disastrous as the no-claim bonus, loyalty discounts, and benefits you had accrued over the years will no longer be available. You will end up having to go through the process of buying a new health insurance policy again. After purchasing a new policy, you will have to wait for the waiting period to pass before your health cover becomes active. Some insurers may give you the option to revive your policy after a lapse. You can revive the policy within 6 months from the date of lapse. You have to pay all the outstanding premiums with interest and policy reinstatement fees. You will have to submit proof of insurability.

How does Health Insurance Works?

A good health insurance policy can help an individual manage the high costs which are incurred when a person has been hospitalised. Not only does a health insurance plan offer some amount of safety to your expenses, it also offers a peace of mind to a policyholder without worrying about sudden costs to clear if hospitalised. A good health insurance policy would also entail pre and post hospitalisation charges.

When a policyholder has to be admitted into a hospital due to some unforeseen circumstance, benefits of a health insurance policy come into play. There are a few health insurance policies which offer cashless hospitalisation, reimbursement, etc. A policyholder will have to inform the insurer under planned hospitalisation so that the insurer can ensure that the policyholder is covered. This should be done within a few days prior to being admitted. If a policyholder is admitted into a hospital due to an unforeseen event such as an accident, the insurer will have to be informed as soon as possible. Once this is done, the policyholder will either pay for the medical expenses out of his/her own pocket after which the insurer will reimburse the policyholder after he/she has been discharged. Another way of coverage is where the insurance company will cover the medical expenses incurred during the treatment of the policyholder. The medical expenses are settled directly between the insurer and the hospital.

Choosing a Health Insurance Plan:

There are a number of different health insurance agencies that offer a plethora of health insurance products, each with its own unique benefits. So what goes into choosing the right insurance plan? A customer will have to factor in their needs and requirements when choosing the right insurance plan rather than going by the advice given by a third party. Here are a few points which a potential policyholder could follow when choosing a health insurance plan:

• Policy Coverage: It is important that you find out about the health insurance coverage that’s offered by a health insurance company. You will have to check and see if your policy covers pre-existing diseases, day care procedures, accident related injuries, and other maternity expenses. It is advisable to select a health insurance policy that offers coverage to you and your family.
• Cover Exclusions: Once you have a deeper understanding about your health insurance plan, you will have to ensure that you have researched on what your health insurance policy does not cover. Some of the basic exclusions in health insurance policies include:
  • Pregnancy
  • Dental Services
  • Joint Replacement Surgery
  • Cosmetic Surgery
  • Ayurveda
  • Homeopathy
  • Any injury inflicted on a policyholder when under the influence of drugs or alcohol
  • Any injury inflicted by terrorism, war, protest, strike or civil commotion
• Premium Payment Frequency: It is important to find out about the premium payment frequency as well as renewal dates. A policyholder will have to renew a health insurance policy to continue availing the benefits offered by the policy. For most insurance plan, a premium payment can be done either monthly, quarterly, half-yearly or yearly. Once you have found out about the premium payment period, you can accurately calculate and plan your expenses to ensure that you have money kept aside to make these payments on time.
• Claim Settlement Ratio: Another important thing to find out about is the claim settlement ratio of the insurance company. The claim settlement ratio gives a customer a brief idea of the number of claims that an insurance company has settled versus the number of claims the company has rejected.
• No Claim Bonus (NCB): No Claim Bonus is a way for the insurer to reward a policyholder for not making a claim for every year that they do not make a claim. This ensures that a customer does not make petty claims during the insurance period. It is important that the customer checks to see if the insurer offers a good No Claim Bonus when purchasing a health insurance plan. A NCB can also be offered as a discount on the premiums that have to be paid at the time of renewal.
• Portability: Portability refers to switching health insurance providers when a policyholder comes across an insurance company that meets their needs and benefits in a better way. A policyholder can choose to switch insurers depending if the insurance companies offer portability. With new insurance products coming out every day, offering better benefits and coverage, it is important that a customer does their research and finds out if the insurer that’s offering the health insurance policy also offers portability.
• Customer Service Department: It is definitely an important aspect to find out about an insurance company. A customer could end up with queries or complaints during the term of the health insurance plan. It is important that the insurance company from where the health insurance policy has been purchased from offers a good and well-trained customer support team that offers its services to make the life of the customer a lot more comfortable.

Health Insurance Network Hospitals:

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.

Cashless facility is provided only after receiving approval from your insurer's Third Party Administrator. TPA acts as a mediator between the network hospital and the insurer to process claims. It is advisable to choose an insurer with a high number of network hospitals across the country. Ensure the network hospital in your area is a decent medical facility providing effective healthcare. If you receive treatment at a non-network hospital, the reimbursement claim and settlement may take 2 to 3 months. You will have to pay the medical bills upfront out of your pocket.

Health Insurance Vs Critical Illness:

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 Vs Life Insurance:

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 Vs Term Insurance:

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.

Mediclaim Policies in India:

Rising costs of healthcare and medical treatments have made having health insurance a necessity in today’s times. More and more people are falling victims to countless health related conditions due to leading unhealthy lifestyles, and general environmental pollution. A medical emergency can give rise to significant expenses which can burn a deep hole in your pockets. However, with rising costs, sometimes, adequate or quality treatment may even be out of your reach. Add to that the various other expenses which accompany the treatment, and you may soon find yourself depleting your hard-earned savings at an alarming pace. This is where a health insurance policy steps in.

Health insurance policies have been designed to help you take care of emergency medical expenses, and also critical illnesses, the treatments for which can easily run into lakhs of rupees. Mediclaim policies are a type of health insurance which is designed to specifically provide reimbursement for expenses which a policyholder incurs in the event of hospitalisation, or for domiciliary treatments. With the help of this policy, the insured have the option of either getting reimbursed for the covered expenses, or avail cashless hospitalisation at network hospitals. If you would like to know more about Mediclaim policies in India, read on.

Health Insurance Vs Mediclaim:

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.

Waiting Period of a Health Insurance Policy:

We live in a world where every individual is at the mercy of an environment where diseases and health hazards lie right around the corner. A sedentary lifestyle coupled with bad eating habits, dangers of traveling on city roads and highways, and exposure to pollution can take a major toll on the health of an individual. Due to these and a number of other reasons, a health insurance policy proves to be a vital tool for an individual to possess in today’s world. Not only does it act as a safety net for their finances in case the individual is hospitalised, but also provides the right medical coverage in the event of an unforeseen circumstance.

When a customer applies for a health insurance policy, the customer has to wait for a certain period of time before they can reap the benefits of the health insurance policy. The waiting period of a health insurance policy is the time period after which a health insurance policy provides coverage to a certain list of diseases or ailments. Generally, the waiting period for pre-existing diseases is 4 years and this is a standard clause which is implemented by most insurance companies. The waiting period of a health insurance policy starts from the date of inception of the policy. The insurance company covers any claim which is made after the waiting period has been completed as long as the claim is legitimate and the insurer approves it.

Let us take a closer look at the various types of waiting periods that accompany a health insurance policy.

• Pre-Existing Diseases: A customer can declare that he/she has been diagnosed with a pre-existing medical condition like high blood pressure, diabetes, thyroid, etc. when applying for a health insurance policy. Such ailments are called pre-existing diseases. The insurer will insist on a medical check-up to determine the extent of the impact that the disease has had on the customer’s health. Based on these medical results, the insurer will decided to accept or reject the proposal of the customer for the health insurance policy. If the insurer accepts the customer’s proposal, the customer will have to wait for a period of 4 years before they make a health insurance claim. After the stipulated time period is completed, the insurer will settle a claim made by the policyholder if it is a valid claim. It is advisable that a person applies for a health insurance policy at an early stage in their lifetime to avoid waiting for a waiting period of the policy to get over before making a claim.
• Waiting Period for a Particular Ailment: Health insurers offer a limited waiting period that ranges from one to two years and this depends on the type of ailment that the customer is diagnosed with. These disorders or ailments can range from ENT disorders, osteoporosis, hernia, etc.
• One Month Waiting Period: Some health insurers offer a waiting period of one moth for general health insurance policies. Accident cases are an exception to this type of waiting period.
• 90 Day Waiting Period: Health insurance policies for new born babies and infants are provided with a 90 day waiting period.

There are some insurance companies that operate in India that offers a waiting period which ranges from 9 months to 36 months. Some of these insurers also offer maternity benefits.

Reducing Waiting Period:

There are health insurance companies that offers a reduced waiting period if the insured makes an extra premium payment towards their health insurance policy. A policyholder can also reduce their waiting period by purchasing a related add-on cover on top of their current insurance policy.

Another point to keep in mind is that if a group insurance plan is offered by an employer for their employees, the insurer can offer the plan without insisting on a waiting period.

Important Points to Note:

According to the guidelines set by the IRDA, an employee is eligible to convert their group health insurance policy into a retail health policy when they leave the employer. The employee will be given a health insurance policy without a waiting period as the employer has already completed the waiting period through the group insurance plan.

Insurance companies have also introduced the “co-pay” clause instead of a waiting period when offering a health insurance policy to senior citizens. With a “co-pay” clause, an insurer will be have to pay a part of the hospital expenses when the insurance policy comes into play.

In summary, the waiting period of a health insurance policy is beneficial to both the insurer and the insured. It is important that the insured reads the offer documents carefully before applying for a health insurance plan. They should also ensure that they read everything related to the waiting period of a health insurance policy before purchasing the insurance policy.

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