A Health insurance policy is a contract between the insurance company and the policyholder, wherein the insurer pays for the medical expenses incurred by the life insured.The insurer will either provide a reimbursement for your medical expenses or ensure you are eligible for cashless treatment for injuries or illnesses covered under the policy at one of the network hospitals. You can also get tax deductions on the premiums paid towards health insurance under Section 80D of the Income Tax Act, 1961.
|Types of Health Insurance Plans||Benefits of Health Insurance||Health Insurance Network Hospital||Mediclaim Policy||Health Insurance News|
The following are the main benefits of being covered by a health insurance policy:
When you are covered under a health insurance policy, you can avail cashless treatments which essentially means that you can receive medical treatments without having to pay the hospital from your own pockets.
Effective insurance policies offer coverage for pre- as well as post-hospitalisation expenses for a period of 60 days before and after an insured individual is hospitalised.
In case you hold a health insurance policy and get hospitalised the plan will cover the costs incurred on using an ambulance to transport you from your home to the hospital or vice-versa.
Most health insurance policies offer free health check-ups. However, most insurance companies only offer these check-ups for free depending on your No Claim Bonus.
If you hold a health insurance policy and do not make any claims over the course of an entire policy year, you will be rewarded in the form of a No Claim Bonus.
In case you are hospitalised, you will have to incur costs on room rent. Having a health insurance policy will ensure that these costs are covered to a significant extent.
Having a health insurance policy can offer tax benefits as well. The premium payments you make towards your health insurance plan qualify for tax deductions under Section 80D of the Income Tax Act.
Thanks to the advancements in technology, you no longer need to visit a branch of the health insurance company in order to purchase a plan. You can do so from the comfort of your own home or office.
The renewal of your health insurance policy can also be done online. There is also a lot of flexibility when it comes to renewing your insurance plan. You can alter the terms of coverage based on what you think will work best for you.
Most of the traditional health insurance plans require the insured individual to be hospitalised for a minimum of 24 hours if they are to be eligible for reimbursements.
With fresh coronavirus-related cases registered in India, insurers are witnessing a sharp increase in enquiries on health insurance policies. As per reports, queries on insurance policies have increased by 40% since the detection of new coronavirus cases.
In this section, we have compiled 7 frequently asked questions related to coronavirus and health insurance policies to make things clearer for you.
• What is coronavirus?
Coronavirus is a type of virus that causes illness ranging from common cold to severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).
• What are the usual symptoms for coronavirus?
Symptoms are similar to any other flu such as cough, runny nose, sore throat, and fever. These symptoms may appear between 2-14 days from contacting the virus.
• Is coronavirus curable?
No specific treatment for coronavirus has been confirmed yet. However, one can be cured depending on the severity of the disease.
• How can I protect myself from contacting the disease?
Precautionary measures like washing your hands thoroughly with sanitiser and warm water would help. Also, avoid large group gatherings for safety. Wear a mask if you are travelling.
• Do health insurance policies cover such diseases?
Most clinics and hospitals in India are conducting coronavirus tests for free. However, hospitalisation charges, including room rent, surgical procedures and medical expenses are to be borne by patients. This is where a standard health insurance policy comes into play. If you have a pre-existing policy, your post-hospitalisation expenses will be covered by your insurer.
• Is there any waiting period?
Coronavirus doesn’t fall under the pre-existing disease category. Hence, waiting period is not applicable.
• Is it necessary to buy a new health insurance policy specifically for coronavirus?
If you don’t have an existing policy, you should sign up for one. Any standard health insurance policy will help covering your hospitalisation and medical expenses. Certain insurance service providers, like Digit has rolled out policies designed specifically to cover coronavirus-related treatments. You might check such policies too.
•What is cost of Covid 19 testing in India?
As of March 17, 2020, testing is being done free of charge for all individuals who require to be tested as per the guidelines. For others, the cost for the first and second step screening analysis is Rs.1,500 and Rs.3,000 respectively.
•How many testing centres are there in India?
As of 16 March, 2020, there are 110 government testing centres in the country. For a detailed and up-to-date list of Covid 19 testing centres, please visit the official website of the Indian Council of Medical Research (ICMR) icmr.nic.in.
Mentioned below are the different types of health insurance plans you can choose to meet your specific requirements:
The following are the documents you will require to purchase health insurance in India:
Certain health insurance companies will require applicants to undergo medical examinations in order to qualify for coverage. Also, insurers can also request other documents apart from the ones mentioned above.
The Central Bureau of Health Intelligence presented a report in 2015-16. According to the report, which was supervised by the Ministry of Health and Family Welfare, less than 30% of Indian citizens were covered by any sort of health insurance. This information highlights the poor situation of the healthcare industry in India. India also happens to be one of the most populated countries in the world, where two-third of the populace is poor and has limited access to basic necessities. As such, investing in health insurance is extremely difficult for many people.
Keeping the situation of its citizens in mind, the Government of India has launched a number of health insurance schemes to financially protect those who cannot afford health insurance. These schemes are made available at affordable prices and offer moderate cover against medical emergencies. A lot of people who come from the middle-income group are making the most of these schemes. Government-sponsored health insurance plans can be purchased from web aggregators that allow you to compare various plans before you find one that best suits your needs.
The following are some of the best health insurance policies offered by the Government of India:
Over the past few years, there has been tremendous growth of the health insurance sector in India. Citizens of the country now have access to a large number of options so far as health insurance companies are concerned, so much so that it is quite hard to find the best health insurance company based on your requirements. A few factors must be kept in mind when choosing an insurer. They are as follows:
There’s more in a name than the ancient proverb suggests. A company’s reputation gives an insight into the kind of services as well as the quality of service you can expect from your insurer. A company with a good reputation with a good brand image is a safe bet as you can be assured of a good experience. While you can always consider word of mouth to choose an insurance company, sound research will go a long way towards ensuring you select the best option at your disposal.
Research is crucial to finding the right insurance company. Look for the company’s financial solidity before picking it. The Credit Rating Information Services of India Private Limited (CRISIL) rating can help you assess the financial stability of an insurance company. Companies with AAA ratings are recommended as they have the best financial strength, making it easier for them to meet obligations.
Considering the fact that insurance is a massive industry, products and services are bound to change over time. Along with the changes in the insurance industry, your insurance requirements can also change as you age. It is therefore very important to consider companies that have a wide variety of insurance plans that can cater to requirements of a diverse customer base.
When you purchase a health insurance plan for emergencies in the future, it is only natural to expect your claims to be settled quickly. The filing of claims is considered a tedious task and the process can take a long time to complete after you submit the form and supporting documents. Approval can take a while if the company is not up to the mark with its settlement process, and there are chances of your claim getting rejected as well. It is therefore crucial to check for the claims settlement ratio along with the simplicity of its claims settlement process to ensure that there are no hassles at the time of making claims.
Lay people often find it difficult to understand insurance. It is for this reason that an increasing number of insurance providers are appointing advisors so that it becomes easier for customers to comprehend the concept of insurance. These advisors offer support when it comes to selecting the right health insurance policy based on your requirements. They also offer assistance with regard to claim-related queries.
Customer service is one of the most crucial factors to consider when purchasing any product. When you buy a health insurance policy, you will have to ensure that you get solutions and support at your fingertips. A reputed company with an efficient customer support team will ensure that all your queries will be resolved at the earliest, be it through email, phone, or online assistance.
Before you buy any product, reading through the customer reviews posted by fellow users of the product will help you gain an insight into their experience. When it comes to health insurance, going through reviews will help you understand how the policy has benefitted other customers. You may also check the website of the Insurance Regulatory and Development Authority of India for the complaints and resolutions of the company.
The following are some of the best health insurance policies offered by the Government of India:
When you wish to purchase health insurance, the insurance company could ask you to take certain medical examinations. After your age, your health is the second most crucial factor that aids an insurance company in assessing your premiums.
Currently, majority of the health insurance companies in India provide coverage to individuals under 45 years of age without the need for medical exams. However, your pre-existing conditions, if any, will certainly be taken into consideration by the health insurance company. If your insurer does not insist on taking a medical exam, you will be asked to furnish a declaration of good health in addition to disclosing your pre-existing conditions such as hypertension and diabetes. Having no pre-existing conditions and being younger will help you find plans for lower premiums.
Medical examinations usually comprise mainly of physical, urine, and blood tests. Although these tests seem simple, they have the ability to disclose a lot regarding human health. They can detect abnormalities in kidney and liver functions as well as an increase or decrease in blood sugar levels. They can also reveal whether you consume tobacco or alcohol. Those who seek health insurance and are above 55 years of age are generally required to take additional medical exams.
Listed below are some of the top insurance companies offering health insurance policies. The insurance companies have been ranked based on the Incurred Claims Ratio of every insurer. This is the ratio between the premium earned and the total claims incurred by the insurer.
This is the ratio that is generally used to determine how an insurance company is performing. A higher incurred claims ratio means the insurance company has a better track record of settling the claims they receive. It is always good to opt for an insurance company with a high Incurred Claims Ratio.
|Health Insurance Companies||Incurred Claims Ratio (ICR)||Grievances Resolved|
|National Health Insurance||115.55%||97.07%|
|Oriental Health Insurance||113.86%||73.83%|
|United India Insurance||110.95%||96.59%|
|Reliance General Insurance||106.54%||98.49%|
|Universal Sompo General Insurance||104.17%||100.00%|
|New India Assurance Health Insurance||103.19%||99.94%|
|Bharti Axa General Insurance||98.50%||99.69%|
|IFFCO Tokio General Insurance||90.69%||98.47%|
|Aditya Birla Health Insurance||89.05%||57.54%|
|Future Generali Health Insurance||87.42%||99.73%|
|Bajaj Allianz General Insurance||77.61%||99.78%|
|Liberty Videocon General Insurance||74.58%||100%|
|ICICI Lombard General Insurance||68.26%||98.91%|
|Star Health and Allied Insurance||61.76%||98.96%|
Source: IRDA Annual Report 2017-18
A joint venture between Munich Health and Apollo Hospitals, Apollo Munich Health Insurance is considered among the top health insurance providers in India. The plans designed by the company are of the highest quality and cater to the requirements of a diverse customer base. The company received the InfoSec Maestros Awards and the Health Insurance Provider Award in recent times. The Incurred Claim Ratio of Apollo Munich Health Insurance Company is remarkable with 62.47% as of 2017-18, and it offers lifelong renewability and portability options.
|Health Insurance Plans offered by Apollo Munich Health Insurance|
|Optima Plus||Easy Health||Day2Day Care|
|Energy||Optima Cash – Daily Hospital Cash Plan||New iCan Cancer Insurance for Women|
|Dengue Care||Optima Super||Maxima|
|Health Wallet||Optima Vital||Optima Restore|
|Optima Senior||New iCan Cancer Insurance||Optima Super – Aggregate Top up Plan|
Star Health and Allied Insurance Company Limited aims at offering excellent service to its customers along with the provision of creative insurance products. The company offers health insurance, personal accident insurance products, and overseas mediclaim policies. Star Health and Allied Insurance Company Limited is a stand-alone insurer that offers insurance products at competitive prices. The Incurred Claim Ratio of Star Health and Allied Insurance Company Limited stands at 61.76% as of 2017-18, and the company continues to design innovative products such as Star NetPlus for HIV+ patients and Diabetes Safe for diabetic patients, among others.
|Health Insurance Plans offered by Star Health Insurance and Allied Insurance Co. Ltd.|
|Star Special Care||Senior Citizens Red Carpet||Star Criticare Plus Insurance Policy|
|Family Health Optima||Star Family Delite Insurance Policy||Star Comprehensive Policy|
|Diabetes Safe Insurance Policy||Star Health Gain Insurance Policy||Medi-Classic Insurance|
|Star Surplus Insurance Policy||Star Care Micro Insurance Policy||Star Cancer Care Gold (Pilot Product)|
|Star Net Plus||Star Cardiac Care Insurance Policy|
A joint venture between UK-based global healthcare group Bupa, and Max India Limited, Max Bupa Health Insurance Company Limited caters to a diverse customer base spread across nearly 200 countries. The company is proficient at health and protection administrations, like life insurance and clinical research, for instance. The company aims at encouraging customers to find an increasingly beneficial life by offering them a wide variety of quality health insurance products. The Incurred Claims Ratio of the company for 2017-18 is 55.16%, and it is also one of the country’s leading insurers in today’s date.
|Health insurance plans offered by Max Bupa Health Insurance Co. Ltd.|
|Heartbeat||Max Bupa Health Recharge|
|Criticare Plan||Accidentcare Plan|
ICICI Lombard General Insurance Company Limited is a joint venture between ICICI Bank Limited and a financial services company based out of Canada known as Fairfax Financial Holdings Limited. The company deals with investment management, reinsurance, and general insurance. It has received several awards for its innovative solutions and customer-centric approach. ICICI Lombard General Insurance Company Limited is known for its provision of specific health insurance policies to a wide customer base, thereby providing customised and specialised health insurance solutions. The company’s Incurred Claims Ratio for 2017-18 is 76.89%.
|Health Insurance Plans offered by ICICI Lombard|
|Personal Protect Policy|
A venture of Religare Enterprises Limited, Religare Health Insurance Company Limited has different investors such as Union Bank of India and Corporation Bank. The aim of the company is to become the most favoured health insurance company in India. Religare Health Insurance Company Limited guarantees access to inventive and financially effective health insurance products. The company has been presented with the Quality Management System as per ISO 9001:2015 guidelines. The Incurred Claims Ratio of the organisation stood at 51.97% for 2017-18, and the company is regarded as one of the top five health insurance companies in India.
|Health Insurance Plans offered by Religare health insurance Company|
ManipalCigna Health Insurance Company Limited is a joint initiative between Manipal Group and Cigna Corporation, which is based out of the US. Cigna Corporation is among the most popular health service pioneers from the US, and the goal of the company is to provide tailor-made health insurance products based on the requirements of its customers. ManipalCigna Health Insurance Company Limited offers a wide variety of health insurance plans, and its Incurred Claims Ratio for the year 2017-18 stood at 46.29%.
|Health Insurance Plans offered by ManipalCigna Health Insurance Co. Ltd.|
|ManipalCigna Health Insurance Plans||ManipalCigna ProHealth Insurance|
|Lifestyle Protection - Critical Care||Lifestyle Protection - Accident Care|
|ManipalCigna ProHealth Select||ManipalCigna ProHealth Cash|
|ManipalCigna Global Health Group Policy||Lifestyle Protection Group Policy|
|ProHealth Group Insurance Policy||Group Overseas Travel Insurance Policy|
Bajaj Allianz General Insurance Company Limited is a joint enterprise between Allianz SE and Bajaj Finserv Limited. The operations of Bajaj Allianz General Insurance Company commenced in 2001, and the organisation has master accomplices that make it one of the biggest and most trusted health insurance providers in the country. The major products of Bajaj Allianz General Insurance Company Limited include Star Package, Silver Health, and Health Guard. The Incurred Claims Ratio of Bajaj Allianz for the year 2017-18 stands at 66.72%.
|Health Insurance Plans offered by Bajaj Allianz General Insurance|
|Health Guard Individual Policy||Global Personal Guard||Health Care Supreme|
|Premium Personal Guard||Health Guard Family Floater Option||Critical Illness|
|Personal Accident||Silver Health||Health Ensure|
|Extra Care||Extra Care Plus||Star Package|
|Tax Gain||Sankat Mochan||Hospital Cash Daily Allowance|
|Surgical Protection Plana||Women Specific Critical Illness|
New India Assurance Company Limited is a 100% government-owned general insurance company which has a presence in 28 countries across the globe. The company has received the AAA/STABLE rating from CRISIL, which shows that the quality of the financial products offered by the company is truly outstanding. New India Assurance Company Limited has over 2000 offices in addition to over 19,000 representatives as well as about 50,000 tied specialists who offer administrations and protection items to customers. The Incurred Claims Ratio of the company for the year 2017-18 stands at 85.66%.
|Health insurance plans offered by New India Assurance Co. Ltd.|
|Asha Kiran||BMB Nirbhaya|
|BMB Parivar Suraksha||BMB Sakhee|
|Cancer Medical Expn-Individual||Family Floater Mediclaim|
|Jan Arogya Bima||Janata Mediclaim|
|New Family Floater 2012||New India Floater Mediclaim|
|New India Global Mediclaim Policy||New India Mediclaim Policy|
|New India Premier Mediclaim Policy||New India Sixty Plus Mediclaim Policy|
|New India Top-up Mediclaim||Rashtriya Swasthya Bima Yojana|
|Senior Citizen Mediclaim||Standard Group Mediclaim 2007|
|Swasthya Bima Policy||Universal Health Insurance|
|Universal Health Insurance BPL|
An auxiliary of Oriental Government Security Life Assurance Company Limited, Oriental Insurance Company Limited provides some major products such as petrochemical plants, chemical, steel and power plants. It also offers a variety of protection solutions to urban as well as rural customers in the country. The company has over 30 regional offices in addition to 1800+ working offices across India. The Incurred Claims Ratio of Oriental Insurance Company Limited for the year 2017-18 stands at 85.39%, and it is one of the most reputed health insurance providers in the country.
|Health Insurance Plans offered by Oriental Insurance Company|
|Mediclaim Policy||Group Mediclaim Policy|
|Pravasi Bharatiya Bima Yojana (PBBY) 2017||Jan Arogya Bima Policy|
|Health of Privileged Elder (HOPE)||Oriental Mediclaim Policy (OBC) 2017|
|PNB 2017||Happy Family Floater Policy 2015|
|Oriental Happy Cash Policy|
National Insurance Company Limited is one of the pioneers in acquainting product customisation with country as well as corporate clients. The workforce of the organisation is around 15,000 faculties, and it has nearly 2000 workplaces across the country. So far as the non-life safety net providers in India is concerned, National Insurance Company Limited ranks second in terms of gross direct composed premiums. The Incurred Claims Ratio of the company for the year 2017-18 stands at 114.24%.
If you wish to purchase health insurance in the near future, you should definitely consider one of the aforementioned companies to receive the best service possible.
|Health Insurance Plans offered by National Insurance Co. Ltd.|
|Overseas Mediclaim Business and Holiday||National Parivar Mediclaim|
|National Parivar Mediclaim Plus||Overseas Mediclaim Employment and Studies|
|National Mediclaim Plus Policy||Parivar Mediclaim|
|National Mediclaim Policy|
Choosing the right insurance plan can be a difficult task, but thanks to advancements in technology, the internet can now grant you access to a large number of options .This can be assessed and compared before you pick the plan that best suits your needs. People tend to make common errors when purchasing health insurance, and avoiding these mistakes can help you make the most of your health insurance policy. The following are the common mistakes you must avoid when purchasing health insurance:
The amount for which you are covered plays a crucial role in determining which policy will best suit your needs. Most people tend to choose plans with lower coverage as it helps them save some money. Lower coverage will help reduce the amount you pay as premium for your insurance policy. While it is important to save money, it is also crucial to ensure that you don’t be too stingy when it comes to buying health insurance as it could prove to be a hassle later.
Many people tend to go with the first insurance company they find. When purchasing a health insurance plan, it is crucial to compare as many plans as possible as it will help you identify which one best suits your needs.
People tend to lie about their medical history when purchasing health insurance as it tends to lower their premiums. When you purchase a health insurance plan, it is essential to be truthful about your past medical health and situations. When you lie about your medical history, there is a chance that your claims could be rejected if the insurer finds out about the same.Ensure that you submit the correct records so that you do not have to encounter a problem later.
The cashless facility is one of the most important things to look for when purchasing a health insurance plan. However, many people tend to even consider this facility when looking for policies. By finding an insurance provider that offers the cashless facility, you can rest assured that you will receive immediate treatment in case of emergencies and the insurer will cover the costs.
When you purchase a health insurance policy, the insurer will provide with an option of co-pay. If you choose this option, you will have to contribute a certain pre-determined amount at the time of making a claim, and the remainder will be paid by the insurance company. The sum assured will not be affected by the co-pay amount.
Health insurance acts as a safety net for an individual's finances in case he/she meets with an unforeseen accident. The insurance policy ensures that the insured gets the best treatment available without worrying about clearing the costs at the time of discharge. Knowing about the claim process is an important piece of information that the insured should be armed with at all times. There are certain procedures that the insured will have to follow at the time of making a claim.
There are two main types of claim process which an individual can choose when making a claim on their health insurance. These are:
For all the illnesses covered under the health insurance policy, the insured can receive treatment from the hospital by providing the details of the health insurance policy along with some proof for the policy.The hospital will then approach the insurance company with the bills. The insurance company will settle the total amount with the hospital after evaluating all the expenses incurred. There is a separate claim process for planned treatments and emergency treatments. In the reimbursement claim process, the policyholder will have to initially pay for the treatment. The money will then be reimbursed by the insurer after the required documents are provided.
Find out more about the claims process to make sure you are aware of all the steps to take at the time of a claim incident.
Cashless facility is available only if you receive treatment in one of the network hospitals of your insurer. A network hospital is a medical facility with which your insurer has a tie-up to provide healthcare to its customers. If you opt for cashless treatment, you don't have to pay the medical bills upfront from out of your pocket. The insurer will pay the network hospital while you receive treatment without any hassle. All you have to do is show your e-card upon arrival at the network hospital to avail cashless treatment.
Check cashless network hospitals nearby your location: Network Hospitals for Cashless Treatment
Portability is the option of switching from one health insurance provider to another. Opting for portability earlier resulted in a loss of all the benefits you may have accumulated with the previous insurer. IRDA made a change to this rule and you can now transfer your insurance from one insurer to another without losing the benefits you gained with the previous insurer. You can also use this option to port from one plan to another plan provided by the same insurer.
Mediclaim covers only hospitalization expenses whereas health insurance reimburses pre and post-hospitalization expenses, pharmacy bills, and ambulance fees besides hospitalization expenses. Often, mediclaim and health insurance are used interchangeably even though they aren’t the same thing.
|Health Insurance Plan||Mediclaim|
|Health insurance plans offer a comprehensive cover against medical expenses incurred by the life insured due to an illness or accidental injury.||Mediclaim provides reimbursement for hospitalization expenses incurred by the life insured.|
|Critical illness cover, personal accident cover, and accidental disability cover are some of the add-ons or riders that can be attached to the base health insurance policy, wherein the life insured is paid a lump sum amount as benefit.||Mediclaim works on the indemnity principle, wherein the life insured is reimbursed his or her hospitalization expenses.|
|Once the claim is made and the sum assured is paid, no further claims can be made under a health insurance plan.||Any number of claims can be made under a mediclaim policy until the sum assured is exhausted or paid in full.|
|The payout in a health insurance plan can be enormous, usually up to Rs.60 lakh.||Medicla.im insurance cover is limited, usually up to Rs.5 lakh.|
To get a health insurance policy, an individual has to pay a premium amount at regular intervals as selected by him/her during the inception of the policy. From the commencement of the policy, if the insured person has any medical expenses to bear, the insurer will be liable to pay them as per the terms and conditions. Please note that few insurers have a waiting period within which no claims will be entertained. The waiting period differs from one insurer to another.
Health insurance is usually included in the benefits offered by an employer to the employees of an organisation. However, the extent of coverage under such a policy may be limited. So, it is advisable to buy a separate individual health insurance policy for extended coverage.
Health insurance plans are available for individuals, families, and senior citizens. The family floater plans protect the entire family under a single insurance policy, covering Out Patient Department (OPD) expenses and much more. Senior citizen health plans usually provide comprehensive health insurance cover for the elderly for treatment of accidental injuries and illnesses.
The following is a brief list of things you should and should not do when buying a health insurance plan:
|Understand your health insurance requirement and choose a customised plan that will meet your needs. The 4 most common kinds of health insurance policies you can consider include mediclaim, surgical benefit plan, hospital cash benefit, and critical illness. Pick a plan that best suits your requirements.||Try not to be over-insured or under-insured. Choose a sufficient health cover that will provide you with the required assistance on time.|
|Go through the fine print of the policy document and ensure that you understand all the inclusions and exclusions of the plan. Customise the plan as per your requirements and make the premium payment only after your proposal has been accepted by the insurer. You can always negotiate the sub-limits and co-payment features in your plan, so make sure you purchase the plan only once you’re certain that your requirements are met.||Don’t settle for a plan because the premium associated with it is cheap. Plans that are offered for low premiums do not provide adequate coverage and may see you incur out-of-pocket expenses in the future.|
|Go through the policy document carefully to understand all the inclusions as well as exclusions of the plan. Look for the waiting period for pre-existing ailments as they vary from policy to policy. Check the fine print in order to avoid shocks later on.||Make sure that your policy does not lapse. Renewing your health insurance plan on time is crucial to ensuring that you will be financially covered in times of emergencies. Delays in renewing your policy can result in the rejection of claims, if any.|
|Look out for the list of network hospitals and the cashless facility. Doing so will ensure that you pick a plan that offers more than just basic healthcare. You will also be able to access quality healthcare in times of emergencies by checking the list of network hospitals.||Be honest about your pre-existing conditions. If you have any illness or condition, it must be disclosed to the insurer as failure to do so or submitting false documents or concealing facts could result in the termination of your health insurance policy.|
Critical illness plan is a rider or add-on that can be attached to your base health insurance or life insurance policy. Under the critical illness rider, the insurer is bound to pay a lump sum amount to the policyholder if the life insured is diagnosed with any of the specified illnesses mentioned in the policy document. On the other hand, medical insurance is an insurance coverage against medical and surgical expenses incurred by the life insured while the policy is active. Insurers will reimburse the policyholder for expenses incurred from accidental injuries or illnesses.
|Health Insurance Plan||Critical Illness Plan|
|It covers hospitalization costs, OPD expenses, and maternity benefits of the life insured.||It offers a lump sum amount on diagnosis of a pre-specified illness of the life insured.|
|Minimum 24 hours of hospitalization is required to claim or receive reimbursement of the medical expenses incurred by the life insured.||Hospitalization of the life insured is not required to receive the critical illness benefit.|
|Policy continues even after a claim is made until the time of renewal.||Policy lapses once the critical illness benefit has been paid by the insurer.|
|Health insurance provides coverage against medical expenses incurred due to an illness or accidental injury.||Critical illness covers only pre-specified illnesses like cancer, heart attack, etc.|
|The waiting period for a health insurance plan is usually 30 days.||The waiting period for a critical illness plan is minimum 3 months.|
Life Insurance offers financial protection to your family at different stages of their lives in your absence whereas health insurance provides insurance coverage against medical expenses incurred by the insured members due to an illness or accidental injury when the policy is active.
|Health Insurance Plan||Life Insurance Plan|
|It provides insurance coverage against medical expenses incurred due to an illness or accidental injury by the life insured.||Sum Assured is paid as death benefit to the nominee or the beneficiary of the life insured.|
|Health insurance plans are not investment products wherein you can save for the future but with a health insurance policy you can receive financial aid at your hour of need in the case of hospitalization due to an illness or injury.||Life insurance companies offer pension and retirement plans to help you secure your future after retirement.|
|The types of health insurance products include mediclaim, critical illness plan, hospital cash plan, and surgical benefit plan.||The types of life insurance products include term plan, Unit Linked Insurance Plan (ULIP), endowment plan, pension or retirement plan, child plan, and annuity plan.|
|No-Claim Bonus and free health check-ups are offered under certain health insurance policies.||Maturity benefit, surrender benefit, and loyalty bonus can be added to the base policy.|
|Get tax deductions on premiums paid towards health insurance under Section 80D of the Income Tax Act, 1961.||Get tax deductions on premiums paid and maturity benefits received under Section 80C and Section 10(10D) of the Income Tax Act, 1961, respectively.|
Term plans are the purest form of life insurance plans which offers optimum life cover upon the death of the life insured without any maturity benefit. Health insurance provides insurance cover against medical and surgical expenses incurred by the life insured while the policy is active. The insurance company will reimburse the policyholder for expenses incurred from accidental injuries or illnesses.
|Medical Insurance Plan||Term Insurance Plan|
|The medical expenses incurred by the life insured due to an accidental injury or illness are reimbursed by the insurer upon hospitalization.||The sum assured is paid to the nominee or beneficiary upon the demise of the life insured.|
|With a health insurance plan, you can avoid taking a loan or using your savings to pay for medical bills.||With a term plan, you can secure the future of your dependents.|
|Premium rates for health insurance plans vary depending upon the policyholder's age.||Insurance premiums for term plans are fixed throughout the policy term.|
|Health insurance plans can be expensive although it offers comprehensive insurance coverage against medical expenses.||Term plans are not only affordable but also offer a comprehensive cover.|
|The reimbursement is only for medical expenses. The payout cannot be used for any other purpose.||The life cover can be used for children’s education, wedding, and the like in the absence of the life insured.|
‘No-Claim Bonus’ is a benefit offered to the policyholder for every claim-free year. It is awarded upon renewal and comes in the form of discounts on premiums or enhancements in the chosen sum assured. Discounts/enhancement range between 5% - 50%.
These are reductions in premiums, awarded to the proposer for covering additional members, usually more than two.
This refers to the number of times an insurer successfully processes claims from admission to pay-out as against the number of times it rejects them. A very high or very low ratio indicates a skewed process. A positive ratio is one where the number of claims processed successfully are higher than those rejected. (This is not a definite indicator but helps a potential customer judge a company’s service levels).
This refers to the number of times an insurer successfully processes claims from admission to pay-out as against the number of times it rejects them. A very high or very low ratio indicates a skewed process. A positive ratio is one where the number of claims processed successfully are higher than those rejected. (This is not a definite indicator but helps a potential customer judge a company’s service levels).
Yes, most insurers feature an online purchasing and renewal facility on their own website. There are, also, a number of financial services portals that provide this service. Leading portals drive business based on trust and security so it’s definitely a safe alternative to traditional methods.
It is cheaper than going through an agent because the middleman viz. the agent does not play a part in the process and the cost of the policy is reduced by the amount of commissions paid (to the agent).
This is when a policyholder moves or ports from his/her current provider to another. Policyholders are allowed to transfer the coverage and benefits from their current policies to a new insurer, subject to certain conditions. Health insurance portability gives policyholders flexibility in case they are not satisfied with their present provider or find more economic options.
Yes, premiums paid on health insurance plans qualify for tax benefits as per Sec80D of the Income Tax Act.
If a policyholder is not satisfied with the policy he/she has taken or the provider of the policy, he/she can cancel and return the policy within 15 days of receiving it. Premiums already paid will be refunded, subject to adjustments.
Yes, service tax and other charges are applicable at rates and conditions as prescribed by the law (subject to change). Consider this aspect when calculating premiums.
Yes, a duplicate can be obtained by following the procedure set in place by the insurer, usually on payment of charges for a copy.
Anyone who depends on the primary member for their livelihood, commonly the proposer’s spouse, children and parents, are considered dependents. Children are often considered dependents beyond 18 years up to the age of 25 years if they are still students (sons) or unmarried (daughters) or mentally challenged. Dependent children are often covered only if a parent is concurrently covered under the same plan.
Premiums are charged based on the age and location of the insured member and the sum assured chosen. In case of plans on a family floater basis, premiums are calculated based on the age of the oldest member. Premiums in this case are also affected by the family size i.e. the number of family members covered under the policy.
This is whereby claimants avail medical services at their network hospitals without making upfront payments (subject to approvals). This is different from reimbursement of claims whereby claimants make upfront payments for treatment and subsequently submit bills to the insurance company for compensation.
Under some plans, the insurer and the insured are jointly liable to meet expenses. The policyholder will pay a certain percentage towards expenses incurred. If policyholders exercise this option, they are often given reductions in premiums.
Sum assured is the overall amount within which all claims have to be made. Sub-limits are caps placed on different kinds of claims. For e.g. only a certain amount of the sum assured can be claimed for room expenses, or, ambulance charges will be reimbursed only up to a certain amount per hospitalisation.
If, during a particular year, a claim was made, the sum assured is reduced by that amount. The amount remaining as sum assured may not be sufficient to cover any future claims. In this case, some companies offer their clients the benefit of restoring the sum assured to the original amount so as to meet a subsequent claim. This is offered once during a policy period as an added benefit to enhance coverage.
Although used interchangeably, mediclaim is technically not the same as health insurance. Broadly, the difference between the two types of health covers lies in the quantum and breadth of coverage offered. Even though it is considered a form of health insurance, mediclaim plans are more specific in their coverage i.e. it is usually only for hospitalisation expenses, particular illnesses and hospitalisation/treatment in case of accidents. Health insurance plans on the other hand can be customised to cover expenses pertaining to pre/ post-hospitalisation, ambulance charges, critical illnesses etc.
Day care procedures ate those medical treatments that do not require the patient to be hospitalised for a minimum of 24 hours. Day care treatments can be done in few hours so it is done as an outpatient procedure. There are many insurers who offer health insurance coverage specially designed for day care treatments.
Thanks to the sophisticated technology we have in the medical field! What took us days now takes us less than 24 hours. Many medical treatments can be given in few hours because of the advancement in the medical industry. If the treatment can be given to the policyholder as an outpatient, it will be termed as day care procedures. Some of the day care procedures are:
More on:day care procedures.
Most of the insurance policy providers cover day care treatments. One has to research well while buying a health insurance plan on basis of day care procedure. Some of the factors you need to consider are:
Domiciliary hospitalisation means that the policyholder is being treated for a certain ailment within the confinement of his/her home and not in a hospital or a nursing set up. Usually, domiciliary hospitalisation is allowed when they aren’t able to move the patient from home to the hospital or when the patient cannot be taken to the hospital due to lack of accommodation. In other words, domiciliary hospitalisation refers to the treatment given to a patient for a certain disease or injury for more than 3 continuous days due to non-availability of accommodation in the hospitals or because the patient cannot be moved to the hospital.
If you have a health insurance policy that covers domiciliary hospitalisation, some of the treatments they cover are:
Most of the health insurance plans do not cover dental treatments. Dental treatments are one of the common exclusions in India. Please check with your insurance provider if they do.
Check various options here - Dental Insurance Coverage.
Listed below are some tips that you can follow to select the best health insurance plan:
There are no shortcuts when it comes to reading the fine print of your health insurance policy document. However, you can follow the steps below to which will help you read the fine print of your policy document:
There are many myths when it comes to health insurance in India. Some of the myths are as follows:
The below documents are required when you submit a reimbursement claim:
A floater option means that under one single health insurance plan, the sum assured amount can be used by all the members covered under the particular policy. All family floater health insurance plans have this option. Unlike individual health insurance plan, the sum assured is not for a single person under floater option.
Health insurance providers in India offers cashless hospitalisation facility where they settle the medical bill directly with the hospital if the policyholder is admitted in any one of their network hospitals. However, if the policyholder is admitted in a non-network hospital due to an emergency, the policyholder will have to pay the bill and later get it reimbursed from the insurer. Based on the terms of the plan, the insurer will reimburse the amount spent by the policyholder.
An individual insurance plan is designed to cater to the needs of one person. The sum assured is completely used by the individual person. However, in a floater option, the sum assured can be used by anyone of the members under the insurance plan. Floater options are perfect for families where more than one member require insurance coverage.
Some of the expenses included in sub-limit amount are room charges, medical tests, operation theatre expenses, medicines costs, and hospitalisation expenses.
More details on:Sub-limits.
Generally, not all health insurance plans cover homeopathy treatments. You will have to check with your insurer if homeopathy is covered under the plan. However, if you are looking for insurers who offer health insurance plans that cover AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatments, visit - Medical insurance for AYUSH.
The benefits you get when you are hospitalised due to an accident depends on the type of plan you hold. Generally, personal accident covers pays for your hospitalisation bill, over-the-counter drugs, consultations fees, and other such expenses. If the accident has left you permanently disabled, the agreed sum assured amount will be given immediately. In case of the unfortunate death of the insured, the death benefit according to the plan will be payable.
Unfortunately, that is not an option. If you have not submitted a claim in one policy year, you will be eligible to get a no-claim bonus (depending on the insurance provider). A no-claim bonus is a discount given on your premium amount, expressed in terms of percentage, and can be used while renewing your policy. Few insurers also increase the sum assured amount without any additional charge if you do not make a claim in a policy year.
When you switch your existing health insurance policy to a new insurance provider, you are entitled to the following benefits:
If you insurer covers pre-hospitalisation expenses, the following will be covered:
Post-hospitalisation cover usually pays for:
More details on pre and post-hospitalisation expenses.
The premium for a family floater policy is calculated after considering various factors like age of the oldest member of the family, policy term, number of members covered under one plan, the health condition of the insured, type of plan selected, and the sum assured selected. There is no universal formula used by insurance companies to calculate the premium for a family floater plan. It differs from one insurer to another.
Most of the insurers today offer cashless hospitalisation benefit to their policyholders. Under cashless hospitalisation, if the insured is hospitalised in a network hospital for more than 24 hours, the hospital bill will be settled by the insurer directly with the hospital. The policyholder do not have to arrange for funds, pay the bill, and later file a reimbursement claim. The insurer will pay the bill as per the terms and conditions of the policy held by the insured and the policyholder will only be responsible for those items that are not covered under the insurance plan.
The entry age and the maximum age criteria of the insured differs from one plan to another. Generally, health insurance plan are available for individuals from 3 months old to 65 years. There are few senior citizen plans that cover senior citizens above 65 years as well.
As the name suggests, pre-existing disease are those medical conditions that an individual suffers from even before buying a health insurance policy. These are not the diseases that the insured developed after buying a health insurance policy. Some of the examples of pre-existing diseases are asthma, diabetes, blood pressure, cancer, or ulcers.
More information on this page - pre-existing diseases.
A family floater health insurance plan, as the name suggests, is an single health insurance policy that covers the entire family. The sum assured, in this case, is used by all the members of the family as and when a issue occurs.
On the other hand, a critical illness insurance plan covers a list of pre-agreed critical illnesses like cancer, heart issues, tumours, or any such diseases. If an insured person is diagnosed with any one of the listed critical illnesses, the sum assured and other benefits under the plan will be paid immediately.
When a family member or loved one is hospitalised, apart from the hospital bills many out of pocket expenses are incurred. Some of the out of pocket expenses are money spent for food, travel, and non-admissible items. To help people meet these expenses, a hospital cash insurance offers a fixed daily cash benefit or allowance if the insured is hospitalised.
Some insurance providers would ask you to undergo a medical check-up before you buy a health insurance policy. However, there are many who do not require it. This differs from one insurer to another.
If you already have an health insurance policy, please check if you have an option to surrender the plan to your insurer. At times, insurers provide certain benefits if a policyholder surrenders the plan after completing certain number of years.
If you have just purchased a health insurance plan, please check for the free-look period or the cooling-off period. Most insurance give free-look period within which the policyholder can return the policy back to the insurer.
You will also have an option to cancel the policy while renewing it. However, this depends on your insurance.
Increasing number of illnesses, unhealthy lifestyle, and poor health habits have forced many to contemplate about buying a comprehensive health insurance plan. No one can predict when an illness will knock us down. That's exactly why having a health insurance is very important these days. Some of the other reasons why health insurance is important are:
Some of the illnesses that are usually covered under a critical illness plan are:
Some of the parameters that an insurer considers while calculating the premium for your health insurance plan are:
For a comprehensive list of factors that are considered while calculating premium, please visit this page.
If a insured person is hospitalised in a non-network hospital, they will have to pay the hospital bill and later file a reimbursement claim. Generally, the procedure to file a reimbursement claim is as follows:
To avail cashless settlement benefit, the process is as follows -
In case of planned hospitalisation:
In case of emergency hospitalisation:
Most insurers allow you to reinstate your health insurance policy within 2 years from the date of the first missed payment or the discontinuance date. However, this differs from one insurer to another. Please check the renewal procedure for your policy with your insurer.
A health card is like an identity card given by the insurer to the policyholder. It contains information like the policyholder’s insurance account number, the name of the insured, the age of the insured, gender, policy expiry date, and other such vital information. It is mandatory for an insured person to show the health card at the hospital in case of hospitalisation.
A health card is very important because:
There are many leading health insurance companies in India. However, the best health insurance company differs from one person to another. It depends on the type of insurance coverage you are looking for and who cater your needs better.
If you are looking for a best health insurance plan, please consider the following:
Most insurers have a change request form that you will have to fill to change the address. Some of the insurance also allow you to change the address online by filling a virtual form. Please note that you will have to submit the form along with your new address proof.
Most insurance providers allow you to increase your sum assured at any time during the policy. Insurers these days also offer top-up health insurance plans. A top-up insurance plan allows you to attach additional cover to your existing insurance plan at a nominal cost. Please check with your insurer for this option.
For more details: Top-up health insurance plans.
Yes. A person can have more than one health policy. In case of hospitalisation and claim settlement, each insurer will pay as per the ratio agreed by them.
More details: Claim settlement procedure for multiple health policies.
The policy can be renewed if you pay the premium dues within the grace period which is 15 days from the expiry date. The policy will lapse if the premiums are not paid within the grace period. There is no insurance coverage available during the grace period.
Yes, as per the Health Insurance Portability and Accountability Act, you can transfer your health insurance policy from one insurer to another without losing the policy benefits.
After a claim has been settled, the policy coverage will reduce by the settled amount till the end of the policy term.
'Any one illness' means the continuous period of illness which includes the relapse period within a certain number of days as specified in the policy document. Usually, this is 45 days.
Any number of claims can be made during the policy term unless there is a specific limit mentioned in the policy document. The sum insured is the maximum limit one can claim under the policy.
Once in 4 years, some insurers pay for health check-ups of the life insured. This is called ‘health check’ facility.
Some insurers appoint a Third Party Administrator (TPA) to process all the claims of their policies. The contact details of the TPA will be available on your health card.
Based on the age of the life insured and certain medical conditions, a medical examination may be required.
No, you don't have to undergo a medical check-up every year if you ensure to renew the policy continuously without fail and there are no changes in the policy terms and conditions.
You have to pay for the pre-policy check-up. Some insurer will reimburse 50% of the cost.
A medical practitioner is a person who is registered with the medical council of any state of India and is thereby entitled to practice medicine within its jurisdiction. It can be a physician, specialist, surgeon, etc.
Medical expenses are the expenses incurred by the life insured for medical treatment received during the policy period on the advice of a medical practitioner due to an illness or accident.
The expenses can be indemnified through reimbursement claims or availing cashless services at a network hospital.
Cashless facility is available only at your insurer’s network hospitals.
Use the network hospital locator available on your insurer’s website for the list of network hospitals available in your area.
Cashless facility may not extend to government institutions.
Yes, the insurer will pay the entire amount for the medical expenses incurred subject to the sum insured. You may have to pay for the non-medical expenses and those that are not covered by the policy to the hospital before your discharge from the hospital.
In case of cashless treatments, the cheque will be sent to the network hospital where the life insured availed treatment.
Co-payment is a cost-sharing requirement wherein the life insured will bear a specific percentage of the admissible costs. Co-payment doesn't reduce the sum insured but it reduces the insurance premium.
It is the specified period of time from the date of policy inception, after the completion of which the full or partial insurance cover will begin or become active. The waiting period for a senior citizen health insurance plan is higher, from 1 to 4 years for certain illnesses.
The group insurance provided by your employer will offer only the basic cover. Employers offer group insurance as a liability cover. It doesn’t fully cover your needs. If you were to shift organizations, the insurance cover from the previous employer will cease. In addition to your group insurance policy, it is advisable to have an individual health insurance plan to adequately cover you and your family.
Group insurance package is purchased by an organization for the benefit of its employees. Individual insurance is bought by individuals for themselves or their families. The differences between the 2 insurance are as follows:
Most countries insist on seeing a valid travel insurance policy upon entry. Receiving healthcare in a foreign country can prove to be a costly affair. When you make travel plans, it is advisable to be prepared for unforeseen, unfortunate events like a medical emergency or a personal accident during the duration of your trip.
Be well-prepared by purchasing an overseas travel insurance policy that offers adequate medical cover against medical expenses including ambulance fees, medical treatment, medical evacuation, and hospitalization. The insurer will settle the claim once the insured person has returned to India except in the case of hospitalization.
Lifestyle diseases like diabetes, hypertension, and obesity have become prevalent among the younger generation. Treatment for critical illness is expensive without an insurance cover. A Critical Illness Rider will provide medical coverage against specified illnesses. Most policies cover 10 to 25 critical illnesses. Heart attack, cancer, stroke, and sclerosis are some of the illnesses covered by this rider.
The insured person must survive minimum 30 days from the date of diagnosis to make the critical illness claim. The waiting period is 60 to 90 days under most policies. You can also get tax deductions on premiums paid towards a critical illness rider under Section 80D of the Income Tax Act, 1961.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.
This article explores the different ways in which hospital cash benefit can be claimed on your health insurance policy. Hospital cash is the daily amount that is given to the insured party, upon a successful insurance claim, to be used for the sundry expenses that arise during hospitalization. This allowance is only paid out under Daily Hospital Cash (DHC) plans, and some plans even offer their entire package of benefits as hospital cash in order to enable a smooth claim process and to ensure that the claimant has cash on hand as and when necessary. The article details the benefits and points to remember when dealing with DHC health insurance plans. There is also a list of the different insurers that offer these plans.
Have you ever wondered what the pre-existing medical condition exclusion was all about? This article explains the pre-existing medical conditions / pre-existing diseases clause in most health insurance policies. It’s important to know that not all health insurance policies exclude the same pre-existing diseases so it’s a good practice to read through the offer documents and policy documents of the insurance policy you’re considering. When getting the health insurance policy, it’s important to disclose all details of all previously existing medical conditions as the insurer can deny a claim based on the fact that some information was withheld at the time of taking the policy. Most health insurance products have a mandatory waiting period before the treatment costs from any medical conditions that existed prior to taking on the policy can be reimbursed.
Read on to know about reimbursement claims and cashless claims when talking about health insurance policies. This article defines and outlines the procedure to be followed when utilizing the cashless claims and reimbursement features of health insurance policies. The documents required when filing a reimbursement claim or a cashless claim on a health insurance policy are also listed out for reference. The Cashless network is also explained and its functioning can be understood through this article. Both these are types of claims that can be availed by the policyholder depending on the case, conditions under which the hospitalization occurred, and provisions of the insurance policy itself.
This article contains the definition and details regarding OPD cover with regard to health insurance policies. OPD stands for Out Patient Department at hospitals, and since most health insurance schemes cover only in-patient treatments and accident claims, other policies that offer OPD coverage are viewed more favourably by customers. Why should a person take on an insurance policy with OPD coverage? What are the top companies that offer insurance policies with OPD coverage? Etc. are some of the questions that are answered in this article. There’s also a link to different health insurance policies that offer OPD cover.
A comprehensive health insurance cover provides the insured the finest medical treatment and care, without having to worry about the financials. However, to accommodate the expenses of hospitalisation, one can purchase multiple health insurance policies. Multiple policies can be effectively utilised for cashless and reimbursement claims. This article elaborates on how two health insurance policies can be used to pay hospitalisation charges. It also explains the procedure for getting the amount reimbursed through cashless and reimbursement claims.
During the time of COVID-19, digital payments along with the service of e-KYC have been helping citizens buy insurance. With the help of digital payments, customers can calculate their premiums to be paid monthly. Apart from this, customers can use their smartphone to upload pictures of a policy which is to be renewed.
Digital mode of payments has also helped extend the process of KYC online. E-KYC can be availed online to buy insurance and banking facilities. Insurers and banking institutions are allowing customers to use the e-KYC services to purchase insurance policies, open bank accounts, transfer money and other services also.
With the help of digital payments and digital customer service, financial transactions can be done online without any requirement to visit the bank branch. Digital payments have increased by 40% since February with many users registering on various online payments.
21 May 2020
Most car-manufacturing companies are now rolling out schemes to attract buyers and stand back on their feet. The lockdown and fear over the coronavirus had put a stop to the customers’ interest in buying. Companies are now preparing themselves to restart factories that have been closed for over six weeks.
Companies like Renault, Hyundai, Volkswagen, Honda, Tata Motors, Mahindra & Mahindra, and Skoda Auto are now providing a lot of finance options which include allowing a car buyer to pay EMIs, only after twelve months of the purchase of the vehicle.
Other than the regular discounts on Bharat Stage VI (BS-VI) cars like Vento, and Polo, the German auto titan, Volkswagen (VW) is now offering its customers a 12-month EMI holiday and the car buyer can start paying the EMIs from the second year onwards.
19 May 2020
A research report by TechSci found that the health insurance market in India will be driven forward by the increasing disposable income that Indians have as well as the various attractive features offered by health insurance companies now. This is augmented by an increasing workforce, awareness of health insurance policies, and an understanding that rising healthcare costs require health insurance policies to be met. Furthermore, it is mandatory that public and private sector employees are provided with heatlh insurance. The ‘'Ayushman Bharat’' health insurance scheme launched by the Government of India is also a boost to the health insurance sector in India. This is a national health protection scheme that provides health insurance to approximately 100 million families. This has increased the reach of health insurance to even the most vulnerable sections of society. In India there are standalone health insurers as well as public and private sector health insurers. The largest share of the health insurance market in India went to private health insurers in the year 2019. Due to the high number of road accidents, medical insurance dominated the insurance sector in India. There is a higher preference for private insurance firms since they provide customized plans according to the coverage required and budget available.
12 May 2020
Health insurance provides cover for various medical emergencies. Apart from the hospitalisation cost, health insurance provides cover for diagnostics tests and medication. Insurers are revamping their products to include more coverage. Any revamp in products could lead to a higher premium.
Health insurance is very popular as it is cheap and can be bought online. In the next 2 to 3 months, health insurance premiums may increase by up to 25% due to the revamp in products. The IRDAI has issued a mandate regarding the inclusions and exclusions of a policy. Therefore, insurers will have to make their products more standardised to follow the guidelines. Various guidelines have been issued by the IRDAI throughout the year. The latest guidelines have been released to offer more coverage. This has led to insurance companies revamping their products and increasing the prices. As per the regulations issued by the IRDAI in October 2019, health cover cannot be denied to individuals under certain circumstances. The IRDAI has made it mandatory for all insurance companies to follow the new guidelines within one year from when they were issued.
27 April 2020
Standalone health insurance firms and non-life insurance companies are revamping their products to include the modifications that have been mandated by the Insurance Regulatory and Development Authority (IRDAI). This will lead to an increase in health insurance premiums.
Based on the features that are being added, the premiums could increase between 5% and 25%. The IRDAI has given insurance companies time until 30 September 2020 to include the modifications. From 1 October 2020, all products must have the required modifications. According to IRDAI’s guidelines, insurance companies are revamping their offerings by standardising products and adding more features. The new products with higher premiums will be launched in the next 2-3 months. According to the Head-Retail Heath, Travel and PA Underwriting, Bajaj Allianz General Insurance, Rashmi Nandargi, the IRDAI wants to standardise the exclusions and include certain diseases. She further added that additional premium can be charged on the basis of certification. However, in case the premium has been increased by more than 5%, the regular file and use process must be followed. Insurance companies can add the features that the IRDAI has asked for or can revamp their products by adding several features. As per the guidelines that were provided last year, no clear decisions were given on the exclusions and inclusions. This led to insurance companies framing their own guidelines.
23 April 2020
Many non-life insurers have been seeing a rise in health segment claims during the lockdown in the country. On the other hand, the number of own damage claims in the motor segment has gone down during this period because of the lockdown.
With the lockdown in place, there have been lesser vehicles on the roads which are preventing accidents and that is resulting in the lesser number of claims. Fewer claims of insurances usually improve the loss ratio of the insurer’s in the motor segment.
The loss ratio is calculated in order to indicate the underwriting performance of the insurer. If the loss ratio is above 100 then the premium which is collected is not adequate to pay for the claims. The industry is currently operating at a loss ratio of 80 in the motor segment.
According to Sanjay Saxena, head of retail claims at Bajaj Allianz General Insurance, losses will be coming down in the motor segment given the lower number of claims in this period of time. There are also insurers who feel that once the lockdown period is over, there will be a surge in claims.
14 April 2020
Arogya Sanjeevani is a standard health insurance policy that all health insurance and general insurance companies in India are mandated to offer by the Insurance Regulatory and Development Authority of India (IRDAI). It now also offers coverage for hospitalisation for Covid-19 related treatments. The pricing of the product is left to the discretion of the insurer. Coverage can go up to Rs.5 lakh with insurance premium of Rs.1,000 for every Rs.1 lakh sum insured.
8 April 2020
India’s first protection plan against Covid-19 has been launched by Clinikk Healthcare through its Coronavirus Support Plan. The features of this plan are as follows: Insurance coverage of up to Rs.1 lakh for expenses related to hospitalization and other costs for Covid-19 infections, a 360-degree coverage of health expenses related to the treatment of Covid-19 diagnosis, free access to teleconsultation with medical experts for questions related to the coronavirus which will help curb misinformation, etc. This is available to both individuals and organizations. Clinikk Healthcare is a startup that aims to democratize healthcare through innovative technology.
7 April 2020
The Insurance Regulatory and Development Authority of India (IRDAI) has decided to make the claims process for health insurance easier and simpler by making proportionate deductions more uniform. This happens, for example, when policyholders choose a hospital room that has a higher rent than what was the eligible limit under their insurance policy. The new mandate may lower the out of pocket expenses for policyholders. The sub-limit feature on health insurance policies causes the health insurance bills to only be paid partially at the time of claims settlement. The claim is sometimes deducted or reduced on the basis of the sub-limit under the room rent category of the policy. This causes policyholders to bear a portion of the expenses of room rent or hospital cost even though they are availing cashless hospitalisation. This often happens when the sub-limit is 1% of the sum insured in the case of the room rent. The sub-limit sets limits for various hospital expenses as per the specific terms and conditions of the policy. So if a room that has a rent that is higher than on the sub-limit for rent is chosen by the policyholder, the insurer adjusts this by reducing the claims that come under other heads. The IRDAI proposes to implement a uniformity in how the claims under other heads are adjusted in times like this.
The IRDAI stated that “Whereas part of product design insurers propose proportionate deductions of the associated medical expenses when a policyholder chooses a higher room category than the category that is eligible as per terms and conditions of the policy, insurers shall define ‘associate medical expenses’ in the terms and conditions of the policy contract.”
The cost of pharmacy, diagnostics, medical devices, and implants do not come under ‘'associate medical expenses’.
27 March 2020
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