Co-pay is a fixed percentage of the hospital bill you will have to pay when you make a claim, while the balance will be paid by the insurance company. For e.g. If your policy has a 10% Co-Pay clause, it means for a Rs 1,000 claim, you have to pay Rs 100 while the insurer will pay Rs 900. Ideally, opt for a "no co-pay" plan so you don't have to shell out for every claim.
Pre-existing diseases are classified as diseases/conditions that a person has before buying health insurance. All pre-existing diseases aren't covered from day one of buying the policy. The time taken to cover pre-existing diseases will vary from plan to plan. Check the amount of time taken to cover pre-existing diseases in your plan.
The duration of coverage is the most important factor in buying a health insurance policy. Your health is most likely going to deteriorate only in your sunset years so ensure that your coverage is lifelong and not for a few years. Always go for a plan that can be renewed lifelong.
Your room preference during hospitalization matters (such as shared room, private room or private room with high-end facilities). A costlier room means you'll pay higher treatment and hospitalization charges! It's better if your plan has a higher room rent limit per day.
Lower premium for younger buyers.
The premium depends on the number of insured members.
Your room preference during hospitalization matters (such as shared room, private room or private room with high-end facilities) Remember costlier room means higher treatment charges too!
Your premium will depend on any pre-existing medical conditions.
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.
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.
|Health Insurance Plans||Types of Health Insurance||Features and Benefits of Health Insurance||Mediclaim Policy||Health Insurance FAQ's|
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:
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.
Diwali is one of the widely celebrated festivals in the country. This is the time of the year families come together and make wonderful memories together. Known as the ‘festival of lights’, this festival celebrates the triumph of good over evil. One of the most significant part of this festival is the fireworks.
Fireworks are an integral part of the celebration and when the night sky lights up in different colours, it is a visual treat to one's eyes. While fireworks do bring a lot of enthusiasm and excitement, it also increases the chances of fire-related hazards during this time. This can prove to be very dangerous and can cause damage to both people and property.
It is important to take some steps to make sure that your loved ones do not have to deal with any fire-related incidents. In case of any untoward incident, it is important to ensure that your family is covered for any medical costs incurred. This is where a comprehensive health insurance policy will offer protection and cover all the costs incurred during a medical emergency. Having health insurance will ensure that any unforeseen event during this festive season will not leave you in a tough spot financially.
With the noise and air pollution from bursting of crackers having a much larger impact on the environment with each passing year, steps are now being taken by the government to limit the usage of crackers and opt for greener alternatives.
Indians and frugality walk hand in hand. Most people living in India have experienced high costs for services like entertainment, medical, and so on. Factors like inflation has hit the country on countless occasions, yet the drive in Indians to live each day to its fullest is praiseworthy.
Having said that, it is an established fact that healthcare costs have skyrocketed over the last few years because of a sudden surge in lifestyle diseases such as diabetes, heart condition, hypertension, and so on. As much as a comprehensive health plan is important for every Indian citizen, there are certain segments of the society who are categorically mandated to invest in a comprehensive medical cover. Some of them are mentioned below:
|Health Insurance Companies||Incurred Claim Ratio||Grievances Solved||Network Hospitals||Number of Policies Issued||Number of Persons Covered|
|Apollo Munich Health Insurance||54.99%||98.18%||4500+||681314||2907000|
|Bajaj Allianz General Insurance||70.41%||99.28%||5700+||473346||9469000|
|Bharati Axa General Insurance||86.84%||99.81%||4500+||21692||323000|
|Cholamandalam MS General Insurance||72.91%||99.82%||2600+||75189||1531000|
|Cigna TTK Health Insurance||48.14%||99.22%||4000+||123921||365000|
|Future Generali Health Insurance||77.31%||99.86%||4300+||41310||5569000|
|HDFC ERGO General Insurance||76.90%||100.00%||4800+||472566||1950000|
|ICICI Lombard General Insurance||80.38%||97.61%||4500+||890383||20805000|
|IFFCO Tokio General Insurance||81.96%||99.94%||3000+||156118||18985000|
|L&T General Insurance||77.83%||100.00%||2800+||71931||339000|
|Liberty Videocon Genral Insurance||79.14%||99.06%||3000+||10918||669000|
|Max Bupa Health Insurance||51.96%||100.00%||3500+||307007||2281000|
|National Health Insurance||97.25%||96.11%||6000+||1780030||103537000|
|Reliance General Insurance||92.23%||99.32%||4000+||80625||8864000|
|Religare Health Insurance||50.52%||100.00%||4500+||320316||1384000|
|Royal Sundaram General Insurance||78.13%||99.28%||3000+||188662||849000|
|SBI General Insurance||75.01%||95.33%||4400+||198876||4123000|
|Star Health and Allied Insurance||60.51%||99.43%||6000+||2579591||7651000|
|Tata- AIG General Insurance||72.32%||99.93%||3000+||160790||942000|
|New India Assurance Health Insurance||91.26%||99.19%||1200+||1785302||95586000|
|Oriental Health Insurance||112.11%||95.36%||4300+||1378773||18602000|
|United India Insurance||107.06%||98.51%||7000+||1160432||129598000|
|Universal Sompo General Insurance||70.91%||100.00%||5000+||162577||913000|
|Aditya Birla Health Insurance||110.68%||80.00%||4500+||2422||190000|
Source: IRDA Annual Report 2016-17
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.
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:
|Specialty||Treatments||Approximate cost for the treatment in India (in Rs.)||Estimated hospitalisation duration|
|Therapy||Hyperbaric Oxygen Therapy||Rs.1,50,000 to Rs.2,22,000||This does not require hospitalisation. The patient can undergo this treatment as an outpatient.|
|Tests||Colonoscopy Test||Rs.9,500 to Rs.22,000||This does not require hospitalisation. The patient can undergo this treatment as an outpatient.|
|Endoscopy||Rs.38,000 to Rs.1,27,000||This does not require hospitalisation. The patient can undergo this treatment as an outpatient.|
|Capsule Endoscopy||Rs.63,500 to Rs.1,27,000||Can be done as outpatient or 1 day of hospitalisation is required.|
|Check-up||Master Health Check-up||Rs.6,350 to Rs.12,700||This does not require hospitalisation. The patient can undergo this treatment as an outpatient.|
|Nephro||Kidney Removal/Nephrectomy||Rs.95,200 to Rs.1,27,000||4-6 days of hospitalisation is required.|
|ENT||Cochlear Implant||Rs.8,25,000 to Rs.14,60,000||2 days of hospitalisation is required.|
|Larynx Removal/Laryngectomy||Rs.2,85,000 to Rs.5,71,000||2 days of hospitalisation is required.|
|Sinus||Rs.1,14,000 to Rs.2,22,050||2 days of hospitalisation is required.|
|Eardrum Reconstruction/TympaNoplasty||Rs.76,000 to Rs.2,22,200||2-3 days of hospitalisation is required.|
|Surgery||Cholecystectomy/LaparOscopic||Rs.95,200 to Rs.1,90,000||2 days of hospitalisation is required.|
|Inguinal Hernioplasty||Rs.57,100 to Rs.1,90,000||2 days of hospitalisation is required.|
|Appendectomy/Laparoscopic||Rs.76,200 to Rs.1,77,800||2-3 days of hospitalisation is required.|
|Urology||TURP||Rs.44,450 to Rs.3,17,000||4 days of hospitalisation is required.|
|Bladder Neck Incision||Rs.1,58,000 to Rs.2,22,000||2 days of hospitalisation is required.|
|Gynecology||Myomectomy-Hysteroscopic||Rs.63,000 to Rs.4,57,000||3-4 days of hospitalisation is required.|
|Lap Hysterectomy||Rs.95,000 to Rs.3,81,000||3-4 days of hospitalisation is required.|
|Bone and Spinal Cord||Laminectomy||Rs.1,27,000 to Rs.4,12,000||6 days of hospitalisation is required.|
|Spinal Fusion||Rs.3,81,000 to Rs.8,25,500||5 days of hospitalisation is required.|
|Neuroscience||Peripheral Nerve Surgery||Rs.2,54,000 to Rs.4,12,000||3-4 days of hospitalisation is required.|
|Parkinson's(Deep Brain Stimulation)||Rs.12,70,000 to Rs.14,60,500||7-10 days of hospitalisation is required.|
|Infertility||IVF Package||Rs.1,14,000 to Rs.3,17,000||This does not require hospitalisation. The patient can undergo this treatment as an outpatient.|
|Eye||Vitrectomy||Rs.69,000 to Rs.1,27,000||2 days of hospitalisation is required.|
|Corneal Transplant||Rs.50,800 to Rs.76,000||Can be done as outpatient or 1 day of hospitalisation is required.|
|Glaucoma||Rs.38,100 to Rs.1,27,000||2 days of hospitalisation is required.|
|Retinal Detachment||Rs.95,000 to Rs.2,54,000||2 days of hospitalisation is required.|
|Cataract Surgery with Lens||Rs.50,800 to Rs.1,27,000||Can be done as outpatient or 1 day of hospitalisation is required.|
|Dental||Root Canal Treatment||Rs.7,620 to Rs.12,700||This can be done as an outpatient in 3- 4 sittings.|
|Ceramic Crown Setting||Rs.8,890 to Rs.15,000||This does not require hospitalisation. The patient can undergo this treatment as an outpatient.|
|Dental Implant||Rs.63,500 to Rs.1,27,000||This treatment can be done as an outpatient in 2 stages over 3 months.|
|Cosmetic||Abdominoplasty||Rs.1,27,000 to Rs.3,81,000||1-4 days of hospitalisation is required.|
|Breast Lift||Rs.1,84,000 to Rs.4,12,750||one-day hospitalisation is required.|
|Breast Reduction||Rs.95,000 to Rs.4,44,500||1-2 days of hospitalisation is required.|
|Face Lift||Rs.1,90,500 to Rs.3,17,000||one-day hospitalisation is required.|
|Lip Reduction||Rs.50,800 to Rs.63,500||This treatment can be done as an outpatient.|
|Weight Loss||Gastric Bypass||Rs.2,85,750 to Rs.5,71,500||4-5 days of hospitalisation is required.|
|Gastric Banding||Rs.3,68,300 to Rs.5,39,750||2 days of hospitalisation is required.|
|Sleeve Gastrectomy||Rs.2,85,750 to Rs.6,03,250||4 days of hospitalisation is required.|
|Oncology||IGRT||Rs.3,17,500 to Rs.4,76,250||one-day hospitalisation is required.|
|IMRT||Rs.2,22,250 to Rs.3,81,000||This treatment can be done as an outpatient or one-day hospitalisation may be required.|
|Stereotactic Radiosurgery||Rs.2,22,250 to Rs.6,35,000||This treatment can be done as an outpatient or one-day hospitalisation may be required.|
|Chemotherapy||Rs.63,500 to Rs.1,90,500||This treatment is required to be done multiple times within a 15-day time period.|
|Breast Cancer Surgery||Rs.1,90,500 to Rs.4,25,450||3-4 days of hospitalisation is required.|
|Prostate Cancer Surgery||Rs.3,49,250 to Rs.6,35,000||6-8 days of hospitalisation is required.|
|Joint Replacement||Single Knee Replacement with Implants||Rs.2,22,250 to Rs.5,39,750||5-7 days of hospitalisation is required.|
|Double Knee Replacement with Implants||Rs.3,81,000 to Rs.9,20,750||7-9 days of hospitalisation is required.|
|Single Hip Replacement||Rs.3,81,000 to Rs.6,35,000||5-7 days of hospitalisation is required.|
|Double Hip Replacement||Rs.5,08,000 to Rs.9,33,450||7 days of hospitalisation is required.|
|Transplants||Liver Transplant||Rs.25,40,000 to Rs.35,56,000||28-30 days of hospitalisation is required.|
|Kidney Transplant||Rs.3,17,500 to Rs.13,97,000||7-9 days of hospitalisation is required.|
|Bone Marrow Allogenic Transplant||Rs.18,41,500 to Rs.20,95,500||40 days of hospitalisation is required.|
|Bone Marrow Autologous Transplant||Rs.10,16,000 to Rs.17,78,000||25-30 days of hospitalisation is required.|
|Lung Transplant||Rs.13,97,000 to Rs.15,87,500||10-20 days of hospitalisation is required.|
|Heart Transplant||Rs.14,60,500 to Rs.25,40,000||10-20 days of hospitalisation is required.|
|Cardiology||Angiogram||Rs.15,875 to Rs.63,500||I day hospitalisation is required.|
|Angioplasty||Rs.1,90,500 to Rs.4,12,750||1-2 days of hospitalisation is required.|
|Bypass Surgery||Rs.1,90,500 to Rs.6,03,250||4-6 days of hospitalisation is required.|
|Valve Replacement||Rs.3,81,000 to Rs.7,62,000||2-5 days of hospitalisation is required.|
|Double Valve Replacement||Rs.3,04,800 to Rs.7,93,750||10 days of hospitalisation is required.|
|Bentall's Surgery||Rs.3,81,000 to Rs.7,62,000||2-5 days of hospitalisation is required.|
|Heart Transplant||Rs.14,60,500 to Rs.25,40,000||8-15 days of hospitalisation is required.|
|Permanent Pacemaker Implant (Single Chamber)||Rs.1,58,750 to Rs.2,85,750||2-3 days of hospitalisation is required.|
|Permanent Pacemaker Implant (Double Chamber)||Rs.1,14,300 to Rs.3,17,500||2-3 days of hospitalisation is required.|
Source: India Healthcare Tourism
Some of the reasons why you should buy an insurance plan are:
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.
To summarise, you should buy a health insurance plan because:
Some of the popular types of health insurance policies are explained below.
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:
Exclusions of an individual health insurance plan includes:
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.
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:
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:
Advantages of senior citizen policies:
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:
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:
Exclusions of a critical illness rider includes:
The policy tenure of a critical illness rider can be anywhere between 10 to 15 years with annual renewability option.
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:
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:
Advantages of maternity insurance plans:
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:
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:
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.
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:
Exclusions of a personal accident cover includes:
There are 2 types of personal accident plans:
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.
Health insurance plans in India are surrounded by multiple structures and features that play a significant role in making them beneficial for the end consumer. However, over the last few years these features and structures have undergone drastic changes, for example, people have started to lead a comparatively healthier lifestyle as opposed to a sedentary lifestyle that leads to lifestyles diseases such as obesity and diabetes.
Having said that, it is equally important to have a comprehensive health insurance policy to fall back on during unforeseen events. The need for an adequate health insurance policy has increased, as much as opting for the right health plan. Therefore, mentioned below are a few important points that one may take into consideration while purchasing a health insurance policy:
There are multiple benefits of purchasing a health cover. Some of them are mentioned below:
“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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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:
|Ideal Health Insurance Plan||Expectations/Requirement|
|Individual health insurance plan||If you looking for an insurance cover against hospitalization costs and surgical expenses for self, opt for an individual health insurance plan that provides claim reimbursement or cashless facility at a network hospital. Mediclaim reimburses all the medical expenses incurred during your hospitalization.|
|Family health insurance plan||Opt for a family floater plan to receive insurance cover against medical expenses for your entire family which can include spouse, children, and parents, one plan for the entire family.|
|Senior citizen health insurance plan||If you or a family member aged 60 to 65 years don’t have a health insurance plan with lifelong renewability option, then opt for a senior citizen health insurance plan that provides coverage against hospitalization costs.|
|Hospital cash benefit plan||There are certain expenses during your hospitalization that don’t come under medical expenses. Hence, not covered under the policy. A hospital cash plan provides daily cash of up to Rs.2,000 to Rs.4,000 per day for the duration of your hospitalization to meet those expenses that aren’t covered by your medical insurance policy.|
|Surgical benefit plan||You will receive a fixed payout if you undergo a certain surgery as specified in the policy document.|
|Critical illness insurance plan||A critical illness rider can be attached to your base medical insurance policy to give you cover against specified critical illnesses like cancer of specified severity or first heart attack. Most plans cover from 6 to 15 critical illnesses. You need to be diagnosed with the specified illness to make a claim.|
|Personal accident insurance plan||Accidents are unforeseen unfortunate events that can’t be predicted. Personal accident insurance rider offers insurance cover against medical expenses incurred from accidental injury, permanent disability, and dismemberment.|
|Maternity insurance plan||This type of plan is for couples who are planning to have a baby. This plan has to be purchased in advance as the waiting period can be 3 to 4 years. It provides coverage against maternity expenses such as pregnancy and childbirth costs.|
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:
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:
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:
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:
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.
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 -
Always! Scrutinize the inclusions and exclusions of each plan to ensure adequate and desired coverage is availed of.
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:
Most people will find themselves eligible for health assurance products, barring those who pose too much of a risk to the company.
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:
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.
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.
The various documents* which are required to make a health insurance claim have been listed below:
*Documents needed may vary from one insurance company to another
Read more on: Health Insurance Claims Process
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.
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.
Read more about health insurance portability
One of the most tedious tasks before purchasing a health insurance policy is comparing multiple plans and insurance providers. Each health plan will have its own distinguishing feature, however, purchasing the one that is most suitable to your needs can become a daunting task.
A reasonable approach to undertake herein would be opting for a cover that offers maximum inclusions and minimum exclusions. Even then, the following factors must be taken into consideration before you purchase a health insurance policy:
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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:
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:
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:
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:
Here is a list of dos and don’ts you must keep in mind when purchasing a health insurance policy:
|Assess your individual insurance needs and purchase a plan that suits you. There are 4 types of policies; mediclaim, critical illness, hospital cash benefit, and surgical benefit plan. Choose a plan that suits you.||Don’t be underinsured or over insured. The main reason for having a medical insurance is to have sufficient financial protection to pay your medical bills without resorting to loan or minimizing your savings.|
|Read the policy document thoroughly. Find out what are the inclusions and exclusions of the policy. Exclusions may include pre-existing conditions. The waiting period for certain illnesses can be 3 to 4 years.||Don’t purchase a plan with the cheapest insurance premium. It may not offer your sufficient coverage to cover all your insurance needs.|
|You can customize your medical insurance plan to suit you. Therefore, pay the premium only after the insurance provider accepts your proposal. You can negotiate or opt out of policies with co-payment or sub-limit.||Don’t let your policy lapse. Be meticulous about policy renewal. Don’t put off payment even by a day.|
|Check the list of network hospitals mentioned by your insurer. You don’t want to be stuck with a medical facility that offers average healthcare. You shouldn’t have to drive out of your city to receive treatment from a network hospital.||Don’t conceal pre-existing conditions. Disclose any pre-existing illness you may have to avoid policy termination or hassle when making a claim. Concealing facts or furnishing falsified documents gives the insurance provider the right to terminate your policy.|
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:
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 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.
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.
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.
|Health Insurance Company||Claims Ratio|
|Star Health and Allied Insurance||61%|
|Health Insurance Company||Claims Ratio|
|Health Insurance Company||Claims Ratio|
|National Health Insurance||97%|
|New India Health Insurance||91%|
|Oriental Health Insurance||112%|
|United Health Insurance||107%|
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.
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.
Here is a list of important things to know about tax deductions for health insurance premium:
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.
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.
|Medical insurance companies||Insurance coverage|
|National Insurance Company Limited||
|The New India Assurance Co. Ltd||
|The Oriental Insurance Company Ltd||
|United India Insurance Company||
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:
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.
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.
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:
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.
Check cashless network hospitals nearby your location: Network Hospitals for Cashless Treatment
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.|
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.
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.|
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.
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.
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.
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.
ANS: ‘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%.
ANS: 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).
ANS: 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).
ANS: 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.
ANS: 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).
ANS: 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.
ANS: Yes, premiums paid on health insurance plans qualify for tax benefits as per Sec80D of the Income Tax Act.
ANS: 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.
ANS: 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.
ANS: Yes, a duplicate can be obtained by following the procedure set in place by the insurer, usually on payment of charges for a copy.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: Day care health insurance comes with many benefits. Some of the benefits are:
ANS: 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:
ANS: 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:
ANS: 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.
ANS: If you have a health insurance policy that covers domiciliary hospitalisation, some of the treatments they cover are:
ANS: 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.
ANS: Listed below are some tips that you can follow to select the best health insurance plan:
ANS: 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:
ANS: There are many myths when it comes to health insurance in India. Some of the myths are as follows:
ANS: The below documents are required when you submit a reimbursement claim:
ANS: 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.
ANS: 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.
ANS: 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.
ANS: Some of the expenses included in sub-limit amount are room charges, medical tests, operation theatre expenses, medicines costs, and hospitalisation expenses.
ANS: 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.
ANS: 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.
ANS: When you switch your existing health insurance policy to a new insurance provider, you are entitled to the following benefits:
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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:
ANS: Some of the illnesses that are usually covered under a critical illness plan are:
ANS: 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.
ANS: 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:
ANS: To avail cashless settlement benefit, the process is as follows -
In case of planned hospitalisation:
In case of emergency hospitalisation:
ANS: 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.
ANS: 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.
ANS: A health card is very important because:
ANS: 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.
ANS: If you are looking for a best health insurance plan, please consider the following:
ANS: 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.
ANS: 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
ANS: 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.
ANS: 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.
ANS: 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.
ANS: After a claim has been settled, the policy coverage will reduce by the settled amount till the end of the policy term.
ANS: '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.
ANS: 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.
ANS: Once in 4 years, some insurers pay for health check-ups of the life insured. This is called ‘health check’ facility.
ANS: 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.
ANS: Based on the age of the life insured and certain medical conditions, a medical examination may be required.
ANS: 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.
ANS: You have to pay for the pre-policy check-up. Some insurer will reimburse 50% of the cost.
ANS: 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.
ANS: 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.
ANS: The expenses can be indemnified through reimbursement claims or availing cashless services at a network hospital.
ANS: Cashless facility is available only at your insurer’s network hospitals.
ANS: Use the network hospital locator available on your insurer’s website for the list of network hospitals available in your area.
ANS: Cashless facility may not extend to government institutions.
ANS: 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.
ANS: In case of cashless treatments, the cheque will be sent to the network hospital where the life insured availed treatment.
ANS: 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.
ANS: 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.
ANS: 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.
ANS: 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:
ANS: 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.
ANS: 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.
Diabetes is considered a pre-existing ailment that is not eligible for claims. Diabetic patients suffer an uphill battle in terms of illness and the medical expenses associated with it. Very like the risks involved with having diabetes, the medical expenses can also be high. Fortunately, with the new health insurance products available in the market, diabetic patients can purchase health cover to ease the financial strain resulting from high medical expenses that persists for life. The top health insurance policies for diabetic patients are Diabetes Safe offered by Star Health Insurance, Diabetes Care offered by ICICI Prudential, Apollo Munich Energy, Varishta Mediclaim offered by National Insurance, and Care Freedom offered by Religare Health Insurance. Although the insurance premium for this type of policy is higher than the regular insurance, it can be brought down by regularly exercising and following a strict diet that reduces the risks posed by diabetes.
Health insurance companies offer No-Claim Bonus to those policyholders who don't make a claim over the policy term. No-Claim Bonus can be availed during the time of policy renewal. This bonus is offered in the form of a cumulative bonus wherein, the insurer will offer minimum 5% increase in the sum insured for a claim-free policy year. The cumulative bonus can be accumulated for up to 10 policy years. This bonus can expire if the policy is not renewed on time. No-Claim Bonus will also be given in the form of a discount in insurance premium at the time of policy renewal, for which the renewal should be done 30 days prior to the policy expiry date. Health insurance portability allows the accrued no-claim bonus to be transferred from one policy to another. When filing a low-value claim, the policyholder will not lose the cumulative bonus.
Looking for a mediclaim policy? Find information here on the different kinds of mediclaim policies available and how to choose the best one. Need to know how to process a claim? Read on to learn about how to make a cashless claim or get your expenses reimbursed.
Buying health insurance isn’t rocket science. And we make it easier still with our easy-to-use premium calculator. Leave the math to us. Learn all about health insurance premium calculators and how it can help you zero-in on the most affordable plan.
What has a public health insurance provider got over a private provider? Are stand-alone companies your best bet? Can’t tell them apart? Browse through our list of public, private and stand-alone health insurance companies and see how their offerings stack up against each other.
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.
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.
The Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as Ayushman Bharat, has benefited 1 lakh people within one month of its launch. Said to be the largest health insurance scheme in the world, PMJAY was launched on 23 September in Jharkhand by the Prime Minister, Narendra Modi. The scheme aims to cover 55 crore people, with an annual health coverage of Rs.5 lakh. This will be provided for hospitalization in Empanelled Health Care Providers (EHCP) for both secondary and tertiary hospitalizations. The scheme does not place a limit on the family age or size. Within 2 weeks of the launch, 38,000 people had benefited from the scheme, as announced by the CEO of the National Health Agency, Indu Bhushan. So far, 32 states as well as union territories have signed up with MoUs for the scheme. More than 9000 hospitals have been empaneled as well. The scheme aims to reduce hospital expenditure and help the economically downtrodden to avoid financial disasters that could arise from expensive or serious health conditions.
10 November 2018
Tamilnadu Government has signed an MOU (Memorandum of understanding) to merge the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) of Tamil Nadu which was introduced in 2009 by previous Chief Minister M Karunanidhi with Ayushman Bharat scheme. As Tamilnadu has an expansive health insurance scheme which is covering 1.57 crore families and provides up to Rs.5 lakh per year, it is in the similar line with the PMJAY scheme and this is the reason why the government has planned to combine the scheme with PMJAY. As a matter of fact, the state insurance scheme of Tamilnadu covers 157 diagnostic procedures, around 1,027 diseases, and 8 high-end complicated surgeries.
9 November 2018
The disagreement between National Insurance Company (NIC) and Mahatma Jyotiba Phule Jan Arogya Yojana Society (MJPJAY) over unspent state health insurance scheme fund is going to end soon. After a long duration of 3 months, the NIC has agreed to refund Rs.80 crore to the state government to resolve this dispute. In turn, the government has assured the NIC to pay the pending premium equalling to Rs.376 crore. The NIC has decided to refund the unused Information, Education and Communication (IEC) fund in installments through the third and fourth quarters of 2018 by subtracting the amount from the premium amount that the state government has to pay the NIC.
8 November 2018
According to the statement by CEO of Pradhan Mantri Jan Arogya Yojana (PMJAY), Indu Bhushan at an event organised by Assocham, the healthcare scheme introduced by Prime Minister Narendra Modi named Modicare is likely to create 10 lakh employment opportunities in the health and insurance sector. Bhushan has also stated that this scheme targets to improve the quality of healthcare in public services along with the private sector while addressing the issue regarding the very high level of expenditure on health in India as compared to other emerging economies. Bhushan has further added that 6 crore people in India go into poverty because of out-of-pocket expenditure on health. As a result, poor people tend to avoid availing health care services including hospitalisation. The total out-of-pocket expenditure in India amounts to 2/3 of the total health expenditure in the country. As per the PMJAY, also known as Modicare, will provide annual insurance coverage of Rs.5 lakh to more than 10.7 crore poor households. 60% of the total funding of this scheme will be received from the central government, while the remaining amount will be received from the state governments in India.
7 November 2018
A Memorandum of Understanding (MoU) was recently signed by the Punjab Government and the deal was made with the Centre to successfully implement the Pradhan Mantri Jan Arogya Yojana (PMJAY) in the State of Punjab which will in turn extend the central government scheme to provide coverage to more than 43 lakh families instead of the proposed number of 14.96 lakh.
Chief Minister of Punjab, Amarinder Singh said that the move made by the Punjab Government is evidently revolutionary and it will most likely change the way in which healthcare is perceived in a country like India. He further added that through this move more and more families (especially the poor and underprivileged ones) will be able to have access to decent medical treatment and healthcare in India.
Health insurance in India has become a complex yet easy to understand concept wherein people are finally gaining awareness about its importance and value. At a time when lifestyle diseases are at an all time surge and people are falling prey to more and more critical illnesses, a comprehensive health insurance policy acts as a vital resource for one’s family and loved ones.
6 November 2018
It’s a huge news for people working in the sectors of insurance and health. Prime Minister, Narendra Modi’s ambitious and hugely anticipated national-level health insurance scheme, Ayushman Bharat is expected to create at least 10 lakh new jobs in the sector.
The CEO of the health insurance scheme, Indu Bhushan recently said that the project, fondly known as Modicare, will most certainly enhance the overall quality of public healthcare in India. He added that private services may also be improved under the national health insurance scheme.
Having said that, it is a noteworthy observation that India still spends huge amounts of money towards healthcare and the expenditure is only increasing in comparison with other nations.
5 November 2018
Government of India’s flagship health insurance scheme, Ayushman Bharat - National Health Protection Mission will soon witness a surge in the number of medical brands for their scheme. This has come as a huge relief to most of the beneficiaries of the scheme as they will now have access to second brands medication from brands such as Pfizer, GlaxoSmithKline Pharma and Abbott.
The above-mentioned brands have recently laid down a proposal wherein they will launch second brand or first copy of their products to be incorporated in Ayushman Bharat. The US India Business Council has recently asked the Government to modify the ‘policy provisions’ so they are able to allow the launch of second brands for introduction into the state-run health insurance scheme. The USIBC has asked the Government for the modification and has also urged them to have a safeguard policy mechanism in place so that the supplies (mentioned above) are tax exempted and price referencing.
The above-mentioned suggestion is in reality a part of a list of other measures that have been proposed by the USIBC some of which include the establishment of screening camps for patient identification and helping the Indian Government in national health stack - an ambitious strategy of the Indian Government to store health records in a digital space by the year 2022. Council’s high-level delegation recently met with some of the officials in the National Health Agency (NHA) which is in turn responsible for the implementation of Ayushman Bharat.
The two parties met earlier this month to discuss the aforementioned suggestions.
3 November 2018
In the state of West Bengal, Ayushman Bharat - the flagship health insurance scheme introduced by Narendra Modi, Prime Minister of India - has been merged with the Swasthya Sathi scheme - a medical insurance scheme launched by the state government under the leadership of Mamata Banerjee. According to the people who are familiar with this turn of events, there will only be one medical insurance scheme in the state under the name of Swasthya Sathi. Under the merged scheme, the Central and State Governments will share the cost for common beneficiaries of Ayushman Bharat and Swasthya Sathi in West Bengal in a 3:2 ratio. Introduced in February 2016, the Swasthya Sathi scheme provides health protection to informal contractual workers who are working in government departments and people from the deprivation index. In addition to the parents and spouse of the insured, this plan also offers health coverage to the extended family members of the beneficiary.
After the merger of Following the merger of the Ayushman Bharat and Swasthya Sathi schemes, beneficiaries will now be able to get a maximum coverage of Rs.5 lakh - the maximum coverage under Ayushman Bharat - as opposed to the previous Rs.1.5 lakh. While 47 lakh beneficiaries from the state had enrolled under the Swasthya Sathi scheme, approximately 1.50 crore families of West Bengal had applied for the Ayushman Bharat scheme. Post the merger, Swasthya Sathi scheme currently provides coverage to about 6 crore individuals. Earlier, the West Bengal Government had declined to participate in the Ayushman Bharat scheme since the state already had its own health protection scheme. However, the state government decided to sign an agreement with the Centre in July to implement the scheme.
2 November 2018
The Insurance Regulatory and Development Authority of India (IRDAI) will examine the proposal by health insurers to be able to settle health and accident policy claims in instalments instead of lump sum payments. This will enable the beneficiaries or claimants to get payments through pre-determined instalments. A working group has been constituted by the IRDAI to look into this further. The working group’s chairman will be Suresh Mathur (ED - Health). The member convenor will be Md Ayaz. Other members of the working group will be Apollo Munich Health Insurance’s CEO and MD, Antony Jacob, New India Assurance Co. Ltd.’s General Manager, R M Singh, HDFC Ergo General Insurance Co. Ltd.’s Chief Financial Officer, Sameer Shah, et al. The working group will discuss operational procedures that protect the interests of beneficiaries or policyholders as well as the need for instalments in such claims. The report is expected to be submitted in 8 weeks.
1 November 2018
The Insurance Regulatory and Development Authority of India (IRDAI) is looking into a proposal that would permit insurance companies to make benefit-based payments for claims made on health insurance and personal accident insurance policies.
Insurance providers have stated that this method of settlement will provide the beneficiaries to the policy payments in predetermined instalments. However, the same will not be applicable in cases where the policyholder is reimbursed for medical expenditure.
The IRDAI has assembled an 8-member group to look into the proposal and the need to permit benefit-based insurance claims in instalments.
31 October 2018
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