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Health Insurance

What is Health Insurance Plan?

Health Insurance plan covers the costs that may arise due to any unforeseen hospitalization/ medical procedures. Health insurance covers the medical expenses for illnesses, injuries and other medical conditions. In general, a health insurance plan offers a financial guard against financial drainage on several diseases. With a health insurance, you don’t need to worry about the treatment expenses.

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Best Health Insurance Plans in India

Insurance Companies Health Plans Sum Insured (Min/Max) Pre- Existing Diseases Co- Payment Pre/Post Hospitalization No Claim Bonus
Religare Health Insurance Co. Religare Care 3 Lakh/75 Lakh Covered after 4 years Applicable 30/60 days Max up to 150% of SI
Star Health Insurance Co. Family Health Optima Insurance Plan 2 Lakh/15 Lakh Covered after 4 years Applicable 60/90 days Max up to 35% of SI
Bajaj Allianz General Insurance Co. Bajaj Allianz Health Guard 1.5 Lakh/10 Lakh Covered after 4 years Applicable 60/90 days Max up to 50% of SI
Universal Sompo General Insurance Co. Complete Health Care Insurance 1 Lakh/ 10 Lakh Covered after 3 years Applicable 30/60 days Max up to 50% of SI
Cigna TTK Health Insurance Co. Cigna TTK ProHealth Plus Plan 2.5 Lakh/10 Lakh Covered after 4 years Applicable 60/90 days Max upto 100% of SI
Future Generali General Insurance Co. Future Health Suraksha Plan 50,000/10 Lakh Covered after 4 years Applicable 60/90 days Max up to 50% of SI
HDFC Ergo General Insurance Co. Health Suraksha 3 Lakh/10 Lakh Covered after 4 years Not applicable 60/90 days Max up to 50% of SI
ICICI Lombard General Insurance Co. Complete Health Insurance 3 Lakh/50 Lakh Covered after 4 years Applicable 30/60 days Max up to 50% of SI
Apollo Minich Health Insurance Co. Optima Restore Individual 3 Lakh/50 Lakh Covered after 3 years Not applicable 60/180 days Max upto 100% of SI
Max Bupa Health Insurance Co. Health Companion Health Insurance 2 Lakh/50 Lakh Covered after 4 years Applicable 30/60 days Max upto 100% of SI
Star Health Insurance Co. Star Comprehensive Insurance Policy 5 Lakh/25 Lakh Covered after 4 years Applicable 30/60 days Max up to 100% of SI

Why should I Buy Health Insurance?

Here are some top reasons why you should buy a Health Insurance Policy.

Hectic Lifestyle

Nowadays, people are busy in their day-to-day life and typically, they don’t have time to look after their health concerns. The hectic lifestyle makes the body suffer from high levels of stress that can lead to serious health issues. In case you need medical treatment, you should be covered by a health insurance.

Rising Medical Costs

The medical treatments are becoming unbelievably expensive. 75% of Indian households are paying medical bills out of their pocket. Innovation and development in the medical arena have resulted in cures for the majority of life-threatening diseases. Treatment for such critical diseases carries enormous medical costs and thus are not affordable to the ordinary people. Treatment in private hospitals will cost you to the extent which will enable a quake in your financial stability.

Effective Financial Planning

Anybody may fall ill, and several medical treatments, especially a critical illness can obstruct you in achieving your financial goals. If you are not covered by medical insurance, you need to pay the huge medical bills with money kept for meeting other financial objectives like buying a car or a new home. If you are the only income earning member of the family, it becomes imperative to get yourself a health insurance at the earliest.

What kinds of Health Plans can I opt from?

Choose the best Health Insurance Policy in India and lessen your financial risks from any unforeseen health problems. There are different types of health plans you can choose from depending on your and your family’s health needs.

Individual Health Plan

This kind of health insurance plans are designed to provide a medical cover for an individual. It is a preferred health insurance plan when you are unmarried or the only earning member of your family. This health insurance provides cover against in-patient hospitalization expenses, pre & post hospitalization expenses, and day care procedures. You only need to ensure that you are not under-covered and opt for the right insurance cover under individual health policy. Such policies are also known as Mediclaim Policy.

Family Floater Health Plan

If you want to cover your entire family for medical expenses, you can go for a Family Floater Health Plan. Under this Health Insurance Plan, your whole family, including spouse, parents, kids and some plans also allow to include parents in laws who can be included as insureds under one policy and claim against hospitalization or medical benefits as per policy contract. At one time, more than one member of your family can also avail the advantages of this health insurance plan subject to the maximum limit. The total health cover or Sum Assured can be shared between the multiple insureds within a single policy year.

Senior Citizen Health Plan

As you grow older, there are more chances of getting sick. In case you go through medical treatment, you have to pay huge medical bills from your pocket, which is quite painful, especially when you don't have a regular source of income. It is thus better to choose a Senior Citizen Health Insurance Plan to put a cover on your finances. You can choose an umbrella plan which includes you and your spouse (if you fall in the senior citizen category), or you can buy individual senior citizen health plans. These health plans cover the medical needs of senior citizens.

Critical Illness Plan

Critical illness is a health related medical condition of a serious nature. A Critical Illness insurance plan guards you against the financial expenses that occur in the diagnosis of critical diseases such as cancer, heart attack, kidney failure, etc. The range of critical illnesses covered and the payout may vary from one plan to another. Critical illness insurance provides a lump-sum payment in case the policyholder is diagnosed with the critical illnesses mentioned in the contract. Critical illness plan can also be taken as an add on benefit to your base health plan.

Personal Accident Plan

A Personal Accident Plan provides you with cover against accidental death or injury resulting in permanent total/partial disablement. Severe accidental injuries affect the earnings of the person. When it comes to securing the future of the family, this plan is quite essential for the sole earning member of the family. This plan pays the sum assured to the insured (in the event of disability due to an accident) or nominee (in the case of death). Some Personal Accident insurance policies also cover Medical Expenses arising out of the accident. The Personal Accident Plan can also be taken as an add on benefit to your base health plan.

Maternity Plan

Under this plan medical expenses pertaining to maternity are covered. It covers the cost of maternity expenses which are incurred during the childbirth. Insurers put some waiting period to avail this cover. Some insurers include maternity benefits inbuilt under their primary health plan also.

Group Health Insurance Plans

A group health insurance policy is a type of insurance plan which provides health care insurance coverage to a group of people, who are usually an employee of a common company, professionals in a common group or members of a cooperative society. For most of the salaried people, group health insurance comes as one of the most beneficial perks, which is offered by an employer. The group health insurance policy helps a company to mitigate the risk faced by their employees and increases employee satisfaction also. Group health insurance policy is a policy issued for one year, which needs to be renewed annually to continue coverage.

What are the Benefits of Buying a Health Plan?

Here are the key benefits under the Best Health Insurance Plans in India and are covered by most of the Mediclaim Policies.

Hospitalization Expenses

A health plan covers in-patient hospitalization costs occur due to an accident, illness, or a medical/ surgical procedure. Typically, your health insurer will pay for room rent, nursing, medical practitioner, anesthesia, blood, oxygen, surgical appliances, operation theater charges, medicines, drugs, consumables, and other devices required during a surgical procedure. This benefit is covered in most of the Indemnity based best medical insurance in India.

Pre-Hospitalization Expenses

It covers medical expenses that occur due to illness for 30 days before the insured person was hospitalized. The days of pre-hospitalization included under the plan may vary from one insurer to another.

Post-Hospitalization Expenses

It covers medical expenses that occur due to illness for 60 days after the insured person was discharged. The days of post-hospitalization included under the plan may vary from one insurer to another.

Cashless Treatment

Best Health Insurance in India offers Cashless Treatment under its Health Insurance Policy. Most of the insurers offer the facility of cashless treatment, provided you are hospitalized in one of the listed network hospitals of your insurance company. In the case of cashless hospitalization, your insurer will pay your hospital bills. If you go to non-network hospitals, you can claim for reimbursement of medical expenses that are covered under the plan.

Day Care Procedures

Some medical surgeries require hospitalization for less than 24 hours. Several insurers also pay for such events where you are not hospitalized for 24 hours rather admitted for few hour basis the treatment or surgery.

No Claim Bonus

No Claim Bonus (NCB) is a benefit under your health plan if the insured person has a claim-free policy year. The advantage of NCB transfers to the insured is either through an increase in the sum assured or specified discount on the premium charges for the succeeding year. Being a healthy individual, you can enjoy a claim-free year and take benefits of NCB under your health plan.

Hospital Cash Benefit

A hospital cash allowance is payable on a day to day basis. The hospital cash benefit depends on the terms of the policy. A specified minimum stay in the hospital is required to avail this facility.

Free Health Check-up

You can avail the benefit of free health check-up under your health. It includes a comprehensive health check-up for members covered under the plan. Some insurers offer health check-ups on renewal, and some provide this benefit of free health check-up upon claim-free year/s.

Emergency Ambulance Benefit

Some insurers cover the ambulance charges for transferring the insured from home to hospital. The coverage amount of ambulance charges depends on the policy terms.

Tax Benefits

The premium amount you pay for your own health policy or your family’s health plan is considered for tax benefit under section 80D of the Income Tax Act 1961. These benefits are subject to change in tax laws.

Note: The benefits mentioned above may differ from one insurer to another. Read your chosen Health Plan policy wordings carefully for more details.

How is my Health Premium Calculated?

Following are the key determinants for computing the premium amount for your chosen Health Insurance Plan or Mediclaim Policy.

Sum Assured

The sum assured or health cover you opt for, determines the premium amount for your health plan. You should select the adequate sum assured, keeping medical inflation in mind so that you get the enough cover for your medical conditions. Higher sum assured attracts a higher premium.

Age

If you buy a health plan at a young age (age bracket of 18-25 years), you will be charged with the lesser premium rates than those aged 40+ years. People at a younger age are less likely to face critical health issues, and thus, your insurer will charge the lesser premium.

Type of Plan

The individual health plan has a lower premium than the family floater health plan. The number of insured covered under a single policy results to increase in premium. Under a Family Floater Policy, the insurance company provides cover for each member of your family who is insured under the health plan and so, the premium is also relatively higher than individual health policy.

Pre-existing Condition

If you have any pre-existing health condition, your insurance company will charge a premium at a higher rate. It is recommended to inform about your pre-existing condition to the insurer while buying the health plan, so you can easily get the claim afterward.

Personal Health

Best Health Insurance Plans in India consider personal health status before giving health insurance policy. Personal health is a vital determinant that decides the cost of the premium. If an individual is healthy, then it reduces his chances of getting hospitalized whereas if a person has any genetic disease the health insurance premium will be high or the disease would be omitted from the coverage, basis the terms and conditions laid by the insurance company. Also, if you are in a habit of taking drugs, chewing tobacco, or smoking, you are charged with increased rates of premium. These unhealthy habits directly put you at a high health risk and thus affects the premium rate.

Claim Free Years

Getting a claim free year may result to discount on the premium rates on your renewal premium or an increase in the sum assured. No claim bonus earned by you under your health plan may reduce your premium amount in the subsequent years.

What are Smart Buying Tips to get Best Health Insurance?

Here are some essential tips that you should consider while buying a Best Health Insurance Policy in India.

Choose Need Based Plan: It is important to purchase a health insurance plan wisely. You should get a health plan that caters all your medical needs, keeping in mind the growing medical costs. If you have a family with multiple dependents, opt for Family Floater Plans which will take care of the health-related costs for the entire family. Also, in case you have parents aging above 60, it's prudent to buy them separate individual health plans as including them under a floater policy will result in usage of maximum sum assured by them only as the age advances people are more prone to diseases due to age factor.

Choose the Right Sum Assured: When buying a plan, apart from understanding its benefits, you also need to select the sum assured (health cover) that can easily cover all yours or family's health treatment expenses. If you are under-covered, you need to pay bills from your pocket, and if over-covered, you need to pay high premiums to get a health cover that you don't require at the current moment. So, be prudent in choosing the sum assured amount.

Go for Lifetime Renewability Health Plan: Some insurers may deny the renewal of your health plan considering your deteriorating health condition. It is, thus, recommended to go for health plans that offer Lifetime Reweability. With lifetime renewability, you can always cover the health risks irrespective of the age and health condition.

Opt for Top-up & Super Top-up: To broaden your health cover, Top-up and Super top-up health covers help you to cover the medical expenses in case the sum assured of your existing health plan exhausts. Rather than buying a new health plan with extended coverage, it is more prudent to go with the top-up /super top up cover. It is more economical and provides an extended health cover over and above your basic health coverage.

Make a Well-Informed Decision: It’s wise to read the policy document carefully and understand your policy wordings. Before buying a policy, you should know about the benefits and exclusions it offers, so that you can make a right decision with the right health plan.

Check Claims Efficiency: It is important to study the claim settlement ratio and turn around time of settling the claim by the insurance company before buying the health policy. Also, it's imperative to check the efficiency of the Third Party Administrator (TPA) involved. For medical emergencies, the need of the hour is the immediate financial support from the insurance company. Choose the insurance company with higher claim settlement ratio and fastest claim settlement turnaround time.

Buy Online: Online buying will enable you to compare the health plans or mediclaim policies from multiple insurers to get the best health insurance plan. Comparing plans online will help you understand the benefits provided under the various plans available on the market and you can take an informed buying decision by choosing the best fit.

Is there any Add on Cover/Rider with Health Plan?

Best Health Insurance in India offers additional benefits or Riders along with the base policy. Riders are additional benefits attached to your base policy which will offer you boosted benefits apart from your base policy. Add-on covers attached to your health insurance policy simply help you enhance the protection level. Listed below are the options:

1. Critical Illness Cover

Critical Illness refers to illness, disease, or sickness which even after the treatment drastically affects the lifestyle of the patient. For example, Cancer even after the treatment needs extreme care and may not make an individual’s life as normal as he/she was before. With Critical Illness add on the cover, the insured is provided with an immediate fixed amount plus the rider cover expenses incurred during the medical procedure as well. By having critical illness cover, you are covered for a wide range of critical illnesses. Critical Illness can also be taken as a standalone policy. Many insurers have separate Critical Illness plans under their health portfolio.

2. Hospital Cash Cover

Hospital cash rider provides for the daily cash that you may need for compensating the medical expenses during the stay in the hospital. Typically, you can claim benefits an amount depending on the nature of your stay. You can also claim a higher payout in case you are admitted to ICU. You will be eligible for the rider payout in case you are hospitalised for a minimum of 24 hours.

3. Room Rent Waiver

This add-on cover enables you to enjoy higher sub-limits for room rent in case of hospitalization. A basic health plan typically provides a defined sub-limit to room rent. With the help of a room rent waiver cover, you can choose an improved room for your hospitalization beyond your basic cover with this rider.

4. Personal Accident Cover

Many insurers have this as an inbuilt rider in their health plans. With this add-on cover, you are covered against the risks that may arise due to the total or partial disablement or death caused by accidents. Personal accident plans are typically offered as a separate insurance cover by paying an additional premium amount. A personal accident cover is of great help in the event of medical emergencies caused due to the accidents and this add on cover provides the separate sum assured apart from your base sum assured. The Personal Accident Plan can also be taken as a stand alone policy. Many insurers have separate Personal Accident Plans under their health portfolio.

5. Top Up/Super Top Cover

A top-up health policy provides additional coverage to those who have a running health plan. This plan covers the medical expenses that may arise due to an illness/injury over and above the limit of the actual cover. A top-up health plan works by ‘single incidence hospitalization’, however, a super top-up plan looks at the aggregate claim. A super top-up health plan puts together several incidence of hospitalization to cover the medical bills. It covers a total/aggregate of the medical bills in a year, not just the single instance of hospitalization.

(Note: The rider benefit, conditions, and eligibility criteria may vary from insurer to insurer.)

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What is Health Insurance Portability?

Health Insurance Portability refers to the right conferred to a health insurance policyholder to switch from one insurer to another without losing the credit gained with respect to the waiting period for a preexisting condition and other time bound exclusions. IRDAI, (Insurance Regulator) had issued guidelines on portability of health insurance policies. Portability in health insurance has come into force w.e.f 1st October 2011.The health insurance policyholders thereby have the right to buy a policy from another insurance company of his/her choice. The portability also applies when you switch from one plan to another with the same insurer. Porting of policy is possible only at the time of renewal. You can carry forward the credit given by the previous insurer, such as the waiting period for Preexisting condition and other time bound exclusions. You can port your health policy to any general insurer or specialized health insurer. Under this provision, your new insurer is bound to insure you at least up to the sum assured as mentioned under the previous policy.

What is Not included in my Health Plan?

Following are the conditions/exclusions that are not included in your Health Plan.

• Pre-existing conditions: Any illness that had symptoms or received medical treatment within 4 years of commencement of the first policy.

• First 30 days: You can’t claim for the first 30 days from the commencement of the health policy. Accident injury claims, however, don’t require a waiting period.

• First year of cover: During the first year of your policy, some specific illnesses are not covered include Cataract, Hydrocele, Hysterectomy, Fistula in anus, Benign prostatic hypertrophy, Sinusitis, and Congenital Internal diseases.

• Cost of contact lenses, hearing aids, and specs.

• Cost of contact lenses, hearing aids, and specs.

• Convalescence, congenital external defects, the use of intoxicating drugs / alcohol, intentional self-injury, general debility, expenses for diagnostic tests related to the disease for which the insured has not been hospitalized.

• Pregnancy or childbirth related treatments.

• Naturopathy treatment.

• Dental treatment/surgery.

(Exclusions may differ from one insurer to another and plan to plan.)

Do’s and Dont’s in Health Insurance

Read the do’s and dont’s related to your Health Plan.

Event : New Policy

Do’s Dont’s
Fill the proposal form carefully (online/offline) and provide the right information about the people to be covered under the policy. Let your agent fill the proposal form on your behalf.
Disclose details regarding all pre-existing conditions of each person covered under the policy a insured. Provide any false information while filling the proposal form. It may affect the claim payment at a later stage.
For your future reference, you may keep one copy of the proposal form with you. Hide the material facts or pre-existing condition of the insured/insured’s.
Take out time and read through the policy document, and if you are not satisfied with the policy terms, you may cancel the policy within 15 days free look period,starting from the date the policy issuance. Sign the proposal form without reading the policy terms and conditions.

Event : Renewal

Do’s Dont’s
Renew the policy on or before the due date via online or by visiting one of the registered offices of the insurance company. Renew after the due date of the policy renewal.
Prior requesting to enhance the sum insured on the policy renewal, you may read through the sum insured enhancement conditions mentioned in the policy document. Forget to renew the policy. (The lifetime renewability feature is available only with those policies, which have been renewed without any failure.)
You should inform to your insurer regarding any change in the risk profile of the insured/insured’s covered under the plan. Delay to inform the insurer of any change in the risk profile of the insured.

Health Insurance Glossary

Here are the basic terminologies used in a Health Insurance domain.

Accident: It is an unforeseen and unexpected event occurring from external means.

Co-Payment: Under this, the policyholder pays the pre-defined fixed percentage of the total claim amount and the remaining amount is then paid by the insurer.

Critical Illness: It includes illnesses/health conditions that even after the treatment have a severe impact on the lifestyle of an insured.

Deductible: It is a portion of medical expenses that the policyholder has to bear before an insurer covers any costs.

Dependents: It includes spouse, unmarried children till age 21 (or as defined by the insurer), and parents of the insured member.

Emergency Care: It involves the management of a severe illness/medical condition that break out unexpectedly and requires urgent medical attention to avoid further severe health consequences.

Health Policy: It’s an agreement between a policyholder and insurance company specifying health coverage, benefits offered, its exclusions, and other related terms & conditions.

Hospitalization: It refers to admission in a hospital/ health care unit for more than 24 consecutive hours. It also applies to specific medical procedures that require hospitalization for less than 24 hours.

Illness: Any disease/condition results in the impairment of the normal physiological function of the body and require medical attention.

Inpatient Care: Inpatient Care means such treatment for which the insured has to stay in a Hospital for more than 24 hours for a covered event.

Network Hospitals: It includes the list of hospitals/ health care units where the insured can get the cashless treatment as covered under a health plan.

Policy Exclusions: It refers to certain incidents or conditions that are not covered under a health policy.

Portability: Portability means the transfer by an individual health insurance policyholder (including family cover) of the credit gained for Pre-Existing conditions and time-bound exclusions if he/she chooses to switch from one insurer to another.

Pre-existing Disease: A medical condition, illness, or injury for which you had symptoms or gone through the treatment during the 48 months prior buying the first health policy.

Room Rent: Room Rent means the amount charged by a Hospital for the occupancy of the bed by the insured person who is admitted on a per day (24 hours) basis and shall include associated medical expenses.

Sum Insured: It is the maximum amount of coverage under your health policy for which the insured or insured’s in the contract is entitled off.

Third Party Administrator (TPA): It refers to an organization that processes claims and performs other administrative services as mentioned in a service contract with the health insurance company.

Waiting Period: It refers to a fixed timeline for which the policyholder has to wait to avail specific health benefits.