Health insurance is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured. Under health insurance insurer provides financial protection against the high costs of medical treatment, providing individuals with access to healthcare services without the burden of paying the full cost out of pocket. Best health insurance plans cover a range of medical services, including doctor visits & fees, hospital charges, medications, hospitalization costs, and other healthcare-related expenses.
A standard health insurance plan is a mutual contract between the insurance provider and the policyholder, in which the insurer agrees to offer financial protection to the policyholder during any medical emergency. As per the chosen plan terms, a health plan offers both cashless treatment benefits and reimbursement benefits while availing of medical treatments.
It acts as a financial safeguard and a protective shield and ensures the beneficiary avails of quality healthcare services without financial worries.
Highlights | Specifications |
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Although medical science has shown several milestone achievements in the last few years and is still growing, we have witnessed that healthcare costs are reaching new heights each day. Considering such a steep and steady inflation rate, it has become essential to invest in a competent health insurance plan.
Major reasons for purchasing best health insurance plans include:
Savings protection: A standard health insurance plan will offer sufficient coverage to protect your savings during medical emergencies.
Compete with medical inflation: Despite the steep and steady rise in the inflation rate in the medical industry, you can complete your treatments at quality healthcare centres without financial worries.
Easy accessibility to quality healthcare services: Health insurance opens the doors to quality medical care facilities with network hospital benefits.
Combat lifestyle ailments: A health plan even takes care of lifestyle ailments like diabetes, and hypertension along with issues that require long-term medical care like cancer, stroke, cardiac arrest, etc., depending on the terms of the chosen plan.
Cashless hospital facility: You can easily access quality treatment facilities without the need for any immediate upfront payment.
Tax benefits: The premiums paid towards health insurance qualify for tax benefits under section 80D of the Income Tax Act.
Before purchasing a best health insurance plan, you should remain aware of its principal features:
Tip: So, opt for a higher coverage limit right from the beginning. You can always step it up.
Tip: Opt for a low waiting period if you have any pre-existing ailments so that you can start filing for the same.
Tip: Ideally, opt for health insurance plans without any sub-limit, even if that is slightly more expensive. This would help you to lower your out-of-pocket expenses.
Tip: Opt for an insurer with a large network of hospitals so that you can avail of cashless hospitalisation benefits.
No Claim Bonus: Similar to auto insurance, health insurance plans providers also offer a No Claim Bonus benefit for raising no claims in a year, eventually raising your total sum insured amount at no additional cost.
Co-payment options: Here the beneficiary shares a pre-defined percentage of healthcare costs incurred. To ensure optimum liability reduction, you can choose a plan with a minimum co-payment percentage.
Plan exclusions: No health plan offers 100% coverage under any circumstances. These exclusions may vary based on the plan terms and the insurer’s business policy. Ensure this list of exclusions beforehand for a seamless claim settlement.
Pre- post-hospitalisation expenses: All health insurance plans cover pre- and post-hospitalisation expenses up to a specified tenure. Read the policy papers well to confirm this tenure. It is generally 30 days prior to hospitalisation and 60 days after hospital discharge the health insurance plans tend to cover. However, this may vary depending on the terms of the insurer and plan concerned.
So far it is clear that health insurance is ideally extremely helpful. Some of its most highlighting benefits include:
Hospitalisation charges: All standard health plans cover hospitalisation costs. However, claims are settled only for those health issues that were not present during the policy purchase. Several insurance providers offer plans like critical illness plans, offering coverage for listed critical ailments, accidental coverage plans, etc.
Zero capping on ICU charges: Several insurance providers offer plans without any room rent capping on ICU charges. The beneficiary can opt to live in a private cabin at the cost of the insurance provider. However, if it exhausts the plan terms, he/she has to settle the excess dues.
Mental illness coverage: Health plans also cover mental illness treatment costs. This has become mandatory as per the IRDAI norms considering the steep rise in mental health issues.
Bariatric surgery costs: Only a specific handful of health insurance plans offer coverage for obesity treatment. The premium rates are slightly higher.
Zero room rent capping: Health plans usually cover room rents during hospitalisation. They previously disclosed the total disbursement amount in this context.
Daycare procedures: These are those medical procedures that require less than 24 hours of hospitalisation like cataract surgery, angiogram, dialysis, etc. Most health plans cover these.
Ambulance charges: General health plans allow road ambulance cost coverage incurred during medical contingency.
Refilling sum insured: Under such health plans, you can make up to 2 claims per year within the specified sum insured limit, provided the health issues differ in both cases.
Daily cash cover: Best health insurance plans also offer daily cash allowance to compensate for the income loss incurred during the term of hospitalisation.
Zone upgrade: In terms of medical insurance, zones are classified as per the average medical expenses in the concerned city. They tend to be comparatively higher in the metro cities than towns and other smaller cities. This particular add-on allows you to consider the cost disparity costing slightly additional premium charges. However, it subsequently saves your total premium payment cost by nearly 10% to 20%.
Domiciliary cost coverage: Certain treatments may require domiciliary treatment rather than hospitalisation as per the doctor’s advice. Some health plans even offer coverage for such treatments too.
Organ donation costs: If any major organ like the liver or kidney requires replacement, it becomes extremely expensive. However, health plans cover organ donation costs depending on the terms of the plan.
During any medical contingency, a cashless treatment facility comes in extremely handy. Some of the major benefits of cashless treatment include:
Before purchasing best health insurance you need to consider certain crucial factors to ensure optimum coverage and smooth claim settlement:
Some of the most significant reasons to buy and maintain health insurance plans are:
Ensure financial coverage: A health plan acts as a protective financial safeguard during medical contingencies. Having competent health insurance allows you to access quality medical care without needing any upfront payment.
Rising inflation: The inflation rates in the medical industry are quite steep and always on the rise. Having a suitable health plan allows efficient financial management.
Affordability: Purchasing a health plan early in life can make you go a long way keeping it affordable and allowing optimum coverage.
Lifestyle issues: The contemporary sedentary lifestyle enhances several lifestyle diseases. If you wisely invest in best health insurance beforehand, you can enjoy its coverage protection when needed.
While dealing with health insurance you must note that health insurance and medical insurance are different:
HEALTH INSURANCE | MEDICAL INSURANCE |
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Allows wide coverage for multiple health ailments | Allows coverage for specific medical ailments and expenses |
Usually bought by individuals or offered by employers under a group plan | Usually bought as an additional rider/add-on to an existing health plan |
Allows preventive care, doctor’s costs, and medicine cost coverage | Only allow hospitalisation, surgery, and rehabilitation costs |
May need deductibles and/or co-payments | May allow lump sum payment as compensation for income loss during recovery and cover for additional charges |
Several variants of health insurance plans are prevalent in India:
Parent's Health Insurance Policies: These are specially crafted for your parents to ensure that they get medical treatment and hospitalisation coverage during emergencies.
Children's Health Insurance Policies: These are designed to meet the unique medical requirement coverage for your child. It usually covers consultation fees, tests, medicines, and sometimes, immunisation.
Women's Health Insurance Policies: This sort of health plan caters to the unique medical coverage exclusively required by women. Diagnosis, medication, treatment, and maternity costs, are all usually covered.
Individual Health Insurance Policies: It covers a single beneficiary and covers treatment and hospitalisation costs.
Family Floater Health Insurance Policies: It is a single umbrella plan that covers all the family members. It usually covers the self, spouse, children, parents, and parents-in-law. However, it may vary depending on the chosen plan.
Senior Citizen Health Insurance Policies: These plans are specifically designed to meet the unique health requirements of people 60 years and above.
Group Health Insurance Policies: It is provided by the employer to all its employees throughout their employment tenure.
Maternity Health Insurance Policies: This sort of plan offers coverage for unforeseen complications due to pregnancy and childbirth. It includes coverage for both normal delivery and C-sections.
Cancer Health Insurance Policies: It allows medical insurance coverage incurred for the treatment of cancer. You are paid a lumpsum amount on detection of the ailment which is equivalent to the expenses incurred.
Personal Accident Health Insurance Policies: It allows financial coverage for injuries, disabilities, or death caused due to an accident. The coverage limit is usually up to INR 25 lakhs.
Critical Illness Insurance Policies: These plans specifically provide coverage for life-threatening ailments such as cancer, kidney failure, heart attack, and more. However, it's important to note that each insurance company maintains a separate list of critical ailments. It's advisable to carefully consider and clarify the coverage details before making a purchase.
Comparing similar health insurance plans offered by different companies is very crucial for understanding the scenario well and acquiring the most suitable plan at the most affordable rate:
Ensuring optimum coverage: There is no single plan that equally fits everyone well. Comparative analysis is essential to understand which plan suits you the best.
Effective cost management: You must compare different plans to ensure receiving the best coverage at the most affordable rate.
Plan terms and conditions: Once you begin your comparative study among different plans, you get a better grasp of the nature of policy terms and conditions. This aids you in making an informed decision.
Additional benefits: Comparing different policies will help you explore different additional benefits and riders.
Customised coverage: When you compare health insurance plans you pave the road to utilise customised coverage, a perfect plan that satisfies most of your requirements.
Value for money: When you purchase a health plan after careful comparison, you ensure to get optimum value for money.
Command: When you compare different health plans before purchasing, you remain in command to secure the perfect match considering your requirements.
Having a competent health insurance plan saves a lot of financial burdens and troubles. The standard coverage benefits of a health insurance plan include:
In-patient hospitalisation coverage
Pre-hospitalisation expenses for a pre-defined tenure
Post-hospitalisation expenses up to a specified period
Daycare treatment coverage
Domiciliary treatment cost
Organ donor costs
Ambulance charges
AYUSH costs
Free health check-ups
Restoration of the sum insured
Maternity benefits
OPD coverage
No Claim Bonus, etc.
Even the best health insurance plan will also not offer 100% coverage. Although the list of exclusions varies from one insurer to another and depending on the terms of the plan, some standard exclusions include:
PEDs are not covered before the specified waiting period has passed
Coverage of certain specific ailments like hernia, piles, fistula, etc. does not happen in the primary year of policy commencement
Any ailments that are contracted within 30 and 90 days right after plan purchase are generally excluded
Any cosmetic treatments that are not medically essential
Any dental treatment other than occurring due to an accident
STDs
Ailments caused as a result of war or similar allied activities
Health issues caused due to overuse of alcohol and/or drugs
Any unproven, experimental form of treatment
Self-inflicted injuries
Health issues arising due to voluntary participation in adventure and hazardous activities
Ailments caused for participating in criminal activities, etc.
The importance of health insurance cannot be exaggerated. Some of the most significant factors that highlight the importance of health insurance especially considering the current-day scenario include:
Competent coverage of medical expenses: Health insurance allows medical emergency coverage without any need for immediate upfront payment.
Cashless hospitalisation facility: You can access cashless hospitalisation facilities throughout the country among network hospitals.
Family protection: You can ensure family protection using a family floater plan.
Combatting medical inflation: Health plans allow you to combat medical inflation most effectively, ensuring efficient finance management.
Critical illness coverage: Some health plans even allow critical illness coverage.
In-patient care: In-patient hospitalisation coverage is allowed under health insurance.
No Claim bonus: Health plans allow NCB for non-claim years, eventually raising the sum insured amount at no additional cost.
Additional riders: You can add befitting riders to enhance the coverage span.
Coverfox is a commendable name in the health insurance industry. Some of the significant reasons for purchasing best health insurance plans through Coverfox include:
User-friendly: Coverfox maintains a simple and easy-to-understand interface for easy online health insurance purchases. You can even use their official site to renew health insurance online.
Ample options: Coverfox offers best health insurance options considering the varied requirements of the wide customer base.
Affordable: The health insurance options available on Coverfox are comparatively much more affordable and offer competent comprehensive coverage.
Network hospitals: Coverfox maintains a wide network of hospitals throughout the country for easy cashless hospitalisation facilities.
You need to meet certain critical criteria for buying best health insurance:
Insured’s age: Most health plans have specific entry age criteria which may vary depending on several factors. Always check it out before purchasing.
Exposure risk: The risk factors vary from person to person and the premium levels too vary accordingly. The higher the risk, the higher the premium.
PEDs: If the beneficiary possesses PED during policy purchase, the premium amount tends to rise as the risk factor is higher.
Age proof like passport, birth certificate, etc.
Identity proof like passport, Aadhaar Card, etc.
Address proof like passport, DL, utility bills, etc.
A duly filled and signed claim form
Recent passport-size photo
All the hospital bills, receipts, documents, reports, prescriptions
Pre-authorised claim form for cashless claim
Identity proof
For reimbursement claim, you need the following documents:</b>
Discharge summary from the hospital
All the receipts, bills, prescriptions, reports, and documents, issued during hospitalisation
Identity proof
For a smooth cashless claim settlement, follow these steps:
Inform your insurer and contact the hospital TPA desk regarding your hospitalisation in a network hospital within 24 hours
Duly fill in, sign, and submit the pre-authorisation form
Once the treatment process is complete, submit all the bills, receipts, and documents issued so far along with the discharge summary
The insurance provider will liaise with the hospital authorities and directly settle the approved claim amount
You have to settle the remaining dues and complete the process.
In this type of claim, you need to pay for the expenses out of your own pocket and then file for the claim after discharge.
Immediately inform your insurer regarding the development and your hospitalisation
Once the treatment process is complete, settle the entire hospital bill out of your pocket.
Contact your insurer at the earliest after discharge.
Submit all the prescriptions, reports, invoices, receipts, and documents along with the discharge summary and a duly filled and signed claim form
Once all the documents are verified to be correct, you receive the approved claim amount directly to your registered bank account.
ELIGIBILITY | EXEMPTION LIMIT |
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For self, spouse, and dependent children | Up to INR 25000 |
For self +spouse + dependent children + parents below 60 years | Up to INR 50000 |
For self + family + parents above 60 years (the eldest member other than the parents must be a non-senior citizen) | Up to INR 75000 |
For self + family + parents ( where both the eldest member and the parents are senior citizens) | Up to INR 1 lakh |
While wrapping up, we must emphasise that health insurance has become a necessity considering the current circumstances of steep medical inflation. So, it is best to purchase one at the earliest. You can easily buy best health insurance online with a few simple clicks and taps on your computer or smartphone. However, consider all the tips and tactics mentioned here to ensure optimum coverage without burdening your pocket.
The best way to get the highest coverage with medical insurance without splurging is through additional riders. You can add riders as per your needs and enhance your policy coverage.
The minimum age to purchase a health insurance plan is 18 years.
Your policy will lapse or get terminated if you fail to pay your premiums.
There is no limit on how many medical insurance plans you can purchase.
Cashless treatment under health plans ensures that you do not have to pay anything when you get admitted to one of the network hospitals of your health insurance provider.
No, medical insurance is quite affordable. For instance, under a basic health plan with a sum insured of Rs. 5 lakh, you might have to pay a premium of Rs. 5,000 - Rs. 10,000 per year. The premium depends on your age, type of policy, and other factors.
Yes, you can add family members like your spouse, children, parents or parents-in-law under a family floater which offers cover for the entire family.
Every policy comes with a waiting period after which your cover gets activated. The waiting period for most health policies is 30 days but we suggest checking with your insurance provider on the same.
Yes, your health policy will still cover you if you are admitted to a non-network hospital. The only difference is that you will have to pay the bills and then file for reimbursement as opposed to getting cashless treatment.