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Health Insurance

Things you need to know
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The thing about medical emergencies is that they can hit anyone, anytime regardless of age, gender or lifestyle. Since it can't be predicted, one can always be prepared for it. Health Insurance protects everyone in your family against financial loss from the unexpected.It's an agreement between you and your insurance company, where for an annual premium, the insurer pays for your hospitalization and other medical expenses as mentioned in your policy.


This provides for the hospitalization expenses you might face in case of accidents, day-care procedures, surgical treatments or critical illnesses. However, the features, limits and sum assured will vary from insurer to insurer.


Similar to top-ups for mobile network services, this adds supplementary coverage to your existing health plan. The aim is to increase overall sum assured with its corresponding coverage by paying a relatively lower premium.

Buy Confidently

With 25 insurers and 100+ products to choose from, Coverfox works actively to find a plan that is ideal for you—basically, the best one, the right one. From providing you with all the right information to offering unbiased comparisons, we do it all. Hey, you don't even need to engage with the insurer yourself.

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What is Covered

Customize your Health Insurance
  • Zero Depreciation Cover

    If you are admitted for treatment in a network or a non-network hospital for more than 24 hours.

  • Engine Protection

    Medical expenses including diagnostic reports, medicines etc. for the treatment you are hospitalized.

  • NCB Protection

    OPD treatments are not included, but procedures such as cataract and kidney stone removal are covered (even if they don't need 24-hour hospitalization).

  • Invoice Cover

    For medical and other out-of-pocket costs in case of an accidental injury. In fact, this cover is active from the very first day of policy issuance.

Compare Health Insurance Plans Before you Buy

Selecting a suitable health plan to protect everyone in your family is not an easy task (Unless, you have been buying insurance only to save on tax so far). Thus, always compare plans on the basis of the following crucial factors:
Assess if the cover and sum assured are suitable against the premium paid. Choose add-ons as per your needs.
Be sure of the insurer's network hospitals in your area. You can avail of cashless services only at these hospitals.
Since hospital room rents vary, some insurance plans pay only a part of the actual rent. It's always best to go for higher or no room-rent limit plans.
Check what is permanently excluded and which treatments are possibly covered after waiting for a certain period.

Should you Opt for Fixed Benefit Health Insurance Plans

With the change in lifestyle and environment and many other hereditary factors, there has been a drastic rise in people falling prey to critical illnesses. Though medical technology and science has improved tremendously, the cost of medical treatments too has reached sky high! So much so, that a middle class sole earner finds it difficult to save his hard-earned money during medical emergencies in absence of a health insurance policy. Unfortunately, opting for personal loans from banks and at times from friends and relatives has created much distress among many families.

What are fixed benefit health insurance plans?

To encounter such financial hardships to treat critical illnesses, it is essential to introduce something called as ‘fixed benefit health insurance plans’. These plans take care of two major expenses such as hospital room charges as well as the entire cost of the surgery. But, remember these plans do not pay the expenses that include pathology, radiology and medical consultation.

How does it work benefits of health insurance plans?

An amount equal to the sum insured is paid off by the insurance company to the insured in case he suffers from an illness which forms a part of the policy wordings. This amount however is fixed and guaranteed. Here, a lump sum amount is offered irrespective of the actual expenses to the policy holder in case of a claim. In short, fixed benefit health insurance plans don’t include ‘indemnity’. The pre-existing ailments are covered only after the waiting clause comes to an end.

The survival period clause mentions that it is necessary for the policyholder to survive for certain period post diagnosis of the critical illness to make a legitimate claim.

Standalone Heart/ Cancer Insurance Plans, Critical Illness Insurance Plans etc. are few products that form a part of the fixed benefit health insurance plan.

Let's illustrate the functioning of this plan with the help of an example:

Rahul had bought a Critical Illness Health Insurance Plan with a sum insured of Rs.20 lakh. During the term of the policy, he got diagnosed with kidney failure. Since this was a legitimate claim, the insurance company paid out the entire sum insured of Rs.20 lakh to Rahul, irrelevant of the actual hospitalization and medical treatment expenses being only Rs.8 lakh. Thereafter, the policy got terminated.

Is it essential to buy a fixed benefit health insurance plan?

Yes, with the surge in critical illnesses and rising medical costs, it becomes essential to buy a ‘Fixed Benefit Health Insurance Plan’. Let’s have a look at the major factors that urge us to buy these plans:

  • Financial safety net The insured gets a peace of mind for having a financial back-up even though the emotional trauma is unavoidable. The fear of the life-long savings getting wiped-off due to diagnosis of a critical illness is thrown away.

  • Lump sum pay out The insurer pays the insured a fixed and guaranteed sum insured amount in lump sum irrelevant of the actual expenses incurred for getting the critical illness treated. It solely depends on the insured how to utilize the sum insured.

  • Zero sub-limits Unlike an indemnity health insurance plan, the fixed benefit health insurance plans don’t have any sub-limits on mandatory co-payment, room rent capping etc. So, the insured has the leverage to manage the funds as per his requirement.

  • Pocket-friendly plan Fixed benefit health insurance plans are pocket-friendly premium wise. You do not have to shell out a huge amount in terms of the annual premium. The competitive pricing makes these plans the most essential plans to buy that cover critical illnesses.

  • Easy renewals Well, you can renew the plans easily. Your plan gets activated once you renew providing you the most required financial security in the hour of need.

  • Tax benefits Section 80D of the Income Tax Act offers tax deduction for the premiums that you pay for the fixed benefit health insurance plan.

Who should buy health insurance plans?

A person who wishes to enhance his existing health cover should definitely opt for the fixed benefit health insurance plan. Besides, a person fearing to face a loss of income due to exorbitant hospitalization expenses should certainly opt for this plan. At times, employers do not offer paid medical leave. This is when a fixed benefit health insurance plan comes as a saviour.

Anyone at any age can fall prey to any critical illness. Having a fixed benefit health insurance plan provides a sense of relief without disturbing your hard-earned savings. A lump sum amount received post making a claim without any sub-limits proves as the financial net for your medical expenses and the years to come!

What is the average health insurance cost?

Health insurance premiums are determined after taking into consideration factors like age, family medical history, pre-existing medical conditions, Body Mass Index and smoking habits, among others. Additionally, the type of coverage, sum insured and members covered under a policy have an impact of the premiums payable. The annual premium for a 35-year old male (non-smoker) for a Rs. 20-lakh health cover can go anywhere from Rs. 11,000 to Rs. 17,000. The premiums payable for a 45-year old male (non-smoker) for a similar health cover can be around Rs. 14,000 to Rs. 25,000. Individuals are advised to use the health insurance premium calculators available online to get an estimate of the premiums they will need to pay for a health plan.

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Types of Health Insurance Plans in India

Health Insurance in India can be broadly classified into the following types:

  • Family Floater plans: cover the entire family in one health insurance plan. It works under the assumption that not all members of a family will suffer from illness at one time. These plans cover hospital-related expenses which can be pre and post hospitalization. Most health insurance companies in India offering family insurance have a wide network of hospitals that help the insured people in times of an emergency.

  • Senior Citizen Health Insurance Plans: As the name suggests, senior citizen health insurance plans are for the older people of the family. These plans cover health issues arising during old age. As per IRDAI guidelines, each insurer must provide cover up to age of 65 years.

  • Maternity Insurance Plans: Maternity health insurance plans provide coverage for maternity and other additional expenses. These policies take care of both pre and post-natal care, and delivery of baby i.e. normal or caesarean deliveries. Just like other health insurance plans, the maternity insurance providers usually have a wide range of network hospitals and also takes care of ambulance expenses. As you progress and you reach 60 years of age, your body needs special attention. Hence, it is only wise to invest in a health insurance plan that takes care of your specific needs. Various insurance providers have customized plans that are designed for senior citizens and cater to the needs of older people of the society. Some of the best health insurance plans are provided by Star Health Insurance, Bajaj Allianz, Max Bupa, HDFC Ergo Health Insurance (Apollo Munich), ICICI Lombard and Religare Health Insurance,

  • Hospital Daily Cash Benefit Plans: Hospital Daily cash benefits is a defined benefit policy that provides a certain sum of money for every day of hospitalization.

  • Critical Illness Plans: These plans are benefit-based policies, where a lump sum benefit amount is paid on diagnosis of covered critical illness. These diseases are usually specific, with high severity and low frequency in nature. Hence, the treatment cost is high when compared to day to day medical / treatment need. Some of these illnesses include heart attack, cancer, stroke etc. Women are subjected to a number of health hazards and medical conditions that the other gender does not have to suffer from. This is basically because of the difference in their biological make and the fact that there are several risks associated with pregnancy, childbirth and menstruation. Many insurance providers understand a woman’s plight and have introduced various health insurance plans that combat critical illnesses associated with the fairer sex of the society. Critical illness plan which covers a number of medical conditions such as breast cancer, cervical cancer, burns, paralysis, fallopian tube cancer, uterine or endometrial cancer, vaginal cancer and ovarian cancer.

  • Health Insurance For Parents: As a child, your parents always invested in raising you well and giving you the best. Hence, now it is important that their needs are catered to so that they stay in the pink of their health in their later years. Therefore, various insurance providers have rolled out special health insurance plans that cater to the medical needs of your parents. These plans cover pre and post hospitalization charges, ambulance charges and a few of them are also inclusive of pre-existing diseases.

Top Health Insurance Plans With Coverage

Top Health Insurance PlansSum Insured RangeEntry AgeCoverage Policy Periods
Star Senior Citizen Red Carpet Plan 1 Lakh to 10 LakhAdults: 60 years to 75 years
  • 1, 2 years
    Religare Joy Plan 3 Lakh to 5 lakhFor children : 1 day - 90 days, Adults: 18 years to 65 years
  • 3 years
    Star Family Health Optima Plan2/3/4/5/10/15 lakhsFor children : 16 days old, Adults: 18 years to 65 years
  • 1 year
    Religare Care Plan2/3/4/5/7/10/15/20/25/50/60 Lakh18 Years to No Limit
  • 1, 2 & 3 years
    Oriental Happy Family Floater Mediclaim PlanUp to Rs.10 LakhsFor children : 91 days, Adults: 18 years to 65 years
  • 1 year
    Star Comprehensive Insurance Policy5/7.5/10/15/20/25 LakhsFor children : 16 days old, Adults: 18 years to 65 years
  • 1 year
    Aditya Birla Activ Assure Diamond PlanUp to Rs.50 Lakhs5 years to 65 years
  • 2 to 3 year
    SBI Arogya Premier PolicyINR 10,00,000 up to INR 30,00,000For children : 91 days, Adults: 18 years to 65 years
  • 1, 2 & 3 years
    SBI General Arogya Plus PolicyRs. 1,00,000, Rs. 2,00,000 and Rs. 3,00,000For children : 91 days, Adults: 18 years to 65 years
  • 1, 2 & 3 years
    Bajaj Allianz Health Guard Family Floater Plan 2 Lakh - 10 LakhFor children : 91 days, Adults: 18 years to 65 years
  • 1 year
    Oriental Bank Mediclaim Policy1 Lakh - 10 Lakh3 months to 79 years
  • 1 year
    National Insurance Parivar Mediclaim 2 Lakh to 5 lakh18 years to 65 years
  • 1 year

    Health Insurance Schemes by Government of India and Various States

    Pradhan Matri Suraksha Bima Yojana – This government-backed scheme extends its benefits to economically underprivileged sections of the Indian society, financially securing them with a sum assured of up to Rs. 2 lakhs. This scheme is designed to financially protect individuals and families against death, and partial and total disability.

    Ayushman Bharat by Government of India / Pradhan Mantri Jan Arogya Abhiyaan – Launched by the Government of India, Ayushman Bharat is an ambitious scheme aimed at offering health insurance benefits of up to Rs. 5 lakhs to 50 crore people who belong to underprivileged families throughout India. Covering even pre-existing diseases, the health insurance benefits can be availed at government as well as private hospitals.

    Rashtriya Swasthya Bima Yojana – This scheme is especially designed by the Government of India for financially protecting unorganized workers from health concerns arising from disability, maternity, old age, etc. this scheme has been launched by the Ministry of Labour and Employment under the Central Government, backed by the Unorganized Workers Social Security Act (2008). Universal Health Insurance Scheme – An initiative of the Government of India that was introduced in 2003, serves the objective of providing quality healthcare to Indian families below as well as above the poverty line, especially BPL families.

    Bhamashah Swasthya Bima Yojana by Government of Rajasthan – Initiated by the Government of Rajasthan, it was introduced to offer IPD patients the benefit of cashless medical treatment. It serves the objective of ensuring financial protection for the treatment of illnesses. It also helps in creating a health database, streamlining processes for any changes in data that may be required in the future. Families covered under the National Food Security Act, and Rashtriya Swasthya Bima Yojana are eligible for this scheme.

    Yeshasvini Health Insurance Scheme by Government of Karnataka – Introduced by the former chief minister of Karnataka in the year 2013, the scheme is aimed at ensuring inexpensive medical treatments to farmers throughout the state. It is specifically tailor-made for farmers of the cooperative society and belonging to the lower middle income and middle income groups. It financially covers them against illnesses like orthopaedic surgeries, paediatric surgeries, neurosurgery, surgical oncology, angioplasty, neurosurgery, neonatal intensive care, among others.

    Mukhyamantri Amrutum Yojana by Government of Gujarat – Initiated by the Government of Gujarat, this health coverage scheme offers financial benefits on medical treatments, surgeries and hospitalization. Financed entirely by the government, this can be availed by all families with an annual income of less than Rs.1.5 lakh. This scheme offers a cover of Rs.2 lakh per family of 5 members. West Bengal Cashless Medical Treatment Scheme – Launched in 2014 by the Government of West Bengal, as evident from the name, it is aimed at offering cashless medical benefits of a maximum of Rs. 1 lakh to employees as well as pensioners of the state government. These benefits can be availed by all their family members and at all network hospitals under this scheme.

    Mahatma Jyotiba Phule Jan Arogya Yojana – This scheme, renamed from Rajiv Gandhi Jeevandayee Arogya Yojana scheme in 2017 by the Government of Maharashtra, is an effort to extend free and quality healthcare services to inhabitants of below poverty line in the state. It plans to introduce the scheme to underprivileged section of the society, that is, those who are holders of a Yellow or Orange Ration Card.

    Chief Minister’s Comprehensive Health Insurance Scheme – Introduced by the Government of Tamil Nadu, it is specifically customized to offer the benefits of comprehensive health insurance to economically underprivileged sections of the society. Offered in collaboration with United India Insurance Company Ltd., one of the pioneers in health insurance in India, this scheme reaches out to more than 1 crore households in the state. It offers medical treatments, follow-up check-ups, and cashless benefits at public and private sector hospitals.

    Rajiv Aarogyasri by Government of Andhra Pradesh – Tailor-made for inhabitants of the state who are below the poverty line, it offers claims of up to Rs. 1.5 lakh on individual and family health insurance plans available on a family floater basis. An additional amount of up to Rs. 50,000 can be availed in case the medical treatments and surgeries exceed Rs. 1.5 lakh. It offers the special benefit of offering coverage on pre-existing diseases as well, a feature that health insurance plans usually do not cover.

    Biju Swasthya Kalyan Yojana by Government of Odisha – This scheme has been introduced by the Government of Odisha and named after a former Chief Minister of the state, Shri Biju Patnaik. It covers medical treatments worth up to Rs. 5 lakh per family and Rs. 7 lakh for women. It is aimed at 70 lakh families.

    Health Insurance Claim Process

    Health Insurance claims can be made in two ways- the cashless claim process and the reimbursement claim process.

    • Cashless claim process- In order to avail the benefits of a cashless claim policy, the insured has to be treated in one of the hospitals that falls under the network of hospitals that the insurance provider has an affiliation with. Upon presentation of the e-card, details of the health insurance policy or any other physical proof of insurance, the insured can avail the benefit of cashless treatment and hospitalization. This facility can be availed only if the injury or illness is covered in the health insurance policy. On discharge of the patient, the medical bills are sent to the insurance provider by the hospital. The company then evaluates the expenses and settles the payment.

    • Reimbursement claim process- Health insurance companies also reimburse up to the sum insured, the amount initially paid by the insured in times of illness or accidents. This usually happens in case the patient is hospitalized or gets treated from a hospital that does not fall under the insurer’s network of hospitals. The insured then has to initially pay the cost of treatment entirely from his own pocket and then submit the bills of treatment to the insurance provider for claim settlement. The company then evaluates the cost and then, according to the scope of the policy coverage, reimburses the amount up to the sum insured. In case the treatment is not covered in the policy, the claim is rejected. The following documents need to be submitted during the reimbursement claim process:

      • Duly filled claim form
      • Medical Certificate or form which is signed by the treating doctor.
      • Patient’s Discharge summary or card (original), availed from the hospital.
      • Prescription and cash memos from pharmacies/ the hospital.
      • Bills and receipts (original)
      • Investigation report
      • In case of an accident, the FIR or Medico Legal Certificate (MLC) is also required.

    Top Health Insurance Companies & It's Top Health Insurance Plans

    HDFC Ergo Health Insurance (previously Apollo Munich Health Insurance)
  • Optima Plus Plan
  • Dengue Care Plann
  • Health Wallet Plann
  • Optima Senior Plann
  • Easy Health Plann
  • New iCan Cancer Insurance Plann
  • 62.47%4500+
    Bajaj Allianz Health Insurance
  • Individual Health Insurance Plans
  • Health Guard
  • Critical Illness Insurance Policy
  • Extra Care Plus Policy
  • M-Care Health Insurance Policy
  • 77.61%5700+
    Aditya Birla Health Insurance
  • Aditya Birla Activ Health Enhanced
  • Aditya Birla Activ Health Essential
  • Aditya Birla Activ Secure - Personal Accident Plan
  • Aditya Birla Activ Secure - Critical Illness
  • Aditya Birla Activ Secure - Hospital Cash
  • Aditya Birla Activ Secure - Cancer
  • Aditya Birla Group Activ Health
  • 89.05%5700+
    Star Health Insurance
  • Senior Citizens Red Carpet
  • Family Health Optima
  • Star Super Surplus Insurance Policy
  • Star Family Delite Insurance Policy
  • Star Special Care
  • Star Criticare Plus Insurance Policy
  • 60.51%6000+
    National Health Insurance
  • National Parivar Mediclaim
  • National Mediclaim Policy
  • National Mediclaim Plus Policy
  • National Parivar Mediclaim Plus
  • Overseas Mediclaim Business and Holiday
  • 115.55%6000+
    ManipalCigna Health Insurance
  • ProHealth Policy
  • ProHealth Protect
  • ProHealth Plus Insurance Plan
  • ProHealth Preferred
  • 46.29%4000+
    New India Health Insurance
  • Asha Kiran
  • New India Top-up Mediclaim
  • Family Floater Mediclaim Policy
  • Janata Mediclaim Policy
  • New India Floater Mediclaim
  • New India Mediclaim Policy
  • 97%1200+
    ICICI Lombard Health Insurance
  • Complete Health Insurance
  • Health Booster
  • Personal Protect Policy
  • 68.26%5025+
    Religare Health Insurance
  • Religare Care Plan
  • Religare Joy Plan
  • Religare Freedom Plan
  • Religare Enhance Plan
  • Religare Assure Plan
  • Religare Secure Plan
  • 51.97%4500+
    United India Health Insurance
  • Family Medicare
  • Individual Mediclaim
  • Super Top-Up
  • 110.95%7000+
    HDFC ERGO Health Insurance
  • HDFC Health Suraksha Insurance policy
  • HDFC Health Suraksha Gold Insurance policy
  • HDFC Health Suraksha Regain Insurance policy
  • Critical Illness Insurance policy
  • 52.58%4800+
    SBI Health Insurance
  • Arogya Plus Policy
  • Arogya Top Up
  • Hospital Daily Cash Plan
  • Critical Illness Plan
  • Arogya Premier Policy
  • 52.93%24000+
    LIC health insurance
  • LIC's Jeevan Arogya
  • LIC's Cancer Cover
  • 98.33%NA
    Reliance Health insurance
  • Reliance HealthGain
  • Reliance Personal Accident Insurance Policy
  • Reliance Critical Illness Insurance Policy
  • Senior Citizen Health Insurance Plan
  • Cashless Health Insurance Policy
  • 106.54%4000+
    Raheja QBE Health Insurance
  • Raheja QBE Health Insurance plan
  • Basic Plan
  • Comprehensive Plan
  • Super Saver Plan
  • A La Carte Plan
  • Cancer Health Insurance
  • 18.19%2000+
    Oriental Health Insurance
  • Individual Mediclaim Health Insurance
  • Group Mediclaim Policy
  • Jan Arogya Bima Policy
  • Personal Accident Policy
  • Janata Personal Accident Policy
  • Nagrik Suraksha Policy
  • Happy Family Silver Plan
  • Happy Family Gold Plan
  • 113.86%4300+
    TATA AIG Health Insurance
  • Injury guard, Maharaksha – Mediclaim Insurance Policy
  • MediPrime – Cashless Health Insurance
  • Wellsurance Executive
  • MediRaksha – Affordable Health Insurance Plan
  • Individual Accident and Sickness Hospital Cash
  • Accident guard, MediPlus- Top-up Medical Health Insurance
  • MediPrime – Cashless Health Insurance
  • Wellsurance Family
  • MediPlus- Top-up Medical Health Insurance
  • MediRaksha – Affordable Health Insurance Plan
  • Secured Future Plan
  • MediSenior – Senior Citizen Health Insurance Policy
  • 60.68%3000+
    Cholamandalam Health Insurance
  • Value Health Line
  • Freedom Health Line
  • Enrich Health Line
  • Standard Health Line
  • Superior Health Line
  • Advanced Health Line
  • Chola Tax Plus Health Line
  • Chola Top-up Health Line
  • Chola Hospital Cash Health Line
  • Chola MS Standard Critical Health Line
  • 39.96%2600+
    IFFCO TOKIO Health Insurance
  • Base Plan
  • Base Plan Plus Critical Care
  • Health Protector
  • Individual Personal Accident Insurance policy
  • Health Protector Plus
  • Swasthya Kavach Policy Base Plan
  • Swasthya Kavach Policy Wider Plan
  • 90.69%3000+
    Royal Sundaram Health Insurance
  • Lifeline Health Insurance Plans
  • Supreme Lifeline Health Insurance
  • Elite Lifeline Health Insurance
  • Family Good Health Insurance Plan
  • Royal Smart Cash Plan Insurance
  • 61.41%3000+
    Bharti AXA Health Insurance
  • Bharti AXA SmartHealth Basic Policy
  • Smart Super Health Insurance Plan
  • Smart Health Insurance Plan
  • Bharti AXA SmartHealth Premium Policy
  • Bharti AXA SmartHealth Optimum Policy
  • Bharti AXA SmartHealth Critical Illness Insurance
  • 98.50%4500+
    Max Bupa Health Insurance
  • Health @ Companion - Silver
  • Health @ Companion- Gold
  • Heartbeat- Gold Policy
  • Heartbeat- Platinum Policy
  • Heartbeat- Silver Plan
  • Family First- Silver Policy
  • Family First- Gold Policy
  • Family First- Platinum Policy
  • Employee First Classic Health Insurance Plan
  • Group Personal Accident
  • 50.19%3500+

    Benefits of Buying Health Insurance Plan Online

    While investing in heath insurance is a good idea, it usually is a cumbersome process. The traditional method of buying health insurance was to contact an agent, decipher those complex clauses and not really understand the true meaning of most of them. Also the entire process was time consuming and would involve a lot of paperwork. But with online methods of getting your health insured, one need not worry about any of this. Hence, buying insurance online has become a preferred method of protecting one’s health for millennials. Benefits of buying health insurance online are:

    • Save on time: Investing in a health insurance plan online saves up on the effort of meeting an agent and time on understanding complex terms and conditions of a policy. With information available at the click of a button, you can check everything related to your needs online and get yourself insured.
    • Availability of information: All crucial information related to your health insurance policy is available online and hence, there is absolutely no chance that your agent can hide or forget to share any information with you. Any information that you might require is easily available on an all exhaustive platforms online.
    • Comparison of health insurance plans: The advent of internet technology has made our lives so much simpler. With the help of web insurance aggregators and online brokers, one can easily compare the health insurance plans that he considers and then select the one which suits his needs and does not burn a hole in his pocket.
    • Premium Calculator: Tools such as a health insurance premium calculator are readily available online. This makes it extremely convenient for the insured to calculate the amount of premium to be paid and efficiently plan his budget accordingly.
    • Reduced premium amounts: A few companies offer lower premium in case you buy a health insurance policy online. As agents are eliminated in this process, the company now is capable of offering a lower premium rate in order to get insured individuals onboard and retain them.
    The Best Health Insurance Plans are Just a Click Away!

    Choose the one that's perfect for you

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    "Having been a customer for over a year, I feel relaxed as far as health insurance is concerned. Their customer service personnel guided me through each step of my process while helping me finding the best plan!"

    Manoj Kumar Jain

    FAQs on Health Insurance

    Why is health insurance essential?

    In line with the recently circulated results of a cross-national analysis on health steered by the National Sample Survey Office (NSSO) in the first half of 2014, the cost of treatment rocketed at a double-digit speed of growth, outstripping normal inflation together in urban and rural India compared to the past decade. As the growing number of patients swarm private health centers and hospitals for consultation and subsequent treatments, they have been confronted with mounting medical bills. The cost of treatment fluctuates considerably across the country.

    average hospitalization cost in india

    Image Source: NSSO National Health Survey 2014

    In 2012, India helplessly watched 253 deaths per 100,000 persons owing to communicable ailments only, much advanced than the worldwide average of 178. India airs a greater ailment issue than other developing markets such as Sri Lanka, Mexico, Brazil, Indonesia and China. It’s an alarming situation that poorer economies such as Bangladesh and Nepal have a healthier record in health in comparison to India.

    deaths from diseases across countries

    With such disturbing figures, Health Insurance serves as a shield to safeguard your savings in any ill-fated instances like hospitalization and succeeding medical expenditures related to either you or your loved ones. It’s very natural to expect an impulsive panic attack on the diagnosis of any ailment. The foremost cause for this fright is largely due the rising expenses involved in the treatment of certain illnesses or injuries. Nevertheless, if you have astutely invested in an all-inclusive health insurance plan, you can be reassured of some financial breather as your health policy will cover bulk of those medical overheads.

    What are the benefits associated with health insurance?

    Secure Health and Finances: Majority of the health-related expenditures in the country are borne out-of-pocket. A lot of people rely heavily on their savings, and sometimes even borrow money, to fund medical treatment. Health insurance products are designed to ensure that one's savings does not dwindle since the insurance company will bear this cost. With medical insurance, one can benefit from quick cashless treatment, medical reimbursement, emergency ambulance cover and daily cash during hospital stay.

    Cashless Treatment: Most insurers offer cashless claim facility. Under such an arrangement, the insured individual does not have to make any out-of-pocket payments in case of hospitalization. The medical bills will be settled by the insurance company directly with the hospital. In order to avail of this benefit, it is necessary that the individual get admitted at one of the insurer’s network hospitals.

    Tax Benefits: The premium paid towards a medical insurance policy qualifies for tax deduction under Section 80D of the Income Tax Act, 1961. A taxpayer (less than 60 years of age), who has availed a health insurance policy for himself or herself and parents (senior citizens) can claim a tax deduction up to Rs. 75,000. Policyholders (above 60 years) who are paying health insurance premium for self and parents can claim up to Rs. 1,00,000 under Section 80D of the Income Tax Act, 1961.

    OPD Expense Coverage: Cover for outpatient department (OPD) is a recent feature offered as part of health insurance policies by some insurance companies. Medical insurance plans with OPD coverage will take care of doctor’s consultation fees, pharmacy bills, health check-ups, dental treatment, diagnostic tests, etc. The extra premium paid for availing the OPD cover is eligible for tax deduction under Section 80D of the Income Tax Act under the prescribed limit.

    Alternate Treatment Coverage: A medical insurance policy will cover expenses related to medical treatments in hospitals. However, sometimes there are situations where alternate treatment, such as Ayurveda, homeopathy, etc. may seem more relevant for treating certain ailments or diseases. Some of the best health insurance policies in the market provide coverage for such treatments. This gives the insured more flexibility with regards to the kind of medical treatment the individual would like to undergo.

    Health Insurance Portability: Health insurance policies are portable, which means the policyholder can change their policy from one insurance company to another. In the past, when a policyholder opted for this option, it resulted in them losing certain benefits, such as the waiting period for covering pre-existing ailments. However, now the insurance regulator protects the policyholder by giving the individual the right to port his or her medical insurance policy to another insurer, keeping the benefits intact. The regulator has stated that the new insurer “shall allow for credit gained by the insured for pre-existing condition(s) in terms of waiting period”.

    Ambulance Cover: Medical insurance policies cover expenses for ambulance service.

    Expenses for Organ Donation: Some insurers cover medical expenses incurred in the process of organ donation. If you are being donated an organ, your donor will be financially secured by your health insurance plan.

    AYUSH Treatment: Alternative medical treatments or AYUSH, which stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy are covered for those policyholders who have opted for it.

    Why should you compare health insurance plans before buying?

    Numerous health insurance companies offer multiple policies-each assuring better than the other. However, it's imperative to recognize that each policy has a different premium, covers different aspects, and are regulated by different policy provisions. With the number of options available, it's unwise to settle for the first policy that comes your way. When you can secure the best deal at a lower premium with a bit of research and comparison, why not? Selecting a suitable health plan to protect everyone in your family is not an easy task (Unless you have been buying only to save on tax so far).

    Thus, always compare health insurance plans before finalizing on one.

    Following are the three most important reasons why it is essential to compare health insurance plans before buying:

    • It is an excellent way to reduce premium and save your money.
    • By comparing policies, you will know which company offers what. That will help you choose the best coverage for you and your loved ones.
    • You get to know how each one fares on critical parameters such as claim settlement ratio, exclusions, deductions, etc. It is necessary to learn about a health insurance company as much as it is important for you to have health insurance in the first place. After all, medical emergencies are stressful, to begin with, and you certainly don’t want to leave such times at the mercy of a non-reliable company.

    What are the things to look for while choosing a health insurance plan?

    Some of the major factors that that affect your premium towards health insurance are:

    • Age & Gender: Many health insurance policies have a variance in premium rates for women and men. According to Insurance Gurus, the reasons being women are more prone to visit doctors or take medicines and are susceptible to chronic diseases. Similarly, young individuals are charged a lower premium since they are deemed to be medically fit compared to older individuals. In addition, young policyholders are likely to have lesser or nil health issues thus evading the claims.

    • Pre-existing health conditions: It is obligatory for the applicant or proposer to provide the truthful health records at the time of purchasing the insurance policy to wriggle out any probability of a pre-existing medical ailment. However, if you do have any pre-existing medical ailment, then the insurance company can take three different course of actions:

      • Application can be rejected if the scope of the coverage of that pre-existing ailment is outside their policy constraint
      • Application can be accepted with a loaded premium (where a particular amount is added to the final premium to cover the risks associated)
      • Application can be accepted with the co-payment clause against the coverage of that particular pre-existing disease or any other medical condition arising out of it.
    • Geographical location: There are several insurance companies whose premiums are built on the geographical location where the applicant resides. They believe that extreme climatic conditions, absence of healthy food preferences, social dislike for exercise etc. habitually originate from similar areas. And as a result, such coincidences have lead insurers to charge greater health insurance premiums.

    • Injurious habits: Most insurers hike up their rates of premium for their insurance covers and sometimes even decline to offer coverage to people who are habitual smokers, chew tobacco or snuff. This is purely for the reason that they are utmost likely to suffer from life threatening diseases like cancer which might ultimately invite the claims payouts.

    • Marital status: It's until now vague if married people live healthier or longer lives, but the insurance premiums by and large are lower in rates. The men usually earn enhanced benefits with this status change.

    Why should you buy health insurance online?

    Owing to the liberalization and general awareness in the insurance segment, Indians are spoilt with choices to acquire the insurance cover from. Right from the neighborhood Insurance Agent Uncle to the Banks we frequent, the list is just ad infinitum. However, with the revolutionary innovation in the ecommerce sector, an online broker is a definitive choice.

    Below are the reasons:

    • Expertise: As the brokers are skilled professionals, licensed by IRDA, they are the finest to approach for any insurance needs. Above and beyond, as they deal with diverse insurance products, they are accountable towards providing accurate solutions as per distinct requirements. Their entire business model is to offer indispensable service to the consumers on priority.

    • User-friendliness: Some insurance brokers like boasts of exceedingly user-friendly and convenient gateway where even a newbie can access and purchase the insurance policy as per his requisite. The facility to compare and make the precise choice is what they exult in. The ease offered is noteworthy and with such astounding features, why look back?

    • Post Sales Service: For the whole kit and caboodle associated with your health insurance policy, you can contact your broker and they are capable enough to deal with the same. Brokers are accredited to handle the requests on behalf of their customers by dealing with the insurance companies. So, next time you want to move your residence, and if you have bought your health insurance policy through a broker, why fear when the broker is here? A phone call is all it’ll take.

    • Claims assistance: Brokers like Coverfox has a far-reaching Claims Team that handle all queries, concerns related to the claims of their customers. Even before submitting the documentation to the insurance company for claims dispensation, they scrutinize them for accuracy and completion to evade back and forth coordination with the insurance companies.

    What are some of the important exclusions under a mediclaim policy?

    There are four important types of exclusions in a Mediclaim policy. These are:

    • Time-related exclusions: e.g. Waiting period- general, specific ailments and pre-existing.
    • Non-medical expenses: e.g. Registration charges.
    • Illegal reasons: e.g. drugs, alcohol abuse, self-inflicted injuries.
    • Out-of-scope: e.g. unproven medical procedures, HIV, adventure sports, etc.
    • Room rent: This may not be an exclusion, however, do check for the capping amount on room rent, if applicable.

    What are common mistakes made while buying the health insurance policy?

    While we encourage people to do in-depth homework to bargain for the pertinent health insurance plan, below are few common slipups while buying the same.

    • Buying the health insurance policy purely for tax-saving benefit: This is the utmost common blooper that we fall victim to. A lot of us invest and buy the insurance products purely for tax saving motive. And even though tax benefits related to the health insurance policy are eye-catching, the key drive of purchasing a health policy should, at all times, be to shield your health. You may perhaps result in buying an inappropriate health policy or picking an inadequate coverage if you purely look at it with the tax saving intention.

    • Insufficient coverage: The premium amount is habitually one of the foremost influential aspect that we mull over when buying a health insurance policy. And in an effort to bargain the lower premium, we finish up purchasing a policy offering deficient coverage. Evaluating your healthcare requirements and comparing the coverage provided by insurers are few steps one needs to take before settling on any specific health insurance plan.

    • Secreting medical history: Under no circumstances, conceal or camouflage the history related to your health fearing the rejection of the insurance policy. Non-disclosure of your prevailing medical illnesses can result in the denial of your insurance claim at crucial times.

    • Disregarding co-payment clause: Quite a lot of insurers have merged co-payment in the policy with an objective to keep an eye on claims payouts. Usually, the co-payment clause is imposed on those who have explicit medical history, for cures that are remarkably costly or moreover on policies catering to senior citizens. According to this clause, treatment cost has to be shared by the policy holder with the insurer. This could be in the range of 10% and 20%, depending on the plan you have opted for. Your premium outflow will be comparatively lesser if you elect for a greater co-pay percentage.

    • Not evaluating the Health Insurance Exclusions: Before you buy any health insurance plan, it is imperative to read the health insurance exclusions. Be aware about the illnesses and medical conditions that are not covered by the Policy, to avoid any rude surprise and a massive bill.

    • Seeing Short term: For purchasing a health insurance policy it is crucial that you consider long term. A policy which appears smart to you at the beginning will not essentially be advantageous as you age. Scout for a health plan useful even when Old.

    I have a health insurance policy covered by my office; will it cover me for my overseas holiday?

    Travelling abroad is awesome. Whether business or leisure, you get to see different places and explore widely. However, uncertainties come uninvited. You may have planned your official trip wisely but medical emergencies can wipe off your savings extensively.

    You may have a health insurance policy offered by your employer, however, it is advisable to check the policy wordings whether the group insurance plan extends its services for an overseas travel.

    Mostly, health insurance policy in India do not cover medical emergencies on an overseas travel. The cost of medical expenses abroad is way too high as compared to any treatment or hospitalization expenses in India.

    In fact, covering overseas medical treatment is explicitly an exclusion when it comes to a health insurance policy in India. However, there are certain insurers in India that offer worldwide coverage to ensure better access to medical emergencies while on an overseas holiday.

    You should buy a travel insurance policy that would take care of your medical emergencies, losses and also give you a peace of mind while you enjoy your stay abroad.

    Nevertheless, your hard-earned savings can also be kept intact in case you face any medical emergencies on your overseas travel.

    Without compromising on the renewal benefits, can the existing health insurance Plan be transferred to another insurer?

    Yes. In simple terms, the process of transferring the prevailing health insurance plan from existing insurer to a new insurer is termed as portability. According to the circular issued by The Insurance Regulatory and Development Authority (IRDA), from 1st October, 2011, the insurance companies are directed to permit portability from one insurance company to another and from one plan to another, without the insured having to lose the renewal benefits for pre-existing illnesses, enjoyed in the preceding policy. The entire process for the portability has to be kick started at least 45 days prior to the actual renewal date. For the terms and conditions related to the subject, it is best to refer the policy documents.

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