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A health insurance plan (also known as a medical insurance policy) covers medical expenditures incurred as a result of an accident, sickness, or accident. Individuals can obtain such coverage in exchange for annual or monthly premium payments for a certain period of time. During this time, if the insured individual gets is diagnosed with any covered illness or gets injured in an accident, the insurance company will cover the costs of treatment.
Here is a list of some common features of health insurance policies:
Here are some benefits when shopping for health insurance online:
Coverfox offers you the ease and convenience of buying health insurance in a few simple steps. The procedure is quite straightforward and does not take more than a few minutes. This smart marketplace allows you to pick from numerous choices that can otherwise make things a little confusing. Take a look at the steps you need to follow when to want to buy a health insurance policy online.
Women in India have a unique set of health concerns and risks. The good news is that there are many health insurance options available to meet their needs. These women's health insurance plans encompass several women health related issues & compensate for the same.
Children's Health Insurance in India is a vital topic. As per NFHS, nearly 37 per cent of Indian children aged 0-5 years are underweight, and 42 per cent are stunted. However, children's health insurance plans encompass several children's health-related issues & compensate for the same.
Many Indians are purchasing individual health insurance plans. These plans offer many benefits, including the ability to choose your own doctor and customise your coverage. Individual health insurance plans are becoming more popular in India as people become more aware of the benefits they offer.
Senior citizen health insurance in India has gained immense attention in recent years. With a large population of senior citizens and a limited number of available resources, the Indian government has been working to create a system that provides adequate health coverage for its elderly citizens.
In India, family health insurance is a type of insurance coverage that provides financial protection to a nuclear family in the event of an unforeseen health crisis. The head of the family is typically the policyholder, and the other members of the family are the beneficiaries.
In India, health insurance for parents is a vital aspect of life. There are many options available for health insurance in India, but it can be difficult to choose the right one. It is of prime importance to carry out a bit of research before purchasing health insurance for your parents in India.
Covid-19 spread like rapid fire in India in 2020. Cases spiked a lot during the mid-period of 2020 & became worse in the early half of 2021. However, many people got the advantage of coronavirus health insurance plans. Coronavirus health insurance plans compensated for the patients' treatment.
Personal accident health insurance offers compensation in case of any losses to the policyholder in terms of injuries sustained due to an accident while being in the vehicle. It is one of the most highly recommended health insurance policies if you have a bike or a car.
Critical illness insurance provides compensation in cash in case you're diagnosed with a pre-specified critical illness or critical ailment. Critical illnesses can have a significant impact on an individual's financial stability, as they often result in high medical costs and a loss of income.
Cancer insurance provides compensation in cash in case you're diagnosed with cancer or cancer-related ailment. Cancer can have a significant impact on an individual's financial stability & physical state of being, as it often results in high medical costs, loss of income & suffering.
Group health insurance in India is offered by employers. It is a cost-effective way of providing health coverage to employees and their families. Group health insurance plans are available from a number of insurers in India, and they can be customised to suit the needs of an organisation.
Coverfox offers a range of benefits and coverage under various health insurance plans. These include:
Note: These are generic inclusions of health insurance plans and may vary from policy to policy. Please refer to your health insurance provider for an exhaustive list of inclusions.
Not everything can be included in a health insurance policy. The terms that are not covered include
Claims during the waiting period of 30 days: Most health insurance plans have a waiting period of 30 days, and during this waiting period, you cannot raise a claim unless hospitalisation is required due to an accidental injury.
Claims for pre-existing illnesses during their waiting period: If your health insurance plan covers pre-existing illnesses of the insured, you cannot raise a claim during the waiting period, which can be up to 48 months. On the other hand, if pre-existing illnesses are not covered, no claim shall be raised for the same.
Cosmetic surgery costs: Expenses incurred due to cosmetic surgeries are not covered under health insurance plans unless required after an accidental injury.
Pregnancy complications: If there occur treatment expenses due to complications in pregnancy/childbirth, the health insurance plan may not cover the expenses.
Treatments for infertility and sterility: Treatments received for infertility and sterility are not covered under a health insurance plan.
Treatments or medications received without prescription: If you take treatments or medications on your own without a doctor's prescription, the expenses will remain uncovered.
Claims arising due to intoxication: If the insured requires medical treatment due to intoxication or drug abuse, the cost of treatment remains uncovered.
Self-harm: Any treatment received against any sort of self-harm is not covered under a health plan.
Claims arising due to law breach: If the insured participates in any unlawful or illegal activity and suffers physical injury, such treatment expenses are not covered.
Claims arising due to exposure to nuclear radiation or war: Any medical treatment received for physical injury/illness due to exposure to war or nuclear radiation is not covered.
Note: These are generic exclusions of health insurance plans and may vary from policy to policy. Please refer to your health insurance provider for a complete exclusion list of your plan.
An incurred claim ratio can be defined as a ratio of the overall claim amount settled by any insurance provider over the overall premium amount collected by the company during a financial year.
For example, ABC Ltd. is an insurance company. The company collected a total of INR 120 lakhs during the financial year 2021-22 as insurance premiums. During the same year, the company settled insurance claims valuing up to a total of INR 90 lakhs. So, for the financial year 2021-22, the incurred claim ratio of ABC Ltd. will be 75%.
This incurred claim ratio reflects the insurance provider's financial health during the year. It demonstrates the company's financial ability to settle an insurance claim. If the incurred ratio goes above 100%, it means the company is currently giving out more claims than the money it is receiving as a premium. In the same way, if the ratio falls below 50%, it means the company is not actively settling insurance claims compared to the premium it is receiving.
There are 21 private health insurance providers and 4 public health insurance providers in India. Here is a list of them:
|Private Health Insurance Providers||Incurred Claim Ratio (FY 2021-22)|
|Public Health Insurance Providers||Incurred Claim Ratio (FY 2021-22)|
In order to file a health insurance claim, you just need to follow the right steps. Depending on the hospital in which you seek admission, you can go for either a cashless treatment or a reimbursement claim.
Here is detailed information on how you can file a health insurance claim:
A reimbursement claim is raised when you pay the admissible medical expenses from your pocket. If the patient/insured is hospitalised or receives treatment from a non-network hospital, cashless treatment cannot be availed. Hence, once the patient gets discharged, a reimbursement claim can be raised either offline or online. Make sure that in case of planned hospitalisation, you inform the insurance company 3 - 4 days in advance, so that the pre-authorisation can be done. In case of emergency hospitalisation, the insurer should be informed in the first 24 hours. The steps involved are:
In case you receive medical treatment from a network hospital (the impanelled/partner hospitals of the insurance provider), you become eligible to avail of cashless treatment. You need not make any payment for the admissible expenses. In case of planned hospitalisation, you need to inform the insurance company 2 - 3 days in advance and get the pre-authorisation formalities completed. If it has been an emergency hospitalisation, the insurer can be intimated within 24 hours of admission to the hospital. The steps involved are:
There are 7 standalone health insurance providers in India. Here is a list of them:
|Standalone Health Insurance Providers||Incurred Claim Ratio (FY 2021-22)|
The eligibility criteria differ from one health insurance policy to another. So, when you are choosing a health insurance provider and the policy, it is essential to check the eligibility details of the particular health plan. Some eligibility criteria include:
Health insurance premium rates depend on various factors, some of them are:
Premium rates of some health insurance policies are generally higher than others. For example, a health insurance plan which covers multiple critical illnesses along with regular healthcare benefits is more expensive than regular Mediclaim policies.
Insurance companies give lower premiums to persons who seek health insurance at a young age, mostly because the likelihood of falling ill and requiring healthcare grows as they get older.
As the number of insured increases, the rate of premium is also increased. However, if the policy is purchased on a family floater basis, the premium rate is decreased as the total sum insured covers the whole family as a whole irrespective of the number of individuals covered.
People with pre-existing conditions are considered to be a riskier group than people who are healthy. This means that they are charged higher premiums, and must wait a set waiting period before they can file claims for their existing medical conditions.
Some people like those who work on construction sites or who participate in adventurous sports create a higher risk for insurance companies, which is again reflected in higher premiums for the policyholders.
Income Tax Act Section 80D offer tax benefits on the total premium paid to active health insurance policyholders. The tax deduction limit is set at INR 50,000 for individuals of or above 60 years of age and INR 25,000 for those under the age of 60 years. These individuals also receive a preventive healthcare tax break of INR 5,000.
Now, if you have a senior citizen in your health insurance plan, you can receive tax deductions up to INR 75,000 (INR 25,000 + 50,000). Similarly, if you are two senior citizens in a policy, you will have entitled to INR 1 lakh (INR 50,000 + 50,000) as a tax deduction under Section 80D.
When you purchase a health insurance policy, 80% of your hospitalisation treatment bills are paid by the health insurance organisation. However, in terms of the claim process you have to either get admitted to a network hospital & get cashless treatment or wait for reimbursement.
In order to port your active health insurance policy, you have to inform both companies before your upcoming date of policy renewal. Your active health insurer needs to be informed at least 25 before your renewal date along with a portability application. The company will respond to your application within 72 hours.
It is important to note that there are zero porting fees involved with the process. However, your ongoing health insurance plan should have a clean history of scheduled policy renewals.
Here is a list of government-initiated health insurance schemes:
The Rashtriya Swasthya Bima Yojana is designed to offer healthcare coverage to people who are working in the unorganised industries of the nation.
The Bhamashah Swasthya Bima Yojana is a medical insurance scheme launched by the Rajasthan Government on December 2015.
The scheme offers a sum insured of INR 30,000 for general illnesses and INR 3 lakhs for specified critical illnesses
The government of Maharashtra launched the Mahatma Jyotiba Phule Jan Arogya Yojana to offer healthcare cover to financially vulnerable families which includes yellow, orange and red ration cardholders along with kids in government orphanages, people living in a senior citizen home and others.
Government officials and employees receive healthcare coverage under the Central Government Health Scheme launched by the Indian government.
Pradhan Mantri Suraksha Bima Yojana is a medical insurance scheme which offers lumpsum payments to individuals between 18 to 70 years who have an Aadhaar card and are active bank account holders.
Employees' State Insurance Scheme is a health insurance scheme which is available for workers who earn INR 21,000 per month or those with current disabilities and earn less than INR 25,000.
The Aam Aadmi Bima Yojana is an accidental health insurance scheme which offers a component of life cover. The coverage is designed for a family’s sole earner or the family head who is diagnosed with any of the 48 listed professions.
The Pradhan Mantri Jan Arogya Yojana offers an annual INR 5 lakh coverage for each family for tertiary and secondary hospitalisation.
Corona Kavach Policy is a new insurance policy launched by the government in response to the outbreak of the novel coronavirus. The policy will provide financial protection to those who contract the virus.
The people of India are united in their fight against the Coronavirus pandemic. The government has announced a new policy called the Corona Rakshak Policy. This policy will provide financial assistance to the families of those who have lost their loved ones to the virus.
The Arogya Sanjeevani Policy is a new health insurance scheme launched by the Indian government. It aims to provide health coverage of Rs. 5 lakhs to every family in India. The scheme is designed to be an affordable and comprehensive health insurance policy.
A health insurance plan is a perfect choice for everyone – from students who are just starting out on their careers to professional experts who are in their late forties to fifties. Though the medical insurance that you get from an employer could be sufficient for you to live a healthy life and carry out your daily tasks, having your own insurance is still better. Whether the injuries and illnesses come from natural or man-made reasons, you will be greatly benefited from getting yourself an insurance policy. So, if you haven’t already, start shopping for the best health insurance in India.
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.