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Health Insurance

Health insurance for you and for your family.
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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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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.

BASIC HEALTH PLAN

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.

SUPER TOP-UP HEALTH PLAN

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.

What is Covered

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  • Zero Depreciation Cover
    HOSPITALIZATION

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

  • Engine Protection
    PRE & POST HOSPITALIZATION

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

  • NCB Protection
    DAY CARE PROCEDURES

    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
    ACCIDENT 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 health insurance plans on the basis of the following crucial factors:
PREMIUM VS COVERAGE
PREMIUM VS COVERAGE
Assess if the cover and sum assured are suitable against the premium paid. Choose add-ons as per your needs.
NETWORK HOSPITALS
NETWORK HOSPITALS
Be sure of the insurer's network hospitals in your area. You can avail of cashless services only at these hospitals.
ROOM RENT LIMIT
ROOM RENT LIMIT
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.
EXCLUSIONS
EXCLUSIONS
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 a fixed benefit health insurance plan work?

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!

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"My first experience with Coverfox was an absolute delight. Their positive response and effective actions changed my opinion of the entire insurance segment. Hope they keep it up!"

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"What I’ll never stop being thankful for is the fact that my claim for total loss was settled in such less time. Thank you so much for all the support from your side!"

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"Their prompt replies, seriousness about policy deliveries and commitment to their job are just some factors that make Coverfox shine through. But their complete transparency in their calls clearly is the icing on the cake!"

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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?

Now that we have discussed the necessity to invest in a good health insurance plan, it's perfectly logical to evaluate few fundamental benefits of opting for one -

  • Shielding against rising medical costs: Whether or not you like it, there is evidence to prove that healthcare costs are rising 18% every year. So essentially, a bypass surgery that costs Rs. 4,50,000 today will cost Rs. 11,00,000 in 5 years from now.

  • Assisting in dealing with Lifestyle Related Ailments: In the stressful and exercise-free world we live in, everyone is at risk of contracting lifestyle diseases such as hypertension, heart-related anomalies, diabetes, joints and bone-related issues, etc. Even though these are not life threatening, costs involved in treating and dealing with them day-to-day is remarkably higher and a good health policy can comfort you by covering for these costs.

  • Offering the Tax Benefits: Under Section 80D of the Income Tax Act 1961, you get a tax benefit of Rs. 25,000 if you have an individual plan or a family floater plan and you do not fall under senior citizen bracket. If you fall under senior citizen bracket, you can avail a tax benefit of Rs. 30,000. If you are have a medical insurance that covers you and your senior citizen parents (and you are not a senior citizen yourself), you stand to avail a benefit of Rs. 25,000 for yourself / family and Rs. 30,000 for holding an insurance policy for your parents. So in total, you stand to avail a tax benefit of Rs. 55,000.

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 Coverfox.com 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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