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under section 80D
Get lump sumpayout for a
critical illness
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Health insurance is a type of insurance that fully or partially covers an individual's medical and surgical expenses. 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.
Health insurance companies offer a wide range of policies, tailor-made to suit the unique health requirements of their customers. Hence, varied plans include different features related to medical treatments, surgeries, etc. Here are some of the salient features of health insurance policies:
Pre-hospitalization expenditures: Coverage extends to medical expenses incurred between 30 to 60 days before hospitalization is covered like medical diagnostic tests, medication, etc.Hospitalization expenditures: Includes expenses incurred during hospitalization for a minimum period of 24 hours. Expenses generally covered are hospital room rent charges, operation theatre charges, ICU charges, doctors’ consultation fee, surgery charges, and other important expenses like blood, anaesthesia, oxygen, etc.
Post-hospitalization expenditures: Expenditures incurred between 60 days and 180 days after hospitalization is generally covered by most insurance companies. These charges include follow-up doctors’ consultation fees, medical diagnostic tests, medication, etc. Domiciliary Hospitalization: Medical expenses incurred due to treatments undertaken at home for a period of more than 3 days.
Day Care Procedures: Day care procedures or medical treatments like dialysis, angiography, radiotherapy, chemotherapy, appendectomy, colonoscopy, lithotripsy, hydrocele, eye surgery, amongst others. Certain high-end health insurance plans cover all day care procedures.
Expenses for Organ Donation: Some health insurance companies 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.
Critical Illnesses: Some critical illnesses that are usually covered by health insurance companies are cancer, heart attack, coronary artery disease, stroke, paralysis, major organ transplant, chronic lung disease, Parkinson’s, etc.
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.
Hospital Cash: Daily expenditures for food, hospital stay, etc. that are incurred by your caretaker during your hospitalization may be offered on health insurance plans or may be available as a rider. Health insurance plans also offer compensation for the loss of income due to health issues.
Ambulance Cover: Health insurance policies cover expenses for ambulance service.
Check-ups: General health check-ups as a preventive measure are covered by some health insurance plans.
Vaccinations: Certain health insurance plans cover vaccination costs for bee stings, dog bites, etc.
Emergency Evacuation: Under emergency situations when a patient needs to be transferred from one hospital to another, health insurance plans cover expenses involved in the relocation process.
Below are some factors that make the purchase of an effective health insurance policy essential for everyone:
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 health insurance, one can benefit from quick cashless treatment, medical reimbursement, emergency ambulance cover and daily cash during hospital stay.
Cashless Treatment: Most health insurance companies 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 health 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. Health 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 health 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 health 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”.
This is applicable both when the policyholder moves from one insurer to another and also from one plan to another with the same company. An essential point to be noted in case of health insurance portability is that 45 days before renewal, the policyholder needs to i) write to the old insurer requesting a shift, ii) mention the company to which the shift is being made and iii) renew the policy without a break (a 30-day grace period is applicable if porting is under process).
In recent years, advancements in medical technology has made it possible to cure ailments and diseases that were once considered incurable. However, the costs associated with them is quite high, making it difficult for middle class families to afford them.
According to various studies, medical inflation is expected to rise in the coming years which in turn would mean health care costs will also see an increase. In order to provide a solution to this, insurance companies have designed different kinds of health insurance plans, available at affordable premium rates. This makes availing healthcare facilities accessible and affordable for all.
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 the 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, 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.
| Health Insurance | Critical Illness Insurance |
|---|---|
| Health insurance is a base policy that provides insurance coverage against medical expenses incurred by the policyholder during the policy period. | Critical illness insurance is a defined benefit policy where the insurer pays out a lump sum benefit if and when the insured individual is diagnosed with a pre-specified critical ailment. |
| A health insurance policy remains active even when a claim has been made, until the sum insured limit is exhausted. | Once the lump sum benefit is paid, the policy ends |
| There is generally an initial waiting period of 1 month for illnesses and 1-3 years for pre-existing ailments. | There is generally an initial waiting period of 3 months. |
| Health Insurance | Term Insurance |
|---|---|
| Health insurance provides medical cover against hospitalization and surgical expenses during the policy period. | Term insurance is a pure risk life insurance product that pays out the sum assured upon the demise of the life insured. |
| The sum insured can only be used to cover medical expenses. | The sum assured can be used in any manner the nominee wants - to cover expenses related to children’s education, wedding, etc. |
| Tax deduction can be claimed on premiums paid under Section 80D of the Income Tax Act, 1961. | Tax deduction can be claimed on premiums paid under Section 80C of the Income Tax Act, 1961. |
| Health Insurance | Mediclaim Policy |
|---|---|
| Health insurance provides a comprehensive health cover. Besides covering hospitalization expenses, it reimburses pre and post-hospitalization expenses, ambulance fees and pharmacy bills. | Mediclaim policy covers only expenses related to hospitalisation and treatments. |
| A health insurance policy may cover critical illnesses. | This policy does not cover critical illnesses. |
| Individual Health Insurance | Family Health Insurance |
|---|---|
| Individual health insurance, as its name would suggest, covers a single person. | Family health insurance, also referred to family floater policy, covers the whole family under a single policy. |
| Individual health insurance, as its name would suggest, covers a single person. | The sum insured under a family floater policy is shared by all the covered family members. When one member files a claim, the cover reduces for the others by that much. |
| Premiums of a family floater policy are determined by the age of the eldest member insured. |
| Government Health Insurance Schemes | Private Health Insurance Plans |
|---|---|
| These schemes are initiated by the government mainly for the welfare of low-income groups. | They are offered by private companies, with varying sum insured and premiums to suit different client needs. |
| Government schemes are normally offered for free. | Insurance premiums are determined on the basis of a number of factors, like age of the policyholder, sum insured, etc. |
Health Insurance in India can be broadly classified into the following types:
Family floater Plans: Family health insurance 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 Citizens 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, 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. One of them is Bajaj Allainz insurance which offers Bajaj Allianz women specific 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.
Investing in a health insurance plan is extremely important for multiple reasons. They are:
The health insurance coverage differs from one insurance company to another. All you can do is compare different health insurance policies provided by different health insurers keeping the coverages and exclusions in mind. Usually, a health insurance plan covers the following medical expenses;
Health insurance plans offered in India provide cover for the following essential health benefits:
In-Patient Hospitalization: Medical expenses related to hospitalization due to an illness or an accident, which is for a period of more than 24 hrs.
Pre-Hospitalization: Medical expenses that one incurs due to illness during the days immediately preceding the hospitalization.
Post-Hospitalization: Medical expenses that one incurs for a certain period after being discharged from the hospital.
Day-Care Procedures: Medical expenses for treatments, which do not require 24 hours hospitalization due to technological advancement.
Domiciliary Treatment: Covers the expenses for treatment done at home for which hospitalization would be needed.
Emergency Ambulance: Costs related to using ambulance service for reaching the hospital.
Ayush Benefit: Treatment done using Ayurveda, Unani, Sidha and Homeopathy.
If there is an organ transplant of the insured, all the donor’s expenses would be covered.
In case you wish to enhance your health insurance cover, you can buy riders at an additional premium or buy top-up health insurance plans.
Mentioned below is the list of the exclusions in a health insurance:
Pre-existing medical conditions Pre-existing medical conditions are the ailments that you might already be suffering from while applying for insurance. In all probability, pre-existing medical conditions are not covered under medical insurance plans. However, health insurance providers have started providing coverage for pre-existing medical conditions after a waiting period ranging between two to four years.
Pre-Existing Diseases: In case you are suffering from any illnesses or health conditions before buying a health insurance plan, are known as pre-existing diseases. Usually, every health insurance company has a waiting period of 2-4 years or more that would roughly depend upon the type of disease as well as the risk in case your health insurer agrees to cover it. Certain pre-existing health conditions such as cataract, few chronic diseases, joints treatment, kidney stones, arthritis, etc. could be the exclusions in a health insurance plan.
Cosmetic surgeries: Cosmetic surgeries are one of the most common health insurance exclusions. However, cosmetic or plastic surgeries that are performed after accidents are covered in several health insurance plans. Also, joint replacements and dental treatments are usually excluded in health insurance policies.
Injuries caused during suicidal attempts: An insured is not covered in case he intentionally causes harm to himself. Hence, injuries caused during suicidal attempts are not covered in health insurance plans by any insurance provider.
Therapies: Health insurance plans do not cover therapies such as acupuncture, naturopathy, magnetic therapies and alternative forms of therapies.
Pregnancy: Certain medical expenses including child birth, pregnancy, vaccination, etc. could not be covered under a health insurance policy. There would be a waiting period of around 1-2 years. Post completion of this waiting period, you will be eligible for receiving decent benefits in case you plan for a child.
Waiting Clause: Almost every health insurance company do not cover illnesses that are a part of the inclusions of the health insurance plan. However, there are certain exceptions such as accidents and deaths. A waiting period of 1-2 months would be applied post which you will get the advantages of the policy.
Surgeries: Certain surgeries such as dental surgery, joint replacement, cosmetic surgery, etc. are generally not covered in a health insurance policy.
There are several parameters to be considered before you invest in a health insurance plan. Some of them are:
Your budget: One needs to consider the financial budget of the family, based on which he/she invests in a health insurance plan that covers all risks related to health of the insured and their family members.
Co-payment: Another consideration factor that one must consider is whether or not the health insurance plan provides a co-payment facility. A standard feature, co-payment is defined as a fixed percentage of each claim amount that has to be paid by the insured.
Number of family members covered: While investing in a health insurance plan, one must always consider the number of family members that shall benefit from the policy. Most insurance providers cover up to 4 to 6 family members under a family floater health insurance plan in India.
Claim settlement process: Claim settlement was a cumbersome process which obstructed a person from investing in a health insurance plan. All insurance providers in today’s day and age, provide easy, hassle-free claim settlement procedures that makes it convenient for the insured.
Addition of new family member: Addition of a new family member is a moment of joy. Hence, when investing in a health insurance plan, one must also consider the conditions in the policy in case you wish to get the new family member added and insured under your health insurance policy.
Compare health insurance plans Before investing in a health insurance plan, one must compare the policies from the best insurance providers and select the one that best suits his needs.
While there are a number of factors one must consider before investing in a health insurance plan, here are our top 10 tips to keep in mind.
All about Coverage- Foremost, one must check the coverage level of a health insurance policy. While the basic coverage remains the same, some absolute limits tend to vary in different policies. Also, it’s always wise to choose a plan which has features that you may need and not overburden yourself with unnecessary features.
Sublimits on the policy- When investing in a health insurance policy, we often tend to overlook the sublimits on certain benefits and then regret later. Hence, it is important to check the limits on ambulance charges, room rent and other expenses so that these don’t end up burning a hole in your pocket later.
Waiting period- Waiting period is the limited period where exclusions of certain ailments are applicable. It is always a good idea to check the waiting period before hand as different plans have different waiting periods associated with them.
Cashless claim facility- Cashless claim facility is a benefit where a direct settlement of medical expenses happens between the hospitals and the insurance provider. This facility is mostly offered in all health insurance plans when the patient is treated in one of the hospitals, listed in the network of hospitals, listed by the company.
Entry age- This factor is particularly important in case you wish to invest in a family floater plan. One must check for the maximum age of dependent children and parents/parents in-law if applicable.
List of Network Hospitals- When selecting a health insurance policy, it’s always wise to learn about the network of hospitals which are associated with the insurance provider and offer a cashless claim facility. This gives you mental relief at times of emergencies.
Exclusions- It would be extremely disappointing if your ailment or medical condition is not covered in your health insurance policy in the times of an emergency. Hence, it is always wise to read the offer document carefully and be aware of all medical conditions which are excluded from your health insurance policy.
Additional benefits- While checking for a health insurance policy, it only makes sense to look for add-on riders attached with your policy in order to increase the scope, coverage and benefits of the comprehensive health insurance plan.
9. Possibility to Renew Health Insurance Policy - An ideal health insurance nowadays provides a lifelong renewal on most health insurance policies. Hence, renewability is a crucial factor while selecting the right health insurance policy for yourself and your loved ones.
Premium- The premium payable should always be kept in mind before investing in a health insurance policy. The amount payable for your health insurance plan should be justifiable and appropriate in comparison to other plans in the health insurance space.
Record of Claim Settlement - Always check the Incurred Claim Ratio of an insurance company. Pick an insurer which has a good claim payment ratio. The higher the ratio, the more are the chances of successful claim settlement.
Top-Up Plans - 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.
Here is An Exhaustive List Of The Best Health Insurance Plans Offered By The Top Health Insurance Companies.
New India Assurance Health Insurance
The Top Companies That Provide Health Insurance Are -
| Apollo Munich | Star Health and Allied Insurance | New India Assurance |
| HDFC Ergo | Oriental Insurance | Raheja QBE General Insurance |
| Religare Health Insurance | Max Bupa Health Insurance | Edelweiss General Insurance |
| ManipalCigna Health Insurance | Iffco Tokio General Insurance | Bharti AXA General Insurance |
Medical inflation has gone sky high. Therefore, it is wise to buy a health insurance plan that would offer maximum coverage. Depending on your health insurance needs, it is better to buy a high risk coverage health insurance plan.
If you are single, it is best to opt for Individual plans. But, are good for single individuals, however, if you have a family, it is best you opt for a family floater health insurance plan. This is because, family floater health insurance plans usually come with a higher sum insured at a lower premium.
Experts advise to buy the right sum insured depending on your age as well as marital status. Simply because, when you are young, there are lesser chances of you falling ill. But, when you are old, there are higher chances of you getting prone to lifestyle diseases like diabetes, heart diseases etc.
Usually health insurance companies offer coverage for pre-existing medical conditions post completion of 2-4 years. Therefore, when you plan buying a health insurance plan, it is good to opt for a mediclaim policy that has a low waiting period to cover pre-existing diseases.
It is best to opt for health insurance plans at a younger age. Also, look for a plan that offers a lifetime renewability.
Every health insurance company has a tie-up with hospitals that fall under their network or are empanelled with them. These are hospitals that offer cashless treatments. Therefore, opt for a health insurance plan that offers a wide network hospitals around you.
| Name Of Insurance Company | June 2016 | Sept 2016 | Dec 2016 | March 2017 |
|---|---|---|---|---|
| Star Health and Allied Insurance | 5.27 | 1.59 | 1.52 | 1.61 |
| Apollo Munich Health Insurance | 1.55 | 1.62 | 1.69 | 1.90 |
| Max Bupa Health Insurance | 2.05 | 2.44 | 2.25 | 2.01 |
| Religare Health Insurance | 2.44 | 2.21 | 1.82 | 1.91 |
| ManipalCigna Health Insurance | 1.68 | 1.68 | 1.68 | 2.65 |
Source: IRDAI
As the name suggests, a Health Premium Calculator helps you determine your health insurance premium, which is the cost that you would need to pay for health insurance. This tool is highly effective to understand the amount of money you need to keep aside from your budget to cover your health insurance needs. The premium calculator asks details such as the number of individuals to be insured, their age, sum insured and some other details. Before investing in a health insurance plan, you must always calculate the premium using the health premium calculator so as to choose the plan that best suits your needs and at the same time does not burn a hole in your pocket.
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-
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.
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.
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.
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:
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.
The premium paid towards a health 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 of 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.
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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Proof of Age: Acceptable documents are Birth Certificate, PAN Card, Voter’s ID, Driving License, Passport, School or College Certificate, etc.
Photo Identity Proof: Aadhaar Card, PAN Card, Driving License, Passport, Voter’s ID, etc.
Proof of Address: Acceptable documents are Ration Card, Telephone Bill, Electricity Bill, Passport, Voter’s ID, Bank A/C Statement, etc.
Proof of Income: Salary Slip, Employer’s Certificate, Form 16, etc.
Medical Checkup: If asked by the insurance company
Passport Size Photograph
Mistakes to Avoid When Buying Medical Insurance?
There are a ton of mistakes that can be made when buying a health insurance policy and many people make them on a daily basis. This ends in the customer being dissatisfied with the terms and conditions, the coverage, the customer care and ultimately leads to a bad review for the insurance company. By choosing the ideal health insurance plan, both the customer and the company can have a mutually beneficial relationship.
Some of the reasons why people make mistakes is lack of information, blindly trusting the agent, lack of time, skip reading and understanding the terms and conditions, and so on. Some of the most common mistakes that you must avoid while buying a health insurance plan are as follows:
Who is Eligible for Health Insurance?
Can I save tax with health insurance?
Yes, Health Insurance can help you reduce your taxable income up to Rs. 1 lakh. Tax saving can happen under Section 80D of the Income Tax Act, 1961. As a Policyholder, a deduction of up to Rs. 25,000 per annum can be availed with regards to the premium paid for a health plan. The policy offers a coverage that can be availed by you, your spouse, and dependent children. However, the limit increases up to Rs. 30,000 if you or spouse is 60 years and above. You can also back this by an additional coverage of Rs. 5,000 for hospital related expenses of the family members such as parents, spouse, and dependent children.
Which health insurance plans are available for women?
Women of all walks of life are now progressing and trying to maintain the fine balance between their personal and professional commitments. Hence, it is important that their medical needs are catered to. Various health insurance providers have now come up with unique health insurance plans that specifically cater to female medical conditions such as breast cancer, ovarian cancer, cervical cancer, complications during pregnancy, childbirth or other forms of critical illnesses. Some of the top companies that provide these kinds of health insurance plans are TATA AIG, Bajaj Allianz, etc.
What are cancer health insurance plans?
A cancer insurance plan is a supplement of health insurance that covers the risks associated with cancer and its various manifestations. This kind of plan is devised to mitigate the cost of cancer treatment of a patient.
What are overseas health insurance policies?
Overseas health insurance is covered under international travel plans. These plans usually cover bodily injuries caused, medical illnesses or diseases contracted during an international journey.
Are children covered in health insurance plans?
Yes, According to the current law, your health insurance plan can cover your dependent children., You can now add or keep your dependent children included in your policy, until they turn 26 years old.
Is my spouse covered in my health insurance plan?
Yes. Most employers that provide health insurance benefits to their employees also cover an employee’s spouse and children. However, if the employer does not provide any such health insurance plan, the spouse can be enrolled for an individual health plan from a health insurance provider or you can cover your spouse in your family floater health insurance plans.
Does my health insurance plan cover my parents?
In certain cases, yes, health insurance plans also cover the parents of the insured. Under individual health insurance plan, you cannot add any dependents, including your parents. However, if you have a family floater plan, you can also opt to add adult dependents for coverage under the same.
Which plans cover parents in health insurance?
Family floater health insurance plans usually cover parents in India. There are specific plans designed by various health insurance providers that cater to medical needs of parents of 55-60+ years of age. Some of the top providers of such unique plans include Star Health Insurance, Bajaj Allianz, Apollo Munich, Max Bupa health insurance etc.
How do I increase sum insured of my health insurance policy?
You can increase the sum insured of your existing health insurance policy at the time of renewal of the health insurance policy. One must keep in mind that sum insured enhancement is not possible in case you have you have made a mediclaim in your previous policy.
Is individual plan better than family floater health insurance plan?
This varies on a case to case basis. Both insurance plans aim to cover the medical expenses in case of medical emergencies. Individual health insurance plans cover a single individual whereas family floater plans cover the medical expenses of the entire family. However, individual plans are more expensive than a family floater plan. Also, family floater plans provide a greater sum insured amount in the event of only one claim in the year as compared to individual plans.
How does smoking affect health insurance premiums?
Smoking has an adverse effect to health insurance premiums. This means that if you are a smoker, you end up paying higher premiums as you are subjected to greater medical risks.
How do I renew my health insurance policy?
You can renew your health insurance policy either offline or online. For offline renewal, you would require to contact your health insurance provider at least 30 days before expiration and make a renewal request. Any change in the health condition must also be notified to the provider at the time of renewal. In case of an online renewal, you must provide your basic details along with your insurance policy number and make the payment online via your debit or credit card, or through net banking.
What if I forgot to pay my health insurance premiums?
In case you forget to pay your health insurance premiums, the provider gives you a grace period that usually varies from one to three months. However, if you fail to pay the premiums during this time as well, your insurance policy lapses and you are no longer entitled to the health insurance benefits of the policy.
Is a medical check-up available in health insurance?
Yes, there is a medical checkup available while applying for health insurance as the insurance provider needs to assess the current health condition of the applicant before they invest in a policy.
Is a pre-medical check-up available before buying health insurance?
Yes, a pre-medical check-up is available before buying health insurance. The pre-medical check-up is a series of tests that the insurance applicant is required to undergo so as to determine the current medical conditions and any pre-existing diseases that the applicant might be suffering from.
Which health insurance plans are available without pre-medical check-up?
Not all health insurance plans mandate a pre-medical checkup. Most insurance providers have a threshold limit of 45 years providing health insurance plans without pre-medical examination. Some of the plans are- a. Star Health Insurance- Health insurance plans such as Family Health Optima, Mediclassic, Health Gain, Comprehensive or Family Delite require no check-ups are required till 50 years of age. b. Oriental Insurance- Happy Family Floater plan by Oriental Insurance does not need a pre medical checkup till the age of 60 years. c. Religare Health Insurance- This insurance provider has a unique Care plan that does not need any medical screening.
How do I buy medical insurance for a diabetic patient?
There are some insurance providers who have come up with health insurance plans specific to diabetic patients. These health insurance plans cover medical expenses arising from diabetic conditions. One can invest in health insurance plans provided by companies such as Star Health Insurance and National Health Insurance. The procedure of buying health insurance for diabetic people is the same as investing in any other health insurance plan.
Is dental covered in health insurance?
Dental treatments are only covered under mediclaim in health insurance if the insured has to undergo the required treatment or surgery because of an accident and not otherwise.
What is Third Party Administration in Health Insurance?
A Third Party Administrator or TPA looks after claim settlement and investigation on behalf of the health insurance provider.
Should I buy Government health insurance plan?
In India, not everyone can afford to invest in health insurance plans provided by private insurance providers. Hence, the government has come up with certain health insurance policies that benefit the ones in medical need. Health insurance plans are extremely cost effective and provide basic medical assistance to the poor and needy. Hence, government related health insurance plans are basically to support the ones who can’t afford health insurance plans by private insurers and promote healthcare in India.
What are the health plans offered by Government of India?
A few health insurance plans offered by government of India are- a. Central Government Health Scheme b. Employment State Insurance Scheme c. Rajiv Arogya Bhagya d. Meghalya Health Insurance Scheme e. Deen Dayal Swasthya Seva Yojana, Goa
Is Ayurvedic treatment covered in health insurance?
With the increasing shift in alternative forms of medicine, a number of insurance providers are now providing coverage for Ayurvedic treatments in their health insurance policies. However, this is restricted to only certain health insurance providers till now.
Is cataract treatment covered in health insurance?
Yes, certain health insurance providers cover the cost of cataract treatments in their health insurance policies. However, they are subject to a few exclusions. These exclusions are factored by the waiting period and limit on claim payable. Some insurers that cover cataract expenses are Bajaj Allianz, Religare Health Insurance and Apollo Munich.
Is dengue covered? What are the special plans for dengue?
Yes, there are special plans that cover the medical expenses incurred in the treatment of dengue. These are called single disease specific plans. No pre medical checkups are required to invest in these plans and the premium paid for the policy remains the same, irrespective of your age.
What is top-up in health insurance?
As the name implies, a top up in health insurance is an additional cover on the health insurance policy, over and above the current available limit, at lower premiums.
What are super top-ups and why you must buy?
A top-up plan has certain limitations which can be resolved by choosing a Super top up plan. One must buy a super top-up plan because while a top-up plan pays only if the threshold limit on a regular policy is exceeded in a single claim, a super top up plan covers the threshold in multiple cases. A Super Top-up policy provides for multiple claims in a year.
What is room rent and why does it matter?
Room rent limit is a maximum per day room charges that an insured is eligible for in case of hospitalization. It is important as it affects the premium one pays for a health insurance policy.
What is claim settlement ratio in Health Insurance?
Claim settlement ratio is the ratio of the total value of claims paid or settled based on the total premium collected in the year. Claim settlement ratio in health insurance is calculated as Total Claims Settled/ (Total Reported Claims + Outstanding Claims at Start of Year – Outstanding Claims at End of Year)
What is waiting period in health insurance?
Waiting period in health insurance is the duration of time specified that must pass before your coverage can begin. Claims cannot be admitted during this waiting period.
What is the procedure to cancel my health insurance policy?
You can cancel your health insurance policy by reaching out to your health insurance provider by calling their customer care number. You must have your policy number and identity proof ready. Simply follow the procedure suggested by the health insurance provider and you would be able to cancel your policy seamlessly.
What is portability in health insurance and how do I port it?
Portability in health insurance is defined by the transfer of an existing health insurance policy from one insurer to another. The steps to port it are-
What is meant by co-pay in health insurance?
A co-payment or co-pay is a fixed amount that a person pays from his/her own pocket towards the claim raised against the Health Insurance plan. For example, if a health plan has 10% co-pay and the total bill is Rs. 1 lakh, then you will have to pay Rs. 10,000 and the insurer will pay the remaining Rs. 90,000
What is NCB in health insurance?
A No Claim bonus (NCB) is a discount in premium offered by the health insurance provider or an increase in the sum insured in case a claim is not made within one policy year.
What does the term Network Hospital mean?
Network Hospital means the number of hospitals associated with the insurer that will provide in-patient treatment care and day care treatment of illnesses and injuries on a cashless basis.
What is cashless health insurance policy?
A cashless health insurance policy is a type of insurance where the insured can be hospitalized, avail the relevant treatment and be discharged without having to pay anything from their pockets.
What is difference health insurance & Critical Illness Plan?
A health insurance plan is more comprehensive and general in nature as compared to a critical illness plan. Health insurance covers a variety illnesses and injuries, whereas critical illness plans only covers defined critical illnesses such as cancer, heart attack, etc.
Is Critical Illness covered in health insurance?
Yes Critical illness is covered in health insurance. A number of insurers provide specific health insurance plans that cater to the needs of a critical illness.
Is cost of Diapers for adults covered in Health Insurance?
While certain adult incontinence products are covered in health insurance, policies in India do not support the cost of diapers for adults.
What does pre-existing diseases in health insurance mean?
Pre-existing diseases are these ailments that the insured already suffered from at the time of investing in a health insurance policy. These diseases are covered in the health insurance policy after a stipulated waiting period.
What are the features of a good health insurance plan?
Some top features of a good health insurance plans are a. The plan is designed according to the needs of the individual b. The policy is cost effective c. The facility of a lifelong renewal d. The facility of cashless hospitalization e. Seamless and hassle-free claim procedure f. Good network of hospitals g. Good reviews of the insurer by insurance web aggregators
How to choose health insurance for parents?
When choosing health insurance for parents, one must keep in mind their age, current medical conditions and any pre-existing diseases that they might suffer from. Also, one must factor in the cover offered by the insurance provider as medical treatments in old age are comparatively expensive.
How to save money on health insurance?
To save money on health insurance, one must compare and select the health insurance plan that does not burn a hole in your pocket. Also, invest in policy directly through an insurance provider, to reduce the cost of an agent involved. Moreover, according to government schemes, one must inquire if they are eligible for any schemes.
How to increase the health insurance plan cover?
To increase the health insurance plan cover, one can invest in a top-up or super top-up plan and increase the sum insured before the expiration of the policy.
What happens if I claim under a health insurance?
If your illness or injury is covered under the health insurance policy, the insured gets the benefits stated in the terms and conditions of the policy. However, in case of death of the insured, the nominee gets the benefits of the health insurance policy.
What is difference between health insurance and Mediclaim?
Health Insurance and Mediclaim are terms that are often used interchangeably. However, both terms are not the same with a major difference being that Mediclaim is limited only to the hospitalization expenses, whereas health insurance is more encompassing and covers pre and post hospitalization expenses among other items.
How to select best health insurance?
Consider the following when selecting health insurance
What is the average cost of healthcare per person in India 2018?
India’s per capita expenditure on health stands at INR3500.
What is the waiting period in health insurance?
The waiting period concept in a health insurance policy is the period of time that needs to pass, lest some or most of your health care coverage starts. During this period, a claim is not considered admissible. This period varies from insurer to insurer and disease to disease. The general waiting period ranges from 2 to 4 years.
What should I try detecting for zeroing on the best health insurance?
The factors that you must consider before zeroing in on the best health insurance are
What is the deductible for health insurance?
This is the amount one pays for health care service before his/her health insurance gets applicable. For instance, when your plan's deductible is INR 75,000, you pay 100 percent of eligible health care expense, until the bill becomes INR 75,000. Post this, you get cost by paying co-insurance.
What age is ideal to opt for health insurance?
There is no ideal age for getting health insurance. The earlier you start, the better. The premium is dependent on the age and the older you are, the higher you pay. However, the ideal age varies between 18 and 25 years.
How much does health insurance cost for 1 month for 1 person?
The cost of health insurance is based on the sum insured chosen and age of the insured person. Hence, it is difficult to arrive at a generic number, as each person and his needs are different from the other person. However, monthly health insurance premium can be as low as Rs. 100 to 300 for an average person.
What all is covered under health insurance?
What is subsidized health insurance (Medical Insurance)?
Subsidized health insurance is benefit provided where the premium is at a subsidy or zero cost, for individuals whose incomes are less than a basic level. For instance, schemes like Rashtiya Swasthiya Bima Yojana, Aam Aadmi Bima Yojana, Employment State Insurance Scheme (ESIS), and Central Government Health Scheme (CGHS) etc. are available in India.
Is health insurance plan from employer sufficient?
Salaried employees often enjoy benefit of the employer-provided health cover. This group cover is often provided at zero cost to the employees. Yet, it is always advisable to maintain your own independent health cover.
What is the waiting period for health insurance?
Most often, health insurance wait duration is 30 days for every policy except for accidents. There is 3 months wait duration for infants or new born babies. Some insurance carriers offer maternity benefits, yet with a waiting period ranging from 9 to 36 months. Pre-existing diseases have a waiting period ranging between 2 to 4 years.
What should I try detecting for zeroing on the best health insurance?
The factors that you must consider before zeroing in on the best health insurance are
What is the deductible for health insurance?
This is the amount one pays for health care service before his/her health insurance gets applicable. For instance, when your plan's deductible is INR 75,000, you pay 100 percent of eligible health care expense, until the bill becomes INR 75,000. Post this, you get cost by paying co-insurance.
What age is ideal to opt for health insurance (Medical Insurance)?
There is no ideal age for getting health insurance. The earlier you start, the better. The premium is dependent on the age and the older you are, the higher you pay. However, the ideal age varies between 18 and 25 years.
How do I buy medical insurance for a person having Hypertension or Blood Pressure?
People suffering from Hypertension or Blood pressure usually invest in a cardiac health insurance plan as risks associated with both these conditions are the similar. Based on a medical examination, the patient is classified and accordingly the cost involved in the health insurance plan is calculated.
How to claim cashless health insurance service during medical treatments?
In order to claim your cashless claim policy, you must submit your policy card to the hospital and fill out relevant details in a pre-hospitalization form. Once the form is submitted, the insurance personal of the hospital scrutinizes the form for authenticity. Note that this facility will only cover illnesses and injuries that are stated in your insurance policy.
How do I port my health insurance policy from one insurance company to another?
According to IRDAI regulations, a health insurance policyholder can transfer an existing health insurance policy to a new provider. Also, the new policy can be customized to take care of the insured’s medical needs. The following steps are involved in the process-
Which are various types of health insurance plans?
The various types of health insurance plans are
What are the benefits of health insurance policy?
Is health care and Health insurance the same thing?
Yes. Mostly, health care and health insurance is referred to as the same thing.
How to buy health insurance online?
As a one-stop platform to check all available health insurance plans, the internet offers quick, hassle free and convenient option to buy the best health insurance plan at a mouse click. Unlike earlier days, today’s life is fast paced and many of us don’t bother to buy a health plan due to daunting and tedious paper work. All you have to do visit the insurer or online broker website, provide a few details about the members being insured, select the coverage amount, fill-up the proposal form and pay the premium. Your Health Insurance plan will reach you at the earliest possible.
Why you should have health insurance (Medical Insurance)?
A health insurance covers various health costs and offers various other benefits. A health insurance protects beneficiaries from various unexpected medical expenses. When you have a health plan or a mediclaim policy or any other valid health coverage, you won’t have to pay the medical bills from your own pocket.
What is a health insurance (Medical Insurance) in India?
In India, a health insurance is something that pays for hospitalizations, medical expenses incurred for an in-patient, sometimes out-patient and for the treatment through alternative modes like Ayurveda, etc. The first health policies in India were Mediclaim Policies.
How much does medical insurance cost per month?
The cost of medical insurance per month depends upon multiple factors such as the policy selected, age and income, no of family members to be insured, smoker or non-smoker. Based on the details you provide, the insurance company will calculate the premium for you.
How To Port A Health Insurance Policy?
Follow The Below Procedure For Porting Your Health Insurance Plan:
What Is The Time Required To Port A Health Insurance Policy?
A health insurance policy is usually ported between 45 days to 60 days from the expiry date of the current policy. However, it may vary among insurance companies.
Can Health Insurance Policies Be Ported?
Yes, health insurance plans can be ported to another insurer.
How Does Health Insurance Portability Work?
The Process For Porting Your Health Insurance Policy Is As Follows:
Which Type of Health Insurance Policy in India will be the Best-fit for you?
There are many types of health insurance policies in India that offer you the best of coverages and features. If you are a single individual, it is best to opt for an individual health insurance plan in India. But, if you wish to cover all the family members, it is better you opt for a family floater health insurance plan since the sum insured would be higher and that too at a lower premium.
If you wish to cover your senior citizen parents in India, it is best you opt for a senior citizen health insurance plan for your parents and a family floater for the other members of the family.
What is GST and how does it impact health insurance?
Goods and Services Tax (GST) – implemented in 2017 – is an indirect tax levied on the sale of goods and services in India. It has replaced many indirect taxes imposed on goods and services by State and Central Government. Tax slabs under GST have been fixed at 0%, 5%, 12% and 28%.
Before the new tax regime, the service tax rate applicable on health insurance was 15%. However, with the implementation of GST, the tax rate has been raised by 3% - placing health insurance in the 18% tax bracket.
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