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Health insurance is a form of insurance that absolutely or partially covers an individual's clinical/medical and surgical expenses. It's an agreement among you and your insurance company, wherein for an annual premium, the insurer will pay for your hospitalization and other medical expenses as stated in your policy.
Health insurance companies offer a wide variety of policies, tailored to unique health necessities of their customers. Hence, numerous plans encompass different functions associated with medical remedies, surgeries, etc.
If you are admitted for treatment in a network or a non-network hospital for more than 24 hours.
Medical expenses including diagnostic reports, medicines etc. for the treatment you are hospitalized.
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).
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.
Health Insurance in India can be broadly classified into the following types:
★ Family Floater plans: cover the entire family in one health insurance plan. It works under the assumption that not all members of a family will suffer from illness at one time. These plans cover hospital-related expenses which can be pre and post hospitalization. Most health insurance companies in India offering family insurance have a wide network of hospitals that help the insured people in times of an emergency.
★ Senior Citizen Health Insurance Plans: As the name suggests, senior citizen health insurance plans are for the older people of the family. These plans cover health issues arising during old age. As per IRDAI guidelines, each insurer must provide cover up to age of 65 years.
★ Maternity Insurance Plans: Maternity health insurance plans provide coverage for maternity and other additional expenses. These policies take care of both pre and post-natal care, and delivery of baby i.e. normal or caesarean deliveries. Just like other health insurance plans, the maternity insurance providers usually have a wide range of network hospitals and also takes care of ambulance expenses. As you progress and you reach 60 years of age, your body needs special attention. Hence, it is only wise to invest in a health insurance plan that takes care of your specific needs. Various insurance providers have customized plans that are designed for senior citizens and cater to the needs of older people of the society. Some of the best health insurance plans are provided by Star Health Insurance, Bajaj Allianz, Max Bupa, HDFC Ergo Health Insurance (Apollo Munich), ICICI Lombard and Care Health Insurance,
★ Hospital Daily Cash Benefit Plans: Hospital Daily cash benefits is a defined benefit policy that provides a certain sum of money for every day of hospitalization.
★ Critical Illness Plans: These plans are benefit-based policies, where a lump sum benefit amount is paid on diagnosis of covered critical illness. These diseases are usually specific, with high severity and low frequency in nature. Hence, the treatment cost is high when compared to day to day medical / treatment need. Some of these illnesses include heart attack, cancer, stroke etc. Women are subjected to a number of health hazards and medical conditions that the other gender does not have to suffer from. This is basically because of the difference in their biological make and the fact that there are several risks associated with pregnancy, childbirth and menstruation. Many insurance providers understand a woman’s plight and have introduced various health insurance plans that combat critical illnesses associated with the fairer sex of the society. Critical illness plan which covers a number of medical conditions such as breast cancer, cervical cancer, burns, paralysis, fallopian tube cancer, uterine or endometrial cancer, vaginal cancer and ovarian cancer.
★ Health Insurance For Parents: As a child, your parents always invested in raising you well and giving you the best. Hence, now it is important that their needs are catered to so that they stay in the pink of their health in their later years. Therefore, various insurance providers have rolled out special health insurance plans that cater to the medical needs of your parents. These plans cover pre and post hospitalization charges, ambulance charges and a few of them are also inclusive of pre-existing diseases.
|Best Health Insurance Plans||Sum Insured Range||Entry Age||Coverage||Policy Periods|
|Star Senior Citizen Red Carpet Plan||1 Lakh to 10 Lakh||Adults: 60 years to 75 years||1, 2 years|
|Care Health Insurance Joy Plan (formerly Religare)||3 Lakh to 5 lakh||For children : 1 day - 90 days, Adults: 18 years to 65 years||3 years|
|Star Family Health Optima Plan||2/3/4/5/10/15 lakhs||For children : 16 days old, Adults: 18 years to 65 years||1 year|
|Care Health Insurance Plan (formerly Religare)||2/3/4/5/7/10/15/20/25/50/60 Lakh||18 Years to No Limit||1, 2 & 3 years|
|Oriental Happy Family Floater Mediclaim Plan||Up to Rs.10 Lakhs||For children : 91 days, Adults: 18 years to 65 years||1 year|
|Star Comprehensive Insurance Policy||5/7.5/10/15/20/25 Lakhs||For children : 16 days old, Adults: 18 years to 65 years||1 year|
|Aditya Birla Activ Assure Diamond Plan||Up to Rs.50 Lakhs||5 years to 65 years||2 to 3 year|
|SBI Arogya Premier Policy||INR 10,00,000 up to INR 30,00,000||For children : 91 days, Adults: 18 years to 65 years||1, 2 & 3 years|
|SBI General Arogya Plus Policy||Rs. 1,00,000, Rs. 2,00,000 and Rs. 3,00,000||For children : 91 days, Adults: 18 years to 65 years||1, 2 & 3 years|
|Bajaj Allianz Health Guard Family Floater Plan||2 Lakh - 10 Lakh||For children : 91 days, Adults: 18 years to 65 years||1 year|
|Oriental Bank Mediclaim Policy||1 Lakh - 10 Lakh||3 months to 79 years||1 year|
|National Insurance Parivar Mediclaim||2 Lakh to 5 lakh||18 years to 65 years||1 year|
Disclaimer: The above information has been sourced from the Insurance Company's Website.
The most common exclusions under health insurance are:
What is Health Insurance Portability?
Health insurance policies are portable, which means the policyholder can transfer 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”.
Policyholder Should Know About IRDAI Regulations
Here are a few IRDAI regulations which a policyholder should be aware of:
Proposal for insurance
Matters to be stated in life insurance policy
Matters to be stated in general insurance policy
Matters to be stated in a health insurance policy
Free look cancellation of life insurance policies
General principles governing issuance of general and health insurance policies
Claims procedure in respect of a life insurance policy
Claim procedure in respect of a general insurance policy
Claim procedure in respect of a health insurance policy
Grievance redressal procedure
|HDFC Ergo Health Suraksha Gold Plan|
|Care Health Insurance Plan (formerly Religare)|
|Star Family Health Optima Plan|
|Max Bupa Health Companion Individual Plan|
|Apollo Munich Optima Restore Plan|
|NAME OF HEALTH INSURANCE COMPANY||INCURRED
(2018 - 2019)
|HDFC ERGO Health Insurance previously Apollo Munich Health Insurance||62%||10000+|
|Bajaj Allianz Health Insurance||85%||5700+|
|Aditya Birla Health Insurance||59%||5700+|
|Star Health Insurance||63%||6000+|
|National Health Insurance||107.64%||6000+|
|ManipalCigna Health Insurance||NA||4000+|
|New India Health Insurance||103%||1200+|
|ICICI Lombard Health Insurance||76%||5025+|
|Care Health Insurance (formerly Religare)||55%||4500+|
|United India Health Insurance||110.51%||7000+|
|HDFC ERGO Health Insurance||52.58%||10000+|
|LIC health insurance||NA||NA|
|Reliance Health insurance||94%||4000+|
|Raheja QBE Health Insurance||33%||2000+|
|Oriental Health Insurance||108.80%||4300+|
|TATA AIG health insurance||78%||3000+|
|Cholamandalam Health Insurance||35%||2600+|
|IFFCO TOKIO Health Insurance||102%||3000+|
|Royal Sundaram Health Insurance||61%||3000+|
|Bharti AXA Health Insurance||89%||4500+|
|Max Bupa Health Insurance||54%||3500+|
Network Hospital List Last updated on 14th September 2020.
Disclaimer: The above information on Incurred Claim Ratio has been sourced from IRDAI’s Annual Report (2018-19). The cashless network hospital information has been collated from Insurance Company's Website
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.
Pre-Hospitalization Expenditures: Coverage extends to medical expenses incurred between 30 to 60 days earlier than hospitalization is included. (Clinical diagnostic tests, medication, etc.) Hospitalization expenditures include costs incurred for the duration of hospitalization for a minimal duration of 24 hours. Expenses generally blanketed are clinic room rent charges, operation theatre charges, ICU charges, doctors’ consultation fee, surgical operation charges, and other crucial fees like blood, anesthesia, 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.
Critical Illnesses Cover: Some critical illnesses which can be normally blanketed with the aid of medical health insurance agencies are cancer, heart attack, coronary artery disease, stroke, paralysis, essential organ transplant, persistent lung disease, Parkinson’s, etc.
Secure Health and Finances: Majority of the health-associated expenditures in India are borne out-of-pocket. A lot of people rely heavily on their financial savings, and sometimes even borrow money, to fund medical remedies. Health coverage products are designed to make certain that one's savings does now not dwindle on the grounds that the insurance agency will endure this cost. With medical health insurance, one can gain from quick cashless remedy, clinical/medical reimbursement, emergency ambulance cover and each day cash for the duration of hospital stay.
Tax Benefits: The premium paid towards a health insurance coverage qualifies for tax deduction as per Section 80D of the Income Tax Act, 1961. A taxpayer (less than 60 years of age), who has availed a medical insurance policy for himself/herself and dad/mom (senior citizens) can claim a tax deduction as much as Rs. 75,000. Policyholders (above 60 years) who're paying health insurance premium for self and dad/mom can claim up to Rs. 1,00,000 under Section 80D of the Income Tax Act, 1961.
Alternate Treatment Coverage: A medical insurance policy will cover costs associated with medical treatments in hospitals. However, from time to time there are conditions where alternate remedies, consisting of Ayurveda, homeopathy, etc. Some of the fine medical insurance policies within the market provide insurance for such treatments. This offers the insured more flexibility on the form of clinical/medical treatment the individual would prefer 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”.
Zero sub-limits: Unlike an indemnity health insurance plan, a fixed medical insurance plan doesn't have any sub-limits on obligatory co-payment, room hire capping etc. So, the insured has the leverage to control the finances within his/her requirement. This is relevant when the policyholder moves from one insurer to any other and also from one plan to another with the same insurance provider.
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.
Below are some factors that make the purchase of an effective health insurance policy essential for everyone:
Cover for outpatient department (OPD) is a recent feature presented as part of medical health insurance guidelines via some insurance coverage providers. Health insurance plans with OPD insurance will take care of doctor’s session fees, pharmacy bills, health check-ups, dental remedy, diagnostic tests, etc. The more premium paid for availing the OPD cover is eligible for tax deduction as per Section 80D of the Income Tax Act, 1961.
Most medical insurance organizations provide cashless facilities. Under such an arrangement, the insured individual does not make any out-of-pocket bills in case of hospitalization. The medical bills can be settled with the aid of the TPA directly with the health facility. In order to avail of this gain, it's far essential that the person gets admitted at one of the insurer’s network hospitals.
Fixed medical health insurance plans are pocket-friendly premium wise. You are not required to shell out a large quantity of money in terms of the annual premium. The competitive pricing makes these plans less expensive.
Under this agreement, the insurer pays the insured a fixed and warranted sum insured amount in lump sum payout. It solely relies upon at the insured how to make use of the sum insured
Today, more than 50 million users around the world prefer online shopping. It has made buying everything simple, secure, and cheap. You can buy almost everything online, and health insurance also has earned a place in people's basket.
Gone are the days when you had to visit an insurance agent as per his availability and buy from the limited options presented by him. Try to figure out the meaning of complex insurance terms, and not understand the true meaning of most of them. Get tangled up in time-consuming paperwork.
With Coverfox here to help you buy health insurance online, all you need is just a few minutes and a credit/debit card or internet banking facility. Hence, buying insurance online has become a preferred method of protecting one's health for millennials.
So, what are the Advantages of Buying Health Insurance Online you ask:
Save on time: Investing in a health insurance plan online saves up on the effort of meeting an agent and time spent in 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. Hence, there is no chance that your agent can hide or forget to share any information with you. Any information that you might require is readily available on an all exhaustive platform online.
Comparison of health insurance plans: The advent of internet technology has made our lives so much simpler. With the help of online insurance brokers, you can easily compare health insurance plans, select one that suits their needs, and do not burn a hole in his pocket.
Premium Calculator: Tools such as a health insurance premium calculator are readily available online. It makes premium calculation extremely convenient for the insured and efficiently plan his budget accordingly. Reduced premium amounts: A few companies offer lower premiums if you buy a health insurance policy online. As agents are not involved in this process, the company is now capable of providing a lower premium rate to get insured individuals on board and retain them.
Online health insurance renewal is a simple, hassle-free and paperless process. Mentioned below are the steps to do the same.
Visit the official website of your health insurance policy provider and select the tab ‘online renewal’
Provide the basic details such as policy number, KYC, expiry date, etc.
Make the payment via debit/credit/net banking
Post payment, your policy will be successfully renewed and the policy document will be emailed to your registered email id
If you want to check the status of your policy, simply login with your registered username and password and check the same.
Policyholder: The minimum entry age varies between 18 years and 21 years, depending on the insurance company. The maximum entry age varies between 60 years and 100 years, with the flexibility of renewal being extended to whole life.
Dependents: Spouse, children and parents are referred to as dependents of the policyholder. The entry age for children starts from 90 days till 18 years or 25 years, depending on insurers.
Renewability: Health insurance policies can generally be renewed for the entire life, but this again varies from one insurance company to the other. After a certain age, medical tests maybe recommended and companies may ask for higher premium rates.
Pradhan Matri Suraksha Bima Yojana – This government-backed scheme extends its benefits to economically underprivileged sections of the Indian society, financially securing them with a sum assured of up to Rs. 2 lakhs. This scheme is designed to financially protect individuals and families against death, and partial and total disability.
Ayushman Bharat by Government of India / Pradhan Mantri Jan Arogya Abhiyaan – Launched by the Government of India, Ayushman Bharat is an ambitious scheme aimed at offering health insurance benefits of up to Rs. 5 lakhs to 50 crore people who belong to underprivileged families throughout India. Covering even pre-existing diseases, the health insurance benefits can be availed at government as well as private hospitals.
Rashtriya Swasthya Bima Yojana – This scheme is especially designed by the Government of India for financially protecting unorganized workers from health concerns arising from disability, maternity, old age, etc. this scheme has been launched by the Ministry of Labour and Employment under the Central Government, backed by the Unorganized Workers Social Security Act (2008).
Universal Health Insurance Scheme – An initiative of the Government of India that was introduced in 2003, serves the objective of providing quality healthcare to Indian families below as well as above the poverty line, especially BPL families.
Bhamashah Swasthya Bima Yojana by Government of Rajasthan – Initiated by the Government of Rajasthan, it was introduced to offer IPD patients the benefit of cashless medical treatment. It serves the objective of ensuring financial protection for the treatment of illnesses. It also helps in creating a health database, streamlining processes for any changes in data that may be required in the future. Families covered under the National Food Security Act, and Rashtriya Swasthya Bima Yojana are eligible for this scheme.
Yeshasvini Health Insurance Scheme by Government of Karnataka – Introduced by the former chief minister of Karnataka in the year 2013, the scheme is aimed at ensuring inexpensive medical treatments to farmers throughout the state. It is specifically tailor-made for farmers of the cooperative society and belonging to the lower middle income and middle income groups. It financially covers them against illnesses like orthopaedic surgeries, paediatric surgeries, neurosurgery, surgical oncology, angioplasty, neurosurgery, neonatal intensive care, among others.
Mukhyamantri Amrutum Yojana by Government of Gujarat – Initiated by the Government of Gujarat, this health coverage scheme offers financial benefits on medical treatments, surgeries and hospitalization. Financed entirely by the government, this can be availed by all families with an annual income of less than Rs.1.5 lakh. This scheme offers a cover of Rs.2 lakh per family of 5 members. West Bengal Cashless Medical Treatment Scheme – Launched in 2014 by the Government of West Bengal, as evident from the name, it is aimed at offering cashless medical benefits of a maximum of Rs. 1 lakh to employees as well as pensioners of the state government. These benefits can be availed by all their family members and at all network hospitals under this scheme.
Mahatma Jyotiba Phule Jan Arogya Yojana – This scheme, renamed from Rajiv Gandhi Jeevandayee Arogya Yojana scheme in 2017 by the Government of Maharashtra, is an effort to extend free and quality healthcare services to inhabitants of below poverty line in the state. It plans to introduce the scheme to underprivileged section of the society, that is, those who are holders of a Yellow or Orange Ration Card.
Chief Minister’s Comprehensive Health Insurance Scheme – Introduced by the Government of Tamil Nadu, it is specifically customized to offer the benefits of comprehensive health insurance to economically underprivileged sections of the society. Offered in collaboration with United India Insurance Company Ltd., one of the pioneers in health insurance in India, this scheme reaches out to more than 1 crore households in the state. It offers medical treatments, follow-up check-ups, and cashless benefits at public and private sector hospitals.
Rajiv Aarogyasri by Government of Andhra Pradesh – Tailor-made for inhabitants of the state who are below the poverty line, it offers claims of up to Rs. 1.5 lakh on individual and family health insurance plans available on a family floater basis. An additional amount of up to Rs. 50,000 can be availed in case the medical treatments and surgeries exceed Rs. 1.5 lakh. It offers the special benefit of offering coverage on pre-existing diseases as well, a feature that health insurance plans usually do not cover.
Biju Swasthya Kalyan Yojana by Government of Odisha – This scheme has been introduced by the Government of Odisha and named after a former Chief Minister of the state, Shri Biju Patnaik. It covers medical treatments worth up to Rs. 5 lakh per family and Rs. 7 lakh for women. It is aimed at 70 lakh families.
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 x2
|What is Incurred Claim Ratio?||What is Claim Settlement Ratio?|
In current years, improvements in medical advances has made it feasible to cure illnesses and sicknesses that had once been considered incurable. However, the prices related to them are pretty high, making it hard for median class families to find the money for them. According to various studies, medical inflation is expected to skyrocket in the coming years which would imply that health care fees will see an increase. In order to provide a solution to this, insurance corporations have designed different types of medical health insurance plans, available at cheap premium rates. This makes available healthcare inexpensive for all.
Below are some factors that make the acquisition of an effective medical health insurance policy essential for everyone:
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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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.
Health insurance premiums are determined after taking into consideration factors like age, family medical history, pre-existing medical conditions, Body Mass Index and smoking habits, among others. Additionally, the type of coverage, sum insured and members covered under a policy have an impact of the premiums payable.
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.
Yes, health insurance plans can be ported to another insurer.
Co-pay is a clause in the health insurance policy that underlines that the insured will have to share the claim burden and co-pay a pre-determined amount.
Yes, maternity is covered under health insurance plans. In fact there are special health insurance plans by many insurers that take care of medical expenses related to maternity.
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.
Yes. Mostly, health care and health insurance is referred to as the same thing.
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.
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