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Health Insurance

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


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


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

What is Health Insurance?

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.

What is Covered

Customize your Health Insurance
  • Zero Depreciation Cover

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

  • Engine Protection

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

  • NCB Protection

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

  • Invoice Cover

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

Compare Health Insurance Before you Buy

There are a number of web insurance aggregators such as Coverfox that help you compare the best health insurance plans for you and your family. Certain parameters that should be considered while comparing medical insurance plans include the features of the health insurance plan, the add on benefits offered by the insurance provider, the sum insured under the policy and the network of hospitals allied with the insurance provider. These factors not only are a major differentiating factor from their competitors, but are also a testament of good service to their end customer. 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:
Assess if the cover and sum assured are suitable against the premium paid. Choose add-ons as per your needs.
Be sure of the insurer's network hospitals in your area. You can avail of cashless services only at these hospitals.
Since hospital room rents vary, some insurance plans pay only a part of the actual rent. It's always best to go for higher or no room-rent limit plans.
Check what is permanently excluded and which treatments are possibly covered after waiting for a certain period.

Features of Health Insurance

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.

Benefits of Health Insurance

Secure Health and Finances: Majority of the health-related expenditures in the country are borne out-of-pocket. A lot of people rely heavily on their savings, and sometimes even borrow money, to fund medical treatment. Health insurance products are designed to ensure that one's savings does not dwindle since the insurance company will bear this cost. With 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”.

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.

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).

Cost of Medical Treatment

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:

  • Life is uncertain and health issues may occur anytime, thereby creating a financial burden for the insured’s family to arrange for finances at short notice or no notice at all
  • Keeps you financially prepared well in advance, despite rising expenses of medical treatments and hospitalization
  • Offers financial protection against most expenditures associated with health and medical treatments
  • Cashless facility offered by insurance companies at their network hospitals enables the insured to overcome the hassles of making payments at the time of hospitalization
  • The insured can focus on speedy recovery, while the insurance company takes care of the incurred expenses

Benefits of Buying Health Insurance Online

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

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

Documents Required for Buy Medical Insurance Policy

  • 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

Give a Guide to The Online Renewal Process of Health Insurance

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.

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

HDFC ERGO Health Insurance (previously Apollo Munich Health Insurance)
  • Optima Plus Plan
  • Dengue Care Plann
  • Health Wallet Plann
  • Optima Senior Plann
  • Easy Health Plann
  • New iCan Cancer Insurance Plann
  • 62.47%10000+
    Bajaj Allianz Health Insurance
  • Individual Health Insurance Plans
  • Health Guard
  • Critical Illness Insurance Policy
  • Extra Care Plus Policy
  • M-Care Health Insurance Policy
  • 77.61%5700+
    Aditya Birla Health Insurance
  • Aditya Birla Activ Health Enhanced
  • Aditya Birla Activ Health Essential
  • Aditya Birla Activ Secure - Personal Accident Plan
  • Aditya Birla Activ Secure - Critical Illness
  • Aditya Birla Activ Secure - Hospital Cash
  • Aditya Birla Activ Secure - Cancer
  • Aditya Birla Group Activ Health
  • 89.05%5700+
    Star Health Insurance
  • Senior Citizens Red Carpet
  • Family Health Optima
  • Star Super Surplus Insurance Policy
  • Star Family Delite Insurance Policy
  • Star Special Care
  • Star Criticare Plus Insurance Policy
  • 60.51%6000+
    National Health Insurance
  • National Parivar Mediclaim
  • National Mediclaim Policy
  • National Mediclaim Plus Policy
  • National Parivar Mediclaim Plus
  • Overseas Mediclaim Business and Holiday
  • 115.55%6000+
    ManipalCigna Health Insurance
  • ProHealth Policy
  • ProHealth Protect
  • ProHealth Plus Insurance Plan
  • ProHealth Preferred
  • 46.29%4000+
    New India Health Insurance
  • Asha Kiran
  • New India Top-up Mediclaim
  • Family Floater Mediclaim Policy
  • Janata Mediclaim Policy
  • New India Floater Mediclaim
  • New India Mediclaim Policy
  • 97%1200+
    ICICI Lombard Health Insurance
  • Complete Health Insurance
  • Health Booster
  • Personal Protect Policy
  • 68.26%5025+
    Religare Health Insurance
  • Religare Care Plan
  • Religare Joy Plan
  • Religare Freedom Plan
  • Religare Enhance Plan
  • Religare Assure Plan
  • Religare Secure Plan
  • 51.97%4500+
    United India Health Insurance
  • Family Medicare
  • Individual Mediclaim
  • Super Top-Up
  • 110.95%7000+
    HDFC ERGO Health Insurance
  • HDFC Health Suraksha Insurance policy
  • HDFC Health Suraksha Gold Insurance policy
  • HDFC Health Suraksha Regain Insurance policy
  • Critical Illness Insurance policy
  • 52.58%10000+
    SBI Health Insurance
  • Arogya Plus Policy
  • Arogya Top Up
  • Hospital Daily Cash Plan
  • Critical Illness Plan
  • Arogya Premier Policy
  • 52.93%24000+
    LIC Health Insurance
  • LIC's Jeevan Arogya
  • LIC's Cancer Cover
  • 98.33%NA
    Reliance Health insurance
  • Reliance HealthGain
  • Reliance Personal Accident Insurance Policy
  • Reliance Critical Illness Insurance Policy
  • Senior Citizen Health Insurance Plan
  • Cashless Health Insurance Policy
  • 106.54%4000+
    Raheja QBE Health Insurance
  • Raheja QBE Health Insurance plan
  • Basic Plan
  • Comprehensive Plan
  • Super Saver Plan
  • A La Carte Plan
  • Cancer Health Insurance
  • 18.19%2000+
    Oriental Health Insurance
  • Individual Mediclaim Health Insurance
  • Group Mediclaim Policy
  • Jan Arogya Bima Policy
  • Personal Accident Policy
  • Janata Personal Accident Policy
  • Nagrik Suraksha Policy
  • Happy Family Silver Plan
  • Happy Family Gold Plan
  • 113.86%4300+
    TATA AIG Health Insurance
  • Injury guard, Maharaksha – Mediclaim Insurance Policy
  • MediPrime – Cashless Health Insurance
  • Wellsurance Executive
  • MediRaksha – Affordable Health Insurance Plan
  • Individual Accident and Sickness Hospital Cash
  • Accident guard, MediPlus- Top-up Medical Health Insurance
  • MediPrime – Cashless Health Insurance
  • Wellsurance Family
  • MediPlus- Top-up Medical Health Insurance
  • MediRaksha – Affordable Health Insurance Plan
  • Secured Future Plan
  • MediSenior – Senior Citizen Health Insurance Policy
  • 60.68%3000+
    Cholamandalam Health Insurance
  • Value Health Line
  • Freedom Health Line
  • Enrich Health Line
  • Standard Health Line
  • Superior Health Line
  • Advanced Health Line
  • Chola Tax Plus Health Line
  • Chola Top-up Health Line
  • Chola Hospital Cash Health Line
  • Chola MS Standard Critical Health Line
  • 39.96%2600+
    IFFCO TOKIO Health Insurance
  • Base Plan
  • Base Plan Plus Critical Care
  • Health Protector
  • Individual Personal Accident Insurance policy
  • Health Protector Plus
  • Swasthya Kavach Policy Base Plan
  • Swasthya Kavach Policy Wider Plan
  • 90.69%3000+
    Royal Sundaram Health Insurance
  • Lifeline Health Insurance Plans
  • Supreme Lifeline Health Insurance
  • Elite Lifeline Health Insurance
  • Family Good Health Insurance Plan
  • Royal Smart Cash Plan Insurance
  • 61.41%3000+
    Bharti AXA Health Insurance
  • Bharti AXA SmartHealth Basic Policy
  • Smart Super Health Insurance Plan
  • Smart Health Insurance Plan
  • Bharti AXA SmartHealth Premium Policy
  • Bharti AXA SmartHealth Optimum Policy
  • Bharti AXA SmartHealth Critical Illness Insurance
  • 98.50%4500+
    Max Bupa Health Insurance
  • Health @ Companion - Silver
  • Health @ Companion- Gold
  • Heartbeat- Gold Policy
  • Heartbeat- Platinum Policy
  • Heartbeat- Silver Plan
  • Family First- Silver Policy
  • Family First- Gold Policy
  • Family First- Platinum Policy
  • Employee First Classic Health Insurance Plan
  • Group Personal Accident
  • 50.19%3500+
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    Types of Health Insurance Plans in India

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

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

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

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

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

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

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

    Top Selling Health Insurance Plans With Coverage

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

    Health Insurance Schemes by Government of India and Various States

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

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

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

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

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

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

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

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

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

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

    Difference Between Health Insurance and Critical Illness Insurance

    Health InsuranceCritical 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.

    Difference Between Health Insurance and Term Insurance

    Health InsuranceTerm 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.

    Difference Between Health Insurance and Mediclaim Policy

    Health InsuranceHealth Insurance
    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.
    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.

    Difference Between Individual Health Insurance and Family Health Insurance

    Individual Health InsuranceFamily 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.

    Difference Between Government Health Insurance and Private Health Insurance

    Government Health Insurance SchemesPrivate 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 Claim Process

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

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

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

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

    Q. Who is Eligible for Medical Insurance?

    • 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.</p>

    Q. 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.

    Q. Are children covered in health insurance plans?

    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.

    Q. What is co-pay?

    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.

    Q. Is maternity covered under health insurance plans?

    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.

    Q. 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.

    Q. Can Health Insurance Policies Be Ported?

    Yes, health insurance plans can be ported to another insurer.

    Q. 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.

    Q. 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.

    Q. Is health care and Health insurance the same thing?

    Yes. Mostly, health care and health insurance is referred to as the same thing.

    Q. 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.

    Q. 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.

    Q. What is the average health insurance cost?

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

    Q. 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.

    Q. How does it work benefits of health insurance plans?

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

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

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

    Q. 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.

    Customer Reviews
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    Ajay raj
    Good info
    Nice info.......
    18 Feb
    Ashwini S
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    Need to improve information
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    Multiple policy in one place
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