Here is a list of some common features of health insurance policies:
Premiums: Premium is the regular payment that the policyholder needs to make in order to keep the health insurance coverage active for the specified policy term. Insurance premiums depend on the policy type, coverage, insured’s age and many other factors.
Waiting terms: Insurance providers do not offer health insurance benefits as soon as the policy is acquired. There is a 30-day initial waiting period where the insured cannot file claims except for accidental claims. Apart from that, there are specified waiting periods for pre-existing diseases and other medical conditions.
Sub-limits: Most insurance companies set limits on their coverages. For example, you can get a health insurance plan with INR 5 lakhs of the sum insured, but the policy can set a sub-limit on hospital room rent to 1% of the entire sum insured, i.e., INR 5,000.
Co-payments: Co-payment provisions allow the insured person to reduce his or her insurance premium in return for contributing a specified proportion of the sum covered at the time of claim filing. Co-payments can be either voluntary or mandated by the insurance policy.
No-claim bonus: No-claim bonus is a monetary benefit that an insurance provider provides to insured individuals if they do not file any claim for a policy year. When you renew health insurance plans, this bonus will be awarded as either a discount on the premium or an increase in the total sum insured.
Medical check-ups: Most health insurance providers offer medical check-ups as a part of their insurance coverage. Some policies offer free healthcare check-ups as a part of their annual no-claim benefit.
Exclusions: Just like any other insurance plan, health insurance plans include a list of policy-specific exclusions. These are conditions when the insurance company will not be obligated to settle any health insurance claims with the insured.
Network hospitals: Network Hospitals are medical facilities which are affiliated with insurance providers and offer cashless treatment to active policyholders of the same company.
Here are some benefits when shopping for health insurance online:
Here is a list of health insurance coverages:
Note: These are generic coverage of health insurance plans. Please refer to your health insurance provider for a complete coverage list of your plan.
Here is a list of health insurance exclusions:
Note: These are generic exclusions of health insurance plans. Please refer to your health insurance provider for a complete exclusion list of your plan.
An incurred claim ratio can be defined as a ratio of the overall claim amount settled by any insurance provider over the overall premium amount collected by the company during a financial year.
For example, ABC Ltd. is an insurance company. The company collected a total of INR 120 lakhs during the financial year 2021-22 as insurance premiums. During the same year, the company settled insurance claims valuing up to a total of INR 90 lakhs. So, for the financial year 2021-22, the incurred claim ratio of ABC Ltd. will be 75%.
This incurred claim ratio reflects the insurance provider's financial health during the year. It demonstrates the company's financial ability to settle an insurance claim. If the incurred ratio goes above 100%, it means the company is currently giving out more claims than the money it is receiving as a premium. In the same way, if the ratio falls below 50%, it means the company is not actively settling insurance claims compared to the premium it is receiving.
There are 21 private health insurance providers and 4 public health insurance providers in India. Here is a list of them:
Private Health Insurance Providers | Incurred Claim Ratio (FY 2021-22) |
---|---|
Public Health Insurance Providers | Incurred Claim Ratio (FY 2021-22) |
---|---|
There are 7 standalone health insurance providers in India. Here is a list of them:
Standalone Health Insurance Providers | Incurred Claim Ratio (FY 2021-22) |
---|---|
Varied health insurance companies have different rules regarding policy qualification. Here are some factors that play an important role in determining your eligibility for a health insurance plan.
Health insurance premium rates depend on various factors, some of them are:
Income Tax Act Section 80D offer tax benefits on the total premium paid to active health insurance policyholders. The tax deduction limit is set at INR 50,000 for individuals of or above 60 years of age and INR 25,000 for those under the age of 60 years. These individuals also receive a preventive healthcare tax break of INR 5,000.
Now, if you have a senior citizen in your health insurance plan, you can receive tax deductions up to INR 75,000 (INR 25,000 + 50,000). Similarly, if you are two senior citizens in a policy, you will have entitled to INR 1 lakh (INR 50,000 + 50,000) as a tax deduction under Section 80D.
In order to port your active health insurance policy, you have to inform both companies before your upcoming date of policy renewal. Your active health insurer needs to be informed at least 25 before your renewal date along with a portability application. The company will respond to your application within 72 hours.
It is important to note that there are zero porting fees involved with the process. However, your ongoing health insurance plan should have a clean history of scheduled policy renewals.
Here is a list of government-initiated health insurance schemes:
1). RSBY or Rashtriya Swasthya Bima Yojana
The Rashtriya Swasthya Bima Yojana is designed to offer healthcare coverage to people who are working in the unorganised industries of the nation.
Features:
The Bhamashah Swasthya Bima Yojana is a medical insurance scheme launched by the Rajasthan Government on December 2015.
Features:
The scheme offers a sum insured of INR 30,000 for general illnesses and INR 3 lakhs for specified critical illnesses
The government of Maharashtra launched the Mahatma Jyotiba Phule Jan Arogya Yojana to offer healthcare cover to financially vulnerable families which includes yellow, orange and red ration cardholders along with kids in government orphanages, people living in a senior citizen home and others.
Features:
Government officials and employees receive healthcare coverage under the Central Government Health Scheme launched by the Indian government.
Features:
Pradhan Mantri Suraksha Bima Yojana is a medical insurance scheme which offers lumpsum payments to individuals between 18 to 70 years who have an Aadhaar card and are active bank account holders.
Features:
Employees' State Insurance Scheme is a health insurance scheme which is available for workers who earn INR 21,000 per month or those with current disabilities and earn less than INR 25,000.
Features:
The Aam Aadmi Bima Yojana is an accidental health insurance scheme which offers a component of life cover. The coverage is designed for a family’s sole earner or the family head who is diagnosed with any of the 48 listed professions.
Features:
The Pradhan Mantri Jan Arogya Yojana offers an annual INR 5 lakh coverage for each family for tertiary and secondary hospitalisation.
Features:
Corona Kavach Policy is a new insurance policy launched by the government in response to the outbreak of the novel coronavirus. The policy will provide financial protection to those who contract the virus.
The people of India are united in their fight against the Coronavirus pandemic. The government has announced a new policy called the Corona Rakshak Policy. This policy will provide financial assistance to the families of those who have lost their loved ones to the virus.
The Arogya Sanjeevani Policy is a new health insurance scheme launched by the Indian government. It aims to provide health coverage of Rs. 5 lakhs to every family in India. The scheme is designed to be an affordable and comprehensive health insurance policy.
A health insurance plan is a perfect choice for everyone – from students who are just starting out on their careers to professional experts who are in their late forties to fifties. Though the medical insurance that you get from an employer could be sufficient for you to live a healthy life and carry out your daily tasks, having your own insurance is still better. Whether the injuries and illnesses come from natural or man-made reasons, you will be greatly benefited from getting yourself an insurance policy. So, if you haven’t already, start shopping for the best health insurance in India.
The best way to get the highest coverage with medical insurance without splurging is through additional riders. You can add riders as per your needs and enhance your policy coverage.
The minimum age to purchase a health insurance plan is 18 years.
Your policy will lapse or get terminated if you fail to pay your premiums.
There is no limit on how many medical insurance plans you can purchase.
Cashless treatment under health plans ensures that you do not have to pay anything when you get admitted to one of the network hospitals of your health insurance provider.
No, medical insurance is quite affordable. For instance, under a basic health plan with a sum insured of Rs. 5 lakh, you might have to pay a premium of Rs. 5,000 - Rs. 10,000 per year. The premium depends on your age, type of policy, and other factors.
Yes, you can add family members like your spouse, children, parents or parents-in-law under a family floater which offers cover for the entire family.
Every policy comes with a waiting period after which your cover gets activated. The waiting period for most health policies is 30 days but we suggest checking with your insurance provider on the same.
Yes, your health policy will still cover you if you are admitted to a non-network hospital. The only difference is that you will have to pay the bills and then file for reimbursement as opposed to getting cashless treatment.