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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 irrespective of age, gender or lifestyle. Since it cannot be predicted, one can always be organized for it. Health Insurance protects absolutely everyone in your own family against economic loss from the unexpected. It is a settlement among you and your insurance company, wherein for an annual premium, the insurer can pay your hospitalization and other medical/clinical expenses as referred in your policy.

BASIC HEALTH PLAN

This plan affords for the hospitalization expenses you might face in case of accidents, day-care procedures, surgical remedies or critical illnesses. However, the features, limits and sum insured will range from insurer to insurer.

SUPER TOP-UP HEALTH PLAN

Similar to top-ups for mobile network services, this adds supplementary insurance cover for your existing health plan. The intention is to increase the average sum insured with its corresponding insurer by paying an additional premium.

What is Health Insurance?

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.

What is Covered

Customize your Health Insurance
  • Zero Depreciation Cover
    HOSPITALIZATION

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

  • Engine Protection
    PRE & POST HOSPITALIZATION

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

  • NCB Protection
    DAY CARE PROCEDURES

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

  • Invoice Cover
    ACCIDENT COVER

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

Compare Health Insurance/Medical 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:
PREMIUM VS COVERAGE
PREMIUM VS COVERAGE
Assess if the cover and sum assured are suitable against the premium paid. Choose add-ons as per your needs.
NETWORK HOSPITALS
NETWORK HOSPITALS
Be sure of the insurer's network hospitals in your area. You can avail of cashless services only at these hospitals.
ROOM RENT LIMIT
ROOM RENT LIMIT
Since hospital room rents vary, some insurance plans pay only a part of the actual rent. It's always best to go for higher or no room-rent limit plans.
EXCLUSIONS
EXCLUSIONS
Check what is permanently excluded and which treatments are possibly covered after waiting for a certain period.

Features of Health Insurance

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.

Domiciliary Hospitalization: Medical charges incurred because of remedies undertaken at domestic for a duration of greater than three days.

Expenses for Organ Donation: Some health insurance plans cover medical charges incurred within the process of organ donation. If you're being donated an organ, your donor may be financially secured by way of your medical health insurance plan.

Day Care Procedures: Day care methods or medical treatments like dialysis, angiography, radiotherapy, chemotherapy, appendectomy, colonoscopy, lithotripsy, hydrocele, eye surgical procedure, amongst others. Certain high-end medical health insurance plans cover all day care treatment techniques.

AYUSH Treatment: Alternative clinical remedies or AYUSH, which stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy are covered for policyholders who've opted for it.

Hospital Cash: Daily expenses for food, health center stay, etc. which might be incurred by way of your caretaker in the course of your hospitalization may be provided on medical health insurance plans or can be available as a rider. Health insurance plans also provide compensation for the loss of income because of health issues.

Ambulance Cover: Health insurance policies cover expenses for ambulance service.

Check-ups: General fitness check-ups are included with the umbrella of some health insurance plans.

Vaccinations: Certain medical insurance plans cover vaccination fees for bee stings, dog bites, etc.

Emergency Evacuation: Under emergency conditions whilst a patient needs to be transferred from one health facility to another, health insurance plans cover prices involved inside the relocation process.

Additional Features of Health Insurance
Choose The Right IDV
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.
Avail No Claim Bonus
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.
Install security devices
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.
Become AAI Member
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.

Benefits of Health Insurance

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).

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
  • Additional Benefits of Health Insurance
    • Zero Depreciation Cover
      OPD Expense Coverage

      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.

    • Engine Protection
      Cashless Treatment

      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.

    • NCB Protection
      Pocket-friendly Plan

      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.

    • Invoice Cover
      Lump sum pay Out

      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

    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/Medical 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.

    Who is Eligible for Health Insurance/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.

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

    NAME OF HEALTH INSURANCE COMPANYBEST HEALTH INSURANCE PLANSINCURRED
    CLAIM RATIO
    (2017 - 2018)
    NETWORK
    HOSPITALS
    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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    Service Managers who assist you with all your post-sale requirements - from claims processing to renewals! They are like superheroes, but only better.
    Post sales assistance

    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
  • DAY CARE TREATMENTS
  • POST HOSPITALIZATION
  • PRE-EXISTING ILLNESSES
  • 1, 2 years
    Religare Joy Plan 3 Lakh to 5 lakhFor children : 1 day - 90 days, Adults: 18 years to 65 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 3 years
    Star Family Health Optima Plan2/3/4/5/10/15 lakhsFor children : 16 days old, Adults: 18 years to 65 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 1 year
    Religare Care Plan2/3/4/5/7/10/15/20/25/50/60 Lakh18 Years to No Limit
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 1, 2 & 3 years
    Oriental Happy Family Floater Mediclaim PlanUp to Rs.10 LakhsFor children : 91 days, Adults: 18 years to 65 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 1 year
    Star Comprehensive Insurance Policy5/7.5/10/15/20/25 LakhsFor children : 16 days old, Adults: 18 years to 65 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 1 year
    Aditya Birla Activ Assure Diamond PlanUp to Rs.50 Lakhs5 years to 65 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 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
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 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
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 1, 2 & 3 years
    Bajaj Allianz Health Guard Family Floater Plan 2 Lakh - 10 LakhFor children : 91 days, Adults: 18 years to 65 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 1 year
    Oriental Bank Mediclaim Policy1 Lakh - 10 Lakh3 months to 79 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 1 year
    National Insurance Parivar Mediclaim 2 Lakh to 5 lakh18 years to 65 years
  • DAY CARE TREATMENTS
  • NO-CLAIM BENEFITS
  • PRE and POST HOSPITALIZATION
  • 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.

    Factors Not Covered Under Health Insurance

    The most common exclusions under health insurance are:

    • Pre-existing medical conditions
    • Alternative therapies - AYUSH
    • Lifestyle related conditions
    • Cosmetic treatments
    • Pregnancy and childbirth
    • Diagnostic expenses
    • Dental, hearing, and vision
    • Injuries caused due to suicide attempt
    • Injuries due to war, HIV, intentional injuries, congenital diseases, and others are permanent exclusions
    • Participation in military operations
    • Participation in extreme sports

    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
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    Difference between ICR (Incurred Claim Ratio) and CSR (Claim Settlement Ratio)

    What is Incurred Claim Ratio?

    Incurred Claim Ratio is the proportion of claims that is paid out against the total amount of premiums received by the health or general insurance provider. For example, if an insurer had approved a total claims of Rs. 60 crores in the year 2019 against the premiums received amounting to Rs.100 crores, the ICR is 60% in 2019.

    What is Claim Settlement Ratio?

    Claim Settlement Ratio is the proportion of the claims that is approved or settled against the total number of claims that the life insurance company had received in a single financial year. For example, if an insurer approves the claims amounting to Rs

    Checklist Before Buying Health insurance Policy

    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:

    • Life is unsure and fitness issues may arise anytime, thereby growing a financial burden for the insured’s own family for medical expenses
    • Keeps you financially organized well in advance, despite rising costs of medical treatments and hospitalization
    • Offers economic safety against most expenditures related to health and medical treatments
    • Cashless facility offered with the aid of insurance organizations at their network hospitals permits the insured to overcome the hassles of making payments on the time of hospitalization
    • The insured can focus on rapid recovery, even as the insurance plan looks after the incurred fees
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    With 25 insurers and 100+ products to choose from, Coverfox works actively to find a plan that is ideal for you—basically, the best one, the right one. From providing you with all the right information to offering unbiased comparisons, we do it all. Hey, you don't even need to engage with the insurer yourself.

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    Health Insurance FAQ's

    FAQs on Health Insurance

    Q. What are overseas health insurance policies?

    Ans: 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?

    Ans: 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?

    Ans: 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?

    Ans: 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. Can Health Insurance Policies Be Ported?

    Ans: 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?

    Ans: 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?

    Ans: 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?

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

    Q. Without compromising on the renewal benefits, can the existing health insurance Plan be transferred to another insurer?

    Ans: 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?

    Ans: 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?

    Ans: 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?

    Ans: 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.

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