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Health Insurance

Health Insurance is a form of insurance that covers the cost of surgical and medical expenses of an insured. Any medical emergency that leads to the hospitalization is covered in a health insurance policy.

You can easily avail cashless treatment in one of the network hospitals of the insurance provider. Alternatively, you can get the reimbursement for your money spent on your treatment directly from your insurance provider. Generally, surgery or illness that results in hospitalization comes under insurance coverage of a health insurance plan. Additionally, health plans also help you get tax exemption under section 80D of Income Tax Act, 1961.

With the ever-so-increasing healthcare expenses, having health insurance plan has become important than ever before. In an interview, the chairman of Insurance Regulatory and Development Authority of India (IRDA), Mr. T.S. Vijayan revealed that out-of-pocket medical costs make up for about 62% of all healthcare costs in India. On the other hand, the healthcare expenses in developed countries such as the USA and UK makes up for just 20% of all healthcare costs. Quite naturally, it is imperative for everyone to ensure buying a comprehensive health cover.

  • Importance & Benefits
  • Types of Health Plans
  • Best Health Plans
  • Why Health Insurnace
  • Inclusions & Exclusions
  • Health Insurance Premium
  • How to Claim
  • How to Port
  • How to Renew
  • Why Compare
  • FAQs

Benefits and Importance of Health Insurance Plans

Over the years, everything right from the lifestyle expenses to the cost of education and or medical treatment costs in India has been rising much faster than the inflation. Therefore, it is crucial for you to make investments in a way that you don’t need to face a financial crisis at the time of a medical emergency.

Investing in a health insurance plan makes for one of the best ways to protect self and loved ones against any medical emergencies or medical treatment expenses. Remember, the cost of medical treatments is prohibitive and soon it may become difficult for an average salaried individual to bear the uncalled for costs of medical emergencies. This is where health plan comes to your rescue. It provides you financial security against sudden expenses that may arise due to medical emergencies.

Listed below are just some of the many benefits of buying a health insurance policy in India:

  • Cashless Hospitalization: If you opt to avail medical treatment in one of the network hospitals of your insurance provider, you can avail the benefits of cashless treatment. This means you don’t need to pay for the treatment in your intended network hospital. Instead, your insurance provider will settle the expenses incurred directly with the hospital on your behalf.
  • Critical Illness Cover: There are some policies that are specifically designed to provide coverage for critical illnesses such as cancer, kidney failure, paralysis, etc. However, if you have a pre-defined medical benefits type of plan, then the insurance provider will give you a fixed lump-sum amount upon the confirmation or diagnosis of the enlisted critical diseases. Therefore, irrespective of the amount spent on the treatment of critical illnesses, you will only get a fixed lump sum amount from your insurance company.
  • Tax Benefits: Health plans also help you enjoy tax benefits under section 80D of the Income Tax Act 1961. You can enjoy tax benefits for up to Rs.55, 000. However, to claim this tax benefit, you’ll need to fulfil the below mentioned conditions:
    • You need to an individual or HUF.
    • You must provide the poof of the premium payment.
    • You must have paid the premium amount through a medium other than cash.
  • The benefit of No Claim Bonus: For the past few years, many health insurance companies have been offering No Claim Bonus to its users. To pass on maximum benefits to the policyholders, some insurance companies even offer up to 100% No Claim Bonus.
  • No Age Limit: Gone are the days when there was a maximum age to renew health insurance policies. Now, you can renew your policy throughout your life or can even buy a health plan at any age.
  • Maternity Benefits: Unlike traditional plans, today most of the health insurance plans provide maternity benefits. Some insurance providers even cover vaccination expenses for newborn babies.
  • Option to Switch the Plan: Insurance companies have become so flexible these days that they provide the option to switch your current policy to a plan offered by a different insurer.
  • Option to Purchase a Policy Online: In order to make it easy for people to compare and buy health insurance plans, insurers now sell plans online. This means you don’t need to coordinate with an insurance agent in order to buy a health cover for self and family members.

Types of Health Insurance Plans in India

The most suitable health insurance plan is the one that offers optimum financial shield during a medical emergency. Therefore, a little knowledge about the different types of health plans goes a long way in buying the right and perhaps the best plan.Listed below are the different types of medical insurance plans that you can customize as per your need, budget, preferences and requirements:

  • Individual Health Insurance Plan: An insurance plan available only for one person is known as ‘Individual Health Insurance Plan‘. Typically, the premium of this type of plan is not very high and depends upon various factors such as location, age, existing medical conditions, etc. Some common inclusions of this plan are – pre and post-hospitalization care, in-patient care, laboratory expenses, charges of medical examination, consultation fees, maternity expenses, etc.
  • Health Insurance Plans for Senior Citizens: This is the best choice of health plan for people aged 60 years of age. Most such policies have comparatively lower premium rates. Usually, those looking to buy this type of plan are required to undergo complete health check-up.
  • Family Health Plan: Also known as family floater, this plan provides comprehensive coverage to the entire family. Typically, family health plans provide coverage to as many as four members of a family including two adults and 2 dependent children. The segregation of coverage amongst the family members depends upon the insurance plan and insurance provider both. Some family floater plans offer an equal division of coverage, whereas some plans offer a combined sum assured for all family members. Generally, the premium of a family health insurance plan is slightly higher as compared to individual plans. However, family floater plans are more cost effective as you end up saving money by having one policy rather than 4 different individual health insurance plans.
  • Critical Illness Insurance: This policy provides financial coverage against critical illness such as heart attack, kidney failure, cancer, etc. This is perhaps the best health plan for those with a family history of certain, critical diseases. In addition, you can avail critical illness plans as standalone policies or as riders with existing family floater or individual health plans.
  • Employee or Group Health Insurance Policy: A large number of companies offer health insurance coverage to their employees to make the work environment more attractive and employee friendly. Most of the times companies go for group health plans as these plans are designed in a way to exclude and include members as they leave or join the company. The premium payment for these plans is relatively low and inclusions are lenient to cover pre-existing diseases.
  • Maternity Health Insurance Plans: Under this type of health plan, the mother and new-born both are covered. Additionally, pre and post-natal care expenses are also taken care of by the insurance policy. One can take this plan as a standalone policy or attach it as a rider in the pre-existing medical insurance plan. Most of the plans provide end-to-end cover and bear the hospitalization cost in case of some related complication.
  • Personal Accident Cover: Life is uncertain and accidents can occur anytime. To protect one against major or small injury that can put a big dent on one’s pocket, this plan is made. Most of the plans under this section offer compensation in the situation of death, injury, disablement, etc. caused due to any external mean such as violence, hazardous events, etc. Generally, a personal accident policy covers accidents occurred on rail, road, air, and water. This plan can also be taken as a rider or as a standalone policy.
  • Preventive Healthcare Policies: Today’s fast-paced and frenzied lifestyle has added to the ever-increasing cases of stress-related diseases. This is the reason why doctors’ advice taking preventive measures. It is recommended to go for a full body check-up at least once every year. However, these tests are mostly expensive and may result burning hole in one’s pocket. Therefore, it is recommended to opt for preventive health policies for preventive medical measures.
  • Unit Linked Health Plan: A health insurance policy that provides a combination of health insurance with investment is termed as Unit Linked Health Plan or ULHP. It is a comparatively newer phenomenon and offers an opportunity to build a corpus for meeting future financial goals with comprehensive health protection. This unique combination is not provided in any other health insurance policy.

How to Perform Quality Check on a Health Insurance Plan?

One of the most difficult questions that every health insurance prospect comes across is – what to look in a health insurance plan? Well, before buying a health insurance policy, it makes sense to mull over a few important things carefully. Here is a list of just some of the many such things that you must mull over before buying an health insurance plan:

Consider a health insurance plan that:

  • Your intended plan has got good ratings from the experts in the industry. Checking reviews can also give the same understanding.
  • Your intended policy offers wellness program.
  • Your intended policy bears the expenses of post-hospitalization and treatment recovery.
  • Your intended health plan has an extensive list of network hospitals and doctors. An insured must check for the network hospital of the insurance provider in his/her area.
  • It does offer co-payments and sub-limits to get comprehensive coverage.
  • It provides a wide range of sum insured options.
  • It has a fast claim settlement and authorization process.

Which Health Insurance Plan is perfect for you?

The sheer abundance of health insurance plans in India can confuse and at times dumbfound even the most seasoned of souls. That’s why it makes sense to compare health insurance plans on a certain parameters before zeroing in on a particular plan.Listed below are just some of the many scenarios that will point you in the right direction when it comes to buying the right health insurance plans.

  • Scenario 1: If you have a family that includes spouse, parents, and children: If you are looking to ensure comprehensive health coverage for your family that includes your children, spouse, and parents, family floater plans are your best bet. Family floater plans can go a long way in ensuring health coverage for your entire family and save you from the hassles of buying and managing different individual health plans for different members of your family.
  • Scenario 2: If you have a health insurance policy, but you want some top-up for it or you do not want a full-fledged plan: There can be situations wherein you may want some added advantages in your medical insurance. In such an event, you would need to buy a top-up plan online. you will be able to fortify your sum insured amount and add layers of benefits to your existing health insurance plans by buying a top-up health plan for a little extra premium.
  • Scenario 3: If you have elderly parents and young kids: In this situation, the medical bills, diagnostic tests, medicines, etc. gradually become tough to manage. If this is the case with you, then you must buy an OPD plan of a reliable insurance provider. Most OPD plans cover:
  • Unlimited consultation with general doctors or some specialist healthcare provider.
  • Some plans as well provide the facility of yearly health check-up.
  • The pharmacy and diagnostic charges as well are included.
  • Scenario 4: You have many financial responsibilities: In such a situation, you should opt for a health insurance Plan that doesn’t demand high premium payment. But here you will need to ensure that you’re not compromising with advantages and offerings of the policy. Some plans provide the facility to carry forward the reserve benefits, wherein all the unused benefit is carried forward to the next policy year. Whereas in some policies, you need to pay only 50% of the premium after renewing the policy for five continuous years. Keep these things in mind when looking for a health plan.
  • Scenario 5: You are planning to expand your family: There are various health insurance plans that offer maternity benefits, cover newborn baby care, etc.
  • Scenario 6: If your family has a history of critical illness: There are various plans that provide comprehensive coverage against critical illnesses. So, if you’ve a family history of critical illnesses, then you must aim at buying a critical illness plan.
  • Scenario 7: If you have hypertension or diabetes: Most health insurance plans do not cover diabetes. However, there are a certain plans that provide cover against diabetes and hypertension.

Top Health Insurance Plans in India in 2018

There are hundreds of health insurance plans easily available both online and offline, and selecting the most suitable plan often turns out to be daunting task even for the most seasoned individuals. Though the claim settlement ratio plays a major role in selecting a reliable medical insurance policy, insurance company’s rank in the health insurance industry, the satisfaction level of customers, cashless advantages, exclusions and inclusions in its different policies are just some of the many other factors to consider.According to a survey by IRDA, below mentioned are the top 10 health insurance providers in India in 2018:

Insurance Company Network Hospitals No Claim Bonus Incurred Claim Ratio Minimum Sum Assured (Rs.)
New India Health Insurance 10,000+ hospitals Yes 103% 1 Lakh
United India Health Insurance 7,000+ hospitals across India Yes 139% 1 Lakh
National Health Insurance 6,000+ hospitals across India Yes 127% 50,000
Oriental Health Insurance Available in most of the major cities of India Yes 118% 50,000
ICICI Lombard Health Insurance 4,500+ hospitals across the country Yes 90% 3,00,000
Star Health Insurance 8,400+ hospitals Yes 61% 1,00,000
Apollo Munich Health Insurance 4,500+ hospitals Yes 55% 2,00,000
HDFC ERGO Health Insurance 6,000+ hospitals Yes 51% 2,00,000
Bajaj Allianz Health Insurance 5,700 hospitals Yes 79% 1,50,000
SBI Health Insurance 6,000+ hospitals Yes 53% 1,00,000

Why Do You Need Health Insurance?

Getting sick is perhaps the worst situation anyone would ever want to get into. However, life is full of surprises and various external factors also play a major role in deteriorating health conditions. Even people of younger age are being diagnosed with diseases that once only affected the old and frail people. Today’s fast-paced lifestyle and frenzied paced of commercialization are some of the most common factors that are triggering medical issues related to hypertension, coronary artery disease, diabetes, etc. Therefore, it makes sense to buy a medical insurance cover at the earliest.Listed below are just some of the many reasons why you need to have health insurance policy in place:

  • Increasing Medical Cost in India: With the rising inflation, the cost of medical treatment is also increasing day by day. It is observed that medical costs in India are escalating at the rate of 10% every year. To ensure that you aren’t faced a financial crisis in order to get medical treatment; you must buy a health insurance policy.
  • Increasing Cases of Lifestyle-Related Medical Issues: The busy lifestyle, unhealthy habits of eating, and stress level at work are some factors that are adding to the ever-so- deteriorating health of people. And the surprising fact is that this is not only increasing the cases of lifestyle disorders like hypertension and diabetes, but is also triggering the cases of chronic illnesses including heart stroke, cancer, etc. However, having a medical insurance plan can help you mitigate the financial costs that you may need to bear upon the diagnosis of these lifestyle illnesses.
  • A Health Insurance Plan is More Than Hospitalization: Gone are the days when health insurance policies covered medical expenses in case of hospitalization only. Today, with advancement in every field, medical insurance plans have become more comprehensive. Today, health plans provide coverage even for OPD and day care procedures. You can easily get a policy that covers medical consultation, medicine bills, laboratory tests, domiciliary treatments, etc.
  • For Better Financial Planning: A critical illness or lifestyle disease may change the entire course of your life as you may be forced to take care of the medical treatment over and above your regular financial needs. In such a situation, the entire financial setup may get disturbed. To overcome such situations and for better financial planning, it makes sense to buy a good medical insurance
  • Group Medical Health Cover May Not Be Sufficient: Today, most reputed organizations and institutions offer group medical health insurance plans. These plans offer limited coverage and hence may not be enough to meet all the medical expenses incurred. Moreover, if you switch jobs and get unwell during the transition period, you may be required to bear medical expenses in case you or one of your family members gets unwell.

Features of Health Insurance Plans in India

With technological advancements, innovations and improvements in the standard of medical facilities in India, the costs of healthcare treatments have been increasing each passing day. In fact, some medical procedures and therapies have become so costly that it has become difficult for normal, middle-class salaried individual to bear the cost of such treatment. This is where health coverage comes to the rescue.Listed below are some of the many significant features of a health insurance policy provided by various top health insurance providers in India:

  • Pre and Post-Hospitalization Coverage: A health insurance policy not only bears hospitalization expenses, but it also covers the pre and post-hospitalization expenses. Usually, insurers stipulate a predetermined number of days for the coverage of pre and post hospitalization expenses.
  • Facility of Cashless Treatment: Almost all health insurance companies have a list of network hospitals, where they offer cashless treatment to the policyholders. These network hospitals are also known as ‘empaneled hospitals’. All you need to do is to provide your policy number to get cashless medical facility in one of the network hospitals of your health insurer. This is one of the most useful features because this facility takes away the hassles of bearing the medical treatment cost upfront and helps save time wasted in the arrangements of medical documents. Everything is taken care of by the insurance provider and network hospital.
  • Ambulance Charges: This is an add-on feature provided by most health insurers. In case of a medical emergency, you can avail ambulance facility from transportation to and from the hospital and the expenses for availing the ambulance facility is bore by the insurance provider.
  • Regular Medical Check-Up: Though it is important for anyone to ensure regular medical check-ups, there are only a few insurance providers that offer the feature of free check-ups. So, if you have an illness that requires regular visits to a clinic, opting for a policy that covers this feature is strongly recommended. Generally, free medical checkups are provided to those who have a good no-claim bonus history.
  • No-Claim Bonus: If you have not availed any treatment in a previous policy year, you can avail the benefits of no-claim bonus (NCB). The NCB can be provided by the insurance provider either in the form of some discount in the cost of premium or as an increase in the total sum assured. You can avail this facility upon renewal of the policy.
  • Facility of Room-Rent under the Sub-Limit of Health Insurance: There are various sub-limits associated with health insurance policies and room-rent is one of these. Most of the times, the room rent is provided on daily basis and has an upper limit associated with it. For example, if the room rent limit associated with the plan opted by you is Rs.3000, but you opt for a room with rent of Rs.5000, then you will need to pay Rs.2000 from your own pocket.
  • Tax Benefits: Under section 80D of the Income Tax Act, 1961, you are entitled to get tax benefits on your health insurance plans. The premium paid by you for your health plan can get you a tax exemption for up to Rs.55000. Moreover, the tax exemption is independent of the dependency of the family members on insured.
  • Co-Payments: You can lower your premium cost by availing the option of co-payment. Though co-payment feature does not reduce the sum-assured, it reduces the premiums to great extent. Co-payment works on the basis of cost-sharing, where the insurance company or the insured bears some amount of share of the entire admissible cost.
  • Health Insurance Plans Provided by Employers: Many organizations provide health insurance coverage to their employees. This type of medical insurance policy provides coverage against hospitalization of the employee and/or their family members. The premiums are not very high for these policies and are paid by the employer only. There can be times when one may find a health insurance plan provided by the employer insufficient.

In such a case, opting for a standalone personal health insurance plan is recommended.

  • Third-Party Administrator: Third-Party Administrator or TPA is the brainchild of IRDAI for providing assistance to both insurers and insured. While it benefits the insured by providing better and quick insurance services, the insurer, too enjoys the benefits of reduced administrative cost, claim ratio, fake claims, etc. Insurance companies usually appoint TPAs for managing claim settlement, premium collection, enrollment, etc. Most insurance providers and hospitals have the facility of TPA in order to make the process of insurance claim process and settlement easier policyholders.

How to Choose Good Health Insurance Plan?

To get the maximum benefits, it makes sense to select the best health plan available in the market. But here’s the problem: there are hundreds of health plans available both offline and online. So how would you choose the best health policy for yourself? The answer is simple! You will need to carefully compare all the available options on different parameters to pick the best one from the lot. We’re sure you’re wondering: what are these parameters? Let’s check out just some of the many parameters you must compare before zeroing in on a health plan:

  • Understand the Requirements: The very first step in order to choose the best health insurance plan is to understand your requirements. You must carefully mull over your requirements from health insurance. For example, you must decide if you are looking to financially protect yourself against the medical expenses of disease running in your family; you are looking to ensure to financially safeguard the health of your loved ones including your elderly parents. Or if you’re looking for maternity benefits from your intended health plan. Carefully think over your requirements before zeroing in on a health plan.
  • Select the Coverage Amount Wisely: How much coverage do you need to financially secure self and your loved ones against medical emergencies? It makes sense to select a medical insurance plan that provides maximum healthcare coverage and covers a long list of treatments and medical expenses.
  • Select the Sum Assured Precisely: Sum assured is the health cover that a health plan You can get the reimbursement of the medical expenses from the insurer up to the limit of your sum assured. Therefore, it is recommended to select the sum assured according to your overall requirement. If you’re single, you will probably need a lower sum assured, but if you’re married and have a family, you will need more sum assured to ensure adequate health cover for self and family.
  • Choose a Plan with Nominal Waiting Period for Pre-Existing Disease: If you are suffering from some pre-existing illness and want it to be covered, it is suggested to go for a health insurance plan that covers this disease and has a minimum waiting period before the coverage starts. Since every health plan has different waiting period especially for pre-existing illnesses, thus it is a must to check this factor first.
  • Check the List of Network Hospitals: Yet another factor that you must check is the list of network hospitals of the insurance company before finalizing it. Your intended insurance provider must have a list of good hospitals in its network and few of these must be in your close vicinity.
  • Consider Renewal Age: You may not require a health plan at a younger age, but as you grow old, the dependency on medical insurance increases owing to the possibility of health issues related to age. Therefore, it is wise to shop for a health insurance plan that can be renewed at an older age of 70 or 75 years.
  • Select a Plan Having Sub-Limits: Sub-limits like room rent must be included in the health insurance plan. Though most of the medical insurance plans provide sub-limits, you must check the list of sub-limits included in your plan, and carefully pick the plan that covers your requirement.
  • Choose a Plan Having High Claim Settlement Ratio: Claim settlement ration is the ratio of the total claims received by the company and the total number of claims settled by it. It is suggested to opt for plans from a health insurance company plan that has a high claim settlement ratio.
  • Consider the Reviews: Reviews play a major role when making a buying decision. And when it comes to health insurance plans, reviews must be considered carefully. It is wise to check the reviews online before finalizing a plan.
  • Keep an Eye on Riders/Add-ons/Critical Illness Add-Ons/Rider for Accidents: Critical illness can easily disturb your financial planning; therefore, it is suggested to consider a plan that offers a rider for critical illnesses. Moreover, if the medical insurance is covering accidental benefits or providing it as a rider, then it can be beneficial for you.
  • Consider the Exclusions: Exclusions are the features that an insurance policy does not cover. Therefore, keeping an eye on the exclusions of the policy is recommended. For example, if you have hernia, but your medical insurance policy does not cover it, then such a health plan is waste for you.
  • Compare Health Insurance Policies Online: Since there are several health insurance plans, it may become difficult for you to choose the most suitable plan. But, a comparison of health insurance policies online can help you pick the best option. There are a number of good insurance web aggregators online that allow you to compare different health insurance policies customized according to your requirements and budget.

Inclusions – What is covered in a Health Insurance Policy?

Health insurance is a blend of coverage subject to the type of the policy you opt for and the insurer you choose. Below are some of the most common inclusions of a medical insurance plans in India:

  • Pre-Hospitalization: All medical expenses incurred due to a medical condition that requires pre-hospitalization are included in a health insurance policy.
  • In-Patient Hospitalization: The expenses incurred due to hospitalization arising due to medical emergencies or accident for more than 24 hours is included in most health plans.
  • Post-Hospitalization: If some medical condition requires post-hospitalization treatment for a certain period of time, it is usually covered under medical insurance policies.
  • Domiciliary Treatment: A medical treatment for which hospitalization is needed, but the treatment currently could be done at home, is also covered under medical plans.
  • Day-Care Treatment: Due to technological advancement, some medical procedures such as Cataract Surgery, Tonsillectomy, Chemotherapy, Hemodialysis, etc. do not necessarily require hospitalization for more than a day. Such day-care treatments are also included in a health plan.
  • Alternate Medical Treatment: Alternative medical treatment or procedures including Unani, Ayurvedic, Homeopathy, and Sidha are also covered under most health plans.
  • Facility of Emergency Ambulance: The cost of availing ambulance services for transportation to and from hospital in the event of a medical emergency is also covered under most health insurance plans.

Exclusions-What is not covered in a Health Insurance Policy?

Although you can easily customize your intended plan according to your needs, budget and requirements, there are certain conditions that are permanently not covered by a standard medical insurance policy.

  • Pre-Existing Health Conditions: Typically, most health plans do not cover pre-existing medical conditions. However, there are some insurance providers that have now started covering pre-existing health conditions after completion of a certain time-period, known as waiting period. This waiting period could be between 1-4 years.
  • Any self-conflicted injury: Any intentional harm or an injury arising due to attempted suicide is usually not covered under health plans.
  • Cosmetic Surgeries: Most health insurance policies do not cover cosmetic surgeries. However, if a cosmetic surgery is a part of the treatment after an accident, it is covered under some plans.
  • Dental Treatment and Joint Replacement: Most policies do not cover dental treatment and joint replacement surgeries.
  • Therapies: Alternative therapies such as naturopathy, acupuncture, magnetic therapy, etc. are usually not covered under most health policies.

Factors that Affect the Premium of the Health Insurance Plan

There are several factors including age, lifestyle, smoking habits, etc. that affect the premium of a health insurance policy. For example, health insurance premium for an applicant aged 25 year will be different to that of an applicant aged 55-year. It is important to get acquainted with these factors beforehand.Listed below are some such factors that affect premium:

  • Age: As explained in the above example, age plays a crucial role in determining the premium of a health policy. As a rule of thumb, the premium amount keeps increasing according to the age of the policyholder. This means the younger you’re at the time of policy inception, the lesser premium you’ll need to pay. This is because younger people are typically healthier as compared to the older generation.
  • Body Mass Index: It is yet another significant factor that decides the premium of a health insurance policy. Those who have Body Mass Index (BMI) at the higher side have higher chances of getting obesity-related medical conditions such as type 2 diabetes, high blood pressure, and high cholesterol levels. This is the reason why a high BMI results in higher premium rates for a health insurance plan.
  • Medical History/Pre-Medical Conditions: Those suffering from some pre-existing medical condition are often required to pay higher premium as compared to those without any pre-exiting medical condition. In some cases, health insurers may deny providing coverage for particular illnesses. However, you should never hide your medical history from your intended insurance provider. Doing so may run you into trouble at the time of claim settlement/clearance process. Moreover, declaring your medical history will help you understand whether your insurance provider is taking your pre-existing disease in consideration or not at the time of policy inception.
  • The Consumption of Tobacco: Smokers are often required to pay higher premium for the health insurance policy as against non-smokers. Consumption of tobacco related products or smoking exposes an individual to a greater health risk. In addition, health insurance companies also carefully consider the frequency of tobacco consumption or the intensity of smoking habit in order to determine the premium payment.
  • Occupation of the Applicant: The premiums for health insurance policies are usually higher for those working in hazardous environment where exposure to chemicals, radiations, and hazardous substances is higher. In addition, the premium payment is also higher for those working at construction sites because the chances of bodily injury in such an occupation are higher against other occupations.

How to Calculate Health Insurance Premium

One of the major concerns that you may have is the calculation of premium. There are various factors that affect the premium of health insurance plans. Apart from the factors, there are certain guidelines that most of the insurers follow while calculating the premium.Following are the guidelines:

  • Cost of Marketing and Management: The cost of marketing and management are also recovered from your premiums. Under this section, the commission of the broker, marketing cost, expense of advertisement and other operating costs are covered.
  • Underwritings of the Policy: Most of the health insurance companies deal with various health insurance plans like a family floater health plan, individual health policy, senior citizen plan, etc. The underwriting of all the policies is planned to maintain a balance among all these plans. Several policy risks are calculated and many factors are considered that can cause a problem at any specific time.
  • Savings: Savings is that section of the health insurance premium which is put in various public investments. These investments are created according to the guidelines of the insurance regulatory body of India. Calculation of the premium is dependent on the returns of such capitalizations.
  • Personal History: It entirely depends upon the health insurance provider to conduct body checkup before giving any health insurance plan. However, most of the insurance providers will likely to know about the personal habits of the insured such as smoking, drinking, etc.
  • Mortality: The cost that the insurance provider has to bear in case of some eventuality with the insured. The cost of mortality that an insurer bears depends upon the age group and income group of the policyholder. Most of the times, it is higher for older policyholders.

How to Make a Claim in Health Insurance Plan?

Insurance claim is the most important and crucial part of any insurance plan. Usually, the best medical care insurance allows policyholders to file claims for cashless treatment and expense reimbursement.Let’s get a brief on both these processes:

  • Cashless Claims:

    This is perhaps the easiest ways of availing insurance benefits. Insurance companies provide policyholders with a wide range of network hospitals where they can easily cashless treatment. In the event of a cashless claim, you don’t need to pay upfront and can still avail quality healthcare facilities at one of the many network hospitals of your health insurer. But here’s something you must remember. You’ll need to get access to TPA/insurer approval to enjoy cashless benefits at network hospitals. You can avail the cashless facility of treatment in two forms:

    • For Planned Hospitalization: In the case of planned hospitalization, you’ll need to inform the hospital at least 48 hours before your intended hospitalization.
    • Emergency Hospitalization: In such situations, you or anyone on your behalf must inform the insurance provider about your hospitalization at the earliest. Most of the insurance providers ask to inform them within 24 hours after the hospitalization in this case.
  • Reimbursement Claims:

    In this method of claim settlement, the incurred expenses can be reimbursed from the insurance company after a stipulated time-period. The reimbursement cost may include the room rent, surgeon’s fee, lab tests, medicines, etc. In order to avail this claim settlement facility, you will need to submit all original bills and invoices to your insurer. This way, you can get compensated for the medical expenses made by you from the insurer.

    • Claim Settlement within 15 Days of the Treatment Completion: You will need to send the duly filled claim form with all the documents mentioned there to the health insurance provider within 15 days of the completion of your treatment.
    • Claim Settlement within 30 Days of the Treatment Completion: You will need to send the duly filled claim settlement form with all the required documents to the insurance provider within 30 days of the completion of your medical treatment.

Health Insurance Claim Process:

In the event of a health insurance claim, here’s the process that you’ll need to follow in order to get your claim settled.

  1. First things first, do inform your insurance provider about your illness/injury.
  1. Next, log on to the official website of your health insurer and register a claim online. Alternatively, you may call up the toll-free number of your insurer and register a claim over the phone.
  2. Then, submit the duly filled and signed claim form with the required documents.
  3. The insurer will then investigate and validate the submitted documents.
  1. After verifying everything, the insurer will release the claim amount within a pre-determined period of time.

Documents Required for Health Insurance Claim Reimbursement

In case of hospitalization, you will need to submit the below mentioned documents to make a claim for the expenses incurred on you medical treatment out of your own pocket:

  • Discharge certificate from the hospital
  • Duly signed and self-attested in-patient hospitalization bills
  • Medical bills and doctor’s prescription
  • Duly filled and signed claimed form
  • Relevant Investigation Report
  • Doctor’s consultation bills
  • Consumables and disposables advised by the doctors, with details
  • Any other documents asked by TPA

What is the Process to Port a Health Insurance Plan

In simple terms, health insurance portability means transfer of an existing health insurance plan from one insurer to another.

When Should One Opt for Health Insurance Portability?

You must choose to port your health insurance plan from one insurance provider to another if you are facing the below mentioned issues in your present health plan:

  • Poor Quality of Service: If your insurer is not able to provide you with high-quality services promised to you at the time of the inception of the policy.
  • Slow Process of Claim Settlement: If your insurance provider has a poor history of processing the claim.
  • Required Additional Covers: If your health insurer is unable to provide additional covers on your present health plan.
  • Hidden Clauses: Transparency is one of the biggest factors you must consider before deciding to port your policy. If you find that there are many hidden clauses in your present policy that you were unaware of at the time of inception of the policy.
  • Moving to a Specialized Company: You may find some specialized health insurance company more suitable in terms of coverage than your insurance company’s medical policy.
  • Better Inclusions: If your present health insurance plan is providing inclusions at higher rates or is not offering inclusions that you are looking for.

Health Insurance Portability Rules

Insurance Regulatory and Development Authority of India (IRDA) has stipulated a certain rules for porting health plans from one insurer to another. Here is a listing of portability rules stipulated by IRDAI:

  • Similar Health Insurance Policies: Only similar health insurance policies can be ported. For example, you can switch from one top-up policy to another top-up policy or from one basic policy to another basic plan.
  • Types of the Policy: Only family floater or individual health policies can be ported from insurer to another.
  • Specialized/General Portability: You can only port your health insurance policy from one specialized/general insurance provider to another specialized/general insurance provider.
  • Policy Renewal Clause: The portability of a health insurance plan is permitted only at the time of policy renewal. Moreover, portability is granted only if you have renewed your present policy in a timely fashion. However, any delay from the insurance provider’s end is not treated as discontinuity and portability can be granted.
  • Notice Period: You must notify your health insurer of portability in writing at least 45 days prior to the policy renewal date.
  • Acknowledgment: Your insurance provider must acknowledge the application for portability within three days.

Health Insurance Portability Process

You can apply for the portability only at the time of renewal of your current policy and at least 45 days before the expiry date of the existing policy (but not before 60 days). You must follow the below mentioned steps to port your health insurance policy from one insurer to another:

  • Send a request to the new health insurer at the time of the renewal of the policy. Upon receiving the request for portability, the new insurance provider will provide the portability and proposal form with details of other available products.
  • You can then select a suitable health insurance product and submit the duly filled portability and proposal form to the new health insurance provider.
  • Upon receiving these forms with details, the new insurance company will either approach the previous insurance provider. This step is performed to check your details like your medical records, claim history, etc.
  • The current insurance provider must provide all the details of the insured on the common data sharing portal of IRDAI within seven working days. However, if the existing insurance provider takes time in sharing information, the new insurer may hold your porting request.
  • As soon as the new health insurance provider gets all the information about you, it decides underwrites the policy within 15 days. If the new insurance provider does not take any decision within this time period, they have to accept the application for portability.

How to Renew a Health Insurance Plan?

Though purchasing a health insurance policy is the right move in order to deal the medical expenses related to health, renewing a policy and that too before its expiration is equally beneficial. Most of the health insurance plans are available to its insured for 1, 2 or 3 years, and after that, you needs to renew it for availing its benefits. Below mentioned is the process to renew health insurance policy online and offline.

  • Online Renewal Process: Online renewal process is easier than offline as you can do that in the comfort of your home. You need to provide certain details online to renew your policy instantly. Below mentioned are step by step process to renew a health insurance plan online:
    • Login to the website of the insurance provider.
    • Fill the basic details on the renewal page of the insurer like policy number, date of birth of the insured, etc.
    • After providing the details, most insurers redirect you to its payment gateway page. From here, you can make the payment of the premium of your health insurance plan. Most insurance providers give the option to pay premiums via credit/debit card or through net banking.
    • Once the premium is paid, the policy is renewed instantly. The insurer provides the digitally signed copy of the renewed policy. This digital copy carries all the necessary information related to the policy.
  • Offline Renewal Process: To renew health insurance policy offline, you can either visit the branch of the provider or can call the policy agent for collecting the premium. It is advised to not to give the premium in cash to the agent instead give a cheque to the insurance provider.

Why Compare Health Insurance Plans Online in India?

The availability of different health insurance providers online, it is difficult to go to the website of various health insurance providers and access the plans one by one. Moreover, the tight and hectic schedule has made it practically impossible to go to the branches of different health insurance providers or meet with their agents personally to understand plans.However, in such situations comparing health insurance plans online through a reliable insurance web aggregator is a most suitable way. It ensures to suggest the most suitable plan to an individual, which means you need not to bear a long line or a long lie.Enlisted are a few advantages of comparing health insurance policies online in India:

  • To get the most accurate and precise information: One gets a comfortable access to every health insurance plan present in the market. Moreover, you also get relief from the insurance agents who most of the times give biased and unreliable information.
  • Affordable Method: Since there is no brokerage or fees of the agent is involved in buying a health insurance plan online, it is one of the most pocket-friendly methods.
  • A Convenient and Time-Saving Process: An individual needs not to meet with various agents for understanding and comparing different health insurance plans, which in turn saves time.
  • Availability to View the Reviews of Different Health Insurance Providers and Plans: To get an idea of the overall reputation of an insurance provider, reviews work the best.

Health Insurance FAQs

Q: What is Health Insurance?

Ans: An insurance policy that provides coverage for medical expenses is known as health insurance. It is basically a contract between an individual or a group and an insurance provider, wherein the insurer agrees to offer pre-specified covers for health insurance at pre-defined ‘premium’.

Q: What are the different categories of Health Insurance?

Ans: Yes, the basic categories of health insurance are – cashless and reimbursement. In the cashless form, the insurance provider directly deals with the network hospital providing absolute coverage to insured for medical expenses incurred on treatment. However, in the reimbursement form, the insured pays for all the expenses and later gets the reimbursement from the insurance provider.

Q: Does Health Insurance policy offer any tax benefits?

Ans: Yes, a health insurance policy provides tax benefits under section 80D of Income Tax Act. If you are paying premium(s) of your health insurance policy that covers you, your spouse, dependent children through any mode other than cash, you are eligible to avail an annual deduction of Rs.25, 000 from your taxable income. However, this deduction is increased for senior citizens to Rs.30,000.

Q: What is the waiting period for a health insurance policy?

Ans: Generally, every new health insurance policy has 30 days of a waiting period that starts from the date of policy inception. During this period, the charges of hospitalization and other medical expenses are not paid by the insurance provider. However, exceptional conditions, such as emergency hospitalization due to the accident, do not have to follow any waiting period meaning such conditions are covered anyways. The waiting period is not applicable to the policies that are under renewal.

Q: Specify the factors that affect the health insurance premium.

Ans: One of the major factors that determine the premium of a health insurance policy is the age of the insured. Pre-existing medical conditions and claim free years are other parameters to decide the premium of your health insurance policy.

Q: What is the condition for pre-existing illness in Health Insurance policy?

Ans: Any disease/illness/condition that exists in an insured before he/she has obtained a health insurance policy is considered as a pre-existing illness. Most of the health insurance providers do not cover any pre-existing condition within 48 months of the 1st insurance policy. This means every pre-existing condition/illness is eligible for payment after completion of 48 months of the contentious medical insurance cover.

Q: How many number of health insurance claims allowed in a year?

Ans: There is no limit on the number of claims allowed in a year unless there is a cap specified for the same by the insurance provider. However, the maximum limit is equal to the sum insured for that policy.

Q: Is it possible to transfer health insurance policy from one insurance provider to other?

Ans: Yes, it is possible to port your health insurance policy from one insurance provider to other. According to a circular provide by Insurance Regulatory and Development of India (IRDA), effective from 1st October’2011, the health insurance policyholders are allowed to switch from one health insurance provider to another and from one health insurance plan to other without making the policyholder to lose the credits of renewal for pre-existing conditions availed in previous policy. For more details on the portability, you must check the insurance provider’s policy for the same.

Q: Does a health insurance policy cover expenses of outpatient treatment as well?

Ans: Generally, most of the health insurance policies cover medical expenses incurred during hospitalization. However, some insurance plans offer reimbursement of the expenses incurred being outpatient.

Q: I am a foreigner, can I take a health insurance policy for my child who is studying in India and will further study here only?

Ans: Yes, but the coverage can be restricted to treatments taken in Indian hospitals during the period of the policy.

Q: Can I avail a Health Insurance policy, if I am not an Indian National but living in India?

Ans: Yes, the foreigners staying in India can take a health insurance policy in India, but the coverage is restricted.

Q: Can an Authorization request for a cashless claim be rejected?

Ans: Yes, the authorization request for a cashless claim can be rejected based on different reasons. Some of the common reasons for the same are:

  • The disease/illness for which the hospitalization is needed is not covered by the insurance provider or in the insurance policy.
  • The policyholder does not have sufficient amount left for covering the cost of hospitalization.
  • Moreover, in the above case, the policyholder cannot even claim for reimbursements for medical expenses incurred.

Q: Is it necessary to get a medical checkup before purchasing a Health Insurance policy?

Ans: Most of the health insurance providers require medical checkup for customers who are more than 50 years of age and want a health insurance policy. Moreover, some health insurance plans do not ask for any medical checkup for senior citizen policies, which is generally offered to people between the age group of 60 to 69 years.

Q: What do you mean by cumulative bonus?

Ans: The cumulative bonus is an amount offered by the health insurance companies to its loyal customers for every claim-free year. In order to be eligible for this bonus, you need to get your policy renewed every year without any break.

Q: What is ‘Donor Expenses’?

Ans: ‘Donor expenses’ include the hospitalization expenses incurred by the donor for donating his/her organ to the insured for an organ transplant. However, it doesn’t include the cost of the organ.

Q: Are there any circumstances where the minimum 24-hours hospitalization criterion doesn’t apply?

Ans: Yes. In case of daycare treatments, 24-hour hospitalization criterion can be overlooked.

Q: What can I do if I am stuck in an emergency but don’t have my card number or my policy number with me?

Ans: In case you are stuck in an emergency, you can ask the TPA (Third Party Administrator) involved tracking down your information with the help of these details:

  • Your name, date of birth and address
  • Name of your insurer
  • Underwriting office code

Q: What can be various situations where you can be denied cashless hospitalization benefits?

Ans: Here are the following situations:

  • If your ailment isn’t covered by your health insurance plan.
  • If the pre-authorization request isn’t received by the TPA in time.
  • The information shared with the TPA is incorrect or
  • In such scenarios, the insured can undergo the treatment, pay for it, and once discharged, can submit the claim to the TPA.

Q: How to check the claim status?

Ans: You can check the status of your claim by calling your TPA’s helpline number or by using your policy number/member ID to log into their website.

Q: What are the benefits of carrying the health card?

Ans: One of the major benefits of carrying a health card is that you and your family members get an easy and immediate access to the cashless facility in any of the network hospitals.In case you are not able to be admitted to a network hospital, you can undergo treatment at a non-network hospital and can file the claim later on.

Q: Can I change the hospital while undergoing the treatment?

Ans: Yes, you can be shifted to another hospital if your request is legitimate. However, the case will be assessed and evaluated by the TPA based on the terms & conditions of the policy.

Q: What to do if I already have bought health insurance but want to increase the sum insured?

Ans: You can opt for super top-up plans to increase the value of sum insured to your desired value.

Q: What if my health insurance company doesn’t have the option to buy top-up covers? Is it possible for me to buy my health insurance plan from one company and a top-up from another one? Will the top up also cover critical illnesses if the base policy covers it already?

Ans: No. Currently, this facility isn’t offered by any insurance provider. However, such provisions are expected in the near future.

Q: Is maternity cost covered by health insurance plans?

Ans: Although most of the companies don’t cover maternity and childbirth costs, there are few companies like Max Bupa, Apollo Munich, etc. that cover maternity costs after the end of the waiting period of usually 2-4 years.

Q: Can I purchase more than one health insurance policy?

Ans: Yes, but each of the insurance companies will pay a proportional ratio of the liability, expenses, compensation, etc. For instance, if you buy insurance from 2 different health insurance companies for Rs. 1 Lakh each, each of the policy will process the claim in the ratio of 50:50 up to the opted sum insured.Note- Both the insurance providers must be aware that you have more than one insurance plan.

Q: What are the exclusions for the first and second year?

Ans: In a basic insurance plan, the treatment expenses of certain diseases such as a hernia, cataract, sinusitis, Hysterectomy for Menorrhagia or Fibromyoma, benign prosthetic hypertrophy, etc. are not covered for a specified period (as mentioned in the policy document) if contracted/developed before the policy tenure.

Q: Does health insurance offer any tax benefits?

Ans: As per Section 80D of the Income Tax Act, 1961, you can avail tax benefit up to Rs. 50,000 on the premium paid for your health insurance.

Q: If I fail to renew my health plan before the expiry date, how can I renew my policy?

Ans: You can renew your plan within the grace period i.e. 15-30 days (as per your insurer) after the renewal date of your plan has passed. However, insurance coverage will cease to exist during that period.In case the plan isn’t renewed even within the grace period, it will lapse.

Q: What do you mean by cumulative bonus?

Ans: The cumulative bonus is an amount offered by the health insurance companies to its loyal customers for every claim-free year. In order to be eligible for this bonus, you need to get your policy renewed every year without any break.

Q: What is ‘Donor Expenses’?

Ans: ‘Donor expenses’ include the hospitalization expenses incurred by the donor for donating his/her organ to the insured for an organ transplant. However, it doesn’t include the cost of the organ.

Q: Are there any circumstances where the minimum 24-hours hospitalization criterion doesn’t apply?

Ans: Yes. In case of daycare treatments, 24-hour hospitalization criterion can be overlooked.

Q: What can I do if I am stuck in an emergency but don’t have my card number or my policy number with me?

Ans: In case you are stuck in an emergency, you can ask the TPA (Third Party Administrator) involved tracking down your information with the help of these details:

  • Your name, date of birth and address
  • Name of your insurer
  • Underwriting office code

Q: What are the various situations where you can be denied cashless hospitalization benefit?

Ans: Here are the following situations:

  • If your ailment isn’t covered by your health insurance plan.
  • If the pre-authorisation request isn’t received by the TPA in time.
  • The information shared with the TPA is incorrect or

In such scenarios, the insured can undergo the treatment, pay for it, and once discharged, can submit the claim to the TPA.

Q: How to check the claim status?

Ans: You can check the status of your claim by calling your TPA’s helpline number or by using your policy number/member ID to log into their website.

Q: What are the benefits of carrying the health card?

Ans: One of the major benefits of carrying a health card is that you and your family members get an easy and immediate access to cashless facility in any of the network hospitals.In case you are not able to be admitted to a network hospital, you can undergo treatment at a non-network hospital and can file the claim later on.

Q: Can I change the hospital while undergoing the treatment?

Ans: Yes, you can be shifted to another hospital if your request is legitimate. However, the case will be assessed and evaluated by the TPA based on the terms & conditions of the policy.

Q: What to do if I already have bought health insurance but want to increase the sum insured?

Ans: You can opt for super top-up plans to increase the value of sum insured to your desired value.

Q: What if my health insurance company doesn’t have the option to buy top-up covers? Is it possible for me to buy my health insurance plan from one company and a top-up from another one? Will the top up also cover critical illnesses if the base policy covers it already?

Ans: No. Currently, this facility isn’t offered by any insurance provider. However, such provisions are expected in the near future.

Q: Is maternity cost covered by health insurance plans?

Ans: Although most of the companies don’t cover maternity and childbirth costs, there are few companies like Max Bupa, Apollo Munich, etc. that cover maternity costs after the end of the waiting period of usually 2-4 years.

Q: Can I purchase more than one health insurance policy?

Ans: Yes, but each of the insurance companies will pay a proportional ratio of the liability, expenses, compensation, etc. For instance, if you buy insurance from 2 different health insurance companies for Rs. 1 Lakh each, each of the policy will process the claim in the ratio of 50:50 up to the opted sum insured.Note- Both the insurance providers must be aware that you have more than one insurance plan.

Q: What are the exclusions for the first and second year?

Answer. In a basic insurance plan, the treatment expenses of certain diseases such as hernia, cataract, sinusitis, Hysterectomy for Menorrhegia or Fibromioma, benign prosthetic hypertrophy, etc. are not covered for specified period (as mentioned in the policy document) if contracted/developed before the policy tenure.

Q: If I fail to renew my health plan before the expiry date, how can I renew my policy?

Answer. You can renew your plan within the grace period i.e. 15-30 days (as per your insurer) after the renewal date of your plan has passed. However, insurance coverage will cease to exist during that period.In case the plan isn’t renewed even within the grace period, it will lapse.

Health Insurance Plans at Your Disposal

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Family Health Insurance

Get your entire family covered under a single Family Health Insurance Policy.

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Mediclaim

Why compromise on quality healthcare? Buy a mediclaim policy and stay financially covered!

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Senior Citizen Health Insurance

Now efficiently plan your golden phase of retirement with Senior Citizen Health Insurance.

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Critical Illness Insurance

Get yourself covered against soaring treatment expenses of lifestyle diseases.

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Accident Insurance

Insure yourself with an Accidental Insurance for accidental eventualities!

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Maternity Health Insurance

When you can’t ignore pregnancy-related consequences, Maternity Insurance covers the eventualities.

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