Health Insurance Plans
Types of Health Insurance Plans in India
To meet the different requirements of people, health insurance companies under the guidance of the Insurance Regulatory and Development Authority of India (IRDAI) provide different types of health insurance plans in India such as Individual Health Insurance Policy, Family Health Insurance, Women Health Insurance Policy, Senior Citizen Health Insurance Policy, Critical Illness Insurance, Group/Corporate Health Insurance Policy, Self-employed Health Insurance Policy, Personal Accident Policy, Health Insurance Policies for newborn babies, kids, etc. Besides, insurers also offer health insurance plans specially designed for cancer, diabetes, heart, dengue, and other diseases.
These health insurance policies are broadly classified into 7 categories that are explained below:
1. Individual Health Insurance Plans
As the name suggests, individual health insurance plans offer coverage for surgical and hospitalisation expenses to the insured on an individual basis. The coverage includes expenses related to pre-hospitalisation and post-hospitalisation, in-patient hospitalisation, medicines, etc. up to the sum insured. Many individual health insurance plans offer other facilities too like daily cash benefits but that depends on the terms and conditions of the policy. With an individual health insurance policy, the insured can avail cashless as well as reimbursement treatment facility.
2. Family Health Insurance Plans
Family health insurance plans offer coverage to all family members. This means that the proposer can include their spouse, children, parents, parents-in-law and other dependent members by paying a single health insurance premium. In terms of coverage, a family floater health insurance policy is similar to an individual health insurance policy. A family floater insurance policy is a good option as it brings the entire family under an umbrella cover thereby reducing the chances to exhaust the sum insured.
3. Senior Citizen Health Insurance Plans
Senior citizen insurance plans are specially designed for people aged above 60 years to offer extensive coverage against medical expenses. Due to wide coverage, these plans come at a higher premium. But the insured can reduce the financial burden as you can always save tax with health insurance by availing tax benefits under Section 80D of the Income Tax Act. For elder people, it is better to opt for a senior citizen health insurance policy as it helps keep them stress-free in their post-retirement years.
4. Women Health Insurance Plans
Women need medical attention at different stages of their lives, for which they need health insurance plans specifically designed for them. There are many insurers in the market that offer women health insurance plans that not only take care of women’s health but also offer them financial security. Common benefits offered under women-specific health insurance plans include maternity cover, cover for hospitalisation expenses, critical illness cover, newborn baby cover, and so on.
5. Children Health Insurance Plans
Health insurance plans for children offer the ideal cover for children at affordable health insurance premiums. But one can get minor children covered individually only when either of the parents is covered under the same health insurance plan. Children specific health insurance policies offer a cluster of benefits such as cover for health check-ups, cashless hospitalisation, specialist consultation, vaccinations, ambulance charges, etc.
6. Critical Illness Insurance Plans
Critical illness insurance policies are fixed benefit policies that offer cover for specific life-threatening diseases such as cancer, stroke, paralysis, kidney failure, amongst others. Under these policies, the insured gets a pre-decided lump sum amount on diagnosis of any critical illness as specified in the policy document. The insured can use the amount as per his/her own choice to pay for treatment in India or abroad, recuperation expenses, or even pay off debts if taken.
7. Disease-Specific Health Insurance Plans
Disease-specific health insurance policies cater to particular diseases. For instance, dengue, diabetes, etc. a disease-specific policy is recommended along with a standard health insurance plan as it provides cover for diseases at all stages, irrespective of if the existing illness is in dormant or critical stage. Unlike regular health insurance policies, these plans do not come with long waiting periods. But remember, disease-specific health insurance plans are no substitute for standard health insurance policies.
How to Choose the Best Health Insurance Plan in India?
You can consider the following tips to select the best medical policy:
Select a medical insurance policy that offers cover against expenses arising due to many health issues and provides various health care facilities such as daycare expenses, pre-hospitalisation expenses, post-hospitalisation expenses, ambulance cover, etc. In case you opt for health insurance for your entire family, then make sure to check if the health plan meets the requirement of each member. Compare the plans on the basis of the benefit offered and reasonable cost before making a decision.
Lifetime Renewability Option
While purchasing a health insurance policy do not forget to check the duration for which the plan is offering you coverage or if it comes with a lifetime renewability option or not. It is always recommended to buy an insurance plan that offers a lifetime renewability option.
Compare Quotes of Various Insurance Company
Compare various health insurance policies online to make sure that you purchase a health plan that meets all your requirements. Also, you can get quotes for various different plans online by providing the necessary details to get an estimated premium of different policies. Gather best quotes and compare in order to make an informed decision. So, all those wondering how to choose the best health insurance plan online, must read the things to consider:
High Claim Settlement Ratio
A claim settlement ratio is the total number of settled claims over by the insurer over the total number of claims received. Therefore, while buying a health insurance plan make sure to check the claim settlement ratio and always opt for the insurance provider that has a high claim settlement ratio.
List of Network Hospitals
After selecting medical insurance plans, make sure to check if your preferred hospitals or doctors are there in the list of network hospitals provided by your insurance provider. Choose an insurance company that has a wide range of network hospitals across India.
Choose Family Health Policy Over Individual Health Plans
People who do not have a family to support should choose Individual health plans. However, if you are purchasing a health insurance plan keeping your family in the picture, then opt for a family health plan to avail more benefits at a reasonable cost.
Affordable Health Policy
While purchasing a medical insurance policy, it is important to select a plan that caters to your requirements. However, you should select a health plan that fits within your budget but make sure to consider the benefits before going for the cost. Compare the plans thoroughly to make a wise decision and to ensure an overall protection against health issues at an affordable cost. Also, you can enhance your coverage with time after considering important factors such as size of family, rise in income and needs of the family members.
Benefits of Comparing Health Insurance Plans
There are several benefits of comparing health insurance plans online. It not only allows you to choose the best one to meet your healthcare requirements but also helps you make an informed decision. But there are various health insurance companies in the market that offer various health insurance plans, so sometimes one may end up buying a health insurance policy that comes at a low premium, but may compromise on the coverage benefits. On the contrary, it may also be the case that someone pays a higher premium for a health insurance policy but still does not get the features as required. Keeping into consideration the increasing healthcare costs of treatment, a health insurance policy protects a medical emergency from becoming a financial emergency, and hence should be chosen wisely.
Listed below are some common benefits of comparing health insurance plans online:
1. Access to Accurate Information: All the information about different health insurance plans in the market is easily accessible online. So, comparing health insurance plans online saves you from dealing with agents who are known to provide biased and unreliable information most of the time and help you access accurate information.
2. Time Efficient And Convenient: Comparing health insurance plans online helps you save time, which is not the case when you meet agents and discuss policies. Also, it is comparatively easy to pay health insurance premiums or renew health insurance plans online. So, the process is transparent and does not take much of your time.
3. Pocket Friendly: When you buy health insurance plans online, you compare them in terms of premium, benefits, etc, thereby shortlisting the most affordable one as per your budget. So, in this case, you end up buying a health insurance policy that fits your budget. But if an agent is involved, then he/she might trick you into buying a policy that you do not actually require or is out of your budget.
4. Customer Reviews: At InsuranceDekho, you will find several customer reviews of different health insurance plans. When shortlisting a policy, you can go through the reviews to be certain of your decision.
How to Make a Claim Under Your Health Insurance Plan?
Under health insurance plans, you can make a claim in two ways, i.e. cashless claim and reimbursement claim. The cashless claim is when you do not pay anything at the hospital for the treatment availed. Whereas in reimbursement claim, you will be first required to pay for the treatment taken, at the hospital, and the insurance company pays to you later. The claim processes for them are mentioned below:
To make a cashless claim, you will be required to follow the steps given below:
- Immediately inform the insurance company in the event of hospitalisation at a network hospital of your choice. Generally, you are required to inform the insurance company within 24 hours of hospitalisation in case of emergency, whereas 48 hours prior in case of planned hospitalisation.
- You will be required to share health insurance details at the network hospital. Show your Health ID card or your policy number with a valid photo ID proof at the desk of the hospital.
- Once the identification has been done, the network hospital will send you the pre-authorisation request form to the insurance company.
- The insurance company will then verify and analyse the documents and may ask the network hospital for more information if required.
- Once the formalities have been completed, the insurance company will pay the medical expenses excluding co-payment if any, directly at the network hospital. You will be informed about the same within the stipulated time. Even if the claim is rejected, you will be informed about the same.
To avail reimbursement treatment, you must follow the steps given below:
- Inform the insurance company within the stipulated time, in case of hospitalisation. You can also connect directly with the insurance company via Email.
- Avail the required treatment at the hospital if your policy covers you for the same. Collect all the medical test reports, discharge summary, medical invoices, and other relevant documents from the hospital to share to the insurance provider.
- Submit the claim documents along with required medical documents to the insurance provider.
You will be required to submit the following documents to the insurance company in case of reimbursement claim:
- Valid ID proof
- Medical practioner’s advising letter for hospitalisation
- Original hospital bills and discharge certificate signed by the medical practitioner
- Medical practioner’s prescription for consultation, medicine, and medical tests
- Original pharmacy bills
- Original reports of diagnostic tests, reports, etc.
- First Information Report (FIR), in a police case
- Post Mortem Report, if applicable.
Key Benefits of Health Insurance Plans
Health insurance plans offer many benefits to the insured. Some of them are explained below:
Health insurance plans offer cover for cashless mediclaim policy in case the treatment is available at a network hospital.
No Claim Bonus
For every claim-free year, the insured can avail No Claim Bonus (NCB) for up to a specific limit.
Health insurance policies also cover for periodic health check-ups. Some health insurance companies also offer free medical check-ups on the basis of accumulated No Claim Bonus.
Premiums paid for health insurance policies are subject to tax deductions under Section 80D of the Income Tax Act, 1961.
Protection Against Healthcare Expenses
The key purpose of purchasing a health plan is to receive the best medical care without having to face a financial crisis. A health insurance plan safeguards the policyholder against high medical expenses and provides coverage for pre-hospitalisation expenses, post-hospitalisation expenses, ambulance cover, domiciliary expenses, etc. Therefore, ensuring that the individual focuses completely on his recovery instead of worrying about medical bills.
Protection Against Critical Illness
Nowadays, many insurance companies provide critical illness insurance. Such coverage includes protection against life threatening illnesses like kidney failure, cancer, bone marrow transplant etc. In case the policyholder is diagnosed with any of the illnesses mentioned in the list by the insurer, then they are entitled to receive a lump sum amount.
Cashless Claim Benefit
A cashless claim facility is offered by various insurance companies, wherein the policyholder is not required to make any expenses from his own pocket. The treatment cost is settled directly between the insurance company and the hospital. However, the policyholder is required to get admitted at any of the network hospitals to avail of the benefits. They are required to submit their health insurance card and fill a pre-authorization form to make use of a cashless claim facility.
Due to the popularity of alternative treatments, various insurance providers offer such treatments like homeopathy, Ayurveda, Unani, Yoga, etc. However, only the treatments which take place either in any government hospital or any government recognized institutes are covered by the insurance companies.
Role of Health Insurance Plans During the COVID-19 Outbreak
The pandemic declared coronavirus has impacted the lives of many in India. During times like these when medical emergencies can arise any time, having a health insurance policy comes handy. Whether you are married, single, have children, are young, old, or do not have any children, you must have a reliable health insurance policy that protects you in case of serious illness, sickness, disease, or an accident. Whether you choose individual health insurance plans or family health insurance plans, remember that the choice will not only affect the quality of healthcare, but also affect your wallet.
During coronavirus times, the policyholders are often confused if the policy under which they are covered protects them from hospitalisation expenses arising due to coronavirus or not. The answer is-YES. All new health insurance plans in the market will cover the insured for coronavirus cases after 30 days i.e. the initial waiting period. COVID-19 related claims will follow the normal processes and will be treated as a normal illness like chikungunya, pneumonia, or any other virus. The good news is that so far there is no exclusion.
So, if you still have not insured yourself and your family, then you should get a health insurance policy that provides COVID-19 cover as soon as possible.
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Type of health insurance plans
Individual Health Insurance Plan
It is an agreement between an insurer and a policyholder where former promises of bearing the medical expenses of the latter subject to the limits of the plan. To own this coverage, the policyholder is required to pay premiums to the insurer for getting the coverage without any break.
- Coverage for pre and post hospitalization expenses
- You can opt for the best treatments for your loved ones
- Your savings will not be affected due to any medical emergency
- Most of the daycare procedures are covered under different plans
- Tax benefits under the section 80D of Income Tax Act
Senior Citizen Health Insurance Plan
With age, the probability of falling prey to diseases increases. Therefore, a senior citizen health insurance plan is an excellent option, as in older age, the lesser or no income enhances the trouble. These plans are designed to cover senior people aged 60 years and above and provides coverage for diseases, critical illnesses, accidents, etc.
- Frequent medical expenses can easily be borne with the plan
- Can afford proper treatment and medication with lesser income too
- May increase life expectancy with regular and advanced treatment
- Investment in health policy save the tax under section 80D of IT Act
- Enhance the savings and bring independence in terms of financial security
Critical Illness Insurance Plan
Treatment of critical diseases is never easy. The procedures related to critical illnesses are highly expensive and prolonged that lead to the loss of a significant amount of savings. These plans provide cover for diseases like kidney failure, heart attack, cancer, muscular dystrophy, and many others.
- Lump sum amount is offered to maintain the lifestyle
- The recuperation aid is covered under the critical illness plan
- Regular health check-ups are also available under such policies
- Offers the best treatment when it comes to life-threatening disease
- TA good amount of tax can be saved under section 80D of IT act
Maternity Health Insurance Plans
Pregnancy is a turning point in every woman’s life. At this time, they require the utmost care. With time, medical technology has made delivery procedures safer, more comfortable, but expensive. Everyone wants that the mother and baby should get the most possible comfort during the delivery procedure. Thus, taking a maternity plan is a gesture of perfect planning.
- Easy to get the delivery done in the best-equipped hospital
- Regular expenses are curbed with the coverage of consultations, health check-ups, tests, etc.
- The coverage of newborn baby don’t let the budget be affected
- Normal and Cesarean deliver cover avoid the financial crisis before delivery
- With tax benefits, you can save money under section 80D of IT act
Group Health Insurance Plans
The group health provides the insurance to eligible professionals of an organization. Under this segment of insurance plans, the employers purchase the health policies for their employees. The payment for it is made two ways, half of the amount is paid by the employer and the remaining by the employees. It is generally given to enhance the morale of the employees and also to retain the employees.
- Enhance the retention rate in the firm
- Boost the morale of employees
- Make employees avail the plan at economical rates
- Tax benefits can be earned under section 80D of IT act
Personal Accident Insurance Plans
An accident is an unforeseen and unfortunate event that can happen to anybody and anytime. Also, its consequences may go disastrous and catastrophic. Therefore, a personal accident insurance plan is necessary for dealing with financial hardships during an accident.
- Expenses of accident-related treatments are covered
- Severe injuries due to an accident can be treated in the best manner
- Many personal accident plans covers funeral and legal expenses
- Worldwide coverage is offered as accidents can happen anywhere, anytime
- Some plans provide the coverage to the entire family for complete health care
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- No claim bonus is one of the key features of health insurance and is of great significance to all the policy buyers. The benefits of no claim bonus can be seen in the long run, in case no claim has been raised by the policyholder during the policy term. Y
- Communicable diseases are the one that transmits from one person to another and it is caused by pathogens like bacteria,viruses, and fungi. These are also at times known as ‘transmissible’ or ‘infectious’ diseases. These diseases are generally mild in na
FAQ About Health Insurance Plans
What are the parameters that I should consider when purchasing a health insurance plan?
Some of the parameters that you must consider in order to purchase the most suitable health insurance policy include waiting periods for pre-existing diseases, capping or sub-limits, waiting period for specific illnesses/diseases/procedures, co-payment clause, if any, exclusions under the policy, number of network hospitals and if your preferred hospital is a part of the network or not, claim settlement ratio of the insurance company, incurred claim ratio, premium, add-on benefits, if any, inclusions and exclusions, etc.
What are the common exclusions under health insurance plans?
Health insurance plans do not offer cover for all healthcare expenses. Some common exclusions include expenses incurred on treatment due to self-inflicted injuries including suicide, expenses incurred due to participation in any adventurous sport, pre-existing conditions are not covered during the waiting period, venereal or sexually transmitted disease, cosmetic treatments, treatments related to dental, hearing, and vision, expenses incurred on treatment of obesity, and cover for accidents due to participation in defence operations.
Do health insurance plans cover healthcare expenses related to COVID-19?
Yes. Standard health insurance plans offer cover for expenses incurred due to positive diagnosis of COVID-19. The health insurance policy will cover you for in-patient and outpatient expenses arising due to treatment of COVID-19. You can also purchase health insurance plans especially designed for coronavirus. These include Corona Kavach Policy and Corona Rakshak Policy. These are short term policies that offer cover against the pandemic declared coronavirus. For more information about these policies, you can connect to the customer care executives at InsuranceDekho and they will help you understand them in detail.
What are the benefits of having a health insurance policy?
A health insurance policy offers you a cashless treatment facility allowing you to get the required medical treatment at the network hospital without paying even a single penny. It offers you several benefits apart from cashless treatment, such as pre-hospitalisation and post-hospitalisation expenses, tax benefits under Section 80D of the Income Tax Act, 1961, daily hospital cash benefit in some plans, organ transplant expenses, No Claim Bonus, lifetime renewability benefit, automatic restoration of sum insured, etc.
What is the restoration benefit under health insurance plans?
If your sum insured amount gets exhausted under a health insurance insurance policy due to claims made in a policy year, then the insurance company will restore the amount automatically without having you to pay anything extra to avail the benefit. Health insurance plans that offer restoration benefits are generally available at higher health insurance premiums.
Can I make a claim for all healthcare expenses up to the sum insured limit?
No. Health insurance plans come with multiple sub-limits which can be for specific treatments, doctor’s consultation fees, pre-planned surgeries like cataract, joint replacements, pre-planned surgeries, etc. You cannot claim an amount that exceeds your sum insured limit. Many health insurance plans also come with room rent limits, ICU charges, surgery expenses, doctor’s fees, lab test expenses, etc. for which the cover is offered proportionately.
What are some good health insurance plans in India?
Some popular health insurance plans that offer wide coverage and yet come at affordable premium include Essential Privilege Plan offered by Universal Sompo Health Insurance, Health Guard Plan offered by Bajaj Allianz Health Insurance, Family Health Optima offered by Star Health insurance, and My: health Suraksha offered by HDFC Ergo General Insurance.
Which is the best medical insurance policy in India?
There is not one, but many health insurance plans in India that offer great benefits to the policyholders. These include Prohealth Plus offered by ManipalCigna Health Insurance, Lifeline Supreme offered by Royal Sundaram Health Insurance, and Activ Assure Diamond offered by Aditya Birla Health Insurance.
What is the importance of health insurance in India?
Purchasing health insurance for yourself as well as your family is important in India because lifestyle diseases are becoming very common and healthcare expenses are skyrocketing, especially in private hospitals. So, if you do not have a suitable health insurance plan, it may burn a hole in your pocket.
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*Standard T&C Apply. All savings/offers are provided by the Insurers, which are subject to modification .For more details on risk factors, terms and conditions, please read the sales brochure of respective insurers carefully before concluding a sale. Tax benefits are subject to changes in applicable tax laws. Girnar Insurance Brokers Private Limited, (CIN: U66010RJ2016PTC054811, Regd .Off: Girnar 21, Govind Marg, Moti Doongari Road, Dharam Singh Circle, Jaipur, Rajasthan- 302004; Corp. Off: 11th Floor, Tower B, Emaar Digital Greens, Golf Course Extension Road, Sector-61, Gurugram-122102, Haryana. IRDAI License no 588. Direct Broker (Life & General) valid till 19th March 2023. Email - firstname.lastname@example.org ; Helpline number: 7551196989.
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