Medical costs are going up, and more people are getting sick because of their lifestyles. If you end up in the hospital without health insurance, it can quickly drain your savings. Buying a health insurance policy can provide you with the required financial assistance in case of hospitalization. This insurance provides coverage against medical expenses that you may incur during the policy period. With a valid mediclaim, you can also receive tax benefits under section 80D of the Income Tax Act, 1961.
Key Features of Health Insurance Plans
|Sum Insured||Rs. 50,000- Rs.3 crore|
|Room Rent||Covered as per policy terms and conditions|
|Pre and post hospitalization expenses||Usually 30-60 days|
|Day care procedures||Covered|
|Sum Insured Restoration Benefit||Available|
|Maternity and newborn expenses||Covered|
|Pre-existing diseases||Covered after the applicable waiting period|
|Organ donor expenses||Covered|
|Free health check up||Covered|
|Tax Benefits||Up to Rs. 1 lakh under section 80D of the Income Tax|
What is Health Insurance?
Health insurance is an agreement between the insurer and the policyholder whereby an insurance company agrees to reimburse for medical costs incurred by the policyholder during the tenure of the policy. According to the policy terms, the insured may incur medical expenses if they get ill or meet an unfortunate accident that leads to treatment at the hospital. To avail of the coverage benefits of health insurance policy, the policyholder must pay a specific amount periodically, called a premium. The premium is determined by the insurance company and must be paid by the policyholders without any fail either monthly, quarterly, half-yearly or annually.
Importance of Health Insurance Plans in India
To Protect Your SavingsThough savings are required to meet unexpected future expenses. But, a single hospitalization can drain your life savings in one go. However, you can overcome the situation by getting secured through comprehensive coverage provided by different insurance providers. Most commonly, the companies provide benefits for in-patient hospitalization expenses, pre and post-hospitalization expenses, day-care treatment, ambulance charges, and much more. Besides all, a variety of plans are available in the market, among which an individual can buy as per their specific requirements.
To Deal With Medical InflationAn unexpected critical illness like Cancer, HIV, Heart disease and more can put anyone under stress because of the increased cost of high-quality treatment. Besides treatment expenses, there are many other costs involved like medicines, diagnosis, ambulance charges, consultation fees of a doctor, and much more. Hence, you can save yourself from this drudgery and stressful situation by purchasing a health insurance plan for yourself and your family at the right time.
Lifestyle ChangesAs we are moving forward with the new lifestyle, critical illnesses like cancer, kidney failure, stroke, and many more critical illnesses are following us. These are unexpected diseases happening to people above 45 years of age due to sedentary lifestyles, stress, pollution, and more. Thus, purchasing a comprehensive health plan will not only keep you updated about your health through regular check-ups but will also provide financial coverage for the treatments.
To Secure the Health of Your Family MembersWithin a single insurance plan, you can be secured financially against unexpected critical illnesses. There are many policies available that cover you including your spouse, dependent parents, dependent children, or any other dependents. A family-floater policy will reduce the complexity of maintaining separate insurance plans and will keep your entire family protected. Furthermore, purchasing a family-floater plan is the most cost-effective way to get benefits.
Timely And High-Quality Medical TreatmentReliable security can be advantageous for having a premium-quality treatment without burning your pockets. The process of availing the benefits is as simple as baking bacon. In case of requirements, you just have to visit the nearest network hospital and get the treatment as per the terms and conditions mentioned in the policy. The benefits of insurance can be availed in both cases, which may be a planned hospitalization or an emergency case.
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Why Should You Buy Health Insurance ?
In today’s uncertain times and with changing lifestyles, you may never know when a medical emergency will knock on your door. To stay protected against such unpredictabilities, it is very important to stay secure with health insurance. There are a number of other reasons why you should buy health plan. Some of them are listed below:
- Rising Medical Expenses: Over the years, the cost of healthcare in India has witnessed a sharp rise so much so that it becomes difficult to access quality medical assistance. The increase in the cost of medicines, hospitalisation, medical examinations, and more have together led to an increase in medical expenses. With this rise in medical expenses, it makes all the more sense to buy a health insurance plan that helps you stay protected against such medical emergencies. Depending on your healthcare needs, buy a suitable plan for yourself and your loved ones.
- Altering Lifestyle: The current-day modern lifestyle is such that individuals have been exposed to health problems even more. The 9-5 job, eating habits, disrupted sleep cycle, and more have together contributed to an unhealthy lifestyle. Due to the unhealthy lifestyle, a number of health problems such as obesity, asthma, have constantly been rising. Moreover, apart from physical problems, the unhealthy lifestyle has also led to increased mental health problems. Thus, due to all of these reasons, it becomes all the more important to buy health plan in India.
- Tax Benefits: A plan like health insurance not only protected you from medical emergencies but also provides tax benefits. It is the premium that is paid towards such plans that offer tax benefits under the Income Tax Act of 1961. The tax benefits vary from one group to another, for instance, the tax benefits for senior citizens are higher as compared to the others. Policyholders can avail of maximum benefit of Rs. 75,000 against their policy.
- Network Hospitals: Network hospitals or cashless hospitals are those where policyholders can avail of cashless treatment. The number of network hospitals varies from one health insurance company to another. Thus, it is important that you check the availability of network hospitals while buying the plans. With the availability of network hospitals, it becomes easier to avail of quick and cashless claims.
- Pre-existing Disease Coverage: Health insurance plans also offer coverage for pre-existing diseases after a specific waiting period. However, if you want to get coverage for these pre-existing conditions like diabetes, hypertension, and more, you can also buy a plan that offers coverage for pre-existing diseases from the start. You can also check with your insurer regarding the coverage for pre-existing diseases in your mediclaim plan.
- Pre and Post Hospitalisation Expenses: With a number of health insurance policies available in India, you will also get coverage for pre and post-hospitalisation expenses. Once you are insured with a relevant type of plan, you can enjoy financial coverage for both pre and post hospitalisation.
- Covid-19: Over the years, we all have seen how the global pandemic had altered our lifestyle. It has affected well-being so much that people have now become more and more inclined towards buying health plans. Most of the these plans now offer coverage for COVID-19.
- Variety of Health Insurance: There are a variety of health insurance plans available such as individual plans, senior citizen, family health insurance, and many more. With different types of plans availablle, you can pick a desired type of plan based on your requirements and budget.
- Provides Additional Discounts: On buying health insurance, you can also get several types of discounts such as wellness discounts, renewal discounts, and more. This means that you can save a lot of money and avail discounts once you have bought health insurance plans.
- Ensures Peace of Mind: When you know you and your loved ones are protected against any kind of medical emergency, it will ensure a great sense of relief for you. Thus, on buying health insurance plans, you can stay stress-free and focus more and more on getting quality treatment.
Health Insurance Renewal
Every health insurance plan has its own policy term and thus comes with an expiry date. The policy term thus varies from insurer to insurer and it is important to check the policy term before buying it. However, every health insurance company has its own renewal period to get it plan renewed. In case policyholders are not able to make the renewal during the renewal period, the insurance company offers a grace period which also differs from one insurer to another. If the policyholder still fails to renew their health insurance, then the policy will get lapsed. Listed below are the steps by which you can easily renew your health insurance plan:
- Review Your Health Insurance Plan: First and foremost, you need to assess the existing plan. This will help you understand what coverage is offered and whether it meets your needs or not.
- Visit the Insurer’s Website for Plan Details: You can also visit the insurer's website to learn more about the plans and accordingly decide whether to renew the existing plan or not.
- Make the Payment: Finally, pay the renewal fees to renew your plan. You can choose among the following payment options such as credit/debit card, NEFT, net banking, e-wallets, UPI, and more to complete your payment.
Benefits of Health Insurance Renewal
Some of the benefits of renewing a health insurance plan online are as follows:
- Continued Coverage: When you renew your health insurance policy online, you will continue to get the relevant coverage without any interruptions. Moreover, if you fail to renew your policy before it gets lapsed, then you will lose the No Claim Bonus benefit which is given when a policyholder raises no claim in a given year. In addition to the No Claim Bonus Benefit, a policyholder may also lose several other benefits.
- Tax Benefits: Once your health insurance expires, you will also be not eligible for getting tax benefits. As of now, there are tax benefits available under such plans as specified under section 80D of the Income Tax Act of 1961. However, once your policy is inactive, you will not get any further tax benefits.
- Discounts: When you renew your health insurance plan on time, you will also be eligible for getting renewal discounts. On the other hand, if you fail to renew your plan, then there are high chances that you will end up paying higher premiums than you are supposed to pay.
Why Should You Buy Health Insurance Online?
In today’s digital era, it makes all sense to buy health insurance plans online. Wondering why? Listed below are some of the convincing reasons why you should buy it online:
- Time-Saving: Unlike the traditional ways of buying a health insurance where you had to explain all your requirements to the insurance agents and follow the tedious process, buying online saves your time and lets you buy the health plan conveniently. All you need to do is fill out a few details, after which you will be able to view quote details and accordingly buy the right insurance plan for yourself. This means that you will be able to buy such plans in a matter of a few minutes and save on both time, effort, and energy.
- Compare Different Plans: The online way of buying a plan has simplified the process of comparing different health plans. With an online premium calculator, it becomes easy to calculate premiums as well as compare different insurance plans. When you buy health insurance plans online, you just need to enter a few details to do a comparison of the different types of plans available. So, compare the different types and buy a desired plan with InsuranceDekho.
- No Paperwork Required: When you buy health insurance online, there will be little to no paperwork involved. You just need to submit a few documents online, followed by which you will be able to buy it online.
- Find a Plan That Suits Your Budget: If a policyholder decided to buy health plans online, then it becomes easier to find a plan that fits your budget. Moreover, there will be no involvement of an agent or intermediary, when you buy it online, resulting in purchasing an affordable plan.
- Availability of Add-ons: You can also check the number of add-ons you can include in your health insurance policy. It is important to check which company offers which add-ons and accordingly include them in your plan. Some of the add-ons or riders that you can include in your existing plan are hospital cash benefit, maternity rider, no claim bonus protector, critical illness rider, and so many more.
How to Buy Health Insurance Plan Online?
Now getting insured online is not rocket science. Buying an affordable mediclaim policy which meets all your requirements is very simple and quick with InsuranceDekho.
- Step 1: Enter Personal Details
Fill up your details like Name, Mobile Number, Email-Id, Gender, City, and other crucial details to see the top insurance plans available as per your requirements.
- Step 2: Compare Plans Online
From all the available health insurance quotes, select the plan which meets your budget and requirements in the best manner.
- Step 3: Complete Online Payment
Choose the payment mode and pay the premium online through a secured payment gateway to get the policy document at your registered email ID.
Key Features of Health Insurance
Listed below are the key features of health insurance that you should know about before buying it for yourself:
- Sub-Limits on Room Rent: The sub-limits are the maximum amount that an insurance company shall pay in case a claim is raised. Generally, this limit is up to 1% of the sum insured and a maximum of 2% in case of ICU expenses. But there are several health insurance companies that offer plans without any sub-limit on room rent. Hence, it is recommended to go for such health plans.
- Pre-Existing Diseases: Pre-existing diseases are those from which an individual has already been suffering. In health insurance policies, pre-existing diseases come with a waiting period, so while buying these plans, you need to check the waiting period for pre-existing diseases.
- Health Insurance Types: Before buying any plan, you need to be clear about the different types of health insurance plans available. For instance, if you are buying it for all your family members, then you must buy a family floater health insurance plan.
- Cashless Treatment: Another major factor that you need to check is the cashless treatment facility. Cashless treatment means the option wherein the insurance companies tie-ups with network hospitals to provide policyholders with the option of getting cashless treatment. If this feature is not covered, then you will be required to pay the expenses incurred at the hospital, from your own pocket, and the insurance company will reimburse you for the same later.
Benefits of Comparing Medical Insurance Plans Online
There are several benefits when you compare health insurance plans online such as the following:
- Select The Best Plan: On comparing the health plans online, you will be able to able to select the best plan as per your budget and requirements. Moreover, comparing these plans also helps you make an informed choice without the involvement of an agent.
- Offers Convenience: The comparison of these policies online is more convenient than offline. The process will become too tedious if you have to visit different locations to get quotes and understand the coverage benefits before shortlisting the health insurance plan. Hence, it becomes easier to buy when you compare plans online.
- 24*7 Availability: You can compare insurance plans anytime at your convenience. Unlike the online process, the offline process has fixed working hours and hence you won’t be able to visit an insurance company’s branch office late at night to compare the plans.
- Saves Time: When comparing the plans online, you will not be required to spend so much time filling forms or discussing with agents or executives. All you need to do is fill in a quote and several plans will be displayed on your screen which you can compare easily. This saves you enough time as well as money.
- Health Insurance Premium Calculator: With the help of a premium calculator available online, it becomes convenient to select the most affordable health insurance for yourself.
- Right Coverage: While comparing the medical insurance plans offline, you may be restricted to understand the coverage benefits of a few plans. However, comparing the plans online will allow you to search for the desired coverage by comparing as many insurance plans as you need.
Checklist for Buying Health Insurance
In order to buy health insurance, here is the checklist that you need to follow:
- Waiting Period: The waiting period refers to the period during which the policyholder will not be able to raise claims. The waiting period varies from one insurer to another, hence it is very important that you check it while buying such plans. You should ideally choose a health insurance company that has a lower waiting period.
- Co-payment: Co-payment refers to the amount you need to pay from your pocket to get the relevant coverage. You should choose a plan that has a lesser or no co-payment so that you don’t have to spend anything from your pocket. However, when you have a higher co-payment, then the premium in such cases will be lower.
- Grace Period: Select the company that offers a greater grace period. The grace period refers to the period during which you can still renew your plan irrespective of its expiry. You must thus read the policy details to know about the exact grace period.
- No Claim Bonus: No Claim Bonus in health insurance refers to the benefit given to the policyholder if you raise no claim in a given year. A No Claim Bonus benefit is given when a policyholder is renewing their plan. So, before buying such plans, you should check the No Claim Bonus.
- Network Hospitals: Network hospitals are those where you can get cashless treatment. You should choose a company that has tie-ups with more network hospitals. The more the number of network hospitals, the easier it becomes for policyholders to locate a nearby cashless hospital and get quality treatment without worrying about hefty medical expenses.
- Restore Benefits: Restoration benefits refer to the process in which the exact sum insured gets automatically restored once it has been used or after a claim has been raised. You should ideally choose a health plan that offers greater restoration benefits or 100% restoration benefits.
- Preventive Health Check-up: Preventive health check-up in health insurance refers to the benefit given to the policyholder to avail of an annual health check-up for free. While buying such plans, you must check with the insurer whether there is a free annual health check-up available with your plan or not.
- Sub-limits: There are a number of health insurance plans that comes with different sub-limits. However, you should choose a company with no sub-limits on your plan. So make sure to go through the policy wording to know all about the sub-limits in your plan.
What is Typically Covered in Health Insurance Plans?
In India, most companies provide coverage for the following:
- In-patient Hospitalization: Coverage for inpatient care, including surgeries, treatments, and room charges in a hospital if the patient is hospitalised for more than 24 hours.
- Pre-existing Illness: Health insurance also provide coverage for pre-existing conditions after a certain waiting period. You should check the waiting period with your insurer.
- Pre and Post Hospitalisation: Heath insurance plan provides coverage for both pre and post hospitalisation expenes. Under pre-hospitalisation expenses, you get coverage for blood tests, urine tests, and more. On the other hand, post-hospitalisation provides coverage for medicines that are prescribed for the well-being after getting discharged from the hospital.
- Preventive Health Check-ups: Many health plans cover preventive services like vaccinations, screenings, and wellness check-ups. With preventive health check-ups, policyholders get such check-ups done at no additional cost.
- Ambulance Expenses: Almost all plans provides coverage for an ambulance, however, the coverage varies from one insurer to another.
- Maternity Cover: Under mediclaim insurance plan, you will also get coverage for expenses related to the birth of a baby.
- Day-care Procedures: In case a policyholder is seeking treatment for less than 24 hours, then such coverage is also offered.
- Home Care: If a policyholder is seeking treatment at home under a medical practitioner, then coverage for that is also offered.
- AYUSH: Health insurance policies in India also provide coverage for AYUSH treatment such as homeopathy, ayurveda, and more.
- Mental Healthcare Cover: As per the latest guidelines by IRDAI, it is now a mandate to provide coverage for mental healthcare problems like bipolar, depression, and more.
What is Not Covered Under Health Insurance Plans?
Some of the exclusions of health insurance are as follows:
- Cosmetic Procedures: Procedures considered cosmetic and not classified as medical treatment such as elective plastic surgery or cosmetic dentistry, are often not covered.
- Experimental or Investigational Treatments: Treatments or medications that are still in experimental or investigational stages may not be covered.
- Alternative and Complementary Therapies: Some plans do not cover alternative therapies like acupuncture, naturopathy, or chiropractic care.
- Weight Loss Treatments: Coverage for weight loss surgeries or programs may be limited or excluded in some plans.
- Infertility Treatments: Fertility treatments, such as in vitro fertilization (IVF), may not be covered or may have limited coverage.
- Abortions: Coverage for elective abortions may not be included in all plans.
- Certain Prescription Medications: Some medications, especially those considered lifestyle drugs, may not be covered by certain plans.
- Cosmetic Dentistry: Cosmetic dental procedures like teeth whitening or veneers are often not covered.
- Vision and Hearing Aids: While some health insurance plans offer optional coverage for these, routine vision and hearing care may be excluded.
- Routine Foot Care: Non-medically necessary foot care, like routine pedicures or orthopedic shoes, may not be covered.
- Self-Inflicted Injuries: Injuries resulting from intentional self-harm or illegal activities may not be covered.
- Non-Prescription Items: Over-the-counter medications and medical supplies are typically not covered.
Key Factors To Consider Before Buying Health Insurance Plans
Buying health insurance for yourself or your loved ones may become a challenging task if you are not aware of the different factors. If you fail to keep these factors in mind, there is high chance that you may end up buying the wrong plan. So, to help you out, we have jotted down some of the tips that will help you in buying the best health insurance plan:
- Sum Insured: The sum insured refers to the total financial coverage that is given to the policyholder with their health insurance plan. Thus, it should be carefully chosen because it covers you and your loved ones for medical expenses incurred during the policy term. You should consider your income as well as your age when deciding on the sum insured for your medical insurance policy. Make certain that the sum insured is not insufficient and that the premium is not excessively high. You should ideally choose a sum insured that is at least 10x your current salary. With the rising medical expenses, it becomes all the more important to choose the right sum insured.
- Claim Settlement Ratio: Before buying a health plan always consider the number of claims settled by the medical insurance company. The ratio between the number of claims settled to the number of claims raised in a given year is called the health claim settlement ratio. The entire purpose of buying a health insurance plan is to get secure financially against unexpected illnesses which means if the claim settlement process is smooth then it is advantageous for the insured. So, always choose a health insurance company that has a higher claim settlement ratio.
- Network Hospitals - Network hospital is where policyholders can get cashless treatment Availing treatment at network hospitals is very convenient as they allow cashless treatment to the insured. This is why you should check the number of network hospitals associated with an insurance company. It is recommended to choose a health insurance provider that has a maximum number of network hospitals. Also, make sure to select the one nearby your place of residence to save time in case of an emergency. With a large number of network hospitals, it will be easier for you to locate a nearby network hospital.
- Health Insurance Premium - The purpose of buying a health insurance is to reduce financial stress in case of any medical emergency. You must choose a plan with an affordable premium so that you continue your policy for a longer period without any financial stress at present. However, choosing a medical insurance policy with a low premium is not always advisable as it may not get you enough coverage in case of an emergency. So, while buying a health insurance policy, it is important to check its premium.
- Add-on Benefits - There are a number of riders that you can include in your health insurance plan such as maternity riders, hospital cash, critical illness rider, and many more that will help in enhancing the plan benefits. You can choose the add-ons voluntarily by paying an extra premium at the time of policy purchase. However, remember that on including these add-ons to your health insurance plan, the premium will vary to a great extent.
- Waiting Period: The waiting period refers to the period during which you cannot raise health insurance claims. Typically, the waiting period varies from one health insurance company to another, which is why it is important that you check the waiting period at the time of buying a policy.
- Inclusions and Exclusions: Just like the inclusions or the coverage offered under your health insurance plan, it is equally important to analyse the exclusions. Exclusions are the conditions for which you cannot make a claim, under your health insurance policy. Hence, when choosing a policy, you must opt for the one with the least number of exclusions. Some common exclusions under health plans are treatment required due to self-harm, treatment required due to participation in adventure sports, any injury due to involvement in adventurous activities, and more. So, be aware of both the inclusions and exclusions while purchasing health plan.
- Lifetime Renewability: You should always check the renewability feature in your health plan. Ideally, you must buy a health insurance policy that offers lifetime renewability. When there is a renewability feature, it becomes easier to renew the plan without any inconvenience at additional costs. So, you save both time and money when you purchase health plan with a lifetime renewability option.
Partner Health Insurance Companies
Top Health Insurance Companies in India 2023
Here is a list of the top health insurance providers based on the claim settlement ratios (CSR):
|Rank||Health Insurance Company||Health Claim Settlement Ratio FY20|
|1||HDFC Ergo Health Insurance||100%|
|2||Niva Bupa Health Insurance||91.20%|
|3||Care Health Insurance||95.22%|
|4||Aditya Birla Health Insurance||94%|
|5||Star Health Insurance||85.47%|
|6||ICICI Lombard Health Insurance||93.10%|
|7||Reliance Health Insurance||100%|
|8||ManipalCigna Health Insurance||93.53%|
|9||Digit Health Insurance||93%|
|10||Cholamandalam MS Health Insurance||56.25%|
|11||SBI Health Insurance||66.08%|
|12||Royal Sundaram Health Insurance||82%|
|13||Future Generali Health Insurance||95%|
|14||National Health Insurance||83.78%|
|15||Liberty Health Insurance||81.03%|
|16||Edelweiss Health Insurance||85.57%|
|17||Magma HDI Health Insurance||95.17%|
|18||Oriental Health Insurance||93.96%|
|19||New India Health Insurance||92.68%|
|20||Bajaj Allianz Health Insurance||92.24%|
|21||Kotak Mahindra Health Insurance||75.45%|
|22||Universal Sompo Health Insurance||96%|
Variety Of Health Insurance Plans
Health Insurance Terminologies
Benefits of Health Insurance
Comprehensive CoverageIn case of any medical emergency, a health plan will protect you against medical expenses. Generally, insurance policies cover in-patient hospitalization expenses, pre-hospitalization and post-hospitalization expenses, ambulance expenses, domiciliary hospitalization expenses, daycare procedures, organ donor expenses, AYUSH system of medical treatments, and so on.
Lifetime RenewabilityAccording to the guidelines of the Insurance Regulatory and Development Authority Of India (IRDA), it is significant to provide policyholders with lifetime renewability advantages. It enables you to renew your insurance plan without any age restrictions. The feature is of great advantage for parents and senior individuals since they can renew their existing insurance plans without having to hunt for new health plans in their old age.
Cashless TreatmentInsurance companies have tie-ups with certain hospitals, known as network hospitals, where the insured can avail of cashless treatment. If you avail treatment at these hospitals, the insurance company will directly settle the bills at the hospital, and you will not be required to pay anything for the treatment availed, except for non-medical expenses incurred.
PortabilityIn case you are dissatisfied with your existing health plan or company, the portability feature will allow you to switch from your existing insurance company to another. Hence, this feature will save your right of being abused or taken for granted. If you are not happy with your existing plan or company you can shift by following the simple and easy steps.
Tax Benefits Under Section 80D of the Income Tax Act, 1961Under Section 80D of the Income Tax Act of 1961, the government of India promotes health policies by providing tax exemptions of up to Rs. 1.5 Lakh on premiums paid for insurance plans. Individuals can also claim a tax deduction of up to Rs. 25,000 for insurance coverage for themselves, their spouses, and their dependant children. Besides, you can also claim a tax deduction of up to Rs. 25,000/Rs. 50,000 for health insurance policies purchased for parents over the age of 60.
Health Insurance Portability
The transfer of your existing health insurance from one company to another is referred to as health insurance portability. With this feature, a policyholder can switch insurance companies without losing the benefits of their existing plan. If as a policyholder, you are dissatisfied with your current insurance policy or are looking for a better health plan, you can change your insurance provider while retaining all of the benefits or credits of the existing one. Some alternatives that a policyholder must consider while transferring their health policy or insurance provider are as follows:
- The policyholder can switch from one insurance company to another.
- Within the same insurance company, the policyholder can switch between the medical plans.
- The policyholder can transfer their individual health plans to a family floater health insurance plan and vice versa.
- Also, the policyholder can apply for a revised sum insured with a new health insurance company.
- The policyholder can also enhance the coverage of their existing health plans. However, you may undergo a medical examination that sometimes may also result in new waiting periods for the enhanced coverage.
Health Insurance Portability Criteria:
Check out the portability criteria of a health insurance in the below-mentioned section.
- You can switch your health plan only at the time of renewal.
- When considering transferring an insurance policy, the policyholder should contact the new company at least 30-45 days before the expiry of the present medical policy.
- Provide necessary documents at the time of porting the insurance policy. The documents can be - Previous policy documents, claim experience, age proof, identity proof, proposal form and other documents requested by the new insurance company.
- Ensure that there are no breaks in between the renewal process of your health plan.
Why Choose InsuranceDekho For Buying Health Insurance?
- Protection Within 5-minutesInsuranceDekho offers a quick and easy way of buying a health plan. At the portal, you can compare and select the best insurance plan for yourself and your dear ones, available at a cost-effective price, within 5-minutes. Simply, you can enter a few details and can get insured in a transparent and hassle-free way.
- 5.5 Lakh+ Happy CustomersWe aspire to establish trust in our customers by making the process of purchasing health plans online as smooth and easy as possible. Over the years, InsuranceDekho has built trust in more than 5.5 lakh insurance buyers by providing a great user experience.
- Dedicated Support TeamA professional team at InsuraceDekho is available seven days a week to address any complaints and clear your doubts that you may have about health insurance. To make your process easier, you can contact us if you have any questions about how to get an insurance policy, file a claim, or renew your plan.
Coronavirus Health Insurance
Standard health insurance plans provide coverage for the treatment of coronavirus (COVID-19). However, the treatment of coronavirus involves numerous types of pre-hospitalisation, hospitalisation, post-hospitalisation, and treatment expenses during quarantine. Thus, it is wise to opt for short-term health insurance policies, namely Corona Kavach and Corona Rakash, especially designed to provide coverage only for coronavirus treatment expenses.
Does Your Medical Insurance Policy Cover COVID-19 Treatment?
According to the guidelines issued by the Insurance Regulatory and Development Authority of India (IRDAI), it is mandatory for all general and health insurance providers to cover COVID-19 treatment expenses in the existing plan of policyholders. The regulatory authority issued a circular on March 4 that directed insurance companies offering health insurance plans to include cover for COVID-19, irrespective of which policy the insured is covered for.
Are you already covered with any type of health insurance? Then You must know the following details:
• An initial waiting period is applied, which is 30 days in most health plans.
• The claim process for COVID-19 is the same in regular health policies like any other medical condition.
• Cover for pre-hospitalisation and post-hospitalisation expenses is offered as per the terms and conditions of the policy selected.
In addition to COVID-19 coverage in existing health plans, the IRDAI has created COVID-19 medical insurance policies, namely Corona Kavach and Corona Rakshak. Both are short-term plans that cover families and individuals, with the former being an indemnity-based policy and later being a benefit-based policy. Both plans make you feel financially secure if you are diagnosed with COVID-19.
Arogya Sanjeevani Health Insurance Policy
Arogya Sanjeevani Policy is a standard health insurance product which aims to simplify health insurance for people by providing them with a basic and standard plan. An Arogya Sanjeevani Health InsurancePolicy is offered by all health insurance companies with exactly the same benefits. An Arogya Sanjeevani Health Insurance Plan comes with the following features -
- No medical check-up up to the age of 45 years
- Sum insured between Rs. 1 Lakh to Rs. 5 Lakh
- Policy tenure of 1 year with lifetime renewability benefit
- No claim bonus of up to 50% of the insurance premium
- Waiting period of 30 days for all illnesses except accidents.
What Is The Difference Between Health Insurance And Mediclaim Policy?
If you have a health insurance policy or a mediclaim policy, you can take advantage of medical insurance coverage benefits in case of an emergency.
What is Mediclaim?
A health policy called Mediclaim only provides you with specific financial protection for costs associated with hospitalization. It covers any necessary hospitalization brought on by an accident, an unexpected illness or operation, as well as any surgeries performed within the insurance period. There are two types of medical claims: reimbursement and cashless.
What is Health Insurance?
It is a comprehensive insurance plan that will provide coverage to the policyholder for unexpected medical and surgical costs. With a health plan, you can avail of cashless treatment or reimbursement for the cost of the covered treatments.
To understand the difference between a medical insurance and mediclaim policy, kindly refer to the table below:
Health Insurance Policy
You are only covered for hospitalization expenses.
Besides hospitalization, it offers a comprehensive coverage including AYUSH treatment expenses, in-patient hospitalization expenses, pre and post-hospitalization expenses, daycare expenses, and much more.
Additional Add-on coverage is not available.
You can pick from several add-on covers based on your needs, such as hospital cash, severe illness, room rent waiver, and so on.
It comes with a limited hospitalisation cover of up to Rs. 5 Lakh
It includes extensive hospitalization coverage that can exceed Rs. 5 lakh depending on numerous parameters including age, the number of persons covered, pre-existing diseases, and so on.
Can be customised according to specific needs and requirements.
The following things need to be taken into account when deciding between a health insurance policy and a mediclaim policy:
- Your economic situation
- Your age, any existing health issues you and your family members may have
- Add-On covers
- Members who will be covered by a health insurance
- Sum insured
- Policy term
Health Insurance Coverage
- What is Covered?
- What is Not Covered?
In-Patient Hospitalisation ExpensesExpenses incurred due to hospitalization of 24 hours or more, including nursing and boarding expenses, fees of nurse, doctor, or surgeon, cost of blood, oxygen, and much more.
Pre-Hospitalisation And Post-Hospitalisation ExpensesExpenses that come up before and after hospitalization for a set number of days in accordance with the terms and conditions of the insurance policy. These cover costs for tests, physician fees, medical records, and much more.
Daycare ProceduresTreatments in which an individual does not have to be admitted to the hospital for more than 24 hours are considered daycare treatments. Some of them include cataracts, sinusitis, chemotherapy, radiotherapy, and much more.
Organ Donor ExpensesExpenses that occur due to harvesting the organ from the donor and for the transplant surgery as covered under this policy. The hospitalization expenses include room rent, doctor's fees, and other expenses.
Domiciliary Hospitalisation ExpensesThis means that treatment is given at home due to a lack of hospital beds, or when the patient cannot be transferred to the hospital due to a medical emergency. It covers therapy that lasts more than three days for any injury or disease.
Road Ambulance ExpensesTransportation expenses for the insured to the nearest hospital in the case of a medical emergency are covered up to a certain level. The ambulance is equipped with everything needed to transport the patients.
AYUSH TreatmentsIt comprises in-patient treatments provided by the AYUSH medical system, which includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy. The expenses are paid up to a certain amount.
Cosmetic TreatmentsCosmetic treatments are performed to enhance your appearance. Hence, these are not covered under the health plan. Some of the examples include plastic surgeries, face lifts, nose jobs, and much more.
HIV/AIDSIt is a critical condition in which a virus attacks the immune system of an individual. And, most of the insurance companies do not provide coverage for HIV/AIDS in their plans.
Self-Inflicted InjuriesSuicide or any other condition in which an individual harms themselves is not covered under a health plan offered by different insurance companies.
Injuries Due to Alcohol or Drug AbuseInjuries that occur due to any harmful substances like alcohol or any kind of drugs are not covered under the health plan.
Participation in Adventure SportsInjuries happened due to the adventure sports activities like mountain climbing, tracking, and many others that are not covered under an insurance policy.
Injuries Due to War, RiotsMishappenings that occur because of any type of war or riots, nuclear contamination, or any other perils are not included in the health plans.
Unproven And Experimental TreatmentsTreatments that are not medically tested and are solely done for the purpose of investigation are not covered under the insurance policies.
Rest Cure, Rehabilitation, And Respite CareHealth plans do not cover expenses related to enforced bedrest and not for treatment.
Health Insurance Riders
Critical Illness CoverWith this add-on, you will be eligible for a lump-sum payment if you are diagnosed with a serious and long-term sickness such as cancer, stroke, kidney failure, and many others. You can utilise the money to compensate for any income loss caused by a catastrophic illness. Some insurance companies offer critical illness coverage as part of a standalone policy, while others offer it as an add-on cover for up to 50 severe illnesses.
Maternity CoverIf you are planning to have a baby, then maternity cover riders would be of great advantage. Both a mother and child need premium quality treatment during this lovable phase of life. So, to cover the financial strain that may occur due to childbirth medical treatment, you can take advantage of maternity riders. Moreover, some insurers also provide childcare expenses. These plans generally come with a waiting period of 2 to 4 years.
Hospital CashThe add-on cover of hospital cash provide you cover for all the non-medical expenses that are incurred during the hospitalization and are not covered under the health plan. The policyholder gets a daily cash allowance as per the limit specified in the policy document, for a specific tenure of the policy. The coverage amount for daily cash benefits may vary from insurer to insurer but, usually, it ranges between Rs. 500 to Rs. 5000 per day.
Room Rent WaiverThe type of room you choose, while you are hospitalised, has a significant impact on your hospital expenditures. A normal health insurance plan includes a restriction on the room's per-day charges. This means that any additional expenditures paid as a result of changing from standard accommodation to a deluxe room must be borne by the insured. However, with the room rent waiver add-on, you can choose any room of your choice at no extra cost.
OPD CoverOutpatient department commonly known as OPD is that area of a hospital, wherein patients can simply visit and consult the doctor. In this type of coverage, the patient has to pay the doctors fee instead of getting admitted as a daycare patient in the hospital. Generally, OPD expenses are not covered as an add-on in health insurance. But, it can cover the cost of medicines, consultation fees, and much more.
Personal Accident CoverConsidering the rising number of road accidents in India, a personal accident add-on cover is a great option as it provides financial protection in case an insurer meets an accident. This includes the coverage in case of permanent total disability, permanent partial disability, total disability, or death. If you are planning to add-on this rider, then you can additionally buy it with your standard health plan by paying an extra premium at the time of purchase.
International Second Opinion CoverWith the help of this add-on cover, you can consult international doctors before availing of a specific treatment. You can use this rider in case the insured is not satisfied with their treatment. Hence, adding on this rider will be empowering for the insured as they can review the treatment advice and recommendations, offered for a particular illness. Moreover, it will help you in getting additional insights into your illness and treatment.
Air Ambulance CoverThis add-on cover helps in transferring the patients to the hospitals through air domestically and internationally, as per the terms and conditions specified by an insurance company. With the help of this add-on, an insured will be able to avail of the benefits of reaching timely at the hospital in case of an emergency.
Reduction in Pre-Existing Diseases Waiting PeriodHealth insurance plans usually come with a waiting period for pre-existing diseases of 48 months. But with an add-on cover of reduction in the pre-existing waiting period, you can reduce your waiting period from 48 months to 24 months. However, terms and conditions related to reductions may vary from insurer to insurer. Simply by paying an extra premium you can avail of this feature.
Which Health Insurance Plan Should You Buy?
If you are planning to buy a health insurance, then you can choose from several plans that are available in India. These include family floater health insurance plans, senior citizen health plans, critical illness insurance plans, maternity insurance, and much more. A number of health insurance companies now offer these types of plans to provide relevant coverage to policyholders from all over. So, if you have planning to buy a health plan and are confused, here is a guide that will help you.
- In case you or your parents are above the age of 60 years of age, then it is recommended that you should buy a senior citizen health insurance plan over the others. Moreover, you can also buy a separate senior citizen insurance policy for your parents and one for yourself if both you and your parents are above 60 years. This is recommended so that both you and your parents can get the relevant type of coverage.
- If you are one of those who is planning to start a family or already have a family consisting of dependant parents, kids, and spouse, then it is best to buy a family health insurance plan. This type of plans will offer greater coverage as compared to an individual health insurance plan and will also be a more affordable option. Kindly note that when going for a family floater health insurance policy, you must choose a higher sum insured so that it is sufficient for all family members. The right approach will be to seek maximum coverage for all the family members at the most affordable premium. It is recommended to do enough research in order to zero down the most suitable insurance policy for yourself and your family.
- On the other hand if you are young and have just started your career, then it is recommended to buy an individual health insurance plan as these plans are more affordable option in this case.
- If you have a number of pre-existing illnesses such as diabetes, hypertension, and others, then buying health insurance with critical illness cover makes sense. The reason behind this is that when you buy critical illness health insurance plan is that you will stay protected from any kind of health risks that might take place in the future.
When choosing the best health insurance policy, there are many other factors besides the premium that should be considered. Hence, after deciding which plan to buy, you can also buy add-on covers to get extensive coverage. Though it is not mandatory to purchase add-ons covers, looking at their advantages it is suggested that you can buy them voluntarily at the time of policy purchase. Some popular add-ons offered under these plans are room rent waiver, hospital daily cash, second e-opinion, critical illness cover, air ambulance cover, and many others.
Why Buy A Health Insurance Plan at An Early Age?
Check out the top reasons for buying a health insurance at an early age in the below section.
Lower Premium - Youngsters of the age of 20 years will have to pay a lesser premium on health plans than those older of age 52 years. The idea behind this is that older people are more vulnerable to getting ill because of a weaker immune system. So, it is suggested to purchase a health policy at an early age.
Lesser Exclusions - Many medical insurance plans come with restrictions on coverage offered, due to which you may not be able to avail full-fledged cover on buying a policy in later years of life. But if you buy a health insurance policy at an early stage in life, when you do not have any health condition, then you will be able to enjoy a full-fledged health cover.
No Health Check-Up - When you purchase a health plan at an early age, there is not any need of undergoing a medical examination. However, most insurance companies will ask you to have a medical test before purchasing a policy at an advanced age, let’s say at 50. Additionally, if a health condition is revealed in the medical test results, you can be obliged to pay a higher premium due to the increased risk of hospitalization.
No Claim Bonus - You will be able to start accumulating No Claim Bonus early on by buying a health insurance timely. You can use this NCB in your senior years when you are more susceptible to illnesses and may need to file a claim. However, if you get the policy later in life, you will not be able to benefit from such expanded coverage.
Aligned Finances - If you buy a health policy at a young age, then you have time to plan your finances for the long term. However, if you buy it in your latter years, your financial planning may go wild. As a result, it is recommended that you purchase health insurance plan when you are young so that financial planning can begin early and that you are prepared for any kind of crisis.
Waiting Period - Waiting periods for various conditions are included in health plans, some of which you are more prone to get in old age. The benefit of purchasing health policies when you are young is that you can complete the waiting period sooner and use the policy advantages when you need them.
Rejections - As you will be more prone to illnesses in your old age, therefore there are higher chances of your health insurance application getting rejected then. Thus, it is advised to purchase insurance policies early on to reduce the likelihood that your application will be denied.
Pre-Existing Conditions - There is a potential that you may already have pre-existing conditions if you get health coverage later in life. But before you may receive the advantages of the coverage, you must first finish a waiting period. On the other hand, if you get the insurance while you are young, you will already have finished the waiting period and be able to access the necessary coverage by the time you might need coverage for pre-existing conditions.
Tax Benefits of Health Insurance
Under Section 80D of the Income Tax Act, 1961, every Hindu undivided family can claim tax benefits. You can avail of tax benefits on the premium paid for yourself and your family members including spouse, dependent children, or parents.
The deduction from the total income can also be availed on the premium paid for top-up health insurance plans as well as critical illness health insurance plans, apart from regular insurance plans.
Refer to the table below to comprehend the amount of deduction now offered to a single taxpayer in various circumstances.
Deduction under Section 80D of the Income Tax Act
Self, Family, Children
When the policyholder and parents are aged below 60 years
When the policyholder and family members are aged below 60 years with parents aged above 60 years
When the policyholder, family members, and parents are more than 60 years of age
Members of the HUF (Hindu Undivided Family)
Non-Resident Individuals (NRIs)
Health Insurance Terminologies
Explained below are terms that you must know in order to understand your health insurance better:
- AYUSH: Ayurveda, Yoga and naturopathy, Unani, Siddha, and Homoeopathy, are the kind of treatments that are covered under AYUSH. There are a number of health insurance plans that provide coverage for AYUSH.
- Bariatric Surgery: Treatment or surgery related to weight loss is called Bariatric surgery. So, if you are planning to undergo weight-loss treatment, make sure that your health plan provides coverage for Bariatric Surgery.
- Base/Indemnity Plan: A base or indemnity plan is one in which the health insurance claim amount is paid out based on the actual medical expenses. For example, if you have a sum insured of Rs. 10 lakhs and the hospital bills are of Rs. 8 lakhs, then Rs. 8 lakhs will be directly settled by the health insurance company.
- Critical Illness: Critical illness refers to life-threatening diseases such as cancer, stroke, kidney failure, and others. There are plans that provide coverage for critical illness at additional costs, thus it is important to check the same while you are buying health insurance.
- Claim: The term refers to the request made by the policyholder to the insurance company to compensate for the medical expenses. Policyholders can claim their policy in two ways; reimbursement claims, and cashless claims. Cashless claims are directly settled by the insurance company at the network hospital where in case of reimbursement claim, the total amount is later reimbursed by the insurance company.
- Co-Payment - Health plans compensate you for healthcare expenses incurred during a treatment that is covered under your policy. However, co-payment occurs when the insured and the insurance company share the expenditures at the time of the claim. In general, health policies with a co-payment clause have lower premiums. This feature is most commonly found in senior citizen health insurance plans.
- Daycare Procedures: Daycare procedures are those that require hospitalisation of less than 24 hours such as chemotherapy, dialysis, and more.
- Domiciliary Treatment: There are times when a policyholder seeks treatment from a medical professional instead of going to the hospital. Such a treatment which can be availed at home is called domiciliary treatment.
- No Claim Bonus - It is a reward that a health insurance company gives to the insured for not making a claim in a particular year. For instance, an increase in the sum insured by a fixed percentage according to the policy, not more than 50% of the sum insured, if the policy has been renewed continuously.
- Deductible - Deductible is identical to co-payment. It is a fixed amount in rupee terms that are shared by the policyholder, and not the insurance company, at the time of claim. It is, however, decided by the insurance company if the insured is required to pay this amount per year, per life, or per event.
- Dependents - Family members including legally wedded spouse, unmarried children, and more who are financially dependent on the insured are known as dependents.
- Exclusions - There is an innumerable list of conditions that are not covered under the health plan during the policy tenure by insurance companies. Hence, these leftovers are known as exclusions. Some common exclusions under health insurance are treatments required due to participation in adventure sports, Injuries due to self-harm, insured committing a breach of law, etc.
- Grace Period - The grace period is a specific period of time that is given to the policyholder to pay the premium to continue availing coverage benefits under the policy, immediately after the expiry of the due date or premium payment. Hence, if you will pay the premium during this period, then you can continue to avail the policy benefits. However, in case you forgot to pay your premium during the grace period also, then your policy may lapse and you may lose all the accumulated benefits.
- Insurer - The insurer is the insurance company from which you choose to buy the relevant health plans and get protection for yourself and your family.
- Premium - A fixed amount that must be paid on a regular basis in order to continue receiving benefits from your health plan.
- Policy - It is a legal contract between an insurance company and the insured, that contains all the terms and conditions of the insurance.
- Pre-Existing Disease - Any condition, illness, or accident for which the insured had symptoms within the past 48 months before purchasing a health policy falls under this category. After a certain waiting period, pre-existing conditions are often covered by the policy. Therefore, it is advised to report any pre-existing conditions in order to prevent complications at the time of claim settlement.
- Network Hospital - Network Hospitals are referred to those medical care centres that have a partnership with an insurance provider and are entitled to pay cashless care to the insured. To ensure maximum ease in the event of an emergency, it is advised to select an insurance carrier with a large number of network hospitals.
- Portability - In case the insured is dissatisfied with their existing company or policy, they can either switch from one company to another or maybe change their insurance plan to another. The portability feature can only be availed of if the insured has maintained their plan without any lapse. Portability allows you to transfer the accumulated benefits as well such as waiting for period benefits, NCB, and much more.
- Restoration Benefits: Restoration benefits refer to the situation when the exact sum insured is automatically restored even after the policyholder has raised a health insurance claim.
- Riders: Riders or add-ons refer to additional benefits given to the policyholder. Some of the add-ons that you can include in your health insurance plan are critical illness rider, hospital cash, rider, maternity rider, and more. However, policyholders need to pay extra premiums to include these riders in their health insurance plan.
- Room Rent Limit: It refers to the limit up to which the insurance company pays for the hospital room. If the room expenses are beyond this, then the policyholder will have to pay the remaining money from their pocket.
- Preventive Health Check-up: Preventive health check-up refers to the benefit given to the policyholder in which the insurance company assesses the health condition of the policyholder for free.
- Super Top-up: A super top-up plan is one which can be added to a base health insurance plan to further enhance its benefits. It is ideal to expand the scope of health insurance coverage.
- Sum Insured - It is the sum amount that an insurance provider is liable to pay to the insured at the time of claim. For instance, if a health insurance policy's sum insured is Rs. 5 lakh and hospitalization costs total Rs. 2 lakh, the insurance company will pay the costs. However, the insured will be responsible for paying any additional costs if the expenses are greater than the maximum sum insured.
- Underwriting: This is the process during which the health insurance company assesses the health insurance application request. Based on the medical condition, the insurance company will set the health insurance premium that needs to be paid by the policyholder.
- Waiting Period - This is a fixed time period for which the medical insurer does not cover you, even after the commencement of the policy term. Waiting periods can be of different types such as initial waiting period, waiting period for specific diseases, waiting period for pre-existing diseases, etc. The waiting period is calculated from the date of commencement of the policy.
- Free Look Period - It is the time period in which the insured can understand all the details, features, benefits, terms, and conditions of their policy. During this period, if the insured is not satisfied with their plan, then they have a choice to cancel the policy.
Waiting Period In Health Insurance
Even after purchasing a health plan, insured is not entitled to receive the entire value for some conditions that are mentioned in your policy due to a waiting period in health insurance. Hence, this means that insured person will only be eligible to get coverage benefits for pre-existing diseases after completing a specific time-period, which is determined from the beginning of the policy.
Types Of Waiting Period In Health Insurance
Following are the types of waiting periods:
- Initial Waiting Period: Initial period, that is also known as cooling period, is that in which the policyholder has to wait for a certain number of days before receiving any claim benefits under the plan. Most of the health insurance plans come with a waiting period of minimum 1-month and maximum 90 days.
- Pre-Existing Diseases (PED) Waiting Period: It is a pre-existing disease waiting period that the insured acknowledges at the time of policy purchase. According to the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing disease is defined as any condition, accident, ailment, or disease detected within 48 months of the policy acquisition. Pre-existing illnesses include thyroid, hypertension, and diabetes. Pre-existing conditions are usually subject to a 1-4 year waiting period in most health insurance coverage.
- Waiting Period for Specific Diseases: There are some conditions, including hernias, tumours, ENT disorders, cancer, strokes, and cardiac problems, that come with a specific waiting period. This period for specific diseases vary from insurer to insurer and can found in the policy provision of each company.
- Maternity Waiting Period: If you are planning to start your family very soon, then you can add maternity coverage to your standard health policy. With this plan, your pregnancy expenses and a newborn baby care cost will be covered. However, a policyholder can avail benefits only after the waiting period of 2 years to 4 years.
- Waiting Period for Bariatric Surgery: Under a variety of health policies, bariatic surgery is also covered. It is a procedure that involves stomach or intestines surgery done to assist a patient with severe obesity-related disorders. The individuals who are experiencing health problems and are with a BMI of over 40 usually undergo bariatic surgery.
- Waiting Period for Coronavirus: Many people in India are purchasing coronavirus specific health plans for themselves and their loved ones because of the increased frequency in the number of cases and a high treatment cost. However, insured must have to wait for 30 days before receiving coverage benefits such as hospitalization and therapy under these plans.
What Is The Importance Of Waiting Period In Health Insurance?
The purpose of a waiting period is to prevent people from claiming benefits under a policy for the wrong reasons. People without health plans have purchased plans after being given a specific diagnosis, often without disclosing the diagnosis to the insurance company. The concept of a waiting period is also included in health policies to stop unethical behaviour like this.
How To Calculate Health Insurance Premium Online?
With the help of health insurance premium calculator, you can easily estimate the value of your health plan or medical insurance policy. The online tool will calculate the premium on your health plan without any hassle. Moreover, it is a free tool through which you can compare a variety of available plans to choose the most suitable for yourself as per your requirements and budget.
The premium is calculated after considering various factors such as BMI, age, lifestyle, income, gender, no. of members to be covered under the plan, and many others. Hence, to avoid any discrepancy in calculating the premium, it is advised to provide the correct details.
Following are the steps to be followed in order to use health insurance premium calculator online:
- Visit an official website of InsuranceDekho and click on ‘Health’.
- Enter your personal details such as name, age, gender, city, mobile number, no. of members to be covered, and much more. Then click on ‘View Instant Quote’.
- You will able to see the most suitable health plans with their premiums displayed on the screen.
- Among a variety of options, you can select the most suitable plan as per the premium and coverage benefits that are offered by different companies.
Factors That Affects Health Insurance Premium
The amount which is paid towards getting health insurance coverage is called the health insurance premium. The premium of a particular health policy for an individual is determined by a number of variables. They are described below:
- Age - Companies that provide medical insurance generally adhere to the rule that older the customer, the higher the premiums. This is due to the fact that as people age, their susceptibility to illness increases, increasing the likelihood that they would file a health policy claim. As a result, premiums increase with age and vice versa.
- Pre-medical History/Past Medical History - In case you have a history of any kind of medical condition, then the health insurance company will charge you higher because of the fact that you have a higher chance of getting hospitalised. But you will be charged a comparatively lesser premium if you do not have any past medical problems. However, it is always a better idea to reveal your existing medical conditions to the insurer right at the time of buying a health insurance policy.
- Type of Health Insurance: The type of health insurance plan you are buying also largely affects the premium. For instance, the premium of family health insurance plans is higher as compared to individual health insurance plan due to the fact that family health insurance plan provides coverage for the entire family under one single plan.
- Lifestyle Habits - Lifestyle habits such as excessive smoking or drinking deteriorate your health and make you more prone to illnesses. If you lead this lifestyle, your health may be at risk, increasing your likelihood of filing a claim. You will pay a greater premium for health plan as a result compared to someone who does not smoke or drink frequently.
- Policy Term - Policy term is another crucial factor that decides the premium for a health insurance policy. You can choose from different policy terms such as 1 year, 2 years, or 3 years, according to its terms and conditions. The higher the policy term you opt for, the higher premium you will be required to pay, due to the higher coverage offered.
- Add-On Covers - For comprehensive coverage, you can add add-on covers to your health insurance policy. You will need to pay an additional premium for this when you buy your insurance. The greater the number of add-on covers you buy, the higher premium you will be required to pay for it. However, it is important to note that on including add-ons, you will be entitled to get greater health insurance coverage.
- Co-Payment - Premiums for medical insurance plans that come with a co-payment clause are generally low, due to the cost-sharing involved. Therefore, if you choose a health insurance policy with a co-payment option, then you will be required to pay a lesser premium and vice versa.
- Body Mass Index - You run a higher chance of developing health problems if your body mass index is higher than average. Your premium will be expensive as a result. However, if it is normal, you will be liable to pay a lower premium.
- Occupation: Individuals who are involved in high-risk professions such as mining are liable to pay higher health insurance premiums. This is simply because such individuals pose greater health risks.
Tips to Reduce Health Insurance Premiums
Worried about hefty health insurance premiums? Don’t worry, here are some of the useful ways in which you can save on health insurance premiums:
- Buy Your Health Insurance Early: Premiums for health insurance are often based on age and health status. When you buy health insurance at a younger age, you are generally healthier, and insurance companies consider you to be at lower risk for developing health issues. As a result, your premiums are likely to be lower compared to someone who buys insurance at an older age when health risks tend to increase. This is evident from a case where an individual who is 30 years of age is likely to pay higher premiums as compared to one who is 50 years old.
- Choose Adequate Coverage: It is very important that you choose the right kind of coverage with your health insurance plan. For instance, if you are a young individual, then it makes sense to buy an individual health insurance plan. However, if you have a family and dependant parents, then it is best to buy a family health insurance plan as compared to any other plans.
- Compare the Health Insurance Plans: Before buying any health insurance plan, you must first compare it with the different plans available so that you do not end up buying an expensive health insurance plan. On comparing the different health insurance plans available, you will not just be able to buy a plan that suits your budget but also get the right plan for yourself and your family.
- Buy Top-up Plans: You might think that buying a top-up plan will be a costly affair. However, this is not the case, as with top-up health insurance plans, you will be able to boost your health insurance coverage. So, buy top-up plans and be prepared for medical emergencies.
- Choose Only Relevant Add-ons: Health insurance comes with a number of add-ons such as maternity rider, hospital cash rider, critical illness rider, and so many more. However, on adding these add-ons to your health insurance plan, the health insurance premium is likely to go up. So, it is very important that you wisely choose the relevant add-ons.
- Lead a Healthy Lifestyle: There is no surprise that health insurance premiums are higher for those who lead an unhealthy lifestyle. This means that individuals who often drink and smoke or lead an unhealthy lifestyle will ultimately end up paying extra health insurance premiums. So, it is better to lead a healthy lifestyle and save on health insurance premiums.
How To File A Health Insurance Claim?
Claim under a health insurance policy can be made in two ways - in a cashless manner and in a reimbursement manner. A cashless claim is when you receive treatment at a network hospital of the insurance provider who is servicing your policy. If the claim request is accepted, the insurance company directly settles the bills at the hospital. Whereas in reimbursement claims, you are required to pay for the hospital bill from your own pocket first, and make a claim request with the insurance company later. The insurance company will process your claim and reimburse you for the same after accepting the claim. You can make a health insurance claim by following the simple steps given below:
- Step 1: Visit the network hospital or the hospital of your choice and inform the insurance company about the hospitalisation.
- Step 2: Fill the pre-authorization form at the hospital’s TPA (third-party administrator) desk.
- Step 3: You will receive an approval letter by the claim management team.
- Step 4: Respond to the query raised by the claim management team, if any.
- Step 5: Avail the required medical treatment.
- Step 6: The insurance company will directly settle the bills at the network hospital as per the terms and conditions mentioned in your policy.
Documents Required For Health Insurance Claim Reimbursement
The documentation needed in the case of a reimbursement claim are as follows:
• Valid identity proof.
• Duly signed and completed original claim form.
• Doctor’s prescription recommending hospitalisation.
• Original pharmacy bills.
• Original prescription for medicines, consultation, and diagnostic tests.
• Indoor case papers.
• Ambulance receipt.
• First Information Report (FIR), if applicable.
• Policy details with the insured person(s) name, policy number, illness, and address.
• Any other document if required by the insurer.
Listed below are additional documents required in case of a cashless medical insurance claim:
• Pre-authorization form.
• Valid identity proof along with a photograph.
• Documents like voter ID card, driving license, PAN card, and Aadhar card.
Am I Eligible to Buy a Health Insurance Plan?
Eligibility Criteria to Buy Health Insurance
The need for health policy is paramount since medical care, particularly in the private sector, is costly and can be difficult to afford. Paying a small annual premium can undoubtedly assist to reduce your worry by preventing a difficult situation during a medical emergency or illness.
You may easily get a good insurance plan online that often pays some or all of the costs associated with hospitalization, ambulance services, and doctor consultation fees. Here are the eligibility criteria-
- Entry age for adults- 18-65 years (exclusive plans are provided for people above 70 years of age.)
- Entry age for children-90 days-18 years.
Purchasing a health policy coverage at a young age can save money because the insurers may not need you to take any medical exams.
Documents Required to Buy Health Insurance Online
Following mentioned are a few documents that you must be able to show to buy a health policy online:
- Age proof: Either of the following-Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter’s ID, etc.
- Identity proof: Either of-Passport, Driving License, Voter ID, PAN Card, Aadhar Card, which proves one’s citizenship.
- Address proof: Either of-Electricity bill, Ration Card, Telephone Bill, Passport, Driving License with your permanent address clearly mentioned on it.
- Medical check-up: Some plans require health check-up to ensure that the individual is not suffering from any chronic illness.
How To Buy Health Insurance Plans With InsuranceDekho?
The following mentioned are some of the steps to buy health insurance from InsuranceDekho-
- Fill Your Details: Visit the official website of InsuranceDekho and browse to ‘Health Insurance’. Enter your personal details such as name, age, gender, and more. Moreover, you can talk to the experts as per your convenience through WhatsApp. Click on the “View Plans” Button to see available plans. Select the family members you want to insure like your father, mother, son, and others.
- Compare Different Health Insurance Quotes: Once you enter the above details, different health insurance quotes will get displayed to you. Compare the available plans and select the health insurance that suits you and your requirements perfectly.
- Make the Payment: After selecting the best health insurance plan for yourself, select or adjust the sum assured and the term of the policy.
- Once all the details are provided by you, make the payment. You can make the payment through credit\debit card or netbanking.
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Some Myths About Health Insurance
Due to lack of knowledge and understanding, people in India have a lot of misconceptions when it comes to health plans. It is important to debunk these myths in order to make the best purchasing choices. Here are some popular misconceptions and the truth about health policies:
Myth 1: Young And Healthy People Do Not Require Health Coverage
Reality: The most effective time to buy a health is a young age. This is because you are young and are less vulnerable to critical illnesses. Hence, the chances of getting hospitalized are low and you will be able to buy a health coverage at an affordable premium. Also, you can serve waiting period of your health plan at young age and get a quality treatment at older age without any obstacles.
Myth 2: Only Hospitalization Charges Are Covered
Reality: It is true that health insurance plans cover you for hospitalisation expenses only when the hospitalisation of at least 24 hours takes place. But it is not true that the plans only cover you for these expenses. In most cases, they also cover you for daycare procedures such as sinusitis, radiotherapy, chemotherapy, etc, which do not require hospitalisation of at least 24 hours. Other expenses covered are OPD expenses, road ambulance expenses, second medical opinion, medical check-up, etc.
Myth 3: People who smoke cannot be covered under any health insurance policy
Reality: You can still buy a health insurance plan even if you are a smoker. But medical insurance companies are concerned about pre-existing conditions, which may even lead to the cancellation of your health insurance application form. So, if there is any pre-existing condition due to smoking, then you must disclose the same to your insurer. It will not deny you the policy but may charge you a higher premium because as a smoker, you will be more prone to illnesses.
Myth 4: Health insurance plans are bought to save taxes
Health insurance plans do not only help you save taxes as per the prevalent tax laws but most importantly, cover you for healthcare expenses, which may help you save even more in the long term.
Myth 5: It is not safe to buy health insurance plans online
Purchasing health plans online through reputable companies such as InsuranceDekho is absolutely safe and easy. All you have to do is fill out a quote, compare the insurance plans offered on the screen, shortlist the one you want to buy for yourself and your family, and pay the premium online through a secure payment method. You can choose from a variety of premium payment methods such as credit cards, debit cards, and e-wallets.
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FAQs About Health Insurance Policy
- Plan Coverage
- Claim Settlement
- Critical Illness
What is a health insurance plan?
Health insurance policy is an agreement whereby an insurance company agrees to undertake a guarantee to compensate the insured for medical expenses in case of a medical emergency. A health insurance policy protects the insured for several surgical expenses, critical illnesses, and daycare expenses, for a policy term, for up to the sum insured limit.
Can I purchase more than 1 health insurance plan? How are the claims settled in this case?
Yes. You can be covered under more than one health insurance plan. In this case, the claims are settled as per the contribution clause, when the claim is higher than the sum insured for one health insurance policy.
Why should I buy a health insurance plan?
A health insurance policy not only protects the insured financially for future, but also offers relief in the present. Lifestyle habits such as drinking, smoking, or sedentary lifestyle invite health issues, which can be minor or serious, may be expensive to treat. To stay financially protected in such times, you need a reliable health insurance plan that covers you at all times. Apart from this, buying a health insurance policy also reduces your overall tax liability by allowing you tax deductions on the premium paid, under Section 80D of the Income Tax Act, 1961.
Can I cancel my health insurance policy? If yes, will I get a refund for the same?
Yes. You can cancel your health insurance policy. Every health insurance company provides you a free look period to understand the policy terms and conditions. During this period, if you find any objectionable clause in your health insurance policy, then you can cancel the policy and ask for a refund. Note that you will receive the refund only if no claim has been made during the policy term. The amount of refund will be calculated after taking into consideration the expenses incurred on medical check-ups, stamp duty, and proportionate risk premium, i.e. the number of days you have been covered for risks under the policy. To know more about a premium refunds, it is recommended to go through the policy document.
What Is The Right Age To Buy A Health Insurance Policy?
The ideal age to buy a health insurance plan is when you are still young. This is because when you are young, the chances of acquiring a disease is less and you are in a better position physically as well. This even reduces your chances of health insurance denial.
How is health insurance premium determined?
Different health insurance plans have different premiums. The insurance companies determine premiums after considering various factors that are explained below:
1. Type of Insurance Plan: Your health insurance premium is based on the type of plan you choose. If you choose a critical illness insurance plan, then the premium will be high. If you choose an individual health insurance policy, then the premium will be different from that of a family floater plan. To know the difference in health insurance premiums, you can use InsuranceDekho’s health insurance premium calculator.
2. Age of the Insured: With age, you become more prone to health issues and are more likely to make health insurance claims. Therefore, you are required to pay higher premiums if you buy health insurance plans in later stages of life. This is why it is recommended to buy health insurance policy when young.
3. Policy Term: Most health insurance plans come for a period of 1 year, 2 years, or 3 years. Greater the policy term you choose, the greater will be your coverage, and hence higher will be your health insurance premium, and vice versa.
4. Lifestyle Habits: If you drink alcohol or smoke regularly, then you may be denied health insurance completely. However, there are some insurance companies that cover you for the same, for which they charge high premiums. This is because, with these lifestyle habits, you are more prone to health issues.
5. Family Medical History: Before deciding your health insurance premium, the insurance company will ask about your family medical history. This is because if someone in your family has a certain disease that you are also vulnerable to, then the insurance company will charge you a higher premium due to increased risk.
6. Sum Insured: Health insurance plans come with different sum insured options that you can choose from as per your budget and requirement. The higher the sum insured, the higher the medical coverage and hence higher the health insurance premium. But it is not recommended to compromise on the sum insured to save on premiums. This is because it will not cover you adequately in the time of need.
What Is a cumulative bonus in a health insurance plan?
A cumulative bonus in health insurance refers to the financial benefit which you receive as a reward for not making any health insurance claims in a policy year.
How does smoking affect health insurance premium?
Smokers have to be prepared to make the payment for higher premium cost for their medical insurance policy as health risks increases for smokers and insurance companies charge a higher amount to combat the medical crisis.
Under what conditions are my policy premium likely to increase at renewal?
Here are different situations that increase the premium during the renewal:
- Healthcare Inflation – Inflation in healthcare is soaring at a rate of 12% to 18% which comprise the costs of medicines, hospital admission costs, medical advancements, etc. It leads your insurance companies to increase your sum insured every year which increase your premium too during policy renewal.
- Age of Policyholder – Increase in age can also impact your health insurance premium while renewing the health insurance policy, especially for those touching 60 just before renewal.
- Change in Coverage – If you change your health insurance policy coverage during the renewal process either by adding some add-on covers to your plan or by changing your insurer altogether, it may increase your premium.
What if I forgot to pay my health insurance premium?
If you could not make the payment for the health insurance premium on time, then your policy can be cancelled. After paying the first premium, you will be given a grace period if you do not make the payment for the premium on time. You can renew your health insurance plan by paying the premium within 15 to 30 days of the grace period, which can vary from insurer to insurer, but, if you miss this opportunity too, then it could risk you losing your coverage.
How can I renew my health insurance policy?
It is imperative to renew your health insurance policy to avail continued coverage, and save on accumulated benefits such as waiting period benefits and No Claim Bonus (NCB). You can easily renew your health insurance policy by following the simple steps given below:
Step 1: Visit the website of the insurance company and navigate to the ‘Health Insurance Renewal’ page.
Step 2: Enter the required details such as health insurance policy number and the registered mobile number.
Step 3: Check the policy details displayed and renewal premium.
Step 4: Pay the required health insurance premium via Credit card/Debit card or Net Banking.
What to do if my health insurance policy renewal date is missed?
Even if you missed the expiry date of the health insurance policy and failed to pay for its premium on time and renew it, you can still do it within a grace period of up to 7 days to 15 days, where may vary from insurer to insurer. Failure to make your payment, even after the grace period, then your policy will lapse.
Why should you avoid policy renewal during the grace period?
If you could not renew your health insurance plan within the expiry date, you can renew it within the grace period but at this time your policy will not be active and anything that happened to you will not be covered. Hence, you should avoid taking your renewal to the grace period.
Do I get a discount on the renewal of the policy with the same health insurance company?
The provision of discounts on the renewal of the health insurance policy varies from one insurance company to another ranging from 5% to 20%. You can get the discount with the renewal of policy from the same in different forms such as a discount for staying with the plan for a longer tenure, discount for family members on adding more members in the plan during renewal, discount for women is also provided by some insurance companies, and discount for no claim bonus.
Can a health insurance policy expire if it is not renewed on time?
Yes, your health insurance plan can get expired if it is not renewed before its expiry date as well as within the grace period.
What if my health insurance policy lapses when I am hospitalised?
There can be two situations. First, where you get hospitalised before the policy expiry date and notify the insurance company before the policy lapses, and the policy lapses when you are still in the hospital. In the second situation, you may be hospitalised during the grace period, the policy lapses then, and you inform the insurance company about the same during the grace period. In both cases, the insurance company will compensate for the coverage availed, as per the terms and conditions stated in the policy document.
Can I avail coverage benefits if I get hospitalised for less than 24 hours?
Yes. Most health insurance plans cover you for medical treatments that do not require hospitalisation of at least 24 hours. These are known as daycare procedures. Daycare treatments are performed under local or general anaesthesia in a clinic, hospital, or daycare center. Some daycare treatments that health insurance plans cover you for are chemotherapy, eye surgery, sinusitis, dialysis, angiography, etc.
Do health insurance plans cover diagnostic charges like X-rays, Ultrasound or MRI?
Yes, most health insurance plans give compensation for various types of diagnostic tests comprise X-rays, MRIs, blood tests, etc., if the policyholder stays in the hospital for at least 24 hours.
Do health insurance covers robotic surgery and modern treatments?
According to the health regulations issued by the Insurance Regulatory and Development Authority of India (IRDAI) in 2019, all insurance companies are required to insure robotic treatments. Therefore, all insurance companies provide it with some sub-limits and policy conditions.
What Are The Diseases Covered Under Health Insurance Policy?
The diseases covered under health insurance plans differ from one insurance company to another. Some of the common diseases that most of the health insurance plan covers include cancer, accident related injury, cataract surgery, dengue, COVID-19, diabetes, amongst others.
What happens to my health insurance plan after a health claim is filed?
After a health insurance claim is filed and settled by the insurance company, then the policy coverage tends to be reduced by an amount that has already been released during the settlement. For Instance, if your buy a plan with Rs. 5 lakh policy coverage and make a claim of Rs. 2 lakh, then you can avail of the health insurance of Rs. 3 lakh in the remaining policy year.
What if the insurance company refuses to settle my claim and I want to file a complaint?
If your insurance company refuses to settle your health insurance claim you can raise your complaint under the Insurance Ombudsman scheme if your insurer rejected the claim, has not resolved your concern to your satisfaction, paid no heed to it for 30 days, etc. After this, IRDAI can take your issue with the insurance company and ensure a re-examination of your complaint or resolution.
Does every network hospital provide a cashless claim facility?
The insurance companies list some hospitals in their network to offer the cashless facility to their health insurance policyholders, hence, all the hospitals in the network of an insurer provide the cashless facility. However, non-network hospitals do not offer cashless treatment and if you go to them for any type of treatment, then you will have to pay the bill on your own and can request reimbursement later.
What is the procedure for reimbursement settlement?
The health insurance reimbursement claim can be made if policyholders opt for a hospital that is not in the network of the insurance company. In such a case, a cashless facility is not applicable and you will have to pay for all your medical bills and then raise a reimbursement claim for it. To make the reimbursement claim, you will have to submit the required and relevant documents such as original medical bills to your insurer. The insurance company will evaluate your documents and pay you accordingly.
If I do not make a claim within a policy period, can I get a refund of my money?
Yes, if you have purchased a health insurance plan, it comes with a provision as per which you can return the policy within a specific period, which is known as Free-look Period, if you have made no claim. However, you will not get any refund of money after passing that period, even if you have not made any claim.
Does a normal health insurance policy cover critical illness?
Not all health insurance policies have inbuilt critical illness cover but there are some regular health insurance policies that provide coverage for critical illness. Usually a regular health insurance policy does not cover critical illness but you always choose to purchase a critical illness add-on cover for your health insurance policy which will provide coverage for critical illness.
Is it worth purchasing a Critical Illness Insurance policy?
With rising health issues and expensive treatment critical illness insurance policy becomes a necessity. Critical illness insurance policy provides coverage for specific life threatening diseases that require funds and regular visits to the hospitals for the treatment. Treatment for such life threatening diseases can be very expensive and this is where a critical illness insurance policy comes in handy.