Health Insurance Plans
Having health insurance is very important these days as an adequate insurance policy provides you with much-needed financial assistance in case of any medical emergency. It covers treatment expenses incurred on pre and post hospitalization, room rent, ambulance services, doctor’s fee, ICU charges, medicine costs, and so on.
Thus, health insurance protects your savings from any unexpected expenses due to medical treatments.
Best Health Insurance Plans in India for 2020
Health Insurance Companies
Health Insurance Plan
Incurred Claims Ratio (2018-19)
Maximum Sum Insured Amount
|Universal Sompo Health Insurance||Essential Privilege Plan||4,000+||92%||Rs. 10 Lakhs|
|Bajaj Allianz Health Insurance||Health Guard Plan||6500+||85%||Rs. 50 Lakh|
|Star Health Health Insurance||Family Health Optima||9,900+||63%||Rs. 25 Lakhs|
|HDFC Ergo General Health Insurance||My: health Suraksha||10,000+||62%||Rs. 75 Lakhs|
|HDFC Ergo Health (Apollo Munich)||Optima Restore||10,000+||62%||Rs. 50 Lakhs|
|ManipalCigna Health Insurance||Prohealth Plus||6,969+||62%||Rs. 50 Lakhs|
|Royal Sundaram Health Insurance||Lifeline Supreme||5,000+||61%||Rs. 50 Lakhs|
|Aditya Birla Health Insurance||Activ Assure Diamond||5,700+||59%||Rs. 2 crores|
|Care Health Insurance(Religare)||Care Health Insurance formerly Religare Health Insurance Plan||7,400+||55%||Rs. 6 Crores|
|Max Bupa Health Insurance||Health Companion Individual||4,500+||54%||Rs. 1 Crore|
What Are Health Insurance Plans?
Health insurance plans reimburse the insured individuals for their medical expenses that include costs related to surgeries, hospitalization, treatments, and the like arising due to injuries, illnesses, or even accidents. In case of a health insurance claim settlement, the insurer, that is the insurance company, pays the benefits to the insured as per the terms and conditions of the policy document.
In other words, a health insurance policy is an agreement between a health insurance company and the insured where the former agrees to provide the specified payment/compensation for medical expenses in case the latter is ill and requires hospitalization. In most cases, health insurance companies have tie-ups with hospitals, known as network hospitals where the insured can avail treatment without paying even a single penny.
Different Types of Health Insurance Plans in India
To meet the different requirements of people, health insurance companies under the guidance of the Insurance Regulatory and Development Authority of India (IRDAI) provide different types of health insurance plans in India such as Individual Health Insurance Policy, Family Health Insurance, Women Health Insurance Policy, Senior Citizen Health Insurance Policy, Critical Illness Insurance, Group/Corporate Health Insurance Policy, Self-employed Health Insurance Policy, Personal Accident Policy, Health Insurance Policies for newborn babies, kids, etc. Besides, insurers also offer health insurance plans specially designed for cancer, diabetes, heart, dengue, and other diseases.
These health insurance policies are broadly classified into 7 categories that are explained below:
1. Individual Health Insurance Plans
As the name suggests, individual health insurance plans offer coverage for surgical and hospitalisation expenses to the insured on an individual basis. The coverage includes expenses related to pre-hospitalisation and post-hospitalisation, in-patient hospitalisation, medicines, etc. up to the sum insured. Many individual health insurance plans offer other facilities too like daily cash benefits but that depends on the terms and conditions of the policy. With an individual health insurance policy, the insured can avail cashless as well as reimbursement treatment facility.
2. Family Health Insurance Plans
Family health insurance plans offer coverage to all family members. This means that the proposer can include their spouse, children, parents, parents-in-law and other dependent members by paying a single health insurance premium. In terms of coverage, a family floater health insurance policy is similar to an individual health insurance policy. Family floater insurance policy is a good option as it brings the entire family under an umbrella cover thereby reducing the chances to exhaust the sum insured.
3. Senior Citizen Health Insurance Plans
Senior citizen insurance plans are specially designed for people aged above 60 years to offer extensive coverage against medical expenses. Due to wide coverage, these plans come at a higher premium. But the insured can reduce the financial burden by availing tax benefits under Section 80D of the Income Tax Act. For elder people, it is better to opt for a senior citizen health insurance policy as it helps keep them stress-free in their post-retirement years.
4. Health Insurance Plans for Women
Women need medical attention at different stages of their lives, for which they need health insurance plans specifically designed for them. There are many insurers in the market that offer women health insurance plans that not only take care of women’s health but also offer them financial security. Common benefits offered under women-specific health insurance plans include maternity cover, cover for hospitalisation expenses, critical illness cover, newborn baby cover, and so on.
5. Health Insurance Plans for Children
Health insurance plans for children offer the ideal cover for children at affordable health insurance premiums. But one can get minor children covered individually only when either of the parents is covered under the same health insurance plan. Children specific health insurance policies offer a cluster of benefits such as cover for health check-ups, cashless hospitalisation, specialist consultation, vaccinations, ambulance charges, etc.
6. Critical Illness Insurance Plans
Critical illness insurance policies are fixed benefit policies that offer cover for specific life-threatening diseases such as cancer, stroke, paralysis, kidney failure, amongst others. Under these policies, the insured gets a pre-decided lump sum amount on diagnosis of any critical illness as specified in the policy document. The insured can use the amount as per his/her own choice to pay for treatment in India or abroad, recuperation expenses, or even pay off debts if taken.
7. Disease-Specific Health Insurance Plans
Disease-specific health insurance policies cater to particular diseases. For instance, dengue, diabetes, etc. a disease-specific policy is recommended along with a standard health insurance plan as it provides cover for diseases at all stages, irrespective of if the existing illness is in dormant or critical stage. Unlike regular health insurance policies, these plans do not come with long waiting periods. But remember, disease-specific health insurance plans are no substitute for standard health insurance policies.
Key Benefits of Health Insurance Plans
Health insurance plans offer many benefits to the insured. Some of them are explained below:
Health insurance plans offer cover for cashless mediclaim in case the treatment is available at a network hospital.
No Claim Bonus
For every claim-free year, the insured can avail No Claim Bonus (NCB) for up to a specific limit.
Health insurance policies also cover for periodic health check-ups. Some health insurance companies also offer free medical check-ups on the basis of accumulated No Claim Bonus.
Premiums paid for health insurance policies are subject to tax deductions under Section 80D of the Income Tax Act, 1961.
Type of health insurance plans
Individual Health Insurance Plan
It is an agreement between an insurer and a policyholder where former promises of bearing the medical expenses of the latter subject to the limits of the plan. To own this coverage, the policyholder is required to pay premiums to the insurer for getting the coverage without any break.
- Coverage for pre and post hospitalization expenses
- You can opt for the best treatments for your loved ones
- Your savings will not be affected due to any medical emergency
- Most of the daycare procedures are covered under different plans
- Tax benefits under the section 80D of Income Tax Act
Senior Citizen Health Insurance Plan
With age, the probability of falling prey to diseases increases. Therefore, a senior citizen health insurance plan is an excellent option, as in older age, the lesser or no income enhances the trouble. These plans are designed to cover senior people aged 60 years and above and provides coverage for diseases, critical illnesses, accidents, etc.
- Frequent medical expenses can easily be borne with the plan
- Can afford proper treatment and medication with lesser income too
- May increase life expectancy with regular and advanced treatment
- Investment in health policy save the tax under section 80D of IT Act
- Enhance the savings and bring independence in terms of financial security
Critical Illness Insurance Plan
Treatment of critical diseases is never easy. The procedures related to critical illnesses are highly expensive and prolonged that lead to the loss of a significant amount of savings. These plans provide cover for diseases like kidney failure, heart attack, cancer, muscular dystrophy, and many others.
- Lump sum amount is offered to maintain the lifestyle
- The recuperation aid is covered under the critical illness plan
- Regular health check-ups are also available under such policies
- Offers the best treatment when it comes to life-threatening disease
- TA good amount of tax can be saved under section 80D of IT act
Maternity Health Insurance Plans
Pregnancy is a turning point in every woman’s life. At this time, they require the utmost care. With time, medical technology has made delivery procedures safer, more comfortable, but expensive. Everyone wants that the mother and baby should get the most possible comfort during the delivery procedure. Thus, taking a maternity plan is a gesture of perfect planning.
- Easy to get the delivery done in the best-equipped hospital
- Regular expenses are curbed with the coverage of consultations, health check-ups, tests, etc.
- The coverage of newborn baby don’t let the budget be affected
- Normal and Cesarean deliver cover avoid the financial crisis before delivery
- With tax benefits, you can save money under section 80D of IT act
Group Health Insurance Plans
The group health provides the insurance to eligible professionals of an organization. Under this segment of insurance plans, the employers purchase the health policies for their employees. The payment for it is made two ways, half of the amount is paid by the employer and the remaining by the employees. It is generally given to enhance the morale of the employees and also to retain the employees.
- Enhance the retention rate in the firm
- Boost the morale of employees
- Make employees avail the plan at economical rates
- Tax benefits can be earned under section 80D of IT act
Personal Accident Insurance Plans
An accident is an unforeseen and unfortunate event that can happen to anybody and anytime. Also, its consequences may go disastrous and catastrophic. Therefore, a personal accident insurance plan is necessary for dealing with financial hardships during an accident.
- Expenses of accident-related treatments are covered
- Severe injuries due to an accident can be treated in the best manner
- Many personal accident plans covers funeral and legal expenses
- Worldwide coverage is offered as accidents can happen anywhere, anytime
- Some plans provide the coverage to the entire family for complete health care
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Health Insurance Plans FAQs
What are the parameters that I should consider when purchasing a health insurance plan?
Some of the parameters that you must consider in order to purchase the most suitable health insurance policy include waiting periods for pre-existing diseases, capping or sub-limits, waiting period for specific illnesses/diseases/procedures, co-payment clause, if any, exclusions under the policy, number of network hospitals and if your preferred hospital is a part of the network or not, claim settlement ratio of the insurance company, incurred claim ratio, premium, add-on benefits, if any, inclusions and exclusions, etc.
What are the common exclusions under health insurance plans?
Health insurance plans do not offer cover for all healthcare expenses. Some common exclusions include expenses incurred on treatment due to self-inflicted injuries including suicide, expenses incurred due to participation in any adventurous sport, pre-existing conditions are not covered during the waiting period, venereal or sexually transmitted disease, cosmetic treatments, treatments related to dental, hearing, and vision, expenses incurred on treatment of obesity, and cover for accidents due to participation in defence operations.
Do health insurance plans cover healthcare expenses related to COVID-19?
Yes. Standard health insurance plans offer cover for expenses incurred due to positive diagnosis of COVID-19. The health insurance policy will cover you for in-patient and outpatient expenses arising due to treatment of COVID-19. You can also purchase health insurance plans especially designed for coronavirus. These include Corona Kavach Policy and Corona Rakshak Policy. These are short term policies that offer cover against the pandemic declared coronavirus. For more information about these policies, you can connect to the customer care executives at InsuranceDekho and they will help you understand them in detail.
What are the benefits of having a health insurance policy?
A health insurance policy offers you a cashless treatment facility allowing you to get the required medical treatment at the network hospital without paying even a single penny. It offers you several benefits apart from cashless treatment, such as pre-hospitalisation and post-hospitalisation expenses, tax benefits under Section 80D of the Income Tax Act, 1961, daily hospital cash benefit in some plans, organ transplant expenses, No Claim Bonus, lifetime renewability benefit, automatic restoration of sum insured, etc.
What is the restoration benefit under health insurance plans?
If your sum insured amount gets exhausted under a health insurance insurance policy due to claims made in a policy year, then the insurance company will restore the amount automatically without having you to pay anything extra to avail the benefit. Health insurance plans that offer restoration benefits are generally available at higher health insurance premiums.
Can I make a claim for all healthcare expenses up to the sum insured limit?
No. Health insurance plans come with multiple sub-limits which can be for specific treatments, doctor’s consultation fees, pre-planned surgeries like cataract, joint replacements, pre-planned surgeries, etc. You cannot claim an amount that exceeds your sum insured limit. Many health insurance plans also come with room rent limits, ICU charges, surgery expenses, doctor’s fees, lab test expenses, etc. for which the cover is offered proportionately.
What are some good health insurance plans in India?
Some popular health insurance plans that offer wide coverage and yet come at affordable premium include Essential Privilege Plan offered by Universal Sompo Health Insurance, Health Guard Plan offered by Bajaj Allianz Health Insurance, Family Health Optima offered by Star Health insurance, and My: health Suraksha offered by HDFC Ergo General Insurance.
Which is the best medical insurance policy in India?
There is not one, but many health insurance plans in India that offer great benefits to the policyholders. These include Prohealth Plus offered by ManipalCigna Health Insurance, Lifeline Supreme offered by Royal Sundaram Health Insurance, and Activ Assure Diamond offered by Aditya Birla Health Insurance.
What is the importance of health insurance in India?
Purchasing health insurance for yourself as well as your family is important in India because lifestyle diseases are becoming very common and healthcare expenses are skyrocketing, especially in private hospitals. So, if you do not have a suitable health insurance plan, it may burn a hole in your pocket.
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