Health is the greatest wealth, but sometimes it can be deployed due to unexpected critical illnesses. Hence, it is wise to get secured with a health insurance plan. Generally popular as medical insurance, it is an agreement under which the insurer agrees to pay medical expenses for the policyholder. Under this, the insurer provides coverage for hospitalization, health check-ups, ambulance charges, and much more under the amount insured by the policyholder.
Health Insurance Key Features
|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?
It 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 the 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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Health Insurance Renewal
Each insurance plan comes with a policy tenure. Thus, your plan is valid for a specific time that varies from one insurance provider to another. Renewing the plan is crucial to carry forward the coverage and make necessary changes and add-ons to your health insurance policy. Every insurance provider offers a renewal period under which the policyholder can renew their plan, in case they are not able to make the renewal, the insurance company offers a grace period which also differs from one insurer to another.
In case, you miss to renew your plan on time, then it can lapse and you may not be able to avail of health coverage and other benefits such as No Claim Bonus (NCB). Here are some basic steps that you can follow to renew your health insurance policy.
Step 1: Review your plan: Before renewing your policy, it is crucial to review your existing plan to assess the type of coverage and other benefits offered in it. Thus, this way you will be able to make necessary changes at the time of renewal.
Step 2: Visit the insurer’s website to renew your policy: It is easy to renew a plan by simply visiting the insurance provider’s website. You can use your policy details such as name, registered mobile number/ email address, policy number, date of birth and more to log in on the website. After logging in you will be able to review your plan and make changes or additions to your existing coverage.
Step 3: Make renewal payment: After implementing the changes to your existing policy, you can proceed to renew your policy by completing the payment. If you have opted for add-on covers it can increase your premium. Moreover, 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.
Why Should You Buy Health Insurance Online?
Convenience in buying and the availability of a wide variety of plans are major reasons why most people prefer to buy coverage against critical illnesses online. More reasons to buy medical insurance are listed in the section below:
Time-Saving - Unlike the traditional ways of buying a plan where you had to explain all your requirements to the insurance agents and follow the tedious process, online services save your time and let you buy the health plan conveniently. All you need to do is fill out a quote and shortlist the most relevant medical health insurance policy from the ones displayed on your screen.
Easy to Compare Different Health Insurance Plans - The online way of buying a plan has simplified the process of comparison by reducing the paperwork. With a premium calculator, it becomes easy to calculate premiums as well as compare different insurance plans.
Right Decision - The flexibility provided in choosing and buying the best plans is one of the best features of buying insurance online. An online insurance company provides access to all the information like policy quotes, coverage benefits, exclusions, and other terms and conditions to do a comparative study of the most suitable plan.
Information Available 24x7 - There are no time-boundations to buy an insurance plan on online platforms like InsuranceDekho. Hence, you can easily compare, choose, and buy the most suitable plan anytime at your convenience.
Discounts - Many insurance companies offer discounts on the online purchase of medical insurance. Hence, you have an opportunity to avail of similar or better benefits at comparatively affordable premiums.
Instant Coverage - Online purchase of health insurance plans provides you with instant investment proof, which makes your coverage active from immediate effect. Also, flexible modes of premium payment are available when you buy an insurance policy online. You can choose the mode at your convenience and pay the premium via a secured payment gateway.
If you want to ensure a smooth medical health insurance buying process, then you must pick a reputed insurance company that offers you enough information about the health insurance plan purchased.
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 Plans
Following are the key features of medical health insurance plans. It is recommended to compare these features with similar health insurance plans before shortlisting one online.
Sub-Limits on Room Rent - Some insurance companies come with a feature of sub-limits on room rent. This means that there is a maximum amount that an insurance company shall pay in case of a claim. 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 general insurance companies that offer health insurance plans without any sub-limit on room rent. Hence, it is recommended to go for such plans.
Pre-Existing Diseases - The diseases from which you are already been suffering before the purchase of medical insurance policy are considered pre-existing diseases. Hence, this is the reason why insurance plans come with a waiting period rather than offering cover from the first day. During this waiting period, no claims are admissible. Thus, you should choose a policy with a minimum waiting period.
Co-Payment - Co-payment is a situation when the insurance company and policyholder join hands to share the cost in case a claim arises. A co-payment can be decided in percentage or in amount. So, to take care of your savings, you must choose a plan that comes without any co-payment.
Network Hospital - Network hospitals are the hospitals that have tie-ups with health insurance companies where the insured can avail of high-quality treatment without spending a penny at the hospital. The benefit of availing of cashless treatment comes with this feature. If a policy does not offer this feature, 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.
Hence, it is recommended to study the data of network hospitals connected with the insurance company nearby your residence to get speedy premium-quality treatment in case of an emergency.
Benefits of Comparing Medical Insurance Plans Online
Some of the benefits of comparing insurance plans online are mentioned in the section below:
Utmost Ease - Comparing a variety of health insurance policies online is easy peasy. Simply, you can use the InsuranceDekho premium calculator to compare different plans. It is a free tool which makes it easier for you to decide which insurance policy you must opt for.
Free Quotes - Insurance Dekho premium calculator is a free tool that you can use to check quotes and coverage benefits available a number of times without paying anything.
Convenience - As compared to the old-school ways of differentiating the plans, the comparison of insurance 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 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 health insurance 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 a quote and several health insurance plans will be displayed on your screen which you can compare easily. This saves you enough time.
Saves Money - While visiting different offices for comparing the plans can spend a lot of your bucks. Thus, comparing the insurance policies online will help you save your travelling expense as you do not have to visit different offices to compare the plans. Also, you have an opportunity to choose and buy the most affordable plan which your insurance agent may not recommend to you.
Useful Premium Calculator - A health insurance premium allows you to calculate premiums of different insurance plans, compare, and customize the plan as per your budget and requirements. As you change the variables, you will see the premium change. This way, you can choose the most economical insurance policy for yourself and your loved ones.
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.
Power to Choose - You should have the power to make decisions when it comes to your health. Comparing health insurance plans does this job for you as it eliminates any influence from the agents or insurance executives. This way, it also helps you make an informed choice.
Customer Support - You can easily compare various medical insurance plans online. The process is indeed very transparent, and you can easily navigate the information about sub-limits, critical illnesses, and sub-limits. If you have any questions, you can call customer service to get the answers.
Key Factors To Consider Before Buying Health Insurance Plans
Before shortlisting an insurance policy, consider the following factors to make the best purchasing decision:
Claim Process - Before buying a health plan always consider the number of claims settled by the medical insurance company. The entire purpose of buying an insurance plan is to get secured financially against unexpected critical illnesses. If the claim settlement process is smooth then it is advantageous for the insured. Additionally, you must look for great customer service.
Family Members to be Covered - You must consider the family members whom you want to cover under the insurance benefits. Under family floater health insurance plans, you can seek cover for yourself, your legally wedded spouse, children, parents, and grandparents. Moreover, age, present ailments, and family medical history are important factors that you should keep in mind. Also, you must inform your insurance company in case any of your family members have a pre-existing disease.
Sum Insured - The sum insured 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.
Add-on Benefits - Add-ons are additional benefits that you can include in your health insurance policy, for extensive coverage. You can choose them voluntarily by paying an extra premium at the time of policy purchase.
Network Hospitals - 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 an 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.
Coverage Benefits - Benefits of coverage should be one of your top priorities while choosing the best insurance policy to cover yourself and your dear ones. Different plans come with different coverage features which you should choose as per your requirement. Common coverage benefits under insurance plans include in-patient hospitalization expenses, pre-hospitalization and post-hospitalization expenses, road ambulance expenses, daycare expenses, domiciliary expenses, and more.
Lifetime Renewability Benefit - Older age individuals are more vulnerable to diseases as compared to younger. Therefore, you must buy an insurance plan with a lifetime renewability benefit to eliminate the chances of buying a new plan at a higher cost.
Free Medical Check-Up - The cost of regular medical check-ups can also put a hole in your pocket. So, it is advised to consider the insurance plan that will cover your medical check-ups.
Waiting Period - The waiting period is a duration at which an insurance company does not provide the benefits of your insurance plan. This is why you should choose a plan that comes with the least waiting period. There are different types of waiting periods such as initial waiting period, waiting period for pre-existing illnesses, waiting for a period for specified illnesses, etc, which you should be informed about, before shortlisting an insurance policy.
Premium - The purpose of buying an insurance plan is to reduce financial stress in case of any medical emergency in future. 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.
Type of Policy - Evaluate your needs thoroughly to identify the type of health insurance that would be advantageous to cover you and your loved ones. After understanding your requirements, you can choose from different types of plans available in the market such as individual plans, family floaters, senior citizen plans, critical illness plans, maternity insurance, and many others.
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 insurance plans are treatment required due to self-harm, treatment required due to participation in adventure sports, etc.
Partner Health Insurance Companies
Top Health Insurance Companies in India 2022
|Rank||Health Insurance Company||Health Claim Settlement Ratio FY20|
|1||IFFCO Tokio General Insurance||96.33%|
|2||Care Health Insurance||95.47%|
|3||Magma HDI Health Insurance||95.17%|
|4||The Oriental Insurance Company||93.96%|
|5||New India General Insurance||92.68%|
|6||Bajaj Allianz General Insurance||92.24%|
|7||Niva Bupa Health Insurance||89.46%|
|8||Navi General Insurance||86.98%|
|9||HDFC ERGO General Insurance||86.52%|
|10||Manipal Cigna Health Insurance||85.72%|
|11||Edelweiss General Insurance||85.57%|
|12||National Insurance Company||83.78%|
|13||Future Generali General Insurance||82.96%|
|14||Royal Sundaram General Insurance||81.50%|
|15||Liberty General Insurance||81.03%|
|16||ICICI Lombard General Insurance||78.67%|
|17||Star Health Insurance||78.62%|
|18||United India Insurance Company||78.03%|
|19||Reliance General Insurance||76.43%|
|20||Tata AIG General Insurance||76.04%|
|21||Kotak Mahindra General Insurance||75.45%|
|22||Acko General Insurance||74.09%|
|23||Aditya Birla Health Insurance||70.81%|
|24||Universal Sompo General Insurance||70.75%|
|25||SBI General Insurance||66.08%|
|26||Go Digit General Insurance||63.56%|
|27||Cholamandalam MS General Insurance||56.25%|
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 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 plan and vice versa.
- Also, the policyholder can apply for a revised sum insured with a new 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 plan 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.
Corona Kavach Policy
Corona Rakshak Policy
In order to cover potential medical costs brought on by the coronavirus, the Insurance Regulatory and Development Authority Of India (IRDAI) made it mandatory for all general and medical insurance companies to follow this policy. The Corona Kavach Policy will pay for the hospitalization, pre-hospitalization, home treatment costs, or AYUSH treatment in case you’ve been tested COVID-19 positive. You can buy this policy as an individual plan or a family floater plan. The greatest advantage of buying this plan is that it has a waiting period of 15-days which means you do not have to spend a penny during your COVID-19 treatment.
The following are some items that are not covered by a Corona Kavach policy:
Corona Kavach Policy additionally covers chronic conditions which may be induced by COVID-19 during the hospitalization for the treatment. However, this policy does not cover any other treatment besides COVID-19.
Corona Rakshak Policy is a single premium, a standard benefit insurance policy that protects an individual financially if he or she is diagnosed with COVID-19. In case the insured is found to be COVID-19 positive and requires hospitalization, 100% of the sum assured is paid in a lump sum. The Insurance Regulatory and Development Authority of India (IRDAI) launched this policy to assist individuals in ensuring financial security against COVID-19 treatment for themselves and their loved ones. Corona Rakshak Policy provides coverage for hospitalization expenses, ICU cover, ambulance cover, home treatment, AYUSH treatment and pre/post hospitalization expenses. You need not to go any medical examination to buy this insurance policy. Moreover, it also has a waiting period of 15 days which means to do not have to wait for availing of the benefits of the plan during the treatment.
Below mentioned are some expenses and aspects which are not included in a Corona Rakshak Policy:
The most appealing feature of this policy is that 100% of the sum is assured as a lump sum to the insured in case they are diagnosed with COVID-19 during the policy tenure.
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 policy 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 plan? Then You must know the following details:
• An initial waiting period is applied, which is 30 days in most health insurance plans.
• The claim process for COVID-19 is the same in regular health insurance plans 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 policy's
- 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 protection plan, then you can choose from several health insurance plans that are available in India. These include family floater plans, senior citizen health plans, critical illness insurance plans, maternity insurance, and much more.
In case you have a huge family or one with senior parents, then it is recommended that you should buy an individual health plan over a family floater policy. Moreover, you can also buy a separate senior citizen insurance policy for parents in this case.
Whereas a family floater medical insurance policy is recommended for a young couple or a small family. 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.
When choosing the best health insurance policy, there are many other factors besides the premium that should be considered. 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.
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, but 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 health insurance 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 plan 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 an insurance policy 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 coverage 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 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)
Understand Terms Included in Your Health Insurance Policies
Explained below are terms that you must know in order to understand your health insurance policy better:
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.
No Claim Bonus - It is a reward that a medical 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 plans 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.
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.
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 insured can understand all the details, features, benefits, terms and conditions of their health insurance policy. During this period, if the insured is not satisfied from 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 period in health insurance-
- 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 policies 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 in health insurance 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.
What Are The Factors That Affects 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.
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 of medical problem.
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-ons covers you buy, the higher premium you will be required to pay for it.
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.
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.
Can A Minor Buy Health Insurance?
No, a minor is not eligible to buy a health insurance plan. However, a minor can get health coverage under child health plans bought by either of the parent or a guardian.
What To Do If I Am Admitted In A Non-network Hospital?
When an individual gets admitted to a non network hospital, they are required to pay treatment expenses from their pocket. These expenses can later get reimbursed after showing the necessary proofs to the respective insurance provider.
Which Health Insurance Is Good For Young Adults?
If you are aged 26 years or above and not residing in a metro city, then a family floater plan ranging between Rs. 5 Lakh to Rs. 10 Lakh sum insured would be sufficient to meet any health emergency.
Why Is Health Insurance Important To Us?
In case of health emergencies, having a reliable health insurance policy helps as it offers the much needed financial backup. A health insurance policy can reimburse you for the expenses arising due to injury or illness or pay directly at the hospital.
What Is The Benefit Of Health Insurance?
There are several benefit of having health insurance, some of which include cashless hospitalisation, tax benefits, No Claim Bonus, cover for expenses related to ambulance and transportation, in-patient hospitalisation expenses, pre-hospitalisation and post-hospitalisation expenses, daycare expenses, domiciliary hospitalisation expenses, etc.
Can A Person Have More Than One Health Insurance Plans?
Yes. A person can have more than one health insurance policy as there is no limit for the same. However, one cannot claim reimbursement for the healthcare expenses incurred, from multiple insurance companies.
Does Health Insurance Provide Tax Benefits?
Yes. If covered under health insurance plans, you can avail tax benefits on the premium paid, under Section 80D of the Income Tax, 1961. Kindly note that the tax benefits can be availed only if the premium is paid in any mode other than cash.
Why Is Health Insurance Important To Us?
In case of health emergencies, having a reliable health insurance policy helps as it offers the much needed financial backup. A health insurance policy can reimburse you for the expenses arising due to injury or illness or pay directly at the hospital.
What Is The Benefit Of Health Insurance?
There are several benefit of having health insurance, some of which include cashless hospitalisation, tax benefits, No Claim Bonus, cover for expenses related to ambulance and transportation, in-patient hospitalisation expenses, pre-hospitalisation and post-hospitalisation expenses, daycare expenses, domiciliary hospitalisation expenses, etc.
Can I Increase The Sum Insured Under My Existing Health Insurance Policy?
Yes. Most health insurance plans allow you to increase the sum insured of your existing health insurance policy but you can do the same only at the time of renewal. To do the same, you can get in touch with either InsuranceDekho or the insurance company.
Can Health Insurance Be Paid In EMI?
Yes. You can pay the premium for a particular health insurance policy in EMI for which you will be required to pay a fixed amount every month. It is a recommended option as it helps you reduce the stress of paying a hefty amount of premium in one go.
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 and get a refund for the same. But for this, you will be required to follow a procedure and notify the insurance company about the same. Also, you would be required to pay the premium for the days you were already covered.
How much health insurance do I require?
It is advised to have a health insurance coverage amount equal to 50% of your annual income. So if you earn Rs. 20 Lakh on a yearly basis then you should consider a health insurance policy for Rs. 10 Lakh. However, there are many factors that you consider before how much health insurance coverage you require, these factors can be income, age, eligibility criteria and health condition.
What are the benefits of the health insurance portability for the policy holders?
There are several advantages of porting a health insurance plan. While porting your health insurance policy you can choose a new sum assured, avail lower premiums, opt for an add-on cover and avail continued benefits. You can choose a health insurance company that you can fully rely on.
What is a free-look period in health insurance?
Under a health insurance policy, a free look period of 15 to 30 days is provided to the policyholder, the free look period depends on the insurance provider. During the free-look period one can cancel their health insurance policy in case they are not satisfied with the terms and conditions of the health insurance policy.
What are pre and post-hospitalization expenses?
Pre-hospitalization expenses refer to expenses/medical cost of tests incurred before a person gets hospitalized such as X-rays, CT Scans, MRI Scan, consultation fee etc. On the other hand post hospitalization expenses are expenses incurred by a person after they get discharged from the hospital, these expenses include medicine follow ups, medicines, diagnostic tests etc.
What do you mean by pre-existing disease?
A pre-existing disease refers to any health condition that the proposer has been facing prior to purchasing a health insurance policy. A pre-existing medical condition can be high blood pressure, diabetes, thyroid, asthma etc.
Do I have to undergo any medical examination before buying health insurance ?
When purchasing a health insurance policy the insurance provider may require you to undergo some medical examination to assess your health condition. These medical tests play an important role in determining your eligibility for getting health insurance and determining the premium of the health insurance policy. However, it does not mean that you cannot purchase a health insurance policy without medical examination.
How can I add my family members to my existing health insurance policy?
You can add your family members to your existing health insurance policy at the time of renewal but you can’t add your family members between the policy tenure except for newborn. By adding a family member into your existing health insurance policy, the premium for the health insurance policy may increase.
What is 'domiciliary Hospitalization?'
Domiciliary hospitalization refers to medical treatment for an illness, disease or an injury which normally requires care and treatment at a hospital but the treatment is actually provided at home.
What to do if I am admitted to a non-network hospital?
In case you are admitted to a non-work hospital for a treatment, you must pay the bills and admission fees of the hospital from your own pocket. After being discharged you can apply for a reimbursement claim under your health insurance policy by submitting all the supporting documents such as reports and bills. The insurance provider will check all the documents and settle the claim accordingly.
What are the benefits available under in-patient hospitalization?
Under in-patient hospitalization, compensation for room rent, ICU charges, operation theater charges, consultation fee, nursing charges, cost of medicines etc. is provided in case the insured person requires to be hospitalized for more than 24 hours.
Can a minor buy health insurance?
Yes a health insurance policy can be purchased for a minor. One can purchase a health insurance policy for their child. A child health insurance policy can be purchased separately which covers the child from day one.
Where can I find my health insurance number?
When you purchase a health insurance policy you get a health insurance card under which the policy number or policy ID is given that helps you and the insurance provider to keep a track of your health insurance policy. You can find your health insurance number on your health insurance card which shall be denoted as ‘Policy ID’ or ‘Policy Number.
Why would my health insurance claim be denied?
There are a few reasons that explain why your health claim can be denied. Below mentioned are some of those reasons:
- Filing a claim during the waiting period.
- In case the insurance provider finds the treatment unnecessary, the claim can be denied.
- Providing false or inaccurate information.
- Failing to submit required documents at the time of filing the claim.
Why is health insurance important for employees?
Employee health insurance is not only beneficial for the employees but also for employers. The main point of providing corporate health insurance to employees is to protect and support the health and wellbeing of the employee.
Can I cancel my health insurance at any time?
Yes, you can cancel your health insurance during the free look period and any time after the free-look period if you are not satisfied with your health insurance policy. However, when you choose to cancel your health insurance policy, the insurance company will provide a refund of premium after deducting applicable charges and proportional risk charges or the time you have been covered under the policy.
What is the right age to buy health insurance?
It is advised to purchase a health insurance policy as early as possible i.e between the age of 20 and 30 years. At this age a person is most likely to be in their best health and can avail comprehensive coverage at an affordable premium rate.
From what age can I include my children in my existing health insurance plan?
This depends on the type of health insurance policy and the insurance provider’s terms and conditions. Generally, under many health insurance policies the dependent child is covered upto the age of 25 years. Check the terms and conditions of the policy to know all about the policy.
Do I need to purchase an additional health insurance plan to get high coverage?
You can purchase an additional health insurance plan to get high coverage and extra help to bear medical costs. Having additional health insurance can be a way to maximize the benefits and receive more coverage but there can be difficulties in maintaining two health insurance policies at once. It can be expensive also. You can always opt for add-on covers at the time renewal or at the time of purchasing the policy. These add-on covers increase the coverage and eliminate the need of purchasing an additional health insurance policy.
What is the sum insured in health insurance?
Sum assured in a health insurance refers to the maximum amount that the insurance company provides to the policyholder in case he/she is hospitalized. Any cost of hospitalization which is above and beyond the sum insured shall be borne by the policyholder.
Can the nominee be changed in the middle of the policy term of the health insurance policy?
Yes, the nominee can be changed anytime during the policy term of a health insurance policy. The policyholder can change the nominee and appoint a new nominee by informing their insurance provider.
I am a Foreign Citizen. Can I take a health policy for my child who is continuing further studies in India?
Yes, you can purchase health insurance for your child who is studying in India. Although the scope of coverage shall be restricted i.e the scope of coverage will be for the treatment taken in hospitals in India during the policy tenure.
What are the best health insurance plan for omicron variant of covid-19?
As we step into the new year 2022 with a lot of hope keeping in mind the effect of COVID-19 back in 2021. However, a new variant of COVID-19 known as ‘Omicron’ has become a matter of concern in the first week of this new year. Cases of the Omicron variant of Covid have been increasing in all parts of the country.
The impact of the second wave of COVID-19 is still in our minds, it becomes very necessary for us to be prepared this time as the Omicron variant spreads like a wildfire all around the world. Health insurance is the need of hour as health emergencies are very unpredictable. It is the most crucial step one can take to ensure the security of their loved ones and themselves in difficult times like this. Health insurance provides comprehensive coverage for hospitalisation and treatment cost for health emergencies.
Health insurance for Omicron variant will provide coverage for the expenses incurred after getting diagnosed with Omicron variant and for the treatment expenses of the disease. Since ‘Omicron’ is a variant of COVID-19 it is covered under all the health insurance policies available in India. If you are planning to purchase a health insurance policy, don’t wait to see if the third wave will arrive or not. It's never too early to plan for a secure future. Now is the correct time to get covered with the best health insurance policy available in India which can help you take care of medical expenses to secure both your present and future.
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 Much Does Health Insurance Cost Per Month For An Individual?
Different health insurance plans come at different premiums, which depend on various factors, some of which include age, number of members covered, policy term, coverage benefits, add-on covers included, pre-existing diseases, etc.
How much does health insurance cost per month for an individual?
Monthly premium of the health insurance plan depends on the sum assured of the health insurance policy. For example a Rs. 5 Lakh family floater plan which also covers the proposer will cost somewhere between Rs. 10,000 to Rs. 15,000 annually. A Rs. 5 Lakh individual plan will cost somewhere between Rs. 4,000 to Rs. 6000 per month.
Why does health insurance premium increase on renewal?
It is very prominent that time and inflation can affect expenses of your life which include health insurance premiums. It is observed that medical treatment costs increase every year which makes it expensive for the insurance companies to settle the claim which eventually increases the cost of premium for a health insurance policy.
Can health insurance companies increase premiums?
While purchasing a health insurance policy the cost of premium can be affected by several factors such as age of the applicant, past medical history, pre-existing disease, occupation, policy tenure, Body Mass Index (BMI), personal habits such as consumption of alcohol or tobacco, geographical location etc. These factors can determine the premium.
What are the payment modes available for the payment of health insurance policy premium on InsuranceDekho?
You can choose to pay premium through Net Banking, NEFT, UPI, E-wallet, Credit/Debit cards while purchasing a health insurance policy at InsuranceDekho.
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 I miss the health insurance policy premium renewal date?
If you miss the renewal date of your health insurance plan, you can get it renewed within the grace period provided by your insurance company. If you fail to renew your plan even then, your plan can be expired.
Can I increase my health insurance cover during renewal?
Yes, you can enhance the coverage of your health insurance policy by adding some add-on covers to your policy. To include additional covers in your plan, you will have to pay an extra premium during the renewal of your policy.
Is there a grace period for health insurance renewal?
Yes, a grace period is offered by health insurance companies to renew your health insurance plan without getting your policy expired. This period varies from insurer to insurer.
How Can I Renew My Health Insurance Policy Online?
You can renew your health insurance policy online by following a few simple steps given below:
- Visit the official website of the insurer and look for the health insurance page.
After visiting the website, search for the health insurance page and find the renewal tab and choose the ‘Renew’ option.
Click renew and renew your existing health insurance policy.
Enter the policy number of your existing health insurance policy.
Click on ‘Renew’ to initiate the premium payment for renewal of your policy.
Pay the required health insurance premium. You will then receive a confirmation on the Email for successful renewal of your health insurance policy.
- Visit the official website of the insurer and look for the health insurance page.
Can I renew my health insurance with another company?
You can port your existing health insurance policy to another health insurance company and renew your policy. To be able to do so, you will have to inform your existing health insurance provider and approach the new company who you wish to get your health insurance policy ported to. The new health insurance company will send a couple of documents which include portability form and proposal form.
Can I transfer my health insurance policy without losing renewal benefits?
Yes, you can transfer your health insurance policy from one health insurance company to another without the renewal benefits accumulated over years.
Can I renew my health insurance policy at InsuranceDekho?
Yes, you can renew your health insurance policy at InsuranceDekho online. Below mentioned are some steps that you follow to renew your health insurance policy:
Step 1: Visit InsuranceDekho and click on the ‘Renew’’ tab displayed on the home page.
Step 2: Log in using your registered mobile number. An OTP will send for verification, after you enter the OTP, health insurance linked to your mobile number shall be displayed.
Step 3: Check your policy details carefully and proceed to renew your policy.
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 Are The Different Types Of Health Insurance Plans Available In India?
There are several types of health insurance plans available in India. These are-family health insurance plans, senior citizen health insurance plans, individual health insurance plans, personal accident health insurance plans, maternity health insurance plans, children health insurance plans, newborn baby health insurance plans, health insurance plans for self-employed, and women health insurance plans.
Can I avail coverage benefits if I get hospitalized for less than 24 hours?
Yes, you can avail coverage benefits of the health insurance policy in case you are not hospitalized for a minimum of 24 hours as there are some illnesses where hospitalization is not required and health insurance companies have now made it possible to get coverage for day care procedures as well.
Will my health insurance policy cover hospitalization outside India?
Unfortunately most domestic health insurance companies do not provide coverage treatments taken outside India. There are some selective health insurance plans available in India that provide coverage for treatment taken outside India.
Does health insurance policy cover dental implants?
Most health insurance policies do not cover dental treatment as they are considered cosmetic treatment surgery. However, if there is a requirement of dental treatment/procedure that may arise due to an accident it may be covered by the insurance company.
What type of health insurance policy covers pregnancy?
Maternity health insurance policy provides coverage for pregnancy. This type of health insurance policy provides coverage for maternity related expenses such as delivery, vaccination, pre and post natal expenses etc.
What are the diseases covered under a health insurance policy?
Inclusions and exclusions of a health insurance policy varies from one insurance provider to another. Below mentioned are some common diseases covered under a health insurance policy:
- High Blood Pressure and High BMI
- Critical Illnesses
- Heart Ailments
- Brain Stroke
What are the diseases which are not covered under a health insurance policy?
Listed below are some common aspects which are not covered under a health insurance policy:
- Congenital Diseases/Genetic Disordered
- Cosmetic Surgery
- Health issues that may arise due to consumption of drugs, alcohol, and smoking
- IVF or Infertility Treatments
- Self-Inflicted injury
- Voluntary Abortion
- Sexually Transmitted Diseases
- Injuries caused due to war, riots or strikes.
I’m covered under my Employer’s Group Health Insurance policy, Do I need a separate health insurance policy?
It is advised to purchase a separate health insurance plan to be able avail higher coverage. Sometimes the employer’s group health insurance policy may not be sufficient and the health cover under the provided employer’s group health insurance shall only be valid till the time you are working with the organization. By having a separate health insurance policy for yourself, you can ensure that you and your family are protected from health emergencies no matter what.
Do health insurance policies cover robotic surgery & modern treatments?
According to the Insurance Regulatory and Development Authority of India (IRDAI), Health Regulations 2019, insurance companies have been directed to cover robotic surgeries as modern treatment. This shall be covered with or without sub-limit.
Does my health insurance policy cover health care expenses related to Covid-19?
Yes, your existing health insurance policy will cover health care expenses for the treatment of COVID-19. As COVID-19 is considered a disease the treatment expenses and hospitalization for the same shall be covered under an existing health insurance policy.
Are pre-existing diseases covered under a health insurance policy?
Most health insurance plans do not provide coverage for pre-existing diseases while purchasing a new health insurance policy. Some health insurance do provide coverage for pre-existing disease but the policies have a waiting period to be able to avail coverage for the same and may it also increase the premium of the health insurance policy.
Does my health insurance policy cover diagnostic charges?
Yes, health insurance policies provide coverage for the cost of diagnostic tests which include X-rays, blood tests, MRI’s etc. as it is associated with a patient's stay at the hospital for treatment for at least a minimum of 24 hours.
I have purchased a health insurance policy, when will I receive my health insurance card?
Health insurance card is provided when the health insurance policy is issued. As soon as you purchase the health insurance policy, the insurance provider will provide you with a medical insurance card and policy documents at the time of policy issuance.
Will health insurance cover lasik laser eye surgery?
Most of the insurance providers consider lasik laser eye treatment as an elective surgery and coverage for the lasik laser eye surgery was not provided under a health insurance policy. Earlier it was considered as a cosmetic treatment. However, the insurance company does provide coverage for lasik laser eye surgery under certain terms and conditions set by the insurance provider.
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.
What is the maximum number of health insurance claims allowed in a year?
There is no specific limit on the number of claims which you can register during a policy year of your health insurance policy. You can keep making claims until the sum insured of your health insurance policy is exhausted.
Can we claim a health insurance policy immediately?
In order to make any claim, the customers need to wait 30 to 90 days after the purchase of the policy. The initial waiting period completely varies from insurer to insurer, however, the minimum waiting period is at least 30 days. However, this is not applicable to any emergency hospitalization occurring due to an accident.
Does a claim have to be lodged in a specific time frame from the time of the accident under a health insurance policy?
In case of an accident it is essential to immediately notify the insurance provider of TPA. Some health insurance policies provide a window of 24 hours to 7 hours to notify the insurance provider in case of admission in hospital for treatment of injuries that may arise due to an accident. Under most health insurance policies one must immediately inform the insurance provider upon the admission of the insured person for the treatment of injuries caused during an accident.
What is a claim settlement ratio?
Claim settlement ratio is denoted to the ratio of number of claims settled against the total number of claims received. It shows the goodwill of the company and helps in making an informed decision. While purchasing a health insurance policy you should choose an insurance provider with a high claim settlement ratio.
What Is Cashless Hospital In Health Insurance?
The term "cashless hospitalisation" refers to the situation in which the insured person does not have to pay any money out of pocket for a hospitalisation or treatment, and the full hospital expense is paid directly by the insurance company.
How does the health insurance claim process work?
The process for filing a claim against your health insurance policy can vary depending on the policy you have purchased. There are two types of claims under a health insurance policy and how do they work:
- Cashless Claims: A cashless claim is one of the options for resolving disputes. Simple terms, a cashless claim process is a part of the health insurance claim settlement process in which the insurer pays the network hospital directly and you, the policyholder, just pays a nominal amount.
- Reimbursement Claims: A reimbursement claim, as the name implies, is a type of insurance settlement in which you pay for your own treatment or hospitalisation and the insurer reimburses you later.
How many times can medical insurance be claimed?
When you buy a Mediclaim Policy from us, you can make as many claims as you like under the policy but not more than the sum insured of the health insurance policy. If your basic sum insured is exhausted, however, you will not be covered for any medical expenses.
Can we claim medical bills in health insurance?
Yes, medical expenses incurred after hospitalisation for a period of 60 days from the date of discharge from the hospital are covered.
How long does it take to settle a mediclaim?
The insurance company will settle health insurance claims within 30 days of receiving all required documents and after thoroughly evaluating your claim. In case further investigation is required it may take a little longer to settle a mediclaim.
How to check medical insurance claim status?
You can easily check your medical insurance claim status online and offline. You can check your medical insurance status by visiting the insurance company’s official website, the claim status can be checked by your policy details such as policy number, registered email ID or mobile number. You can also call the helpline number of the insurance company, write an email or visit the nearest branch office to know the claim status of your medical insurance claim.
Why Do Health Insurance Claims Get Rejected?
Non-disclosures, partial disclosures, and inaccurate disclosures of important facts such as age, nature of occupation, income, current insurance plans, major ailments, or pre-existing medical conditions are all common reasons for claims being rejected under a health insurance company.
Will my travel history abroad affect the admissibility of claim under the policy?
As long as the hospitalisation takes place in India, the travel history will have no impact on the insurance claim's validity.
What do you mean by No claim bonus in health insurance plans?
In health insurance, the insurance provider may offer a No Claim Bonus to the policyholder if certain terms and conditions are met. The policyholder must not have made a claim during the previous policy period in order to qualify for the No Claim Bonus.
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.