Health Insurance is a contract between the policyholder and the insurer where the health insurance company provides financial coverage to the insured up to the sum insured limit. It offers medical coverage for healthcare expenses incurred on hospitalization along with multiple benefits, like pre & post-hospitalization cover, medical check-ups, cashless facility, etc.

Health Insurance at a Glance

Categories	Specifications
Sum Insured	₹50,000 to up to ₹3 crore
Maternity Cover	Available
Pre & Post-hospitalization Expenses	Covered
OPD Cover	Available
ICU Charges	Covered
Free Health Check-ups	Available
Pre-existing Diseases	Covered*
Ambulance Cover	Available
Day Care Procedures	Covered
Tax Benefits	Up to ₹75,000 per financial year

*Pre-existing diseases are covered after the waiting period is over.

Benefits of Buying Health Insurance Plans Online?

Buying a health insurance policy online comes with several benefits. Take a look at them below:

Easier to Compare Plans – It is easier to compare health insurance plans from different insurers online at websites like Policybazaar.com to make an informed decision.
More Convenient – It is more convenient to buy the policy online as you do not have to visit the branch of the insurance company or take an appointment to meet an insurance agent.

Online Discounts – It allows you to avail discount on premiums for buying the policy online.
Lower Premiums – Health plans are available for a lower premium online as insurance companies save a lot on operational costs.
Minimal Paperwork – The process of buying a health insurance policy online involves minimum to zero paperwork.
Policy Available 24x7 – A health insurance policy can be purchased online any time of the day, even on public holidays, which is not possible in offline buying.
Digital Payment Options – It allows you to avoid cash payments and use digital payments methods to pay the premium online safely.
Instant Policy Purchase – A health insurance policy is issued instantly when purchased online unlike offline buying.
Time-saving – It saves you a lot of time as the policy is issued within a few minutes of buying.

Waiting Period

You should buy a health insurance policy with a minimal waiting period. Read more

Co-payment

You should opt for a health insurance plan with no co-payment. Read more

Preventive Health Check-up

You must choose a health insurance plan that offers free preventive Read more

Grace Period

You should buy a health insurance policy that offers the maximum Read more

Top Reasons to Buy a Health Insurance Plan

Medical inflation is increasing every day making treatments expensive. If you get hospitalized for a critical illness or lifestyle disease, you may end up losing all your savings. The only way to afford quality medical treatment during a health emergency is by buying a health insurance policy. Take a look at some of the top reasons to buy a health insurance plan below:

Beat Medical Inflation - A health insurance policy can help you pay your medical bills, including pre and post-hospitalization expenses, today as well as in future despite the rising medical costs.
Afford Quality Medical Treatment - It helps you to afford the best quality medical treatment and care so that you can focus only on getting cured.

Fight Lifestyle Diseases - It allows you to pay for the long-term treatment of lifestyle diseases like cancer, heart attack, etc. that have been on the rise with the changing lifestyles.
Protect Your Savings - It helps you to protect your hard-earned savings by covering your medical expenses so that you can avail the required treatment without any financial worries.
Avail Cashless Hospitalization Facility - It allows you to obtain a cashless hospitalization facility at any of the network hospitals of your insurance provider by raising a cashless claim.
Get Tax Benefits - It enables you to save tax on the health insurance premium that you’ve paid under section 80D of the Income Tax Act for better financial planning.
Ensure Peace of Mind - It allows you to obtain medical treatment with peace of mind as you do not have to worry about paying the hefty hospital bills.

Key Benefits of Health Insurance Plans in India

Health insurance plans offer a variety of health benefits to the insured depending on the plan. Following are the key benefits of buying a health insurance plan in India:

benefits of health insurance plans

Hospitalization Expenses - A health insurance plan covers the medical expenses incurred on getting admitted to a hospital for more than 24 hours. It includes room rent, doctor’s fee, medicine cost, diagnostic test fees, etc.
Pre & Post Hospitalization Expenses - It covers the medical expenses that you may have incurred on an illness before getting hospitalized as well as follow-up treatment expenses incurred after getting discharged. The pre-hospitalization and post-hospitalization expenses are covered up to a fixed number of days as specified in the policy document.

ICU Charges - A health insurance plan also covers the cost of availing treatment in an ICU during hospitalization.
Ambulance Cost - It covers the cost of ambulance services availed to reach the nearest hospital during a medical emergency.
Cashless Treatments - All health insurance providers in India offer cashless treatment facilities at their network hospitals. You do not have to worry about arranging money to pay the hospital bills if you get admitted to a network hospital as it will be settled by your insurer under cashless claims.
Day Care Procedures - It also covers the cost of availing day care treatment that requires hospitalization for less than 24 hours.
Pre-existing Diseases - The best health insurance policy also provides coverage for pre-existing diseases after you have completed the waiting period. Usually, pre-existing diseases are covered after a waiting period of 2 to 4 years.
AYUSH Treatment - It covers the cost of availing medical treatment through AYUSH school of medicines that includes Ayurveda, Unani, Homeopathy, Siddha and Yoga.
Medical Check-ups - Most health insurance companies in india offer free preventive health check-up facilities to the insured at regular intervals depending on the policy terms and conditions.

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Best Health Insurance Plans in India

We at Policybazaar can help you to buy the best health insurance plan that suits your health requirements. Below is the list of health insurance plans offered by the top insurance companies in India. You can do an online comparison and find the best health plan for yourself.

Health Insurance Plans	Sum Insured (Rs)	Network Hospitals	Key Benefits
Aditya Birla Activ Assure Diamond Plan	Min – 2 lakh Max – 2 Crore	8700+	Pre-post hospitalization cover In-patient hospitalization cover Domiciliary hospitalization cover 100% Ambulance cover AYUSH in-patient cover
Bajaj Allianz Health Infinity Policy	Unlimited	6500+	Pre-post hospitalization cover Day care procedures Preventive health check-ups Road ambulance In-patient hospitalization
Bharti AXA Smart Health Insurance Policy	Min – 50,000 Max – 5 lakh	4500+	Day care treatment cover In-patient hospitalization benefit Critical illness cover Pre-post hospitalization cover Domiciliary hospitalization
Care Health Insurance Plan	Min – 3 lakh Max – 75 lakh	16500+	In-patient care Alternative treatment Organ donor cover Pre-post hospitalization cover Second opinion
Cholamandalam Healthline Plan	Min – 1 lakh Max – 25 lakh	6500+	Emergency ambulance expenses Pre-post hospitalization expenses Maternity expenses In-patient hospitalization expenses AYUSH coverage expenses
Digit Health Care Plus Policy	Min – 2 lakh Max – 3 crore	6400+	Hospitalization cover Daily hospital cash cover Critical illness cover Complimentary health check-up Psychiatric illness cover
Edelweiss Health Insurance Policy	Min – 1 lakh Max – 1 crore	3200+	Day care treatment Pre-post hospitalization cover Maternity benefit Ambulance cover Hospitalization expenses
Future Generali Health Total Policy	Min – 3 lakh Max – 1 crore	6000+	Maternity benefit Hospitalization expenses OPD medical expenses Road ambulance charges Mental healthcare cover
IFFCO Tokio Individual Health Protector	Min – 50,000 Max – 20 lakh	6400+	Hospitalization expenses AYUSH hospitalization cover Organ donor cover Domiciliary hospitalization
Kotak Mahindra Health Premier Policy	Min – 3 lakh Max - NA	5000+	In-patient treatment Annual health check-up Maternity cover Home nursing benefit Air ambulance cover
Liberty Health Connect Policy	Min – 2 lakh Max – 15 lakh	5000+	Hospital daily cash allowance In-patient treatment expenses Pre-post hospitalization expenses Recovery benefit Second opinion
ManipalCigna ProHealth Insurance Policy	Min – 2.5 lakh Max – 1 crore	6500+	Hospitalization expenses Outpatient expenses AYUSH In-patient hospitalization cover Donor expenses Medical check-up
Niva Bupa (Formerly known as Max Bupa) Health Companion Plan	Min – 3 lakh Max – 1 crore	7400+	Day care treatments In-patient care Modern treatment Pre-post hospitalization expenses Health check-up
National Mediclaim Policy	Min – 1 lakh Max – 10 lakh	6000+	In-patient hospitalization expenses Ambulance charges Pre-post hospitalization expenses Modern treatments Mental illness cover
New India Assurance Mediclaim Policy	Min – 1 lakh Max – 15 lakh	3000+	Pre-post hospitalization expenses Ambulance charges In-patient hospitalization Health check-up Hospital cash allowance
Oriental Mediclaim Insurance Policy (Individual)	Min – 1 lakh Max – 10 lakh	4300+	Ambulance charges Hospitalization expenses Mental illness cover Modern treatment Telemedicine expenses
Raheja QuBE Insurance Policy	Min – 1 lakh Max – 50 lakh	5000+	In-patient hospitalization Domiciliary hospitalization Organ donor benefit Pre-post hospitalization expenses Medical check-up
Reliance Health Infinity Insurance Policy	Min – 3 lakh Max – 1 crore	7300+	Emergency ambulance In-patient care Transportation benefit AYUSH benefit Day care procedures
Royal Sundaram Lifeline Supreme	Min – 5 lakh Max – 50 lakh	5000+	Emergency domestic evacuation cover Pre-post hospitalization expenses Second opinion In-patient hospitalization expenses Annual health check-up
SBI Arogya Premier Policy	Min – 10 lakh Max – 30 lakh	6000+	Maternity expenses Hospitalization expenses Advanced treatment procedures Mental illness cover Air ambulance
Star Medi Classic Insurance Policy (Individual)	Min – 1.5 lakh Max – 15 lakh	11,000+	Pre-post hospitalization expenses In-patient treatment Modern treatment Psychiatric & Psychomatic disorder Health check-up
Tata AIG MediCare Insurance Policy	Min – 3 lakh Max – 20 lakh	7200+	Day care treatment In-patient treatment Compassionate travel Ambulance cover Domiciliary treatment
United India Individual Health Insurance Policy	Min – 2 lakh Max – 20 lakh	7000+	Pre-post hospitalization expenses In-patient Ayurvedic treatment Health check-ups Day care procedures Domiciliary hospitalization
Universal Sompo Complete Healthcare Insurance Plan	Min – 1 lakh Max – 10 lakh	4000+	OPD treatment Maternity expenses Accidental dental treatment In-patient hospitalization Organ donor expenses

See More Plans

Disclaimer : *Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

Types of Health Insurance Plans

Health Insurance for Family

Family health insurance offers insurance coverage to entire family against a single premium. Under this health plan, a defined sum insured is divided among the members equally, which can be claimed by one or more family members during the policy term.

Health Insurance for Senior Citizens

Senior Citizen health insurance plans offer insurance coverage to the age group of 60 years and above. The health insurance plan covers hospitalization expenses like in-patient, pre and post-hospitalization expenses, OPD expenses, Daycare procedures with tax-saving benefits.

Health Insurance for Critical Illness

Critical illness health insurance plans offer a lump sum amount in case the insured is diagnosed with a critical illness such as kidney failure, paralysis, cancer, heart attack, etc. Usually brought as a standalone policy or as a rider, the sum insured is pre-defined

Health Insurance for Parents

Health insurance for aging parents refers to the senior citizen health plans that are designed for elderly people above the age of 60 years. It is essential for aging parents as they are more vulnerable to health risks like heart ailments, kidney ailments, and other critical illnesses.

Health Insurance for Coronavirus

Post COVID-19 outbreak, the IRDAI has also launched two Coronavirus specific health insurance plans i.e. Corona Kavach health plan and Corona Rakshak health insurance plan. Corona kavach is a family floater plan while Corona Rakshak is an individual coverage based plan.

Health Insurance for Diabetic

Health insurance for diabetes covers hospitalization expenses for diabetic patients, who otherwise find it hard to get insurance cover. The policy can cover both Type 1 and Type 2 diabetes and related medical complications. Tax benefits on the premium can also be availed.

Personal Accident Health Insurance

Personal accident insurance is a health policy that reimburses the medical costs incurred on hospitalization due to death or disability caused by an accident. The insurance company pays a certain amount as per the nature of the disability.

What is Covered in a Health Insurance Plan?

Most health insurance companies in India cover the following medical expenses under a health insurance policy:

In-patient Hospitalization Expenses -The hospitalization expenses incurred during the treatment of an illness or injury are covered provided the hospitalization is for more than 24 hours.
Pre-existing Illnesses or Diseases - After the completion of the waiting period, you can file a claim for the expenses incurred on the treatment of any pre-existing illness or condition.

Pre and Post Hospitalization Expenses - Medical expenses incurred on blood tests, x-ray, and other medical check-ups that are required before hospitalization are taken care of by the insurance company. Similarly, the cost of medicines and preventive health check-ups that are done to ascertain your health after the discharge from the hospital is covered under the health insurance plan.
Ambulance Charges - Although the coverage amount varies from insurer to insurer, most medical insurance plans cover emergency ambulance charges.
Maternity Cover - Medical expenses incurred during the pregnancy and delivery are covered along with newborn baby expenses.
Preventive Health Check-ups - Regular health check-up facilities are also made available in some health insurance plans in India.
Day-care Procedures - Daycare treatments where hospitalization is not required for more than 24 hours are covered. It includes eye surgery, dialysis, and other common daycare surgeries as mentioned in your policy document.
Home Treatment Cover - It also covers the expenses incurred on getting medical treatment at home on the advice of a medical practitioner.
AYUSH Benefit - A health insurance plan also reimburses the medical costs incurred on Ayurveda, Unani, Siddha or Homeopathy treatment up to a specified limit.
Mental Healthcare Cover – Several health plans in India offer coverage for the medical expenses incurred on the treatment of mental illness, like depression.

What is Not Covered in a Health Insurance Plan?

The following medical expenses and situations are not covered in a health insurance plan:

Unless there is an accidental emergency, claims arising during the initial 30 days of buying a health insurance plan are not covered.
Coverage of pre-existing diseases is subject to a waiting period of 2 to 4 years

Critical illnesses coverage usually comes with 90 days waiting period
Injuries caused by war/terrorism/ nuclear activity
Self-inflicted injuries or suicide attempts
Terminal illnesses, AIDS, and other diseases of similar nature
Cosmetic/plastic surgery, replacement of hormones surgery, etc.
Dental or eye surgery expenses
Bed rest/hospitalization and rehabilitation, common illnesses, etc.
Treatment/diagnostic tests and post-care procedures
Claims arising out of adventure sports injuries

Note: It is recommended to check your policy wordings to get a detailed list of exclusions.

Key Factors to Consider before Buying a Health Insurance Plan

There are a few factors that you should consider closely to make the right decision while buying a health insurance plan:

Check the Scope of Coverage -The policy coverage and the sum insured amount will decide the type of illnesses and surgeries that you can claim during the policy term. Closely look at the benefits offered like hospitalization expenses, daily cash benefit, COVID hospitalization cover, critical illness cover, maternity cover, etc. while choosing a health plan.

Adequate Sum Insured - The sum insured amount is a crucial deciding factor in selecting a medical insurance policy. Looking at the ongoing inflation it is advisable to buy a health insurance plan with a minimum sum insured of Rs 10 lakh that can go up to Rs 1 crore. If it’s a family floater policy or senior citizen insurance, the higher the sum insured the better the coverage will be.
Policy Type - There are different types of medical insurance policies that are available in India. As per your requirement, you can choose to buy individual health insurance, senior citizen health insurance, family floater or critical illness plans. Moreover, you can buy Top up and Super Top up health insurance along with your existing health plan to enhance the coverage. This is beneficial in case your base sum insured gets exhausted during the treatment. You can choose this option at the time of policy purchase and renewal.
Waiting Period Clause - Your health insurance policy only comes into action once the initial waiting period is over. If any claim is filed during the initial waiting period except for accidental hospitalization claims, the insurer can reject it. Moreover, the waiting period clause also applies to pre-existing diseases like thyroid, blood pressure, diabetes, etc. It is also applicable to specific illnesses, treatments, and maternity cover. You can choose a plan with a minimal waiting period.
Co-payment Clause - Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (insured). The co-payment option does not have any effect on the sum insured. It allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Only opt for this clause if you can pay off a portion of your hospitalization bills, that can be 10% and above without a financial burden.
Room Rent Sub-limits - A health insurance plan may have various sub-limits and the most common one is the room rent sub-limit. For instance, if your medical insurance policy comes with a sum insured of Rs 3 lakh with a sub-limit of 1%on daily room rent, then your room cost will be covered up to Rs 3,000 per day. Any additional amount on room rent will have to be paid from your own pocket. So, a health plan with no or minimal sub-limits is advisable.
Network of Cashless Hospitals - Check the list of network hospitals for an insurance company where cashless claims can be filed. The maximum number of network hospitals you have in your vicinity,the better are the chances of availing cashless hospitalization benefits.
Lifelong Renewability Option - Medical insurance policies are usually renewed every year. When the policy term is about to end, in order to continue the insurance coverage, the insured has to pay the insurance premium at the time of renewal. When buying a health insurance plan, choosing a plan with a lifetime renewal option is beneficial in the long run.
Premium Loading Factor - Premium Loading is the additional amount that is charged to a risk-prone policyholder in the premium, especially in senior citizen health insurance plans. Choosing a medical insurance plan with no loading will save you from paying an extra premium. Some insurers also charge a claim loading. This aspect, though ignored in the beginning, usually increases your out-of-the-pocket expenses at the time of claim.
Check the Claim Settlement Ratio - This is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. A claim settlement ratio above 80% can be an ideal choice.

Health Insurance Riders

Riders in health insurance are the additional coverage that you can purchase to avail extra benefits and make your health policy more comprehensive. The cost of the health insurance rider depends on your age, sum insured, type of coverage, etc. Take a look at the five most common riders that you can consider buying under your health insurance policy:

Maternity Cover Rider- The maternity cover rider can help you to get your maternity expenses covered, including childbirth, pre and post-natal expenses, etc. Some insurers may offer coverage for newborn baby expenses until the end of the policy tenure. However, this rider comes with a waiting period that may range from 2 years to 6 years depending on the health insurer.

Critical Illness Rider- The critical illness rider will ensure that your health insurance policy covers critical illnesses, such as heart attack, cancer, etc., diagnosed for the first time during the policy tenure. It will provide you with a lump sum benefit amount irrespective of the actual medical expenses incurred during the treatment. It comes with a waiting period of 90 days & a survival period of 30 days and covers about 10 to 40 critical diseases depending on the insurer.
Personal Accident Rider- The personal accident rider can help you get compensation from your insurer in case an accidental injury leads to your disability or death. It will pay you the entire sum insured in case of permanent total disability but only a part of the sum insured depending on the nature of the injury in case of partial disability. It is also known as the double indemnity rider as your family will get an additional death benefit in case of accidental death.
Hospital Cash Rider- The hospital cash rider enables you to get a fixed daily cash allowance from your insurer to cover incidental expenses that you may incur during hospitalization for an injury or illness. It offers twice the coverage amount for a specific number of days in case you are admitted to the ICU. The daily cash amount may vary as per the policy terms and opted coverage. However, you need to be hospitalized for at least 24 hours to activate this rider.
Room Rent Waiver- The room rent waiver ensures that your health insurance policy covers the rent for the hospital room of your choice during hospitalization. It ensures that no cap on room rent applies to you and thus, allows you to opt for a room with higher sub-limits or no sub-limits without paying extra money from your pockets.

Does Your Health Insurance Policy Cover Coronavirus (COVID-19) Treatment?

Yes, your existing health insurance policy covers the cost of COVID-19 treatment. Several health insurers and general insurers have already launched health insurance plans for coronavirus that cover the medical expenses incurred on the treatment of coronavirus. After the IRDAI guidelines, two special standard health insurance products, namely Corona Kavach policy and Corona Rakshak policy were launched and are being purchased by a lot of people already. Lets’ check out these two COVID insurance products and how they are different from basic health plans.

Corona Kavach Policy

It is an indemnity based health insurance plan that covers COVID hospitalization expenses, home treatment, and AYUSH treatment costs. The cost of masks, gloves, ventilators, oxygen cylinders, PPE kits, is also covered.
Corona Rakshak Policy

Corona Rakshak policy is a benefit based product that provides a lump sum payment for hospitalization (minimum 72 hours) expenses upon the diagnosis of coronavirus during the policy term. The minimum policy term is 3.5 months and the maximum is 9.5 months.

Eligibility Criteria to Buy a Health Insurance Plan

The eligibility criteria to buy a health insurance plan depends on a number of factors such as the age of the policyholder, pre-existing diseases, etc. In most health insurance plans, the following eligibility criteria should be met:

Criteria	Specifications
Age Criteria for Adults	Entry age for Adults: 18 to 65 years
Age Criteria for Dependent Children	Entry age for Children: 90 days to 25 years
Pre-medical Screening	Above the age of 45/55/60 years
Pre-existing Disease waiting period	2 years to 4 years

Age Criteria- The entry age criteria for adults and children varies and can range from 18-65 years and 90 days to 25 years respectively. The actual age can vary from one medical insurance policy to another.

Pre-medical Screening- Pre-medical examination is required for applicants mostly above the age of 45 years or 55 years. However, most of the senior citizen health plans require pre-medical tests before policy issuance.

Pre-existing Diseases- Any pre-existing illness is covered after the completion of the waiting period i.e. 2-4 years. Most health insurers ask the applicant if they are going through any medical conditions like blood pressure, diabetes, cardiovascular diseases, kidney problems, etc. at the time of buying a health insurance plan. If you are a smoker or an alcoholic, then you need to disclose it to the insurance company.

Do not keep it as a secret as it may cause problems at the time of claim settlement. It can even lead to rejection of you claims. Based on this criterion the insurance company decides to offer medical coverage to the applicant.

Why Compare Health Insurance Plans Online?

Comparing health insurance quotes online helps you in choosing the best health plan to suit your healthcare needs. Sometimes, it can also get confusing to select the best health insurance plan as so many insurers offer different health insurance products with impressive features.

Thankfully, Policybazaar.com understands the confusion of the customers and hence, offers a platform where you can compare different health insurance plans’ features, sum insured and quotes online. Here are some of the major advantages of comparing and buying a health insurance plan online:

Access to Accurate Information: It offers easy access to every medical insurance policy available in the market. It also saves the buyers from dealing with the insurance agents who are known to provide unreliable and biased information most of the time.

Easy Comparison of Different Health Plans: Comparing different health insurance plans online is both time-saving and convenient. You don’t have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing the health insurance plans, etc., are also easier via online mode.

Find a Policy with Suitable Premiums: If a customer buys a health plan online, he/she will be able to compare the premium and opt for the one that fits in the budget. Also, no brokerage or agent fees are levied and hence, the buyer ends up saving a significant amount of money.

Availability of Provider/Plan Reviews: You can check an insurance company’s ability to meet your claim requests by comparing the Claim Settlement Ratios online on our website. Doing so will help you get an overall idea of an insurer’s reputation, enabling you to make an informed decision.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

Some Myths about Health Insurance

Before buying a health insurance policy, you must be aware of how it works. Mentioned below are some popular myths that most people believe about health insurance:

I am Healthy, and I Don't Need Medical Insurance

Despite taking good care of your health, there are numerous unforeseen circumstances, like seasonal illnesses, dengue, malaria, or an accident, that can hit anyone anytime. Nowadays, hospitalization expenses are not easy to pay off. Even 2 days of hospitalization would cost you somewhere between Rs 60,000 to Rs 1 lakh and even more (depending on the type of illness and hospital). A medical insurance plan provides financial assistance to pay for expensive hospitalization costs.
My Health Insurance will Cover all the Medical Expenses

As per the IRDAI regulations, all health insurance plans come with a set of exclusions/limitations. It is advised to check all the policy details and the coverage mentioned in the plan. The insurer will only compensate for the expenses that are covered in the policy and up to the sum insured limit.
Declaration of Pre-existing Diseases

It is essential to declare all your pre-existing diseases in the proposal form. You must mention pre-existing diseases clearly before buying a health insurance policy. Inadequate information can lead to rejection of the claim and can cost more than the expected amount.
Smokers are not Eligible to Buy a Health Insurance Plan

As per a survey, nearly 49% of the applicants who consume alcohol are perplexed to buy a health insurance policy. But there are health insurance companies that offer medical insurance coverage to them as well. Taking into consideration the risks, alcohol consumers, and smokers would need to undergo a stringent pre-medical examination and pay a higher premium to get health insurance coverage.
Medical Insurance will only Cover Hospitalization Expenses

Though most health insurance plans cover medical expenses for hospitalization of more than 24-hours, there are plans that have a capping on the duration of hospitalization as well. Most insurers these days cover daycare procedures as well, where it is not required to be hospitalized for at least 24-hours. It includes cataract surgery, varicose veins surgery and similar medical procedures.
I am Covered Under a Group or Corporate Health Insurance Plan!

Most people rely on the health insurance plan that is provided by their employer. It is important to know that a group health insurance policy comes with a set of limitations. It will not offer coverage to your family members in most of the cases, the sum assured will not be sufficient, or it will not cover critical illnesses. Also, getting health insurance coverage after retirement or losing a job can prove to be an expensive affair.

How to Calculate Health Insurance Premium?

In order to keep the policy in force, regular payment of a fixed premium is essential. Did you ever think about how this premium is calculated? There are certain factors that affect health insurance premiums such as the medical background of your family, sum insured, cumulative bonus, your personal medical history and so on.

Based on that, you might want to calculate your premium to figure out how much you would have to pay for the policy. It can be done through a health insurance premium calculator. A premium calculator is an online tool that calculates the premium to be paid as per the information provided by you, such as the preferred sum insured, age of the insured, etc. At Policybazaar.com, you can calculate your health insurance premium online easily.

Which Factors Affect Health Insurance Premium?

With the advancement in medical facilities, health care costs have also increased. The main benefit of health insurance is that it takes care of healthcare expenses. It offers financial security to you and your family in the event of an unanticipated serious illness or accidental injuries that could drain all your savings. Here is how the cost of your insurance premium is determined:

Medical History: Your medical history is one of the major determinants of the health insurance premium. Almost all health insurers in India make pre-medical tests mandatory (after a certain age) before buying a health insurance policy.

While some insurance companies don’t make medical screening mandatory, they do consider your current medical conditions, lifestyle-related health risks and the medical background of your family. That is why medical insurance premium for smokers is higher than other people.

Gender and Age: Age is another important determinant of the medical insurance premium. The premium varies based on the age of the insured person. That is why it is recommended to buy a policy at a young age because the cost of the premium is low for young applicants.

Elderly people are vulnerable to cardiovascular diseases, and other critical illnesses such as cancer, kidney problems, etc. For this reason, senior citizens' medical insurance premium is usually on the higher side. Also, the cost of the premium for women's health insurance is lower in comparison to the male candidates due to the lower risk of stroke, heart attack, etc.

Policy Term :The premium for a 2-year health insurance plan will be higher than a 1-year plan. However, almost all insurance companies offer a discount on long-term medical insurance plans.

Type of Health Insurance Plan: The type of health insurance policy you select also affects the cost of the premium. The higher is the coverage, the higher will be the premium. With the help of an online health insurance premium calculator, you can compare the premium for different health insurance plans before buying.

No-Claim-Discount: If you have not made any claim during your previous policy term, then you can earn NCB or No Claim Bonus discount. Also known as a cumulative bonus, the savings on premium ranges from 5 to 50 percent depending on the number of claim-free years. It is also one of the most important factors that are taken into consideration while calculating the cost of the premium.

Lifestyle: If you drink or smoke regularly, chances are high that you will be charged more premium amount. In some cases, the insurer can also reject your medical insurance policy request.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

How to File a Health Insurance Claim?

Health insurance plans come with additional benefits of cashless treatment and expense reimbursement by the insurer. One can file a claim for expenses incurred as per the sum insured limit of the health insurance policy. Following are the two types of claim processes:

1. Health Reimbursement Claims

For the treatments availed in the non-network hospitals, the policyholder can file a claim for reimbursement of the treatment charges. Once the treatment is completed, the insured needs to settle the bill, collect all the documents, and then file a claim with the Insurer or the TPA for reimbursement.

2. Cashless Claims

If the treatment is availed in a network hospital or cashless hospital, then the policyholder will be eligible to avail cashless treatment services. Once the treatment is completed the insurance company settles the bill directly with the hospital.

For both cashless and reimbursement claims the procedure for planned and emergency hospitalization may vary as given below:

In Case of Planned Hospitalization

In case of planned hospitalization, you need to inform the insurer at least 48-hours before the treatment.
Once you get the approval from the TPA, you can then file for reimbursement and cashless claims on submission of the claim form
Also, submit other related documents like medical bills, reports, discharge summary, etc.
Once the approval is provided, the claim amount is paid to you by the insurer in case of reimbursement claims.
In the case of cashless claims, the hospital bill is directly settled by the insurer

In Case of Emergency Hospitalization

In case of emergency hospitalization, you need to inform the insurer within 24hours of getting hospitalized.
Showcase your health card at the hospital
Submit the pre-authorization form to get TPA approval for emergency hospitalization for cashless claims
If approved, the insurer will settle the claim amount directly with the network hospital
If you fail to get TPA approval, you would need to file for reimbursement later.
Submit all the required documents like hospital bills, discharge bills, etc.,
The claim amount will be paid to you.

Documents Required for Health Insurance Claim Reimbursement

In the event of a hospitalization, the policyholder needs to submit certain documents as mentioned below:

Discharge card issued by the hospital/network hospital
In-patient hospitalization bills signed by insured for authenticity
Doctors’ prescriptions and medical store bills
Claim-form with insured’s signature on it
Valid investigation report
Consumables and disposables prescribed by the doctors with complete details
Bills of doctors’ consultation
Copies of the Insurance policy from the previous year and the current year/copy of ID Card of TPA
Any other document(s) asked by the TPA

How to Buy Best Health Insurance Plans Online from Policybazaar?

Buying health insurance can be easy if you approach the right channel. Having said this, Policybazaar.com can be a good platform for choosing the right insurance policy. Policybazaar Insurance Broker Private Limited has made the process of comparing & buying a health insurance policy easier in comparison to earlier days. A person has easy access to complete details of almost all health insurance plans available in the Indian insurance market at a competitive price.

Policybazaar.com helps you to compare numerous health insurance plans and zero down on the plan that best fulfills your needs. Moreover, the post-sale services are extended to the customers online as well even at the time of medical insurance claim.

Steps to Buy a Health Insurance Plan Online from Policybazaar

To get insured from the comforts of your home, you can buy health insurance online from Policybazaar Insurance Broker Private Limited. No medicals are required and payment can be made online. Steps to buy a health insurance plan online from Policybazaar are listed below:

Step 1- Select Male/Female and enter your full name

Step 2- Enter your correct phone number, and click on view plans and select your age

Step 3- Click on continue and your city where you are living in and the pin code

Step 4- Click on Yes or No, if you take any medications

Step 5- Select the best health insurance plan from the options that are displayed. Choose ‘Get Free Advice’ if you want suggestions or help

Step 6- Select and compare the different health insurance plans on Policybazaar.com. You can choose the personalized plans options as well.

Step 7- Once the plan is selected, you can pay the premium or speak to our customer care representative to take you through different options.

Step 8- Make an informed decision and pay the premium. Once all the steps are completed, the policy will be emailed to your registered email-id.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

FAQs About Health Insurance

General

Coverage

Premium

Claims

Renewal

Q: What are the discounts available in Policybazaar in health insurance policy?

Ans: Health insurance plans available at Policybazaar offers various kinds of discounts to people. You can avail family discount, long term discount, loyalty discount as well as online discount while buying a health insurance plan on Policybazaar depending on the policy terms and conditions. Moreover, you can also avail cumulative bonus during policy renewals at Policybazaar if you had not raised any claims in the last policy tenure.
Q: What is the right age to buy health insurance?

Ans: There is no right or wrong age to buy a health insurance policy. However, it is suggested to buy it as early as possible to keep your premium low. The earlier you buy health insurance, the lesser would be the premium because you have a lesser risk of health issues at a young age as compared to someone who is in their mid-50s or 60s as they are more prone to critical illnesses. Therefore, if you get health insurance in your 30s, you will be able to avail maximum insurance benefits that too at a lower premium.
Q: Is a medical test mandatory to buy a health insurance policy?

Ans: Medical tests are not mandatory before buying a health insurance policy. However, most health insurance companies in India require medical test reports if the age of the applicants is above 45 years. The type of medical tests required can vary depending on the age of the applicant and the insurer’s requirement.
Q: What does cashless hospitalization mean in a health insurance policy?

Ans: Cashless hospitalization means that the in-patient treatment charges availed by the insured are paid by the insurance company directly to the hospital. All insurance companies in India have a tie-up with a large network of hospitals where the insured/policyholder can avail cashless treatment for an illness or accidental treatment.
Q: At what age can I include my children in my health insurance plan?

Ans: You can include your children in a family floater policy from day 1. In some health plans, children are covered from 91 days onwards. Nonetheless, you are advised to go through the terms and conditions of a health plan carefully to know about the entry age for children.
Q: What is a free-look period in health insurance?

Ans: A free-look period in health insurance refers to the period of the first 15 days of the policy commencement. During this period, you can review your health insurance policy features, coverage, etc. and decide if you want to continue with it or not. You can also opt for add-on covers during this period. If you decide to discontinue the policy during this period, you will not attract any cancellation fee.
Q: What is the sum insured in health insurance?

Ans: Sum insured refers to the maximum amount that the insurance company pays to the policyholder in case a claim is raised due to an illness or accidental injury. It is the maximum claim amount that the insurer will pay under your health policy to cover your incurred medical expenses. It is also referred to as maximum coverage under health insurance.
Q: What are pre-existing diseases or conditions?

Ans: Any health problems or illnesses diagnosed prior to buying a health insurance policy is called pre-existing diseases. Insurance companies are reluctant to cover such diseases as it is a costlier affair for them. Therefore, pre-existing diseases are covered mostly after a waiting period of 2 to 4 years. Besides, every insurance company has its own terms & conditions regarding such illnesses. While some firms prefer to check a person’s entire medical history to know pre-existing condition status, other insurers look for medical records over the past four years
Q: Can a person have more than one health insurance policy?

Ans: Yes, you can buy more than one health insurance policy in India. For example, if you are covered under a corporate health plan then you can get an individual or family floater health insurance policy as well. Similarly, if you already have individual health insurance, you can get another top-up health plan or a senior citizen health insurance plan for your parents.
Q: I have my employer's group policy; do I need to buy a separate health insurance plan?

Ans: Yes, you must buy a separate health insurance policy in addition to your employer’s health insurance policy for better coverage. The sum insured under an employer’s health insurance is usually between Rs 2 lakh and Rs 5 lakh, which might not be sufficient under the current medical inflation. To cover the various expensive treatment costs, it is important to have a separate health insurance plan of a minimum of Rs 10 lakh.
Q: How to add my family members to my existing medical policy?

Ans: You can add your family members to your health insurance policy at the time of renewal or at the time of purchase. You, your spouse, dependent children, parents and parents-in-law can be covered in a family health insurance plan as per its terms & conditions.
Q: What are the documents required for purchasing a health insurance policy?

Ans: There are no documents required as such for purchasing a health insurance policy. You may only have to undergo a pre-policy medical check-up if you are a senior citizen. However, you must have valid proof of your identity, address, age, etc. when you need to file a claim with your insurer.
Q: Can my friend buy a health insurance policy if he/she is not an Indian national but living in India?

Ans: Yes, foreigners living in India can apply for a health insurance policy. However, the coverage will be applicable within India only.
Q: What if I already have a health insurance policy, but just want to increase my sum insured?

Ans: If you want to increase the sum insured of your existing health insurance policy, you can do so at the time of policy renewal. In case sum insured enhancement under your ongoing policy is not possible, you can buy a top-up plan or another health policy to extend the scope of coverage.
Q: What are pre and post-hospitalization expenses in health insurance?

Ans: Pre-hospitalization expenses refer to the medical expenses incurred before getting admitted to a hospital. Post-hospitalization expenses refer to the cost of follow-up tests and consultation treatment charges incurred after getting discharged from the hospital. Health plans in India mostly cover pre-hospitalization expenses up to 30 to 60 days and post-hospitalization expenses up to 60 to 90 days, depending on the plan.

Q: Which diseases are not covered in health insurance?

Ans: A health insurance policy usually does not cover HIV/AIDS treatment except for a few companies. Any claims arising out of congenital disorders, venereal diseases, general debility, sexually transmitted disease and dental treatment/surgery (unless required as a part of treatment) is excluded from health insurance coverage. But do check your policy wordings to know more about the detailed list of exclusions in a health insurance plan.
Q: Does my health insurance policy cover healthcare expenses related to COVID-19?

Ans: Yes, health insurance plans cover COVID-19 hospitalization expenses. You can also buy COVID-19 specific health plans like Corona Kavach and Corona Rakshak if you want coverage for COVID-19 treatment, including the cost of the consumable items like PPE kits, ventilators, etc.
Q: How much health insurance coverage do I need?

Ans: You need to decide the medical insurance coverage you need based on your lifestyle, pre-existing health conditions, medical background of your family, annual income, age, health risks and the premium that you can afford to pay.
Q: Do health insurance plans cover diagnostic charges like X-ray, ultrasound or MRI?

Ans: Health insurance plans cover diagnostic charges like X-ray, ultrasound, blood tests or MRI, only if a patient stays in a hospital for at least one day. Any diagnostic test which doesn’t lead to a treatment or has been prescribed to outpatients are not covered.
Q: Will I get coverage for pre-existing diseases?

Ans: Yes. Most health insurance plans provide coverage for pre-existing diseases. However, they are covered only after a waiting period of 2 to 4 consecutive years. You must check your policy documents carefully to know about the waiting period for pre-existing diseases.
Q: Do health insurance covers robotic surgery & modern treatments?

Ans: Yes. Several health insurance plans in India cover the cost of robotic surgery and modern treatments. You are advised to go through the policy wordings to check if it covers robotic surgery and modern treatments.

Q: What is a Cumulative Bonus in a health insurance plan?

Ans: A cumulative bonus in health insurance implies monetary benefits that the insurer provides you as a reward for not filing a claim during the previous policy year. For instance, discount on premium or sum insured enhancement. It is also called a No Claim Bonus similar to that in car insurance. However, the policy benefits differ from one health insurance company to another.
Q: Can I cancel my health insurance? If yes, will I get my premium back?

Ans: Yes, you can cancel your health insurance. A free look period of 15 days from the date of policy receipt is available to you to review the terms and conditions of the policy. If you are not satisfied with the terms of the policy, then you may seek a cancellation of it. In such an event, the insurance company allows refund of premium paid after adjusting underwriting costs, cost of pre-acceptance medical screening, etc.
Q: How does smoking affect health insurance premiums?

Ans: The cost of getting a health insurance plan can be significantly higher for those who are regular smokers or tobacco users. This is because smoking predisposes an individual to various diseases like heart complications, hypertension, respiratory issues, cancer, etc. Although more number of men smoke, women smokers are also prone to osteoporosis. As a result, the premium for health insurance is higher for smokers and tobacco users than for those who do not smoke.
Q: Under what conditions is my policy premium likely to increase at renewal?
Ans: There are several reasons why your health insurance premiums can increase during renewal. They are:
- Medical inflation
- Increase in your age
- Claims raised in the previous year
- Alteration in coverage benefits
- Diagnosis of a disease recently
- Policy lapse
Q: What if I forgot to pay my health insurance premiums?

Ans: If you forget to pay your health insurance premium or did not renew your policy by the due date, your policy will cease to exist. As a result, your insurance company will not be liable to cover your medical expenses and you will have to pay for the treatment cost for any injury/illness from your own pockets.
Q: What are the modes available for the payment of premiums on Policybazaar?

Ans: Policybazaar allows its customers to pay the premium for a health insurance policy through various modes, including credit cards, debit cards and internet banking.

Q: What happens to my health insurance policy after a health claim is filed?

Ans: When you file a health insurance claim with your insurer, they will verify your submitted documents with your policy coverage. They might ask you to submit a few additional documents if required. Once all the documents have been received and verified, the insurer will either accept or reject the claim and inform you about the same.
Q: What do you mean by No claim bonus in health insurance plans?

Ans: No claim bonus (NCB) is a discount on the base premium offered if no claim on the health policy is made during the previous policy term. This bonus is usually given in the form of a premium discount or enhancement of the sum insured amount.
Q: What if the insurance company refuses to settle my claim and I want to file a complaint?

Ans: In order to monitor the grievances of policyholders, IRDAI has implemented the Integrated Grievance Management System (IGMS). It is a platform where policyholders can register their complaints with insurance companies first and if required, it can be escalated to IRDA Grievance Cells. You can reach IRDA Grievance Call Centre (IGCC) by calling on the toll-free number 155255 or by sending an email on complaints@irda.gov.in
Q: What to do if I am admitted to a non-network hospital?

Ans: If you are admitted to a non-network hospital then you can avail of the treatment and file a reimbursement claim after getting discharged. The health insurance company will reimburse your medical expenses up to the sum insured limit.
Q: Does every network hospital provide a cashless facility?

Ans: Yes, all network hospitals of your insurer will provide cashless facilities to you as they have a tie-up with your insurance company. Therefore, the bill amount is settled directly with the hospital.
Q: What is the procedure for reimbursement settlement?
Ans: The process for reimbursement claim goes as follows:
- Inform the insurer about your hospitalization and submit the filled-in reimbursement claim form within the prescribed time period from the date of your discharge from the hospital
- Submit all the original and duly stamped medical reports, medical bills, hospital bills and hospital discharge card with the claim form
- Doctor’s follow-up prescription along with other required documents should also be submitted to the insurer. Keep copies of all submitted documents for future reference and retain them all
- The insurer will verify your documents and contact you in case any clarification is required.
- Usually, a health insurance claim is settled within 2-3 weeks of receiving all the documents
Q: If I do not make a claim within a policy period, can I get a refund of my money?

Ans: If you do not raise a health insurance claim during the policy year, you cannot get a refund on your paid premium. This is because the premium was paid to ensure coverage to you throughout the policy tenure irrespective of whether you raise a claim or not. The only situation where you will get a refund on your health insurance premium is when you cancel your policy during the free look period.
Q: What is the maximum number of health insurance claims allowed in a year?

Ans: The maximum number of claims allowed under health insurance during a policy year varies from one plan to another. While some plans allow you to raise only one or two claims per policy tenure, a lot of plans do not come with any limit to the number of claims that you can file during a policy year as long as the sum insured is not exhausted. You can contact your insurer to know about the number of claims that you are permitted to file during a policy year.

Q: What to do if my health insurance policy renewal date is missed?

Ans: If you have missed the renewal date of your health insurance policy, you must renew your policy as soon as possible. You can renew it during the grace period preventing the policy from getting lapsed. But if you renew your policy after the grace period, it will get lapsed and you may have to undergo a medical test or pay a higher renewal premium.
Q: Why should you avoid policy renewal during the grace period?

Ans: You should avoid renewing your health insurance policy during the grace period as your insurer will not provide coverage during this period. As a consequence, you will have to pay for your medical expenditure from your own pockets in case of an illness or an injury. But if you renew your policy before the due date, you will get continuous coverage from your insurer at all times.
Q: Do I get a discount on the renewal of the policy with the same health insurance company?

Ans: You may get a discount on your health insurance premium in the form of a No Claim Bonus if you renew your policy with the same insurer, provided you had not raised a claim during the previous policy tenure. You can also avail long term discount and family discount on your premium if you opt for long term policy tenure or include your family members under the same policy respectively.
Q: Can a health insurance policy expire if it is not renewed on time?

Ans: Yes. Your health insurance policy will expire if you do not renew it on time. An expired policy will not cover you against medical emergencies forcing you to pay for your expenses on your own. Hence, you must ensure to renew your policy before the expiry date and ensure continued coverage.
Q: What if I miss the health insurance policy premium renewal date?

Ans: If you miss the renewal date of your health insurance, your policy will get expired. Your insurer will not be legally liable to cover your medical expenses in case of an expired policy. As a result, you will have to pay for your medical expenses on your own unless your policy is renewed.
Q: Can I increase my health insurance cover during renewal?

Ans: Yes. You can increase your health insurance coverage at the time of renewing your policy.
Q: Is there a grace period for health insurance renewal?

Ans: Yes, all health insurance plans come with a grace period of 30 days for policy renewal. In case you are unable to renew your policy before the policy due date, you can renew it during the grace period. If you do not renew your policy even during the grace period, your policy will lapse.
Q: Can I transfer my health insurance policy without losing renewal benefits?

Ans: While transferring your health insurance policy from one insurance company to another, you don’t lose the benefits that you have accumulated during the policy term. As per IRDAI’s new regulations, the benefits remain intact. Earlier it resulted in losing out on benefits accumulated in health insurance policies, like the waiting period for covering Pre-existing Illnesses.
Q: What happens if my medical policy lapses during hospitalization?

Ans: If the policy lapses during hospitalization you won’t be able to avail the insurance benefits. Therefore, it is recommended to renew your policy timely if you want to avail continuous policy coverage benefits.
Q: Do I get any discount on the premium at the time of my health insurance policy renewal?

Ans: It is not necessary that you will get a discount on the premium at the time of renewal. However, if you renew it online from Policybazaar you can save between 7.5% and 12.5% on the premium.
Q: If I increase my sum insured during policy renewal, will a waiting period apply?

Ans: If you increase your sum insured at the time of renewing your health insurance policy, your insurer may apply a fresh waiting period depending on the policy terms. It is best to check with your insurer if a fresh waiting period will be applicable in case of sum insured enhancement.