Health Insurance

Health insurance is also called medical insurance offering coverage that pays for unexpected medical & surgical expenses to the policyholder. A health insurance plan is one of the most secured & safest way to provide financial coverage to the insured family.

What is Health Insurance?

Health insurance is a medical insurance policy that offers financial coverage for medical expenses when the policyholder is hospitalised. A health insurance plan covers the insured with the facility of cashless hospitalization at a network hospital or provide a reimbursement for the incurred expenses.

Health insurance plans are the insurance plans that reimburse the policyholder for their medical expenses that include surgeries, treatments, hospitalization, and injuries, or a direct payout of some pre-determined amount to the insured. Health Insurance Plans also offer coverage for cashless hospitalization facility at network hospitals during policy term.

Furthermore, health insurance cost is subsidized to the insured in the form of tax exemption under section 80D of Income Tax Act, 1961.

Medical expenses are sky-rocketing! Get health insurance policies for your medical outlay. With cashless facility, stay tension-free. Approved by IRDAI, PolicyBazaar helps you compare and find the best health plan.

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Top Health Insurance Plans in India

When it is imperative to buy health insurance in India, with myriad options available in the market, selecting the right health cover is not that easy. That’s why the comparison of top health insurance plans in India is necessary.

In this regard, Following is the list of top health insurance plans which can help you get the optimum coverage.

• Religare Care Health Insurance Plan
• Max Bupa Health Companion Insurance Plan
• Star Health Optima Insurance Plan
• Apollo Munich Optima Restore Health Insurance Plan
• HDFC ERGO Suraksha Silver Smart Health Insurance Plan
• Aditya Birla Assure Diamond Health Insurance Plan

Importance of Health Insurance

Health insurance in India is one of the fastest growing industries. However, this wide scope for growth indicates the limited penetration of health insurance among the Indian populace. As per the latest report released by National Sample Survey Organization (NSSO) titled ìKey Indicators of Social Consumption in India: Healthî, only 20 percent of the Indian population had health insurance coverage. Additionally, only 18 percent of the total population residing in urban areas and 14 percent of the total population residing in rural areas had any form of health insurance coverage.

Thus, there is no debating the importance of having insurance in a country like India where medical expenses are sky-rocketing. Everyone must buy a good health insurance policy that includes medical costs, hospitalisation costs, medication and laboratory test costs, including critical illness. Donít get confused with questions like ñ Which health policy to buy? Does it cover every eventuality? What illnesses are excluded from this cover? PolicyBazaar is here to resolve all such confusions.

Compare Health Insurance Plans & Save Big

It is vital that you compare health insurance plans online in order to choose the best one to meet your healthcare needs. It can get confusing to select the best health insurance policy as so many insurance companies offer different health insurance plans with varied features.

It is no wonder that sometimes, people end up with a plan that, though costs less, has contradictory clauses, and they practically get nothing when a claim is filed. On the other hand, you end up buying a plan with a higher cost just to find out later that it has features that you did not use or might never need.

Treatment costs are increasing by the day. A Health insurance policy prevents a medical emergency from turning into a financial emergency. It makes sure that one's healthcare needs are taken care of without depleting his/her savings or compromising on oneís future goals.

Benefits of Comparing Health Insurance Plans Online

Due to tight and hectic schedules these days, it has become quite impossible to visit different offices or branches of different health insurance companies in order to compare various medical insurance policies.

Thankfully, Policybazaar understands the dilemma of the customers and hence, has offered a platform where you can compare health insurance policies online. Which means, no more lines and no more lies. But, there is more.

Enlisted below are few of the major advantages of buying a health insurance plan online:

Access to Accurate Information:

Offers an easy access to every insurance policy available in the market. It also saves the buyers from dealing with agents who are known to provide unreliable and biased information most of the times.

Time Efficient and Convenient:

By comparing health insurance plans online, the users are able to save their time as they donít have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing the plans, etc., are also easier via online mode.

Pocket-Friendly:

If a customer buys a health plan via an online channel, he/she will be able to compare plans 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:

Doing so will help you get an overall idea of an insurerís reputation, enabling you to make an informed decision.

Tips to Compare Medical Insurance Plans in India

With more than 25 insurance companies and more than 200 health insurance products in the Indian health insurance market, comparing health plans and finding the best one is not an easy task. Enlisted below are a few pointers that can help make this process easier and smoother. One must go through these tips to make an informed decision:

Focus on the Sum Assured of Your Choice

The healthcare inflation in the country is skyrocketing and is increasing at the rate of 17% to 20% annually. To cover this inflation, itís important to look for the maximum available sum assured at the best possible rate.

Provide Complete & Correct Details

Provide accurate information regarding your health in the proposal form, as any sort of inaccurate or mismatched information can make the insurer reject your claim form.

Keep in Mind the Factors That Influence the Premium

A few factors that influence the premium of a health plan include the proposerís life history, family health history, lifestyle, smoking habits, etc. These are taken in account before the premium amount is determined.

Check the Credibility of the Company

Do go through the history of the insurance company you are planning to buy the plan from. You should select a company based on the following parameters:

• ICR: Incurred Claim Ratio or ICR, is the most important parameter to check for when comparing health insurance companies. Each year, it is calculated using the following formula:

When taking in account the ICR of a company, look for the average ICR of all companies on PolicyBazaar and go for the one which is closest to this average for a period of few years.

• Customer Experience: You should always take heed to the mass opinion. Look for customer reviews online. If a large number of customers of an insurance company are unhappy, it may be because their customer support or after-sales service isnít up to the mark.
• Find out the Claim Process: Though health insurance claim process is pretty generic over providers, knowing the nitty-gritty of the process can help save a lot of hassle at the eleventh hour.

Incurred Claim Ratio and Claim Settlement Ratio in Health Insurance

Incurred claim ratio or ICR is the net claim amounts that the insurer has paid in a year against the total net premiums earned. ICR of all the insurance providers is published by the Insurance Regulatory and Development Authority of India/IRDAI every year.

Basically, ICR is the total value of every claim that the company has paid and is divided by the total premium amount collected during the same duration.

Incurred Claim Ratio is derived by dividing Net earned premium in a year to the Net Claims Incurred in a year.

On the other hand, Claim Settlement Ratio is the ratio of the total claims settled by the health insurance provider to the total number of claims accepted in that time period.

Disclaimer: The ranking of the insurance companies in this content is not in any particular order. The list is not compiled as per the IRDA ranking. Figures shown in the above table are for FY 2018-19

Types of Health Insurance Plans in India

With the increasing cost of healthcare in India, buying a health insurance plan has become almost mandatory for everyone. There are various health insurance plans readily available in India to cater to every aspect of your medical needs. However, with plenty of options, ensuring the right plan can be difficult though. Hence, the online comparison comes in handy in purchasing health insurance plan.

Below is the list of different types of health insurance plans in India:

Individual Health Insurance Plan

This type of health insurance plan provides financial coverage to an individual policyholder against certain illnesses, offering advantages like cashless hospitalisation, reimbursement, coverage of pre-hospitalisation and post-discharge expenses and various add-ons. The entire sum assured is available for only one individual.

Family Health Insurance Plan

With a family health plan, you can include your family members under the umbrella of a single health cover. Though family floater offers a higher premium than an individual plan, the expenses involved in buying separate individual plans still can be higher than this. Family floater mediclaim policies offer a fixed sum assured to the family members, which can be availed either by one or all members of a family for one or more claims during the tenure of the policy. Family health plans come are more expensive than an individual health plan.

Senior Citizen Health Insurance

Senior Citizen health insurance is designed particularly for anyone aged above 60 years and offers protection from health issues during old age. According to IRDAI, every health insurance firm must include people up to the age of 65 years in its plans.

Critical Illness Insurance

This plan is usually brought as a standalone policy or as a rider for the treatment of various critical illnesses, such as kidney failure, paralysis, cancer, heart attack etc. As the medication of such illnesses is expensive, the imbursement related to them is also very high. A critical illness is a serious, possibly terminal, disease and is pre-defined by the provider. Most critical illness policies provide a lump-sum benefit if the insured is diagnosed with one or more of the specified terminal conditions.

Maternity Health Insurance

Medical insurance companies today cover additional costs, including those incurred in both pre and post-natal care, child delivery (normal or caesarean), and sometimes include vaccination of newborn babies in a maternity plan. This insurance covers the newborn baby up to the validity of this policy. It also covers transportation fee for ferrying the mom-to-be to the nearest network hospital of her choice.

Personal Accident Insurance Cover

These personal accident plans are frequently offered as riders. They include hospitalisation and bear the medical outlay in the event of an accident. These are issued as fixed benefit policies, where a specified sum is paid on the occurrence of unforeseen events, such as accidents, which can result in death or disability of the person. However, the payout is not related to the sum assured.

Pre-Existing Disease Cover

After 2-4 years of policy inception, various policies begin considering pre-existing diseases, e.g. diabetes, hypertension, kidney failure, cancer etc., for claims. Pre-existing disease cover is offered for the policy-specified illness(es) that the insured had before purchasing the policy.

Preventive Healthcare

Undoubtedly, healthcare is very expensive and nobody wants to fall ill. So, now we have preventive health care that takes care of you before you fall sick. Preventive care, such as regular health check-ups, concession in X-ray fees, consultation fee etc., is offered by this policy. By offering various healthcare provisions, this plan aims at keeping you healthy. Preventive care is a medical care rendered not for a specific complaint but for prevention and early-detection of ailments.

Unit Linked Health Plan

Unit- Linked Health Plan (ULHP) has been introduced recently, which offers a unique combination of health insurance and investment. Apart from giving health protection, ULHPs also contribute in building a corpus that can be used to meet expenditures which are not covered by health insurance policies.
Among the ULHPs available in Indian market, ICICI Pru's Health Saver, LIC's Health Protection Plus, Birla Sunlife's Saral Health and IndiaFirst's Money Back Health Insurance Plan are a few big names. By opting for this plan, one can save a certain amount which can later be used to pay for the treatment of any pre-existing illnesses that are not covered by a normal health policy during the waiting period.

Which Health Insurance Policy You Should Buy?

Key Advantages & Features of Health Insurance Policies in India

The cost of healthcare in the modern days is increasing at a crazy rate while oneís earnings do not seem to match up that level. A patient looking forward to availing frequent health check-ups may no longer be able to bear the expenses associated. A comprehensive health insurance comes packed with features that can assist a person in managing expenses associated with medical emergencies and also with preventive healthcare. Understanding the following features can make purchasing a medical insurance policy easy:

• Cashless Treatment: Every medical insurance organization has tie-ups with various nursing homes and hospitals across the country called 'empanelled hospitals'. If you are admitted to one of these, you donít need to pay anything. You only need to mention your policy number and everything else will be taken care of by the hospital and your insurer. This type of plan is preferred because there is no stress of claim reimbursement and arranging documentation. However, if your expenses go beyond the sub-limits specified by the insurance cover or marked as ìnot coveredî by the provider, then you will have to settle it directly with the hospital. Another important thing to remember is that cashless Mediclaim is not available if one gets treatment at a hospital which is not a part of the hospital network of the insurance provider.
• Coverage of Pre and Post-Hospitalization expenses: This feature of a health insurance policy takes care of both pre and post-hospitalisation fee. It takes into account the costs incurred during a certain number of days both prior to and post hospitalization for a specified period from the date of discharge as part of the claim, provided the expenditures are related to the disease/sickness.
• Ambulance Fee: The person is free from burden of transportation fee as it is borne by the insurer. This is an add-on benefit and you should opt for it while purchasing medical insurance.
• No Claim Bonus: NCB (or No Claim Bonus) is a bonus provided to the insured if the no claim has been filed for any treatment in the previous policy year. The reward can be offered either as an increment in the sum assured or as a discount in the premium cost. You can avail this advantage on policy renewal.
• Medical Check-Up: A Medical plan entitles the insured to receive regular medical check-ups. A free check-up is provided by few insurers, provided you have a good history of no-claim bonus.
• Room Rent in Your Health Insurance Sub-limits: A health insurance policy may have various sub-limits associated with it; room rent is one of those sub-limits. General Insurance Companies provide you with a maximum coverage up to the sum assured. However, they can deliberately trim down their liability by introducing the sub-limit clause in the coverage for hospital room rent.
  A sub-limit on room rent in case of hospitalization works on per day basis. For instance, if your medical insurance policy covers your daily room rent up to a maximum of Rs. 3,000 and your room costs you Rs. 5,000 per day, then you will have to pay the remaining Rs. 2,000 out of your own pocket. Besides, room charges are directly associated with the type of room you are availing, i.e. a single room or on a sharing basis. Everything else is calculated proportionately.
  If the total cost incurred for your treatment at the hospital is Rs. 5,00,000, the table shown below illustrates the proportionate expenses that are expected to be borne by your insurer and you, respectively.

In this case, the total cost borne by you is Rs. 1,16,000 out of the total expense incurred, i.e. Rs. 5, 00,000. Thus, make sure you choose wisely if you want any such sub-limits in your health insurance policy.

• Co-Payment: According to this feature, you can lower the cost of your health insurance. Medical insurance plans offer co-payment option that pre-defines the voluntary deductibles which have to be borne by the insured. So, in the event of a medical exigency, some amount is paid by the customer and the rest, by the provider. Co-payment is a cost-sharing requirement under a health policy, which states that the organization or the person will bear a certain share (in percentage) of the total admissible cost. However, the co-payment option does not have any effect on the sum assured. It allows you to reduce your premium to a certain extent (subject to the insurer and insurance policy).
• Tax Benefits of Health Insurance: Health insurance policies entitle you to receive tax benefits under section 80D of Income Tax Act, 1961. The premium you pay towards insurance plans for yourself or your family members, get you a tax rebate, irrespective of whether they are dependent on you or not. The tax benefit offered, with respect to the premiums, is subject to the age of the person and there is a cap on the maximum benefit that can be availed. You can save a max up to Rs. 25, 000 in taxes a year unless your age is above 60 years. If your age is above 60 years, then this cap of maximum tax benefit increases to Rs. 50,000.
  If you are paying the insurance premiums for your parents as well as your own, then you are eligible for tax exemption up to Rs. 55, 000 a year under section 80D, provided your parents are senior citizens.
• Health Insurance by Employer: More than 80% of employers in todayís age provide health coverage to their employees. The health insurance offered by an employer covers hospitalization expenses of the employee and his/her family including spouse, children or parents. It is a wise decision to opt for the mediclaim offered by your company as you need not pay any premium. This comes under a group health insurance policy and the premium is paid by the employer, based on the group size and the opted benefits.
  However, it might be that you feel your employerís mediclaim policy is insufficient to fulfil your medical needs. Also, what if you change your job? You will no longer be a member of this plan once you leave the organisation. Hereby Hence, it is necessary to understand the policy terms thoroughly. You can communicate with the HR department regarding whatís covered and whatís not in your health insurance. Mostly, we have observed that employees are more than satisfied with their company providing health insurance, only to find out later that the plan is not sufficient. So, before itís too late, make your call!
• Third Party Administrators: The TPA concept is the brainchild of Insurance Regulatory and Development Authority of India (IRDA), to assist both the insured and the insurer. While it benefits the insurer by reducing their overheads or administrative costs, fake claims, and claim ratios, the insured, too, enjoy improved and fast insurance services.
  TPAs are an important players in the sector of health insurance. They have the capacity to handle all or a portion of the claims related to mediclaim insurance. They have tie-ups with the health insurers or self-insuring companies to manage services such as premium collection, enrollment, claim settlement and other administrative services. Often, hospitals and insurance companies organizations outsource health and insurance-related responsibilities to lower their burden. Similarly, an employer may prefer to provide claim resolution of the group health insurance policy via a TPA to manage various aspects of an employer-funded healthcare policy.

Factors to Consider Before Buying Medical Insurance Plans in India

There are few factors that you should consider closely to make the right decision.

• Caps and sub-limits: Caps and sub-limits are the thresholds set on various policy-covered expenses. If a health policy has impositions of co-payments, sub-limits, and other caps, this would mean that there will be a policy-stated coverage offered for various expenses. At times, co-pay clause and caps help in reducing the premium of the plan. These, however, would alter the benefits in the long run. To make the most of your health insurance policy, you must understand these factors before you pay for a plan.
• Claim settlement record: 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. Thus, you can ensure that your claims would not be wrongly withheld. Always ask for the companyís claim settlement ratio before purchasing their health plans and save yourself from unnecessary harassment in future.
• Scope of cover: Donít buy a plan by just comparing health insurance premium. Less cost does not necessarily mean a good plan. On the contrary, such a plan might not consider your needs properly. Closely look at what the plan includes. Buying a comprehensive plan is a better option comes to your rescue when you need it the most.
• Renewability: It is important to see how many years the plan proposes to protect you. It makes no sense if you are covered by a health insurance plan during your youth only to be left without a safeguard when you need it the most - during your old age. Mediclaim policies are usually annual contracts. Once the policy term ends, in the order to continue the insurance coverage, the insured has to pay a premium. This recurring process is called renewal. The policy should be renewed continuously, because if there is a break, then, the person will lose the benefits of insurance.
• Cashless Hospital Network: Check if a hospital around you is included by the company you are considering to buy the plan from. You and your family wonít be required to run around collecting documents and filling reimbursements. The provider or its Third Party Administrator should have a tie-up with a range of hospitals. The insured can get admitted in any of these nursing homes without paying anything from the pocket. However, cashless mediclaim resolution is subject to limits and sub-limits, which, in turn, are subject to the sum assured of the policy.
• Premium Loading: Premium Loading refers to the increase in standard premium applicable when the insurer perceives a person to be more at risk (of claiming the insurance) in comparison to others. It is strongly recommended that you check the terms and conditions pertaining to premium loading. This will save you from paying an incremented premium after making a claim. This aspect, though ignored in the beginning, usually becomes a bone of discontentment later. The best practice would be to verify the cost fluctuation data of the plan for the previous 5 years at the very least.
• Internal Team: Check for plans from firms who have a dedicated internal team for handling Mediclaim. This expedites the Mediclaim resolution process. Most of the players use a third-party administrator to process the claims and do the paperwork. Even though most of these Administrators provide great services, the fact that they are a third-party slows down the process. There are certain rules and regulations to be followed when an administrator processes a claim before it is handed over to the insurance company. These affect the turnaround time.
• Floater (family) Size: Everyone has a different family size, so you should always look for the family size allowed under the plan before purchasing it. If you are a person in your late 20s and your parents are in their 40s, 50s or 60s, then purchasing insurance only for yourself does make sense. Alternatively, if you are married with or without kids and have dependent parents, parents-in-law, siblings etc., then a family health plan is best for you. Checking the cost, family size covered, critical illnesses or other benefit will ensure that you are able to purchase the plan you need.
• Health Insurance Portability: It is wise to choose a health insurance company that offers health insurance portability. Earlier, policyholders had to stick to a policy just to retain the advantage. Now, you are allowed to switch from one insurance company to another without losing the waiting period advantages earned in your current policy. Moreover, with insurance landscape changing so regularly, insurance companies regularly come up with better policies and it may make sense to opt for health insurance policy portability. Although health insurance portability is free, some companies may charge you a certain fee if you are to port out of their plans to those of some other players. Therefore, make sure you do not pay any charges for medical insurance portability. Health insurance portability is a good thing to check when you are finding the best health policy or mediclaim.
• Restore Benefit: With 'restore benefit' facility in your health care plan, you can restore your basic sum assured in case you have already spent the same or the multiplier advantage during your policy tenure. Mostly, the benefit cannot be obtained on the same ailment if you have exhausted the existing sum limit.
  Restoration assistance proves to be helpful for a family floater health plan, where if the entire sum assured is used in the treatment of only a single family member, the other members are not left uncovered. In such a case, the other family members can avail policy coverage for the illness other than the one for which the expenses have already been compensated by the insurer.
  Well, while finalising your health insurance plan, you should consider other influencing factors such as waiting period, sub-limit, claim settlement procedures etc. You can replace restore benefit with a super top-up plan at an affordable price. Moreover, top-up plans are more comprehensive since they comes with less or no restrictions.
• Top up Plans: With the rise of medical inflation, having a large medical cover is prudent. But, not all can afford it due to the high premium. This is where a top-up plan comes into the picture. A top up plan reduces the deductibles cost i.e. the portion of claim you pay willingly for the damages before the insurer compensates the rest or up to the sum assured. With a top up policy, you donít pay until a hospital breaks its defined limit. A top up plan is considered far cheaper than a standalone medical policy.
  For instance, if the medical bill is Rs. 6 lakhs with a deductible of Rs. 2 lakhs, you are required to pay only the latter amount and the remaining 4 lakhs will be paid by the insurer. But, you can utilise your health policy to pay the liable amount. Again, the blending of a top-up plan with a medical cover is helpful as the premium you pay is much more affordable than the single plan. For example, if you pay 6,500 as a premium for Rs. 5 lakh regular cover, a top up coverage of Rs. 15 lakh will entail to an additional premium of 5,000, which is anyhow cheaper than a separate policy of identical cover.
• Waiting Period: As per the insurance norms, every insured must serve a defined waiting period for any pre-existing illness. It is usually a 30-day period from the day your health insurance policy is initiated. If any claim falls during the waiting period, the insurer has the right to reject the claim for any hospitalisation, except in the case of an emergency. A hospitalisation that arises out of an accident can be registered as a claim and the insurer will compensate the hospitalisation cost. However, the insured is not required to serve the waiting period for subsequent years.

Read More About Question You Should Ask Before Buying Health Insurance

Compare Health Insurance Plans Online with Policybazaar

Policybazaar has made the process of comparing & buying a health insurance policy easier in comparison to earlier days. One has easy access to the complete details of almost all the health insurance plans available in the Indian insurance market at a competitive price.

You have the option of comparing health insurance policies from top health insurers on our website and buy the best plan. Or, let us know your basic requirements and we will find the best-suited health insurance plans for you. You can, then, compare health insurance quotes side-by-side, based on parameters like health insurance cost, add-on riders etc., and choose the best health insurance plan for yourself and/or your family members.

Policybazaar helps you sieve through numerous mediclaim and health insurance policies and zero down on the one that measures up to your needs. As Policybazaar is an unbiased portal, the first priority is to ensure customer satisfaction. The first step in this direction is the post-sales services which are extended to the customers at the time of claim as well.

Also, instead of going to different insurance websites and accessing the plan details one by one, Policybazaar can provide an insurance-seeker with the option of comparing various health insurance policies on a single page, including their quotes. The entire process is smooth and hassle-free.