Health Insurance

Health Insurance is a type of insurance that offers financial coverage for medical expenses, in case of a medical emergency. A health insurance plan provides insurance coverage to the insured with multiple benefits, including cashless hospitalization, day-care facility & coverage for terminal & critical illness etc.

What is a Health Insurance Policy?

A health insurance policy is a contract between the insurer and policyholder in which insurance company provides financial coverage for medical expenses incurred by the insured. A health policy provides benefit of reimbursement of medical expenses or cashless treatment mentioned in the health policy.

Apart from the medical coverage, Health Insurance plans also offer tax benefits under section 80D of the Income Tax Act, 1961.

Medical expenses are sky-rocketing, where even a single hospitalization is enough to wipe off your lifetime savings. With a cashless facility, keep your savings intact with best health insurance plans from different insurance providers. Approved by IRDA, Policybazaar helps you compare and find a good health insurance plan. Here is why you should consider Policybazaar.com while looking for a health plan.

• Individual Health Insurance Plan from Top Insurers
• Lowest Premium on Medical Insurance
• Compare Health insurance plans Instantly

Health Insurance Plans Comparison Chart Table in India

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

Why Do You Need Health Insurance?

Health insurance comes at your rescue when you need any medical assistance at any point in time. In case, when you fall sick or ill, meet with an accident and so forth having a health insurance policy provides cover for the expenses incurred and provides additional benefits as well.

A health insurance plan essentially protects you from any health-related perils. It safeguards in case of any unexpected high medical expenses. A medical emergency can happen anywhere, anytime and it can easily put you in stress and drain you both financially and emotionally. In the hustle-clamor of life and the lifestyle we are leading today, it, therefore, becomes important for every individual to be insured under a health insurance policy.

Besides, the constant rise in the number of diseases and healthcare prices in our country, make it essential to have health insurance coverage as it offers a financial backup in case of medical emergencies. Unfortunately, only 20% of the total population in India has 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.

Everyone must buy a good health insurance policy that includes benefits such as hospitalisation expense cover, medication and laboratory test costs, including critical illness and many. Some health plans also cover OPD expenses up to a certain limit.

Types of Health Insurance Plans in India

To ensure that the health insurance plan meets your insurance needs, it is important to know the different types of health insurance plans, to decide the right policy.

Mentioned below are the different types of health insurance plans you can choose as per your insurance requirement:

Individual Health Insurance Plans

Individual health insurance plans offer insurance protection with benefits such as cashless hospitalisation, reimbursement, compensation for expenses incurred on pre and post hospitalization expenses, coverage for domiciliary treatment and many more. Individual health plans come with add-on covers as well to enhance the basic health insurance coverage, at a minimal premium.

Family Health Insurance Plans

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 policy members equally, which can be availed either by one or all members of a family for one or more claims during the tenure of the policy. With a family health plan, almost all the family members can be added under a single health insurance premium.

Senior Citizen Health Insurance Plans

Senior Citizen health insurance plans offer insurance coverage to the age group between 60 and above. The health insurance plan covers hospitalization expenses including in-patient expenses, OPD expenses, Daycare procedures, pre, and post-hospitalisation expenses along with tax deduction benefit u/s 80 D.

Critical Illness Insurance Plans

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, where the insured has to survive a particular survival period after being diagnosed to avail the policy benefits.

Maternity Health Insurance Plans

The maternity health insurance plans offer coverage for maternity expenses incurred during both pre and post-natal care, child delivery (normal or cesarean). Some providers also include expenses incurred on vaccination of newborn babies in a maternity health insurance plan. The list of coverage also includes the transportation fee for ferrying the mom-to-be to the nearest network hospital of her choice.

Personal Accident Insurance Cover

Personal Accident Insurance is a rider cover that offers insurance coverage in case of an accident leading to disability or death. The policy coverage includes hospitalization and bears the medical outlay in the event of an accident. A fixed monetary benefit is offered in the case of an unfortunate event leading to loss of income.

Group Health Insurance Plans

More than 80% of employers these days 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 benefits offered.

Unit Linked Health Insurance Plans

Unit- Linked Health Insurance Plan (ULHP) is a type of health plan, which has been introduced recently. Unit Linked Health Insurance plans offer a unique combination of health insurance and investment. Apart from giving health protection, ULHPs also contribute to building a corpus that can be used to meet expenditures that are not covered by health insurance plans.

Among the ULHP health plans available in the Indian market, ICICI Pru's Health Saver, LIC's Health Protection Plus, Birla Sunlife's Saral Health, and India First’s Money Back Health Insurance Plan are a few big names.

Key Benefits of Health Insurance Plans in India

The cost of healthcare in the modern days is increasing at a crazy rate while one’s 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 associated expenses. Comprehensive health insurance plans come packed with features that can assist a person in managing expenses associated with medical emergencies and also with preventive healthcare check-ups. Some health insurance plans also offer add-on cover for OPD expenses.

• Cashless Medical Treatment

  Every medical insurance company has tie-ups with various nursing homes and hospitals across the country called 'empanelled hospitals'. If you are admitted to one of these, you don’t 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.

  These types of health insurance plans are preferred because there is no stress of claim reimbursement and documentation. However, if your expenses go beyond the sub-limits specified by the insurance cover or marked as not covered 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 hospitalized which is not a part of the hospital network of the insurance company.

• Coverage of Pre and Post-Hospitalization Expenses

  This feature of a health insurance policy takes care of expenses incurred on both pre and post-hospitalisation. It takes into account the costs incurred during a certain number of days both prior to and post hospitalization as part of the claim, provided the expenditures are related to the covered disease/illness.

• Ambulance Fee

  Once hospitalized the person is free from the burden of transportation fees as it is borne by the insurer.

• No Claim Bonus

  NCB (or No Claim Bonus) is a bonus provided to the insured if 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 on the premium cost. You can avail this advantage on policy renewal.

• Medical Check-Up Facility

  A medical plan entitles the insured to receive regular medical check-ups. A free check-up facility is provided by some insurers, or you can get it as an add-on benefit.

• Room Rent Sub-limits in Your Health Insurance Plan

  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 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.
  
  Once the insured is hospitalized the sub-limit on room rent coverage is applicable on a 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 cost incurred is Rs. 5,000 per day, then you will have to pay the remaining Rs. 2,000 from your own pocket. Besides, room charges are directly associated with the type of hospital roomyou are availing, i.e. a single room or on a sharing basis. Everything else is calculated accordingly.
  
  If the total cost incurred on treatment at the hospital is Rs. 5, 00,000, the table shown below illustrates the expenses that are expected to be borne by your insurer and you, respectively.

  Policy Sum Assured (in Rs.)			5,00,000
  Room Rent as per Sub-Limit (in Rs.)			3,000
  Room Rent Per Day (in Rs.)			5000
  Room Availed at the Hospital (in Days)			10
  	Actual Hospital Bill (in Rs.)	Reimbursed Amount (in Rs.)	To be Borne by You (in Rs.)
  Incurred Room Charges (in Rs.)	50,000	30,000	20,000
  Doctor's Fee (in Rs.)	20,000	12,000	8,000
  Medical Tests' Cost Incurred (in Rs.)	20,000	12,000	8,000
  Operation/Surgery Cost (in Rs.)	2,00,000	1,20,000	80,000
  Incurred Medicine Cost (in Rs.)	15,000	15,000	0
  Total Expenses Incurred (in Rs.)	3,05,000	1,89,000	1,16,000

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

• Co-Payment

  According to this feature, you can lower the cost of your health insurance. Medical insurance plans offer a 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 insured 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 incurred. 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 Plans

  Health insurance policies entitle you to receive tax benefits under section 80D of the Income Tax Act, 1961. The premium you pay towards health 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 deduction offered, with respect to the premium, is subjected to the age of the insured and the maximum tax deduction limit that is available. You can save up to a maximum of Rs. 25, 000 in a financial year if you are below the age of 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 medical insurance premium for your parents and for self, then you are eligible for tax exemption up to Rs. 55, 000 in a year under section 80D, provided your parents are senior citizens.

  *Tax benefit is subject to changes in tax laws

• Third Party Administrators

  The TPA concept is the brainchild of the 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, enjoys improved and fast insurance services.
  TPAs are important players in the health insurance sector. They have the capacity to handle all or a portion of the claims related to health insurance plans. They have tie-ups with health insurers or self-insuring companies to manage services such as premium collection, enrollment, claim settlement and other administrative services.

  Often, hospitals and health insurers outsource medical insurance-related responsibilities to lower their burden.

• Pre-Existing Disease Cover

  After 2-4 years of policy inception, various policies begin considering pre-existing diseases, e.g. diabetes, hypertension, etc., for claims. Coverage for pre-existing diseases is offered for \specific illness (es) that the insured had before purchasing the policy.

• Preventive Healthcare

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

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

The recent coronavirus outbreak has recently shaken everyone. More than 118,000 cases in 114 countries and 4,291 have already lost their lives. Besides, thousands more have been fighting for their survival in hospitals.

In India, 110 confirmed cases have been tested positive with coronavirus including non-Indian citizens (COVID-19) as per the data provided by the Ministry of Health and Family Welfare on 15 March 2020.

The increase in the number of cases related to coronavirus, the policyholders of health insurance are in a state of dilemma. The insured are in a quest that will a standard health insurance policy cover coronavirus (COVID-19).

Listed below are some important pointers that you should not miss as per IRDA’s circular:

• On March 4 2020, Insurance Development and Regulatory Authority of India has advised on the handling of claims under the coronavirus wherein the claims of coronavirus need to be handled expeditiously and the health insurance companies need to provide cover for the medical expenses incurred during the treatment and the quarantine period. As per the applicable terms and conditions of the health insurance plan.
• Any claim reported under the coronavirus will be thoroughly reviewed by the claim review committee.
• IRDA has also advised the health insurance companies to design health insurance plans for coronavirus, which can cover the expense of treatment of coronavirus.

Understanding the spread and the severity of the coronavirus (COVID-19), the World Health Organization (WHO) has characterized as a pandemic, which can be controlled on 11 March 2020.

Now, COVID-19 has been declared as a pandemic therefore, you need to check with the health insurance company as they might be unable to settle the claim under the health insurance policy under such a situation. However, most of the health insurance companies do provide a cover under pandemics or epidemics depending upon the health insurance plan you choose.

Now, let us understand the following situations wherein claims for the treatment of coronavirus will get rejected:

• In case, if an individual is affected with coronavirus and then intending to buy health insurance policy most likely it will not be covered under the newly bought health insurance policy.
• The policyholder will not get a claim filed if the treatment of coronavirus falls within the waiting period of the health insurance policy.
• If an individual is diagnosed with coronavirus within the waiting period of the health insurance policy it will not get covered.
• Any claim will not be settled if an individual gets infected with coronavirus from any of the family members who recently travelled to coronavirus affected countries such as Italy, China, Republic of Korea, Japan, Macau, Taiwan, Kuwait, Singapore, South Korea and Hong Kong.

Health Insurance Inclusions

• In-patient hospitalization expenses
• Donor expenses, in case of organ transplantation
• During injuries requiring overnight hospitalization
• Pre-existing illnesses or diseases
• Pre and post hospitalization
• Ambulance charges
• Maternity or newborn
• Health check-ups
• Daycare procedures
• Treatment availed at home or domiciliary hospitalization

Health Insurance Exclusions

Coverage offered by health insurance policies varies with the insurer; however, certain points are not covered by health policies and fall under the category of policy exclusions.

Following are common health insurance plans exclusions:

• Unless an accidental emergency, no coverage or reimbursement offered with the waiting period of the policy, usually initial 30 days.
• Coverage of critical illnesses and pre-existing diseases is subject to a waiting period of 2 to 4 years
• Clear exclusion of expenses incurred for maternity/newborn unless a maternity rider has been added on
• Injuries caused by war/terrorism/ nuclear activity/suicide attempt
• Terminal illnesses, AIDS, and other diseases of similar nature
• Cosmetic/plastic surgery, replacement of hormones, sex change and more.
• Dental or eye surgery
• Non-allopathic treatment
• Bed rest/hospitalization and rehabilitation, common illnesses, etc.
• Treatment/diagnostic tests, post-care procedures
• Treatment abroad or by an under-qualified medical professional

Note: It is recommended to explore each plan to ensure maximum coverage

Which Health Insurance Policy Should You Buy?

Why Compare Health Insurance Plans?

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 plan as so many insurers 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 health insurance plan with a higher cost just to find out later that it has features that you did not use or might never need.

Amid the increasing cost of treatment, 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 one's future goals

Health Insurance Plans Comparison Chart 2020

How to Compare Health Insurance Plans?

With more than 25 insurance companies’ providers and more than 200 health insurance products in the Indian health insurance market, comparing health insurance plans and finding the best one is not an easy task. Listed below some of the tips to help you make an informed decision:

• Select the Appropriate Sum Assured

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

• 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 insurance plan include the proposer’s life history, family health history, lifestyle, smoking habits, etc. These factors are taken into account before the premium amount is determined.

• Check the Credibility of the Health Insurance Company

  Do go through the history of the health insurance company you are planning to buy the medical insurance plan from. It is recommended that you select the health insurance company on the basis of the following parameters:

  • ICR: Incurred Claim Ratio or ICR, is one of the most important parameters to check while comparing health insurance companies in India. When taking into account the ICR of a health insurance company, look for the average ICR of all the health insurance companies online on Policy Bazaar and go for the one that 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 isn’t up to the mark.
• Find out the Claim Process: Though the 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.

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 insurers in order to compare various medical insurance policies.

Thankfully, Policy Bazaar understands the dilemma of the customers and hence, has offered a platform where you can compare different health insurance plans online.

Enlisted below are some of the major advantages of 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 agents who are known to provide unreliable and biased information most of the time.

• Time Efficient and Convenient:

  By comparing health insurance plans online, the users are able to save their time as they 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.

• Pocket-Friendly:

  If a customer buys a health plan via an online channel, he/she will be able to compare health insurance 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 insurer’s reputation, enabling you to make an informed decision.

Arogya Sanjeevani Policy: A Health Insurance for All

Arogya Sanjeevani is a standard health insurance policy that is provided by every health insurance company in India. Arogya Sanjeevani policy covers basic health insurance needs and is a good option for those who not have medical insurance cover, especially in smaller towns.

As mandated by the IRDAI, Arogya Sanjeevani policy provides coverage from Rs. 1 lakh to Rs. 5 lakhs, with a waiting period of just 30 days. However, the waiting period for specific diseases ranges from 24 months to 48 months, which depends on the illness as well.

• Benefits of Buying Arogya Sanjeevani Policy:

  • The policyholder under Arogya Sanjeevani get coverage for Coronavirus related hospitalization expenses
  • It reduces the complications that arise while selecting from several health plans with varied inclusions, exclusions, and sum assured. Therefore, it is easier for common people to buy a health cover without any difficulty to understand the policy terms and conditions
  • Cashless hospitalization, NCB, and lifelong renewal facility is provided
  • Moreover, it is easily portable from one insurer to another

• Features of Arogya Sanjeevani Policy:

  • Arogya Sanjeevani health plans cover anyone between the age group of 5 months and 65 years
  • The minimum sum assured is Rs. 1 lakh and the maximum sum assured is Rs. 5 lakhs, therefore it makes a perfect health plan for people in rural areas and those who cannot afford to pay a higher premium
  • The policy cover hospitalization expenses, all daycare procedures, ICU expenses, Ayush treatment, Ambulance charges, Cataract treatment etc.
  • A co-pay of 5% is applicable regardless of the age of the policyholder

List of Government Health Insurance Schemes in India

The government health insurance scheme refers to the health insurance programmes that are backed by the Indian Government. The motive of launching government health schemes is to make health insurance accessible to the economically deprived section of the society.

Mentioned below are some of the health insurance schemes owned by the government of India:

• Ayushman Bharat Scheme
• Pradhan Mantri Suraksha Bima Yojana
• Rashtriya Swasthya Bima Yojana
• Universal Health Insurance Scheme
• Aam Aadmi Bima Yojana
• Employment State Insurance Scheme (ESIS)
• Central Government Health Scheme (CHGS)

Ayushman Bharat Scheme

The governments’ Ayushman Bharat Scheme aims to offer medical insurance coverage to at least 50 lakh Indians. The insurance programme focuses on two aspects: One focus is to ensure health insurance cover of Rs. 5 lakhs to each family, including in-patient hospitalization expenses and tertiary care. Another focus is to develop health and wellness centers for these people. The scheme has already benefitted 10 lakh Indians. Moreover, 1.5 lakh wellness centers would be set up by December 2022.

Pradhan Mantri Suraksha Bima Yojana (PMSBY)

It is a government-of-India-backed health insurance scheme, which offers coverage against personal accidents resulting in accidental disabilities, or death on account of an accident. It is offered for a period of one year and requires annual renewals. The policy is available with all public sector insurance companies that dealwith the general insurance sub-domain. All private sector insurers are open to selling the scheme on a similar set of terms in collaboration with various banks upon necessary approval. Anyone within the age group of 18 to 70 years, with a savings account in any of the participating banks can benefits from the scheme while the AADHAR would be the prime KYC for the scheme and bank account.

Rashtriya Swasthya Bima Yojana (RSBY)

A government-run health insurance scheme for poor people in India, it provides them with the cashless facility at various public and private hospitals across the country. Launched in 2008, the scheme already has over 36 million families (as on February 2014) enrolled across 25 Indian states. The operations under this plan started under the Ministry of Labor and Employment and were transferred to the Ministry of Health and Family Welfare on April 1, 2015.

As this plan works for BPL (Below Poverty Line) families, they get a smart-card that is biometric-enabled to become eligible for inpatient medical care worth Rs. 30, 000 per year at an empanelled hospital. The coverage for pre-existing diseases is there right from day one for parents and up to three children.

Universal Health Insurance Scheme (UHIS)

Aimed at improving the health standards of people at or below the poverty line, four of the public sector general insurers implemented UHIS in India. Under this scheme, the eligible families can get reimbursement for medical expenses up to Rs. 30, 000 and accidental death benefit of Rs. 25, 000 to the breadwinner in the family.

The loss of income of the family is also compensated with Rs. 50 per day up to 15 days in a month. The scheme was revised later, thereby increasing the premium subsidy from Rs. 100 to Rs. 200 for an individual and Rs. 300 for a family of 5 members and Rs. 400 for a family of 7 members.

Aam Aadmi Bima Yojana (AABY)

A government-of-India-run scheme for people from rural regions of India, who are landless, was launched in October 2007 and covers the prime earner in the family with the benefits. An annual premium of Rs. 200 is payable by the family, which is divided between the Central Government and State Government, while the age of the insured lies between 18 and 59 years. Below are the coverage benefits:

Employment State Insurance Scheme (ESIS)

Employment State Insurance Scheme or ESIS is designed for workers who work in non-seasonal factories with an employee strength of at least 10 employees. The insurance coverage under this scheme is extended for self and dependents. The policy or act now applies to around 7.83 lakhs factories across the country with 2.13 cr insured persons/families. The total beneficiary stands at approx. 8.28 crores. The list of coverage under this scheme includes hospitalisation expenses along with daily cash benefits in case of sickness and disablement. Under ESIS, the offered cash

• Illness Benefit at 70% of total wages for 91 days
• Disablement benefit for the insured

• 90% of last wages in case of temporary disability
• Cash benefit on pro-rata basis for loss of earning capacity for lifelong in case of permanent disability
• Maternity benefit equal to 100% of wages for 12 weeks
• RGSKY for unemployment at 50% of last wages for 1 year
• Dependent benefit at 90% of wages
• Funeral Expenses cover Rs 10,000/-

Additional Benefits

• Vocational rehabilitation
• Physical Rehabilitation

Central Government Health Scheme (CHGS)

Central Government Health Scheme is one of the popular health schemes owned by the Indian government where health care benefits are provided to Central Government employees. The scheme also covers the pension holders, in fact, it covers all four pillars of a democratic state such as Legislature, Judiciary, Executive and Press. The scheme is unique of its kind due to the comprehensive health insurance benefit. At present, around 35 lakh beneficiaries are covered by CHGS in 71 cities in India. Under CHGS, health coverage is provided for treatment availing under allopathic, homeopathic, Ayurveda, Unani, Siddha and Yoga.

Factors to Consider Before Buying Health Insurance Plans

There are a 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, the 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 health insurance 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 medical insurance claims would not be wrongly withheld. Always ask for the company’s claim settlement ratio before purchasing their health insurance plans and save yourself from unnecessary harassment in the future.

• Scope of Coverage

  Don’t buy a health insurance plan by just comparing health insurance premiums. Less cost does not necessarily mean a good medical insurance plan. On the contrary, such a health plan might not consider your coverage 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. Mediclaim policies are usually annual contracts. Once the policy term ends, in order to continue the insurance coverage, the insured has to pay the insurance premium. This recurring process is called health insurance renewal. The policy should be renewed continuously, because if there is a break, then, the person will lose the benefits of medical insurance.

• Cashless Hospital Network

  Check if a hospital around you is included by the medical insurance company you are considering to buy the plan from. You and your family won’t 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 network hospitals. The insured can get admitted to any of these nursing homes/network hospitals without paying anything from the pocket. However, cashless claim settlement is subjected to limits and sub-limits, which, in turn, are subjected to the sum assured of the medical insurance policy.

• Premium Loading

  Premium Loading refers to the increase in standard premium applicable when the medical insurance company 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 extra premium after making a medical insurance claim. This aspect, though ignored in the beginning, usually becomes a bone of discontentment later.

• Internal Claim Settlement Team

  Check the health insurance plans from insurers that have a dedicated internal claim settlement team. This expedites the claim settlement process. Most of the medical insurance 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 medical insurance claim before it is handed over to the medical insurance company, which in-turn affects the turnaround time.

• Members Included

  Everyone has a different family size, so you should always look for the family size allowed under the medical insurance plan before purchasing it. If you are in your late 20s and your parents already have a health insurance cover, 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 insurance plan is best for you. Checking the premium cost, family size covered, critical illnesses or other benefits 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 the insurance landscape changing so regularly, insurance providers 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 the '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 finalizing your health insurance plan, you should consider other important 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 health insurance plans are more comprehensive since they come with few or no restrictions.

• Top up Health Insurance Plans

  With the rise of medical inflation, it is prudent to increase the medical insurance coverage amount. But, not all can afford it due to the high cost of the premium. This is where a top-up medical insurance plan comes into the picture. A top up health plan reduces the deductibles cost i.e. the portion of a claim you pay willingly for the damages before the insurer compensates the rest or up to the sum assured. With a top up medical policy, you don’t pay until a hospital breaks its defined limit. A top up plan is considered far cheaper than a standalone medical insurance 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 utilize 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 an individual health 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 an additional premium of 5,000, which is anyhow cheaper than a separate policy.

• Waiting Period

  As per the medical insurance norms, every insured must serve a defined waiting period to get coverage for any pre-existing illness. It is usually a 30-day period from the day your health insurance plan 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 for the hospitalisation cost. However, the insured is not required to serve the waiting period for subsequent years.

Health Insurance Eligibility Criteria

Health insurance policy is mandatory for almost everyone, especially for those who have dependents and/or families since they certainly do not want them to go through financial stress. Buying a medical insurance policy ensures that one's health is secured and medical expenses are covered across a wide network of hospitals in India. One can opt for the best health insurance policy with extended coverage on the following two bases:

• Individual
• Family Floater

The following criteria must be fulfilled without failure:

• Entry age for Adults: 18 to 65 years (70 and above, based on the plan and insurer)
• Entry age for Children: 90 days to 18 years
• Policy renewability: Lifelong and subject to medical clearance

Health Insurance Portability Explained

You do not have to stick to your current insurer any longer if you do not want to since IRDA now allows you to change your current insurer without losing any of the existing benefits. Previously, if you changed your insurer, then you had to compromise on the benefits, viz. coverage for any pre-existing disease offered by your existing medical insurance policy.
According to the new rules, IRDA allows you to switch from one insurer to another while the new insurer will have to consider the credits you gained from your previous insurer, where credits refer to the waiting period under pre-existing conditions. The same applies if you switch from one plan to another with the same insurance company.

What you can do

• Switch from one health insurance company to another
• Any family floater or individual policy can be switched from/to.
• Avail insurance cover by your new insurer up to the sum assured by the previous policy.
• Both the insurers should mutually complete the formalities as per the IRDA timeline.

Criteria to meet

• A policy can be switched only at the time of renewal.
• With the new policy, the terms and conditions, including the premium are at the discretion of the new insurer.
• Submit a formal shifting request to your current insurer at least 45 days before the due date of the renewal.
• Make sure you specify the name of the new insurer you are willing to switch to.
• There should not be any break between policy renewals.

Health Insurance Premium Calculator

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 premium such as the medical background of your family, 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. Premium calculator is an online tool that calculates the premium to be paid as per the information provided by you. At Policybazaar.com, you can calculate your health insurance premium easily.

Health Insurance Claim Procedures

Documents Required for Health Insurance Claim Reimbursement

In the event of 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

Some Myths about Health Insurance

Before relying on the information it is imperative to check the facts and then buy a health insurance policy. Mentioned below are some popular myths that most people believe about medical policies:

• 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 expenses would cost you somewhere between INR 60,000 to INR 1 lakh and even more (depending on the type of illness).

• My Health Insurance will Cover all the Medical Expenses

  As per the IRDAI regulations, all the health insurance plans come with a set of exclusions/limitations. It is required that you check all the policy details and the coverage that is mentioned in the plan. The insurer will only compensate for the expenses that are covered in the policy and up to the specified limit.

• Declaration of Pre-existing Diseases

  It is essential to declare all the pre-existing diseases in the proposal form. One 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 the 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. But taking into consideration the risks, alcohol consumers, and smokers would need to undergo a stringent pre-medical examination procedure and pay a higher premium to get health insurance coverage.

• Medical Insurance will only Cover Hospitalization Expenses

  Though most of the health insurance plans cover medical expenses for hospitalization more than 24-hours, there are plans that have a capping on the duration of hospitalization as well. But most of the insurers these days cover daycare procedure as well, where it is not required to be hospitalized for 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, it will not cover critical illnesses. Also, getting health insurance coverage after retirement or losing a job can prove to be an expensive affair.

List of Health Insurance Companies in India

In order to help you with the best and convenient buying experience, we have compiled a list of General Insurance Companies in India providing health insurance in India. This list is prepared based on the Incurred Claim Ratio (ICR) and the overall health insurance policy benefits that they are offering:

Let’s discuss these Health Insurance Providers in detail.

Aditya Birla Health Insurance

Aditya Birla health insurance plans are designed to meet the diversified needs of the customers. The insurer offers a range of comprehensive plans with a sum assured limit up to Rs. 2 Crores. It is known for its individual, family, critical illness, and group health insurance plans. With more than 17,000 advisors, the insurance provider has presence in more than 650 Cities.

Health Insurance Plans by Aditya Birla Capital

Bajaj Allianz Health Insurance

A joint venture of Bajaj Finserv Limited, a comprehensive financial services company based out of India and Allianz SE, the global financial services major based out of Munich, Germany, Bajaj Allianz General Insurance Company focuses on the general insurance space in the country, including medical insurance. The insurance company has received the iAAA rating from ICRA for the 10th year in a row. With more than 6500 cashless hospitals in India, the insurer offers supreme healthcare with high sum insured options. As of 2019, Bajaj Allianz continues to be one of the robust general insurers in India with a profit of Rs 780 crore and revenue of Rs. 11,097 crore with a growth of 17%.

Health Insurance Plans by Bajaj Allianz Insurance Company

Bharti AXA Health Insurance

Bharti AXA claims to have settled 98.27% claims in a year, 1.3 million policies issued, 101 branch offices all over India and PAN India network hospitals to avail cashless treatment and these figures are enough to prove the reliability of the insurer. Health insurance offered by Bharti AXA offers extensive coverage maximum up to Rs. 1 Crore.

Health Insurance Plans by Bharti AXA Insurance Company

Cholamandalam MS Health Insurance

Cholamandalam MS General Insurance Company Limited, established in 2001, was set up by the India-based Murugappa Group, a multi-business conglomerate, and the Japan-based Mitsui Sumitomo Insurance Group as a joint venture to address the general insurance market in India. The company provides both individual and corporate insurance solutions through its 105 branches and 9000 plus agents in the country.

The insurer has received many accolades in a form of numerous awards for being perfect in its niche. The Pride of Tamil Nadu Award for BFSI, Golden Peacock Award in 2017 for best risk management, named as dream company to work to name a few.

Health Insurance Plans by Cholamandalam MS Insurance Company

Digit Health Insurance

Digit Insurance as the name suggests is a digital friendly health insurance provider that offers customized plans that can be easily purchased online. The policies are designed for individuals, families, and senior citizens, who can avail cashless claims in more than 5900 partner hospitals PAN India.The Insurer has bagged a couple of awards such as - ' Top Indian Startup 2019', and Asia's General Insurance Company of the Year 2019.

Health Insurance Plans by Digit General Insurance Company

Edelweiss Health Insurance

Edelweiss medical insurance plans offer coverage to Individuals, Families, and Groups. It comes in three variants- Silver, Gold, and Platinum. The Platinum plans offer comprehensive coverage upto sum assured of Rs. 1 Crore. Coverage for Critical Illness is provided in both Gold, and Platinum plans.

Health Insurance Plans by Edelweiss General Insurance Company

Future Generali Health Insurance

A joint venture of the Indian Conglomerate Future Group, and the Generali Group, one of the world’s largest international insurance companies, Future Generali an Insurance Company has a PAN India presence with its 137 branches. The company provides a range of insurance solutions and intends to exploit the expansive network and local experience of the Future Group and the in-depth insurance expertise of Generali Group.

Health Insurance Plans by Future Generali Insurance Company

HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance)

With a promise of 90% health claims get settled within 20 minutes, HDFC Ergo is one of the leading General Insurance Companies in India. With 10,000+ network hospitals across the country, where quality healthcare can be availed cashless, the insurer offers indemnity-based health insurance with affordable premiums.

Apart from health, the insurer also has expanded its business over other domains such as travel, motor, home insurance, commercial vehicle, property, and miscellaneous insurance. HDFC ERGO Health (formerly known as Apollo Munich Health Insurance) focuses on being a trusted leader in the health insurance space with its innovative solutions.

Health Insurance Plans by HDFC ERGO Insurance Company

Iffco Tokio Health Insurance

IFFCO Tokio Health Insurance is one of the most sought after insurance products in the market offered by IFFCO Tokio General Insurance Company. Formed in December, 2000, the provider is one of the most renowned insurance providers with maximum customer satisfaction that promises transparency and a hassle-free claim settlement. The health insurance company caters to the rural population as well and offers cashless treatment in more than 5000 network hospitals across India.

Health Insurance Plans by Iffco Tokio General Insurance Company

Kotak Mahindra Health Insurance

The insurance company is a subsidiary of one of the leading private sector banks in India i.e. Kotak Mahindra Ltd. In addition to the basic coverage, the insurer also provides add-on covers and discounts on premium. In more than 4000 network hospitals, the policyholders and the insured members in a plan can avail cashless hospitalization facility.

Health Insurance Plans by Kotak Mahindra Insurance Company

Liberty Health Insurance

Liberty General Insurance was commenced in the year 2013 and has been providing diversified health insurance products catering to the needs of different customers. The insurer has more than 5000 partner hospitals where the insured can avail cashless treatment. For it services in the insurance sector, Liberty General Insurance has been awarded Employer of Choice by the Excellence Awards.

Health Insurance Plans by Liberty General Insurance Company

Max Bupa Health Insurance

Max Bupa Health Insurance has a presence in more than 190 countries and offers direct claim settlement without Third-party Administrator. To ensure convenience to its policyholders and seamless claim settlement the insurer offers cashless claim pre-authorization in 30-minutes

Health Insurance Plans by Max Bupa General Insurance Company

ManipalCigna Health Insurance

ManipalCigna Insurance Company Limited (formerly known as CignaTTK Insurance Company Limited) is a joint venture between the Manipal Group and Cigna Corporation; both are global market leaders with a huge customer base. ManipalCigna Health Insurance offers a full suite of insurance solutions ranging from health, personal accident, major illness, travel and global care to individual customers, employer-employee, and non-employer-employee groups to meet their diverse health needs.

Health Insurance Plans by ManipalCigna Insurance Company

National Health Insurance

It is one of the most renowned and oldest fully government organizations providing insurance cover In India. It was started in 1906 and now has nearly 1998 offices across India. It is one of the leading insurers providing customized health plans with comprehensive coverage to individuals, families, groups and senior citizens. Cashless hospitalization is provided in more than 6000 network hospitals across India

Health Insurance Plans by National Insurance GI Company

New India Assurance Health Insurance

New India Assurance GI Co. was founded in 1919 and has its headquarters in Mumbai and has its presence across 28 countries. In addition to other insurance products, New India Assurance Health Insurance is one of the most trusted products among its customers. Most of the health plans do not require pre-medical check-ups up to the age of 50 years

Health Insurance Plans by New India Assurance

Oriental Health Insurance

The Oriental insurance company offers a range of comprehensive general insurance products. In addition to India the insurer offers services in Nepal, Kuwait, and Dubai. People can easily compare, buy and renew health insurance policies online. It offers the medical insurance plans promising an enhanced coverage at an affordable price. The insurance provider also offers insurance products for chemical and petrochemical industries.

Health Insurance Plans by the Oriental insurance Company

Religare Health Insurance

With a wide network of over 4,100 hospitals across the country, Religare General Insurance Company is promoted by the founders of India’s leading private hospital chain, Fortis Hospitals. The insurance claims are directly entertained by the company executives and there is no third-party involved in the claim processing. Based on the coverage offered by individual health plans, customers can opt for riders for protection enhancement. Recently, the insurer was awarded MCX Award in 2019, Best Claims Service Provider of the Year for 2018 by Insurance India Summit & Awards 2018 and many more.

Health Insurance Plans by Religare Insurance Company

Reliance Health Insurance

Reliance is one of the most renowned general insurance providers in India. The insurer has 139 offices PAN India to where you easily reach out to them and avail their seamless services as per your own convenience. With online purchase and renewal services, they are even more accessible.

Moreover, Reliance health insurance has its presence across India and abroad. Reliance provides both Individual and family floater plans. Moreover, Independent women can avail a discount of 5 percent on the premium

Health Insurance Plans by Reliance General Insurance Company

Raheja QuBE Health Insurance

QBE Insurance belongs to the Rajan Raheja Group. It is one of the most popular general insurers in India. The insurer offers health insurance policy and cancer insurance policy with comprehensive policy features. Even the non-medical expenses are covered like attendants and hygiene in case of cashless claims. The Cancer Insurance policy offers coverage to individuals in the age group of 1 day to 70 years.

Health Insurance Plans by Raheja QuBE General Insurance Company

Royal Sundaram Health Insurance

Royal Sundaram GI Co. Ltd is recognized as one of the most popular general insurance companies in India. The insurer also offers cashless hospitalization facilities in nearly 5000 network hospitals in India itself. Royal Sundaram health insurance offers a lifelong renewability option.

Health Insurance Plans by Royal Sundaram Insurance Company

Star Health Insurance

Star Health is the first standalone insurance company. Founded in the year 2006 Star Health and Allied Insurance Co Ltd. initially the company focused on Overseas Medicliam Policy, Health Insurance, and Personal Accident Plan but the vision has now expanded. With more than 9800 network hospitals across the country, the insurer was awarded the best BFSI Brand Award by Economic Times in 2019.

*Tax benefit is subject to changes in tax laws

Health Insurance Plans by Star Health Insurance Company

SBI Health Insurance

SBI Health Insurance operated as a joint venture between State Bank of India and Insurance Australia Group. The company offers a range of health insurance plans for both individuals and groups. Serving a large share of insurance customers in India, it has gained the trust of its existing as well as prospective customers.

Over these years, the company has successfully established its feet in the vast insurance market of India. The health insurance products of SBI allow its customers to manage their financial expenses. Based on the health cover required, its customers can opt for health insurance plans with sum assured up to Rs. 50,000 to Rs. 5,00,000.

Health Insurance Plans by SBI Insurance Company

Tata AIG Health Insurance

Tata AIG General Insurance is a collaboration between TATA Group and the American International. The insurer has tie-ups with more than 4000 network hospitals in India where cashless treatment is available. The insurance provider ensures a seamless settlement of claims so that the insured can focus on the treatment.

Health Insurance Plans by TATA AIG General Insurance Company

United India Health Insurance

United India Insurance is one of the most popular general insurance companies in India. It was formed as a merger of 22 companies with their headquarters in Chennai. The insurer facilitates cashless medical treatment in more than 7000 hospitals PAN India. Also, the insurer has been accredited by ICRA for its high claim paying ability and high solvency margin ratio.

Health Insurance Plans by United India Insurance Company

Universal Sompo Health Insurance

Universal Sompo GI Co. is a private-public undertaking, which was founded in 2007. It is a joint collaboration between Dabur Investment Corporation, Indian Overseas Bank, Karnataka Bank, Allahabad, and Sompo Japan. Universal Sompo health insurance plans are designed in a simple and affordable manner to meet the most of the insurance needs of its customers. Moreover, cashless treatment is available in more than 5000 network hospitals across India. Diversified plans available for individuals, families, groups, NGOs, students and the likewise.

Health Insurance Plans by Universal Sompo

Health Insurance Network Hospitals

Network hospitals mean a group of hospitals associated with a particular insurance company. The best part is that insurance holders cab avail cashless services at a network hospital, which is not the same as a non-network hospital.

Health Insurance vs Mediclaim

Though are used interchangeably, there is a slight difference between mediclaim and health insurance. A medicliam policy is a type of health insurance that offers hospitalization expenses owing to an accident or illness. The sum insured is pre-specified which doesn’t exceed Rs. 5 lakh. On the other hand, health insurance is more comprehensive than a mediclaim plan, where the coverage is extended towards hospitalization expenses, pre and post hospitalization expenses ambulance cover, OPD cover, daycare, etc. as inbuilt benefits.

Health Insurance vs Critical Illness

An ordinary health insurance policy may not suffice your requirement when it comes to treating a critical illness. Here comes Critical Illness Insurance into the picture which is specially designed to cater to the specific needs of an illness. The basic difference between health insurance and a critical illness plan is given below:

Health insurance vs Life Insurance

Both health and life insurance is important, depending on their offerings. However, the major differences between health insurance and life insurance include:

Health Insurance vs Term Insurance

Term insurance is a type of life insurance, where the insured can avail death benefit where the beneficiary gets the insurance amount in case of the sudden demise of the policyholder. The basic difference between the two are:

Buy Top Health Insurance Policy Online

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. Policy Bazaar 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.

Policy Bazaar helps you sieve through numerous mediclaim and health insurance plans and zero down on the one those measures up to your needs. Moreover, the post-sale services are extended to the customers online as well even at the time of medical insurance claim.

PolicyBazaar Facilitates you to do the following:

• Explore and figure out the best health insurance plans
• Read quality articles and news of various insurance companies in India
• Compare multiple health insurance plans
• Find the best health insurance plan for you
• Read user reviews and decide which insurer to go with
• Get expert advice from a well-versed customer support team.

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