Health Insurance

Health insurance is an insurance plan that offers financial coverage for medical expenses when the policyholder is hospitalized. Health insurance plans cover the insured with multiple benefits such as cashless hospitalization, day-care facility, etc. or provide coverage for reimbursement of the incurred expenses.

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, a Health Insurance Policy also offers tax under section 80D of the Income Tax Act, 1961.

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

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Top Health Insurance Plans in India 2020

Disclaimer: The ranking of the insurance companies in this content is not in any particular order. The list is not complied as per the IRDA ranking.

Best health Insurance Companies and Their Popular Health Insurance Plans

The best health insurance plans provide insurance coverage that pays medical and surgical expenses incurred by policyholder. It also provides benefit such as cashless hospitalization, day-care facility, etc. The health insurance plans should be compared on the basis of benefits, network hospitals and ICR.

Source: IRDA Annual Report 2018-19

Disclaimer: The above table does not represent any chronological order

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.

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, 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.

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
• Family Health Insurance
• Senior Citizen Health Insurance
• Critical Illness Health Insurance
• Maternity Health Insurance
• Accident Health Insurance
• Group Health Insurance
• Unit Linked Health Insurance

Now, let us understand each type of health insurance policy. 

Individual Health Insurance

An individual health insurance plan offers insurance coverage to an individual with benefits such as cashless hospitalisation, reimbursement, compensation for expenses incurred on pre-hospitalisation and post-expenses along with various add-on coverage benefits. 

Family Health Insurance

Family health insurance is designed for the entire family where insurance coverage is offered against a single premium annually. A fixed sum insured is divided among the insured policy 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. 

Senior Citizen Health Insurance

Senior Citizen health insurance offers insurance coverage to the age group between 60 and above. The policy 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 Health Insurance

Critical illness health insurance plan offers 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

The maternity health insurance plan offers 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 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

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

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 to building a corpus that can be used to meet expenditures that are not covered by health insurance plans.

Among the ULHPs 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.

• 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.

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 policy 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

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.

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