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.
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.
|Insurance Companies||Health Plans||Sum Insured (Rs.)||Network Hospitals||Incurred Claim Ratio|
|Religare Health Insurance||Care Health Plan||4 lakh-6 Crore||4987||55%|
|Max Bupa Health Insurance||Health Companion Individual Plan||3 lakh-1 Cr.||4115||54%|
|Star Health Insurance||Family Health Optima Plan||1 lakh-25 lakh||9800||63%|
|HDFC Ergo Health Insurance||Optima Restore Plan||3 lakh-50 lakh||4721||62%|
|Bajaj Allianz Health Insurance||Health Guard Insurance Plan||1.5 to 50 lakh||6500||85%|
|ManipalCigna Health Insurance||Prohealth Plus Insurance Plan||2.5-50 lakh||4000||62%|
|Star Health Insurance||Senior Citizen Red Carpet Insurance Plan||1 lakh-25 lakh||9800||63%|
|SBI Health Insurance||Arogya premier Policy||10 lakh-30 lakh||6000||52%|
|Royal Sundaram Health Insurance||Lifeline Supreme Plan||5/10/15/20/50 lakh||5000||61%|
|Aditya Birla Health Insurance||Activ Assure Diamond Plan||10 lakh-30 lakh||5850||59%|
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.
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.
|Health Insurance Companies||Incurred Claim Ratio||Popular Health Plans||Network Hospitals||No. of Persons Covered|
|Religare Health Insurance||55%||Care Health Plan||4987||10713|
|Max Bupa Health Insurance||54%||Health Companion Individual Plan||4115||5433|
|Star Health Insurance||63%||Family Health Optima Plan||9800||11617|
|HDFC Ergo Health Insurance||62%||Optima Restore Plan||4721||9605|
|SBI Health Insurance||62%||Arogya Premium Policy||6000||2748|
|ManipalCigna Health Insurance||62%||Prohealth Plus Insurance Plan||4000||1101|
|Future Generali Health Insurance||73%||Future Health Suraksha Family Plan||4300||4838|
|Bajaj Allianz Health Insurance||85%||Health Guard Insurance Plan||6500||24685|
|Royal Sundaram Health Insurance||61%||Lifeline Supreme Plan||5000||1406|
|Aditya Birla Health Insurance||59%||Activ Assure Diamond Plan||5850||1489|
Source: IRDA Annual Report 2018-19
Disclaimer: The above table does not represent any chronological order
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.
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:
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:
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:
Now, let us understand each type of health insurance policy.
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 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 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 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.
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 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.
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 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.
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.Following are the key benefits of a health insurance policy that one can consider:
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.
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.
Once hospitalized the person is free from the burden of transportation fees as it is borne by the insurer.
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.
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.
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.
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).
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.
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.
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.
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.
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:
Note: It is recommended to explore each plan to ensure maximum coverage
|Your Requirement||What You Should Get|
|Coverage for hospitalisation expenses including surgical bills||Medical insurance offering cashless facility and claim reimbursement|
|A fixed amount daily while you are hospitalised||Hospital Cash Plan|
|If diagnosed/hospitalized with a critical illness or if the illness leading to loss of income||Critical Illness Plan|
|When an accidental disability leading to loss of income||Personal Accident Insurance|
|Coverage for expenses in the event of caesarean and normal delivery||Maternity Insurance|
|Insurance coverage for the entire family in a single plan||Family Floater Health Plan|
|Coverage for senior citizens||Senior Citizen health Insurance|
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
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:
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 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.
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.
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:
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:
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.
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.
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.
Doing so will help you get an overall idea of an insurer’s reputation, enabling you to make an informed decision.
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:
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.
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.
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.
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.
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:
|Rs. 30,000 payable||In the case of Natural Death|
|Rs. 75,000 payable||In case of death or total permanent disability because of an accident causing the loss of both eyes or 2 limbs|
|Rs. 37,500 payable||In case of partial permanent disability because of an accident causing the loss of one eye or 1 limb|
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
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.
There are a few factors that you should consider closely to make the right decision:
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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 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:
The following criteria must be fulfilled without failure:
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
Criteria to meet
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.
With the advancement in medical facilities, health care costs have also increased. The main benefit of health insurance is that it takes care of the healthcare expenses. It offers financial security to you and your family in the event of an unanticipated serious illness or accidental injuries that could drain all your savings. And here is how the cost of your insurance premium is determined:
Your medical history is one of the major determinants of the health insurance premium. Almost all the ' health insurers in India make pre-medical tests mandatory (after a certain age) before buying a health insurance policy.
While, some insurance companies don’t make medical screening mandatory but do consider your current medical conditions, lifestyle-related health risks and medical background of your family.
That is why medical insurance premium for smokers is higher than other people.
Age is another important determinant of the medical insurance premium. The premium varies based on the age of the insured person.
That is why it is recommended to buy a policy at a young age because the cost of the premium is low for young applicants.
Elderly people are vulnerable to cardiovascular diseases, and other critical illnesses such as cancer, kidney problems, etc. For this reason, senior citizen medical insurance premium is usually on a higher side.
Also, the cost of the premium for women's health insurance is lower in comparison to the male candidates due to lower risk of stroke, heart attack, etc.
The premium for a 2-year health insurance plan will be higher than a 1-year plan. However, almost all insurance companies offer a discount on long-term medical insurance plans.
The type of health insurance policy you select also affects the cost of the premium. The higher the risks involved the higher will be the premium and vice-versa.
With the help of an online health insurance premium calculator, you can compare the premium for different health insurance plans.
If you have not made any claim during your policy term, then you can earn NCB or No-claim-bonus ranging from 5 to 50 percent. It is also one of the most important factors that are taken into consideration while calculating the cost of the premium.
If you drink or smoke regularly, chances are high that you will be charged more premium amount. In that case, the insurer can also reject your medical insurance policy request.
Health insurance plans come with additional benefits of cashless treatment and expense reimbursement by the insurer. One can file a claim against an event that is covered by the insurance policy. Following are two claim processes:
Health insurance plans provide the insured with the benefit of getting their medical expenses reimbursed by the insurer. The cost of various hospital charges such as bed charges, medicines, lab tests, surgeon's fees, etc. are paid back to the insured if the claim for reimbursement is filed. The insured pays the (hospital) expenses but gets reimbursed by the insurance company.
Insurance companies provide policyholders with a wide range of network hospitals to get medical treatment without having to make upfront payments. No payment is required to be done by the insured since the clause involves a mutual agreement between both the parties, i.e. the insurer and the network hospital. Availing cashless benefit requires TPA approval.
The insured can also show the insurer-issued health card at the particular hospital as proof of medical insurance cover along with a valid government ID. Following cases are considered for cashless treatment:
In case of planned hospitalization, in order to avail health insurance benefit the insured needs to have TPA approval in advance along with other mandatory documents. Fill the pre-authorization form at the network hospital signed by the treating doctor(s).
Show the health card issued by the insurer at the hospital along with the appropriately-filled pre-authorization form to get TPA approval for emergency hospitalization. If you fail to get TPA approval, you would need to file for reimbursement later. The insured might have to show the itemized bill, proof of medical expenses, discharge bill, etc., as the proof of the treatment availed to avail claim reimbursement.
In the event of hospitalization, the policyholder needs to submit certain documents as mentioned below:
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:
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).
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.
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.
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.
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.
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.
In order to help you with the best and safest buying experience, we have compiled a list of top 10 best health insurance companies in India. This list is prepared based on the Incurred Claim Ratio (ICR) and the overall financial standings of these companies.
Let’s have a look at the list of the health insurance providers below:
Let’s discuss these Health Insurance Providers in detail.
Star Health is the first standalone health 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. Since then, there has been no stopping and today Star Health is being counted among the top insurance providers in India. With more than 9800 network hospitals across the country, the insurer was awarded the best BFSI Brand Award by Economic Times in 2019.
|Family Health Optima Plan||Senior Citizens Red Carpet||Star Comprehensive Insurance Policy|
|Star Health Gain Insurance Policy||Super Surplus Insurance Policy||Diabetes Safe Insurance Policy|
|Star Criticare Plus Insurance Policy||Star Family Delite Insurance Policy||Medi-classic Insurance Policy (Individual)|
|Star Cardiac Care Insurance Policy|
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.
|Optima Restore - Our Bestselling Plan||Easy Health - An Affordable Plan||Optima Cash - Daily Hospital Cash Plan|
|Maxima - Our Comprehensive Plan||Optima Super ñ Aggregate Top up Plan||Optima Vital- The critical Illness Plan|
|Easy Health - Our Plan For Young Family||Easy Health - Our Premium Plan||NEW iCan Cancer Insurance - Covers Cancer Treatment Costs|
|Optima Plus - A Top Up Plan||Energy ñ The Sweetest Thing for people living with Diabetes||Dengue Care Plan - Comprehensive & Exclusive Cover for Dengue Fever|
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 Guard Family Floater Plane||Critical illness Policy||Extra Care Health Plan|
|Hospital Cash Daily Allowance Plan||Silver Health Plan||Star Package Health Plan|
|Tax Gain Health Plan||Critical illness for Women||Individual Health Guard Insurance|
|Health Care Supreme Plan||Health Ensure Plan||Silver Health Plan for Senior Citizens|
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.
|Individual health insurance||Family health insurance||Parents Health Insurance Plans|
|health Medisure Super Top Up||Critical Illness Policy||Senior Citizens 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.
|Chola Swasth Parivar Insurance||Chola Tax Plus Healthline||Chola MS Family Healthline Insurance|
|Chola Topup Healthline||Chola MS Critical Healthline Insurance||Chola Accident Protection|
|Chola Hospital Cash Healthline||Chola Classic Health - Individual||Chola Classic Health - Family Floater|
|Chola Super Topup Insurance||Individual Healthline Insurance||Hospital Cash Healthline Plan|
Manipal Cigna Health Insurance Company Limited (formerly known as CignaTTK Health Insurance Company Limited) is a joint venture between the Manipal Group and Cigna Corporation; both are global market leaders with a huge customer base. Manipal Cigna 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.
|ProHealth Insurance||Lifestyle Protection Critical Care||Lifestyle Protection Accident Care|
|Lifestyle Protection Group Policy||ProHealth Group Insurance Policy||ProHealth Select|
|Global Health Group Policy||ProHealth Cash|
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.
|Future Health Suraksha - Individual Plan||Future Health Suraksha - Family Plan||Future Hospicash - Hospital Cash|
|Comprehensive Plan - Health Total||Accident Suraksha - Personal Accident||Future Criticare - Critical Illness|
|Future Vector Care||Future Advantage Top up||Future Health Surplus - Top-Up|
|Surakshit Loan Bima|
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||Group Health Insurance - SBI||Critical Illness||Hospital Daily Cash|
|Loan Insurance||Arogya Premier||Arogya Plus||Arogya Top Up|
With a wide network of over 4,100 hospitals across the country, Religare Health 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.
|Care (Comprehensive Health Insurance)||Enhance (Super Top Up Insurance)||Care Freedom (Health Insurance with Medical Check-up)||Joy (Maternity & New Born Cover)|
|Group Care (Group Health Insurance)||Secure (Personal Accident Insurance)||Cancer Mediclaim (Lifelong Cancer Protection Cover)||Heart Mediclaim (Health Cover for 16 Types of Heart Ailments)|
|Critical Mediclaim (Critical Illness Cover)||Operation Mediclaim (Surgery/Operation Expenses Cover)||Group Secure (Group Personal Accident Insurance)|
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.
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.
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||Critical Illness Insurance|
|Health insurance mainly covers hospitalisation expenses owing to an accident or illness||A critical illness plan offers a lump sum amount in case the insured is diagnosed with a critical illness such as cancer, kidney failure, etc.|
|Loss of income can be availed only with a rider called Personal Accident Cover||With a critical illness policy, the loss of income due to the illness can be mitigated|
|The sum insured amount is restored after a claim||The sum insured amount is paid in a lump sum and is not restored|
Both health and life insurance is important, depending on their offerings. However, the major differences between health insurance and life insurance include:
|Health Insurance||Life Insurance|
|Health insurance doesn’t offer death benefit or maturity benefit as an inbuilt benefit||Death and maturity benefit is the major attraction in a life insurance policy|
|Hospitalisation expenses covered due to an accident or illness||No hospitalization expense cover|
|NCB benefit for not claiming the insurance||No NCB benefit|
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:
|Health Insurance||Term Insurance|
|No death or maturity benefit is offered||The insured can avail death benefit where the beneficiary gets the insurance amount in case of the sudden demise of the policyholder|
|Medical expenses including hospitalisation expenses, OPD, day care, pre and post hospitalisation expenses tec. Are covered||No such cover except death benefit is covered|
|Based on indemnity where hopsitalisation expenses are reimbursed||Pure protection plan and is an absolute must plan|
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.