Health Insurance

What is Health Insurance?

Health Insurance is a type of insurance that offers medical coverage against medical expenses arising out of a health emergency. A health insurance plan offers financial assistance to the policyholder to cover hospitalization expenses, day care procedures, ICU charges and critical illness benefits. The policyholder can also buy a health insurance plan to avail tax benefits on premium as per the Income Tax Act, 1961.

Top Reasons to Buy a Health Insurance Plan

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

• Beat Medical Inflation - A health insurance policy can help you pay your medical bills, including pre and post-hospitalization expenses, today as well as in future despite the rising medical costs.
• Afford Quality Medical Treatment - It helps you to afford the best quality medical treatment and care so that you can focus only on getting cured.
• Fight Lifestyle Diseases - It allows you to pay for the long-term treatment of lifestyle diseases like cancer, heart attack, etc. that have been on the rise with the changing lifestyles.
• Protect Your Savings - It helps you to protect your hard-earned savings by covering your medical expenses so that you can avail the required treatment without any financial worries.
• Avail Cashless Hospitalization Facility - It allows you to obtain a cashless hospitalization facility at any of the network hospitals of your insurance provider by raising a cashless claim.
• Get Tax Benefits - It enables you to save tax on the health insurance premium that you’ve paid under section 80D of the Income Tax Act for better financial planning.
• Ensure Peace of Mind - It allows you to obtain medical treatment with peace of mind as you do not have to worry about paying the hefty hospital bills.

Benefits of Buying a Health Insurance Plan in India

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

• Hospitalization Expenses - A health insurance plan covers the medical expenses incurred on getting admitted to a hospital for more than 24 hours. It includes room rent, doctor’s fee, medicine cost, diagnostic test fees, etc.
• Pre & Post Hospitalization Expenses - It covers the medical expenses that you may have incurred on an illness before getting hospitalized as well as follow-up treatment expenses incurred after getting discharged. The pre-hospitalization and post-hospitalization expenses are covered up to a fixed number of days as specified in the policy document.
• ICU Charges - A health insurance plan also covers the cost of availing treatment in an ICU  during hospitalization.
• Ambulance Cost - It covers the cost of ambulance services availed to reach the nearest hospital during a medical emergency.
• Cashless Treatments - All health insurance providers in India offer cashless treatment facilities at their network hospitals. You do not have to worry about arranging money to pay the hospital bills if you get admitted to a network hospital as it will be settled by your insurer under cashless claims.
• Day Care Procedures - It also covers the cost of availing day care treatment that requires hospitalization for less than 24 hours.
• Pre-existing Diseases - The best health insurance policy also provides coverage for pre-existing diseases after you have completed the waiting period. Usually, pre-existing diseases are covered after a waiting period of 2 to 4 years.
• AYUSH Treatment - It covers the cost of availing medical treatment through AYUSH school of medicines that includes Ayurveda, Unani, Homeopathy, Siddha and Yoga.
• Medical Check-ups - Most health insurance companies in india offer free preventive health check-up facilities to the insured at regular intervals depending on the policy terms and conditions.

Best Health Insurance Plans in India

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

What is Covered in a Health Insurance Plan?

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

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

What is Not Covered in a Health Insurance Plan?

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

• Unless there is an accidental emergency, claims arising during the initial 30 days of buying a health insurance plan are not covered.
• Coverage of pre-existing diseases is subject to a waiting period of 2 to 4 years
• Critical illnesses coverage usually comes with 90 days waiting period
• Injuries caused by war/terrorism/ nuclear activity
• Self-inflicted injuries or suicide attempts
• Terminal illnesses, AIDS, and other diseases of similar nature
• Cosmetic/plastic surgery, replacement of hormones surgery, etc.
• Dental or eye surgery expenses
• Bed rest/hospitalization and rehabilitation, common illnesses, etc.
• Treatment/diagnostic tests and post-care procedures
• Claims arising out of adventure sports injuries

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

Health Insurers

Aditya Birla Health Insurance

Bajaj Allianz Health Insurance

Bharti AXA Health Insurance

Care Health Insurance

Cholamandalam Health Insurance

Digit Health Insurance

Edelweiss Health Insurance

Future Generali Health Insurance

IFFCO Tokio Health Insurance

Kotak Mahindra Health Insurance

Liberty Health Insurance

ManipalCigna Health Insurance

Max Bupa Health Insurance

National Health Insurance

New India Health Insurance

Oriental Health Insurance

Raheja QBE Health Insurance

Reliance Health Insurance

Royal Sundaram Health Insurance

SBI Health Insurance

Star Health Insurance

Tata AIG Health Insurance

United India Health Insurance

Universal Sompo Health Insurance

Health Insurance Companies Expand

Key Factors to Consider before Buying a Health Insurance Plan

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

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

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

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

• Corona Kavach Policy

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

  Eligibility	Specification
  Entry Age	18-65 years
  Coverage Type	Individual/Family Floater
  Sum Insured ( Rs)	50,000-500,000
  Discount on Premium	5% for health workers and doctors

• Corona Rakshak Policy

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

  Eligibility	Specification
  Entry Age	18-65 years
  Coverage Type	Individual
  Sum Insured ( Rs)	50,000-2,50,000
  Discount on Premium	5% for health workers and doctors

Health Insurance Eligibility Criteria

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

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

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

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

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

Why Compare Health Insurance Plans Online?

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

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

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

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

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

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

Some Myths about Health Insurance

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

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

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

• My Health Insurance will Cover all the Medical Expenses

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

• Declaration of Pre-existing Diseases

  It is essential to declare all your pre-existing diseases in the proposal form. You must mention pre-existing diseases clearly before buying a health insurance policy. Inadequate information can lead to rejection of the claim and can cost more than the expected amount.

• Smokers are not Eligible to Buy a Health Insurance Plan

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

• Medical Insurance will only Cover Hospitalization Expenses

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

• I am Covered Under a Group or Corporate Health Insurance Plan!

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

How to Calculate Health Insurance Premium?

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

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

How to File a Health Insurance Claim?

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

1. Health Reimbursement Claims

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

2. Cashless Claims

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

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

In Case of Planned Hospitalization

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

In Case of Emergency Hospitalization

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

Documents Required for Health Insurance Claim Reimbursement

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

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

How to Buy Best Health Insurance Plans Online from Policybazaar?

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

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

Steps to Buy a Health Insurance Plan Online from Policybazaar

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

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

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

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

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

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

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

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

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