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Health Insurance: Compare and Buy The Best Plan

What is Health Insurance?

Health Insurance is an insurance policy that ensures that you get cashless treatment or expense reimbursement, in case you fall ill. A health insurance policy reimburses the insured for medical and surgical expenses arising from an illness or injury that leads to hospitalization. The insurance company provides the insured with the facility of cashless hospitalization at a network hospital or provides a reimbursement for the incurred expenses. Furthermore, health insurance cost is subsidized to the insured in the form of tax exemption under section 80D of Income Tax Act, 1961.

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

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Importance of Health Insurance in India

There is no debating the importance of having insurance in a country like India that ranks very low on human life index. Everyone must buy a good health insurance policy that includes medical outlay, hospitalisation costs, medication and laboratory test costs, including critical illness. Don’t get confused with questions like – Which health policy to buy? Does this consider every eventuality? What illnesses are excluded from this cover? PolicyBazaar is here to resolve all such confusions.

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Buy Best Health Insurance Policy

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

The treatment cost is getting more expensive by the day. A Health insurance policy prevents a medical emergency from turning into a financial emergency. It makes sure that one's health care needs are taken care of without depleting one’s savings and compromising on one’s future goals. The contract of medical insurance requires the provider to pay some or all of one’s health care costs in exchange of a periodic imbursement. Additional advantages of health insurance policies include regular health check-ups, cashless services, pre and post hospitalization expense reimbursement etc.

Health insurance policies allow you to save thousands on taxes under section 80D of Income Tax Act, 1961. The premiums paid towards the policy reduces your annual tax liability, thereby reducing your taxable earnings per year.

Health Insurance Policies

Best Health Insurance Policies in India By Top Health Insurance Companies

Insurance Company Coverage Incurred Claim Ratio Waiting Period Renewability Network Hospitals
Max Bupa Health Insurance 4 members of the family (2 adults + 2 children) 51.96% 4 years Lifelong Over 3500
HDFC ERGO Health Insurance 4 members of the family (2 adults + 2 children) 76.90% 4 years Guaranteed Lifelong Renewal Over 5000
Bharti AXA Health Insurance 4 members of the family (2 adults + 2 children) 76.88% 4 years Lifelong Over 5000
SBI Health Insurance 4 members of the family (2 adults + 2 children) 75.01% 1 to 4 years Lifelong Over 3000
L&T Health Insurance 4 members of the family (2 adults + 2 children) 77.83% 3 years Lifelong Over 2800
Bajaj Allianz Health Insurance 6 members of the family (2 adults + 4 children) 78.50% 4 years Lifelong Over 3700
Reliance Health Insurance 6 members of the family (2 adults + 4 children) 92.23% 4 years Lifelong Over 4000
National Health Insurance 6 members of the family (2 adults + 4 children) 97.25% 4 years Lifelong Over 6000

Note: Figures shown in the table above belong to the Financial Year 2016-17.

List Of Health Insurance Plans

Types of Health Insurance Policies in India

Everyone needs to secure their own and their family's health. With the increasing cost of healthcare in India, buying a health insurance policy has become almost mandatory for everyone. Medical insurance makes sure not only medical security but also a hassle-free claim resolution. In today’s world of options, people have different choices when it comes to purchasing health insurance. There are various plans readily available in India to include every aspect of a medical emergency. Some popular types of policies are explained below:

  • Individual Health Insurance Policy: This health insurance policy provides coverage to an individual against certain illnesses, offering advantages like cashless hospitalisation and various add-ons. The entire sum assured is available for only one individual and the premium is determined by the age of the insured. Under this policy, each insured member is entitled to receive the entire amount separately.

  • Family Health Plan: With family health plan, you can include all your family members against multiple diseases under a single cover. This Family Floater Mediclaim Policy offers a fixed sum assured for the family members, which can be availed either by one or all members of his/her family for one or more claims during the tenure of the policy. Family health plans come at a marginally incremental expense.

  • Senior Citizen Health InsuranceSenior Citizen health insurance is designed particularly for anyone with age above 60 years, offering protection from health issues during old age. According to IRDAI, every firm must include people up to the age of 65 years.

  • Surgery & Critical Illness Insurance PlansThis plan is usually brought as a standalone policy or a rider for the treatment of various critical illnesses, such as kidney failure, paralysis, cancer, heart attack etc. As the medication of such illnesses is expensive, the imbursement is also very high. A critical illness is a serious, possibly terminal disease, strictly defined by the provider. Most critical illness policies provide a lump-sum benefit if the insured is diagnosed with one or a number of the specified terminal conditions.

  • Maternity Health InsuranceMedical insurance companies today cover such additional costs, including both pre and post-natal care, child delivery (normal or caesarean), which sometimes includes vaccination of newborn babies. This insurance covers the newborn baby up to the validity of this policy. It also covers transportation fee for ferrying the mom-to-be to the nearest network hospital of choice.

  • Personal Accident CoverThese personal accident plans are frequently provided as riders to standard health plans. They include hospitalisation and bear medical outlay, in the event of an accident. These are issued as fixed benefit policies, where specified sums are paid on occurrence of unforeseen events, such as accidents. Such events that can result in death or disability of the person. However, the payout is not related to the expenditure.

  • Pre-Existing Disease Cover: After a time of 2-4 years, various policies consider pre-existing diseases, e.g. diabetes, hypertension, kidney failure, cancer etc. Pre-existing disease cover includes the illness that the insured had before purchasing the policy.

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

  • Unit Linked Health Plan: Unit- Linked Health Plan (ULHP) has been introduced recently, which offers a unique combination of health insurance and investment. Despite giving health protection, ULHPs also contribute in building a corpus that can be used to meet expenditures not covered by health insurance policies.

    Among the ULHPs available in Indian market, ICICI Pru's Health Saver, LIC's Health Protection Plus, Birla Sunlife's Saral Health and IndiaFirst's Money Back Health Insurance Plan are worth investing your money in. The limit of the cover depends on age, health, gender or other mentioned variables. By opting for this plan, one can save a certain amount to be used to pay for the treatment of pre-existing illnesses that are not covered by a normal health policy during the waiting period.

Health Insurance Plans

Which Health Insurance Policy You Should Buy?

What You Seek What You Should Get
Coverage for your expenses and surgical bills Medical insurance offering cashless facility and claim reimbursement
A fixed amount of cash on a daily basis to bear expenses when at the hospital Hospital cash plan
A lump-sum pay out to let your family manage their daily expenditure (inclusive of cost of medicines) because you have been diagnosed with a serious disease Critical illness insurance
A fixed amount of cash to avoid any financial trouble while availing treatment for total/partial temporary or permanent disability causing loss of earnings due to an accident Personal accident insurance
Coverage for expenses in the event of caesarean and normal delivery Maternity insurance
Insurance & coverage For Entire Family during medical emergency Family Health Plan
Coverage for senior citizen health issues Senior Citizen health Insurance


Features of Health Insurance Policies

Key Advantages & Features of Health Insurance Policies 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. And, so do regular health checkups. A patient looking forward to availing frequent health check-ups is no longer expected. A comprehensive health insurance comes packed with features. Understanding the following features makes purchasing medical insurance policy easy:

  • Cashless Treatment: Every medical insurance organization has tie-ups with various nursing homes across the country or 'empanelled hospital'. If you are admitted, 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. This type of plan is mostly preferred because there is no stress of claim resolution and arranging documentation. However, if your expenses go beyond the sub-limit specified by the insurance cover or marked as not covered by the provider, then they have to settle it directly with the hospital. Another important thing to remember is that cashless Mediclaim is not available if one gets treatment in a hospital that is not part of the hospital network of provider.

  • Pre and Post Hospitalization: This feature of a health insurance policy takes care of both pre and post hospitalisation fee over a time of 30 to 60 days, depending on the plan purchased. It takes into account costs incurred during a certain number of days both prior to and post hospitalization for a specified period from the date of discharge as part of the claim, provided the expenditures are related to the disease/sickness.

  • Ambulance Fee: The person is free from burden of transportation fee, as it is borne by the firm. This is an add-on benefit and you should opt for it while purchasing.

  • No Claim Bonus: NCB (or No Claim Bonus) is an advantage provided if the person does not file a claim for any treatment in the previous year. Advantage could be in any form, either as an increment in the sum assured or as a discount in the cost. You can avail this advantage on renewal.

  • Medical Check- Up: A Medical plan entitles the insured to receive regular medical check-ups. Free check-up is provided by few insurers, provided you have a good history of no claim bonus.

  • Room Rent in Your Health Insurance Sub-limits: A healthy insurance policy may have various sub-limits associated with it; room rent is one of those sub-limits. General Insurance Companies provide you with coverage max up to sum assured. However, they can deliberately trim down their liability by introducing the sub-limit clause in the coverage for the room rent.

    A sub-limit on room rent in case of hospitalization works on per day basis. For instance, if your medical insurance policy covers your daily room rent up to a maximum of Rs. 3,000 and the particular room costs you Rs. 5,000 per day, then you will have to pay the remaining Rs. 2,000 out of your own pocket. Besides, the room charges are directly associated with the type of room you are availing, i.e. a single room or on a sharing basis. Everything else is calculated proportionately.

    If the total cost incurred for your treatment at the hospital is Rs. 5, 00,000, the table shown below illustrates the proportionate expenses to be borne by your insurer and you, respectively.

    Sum Assured by Your Policy (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.)
    Room Charges (in Rs.) 50,000 30,000 20,000
    Doctor's Fee (in Rs.) 20,000 12,000 8,000
    Medical Tests' Cost (in Rs.) 20,000 12,000 8,000
    Operation/Surgery Cost (in Rs.) 2,00,000 1,20,000 80,000
    Medicine Cost (in Rs.) 15,000 15,000 0
    Total (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 expense incurred, i.e. Rs. 5, 00,000. Thus, make sure you choose wisely if you want any such sub-limits in your health insurance policy.

  • Co-Payment: According to this feature, you can lower the health insurance cost. Medical insurance plans offer co-payment option that pre-defines the voluntary deductibles to be borne by the firm. So, in the event of medication, some amount is paid by the customer and the rest by the provider. It is a cost-sharing requirement under a health policy, which states that the organization or the person will bear a certain share (in percentage) of the total admissible cost. However, the co-payment option does not have any effect on the sum assured. It allows you to reduce your premium to a certain extent (subject to the insurer and insurance policy). 

  • Tax Benefits of Health Insurance: Health insurance policies entitle you to receive tax benefits under section 80D of income tax act, 1961. The premiums you pay towards insurance plans for yourself or your family members get you a tax rebate, irrespective of whether they are dependent on you or not. The tax benefit offered, with respective to the premiums, is subject to the age of the person and there is a cap of maximum benefit that can be availed. You can save max up to Rs. 25, 000 in taxes a year unless your age is above 60 years. If your age is above 60 years, then this cap of maximum tax benefit increases to Rs. 30, 000.

    If you are paying the insurance premiums for your parents as well as of your own, then you are eligible for tax exemption of up to Rs. 55, 000 a year under section 80D, provided your parents are senior citizens.

  • Health Insurance by Employer: More than 80% of employers in today’s age provide health coverage for 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 mediclaim offered by your company as you don’t need to pay the premium. This comes under a group health insurance policy and the premium is paid by the employer, basis the group size and benefit opted.

    However, it might be that you feel your employer’s medicliam policy is insufficient to fulfil your medical needs or what if you change your job? You’re no more a member of this plan once you leave the job. Hereby, it is necessary to understand the policy terms thoroughly. You can communicate with the HR department regarding what’s covered and what’s not in your health insurance. Mostly we observed employees are more than satisfied with their company providing health insurance, only to find out later that the plan is not sufficient. So, before it’s too late, take your call!

  • Third Party Administrators: The TPA concept is the brainchild of Insurance Regulatory and Development Authority of India (IRDA), to assist both the insured and the insurer. While it benefits the insurer by reducing their overheads or administrative costs, fake claims and claim ratios, the insured can avail the benefit of improved and fast healthcare services.

    TPAs are the important players in the sector of health insurance. It excels the capacity to handle all or a portion of the claims related to mediclaim insurance. They have tie-ups with the health insurer or self-insuring companies to manage services such as premium collection, enrollment, claim settlement or other administrative services. Often hospitals or organizations outsource health-related responsibilities to a TPA to lower the burden. In this, an employer may prefer to provide the health care expenses to its employees via a TPA to manage various aspects of employer-funded healthcare policy.

Best Health Insurance

Factors to Consider Before Purchasing Best Medical Insurance Plans in India

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

  • Caps and sub-limits: The amount you pay for a health policy has impositions of co-payments, sub-limits, and other caps, which would alter the benefits in the long run. To make the most of your health insurance policy, you must understand these factors before you pay for a plan.

  • Claim settlement record: This is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. Thus, you can ensure that your claims would not be wrongly withheld. Always ask for the company’s claim settlement ratio before purchasing their health plans and save yourself from unnecessary harassment.

  • Scope of cover: Don’t buy a plan by just comparing health insurance cost. Less cost does not necessarily mean a good plan. On the contrary, such a plan might not consider your needs properly. Closely look at what the plan includes. Buy a comprehensive plan.

  • Renewability: It is important to see how many years the plan proposes to protect you. You should not be left without a safeguard when you need it the most, say during your old age. Mediclaim policies are usually annual contracts. The automatic re-establishment of in-force status affected by the cost is known as renewal. In other words, issuing a new policy or the continuation of the current policy, once the old policy’s plan year ends, is termed renewal. At the end of the policy term, the policy has to be renewed by the insured. There should be continuous renewal of the policy because if there is a break, then the person will lose the benefit of insurance, in the event of a contingency.

  • Cashless Hospital Network: Check if a hospital around you is included by the company you are considering to buy from. You and your family won’t be required to run around collecting documents and filling reimbursements. The provider or its Third Party Administrator has a tie-up with a range of nursing homes. The insured can get admitted in any of these nursing homes and medication for a disease covered by the policy. However, cashless mediclaim resolution is subject to limits and sub-limits, which are subject to the sum assured of the policy.

  • Premium Loading: Loading is an additional cost built into the insurance policy to consider losses, which are higher than anticipated, for an insurance company, arising from insuring a person who is prone to a form of risk. Premium Loading is the amount an insurer needs to consider its expenses and generate profit. We strongly recommend you check the terms and conditions pertaining to premium loading. This will save you from paying a high incremental premium post making a claim. This aspect, though ignored in the beginning, usually becomes a bone of discontentment later. The best practice would be to verify the cost fluctuation data of the plan for the previous 5 years at the very least.

  • Internal Team: Check for plans from firms, who have a dedicated internal team for handling Mediclaim. This comes in handy while expediting the Mediclaim resolution process. Most of the players use a third-party administrator to process the claims and do the paperwork. Even though most of these Administrators provide great services, the fact that they are a third party slows down the process. There are certain rules and regulations to be followed when an administrator processes a claim before it is handed over to the insurance company. These affect the turnaround time.

  • Floater (family) Size: Everyone has a different family size, so you should always look for the family size allowed under the plan before purchasing it. If you are a person in your late 20s and your parents in their 40s, 50s or 60s, then purchasing for yourself does make sense. Alternatively, if you are married with or without kids and have dependent parents, parents-in-law, siblings etc., then a family health plan is best for you. Checking the cost, family size covered, critical illnesses or other benefit will ensure that you are able to purchase the plan you need.

  • Health Insurance Portability: It is wise to choose a health insurance company that offers health insurance portability. Earlier, policyholders had to stick to a policy just to retain the advantage. Now, the policies allow you to switch from one insurance company to another without losing the waiting period advantages earned in your current policy. Moreover, with insurance landscape changing so regularly, insurance companies regularly come up with better policies and it may make sense to opt for health insurance policy portability. Although health insurance portability is free, some companies may charge you a certain fee if you are to port out of their plans to those of some other players. Therefore, make sure you do not pay any charges for medical insurance portability. Health insurance portability is a good thing to check when you are finding the best health policy or mediclaim.

  • Restore Benefit: With 'restore benefit' facility in your health care plan, you can restore your basic sum assured, in case you have already spent the same or the multiplier advantage during your policy tenure. Mostly, the benefit cannot be obtained on the same ailment, if you exhaust the limit.

    Restoration assistance proves to be helpful for a family floater health plan, where the entire sum assured is used in the treatment of only a single family member. This leaves the remaining policy members with zero policy cover in case of hospitalisation for the remaining policy year. In such a case, the other family members can avail policy coverage for the illness other than the one for which the expenses have already been compensated by the insurer.

    Well, while finalising your health insurance plan, you should consider other influencing factors such as waiting period, sub-limit, claim settlement procedures etc. You can replace restore benefit with a super top-up plan at an affordable price. Moreover, top-up plans are more comprehensive since it comes with less or no restrictions.

  • Top up Plans: With the rise of medical inflation, having a large medical cover is prudent. But not all can afford it, due to the high premium. This is where a top-up plan comes into the picture. A top up plan reduces the deductibles cost i.e. the portion of claim you pay willingly for the damages before the insurer compensates the rest or up to the sum assured. With a top up policy, you don’t pay until a hospital breaks its defined limit. A top up plan is considered far cheaper than a standalone medical policy.

    For instance, if the medical bill is 6 lakh with a deductible of 2 lakh, you are required to pay only the latter amount and the remaining 4 lakh will be paid by the insurer. But you can utilise your health policy to pay the liable amount. Again, the blending of a top up plan with a medical cover is helpful as the premium you pay is much more affordable than the single plan. For example, if you pay 6,500 as a premium for Rs. 5 lakh regular cover, a top up coverage of Rs. 15 lakh will entail to an additional premium of 5,000, which is anyhow cheaper than a separate policy of identical cover.

  • Waiting Period: As per the insurance norms, every insured must serve a defined waiting period for any pre-existing illness. It is usually a 30-day period from the day your health insurance policy is initiated. If any claim falls during the waiting period, the insurer has the right to reject the claim for any hospitalisation, except in the case of an emergency. A hospitalisation that arises out of an accident can be registered as a claim and the insurer will compensate the hospitalisation cost. However, the insured is not required to serve the waiting period for subsequent years.

Read More About Question You Should Ask Before Buying Health Insurance

Health Insurance Comparison online

Compare Health Insurance Online

It is vital that you compare health insurance online before purchasing any plan for you & your beloved ones in order to choose the best plan for their health needs. There are so many companies offering health insurance policies and each of them has a different set of features and advantages that it gets mind-boggling to select one. Sometimes, you end up buying a plan that though costs less but has contradictory clauses and you practically get nothing when filing a claim. On the other hand, you might choose to buy a plan with a higher cost just to realize that it had features that you never needed or did not use.

PolicyBazaar facilitates comparison of health insurance online and ensures that you buy the best-fitted policy, based on favorable insurance rates. We help you sieve through numerous mediclaim policies and you get best health insurance plans, based on your needs. You can, then, compare them side by side and not only save money but also buy a policy for you properly. Make an informed choice!

  • 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 Inclusions

    The coverage offered by a health insurance policy is subject to the type of policy and the insurer. An ideal policy is customizable and suites your requirements in the best way possible. Following are common health insurance policy inclusions:

    • In-patient hospitalization expenses

      • Donor, 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 vary with the insurer; however, certain points are not covered by health policies, that fall under the category of policy exclusions. Following are common health insurance policy exclusions:

      • 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 3 years.

      • Clear exclusion of expenses incurred for maternity/newborn.

      • 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 diseases’ treatment.

      • Bed rest/hospitalization and rehabilitation, common illnesses etc.

      • Treatment/diagnostic tests, post-care procedures.

      • Treatment in abroad or by an under-qualified medical professional.

    Note: It is recommended to explore each plan to ensure the maximum coverage can be availed.

  • Health Insurance Premium Calculator

    Health insurance policies provides an assurance that you will get the required medical assistance whenever you need it. You pay a fixed amount of money in exchange for that at certain intervals to ensure that the policy remains in force. Did you ever think how this premium is calculated? There are multiple certain factors that affect your health insurance premium, including some provider-specific terms, such as the medical background of your family, your personal medical history and so forth.

    Based on that, you might want to calculate your premium to figure out how much you would have to pay for the policy. At PolicyBazaar, we allow you to choose one of the best medical plans online, thereby comparing health plans offered by the most reliable medical insurance players in the market. Keeping your affordability in view, we hand you the premium calculator to calculate your premium and purchase the plan that suits your needs in the best way possible.

  • 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 have financial strains. Buying a medical insurance ensures that one's health is secured and medical expenses are covered across a wide network of hospitals in India. One can opt for health policies 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

  • Important Points to Remember while buying Health Insurance

    Buying insurance is not child’s play and when it comes to buying a health insurance policy, you need to be pretty sure about certain points. A few of such key points are listed below:

    • What covers are you offered and who offers the covers?

    • Are add-on features available for later use?

    • Are individual and/or family floater options available?

    • What is the Sum Assured?

    • What are Sum-limits applicable?

    • Is/are there any discount(s) offered?

    • Is there any voluntary/co-payment deductible options?

    • Are policy exclusions mentioned on the documents?

    • What are likely processes of claim – reimbursement, cashless benefit, claim settlement immediately/later?

    • Is there any medical check-up required before policy acceptance?

  • Health Insurance Claim Procedures

    Medical 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 taken. Following are two claim processes:

    Expense Reimbursement:

    Health insurance policies provide the insured with the benefit of getting their medical expenses reimbursed by the insurer after paying them off, based on the policy terms documented. The cost of various hospital charges such as bed charges, medicines, lab tests, surgeon's fees etc. are paid back to the insured at the time of making a claim. The insured pays the (hospital) expenses incurred, but gets reimbursed by the insurance company.

    Cashless Treatment:

    Insurance companies provide policyholders with a wide network of hospitals to get medical treatment without having to make upfront payments. No payment is required to be done by the insured but the insurer since the clause involves a mutual agreement between both the parties, i.e. the insurer and hospital. In contrast, availing cashless benefit requires TPA approval.

    The insured can also show the health card at the particular hospital as the proof of medical insurance cover along with a valid government ID proof. Following are the cases considered:

    Planned Hospitalization:

    In the case of planned hospitalization, to avail health insurance benefit the policyholder needs to have the TPA approval in advance along with the other mandatory documents to be submitted. Fill the pre-authorization form at the hospital with a particular section signed by the treating doctors.

    Emergency Hospitalization:

    Show the health card issued by the insurer at the hospital along with the pre-authorization form filled appropriately. Get the TPA approval for emergency hospitalization. If failed to get the TPA approval, get the expenses reimbursed later instead. The policyholder might have to show the itemized bill, proof of medical expenses, discharge bill etc for claim reimbursement as the proof of the treatment availed at the particular hospital.

  • Documents Required for Health Insurance Claim Reimbursement

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

    • Discharge card issued by the hospital.

    • In-patient hospitalization bills signed by insured for authenticity.

    • Doctors’ prescriptions and medical store bills.

    • Claim-form with insured’ 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 TPA.

  • Top 10 Best Health Insurance Companies in India

    • Best Health Insurance Companies
    • L&T Health Insurance

    • HDFC Ergo Health Insurance

    • Cigna TTK Health Insurance

    • Apollo Munich Health Insurance

    • Bajaj Allianz Health Insurance

    • Bharti AXA Health Insurance

    • Cholamandalam MS Health Insurance

    • Future Generali Health Insurance

    • SBI Health Insurance

    • Religare Health Insurance

    Lets discuss about these Health Insurance Providers in detail

    Apollo Munich Health Insurance

    A joint venture between Apollo Hospitals Group, India’s premier private hospitals company and Munich Health, the medical insurance arm of Munich Re, the German reinsurance major, Apollo Munich Insurance is a focused insurance services provider in India providing a range of health insurance plans. The health insurance company merges the corporate healthcare competencies of Apollo Hospitals Group with the global healthcare insurance and reinsurance expertise of Munich Health.

    The company has won numerous accolades over the years and has recently been honoured with awards like the Infosec Maestros Awards - 100 Top CISO 2015 for the second time in a row and Health Insurance Provider Award by Money Today (of India Today Group) and Financial Planning Corporation (India) Pvt. Ltd. (FPCIL) in 2015.

    Apollo Munich Insurance focuses on being a trusted leader in the health insurance space with its innovative solutions. Their mission is to regularly introduce pioneering health insurance and wellness solutions that meet customer needs. The company also intends to build an organisation on the principles of transparency, trust and integrity that can constantly deliver on various commitments to all stakeholders.

    Bajaj Allianz Health Insurance

    A joint venture of Bajaj Finserv Limited, a comprehensive financial services company based out of India and Allianz SE, the global financial services major based out of Munich, Germany, Bajaj Allianz General Insurance Company focuses on the general insurance space in the country, including medical insurance. The joint venture seeks to leverage successfully Bajaj Finserv's in-depth understanding of the local Indian market and its extensive distribution network across the country with the vast global experience of the Allianz Group. Bajaj Finserv Limited holds a 74% stake in the general insurance company while Allianz holds the remainder.

    The company has been one of the outperformers in the space as testified by it receiving the iAAA rating from ICRA for the 10th year in a row. The rating highlights the company's highest claims paying ability and its strong position in the general insurance industry. Most recently, the company was conferred the Economic Times; Best Corporate Brand Award as an outcome of the newspaper's Best Brands Survey for 2016. Bajaj Allianz General Insurance was also acknowledged as the Most Admired Health Insurance Company of 2015 by Pharma Leaders Power Brands Awards. In addition, Indian Market Research Bureau (IMRB) ranked it second among the top health insurance brands in the country on the basis of customer loyalty based on a syndicated survey.

    Bajaj Allianz General Insurance was also recently awarded a Certificate of Appreciation by Rajasthan High Court, and Punjab and Haryana High Court for excellence in the field of claim servicing for motor third party claims. Other awards in 2015 included The Silicon Valley Business Award 2015 under the categories of Best Financial App and Best Overall App for Insurance Wallet product. In addition, it won the Claims Award Asia 2015 for the third year running, under the categories of Insurer Claims Team of the Year for Claim Settlement during the Jammu and Kashmir floods, and Claims Innovation of the Year for launching pioneering claim settlement practices for health insurance claims.

    Bajaj Allianz General Insurance intends to be the first choice in insurance for Indians. It has a mission to be a responsible and customer focused market leader that understands and meets the insurance needs of the market through affordable, value for money products.

    Bharti AXA Health Insurance

    A joint venture of Bharti Enterprises, one of Indian's leading business groups, and AXA, the France-based international insurance solutions company, Bharti AXA General Insurance is a provider of various general insurance solutions in addition to health insurance. Bharti Enterprises owns the majority 74% stake while AXA holds the remainder in the company. Bharti AXA General Insurance started operations in August 2008 and is headquartered in Bangalore and has 59 branches across India.

    The company has received numerous awards for innovation and performance over the years, among other categories. In 2014, it received the Asia Insurance Industry award for its initiative to reach the under penetrated smaller towns and cities where the physical branch network was limited. In addition, it received the honour of being the best insurance company in the private general insurance sector from the World HRD Congress at the 2014 BFSI Awards.

    Bharti AXA General Insurance focuses on serving all its stakeholders including its customers, business partners, employees, shareholders and the overall society. It uses its fundamental values of professionalism, integrity, team work, innovation and pragmatism to realign industry standards through empathetic service that helps drive customers towards its comprehensive and innovative insurance solutions.

    Cholamandalam MS Health Insurance

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

    Also known as Chola MS, the company was awarded the best insurance company across Asia as ‘Health Insurer Claims Team’ at the 2013 Claims Asia Awards. It also received the ‘Innovation Leader Award’ for 2012 from Fintelekt and was adjudged the best insurance company for ‘In time Claims Settlement for the year 2011-12’ in the Rashtriya Swasthya Bima Yojana (RSBY) scheme operated under the aegis of the Ministry of Labour and Employment, Government of India.

    Cholamandalam MS has a singular focus on value creation and hopes to become the most respected general insurance company in India. It uses a T3 strategy of Trust, Transparency and Technology to deliver innovative risk-free medical insurance solutions for all its customers.

    Cigna TTK Health Insurance

    Established as a joint venture between TTK Group, the Indian conglomerate and Cigna Corporation, the US based international medical insurance solutions company, CignaTTK Health Insurance Company Limited focuses on providing health policy solutions to the Indian market. The health insurance company was launched in February 2014 and has ramped up its operations to create a pan India presence across 15 cities within a short while. The company is headquartered in Mumbai.

    The company was recently awarded the Economic Times’ ‘Best Promising Brands 2015’ award. CignaTTK has also shown its focus on good health and wellness and has served as the official health insurance partner for the popular Delhi and Mumbai marathons.

    CignaTTK Health Insurance Company’s mission is to improve the health, well-being and sense of security of the people. Its service philosophy is to make customer experiences easy and reliable so that customers always receive personalised and empathetic services.

    Future Generali Health Insurance

    A joint venture of the Indian conglomerate Future Group, and the Generali Group, one of the world’s largest international insurance companies, Future Generali India Insurance Company has a pan India presence through 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.

    It's solutions include both life insurance and general insurance, with the latter providing solutions for motor insurance, travel insurance, home insurance besides a host of health insurance policies. The company has also moved into the rural and commercial insurance space and provides a range of products that take care of the specific needs of these sectors.

    HDFC Ergo Health Insurance

    A 74:26 joint venture between HDFC Limited, India’s premier housing finance institution, and ERGO International AG, the primary insurance entity of global reinsurance and insurance major, Munich Re Group, HDFC ERGO General Insurance Company provides a range of solutions for the general insurance market in India. The company has been expanding its network across the country at a rapid pace and currently has 109 branches across 89 cities. The company has an employee base of over 1900 people.

    HDFC ERGO General Insurance has been awarded the ‘iAAA’ rating by ICRA that indicates its highest claim paying ability. The company has also received the CMS Outstanding Affiliate World-Class Service Award for 2015 from Chubb Multinational Solutions in addition to ICAI Award for Excellence in Financial Reporting in the Annual Report for the financial year 2014-15 under the insurance sector category.

    SBI Health Insurance

    SBI Health Insurance operated as a joint venture between State Bank of India and Insurance Australia Group. The company offers a range of health 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 customer can opt for plans with sum assured up to Rs. 50, 000 to Rs. 5, 00,000.

    Religare Health Insurance

    Religare Health Insurance, founded by Religare Enterprise Limited along with Corporation Bank and Union Bank of India, operates as a standalone insurance company. The company, during its service years, has successfully managed to be one amongst the most popular medical insurance companies in India.

    With a wide network of over 4, 100 hospitals across the country, the 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.

  • List of Health Insurance Companies in India

    India has a huge insurance market that comprises of many life and general insurance companies. These companies offer different insurance plans, targeting customers with specific needs in terms of protection. The following is a table that segregates some renowned private and public sector insurers in India.

    Private Sector Insurer(s) Public Sector Insurer(s) Public-Private Sector Insurer(s)

    IFFCO-Tokio General Insurance
    L&T General Insurance
    Liberty Videocon General Insurance
    Max Bupa Health General Insurance
    Raheja QBE Health Insurance
    Reliance General Insurance
    Religare Health Insurance Company
    Royal Sundaram General Insurance
    SBI General Insurance
    Star Health and Allied Insurance
    Tata AIG Health Insurance
    Apollo Munich Health Insurance
    Cigna TTK Health Insurance
    Bharti AXA General Insurance
    Cholamandalam MS General Insurance
    HDFC ERGO General Insurance
    Future Generali India Insurance
    Bajaj Allianz General Insurance

    United India Health Insurance
    National Insurance
    New India Assurance
    Oriental Insurance

    Universal Sompo General Insurance

  • List of Government Health Insurance Schemes in India

    Pradhan Mantri Suraksha Bima Yojana (PMSBY)

    It is a government-of-India-backed health insurance scheme, which offers coverage against personal accident 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 deal in 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.

    Read More About Pradhan Mantri Suraksha Bima Yojana

    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. Enrolled 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 benefits

    Rs. 30, 000 payable

    In 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

  • Buy Best Health Insurance Policies Online

    The leading trend of buying insurance policies online has changed the way people used to think about insurance. Today, you can explore multiple insurance plans offered by various insurers across the country at your own convenience, based on the information gathered online. We, at PolicyBazaar, understand the needs of an individual to buy health or medical insurance, and therefore, let you compare multiple insurance plans to make it to the best health insurance as per your affordability.

    PolicyBazaar facilitates you to do the following:

    • Explore and figure out the best health insurance plans

    • Read quality articles and news of various insurance companies in India

    • Compare multiple health insurance plans

    • Find the best health insurance plan for you

    • Read user reviews and decide which insurer to go with

    • Get expert advice from a well-versed customer support team.

Insurer Nerwork Hospitals  Plan Name Sum Insured Options  Features Available Features excluded
Apollo Munich Health Insurance 3880 Easy Health Floater Exclusive 3lacs, 4lacs, 5lacs, 7.5lacs, 10lacs, 15lacs, 20lacs, 25lacs, 50lacs
  • Health Check Up
  • Ambulance Charges
  • Maternity Cover
  • OPD Coverage
  • Restore Benefits
Easy Health Floater Premium 4lacs, 5lacs, 7.5lacs, 10lacs, 15lacs, 20lacs, 25lacs, 50lacs
  • Health Check Up
  • Organ Donor
  • Maternity Cover
  • Restore Benefits
  • OPD Coverage
Easy Health Floater Standard 2lacs, 3lacs, 4lacs, 5lacs
  • Health Check Up
  • Ambulance Charges
  • Daily Cash
  • Maternity Cover
  • Restore Benefits
Optima Restore 3lacs, 5lacs, 10lacs, 15lacs, 20lacs, 25lacs, 50lacs
  • Restore Benefits
  • Organ Donor
  • Domicillary Hospitalization
  • Maternity Cover
Bharti AXA Health Insurance 1609 Smart Health Basic 2lacs, 5lacs
  • Ambulance Charges
  • Domicillary Hospitalization
  • OPD Coverage
  • Restore Benefits
Smart Health Optimum 5lacs
  • Ambulance Charges
  • Domicillary Hospitalization
  • Health Check Up
  • Restore Benefits
Smart Health Premium 3lacs
  • Ambulance Charges
  • Domicillary Hospitalization
  • Health Check Up
  • Restore Benefits
Cigna TTK Health Insurance 5023 ProHealth Plus SB 15lacs, 30lacs, 50lacs
  • Health Check Up
  • Restore Benefits
  • Maternity Cover
  • Alternative Benefit
  • Dental Cover
  • Daily Cash
ProHealth Preferred SB 4.5lacs, 5.5lacs, 7.5lacs, 10lacs
  • Restore Benefits
  • Ambulance Charges
  • Maternity Cover
  • Alternative Benefit
  • Convalescence Benefit
ProHealth Protect PLAN 2 Sub Plan 10lacs
  • Health Check Up
  • Ambulance Charges
  • Maternity Cover
  • Restore Benefits
  • Eye Cover
ProHealth Protect SB 2.5lacs, 3.5lacs, 4.5lacs
  • Restore Benefits
  • Ambulance Charges
  • Organ Donor
  • Alternative Benefit
  • Maternity Cover
HDFC ERGO Health Insurance 8318 Health Suraksha Plus - Gold 3lacs, 4lacs, 5lacs, 7.5lacs, 10lacs
  • Health Check Up
  • Maternity Cover
  • Organ Donor
  • Restore Benefits
  • OPD Coverage
Health Suraksha Plus Regain - Gold 3lacs, 4lacs, 5lacs, 7.5lacs, 10lacs
  • Health Check Up
  • Restore Benefits
  • Maternity Cover
  • Dental Cover
  • OPD Coverage
Health Suraksha Plus Regain - Silver 3lacs, 4lacs, 5lacs, 7.5lacs, 10lacs
  • Restore Benefits
  • Ambulance Charges
  • Maternity Cover
  • Convalescence Benefit
  • OPD Coverage
Health Suraksha Plus Silver 2lacs, 3lacs, 4lacs, 5lacs
  • Ambulance Charges
  • Domicillary Hospitalization
  • Restore Benefits
  • Maternity Cover
Iffco Tokio Health Insurance Swasthya Kavach (Basic) 1lac, 2lacs, 3lacs, 4lacs, 5lacs
  • Domicillary Hospitalization
  • Organ Donor
  • Health Check Up
  • Restore Benefits
Swasthya Kavach (Wider with Critical Illness Cover) 1lac, 2lacs, 3lacs, 4lacs, 5lacs
  • Health Check Up
  • Domicillary Hospitalization
  • Restore Benefits
  • OPD Coverage
Swasthya Kavach (Wider) 1lac, 2lacs, 3lacs, 4lacs, 5lacs
  • Ambulance Charges
  • Organ Donor
  • Restore Benefits
  • OPD Coverage
Max Bupa Health Insurance 3480 Health Companion 2lacs, 3lacs, 4lacs, 5lacs, 7.5lacs, 10lacs, 12.5lacs, 15lacs, 20lacs, 30lacs, 50lacs, 100lacs
  • Restore Benefits
  • Ambulance Charges
  • Health Check Up
  • Maternity Cover
  • OPD Coverage
Heartbeat Gold 5lacs, 7.5lacs, 10lacs, 15lacs, 20lacs, 50lacs
  • Health Check Up
  • Domicillary Hospitalization
  • Maternity Cover
  • Restore Benefits
  • OPD Coverage
Heartbeat Platinum 15lacs, 20lacs, 50lacs, 100lacs
  • Health Check Up
  • Ambulance Charges
  • OPD Coverage
  • Convalescence Benefit
  • Restore Benefits
Heartbeat Silver 2lacs, 3lacs
  • Health Check UpAmbulance ChargesMaternity Cover
  • Restore Benefits
  • OPD Coverage
Reliance Health Insurance 1583 Health Gain 3lacs, 6lacs, 9lacs
  • Restore Benefits
  • Ambulance Charges
  • Health Check Up
  • Maternity Cover
Religare Health Insurance 4439 Care 3lacs, 4lacs, 5lacs, 7lacs, 10lacs, 15lacs, 20lacs, 25lacs, 50lacs, 60lacs
  • Health Check Up
  • Restore Benefits
  • Domicillary Hospitalization
  • Maternity Cover
  • OPD Coverage
Care Freedom 3lacs
  • Restore Benefits
  • Health Check Up
  • Ambulance Charges
  • Maternity Cover
Joy 3lacs, 5lacs
  • Health Check Up
  • Restore Benefits
  • Maternity Cover
NCB Super Premium 3lacs, 4lacs, 5lacs, 7lacs, 10lacs, 15lacs, 20lacs, 25lacs
  • Restore Benefits
  • Health Check Up
  • Ambulance Charges
Royal Sundaram Health Insurance Lifeline Classic 2lacs, 3lacs, 4lacs
  • Health Check Up
  • Restore Benefits
  • Ambulance Charges
  • Maternity Cover
  • OPD Coverage
Lifeline Supreme 5lacs, 10lacs, 15lacs, 20lacs, 50lacs
  • Health Check Up
  • Restore Benefits
  • Ambulance Charges
  • Maternity Cover
  • OPD Coverage
Lifeline Elite 25lacs, 30lacs, 50lacs, 100lacs, 150lacs
  • Health Check Up
  • Restore Benefits
  • Ambulance Charges
  • Maternity Cover
  • OPD Coverage
Star Health Insurance 6313 Health Optima 2lacs, 3lacs, 4lacs, 5lacs
  • Restore Benefits
  • Ambulance Charges
  • Maternity Cover
Star Comprehensive 5lacs, 7.5lacs, 10lacs, 15lacs, 20lacs, 25lacs
  • Health Check Up
  • Restore Benefits
  • Ambulance Charges
  • OPD Coverage
  • Convalescence Benefit
Tata AIG Health Insurance 1985 Mediprime 2lacs, 3lacs, 4lacs, 5lacs, 7.5lacs, 10lacs
  • Health Check Up
  • Ambulance Charges
  • Restore Benefits
  • Maternity Cover
Universal Sompo Health Insurance Individual Privilege 6lacs, 8lacs, 9lacs, 10lacs
  • Health Check Up
  • Restore Benefits
  • Ambulance Charges
Universal Sompo Individual Basic 1lac, 2lacs
  • Health Check Up
  • Restore Benefits
  • Ambulance Charges
Universal Sompo Individual Essential 3lacs, 4lacs, 5lacs
  • Health Check Up
  • Restore Benefits
  • Ambulance Charges

Why do I need Health Insurance?


Health insurance policy ensures that you would not have to bear medical bills and hospitalization expenses out of your own pocket. It comes with the dual-benefit of coverage against medical emergencies and assured tax benefit under section 80D of Income Tax Act, 1961. With increasing risk of medical contingencies and its corresponding rise in hospitalization cost, medical insurance is quite important for your family and you. It safeguards your loved ones against financial troubles, thereby assuring you for best medical facilities

What are the best health insurance companies in India in 2017?


Given the ever-increasing inflation and the cost of medical treatment in the country, having a health insurance has become increasingly important. Mediclaim policy provides policyholders with iron-clad financial protection against medical emergencies. However, the sheer multiplicity of health insurers in the Indian insurance sector can baffle even the most seasoned investors. And that’s why, here, we present to you some of the best medical insurance companies in India in 2017:

  1. Bajaj Allianz Health Insurance
  2. Apollo Munich Health Insurance
  3. Bharati AXA Health Insurance
  4. Religare
  5. Max Bupa
  6. Future Generali Health Insurance
  7. HDFC ERGO Health Insurance
  8. Oriental Health Insurance
  9. United Health Insurance

How to select the best health insurance plan in India in 2017?


Almost all health insurance companies offer a large number of health plans to make it easy for policyholders to pick the best plan according to their needs, requirements and necessities.

Here are some of the most important points that you must keep in mind when selecting the best health plan in India in 2017.

  1. Coverage Amount (Sum Assured)
  2. Entry Age and renewability clause
  3. Room rent capping
  4. Co-payment clause
  5. Inclusions & exclusions
  6. Waiting Period
  7. No-Claim Bonus

How much coverage do I need?


The term coverage in reference to health insurance means the sum assured by the policy, and the degree of coverage you need is subject to your existing lifestyle, medical background of your family, annual income, place of residence, and age.

What are the documents required for purchasing a health insurance policy?


There are no documents required as such for purchasing a health insurance policy. You may have to undergo a pre-policy medical check-up if you are a senior citizen. However, you must have a valid proof of your identity, address, age etc. when you need to file a claim with your insurer.

Note: You can always check on your insurer’s website about the documents required for purchasing a health insurance policy.

What do you mean by no claim bonus?


No claim bonus (NCB) is a discount on the base premium if no claim on the health policy is made during the policy term. This bonus is usually given in the form of a discount or enhancement of sum assured. Some insurers also add to the total at a pre-defined rate. However, more commonly NCB is offered in the form of discount on the payable total. NCB is quite attractive for a healthy person who has bought health insurance policy for emergency situations. He/she doesn’t need to make small claims at regular intervals and thus, he can enjoy NCB.  However, for a person who is suffering from chronic heart ailment, NCB is almost not applicable.

How can I exercise portability procedure on my current health insurance?


Portability can be exercised only at the time of renewing a policy, not at any time during the policy term. Switching to a new firm can be easy if you follow below simple steps.           

  1. An insured needs to send an application to port the policy to the new firm which should reach at least 45 days prior to the last day of renewal of the current policy. Though the insurance company is free to consider a proposal even if the person fails to approach them before 45 days of policy renewal, but in that scenario it will not be legally bound to consider your application. So, chances are high that your application will be rejected.
  2. Once your request is received by the new firm, they will send proposal and portability forms along with details of different products offered by it. Choose the insurance product which suits you most and fill up the proposal and portability forms and submit them to the new firm.
  3. After receiving both the forms, insurance company will approach your current firm seeking details like medical history and claim history. The data will be received through a common data sharing portal developed by IRDA for all insurance companies. The current firm will have to furnish all details about your policy within seven working days.
  4. After the new firm receives all details regarding your previous policy, he has to take a decision on underwriting your insurance application within 15 days. If the new firm fails to abide by this duration, he will be bound to accept your application.

How much does health insurance cost?

  1. Buying a health policy is not an easy task. There are various factors that collectively play an important role in deciding the total cost which you need to shell out to get cover. Young, healthy people need to pay far less for insurance than their old counterparts. Similarly, if you are buying a single policy then total payable would be low in comparison to a family health plan as the latter is a comprehensive plan that includes protection for the entire family, whereas the former covers only one. Similarly, corporate health insurance is cheap as it is similar to buy policies in bulk.
  2. The cost of medical insurance also depends upon total assured. If you opt for a higher assured total, your premium rates will increase. Similarly any rider attached with the plan increases its cost. For instance, premium rates of a basic health policy offering Rs 3 lakh to a person aged 30 years would vary between Rs 3000-4000/annum. But if you take a critical illness rider, you have to spend more 1500-2000/annum.
  3. The cost of health insurance also varies on the basis of the health condition of a person. For example, an unhealthy person who is already suffering from any pre-existing condition may need to pay higher total in the form of loading as compared to a healthy person who doesn’t need to pay the loading fees.
  4. Also, in certain scenarios, the total payable may vary from the city to city. For example, a person living in metro city may need to pay the higher cost as compared to the other person of same age and family size living in the remote area, for the same assured total.

What are the various riders and benefits available in a health insurance policy?


A rider is an add-on option that can be added to a current health policy to get additional cover. There are various riders available in medical insurance sector and some of the major ones are listed below-

  1. Critical illness rider= There are certain critical ailments, such as heart attack, paralysis, cancer, etc; for which medical expenses are too high to be covered under a regular health policy. Under critical illness rider, mostly lump-sum is paid to the person and this total is substantial for massive expenses which are involved due to critical illness.
  2. Hospital Cash= Insurer provides fixed cash on a daily basis to compensate the loss of income & meet petty expenses of the person during hospital stay
  3. Top-ups= If there is a change in the inclusion needed or paying ability increases, then it is better to opt for a top-up insurance plan than buying an individual plan. It helps in expanding the current health insurance cover.
  4. Attendant allowance= Some insurers are giving attendant allowance to accompany the insured person who is hospitalized.
  5. Co-Payment= It is the portion of the claim that a policyholder agrees to pay in the event of a claim. For a policyholder, main benefit comes in the form of low premium. The higher the ratio, the lower is the premium. A healthy person whose chances of being hospitalized are low can consider buying a policy with this deductible.
  6. Deductible= Also known as ‘excess’, deductible is the uninsured part of the claim amount which the person has to pay before the insurance company takes over and pays remaining expenses as per the policy. Since the firm shifts the small portion of risk on you, he gives you discounts on the payable total. Unlike co-payment, the person has to first pay his portion and then only firm settles the remaining portion.

What are pre-existing diseases or conditions?


Any health problem faced by one prior to seeking insurance policy is called pre-existing diseases. Insurance companies are reluctant to cover such diseases as it is a costlier affair for them.

The problem is that people with such conditions usually do not get warm welcome from insurance companies. But it should not deter you from buying a health plan even if you have any such ailment.

Every insurance company has its own conditions regarding such illnesses. Some firms prefer to check a person’s entire medical history to know pre-existing condition status, while other insurers will look for medical records over the past four years. So while choosing a policy, you should also need to compare waiting period stipulated in policies for covering such ailments.

What are the fine prints which I should know before buying health policy?


A) Buying health insurance can be a painstaking process, so you should make sure you keep below things in mind before buying a health insurance policy.

B) What’s covered and what’s not covered in the policy= No health policy includes all illnesses, so it is important to know the list of covered illnesses

c) Pre-existing diseases= Be upfront about your current health state and pre-existing diseases. Concealing information may become the reason of claim rejection.

d) When does it start= No medical insurance includes starts covering from Day 1. So it is important to know when your inclusion will start. If you will undergo medication before that time, you will not be entitled to get a claim.

e) Family or individual policy= A family insurance plan considers entire family under one plan and is cheaper than individual policy. However, it is crucial to check what happens if the main insured of the plan dies. Some policies may lapse while some won’t. Also, taking a family plan with your ageing parents would mean that most of your inclusion would go in their treatment and less inclusion would be available for the rest of the family.

f) Understand the premium= Costs of healthcare services are rising exponentially. Thus, it is important to have comprehensive health inclusion so that timely medication could be made. However, before you buy a plan, it is crucial to compare costs with the total assured total and cover. There is no sense in taking up low priced plan if it includes only a few sicknesses.

What if the insurance company refuses to settle my claim and I want to file a complaint? Or I am not happy with processed claim amount.


In order to monitor grievances and turnaround times of policyholders, IRDA has implemented the Integrated Grievance Management System (IGMS). It is a platform where policyholders can register their complaints with insurance companies first and if required, it can be escalated to IRDA Grievance Cells. You can reach IRDA Grievance Call Centre (IGCC) through-

Call - Toll free number 155255 for voice calls

Email -

Can I cancel my health insurance? If yes, will I get my premium back?


Yes, you can cancel your health insurance. A free look period of 15 days from the date of policy receipt is available to you to review terms and conditions of the policy. If you are not satisfied with the terms of the policy, then you may seek cancelation of it. In such an event, insurance company allows refund of expense done after adjusting underwriting costs, cost of pre-acceptance medical screening, etc.

What do you mean by health card?


It is a card that comes along with health insurance policy. Similar to the identity card, this card will allow you to avail cashless hospitalization.

What is the right time to buy health policy?


ASAP- As soon as possible is the perfect answer to this question. By buying at a younger age, you can enjoy low premium rates. Moreover, for critical illnesses, every firm has its own waiting period. By buying it at the young age means you get access to health inclusion when the need actually arises. So don’t wait for any accident or a medical condition to occur before you hit a panic button and buy a health insurance policy.

What is personal accident insurance?


Personal accident insurance is an annual policy that offers compensation in the event of injury, disability or death due to an accident caused by external and violent means. An accident may include events like rail/road/air accident, injury due to cylinder burst, injury due to collision, burn injury, drowning, etc.

Why should I buy critical illness cover?


A critical illness benefit complements the health insurance benefits. While mediclaim takes care of hospitalization expenses, critical illness cover is used to cover extra costs that may arise while seeking treatment for critical diseases like cancer, stroke, coronary heart disease, major organ failure, paralysis, etc.  Under critical illness, insurer agrees to pay a lump sum amount on diagnosis of dreadful diseases listed in the policy document. The lump sum amount that you get can be used for different purposes like paying for expensive treatment or recuperation aids, make up for the loss of income due to fall in the ability to earn, etc.

Imagine an individual who has been diagnosed with coronary heart disease and the patient has a health plan of Rs 5 lakh. In a regular health plan, payment is usually associated with hospitalization but what happens if total expenses connected with treatment are Rs 8 lakh, out of which hospitalization expense is Rs 5 lakh? Now who will bear Rs 3 lakh expenses (8-5) related to innumerable diagnostic pre & post hospitalization? Having a critical illness plan would give an additional amount to cover Rs 3 lakh expenses.

A critical illness plan supplements your medical insurance portfolio. The purpose of a critical illness cover is to pay for costly treatments. The scope of coverage is much wider as it covers up to 20 critical illnesses. Moreover, general insurance companies offer a critical illness cover for 1-5 years. It means, you have ample coverage for a longer duration.

What is sum assured?


Sum Assured is a pre-determined benefit paid by the insurance company. In case of an accidental death of the policyholder, the insurer pays the nominee the sum assured and the policy ceases right away. Let’s say, you buy a policy with health coverage of Rs. 5 lakh. At the time of buying, the insurer guarantees to pay, a pre-decided amount of 2 lakh to the nominee in case of your accidental demise. This 2 lakh is your sum assured.

It is one of the determinants, based on which the insurer decides the premium amount payable for a particular health plan.

What do you mean by waiting period?


The waiting period is a defined time-period that the insured has to serve to cover the pre-existing illness. No claim during this period will be accepted by the insurer except the case of an emergency hospitalisation.

If I increase my policy Sum Insured at the time of renewal, do any waiting periods apply?

With the increase of the Sum Insured, waiting periods will be applicable afresh. Let’s say if the waiting period is 3 years, a claim for the cover can be claimed only after serving 3 years from the date of inception of the policy.

What is the procedure for reimbursement settlement?


1. Inform the insurer and submit the filled reimbursement claim form within 30 days from the date of release from the hospital

2. You are required to submit all the original and duly stamped medical reports, medical bills and hospital bills with the claim form. Registration number of the hospital is required to be mentioned in the hospital bill.

3. A discharge card, which ensures that you are medically fit, is to be submitted to the insurer as well.

4. Doctor’s follow-up prescription should also be submitted at the time of filing a claim. For a post-hospitalization expense to be covered, you can submit the bills within 60/90/120 days from discharge, as per your insurer’s norms.

5. Keep copies of all submitted documents for future reference and retain them all. The insurer will follow you once the claim is registered and he/she will further guide you. Usually, a claim is settled within 2-3 weeks after it is registered.

Does a health insurance plan cover maternity?


One can add maternity benefits as an add-on or a rider with his/her main health insurance policy. However, some corporate organisations offer maternity benefits with their group health insurance, while some prefer to offer maternity as an add-on cover. But some best health insurance plans that cover maternity include

1. Royal Sundaram Master Product – Total Health Plus

2. Apollo Munich Insurance – Easy Health Family Floater

3. Cigna TTK Health Insurance – ProHealth Plus Plan

4. Star Health Wedding Gift Pregnancy Cover

Is medical checkup necessary before buying a policy?


Pre policy medical checkup is mostly applicable on higher age bracket or people having past medical history and opting for high sum insured. However, it is in our best interests to undergo medical test at the time of buying a policy to ensure the fast and efficient claim settlement.

What are the minimum and maximum policy durations?


You have the option to buy medical insurance either for 1 year, 2 years or 3 years. Buying it for 2 years entitles you to get discounts.

Can my friend buy a health insurance policy if he/she is not an Indian National but living in India?


Yes, foreigners living in India can apply for health insurance policy. However, coverage would be applicable within India only.

Do health insurance policies cover diagnostic charges like X- ray, ultrasound or MRI?


A health insurance policy covers diagnostic charges like X ray, ultrasound, blood tests or MRI, only if a patient stays in a hospital for at least one day. Any diagnostic test which doesn’t lead to treatment or those tests which have been prescribed to outpatients are not covered.

When should I make a claim?


Much like car insurance, you need to assess your medical cost and compare it with bonus amount to decide whether it would be wise to make a claim or not. For instance, if you have been hospitalized for one day and total medical bills comes to Rs 5000 only. Calculate the NCB for which you are eligible. If the bonus amount is more than Rs 5000, it is advised to pay for medical bills yourself and then earn NCB.

What happens to the policy after the claim is filed?


After a claim is filed and settled, the coverage amount would be reduced by the sum that has been paid. For instance, in January, you start a health policy with Rs 10 lakh coverage and in May, you make a claim of Rs 5 lakh. The coverage available to you for June-December would be the balance amount i.e. Rs 5 lakh.

Do insurance policies cover outpatient expenses also?


Most of the insurance companies have a mandatory requirement of 24 hours hospitalization. However, insurance companies like ICICI Lombard, Apollo Munich, Cigna TTK and MAX Bupa cover OPD (outpatient department) expenses in their base mediclaim policy, while companies like National Insurance offer an OPD cover as a rider at an additional premium.

Can I take policy for my kid who is 3 years old?


Usually children are not covered individually in a policy but can be covered by either of the parent in their own health policy.

How will the no claim bonus be affected in Apollo Optima Restore plan if the claim has been made after few years?


If you get a no claim bonus in your Apollo Optima Restore plan and a claim is made in the subsequent policy year, the company will decrease the multiplier bonus by 50% of the basic sum insured in the following policy year. However, this reduction will not be below basic sum insured.

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