Health insurance policy is one of the most common types of insurance policy that offers coverage for the whole or some part of the risks of an individual leading to different medical expenses. Medical insurance is imperative if you don't want to hamper your financial portfolio.
What is Health Insurance?
Health insurance is a medical insurance policy that offers financial coverage for medical expenses when the policyholder is hospitalised. A health insurance plan covers the insured with the facility of cashless hospitalization at a network hospital or provide a reimbursement for the incurred expenses.
Health insurance plans are the insurance plans that reimburse the policyholder for their medical expenses that include surgeries, treatments, hospitalization, and injuries, or a direct payout of some pre-determined amount to the insured. Health Insurance Plans also offer coverage for cashless hospitalization facility at network hospitals during policy term.
Furthermore, health insurance cost is subsidized to the insured in the form of tax exemption under section 80D of Income Tax Act, 1961.
Medical expenses are sky-rocketing! Get health insurance policies for your medical outlay. With cashless facility, stay tension-free. Approved by IRDAI, PolicyBazaar helps you compare and find the best health plan.
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Top Health Insurance Plans in India
Insurer Name
Plan Name
Sum Insured
Network Hospitals
Religare Health Insurance
Care
Rs. 3 Lacs to Rs. 60 Lacs
4987
Max Bupa Health Insurance
Health Companion
Rs. 3 Lacs to Rs. 1 Crore
4115
Star Health Insurance
Health Optima
Rs. 1 Lacs to Rs. 25 Lacs
8341
Apollo Munich Health Insurance
Optima Restore
Rs. 3 Lacs to Rs. 50 Lacs
4721
HDFC ERGO Health Insurance
Health Suraksha Silver Smart
Rs. 3 Lacs to Rs. 5 Lacs
6402
Aditya Birla Health Insurance
Active Assure Diamond
Rs. 2 Lacs to Rs. 2 Crore
5850
Importance of Health Insurance
Health insurance in India is one of the fastest growing industries. However, this wide scope for growth indicates the limited penetration of health insurance among the Indian populace. As per the latest report released by National Sample Survey Organization (NSSO) titled ìKey Indicators of Social Consumption in India: Healthî, only 20 percent of the Indian population had health insurance coverage. Additionally, only 18 percent of the total population residing in urban areas and 14 percent of the total population residing in rural areas had any form of health insurance coverage.
Thus, there is no debating the importance of having insurance in a country like India where medical expenses are sky-rocketing. Everyone must buy a good health insurance policy that includes medical costs, hospitalisation costs, medication and laboratory test costs, including critical illness. Donít get confused with questions like ñ Which health policy to buy? Does it cover every eventuality? What illnesses are excluded from this cover? PolicyBazaar is here to resolve all such confusions.
Compare Health Insurance Plans & Save Big
It is vital that you compare health insurance plans online in order to choose the best one to meet your healthcare needs. It can get confusing to select the best health insurance policy as so many insurance companies offer different health insurance plans with varied features.
It is no wonder that sometimes, people end up with a plan that, though costs less, has contradictory clauses, and they practically get nothing when a claim is filed. On the other hand, you end up buying a plan with a higher cost just to find out later that it has features that you did not use or might never need.
Treatment costs are increasing by the day. A Health insurance policy prevents a medical emergency from turning into a financial emergency. It makes sure that one's healthcare needs are taken care of without depleting his/her savings or compromising on oneís future goals.
Benefits of Comparing Health Insurance Plans Online
Due to tight and hectic schedules these days, it has become quite impossible to visit different offices or branches of different health insurance companies in order to compare various medical insurance policies.
Thankfully, Policybazaar understands the dilemma of the customers and hence, has offered a platform where you can compare health insurance policies online. Which means, no more lines and no more lies. But, there is more.
Enlisted below are few of the major advantages of buying a health insurance plan online:
Access to Accurate Information:
Offers an easy access to every insurance policy available in the market. It also saves the buyers from dealing with agents who are known to provide unreliable and biased information most of the times.
Time Efficient and Convenient:
By comparing health insurance plans online, the users are able to save their time as they donít have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing the plans, etc., are also easier via online mode.
Pocket-Friendly:
If a customer buys a health plan via an online channel, he/she will be able to compare plans and opt for the one that fits in the budget. Also, no brokerage or agent fees are levied and hence, the buyer ends up saving a significant amount of money.
Availability of Provider/Plan Reviews:
Doing so will help you get an overall idea of an insurerís reputation, enabling you to make an informed decision.
Tips to Compare Medical Insurance Plans in India
With more than 25 insurance companies and more than 200 health insurance products in the Indian health insurance market, comparing health plans and finding the best one is not an easy task. Enlisted below are a few pointers that can help make this process easier and smoother. One must go through these tips to make an informed decision:
Focus on the Sum Assured of Your Choice
The healthcare inflation in the country is skyrocketing and is increasing at the rate of 17% to 20% annually. To cover this inflation, itís important to look for the maximum available sum assured at the best possible rate.
Provide Complete & Correct Details
Provide accurate information regarding your health in the proposal form, as any sort of inaccurate or mismatched information can make the insurer reject your claim form.
Keep in Mind the Factors That Influence the Premium
A few factors that influence the premium of a health plan include the proposerís life history, family health history, lifestyle, smoking habits, etc. These are taken in account before the premium amount is determined.
Check the Credibility of the Company
Do go through the history of the insurance company you are planning to buy the plan from. You should select a company based on the following parameters:
ICR: Incurred Claim Ratio or ICR, is the most important parameter to check for when comparing health insurance companies. Each year, it is calculated using the following formula:
When taking in account the ICR of a company, look for the average ICR of all companies on PolicyBazaar and go for the one which is closest to this average for a period of few years.
Customer Experience: You should always take heed to the mass opinion. Look for customer reviews online. If a large number of customers of an insurance company are unhappy, it may be because their customer support or after-sales service isnít up to the mark.
Find out the Claim Process: Though health insurance claim process is pretty generic over providers, knowing the nitty-gritty of the process can help save a lot of hassle at the eleventh hour.
Incurred Claim Ratio and Claim Settlement Ratio in Health Insurance
Incurred claim ratio or ICR is the net claim amounts that the insurer has paid in a year against the total net premiums earned. ICR of all the insurance providers is published by the Insurance Regulatory and Development Authority of India/IRDAI every year.
Basically, ICR is the total value of every claim that the company has paid and is divided by the total premium amount collected during the same duration.
Incurred Claim Ratio is derived by dividing Net earned premium in a year to the Net Claims Incurred in a year.
On the other hand, Claim Settlement Ratio is the ratio of the total claims settled by the health insurance provider to the total number of claims accepted in that time period.
Health Insurance Plans in India by Top Health Insurance Companies
Insurance Company
Coverage
Claim Settlement Ratio as per Public Disclosure
Effective Ratio
Waiting Period
Renewability
Network Hospitals
Max Bupa Health Insurance
4 members of the family (2 adults + 2 children)
96%
96%
4 years
Lifelong
Over 3500
HDFC ERGO Health Insurance
4 members of the family (2 adults + 2 children)
97%
99%
4 years
Guaranteed Lifelong Renewal
Over 9000+
Bharti AXA Health Insurance
4 members of the family (2 adults + 2 children)
N/A
N/A
4 years
Lifelong
Over 5000
SBI Health Insurance
4 members of the family (2 adults + 2 children)
N/A
N/A
1 to 4 years
Lifelong
Over 3000
Bajaj Allianz Health Insurance
6 members of the family (2 adults + 4 children)
98%
98%
4 years
Lifelong
Over 3700
Reliance Health Insurance
6 members of the family (2 adults + 4 children)
84%
84%
4 years
Lifelong
Over 4000
National Health Insurance
6 members of the family (2 adults + 4 children)
N/A
N/A
4 years
Lifelong
Over 6000
TATA AIG Health Insurance
Individual/ Family Floater
96%
96%
4 years
Lifelong
Over 3000
Royal Sundaram Health Insurance
Individual/ Family Floater
N/A
N/A
4 years
Lifelong
Over 3000
ManipalCigna Health Insurance
Individual/ Family Floater
91%
91%
4 years
Lifelong
Over 3000
IFFCO Tokio Health Insurance
Individual/ Family Floater
90%
90%
2 to 4 years
Lifelong
Over 3000
Aditya Birla Health Insurance
6 members of the family (2 adults +4 children)
94%
97%
4 years
Lifelong
Over 5850+
Disclaimer: The ranking of the insurance companies in this content is not in any particular order. The list is not compiled as per the IRDA ranking. Figures shown in the above table are for FY 2018-19
Types of Health Insurance Plans in India
With the increasing cost of healthcare in India, buying a health insurance plan has become almost mandatory for everyone. There are various health insurance plans readily available in India to cater to every aspect of your medical needs. However, with plenty of options, ensuring the right plan can be difficult though. Hence, the online comparison comes in handy in purchasing health insurance plan.
Below is the list of different types of health insurance plans in India:
Individual Health Insurance Plan
This type of health insurance plan provides financial coverage to an individual policyholder against certain illnesses, offering advantages like cashless hospitalisation, reimbursement, coverage of pre-hospitalisation and post-discharge expenses and various add-ons. The entire sum assured is available for only one individual.
With a family health plan, you can include your family members under the umbrella of a single health cover. Though family floater offers a higher premium than an individual plan, the expenses involved in buying separate individual plans still can be higher than this. Family floater mediclaim policies offer a fixed sum assured to the family members, which can be availed either by one or all members of a family for one or more claims during the tenure of the policy. Family health plans come are more expensive than an individual health plan.
Senior Citizen health insurance is designed particularly for anyone aged above 60 years and offers protection from health issues during old age. According to IRDAI, every health insurance firm must include people up to the age of 65 years in its plans.
This plan is usually brought as a standalone policy or as 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 related to them is also very high. A critical illness is a serious, possibly terminal, disease and is pre-defined by the provider. Most critical illness policies provide a lump-sum benefit if the insured is diagnosed with one or more of the specified terminal conditions.
Medical insurance companies today cover additional costs, including those incurred in both pre and post-natal care, child delivery (normal or caesarean), and sometimes include vaccination of newborn babies in a maternity plan. 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 her choice.
These personal accident plans are frequently offered as riders. They include hospitalisation and bear the medical outlay in the event of an accident. These are issued as fixed benefit policies, where a specified sum is paid on the occurrence of unforeseen events, such as accidents, which can result in death or disability of the person. However, the payout is not related to the sum assured.
Pre-Existing Disease Cover
After 2-4 years of policy inception, various policies begin considering pre-existing diseases, e.g. diabetes, hypertension, kidney failure, cancer etc., for claims. Pre-existing disease cover is offered for the policy-specified illness(es) that the insured had before purchasing the policy.
Preventive Healthcare
Undoubtedly, healthcare is very expensive and nobody wants to fall ill. So, now we have preventive health care that takes care of you before you fall sick. Preventive care, such as regular health check-ups, concession in X-ray fees, consultation fee etc., is offered by this policy. By offering various healthcare provisions, this plan aims at keeping you healthy. Preventive care is a medical care rendered not for a specific complaint but for 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. Apart from giving health protection, ULHPs also contribute in building a corpus that can be used to meet expenditures which are 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 a few big names. By opting for this plan, one can save a certain amount which can later be used to pay for the treatment of any pre-existing illnesses that are not covered by a normal health policy during the waiting period.
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 the 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 income 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 against any medical emergency
Family Health Plan
Coverage for senior citizen health issues
Senior Citizen health Insurance
Key Advantages & Features of Health Insurance Policies in India
The cost of healthcare in the modern days is increasing at a crazy rate while oneís earnings do not seem to match up that level. A patient looking forward to availing frequent health check-ups may no longer be able to bear the expenses associated. A comprehensive health insurance comes packed with features that can assist a person in managing expenses associated with medical emergencies and also with preventive healthcare. Understanding the following features can make purchasing a medical insurance policy easy:
Cashless Treatment: Every medical insurance organization has tie-ups with various nursing homes and hospitals across the country called 'empanelled hospitals'. If you are admitted to one of these, you donít 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 preferred because there is no stress of claim reimbursement and arranging documentation. However, if your expenses go beyond the sub-limits specified by the insurance cover or marked as ìnot coveredî by the provider, then you will have to settle it directly with the hospital. Another important thing to remember is that cashless Mediclaim is not available if one gets treatment at a hospital which is not a part of the hospital network of the insurance provider.
Coverage of Pre and Post-Hospitalization expenses: This feature of a health insurance policy takes care of both pre and post-hospitalisation fee. It takes into account the 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 insurer. This is an add-on benefit and you should opt for it while purchasing medical insurance.
No Claim Bonus: NCB (or No Claim Bonus) is a bonus provided to the insured if the no claim has been filed for any treatment in the previous policy year. The reward can be offered either as an increment in the sum assured or as a discount in the premium cost. You can avail this advantage on policy renewal.
Medical Check-Up: A Medical plan entitles the insured to receive regular medical check-ups. A 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 health insurance policy may have various sub-limits associated with it; room rent is one of those sub-limits. General Insurance Companies provide you with a maximum coverage up to the sum assured. However, they can deliberately trim down their liability by introducing the sub-limit clause in the coverage for hospital room rent. 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 your 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, 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 that are expected 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 cost of your health insurance. Medical insurance plans offer co-payment option that pre-defines the voluntary deductibles which have to be borne by the insured. So, in the event of a medical exigency, some amount is paid by the customer and the rest, by the provider. Co-payment is a cost-sharing requirement under a health policy, which states that the organization or the person will bear a certain share (in percentage) of the total admissible cost. 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 premium 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 respect to the premiums, is subject to the age of the person and there is a cap on the maximum benefit that can be availed. You can save a 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 your own, then you are eligible for tax exemption 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 todayís age provide health coverage to their employees. The health insurance offered by an employer covers hospitalization expenses of the employee and his/her family including spouse, children or parents. It is a wise decision to opt for the mediclaim offered by your company as you need not pay any premium. This comes under a group health insurance policy and the premium is paid by the employer, based on the group size and the opted benefits. However, it might be that you feel your employerís mediclaim policy is insufficient to fulfil your medical needs. Also, what if you change your job? You will no longer be a member of this plan once you leave the organisation. Hereby Hence, it is necessary to understand the policy terms thoroughly. You can communicate with the HR department regarding whatís covered and whatís not in your health insurance. Mostly, we have observed that employees are more than satisfied with their company providing health insurance, only to find out later that the plan is not sufficient. So, before itís too late, make 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, too, enjoy improved and fast insurance services. TPAs are an important players in the sector of health insurance. They have the capacity to handle all or a portion of the claims related to mediclaim insurance. They have tie-ups with the health insurers or self-insuring companies to manage services such as premium collection, enrollment, claim settlement and other administrative services. Often, hospitals and insurance companies organizations outsource health and insurance-related responsibilities to lower their burden. Similarly, an employer may prefer to provide claim resolution of the group health insurance policy via a TPA to manage various aspects of an employer-funded healthcare policy.
Factors to Consider Before Buying Medical Insurance Plans in India
There are few factors that you should consider closely to make the right decision.
Caps and sub-limits: Caps and sub-limits are the thresholds set on various policy-covered expenses. If a health policy has impositions of co-payments, sub-limits, and other caps, this would mean that there will be a policy-stated coverage offered for various expenses. At times, co-pay clause and caps help in reducing the premium of the plan. These, however, would alter the benefits in the long run. To make the most of your health insurance policy, you must understand these factors before you pay for a 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 companyís claim settlement ratio before purchasing their health plans and save yourself from unnecessary harassment in future.
Scope of cover: Donít buy a plan by just comparing health insurance premium. 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. Buying a comprehensive plan is a better option comes to your rescue when you need it the most.
Renewability: It is important to see how many years the plan proposes to protect you. It makes no sense if you are covered by a health insurance plan during your youth only to be left without a safeguard when you need it the most - during your old age. Mediclaim policies are usually annual contracts. Once the policy term ends, in the order to continue the insurance coverage, the insured has to pay a premium. This recurring process is called renewal. The policy should be renewed continuously, because if there is a break, then, the person will lose the benefits of insurance.
Cashless Hospital Network: Check if a hospital around you is included by the company you are considering to buy the plan from. You and your family wonít be required to run around collecting documents and filling reimbursements. The provider or its Third Party Administrator should have a tie-up with a range of hospitals. The insured can get admitted in any of these nursing homes without paying anything from the pocket. However, cashless mediclaim resolution is subject to limits and sub-limits, which, in turn, are subject to the sum assured of the policy.
Premium Loading: Premium Loading refers to the increase in standard premium applicable when the insurer perceives a person to be more at risk (of claiming the insurance) in comparison to others. It is strongly recommended that you check the terms and conditions pertaining to premium loading. This will save you from paying an incremented premium after 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 expedites 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 are in their 40s, 50s or 60s, then purchasing insurance only for yourself does make sense. Alternatively, if you are married with or without kids and have dependent parents, parents-in-law, siblings etc., then a family health 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, you are allowed 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 have exhausted the existing sum limit. Restoration assistance proves to be helpful for a family floater health plan, where if the entire sum assured is used in the treatment of only a single family member, the other members are not left uncovered. In such a case, the other family members can avail policy coverage for the illness other than the one for which the expenses have already been compensated by the insurer. Well, while 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 they 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 donít 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 Rs. 6 lakhs with a deductible of Rs. 2 lakhs, you are required to pay only the latter amount and the remaining 4 lakhs will be paid by the insurer. But, you can 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.
Compare Health Insurance Plans Online with Policybazaar
Policybazaar has made the process of comparing & buying a health insurance policy easier in comparison to earlier days. One has easy access to the complete details of almost all the health insurance plans available in the Indian insurance market at a competitive price.
You have the option of comparing health insurance policies from top health insurers on our website and buy the best plan. Or, let us know your basic requirements and we will find the best-suited health insurance plans for you. You can, then, compare health insurance quotes side-by-side, based on parameters like health insurance cost, add-on riders etc., and choose the best health insurance plan for yourself and/or your family members.
Policybazaar helps you sieve through numerous mediclaim and health insurance policies and zero down on the one that measures up to your needs. As Policybazaar is an unbiased portal, the first priority is to ensure customer satisfaction. The first step in this direction is the post-sales services which are extended to the customers at the time of claim as well.
Also, instead of going to different insurance websites and accessing the plan details one by one, Policybazaar can provide an insurance-seeker with the option of comparing various health insurance policies on a single page, including their quotes. The entire process is smooth and hassle-free.
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 insurance provider. An ideal policy is customizable and suites your requirements in the best way possible. Following are some common health insurance policy inclusions:
In-patient hospitalization expenses
Donor expenses, in case of organ transplantation
During injuries requiring overnight hospitalization
Pre-existing illnesses or diseases
Pre and post hospitalization
Ambulance charges
Maternity or newborn
Health check-ups
Daycare procedures
Treatment availed at home or domiciliary hospitalization
Health Insurance Exclusions
Coverage offered by health insurance policies varies with the insurer; however, certain points are not covered by health policies, and fall under the category of policy exclusions. Following are common health insurance policy exclusions:
Unless an accidental emergency, no coverage or reimbursement offered with the waiting period of the policy, usually initial 30 days.
Coverage of critical illnesses and pre-existing diseases is subject to a waiting period of 2 to 4 years.
Clear exclusion of expenses incurred for maternity/newborn unless a maternity rider has been added on.
Injuries caused by war/terrorism/ nuclear activity/suicide attempt.
Terminal illnesses, AIDS, and other diseases of similar nature.
Cosmetic/plastic surgery, replacement of hormones, sex change and more.
Dental or eye surgery.
Non-allopathic diseasesí 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 maximum coverage.
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, by comparing health plans offered by the most reliable medical insurance players in the market. Keeping your affordability in view, we hand you the health insurance premium calculator to calculate your premium and purchase the plan that suits your needs in the best possible way.
Factors That Affect Your Health Insurance Premium
With advancement in medical facilities, health care costs have also increased. The main benefit of health insurance is that it takes care of the healthcare expenses. It offers financial security to you and your family in the event of an unanticipated serious illness or accidental injuries that could drain all your savings. And hereís how the cost of your insurance premium is determined:
1. Medical History
Your medical history is one of the major determinants of the health insurance premium.
Almost all the insurance companies in India make pre-medical tests mandatory (after a certain age) before buying a health insurance policy.
While, some insurance companies donít make medical screening mandatory but do consider your current medical conditions, lifestyle-related health risks and medical background of your family.
That is why medical insurance premium for smokers is higher than other people.
2. Gender and Age
Age is another important determinant of the medical insurance premium. The premium varies based on the age of the insured person.
That is why it is recommended to buy a policy at a young age because the cost of the premium is low for young applicants.
Elderly people are vulnerable to cardiovascular diseases, and other critical illnesses such as cancer, kidney problems etc. For this reason, senior citizen medical insurance premium is usually on a higher side
Also, the cost of the premium for women health insurance is lower in comparison to the male candidates due to lower risk of stroke, heart attack etc.
3. Policy Term
The premium for a 2-year health insurance plan will be higher than a 1-year plan. However, almost all the insurance companies offer a discount on long-term medical insurance plans.
4. Type of Health Insurance Plan
The type of policy you select also affects the cost of the premium. The higher the risks involved the higher will be the premium and vice-versa. With the help of an online health insurance premium calculator, you can compare the premium for different plans.
5. No-Claim-Discount
If you have not made any claim during your policy term, then you can earn NCB or No-claim-bonus ranging from 5 to 50 percent. It is also one of the most important factor that is taken into consideration while calculating the cost of the premium.
6. Lifestyle
If you drink or smoke regularly, chances are high that you will be charged more premium amount. In that case, the insurer can also reject your insurance policy request.
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 policy ensures that one's health is secured and medical expenses are covered across a wide network of hospitals in India. One can opt for the best health insurance policy with extended coverage on the following two bases:
Individual
Family Floater
The following criteria must be fulfilled without failure:
Entry age for Adults: 18 to 65 years (70 and above, based on the plan and insurer)
Entry age for Children: 90 days to 18 years.
Policy renewability: Lifelong and subject to medical clearance
Important Points to Remember while buying Health Insurance
Buying insurance is not childís 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?
Are there any voluntary/co-payment deductible options?
Are policy exclusions mentioned in the documents?
What is the claim process like? ñ Reimbursement, cashless benefit, immediate claim settlement?
Is there any medical check-up required before proposal 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. 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, 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 claim. The insured pays the (hospital) expenses, 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, 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 insurer-issued health card at the particular hospital as a proof of medical insurance cover along with a valid government ID. Following cases considered for cashless treatment:
Planned Hospitalization:
In case of planned hospitalization, to avail health insurance benefit the policyholder needs to have TPA approval in advance along with other mandatory documents. Fill the pre-authorization form at the hospital signed by the treating doctor(s).
Emergency Hospitalization:
Show the health card issued by the insurer at the hospital along with the appropriately-filled pre-authorization form to get TPA approval for emergency hospitalization. If you fail to get TPA approval, get the expenses reimbursed later. The policyholder might have to show itemized bill, proof of medical expenses, discharge bill etc., as the proof of the treatment availed to avail claim reimbursement.
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.
Doctorsí prescriptions and medical store bills.
Claim-form with insuredís signature on it.
Valid investigation report.
Consumables and disposables prescribed by the doctors with complete details.
Bills of doctorsí consultation.
Copies of the Insurance policy from the previous year and the current year/copy of ID Card of TPA.
Any other document(s) asked by the TPA.
Some Myths about Health Insurance
Before relying on the information it is imperative to check the facts and then buy a health insurance policy. Mentioned below are some popular myths that most people believe about medical policies:
I am Healthy, and I Don't Need Medical Insurance
Despite taking good care of your health, there are numerous unforeseen circumstances like seasonal illnesses, dengue, malaria, or an accident can hit anyone anytime. Nowadays, hospitalization expenses are not easy to pay off. Even 2-days of hospitalization expenses would cost you somewhere between INR 60,000 to INR 1 lakh and even more (depending on the type of illness).
My Health Insurance will Cover all the Medical Expenses
As per the IRDA regulations, every health plan comes with a set of exclusions/limitations. It is required that you check all the policy details and the coverage that is mentioned in the plan. The insurer will only compensate for the expenses that are covered in the policy and up to the specified limit.
Declaration of Pre-existing Diseases
It is essential to declare all the pre-existing diseases in the proposal form. One must mention pre-existing diseases clearly before buying a health policy. Inadequate information can lead to rejection of the claim and can cost more than the expected amount.
Smokers are not Eligible to Buy a Health Insurance Plan
As per the survey, nearly 49% of the applicants or consume alcohol are perplexed to buy a health insurance policy. But there are insurance companies that offer medical insurance to them as well. But taking into consideration the risks, alcohol consumers, and smokers would need to undergo a stringent pre-medical examination procedure and pay a higher premium to get health insurance coverage. Medical Insurance will only cover hospitalization expense
Medical Insurance will only Cover Hospitalization Expense
Though most of the insurance plans cover medical expenses for hospitalization more than 24-hours. There are plans that have a capping on the duration of hospitalization as well. But most of the insurers these days cover daycare procedure as well, where 24-hours of hospitalization is not required. It includes cataract surgery, varicose veins surgery and similar procedure.
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 comes with a set of limitations. It will not offer coverage to your family members in most of the cases, the sum assured will not be sufficient, it will not cover critical illnesses. Also, buying a cover after retirement or losing a job can prove to be an expensive affair.
Top 10 Best Health Insurance Companies in India
In order to help you with the best and safest buying experience, weíve compiled a list of top 10 best health insurance companies in India. This list is prepared based on incurred claim ratio (ICR) and the overall financial standings of these companies. With this list, you can easily compare health insurance companies in India and pick the one that features the best health insurance plans at affordable premium rates. Letís have a look at the list below:
Star Health Insurance
HDFC Ergo Health Insurance
ManipalCigna 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
Star Health Insurance
Indiaís first standalone health insurance company, Star Health and Allied Insurance Co Ltd. was founded in the year 2006. The initial business focus was on Overseas Medicliam Policy, Health Insurance, and Personal Accident Plan but the vision has now expanded. Since then, the company has been trying to deliver innovative insurance solutions to its customers. Today, Star Health is counted among the best health insurers in India. It has more than 340 branches around the world and more than 8400 network hospitals across the country to offer cashless facilities to its policyholders. Moreover, the company settled around 3,78,710 claims in the year 2016-17. For its excellent performance, Hindustan MaRs Survey rated Star Health as the company with the best claim settlement.
Health Insurance Plans by Star Health
Family Health Optima Plan
Senior Citizens Red Carpet
Star Comprehensive Insurance Policy
Star Health Gain Insurance Policy
Super Surplus Insurance Policy
Diabetes Safe Insurance Policy
Star Criticare Plus Insurance Policy
Star Family Delite Insurance Policy
Medi-classic Insurance Policy (Individual)
Star Cardiac Care Insurance Policy
Apollo Munich Health Insurance
A joint venture between Apollo Hospitals Group, Indiaís 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.
Health Insurance Plans by Apollo Munich
Optima Restore - Our Bestselling Plan
Easy Health - An Affordable Plan
Optima Cash - Daily Hospital Cash Plan
Maxima - Our Comprehensive Plan
Optima Super ñ Aggregate Top up Plan
Optima Vital- The critical Illness Plan
Easy Health - Our Plan For Young Family
Easy Health - Our Premium Plan
NEW iCan Cancer Insurance - Covers Cancer Treatment Costs
Optima Plus - A Top Up Plan
Energy ñ The Sweetest Thing for people living with Diabetes
Dengue Care Plan - Comprehensive & Exclusive Cover for Dengue Fever
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.
Health Insurance Plans by Bajaj Allianz
Health Guard Family Floater Plane
Critical illness Policy
Extra Care Health Plan
Hospital Cash Daily Allowance Plan
Silver Health Plan
Star Package Health Plan
Tax Gain Health Plan
Critical illness for Women
Individual Health Guard Insurance
Health Care Supreme Plan
Health Ensure Plan
Silver Health Plan for Senior Citizens
Bharti AXA 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.
Health Insurance Plans by Bharti AXA
Individual health insurance
Family health insurance
Parents Health Insurance Plans
my:health Medisure Super Top Up
Critical Illness Policy
Senior Citizens Health Insurance
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 ëHealth Insurer Claims Teamí at the 2013 Claims Asia Awards. It also received the ëInnovation Leader Awardí for 2012 from Fintelekt and was adjudged the best insurance company for ëIn time Claims Settlement for the year 2011-12í 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.
Health Insurance Plans by Cholamandalam MS
Chola Swasth Parivar Insurance
Chola Tax Plus Healthline
Chola MS Family Healthline Insurance
Chola Topup Healthline
Chola MS Critical Healthline Insurance
Chola Accident Protection
Chola Hospital Cash Healthline
Chola Classic Health - Individual
Chola Classic Health - Family Floater
Chola Super Topup Insurance
Individual Healthline Insurance
Hospital Cash Healthline Plan
Chola Healthline
ManipalCigna Health Insurance
ManipalCigna Health Insurance Company Limited (formerly known as CignaTTK Health Insurance Company Limited) is a joint venture between the Manipal Group, a leader in the field of healthcare delivery and higher education in India and Cigna Corporation, a global health services company with presence in 30+ countries and serving 160 million+ customers around the world. With a deep focus on health and wellness, ManipalCigna Health Insurance offers a full suite of insurance solutions ranging from health, personal accident, major illness, travel and global care to individual customers, employer-employee, and non-employer-employee groups to meet their diverse health needs.
Health Insurance Plans by ManipalCigna
ProHealth Insurance
Lifestyle Protection Critical Care
Lifestyle Protection Accident Care
Lifestyle Protection Group Policy
ProHealth Group Insurance Policy
ProHealth Select
Global Health Group Policy
ProHealth Cash
Future Generali Health Insurance
A joint venture of the Indian conglomerate Future Group, and the Generali Group, one of the worldís 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.
Health Insurance Plans by Future Generali
Future Health Suraksha - Individual Plan
Future Health Suraksha - Family Plan
Future Hospicash - Hospital Cash
Comprehensive Plan - Health Total
Accident Suraksha - Personal Accident
Future Criticare - Critical Illness
Future Vector Care
Future Advantage Top up
Future Health Surplus - Top-Up
Surakshit Loan Bima
HDFC Ergo Health Insurance
A 74:26 joint venture between HDFC Limited, Indiaís 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 ëiAAAí 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.
Health Insurance Plans by HDFC ERGO
Individual health insurance
Family health insurance
Parents Health Insurance Plans
my:health Medisure Super Top Up
Critical Illness Policy
Senior Citizens Health Insurance
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.
Health Insurance Plans by SBI
Health Insurance
Group Health Insurance - SBI
Critical Illness
Hospital Daily Cash
Loan Insurance
Arogya Premier
Arogya Plus
Arogya Top Up
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 Indiaís 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.
Health Insurance Plans by Religare
Care (Comprehensive Health Insurance)
Enhance (Super Top Up Insurance)
Care Freedom (Health Insurance with Medical Check-up)
Joy (Maternity & New Born Cover)
Group Care (Group Health Insurance)
Secure (Personal Accident Insurance)
Cancer Mediclaim (Lifelong Cancer Protection Cover)
Heart Mediclaim (Health Cover for 16 Types of Heart Ailments)
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 Liberty 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 ManipalCigna 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
List of Government Health Insurance Schemes in India
Ayushman Bharat Scheme
The governmentís Ayushman Bharat Scheme aims to offer medical coverage to at least 50 lakh Indians. The insurance programme focuses on two aspects: One focus is to ensure health insurance cover of Rs. 5 lakhs to each family, including in-patient hospitalization expenses and tertiary care. Another focus is to develop health and wellness centers for these people. The scheme has already benefitted 10 lakh Indians. Moreover, 1.5 lakh wellness centers would be set up by December 2022.
Pradhan Mantri Suraksha Bima Yojana (PMSBY)
It is a government-of-India-backed health insurance scheme, which offers coverage against personal 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.
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 Top Health Insurance Policy 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 insurance needs of an individual to, 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.
Written By: PolicyBazaar - Updated: 04 December 2019
What are the best health insurance companies in India in 2019?
Ans:
Some of the best health insurance companies are as follows: Max Bupa Health Insurance, HDFC ERGO Health Insurance, Bharti AXA Health Insurance, SBI Health Insurance, Bajaj Allianz Health Insurance, Reliance Health Insurance, National Health Insurance, TATA AIG Health Insurance, Royal Sundaram Health Insurance, Cigna TTK Health Insurance and IFFCO Tokio Health Insurance.
You can select the one based on the incurred claim ratio, type of plans, waiting period, co-payment clause, etc.
Q:
How can I exercise portability procedure on my current health insurance?
Ans:
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.
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. 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. 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. 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.
Q:
Can I cancel my health insurance? If yes, will I get my premium back?
Ans:
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.
Q:
What do you mean by waiting period?
Ans:
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. Read more about waiting Period in details
Q:
Does a health insurance plan cover maternity?
Ans:
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
2. Apollo Munich Insurance – Easy Health Family Floater
3. Cigna TTK Health Insurance – ProHealth Plus Plan
4. Star Health Wedding Gift Pregnancy Cover
Q:
Do insurance policies cover outpatient expenses also?
Ans:
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.
Q:
When should I make a claim?
Ans:
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 no claim bonus (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.
Q:
How will the no claim bonus be affected in Apollo Optima Restore plan if the claim has been made after few years?
Ans:
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.
Q:
What do you mean by no claim bonus?
Ans:
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.
Q:
Why do I need Health Insurance?
Ans:
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
Q:
How much does health insurance cost?
Ans:
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.
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.
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.
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.
Q:
What are the various riders and benefits available in a health insurance policy?
Ans:
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-
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.
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
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.
Attendant allowance= Some insurers are giving attendant allowance to accompany the insured person who is hospitalized.
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.
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.
Q:
What are pre-existing diseases or conditions?
Ans:
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.
Q:
What are the fine prints which I should know before buying health policy?
Ans:
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.
Q:
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.
Ans:
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 - complaints@irda.gov.in
Q:
What do you mean by health card?
Ans:
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.
Q:
What is the right time to buy health policy?
Ans:
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.
Q:
What is personal accident insurance?
Ans:
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.
Q:
Why should I buy critical illness cover?
Ans:
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.
Q:
What is sum assured?
Ans:
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.
Q:
How to select the best health insurance plan in India in 2019?
Ans:
Almost all health insurance companies offer different health insurance plans to meet the needs and requirements of its different customers.
Here are some of the most important points that you must keep in mind when selecting the best health plan in India in 2019. Check the Sum Assured, Coverage limit, Entry Age and renewability clause, co-payment clause, Inclusions & exclusions, waiting Period and the No-claim-bonus. After comparing different plans on the basis of above parameters you can select the right plan.
Q:
What is the procedure for reimbursement settlement?
Ans:
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.
Q:
How much coverage do I need?
Ans:
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.
Q:
Is individual plan better than family floater health insurance plan?
Ans:
An individual health insurance plan only provides coverage for an individual, whereas a family floater plan ensures coverage for the entire family in case of a medical emergency.
However, an individual plan costs more than a family health insurance floater plan, which is why most individuals opt for family floaters.
Family floaters also offer a higher sum insured than individual health insurance plans, in case of only one claim in a year.
Q:
How does smoking affect health insurance premiums?
Ans:
The cost of getting a Health Insurance plan can be significantly higher for those who are regular tobacco users.
This is because smoking predisposes an individual to various diseases like heart complications, hypertension, respiratory issues, cancer, etc.
Though the number of smokers is higher for men, women who smoke are also prone to osteoporosis.
As a result, the premiums for health insurance are higher for smokers and tobacco users are higher than those who do not smoke.
Q:
What is covered by health insurance?
Ans:
Health Insurance provides all essential health benefits, including doctors' consultation fee, inpatient and outpatient expenses, while some insurers also cover pregnancy and childbirth-related expenses.
Q:
What is Health Insurance?
Ans:
Health Insurance Policy is a kind of insurance offering coverage for surgical and medical expenses incurred by the insured when s/he is hospitalized during the policy term. Various health insurers also offer coverage for pre-hospitalization, post-hospitalization, critical illness expenses and day care procedures to its policyholder.
Q:
What are the documents required for purchasing a health insurance policy?
Ans:
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.
Q:
Is medical checkup necessary before buying a policy?
Ans:
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.
Q:
What are the minimum and maximum policy durations?
Ans:
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.
Q:
Can my friend buy a health insurance policy if he/she is not an Indian National but living in India?
Ans:
Yes, foreigners living in India can apply for health insurance policy. However, coverage would be applicable within India only.
Q:
Do health insurance policies cover diagnostic charges like X- ray, ultrasound or MRI?
Ans:
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.
Q:
What happens to the policy after the claim is filed?
Ans:
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.
Q:
Can I take policy for my kid who is 3 years old?
Ans:
Usually children are not covered individually in a policy but can be covered by either of the parent in their own health policy.
Although I didn’t faced and claim assistance issue yet. But uptil now everything is fine after taking insurance policy for me and my family from policybazaar. I am sure if there will be any problem related to claim it will also be resolved on timely basis. As, I used to have few queries in the starting and they used to reply very quickly and resolved it too. Thank PB.
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Ashti, September 03, 2019
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