Health Insurance – A Quick Guide

In-Patient Treatment

It is the case wherein the patient has been admitted in the hospital for more than 24 hours. Typically it provides a cover for room rent, boarding expenses, ICU, doctor’s fees, medicines, diagnostic procedures etc.

Pre-Hospitalization

Pre-hospitalization covers the expenses under diagnostics, medicines and consultation in reference to the treatment received before hospitalization. All these medical expenses incurred due to illness are reimbursed when the claims are accepted by the insurer. This cover is valid for 30 days prior to hospitalization.

Post-Hospitalization

Once the insured is discharged, the post-hospitalization expenses in relation to the treatment are covered under this section. This cover is valid for 60 days post hospitalization. It includes the cost of medicines and consultancy etc.

Domiciliary Hospitalization

At times, the insured needs to get medical treatment at home. Such a treatment is allowed only under the following two reasons –

Could not be transferred to a hospital, or
The hospital bed was unavailable

All sorts of medical expenses incurred during such treatments are covered under domiciliary hospitalization. The pre-requisite for this cover is that the patient needs to get a doctor’s recommendation and his illness should continue for at least 3 days.

Diseases not Covered Under Domiciliary Hospitalization:

Brain-related disorders (Epilepsy, Hypertension, Psychiatric or Psychosomatic Disorders etc.), diseases related to respiratory disorders (Asthma, Bronchitis, Cough and Cold, Influenza etc.), bone related disorders (Arthritis, Gout and Rheumatism) and kidney disorders (Chronic Nephritis, Diarrhoea, Dysenteries, Diabetes Mellitus etc.).

Day Care Treatment

Because of technological advancement, there are many diseases, the treatments of which do not require the patient to get admitted for 24 hours. Such cases are a part of in-patient treatment but because of the shorter time, these are categorized as day care treatment. The list of day care procedures covered may vary from one insurer to the other. Few popular procedures under this section are - cataract eye surgery; operations on the nose & the nasal sinuses; operations on the tonsils & adenoids; cancer chemotherapy; lithotripsy (kidney stone removal) etc.

Organ Donor Expenses

Donating organ is a noble cause and thus insurance companies provide a cover for the medical expenses on the treatment and recovery of the individual who volunteers to donate the organ. The pre and post hospitalization expenses of the donor are not considered under this feature, but yes all the medical expenses of the insured are taken care of by the insurer. They might not include the complications, which are likely to arise during the transplant process.

Waiting Period

When you buy health insurance, there is a waiting period of around 1 to 3 months, depending on the insurer. During this activation period, the insured is not provided with a cover for any illness apart from accidents.

Health Insurance Portability

With health insurance portability, one can change his/her insurance company without fear of surrendering the benefits of the waiting period. You can shift your company during the renewal processor when buying new insurance. It has become an integral part of health insurance from October 2011.

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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*We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.

*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

*The values taken for effective cost calculation are indicative values and may change as per the selected plan.

*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

*The scope of coverage may vary from plan to plan.

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##On ground claim assistance is available in 114 cities

Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.

STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.

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Health Insurance - A Quick Guide