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Health Insurance Guide – Key Sections
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Overview
Plans & Coverage
Buying Guide
Premiums & Claims
What is Health Insurance?
In simple terms, when you buy health insurance, you get a financial cover up to a certain amount for the medical expenses you may incur in a year. It covers emergency and planned expenses for hospitalisation, day care treatments, surgeries, pre & post-hospitalisation, and ambulance charges. Hence, a right health insurance policy helps you ward off unnecessary financial burden when a medical situation or emergency arises. Moreover, it also offers tax savings under Section 80D of the Income Tax, 1961 on the premium amount paid by you.
Directly From Experts
Sarbvir Singh
Joint Group CEO
We understand the emotional and financial havoc a medical situation can create in a family. Hence, at Policybazaar, health insurance is not merely a product – it is a promise to stand beside families when life takes an unexpected turn.
This promise is now more relevant than ever as the treatment costs are doubling roughly every 7 years, but 48% of policyholders in India still have coverage below ₹5 lakh, which is far below what modern healthcare demands.
We believe bridging this gap is our responsibility. Hence, we strive to do everything to empower people with the right information and guidance to protect their savings and secure their future.Read more
How Health Insurance Works in India
Let’s understand how health insurance works with a real-life example.
Karan, a 26-year-old from Lucknow, has no pre-existing diseases. But he wants protection against future medical expenses.
He purchased a ₹10 lakh health insurance policy for a premium of ₹426 per month.
After 3 years, Karan was diagnosed with dengue and was hospitalized for a week, generating a bill of ₹5 lakh.
Since Karan had opted for cashless hospitalization, his insurance company paid his hospital bill.
Karan still has ₹5 lakh left in his sum insured limit and can raise another claim up to this amount before renewals.
Hence, as seen in the example above, health insurance in India works by providing financial protection to insured against medical crises in exchange for a small premium. It is a great way to keep yourself & your family covered against the rising cost of medical expenses.
What are the Key Benefits of Buying Health Insurance Plan?
With the rising healthcare costs and increasing lifestyle diseases at an early age, the only way to afford quality medical treatment during a health emergency is by buying a health insurance policy. Take a look at some of the top reasons to buy a health insurance plan.
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Protect Your Savings
If you get hospitalized for a critical illness or lifestyle disease, you may end up losing all your savings in one go. A mediclaim policy helps you to protect your hard-earned savings by covering your medical expenses so you can stay financially protected.
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Avail Cashless Hospitalization Facility
A health insurance policy allows you to obtain a cashless hospitalization. This means you can focus on obtaining medical treatment rather than arranging the finances.
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Fight off Medical Inflation
Increasing medical costs make healthcare treatments expensive. The cost can rise more than you estimate, creating a financial burden at the time of a health crisis. A health insurance policy can help you easily pay your medical bills, despite the rising medical costs.
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Get Quality Medical Treatment
It helps you to afford the best quality medical treatment and care at top network hospitals, which could be costlier without a health insurance plan.
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Fight Lifestyle Diseases
It allows you to manage expenses for the long-term treatment of diseases like cancer, heart ailments, etc., that have been on the rise with the changing lifestyles.
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Get Tax Benefits
You can save tax on the health insurance premium that you have paid under Section 80D of the Income Tax Act for better financial planning.
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Ensure Peace of Mind
It allows you to obtain medical treatment with peace of mind and focus on recovery rather than worrying about paying hefty hospital bills.
Health Insurance Buying Checklist
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Waiting Period
You should buy a health insurance policy with a minimal waiting period. The lower is the waiting period, the sooner you will be able to avail coverage. You should go through the policy terms & conditions carefully and check the waiting period before buying a policy.
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Co-payment
You should opt for a health insurance plan with no co-payment. Without co-payment, you will not have to make any out-of-pocket expenses for each claim. You can check the policy documents to know about any applicable co-payment before buying the policy.
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Restore Benefits
You should purchase a health insurance plan that offers 100% restore benefits. With restore benefit, your sum insured amount will be fully restored as soon as it gets exhausted after a claim. You can check the policy documents to know if the restore benefit is available.
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No Claim Bonus
You should pick a health insurance plan with the maximum No Claim Bonus/Cumulative Bonus for every claim-free year. The higher is your No Claim Bonus, the higher will be the increase in your sum insured. You must read the policy documents before buying to know about NCB.
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Sub-limits
You should buy a health insurance plan that comes with no sub-limits. Without sub-limits, you will be free to raise a claim up to the sum insured amount. You can go through the policy wordings to find out about any applicable sub-limits under the health plan.
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Preventive Health Check-up
You must choose a health insurance plan that offers free preventive health check-up facilities every year. With this benefit, you don’t need to pay for annual medical examinations. You can check the policy benefits while buying to know about preventive health check-up facilities.
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Network Hospitals
You should choose a health insurance company with the largest network of hospitals in India. The more is the number of network hospitals, the more likely you are to avail cashless treatment in your locality. You can check the network hospitals’ list before buying a health policy.
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Grace Period
You should buy a health insurance policy that offers the maximum grace period. A bigger grace period gives you more time to renew your policy after the due date has passed. You can read the policy wordings to find the exact grace period available under the policy.
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Why Should You Buy Health Insurance Online?
Buying a health insurance policy online comes with several benefits. Take a look at them below:
Easier to Compare Plans
It is easier to compare health insurance plans from different insurers online at websites like Policybazaar.com to make an informed decision.
Online Discounts
It allows you to avail discount on premiums for buying the policy online.
Minimal Paperwork
The process of buying a health insurance policy online involves minimum to zero paperwork.
Digital Payment Options
It allows you to avoid cash payments and use digital payment methods to pay the premium online safely.
More Convenient
It is more convenient to buy the policy online as you do not have to visit the branch of the insurance company or take an appointment to meet an insurance agent.
Lower Premiums
Health plans are available for a lower premium online as insurance companies save a lot on operational costs.
Policy Available 24x7
A health insurance policy can be purchased online any time of the day, even on public holidays, which is not possible in offline buying.
Time-saving
It saves you a lot of time as the policy is issued within a few minutes of buying.
What’s Covered & Not Covered in a Health Insurance Plan
It is important to know what your health insurance policy covers and what it does not. Here are the general inclusions and exclusions in a standard health plan:
Covered in a Health Insurance Plan
Most health insurance plans in India cover the following medical expenses:
In-patient Hospitalization Expenses
The hospitalization expenses incurred during the treatment of an illness or injury are covered, provided the hospitalization is for more than 24 hours.
Pre-existing Illnesses or Diseases
After the completion of the waiting period, you can file a claim for the expenses incurred on the treatment of any pre-existing illness or condition.
Pre and Post Hospitalization Expenses
Medical expenses incurred on blood tests, x-rays, and other medical check-ups required before hospitalization are covered. Similarly, the cost of medicines, and diagnostic tests and follow-up consultations after discharge from the hospital is also covered.
Ambulance Charges
Although the coverage amount varies from insurer to insurer, most medical insurance plans cover emergency ambulance charges.
Maternity Cover
Medical expenses incurred during the pregnancy and delivery are covered along with newborn baby expenses under most health insurance plans.
Preventive Health Check-ups
Regular preventive health check-up facilities are also made available in most health insurance plans in India on an annual basis.
Day-Care Procedures
Day care treatments, including eye surgery, chemotherapy, dialysis and tonsillectomy, that require hospitalization of less than 24 hours are covered.
Home Treatment Cover
It covers expenses incurred on getting medical treatment at home on a doctor’s advice that would have otherwise required hospitalization.
AYUSH Benefit
A health insurance plan also pays for the hospitalization costs incurred on availing Ayurveda, Unani, Siddha, Yoga or Homeopathy treatment up to the specified limit.
Mental Healthcare Cover
All health plans in India cover mental illnesses as per the Mental Healthcare Act, 2017. IRDAI had made it compulsory for all insurers to cover in-patient treatment of mental illnesses, like acute depression, bipolar affective disorder, schizophrenia, etc. from 31st October, 2022.
Not Covered in a Health Insurance Plan
The following medical expenses and situations are usually not covered in a health insurance plan:
Injuries Caused by War/ Nuclear Activity
It does not cover treatment of injuries caused due to terrorism, war-like situations and use of nuclear or biological weapons.
Self-inflicted Injuries
Illnesses or injuries arising from self-harm or suicide attempts are not covered in health insurance.
Cosmetic/Plastic Surgery
A health insurance plan usually does not cover expenses incurred on plastic surgery or cosmetic procedures, unless medically necessary.
Treatment for Alcoholism or Drug Abuse
Treatment for addiction of alcohol or any other substance or their consequences is not covered.
Unproven Treatments
Expenses incurred on treatments whose efficiency have not been proven through medical documentation are not covered.
Injuries due to Adventure Sports
It excludes the treatment of injuries resulting from adventure sports activities, like mountaineering, rafting, horse riding, etc.
Infertility Treatment & Sterility
Assistive reproductive treatments, like IVF and GIFT, gestational surrogacy and sterilization are usually not covered under health insurance plans.
External Congenital Anomaly
Expenses incurred on evaluation or treatment of physical abnormalities present from birth, such as cleft lip and clubfoot, are not covered.
Investigation & Evaluation
It does not cover expenses for hospitalization done only for the purpose of investigation or diagnostics, without any medical treatment being done.
Note: It is recommended to check your policy wordings to get a detailed list of exclusions.
Types of Health Insurance Plans
Suitable to cover the medical expenses of the entire family in a single policy
Designed to cover the medical expenses of senior citizens aged 60 years and above
Ideal for pregnant women to cover medical expenses during pregnancy and childbirth
Pays a lump sum amount on the diagnosis of critical illness like cancer, stroke, etc.
Designed to pay compensation in case of accidental death or disabilities
List of Best Health Insurance Plans in India
| Name of Health Insurance Plans | Sum Insured | Entry Age |
|---|---|---|
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2 lakh to 6 crore | Adult: 18 years onwards Child: 91 days to 25 years |
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3 lakh to 5 crore | Adult: 18 to 65 years Child: 90 days to 30 years |
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5 lakh to 1 crore | Adult: 18 years onwards Child: 91 days to 24 years |
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50,000 to 25 lakh | Adult: 18 to 65 years Child: 90 days to 26 years |
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5 lakh to 3 crore | Adult: 18 years onwards Child: 91 days onwards |
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7.5 lakh to 2 crore | Adult: 18 to 65 years Child: 91 days to 25 years |
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. This list of plans listed here comprises of insurance products offered by all the insurance partners of Policybazaar. For a complete list of insurers in India, refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in. Read more
What is Ideal Health Insurance Coverage?
You should opt for health insurance coverage of at least 50% of your annual income. But your city of residence, age & medical inflation also impact your ideal medical insurance coverage. Experts suggest buying a health cover of at least ₹10 lakh to combat rising healthcare costs easily. Below is the ideal health insurance coverage amount for different types of medical insurance plans:
Individual Health Insurance
Tier-1 City
₹10 lakh & above
Tier-2 City
₹5 lakh to ₹10 lakh
Tier-3 City
₹5 lakh
Family Floater Health Insurance
Tier-1 City
₹30 lakh & above
Tier-2 City
₹20 lakh & above
Tier-3 City
₹10 lakh & above
Senior Citizen Health Insurance
Tier-1 City
₹20 lakh & above
Tier-2 City
₹15 lakh & above
Tier-3 City
₹10 lakh & above
How Much Cover Do You Need?
Find the ideal health insurance amount based on your lifestyle and needs.
Health insurance coverage should be tailored to your individual medical needs. However, you must consider the following three factors to decide the ideal coverage for your health insurance plan:
- City of residence (i.e., tier-1, tier-2, or tier-3 city)
- Age or life stage of the insured
- Future healthcare costs (while considering medical inflation)
For instance, if you have no pre-existing diseases and live in a tier-3 city, where the living cost is less than in metropolitan areas, health insurance of ₹5 lakh may be enough to provide financial protection against medical expenses. Similarly, if you are residing in a tier-1 city where the living costs are high or have a critical illness, you may have to increase the coverage to ₹10 or 20 lakh for better financial protection.
Alternatively, you can also opt for a ₹1 crore health insurance policy that has become extremely affordable these days. A ₹1 crore health policy can come in handy for treating a disease that requires long-term care or for medical procedures taken abroad. You can easily get a ₹1 crore health cover by paying an extra premium of approximately ₹1500.
You also have a more affordable option of purchasing a base policy with a low sum insured and adding a top-up health insurance with a high sum insured.
What are the Key Factors to Consider Before Buying a Health Insurance Plan?
There are a few factors that you should consider to make the right decision while buying a health insurance plan:
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Scope of Coverage
The policy coverage will decide the type of illnesses and surgeries that you can claim during the policy term. Closely look at the benefits offered like hospitalization expenses, daily cash benefit, COVID hospitalization cover, critical illness cover, maternity cover, etc., while choosing a health plan.
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Sum Insured
The sum insured amount is a crucial deciding factor in selecting a medical insurance policy. Looking at the ongoing inflation, it is advisable to buy a health insurance plan with a minimum sum insured of ₹10 lakh. If it’s a family floater policy or senior citizen health insurance, the higher the sum insured, the better the coverage will be.
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Policy Type
There are different types of medical insurance policies available in India. As per your requirement, you can choose to buy individual health insurance, senior citizen health insurance, family floater or critical illness plans. Moreover, you can buy top up and super top up health insurance along with your existing health plan to enhance the coverage. This is beneficial in case your base sum insured gets exhausted during the treatment.
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Waiting Period Clause
Your health insurance policy only comes into action once the initial waiting period is over. This means that a claim will be accepted only after the initial waiting period is completed except for accidental hospitalization claims. Moreover, the waiting period clause also applies to pre-existing diseases like thyroid, blood pressure, diabetes, etc. It is also applicable to specific illnesses, treatments, and maternity cover. Ensure to choose a plan with a minimal waiting period.
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Co-payment Clause
Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (policyholder). It allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Thus, opt for this clause only if you can afford to pay off a portion of your hospitalization bills, that can be 10% and above, without a financial burden.
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Room Rent Sub-limits
A health insurance plan may have various sub-limits and the most common one is the room rent sub-limit. For instance, if your medical insurance policy comes with a sum insured of ₹3 lakh with a sub-limit of 1% on daily room rent, then your room cost will be covered up to ₹3,000 per day. Any additional amount on room rent will have to be paid from your own pocket. So, choosing a health plan with no or minimal sub-limits is advisable.
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Network of Cashless Hospitals
Check the list of network hospitals for an insurance company where cashless claims can be filed. The higher is the number of network hospitals in your vicinity, the better are the chances of availing cashless hospitalization benefits.
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Lifelong Renewability Option
Medical insurance policies are usually renewed every year. When the policy term is about to end, the policyholder has to pay the insurance premium at the time of renewal in order to continue the insurance coverage. Thus, when buying a health insurance plan, choosing a plan with a lifetime renewability option is beneficial in the long run.
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Premium Loading Factor
Premium loading is the additional amount that is charged to a risk-prone customer in the premium, especially in senior citizen health insurance plans. Choosing a medical insurance plan with no loading will save you from paying a higher premium. Some insurers also charge a claim loading. This aspect, though ignored in the beginning, usually increases your out-of-pocket expenses at the time of claim.
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Check the Claim Settlement Ratio
Claim Settlement Ratio is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. A claim settlement ratio above 80% can be an ideal choice.
What are Health Insurance Riders?
Riders in health insurance are the additional coverage that you can purchase to avail extra benefits and make your health policy more comprehensive. The cost of the health insurance rider depends on your age, sum insured, type of coverage, etc. Take a look at the six most common riders that you can consider buying with your health insurance policy:
Maternity Cover Rider
The maternity cover rider can help you to get your maternity expenses covered, including childbirth, pre and post-natal expenses, etc. Some insurers may offer coverage for newborn baby expenses until the end of the policy tenure. However, this rider comes with a waiting period that may range from 9 months to 6 years, depending on the health insurer.
Consumables Cover Rider
The consumables cover rider pays for non-medical expenses incurred by the insured during hospitalization, such as cotton, bandages, prescriptions, thermometers, syringes, registration charges, gloves, masks, etc. These expenses account for approximately 10-20% of the total hospital bill but are usually not covered by insurers. With consumable cover, policyholders can significantly reduce out-of-pocket expenses while obtaining the best quality treatment.
Critical Illness Rider
The critical illness rider will ensure that your health insurance policy covers critical illnesses, such as heart diseases, cancer, etc., diagnosed for the first time during the policy tenure. It will provide you with a lump sum benefit amount irrespective of the actual medical expenses incurred during the treatment. It comes with a waiting period of 90 days & a survival period of 30 days. Most plans cover about 10 to 40 critical diseases, depending on the insurer.
Personal Accident Rider
The personal accident cover can help you get compensation from your insurer in case an accidental injury leads to your disability or death. It will pay you the entire sum insured in case of permanent total disability but only a part of the sum insured, depending on the nature of the injury in case of partial disability. It is also known as the double indemnity rider, as your family will get a death benefit in case of accidental death.
Hospital Cash Rider
The hospital cash rider enables you to get a fixed daily cash allowance from your insurer to cover incidental expenses that you may incur during hospitalization for an injury or illness. It offers twice the coverage amount for a specific number of days in case you are admitted to the ICU. The daily cash amount may vary as per the policy terms and opted coverage. However, you need to be hospitalized for at least 24 hours to activate this rider.
Room Rent Waiver
The room rent waiver ensures that your health insurance policy covers the rent for the hospital room of your choice during hospitalization. It ensures that no cap on room rent applies to you and, thus, allows you to opt for a room with higher sub-limits or no sub-limits without paying extra money from your pockets.
What's New in Health Insurance?
Zero GST on Health Insurance
The zero GST on health insurance means that policyholders no longer have to pay the additional GST that was previously charged over and above the policy premium. This implies that the medical insurance plans are now 18% cheaper.
Along with health insurance plans, riders and add-ons such as critical illness cover and personal accident cover have also become GST-free.
Current Health Scenario in India
Lifestyle diseases, like hypertension, diabetes, cancer, etc., are growing at an alarming rate in India. This surge is largely driven by poor lifestyle choices, environmental factors, stress and genetics. Moreover, these diseases, which were previously seen mostly among people in their 50s and 60s, are now affecting young adults above 30 years!.
Did You Know?
- With a 90 million diabetic population, India has been ranked as the second-largest country (in 2024) for Diabetes. (Source: 11th Edition of the IDF Diabetes, The Lancet Diabetes & Endocrinology)
- Hypertension affects about one-third of adults (28.5%) in India. (Source: National Noncommunicable Disease Monitoring Survey (NNMS) 2017-18)
Benefits of Buying Health Insurance at an Early Age
Here are some of the reasons why you should buy health insurance at an early age:
Lower Premiums
Insurers charge a lower premium at a younger age, as you are less likely to have an pre-existing disease and file a health insurance claim.
Easy to Serve Waiting Periods
It is easier to serve the waiting periods at an early age, as you are less prone to falling severely ill, resulting in a claim.
No Pre-Policy Check-up Required
Most mediclaim policies may require you to undergo a pre-policy medical check-up if you are above 45 yrs, making you more prone to discovering a medical condition.
More Plan Options
When buying medical insurance at an early age, you have more plan options and can access wider coverage, as not all plans are available to elderly people.
Build No Claim Bonus
If you buy health insurance at an early age, you can easily earn No Claim Bonus (NCB) as you are less likely to file claims frequently.
What are the Eligibility Criteria to Buy a Health Insurance Plan?
The eligibility criteria to buy a health insurance plan depend on several factors, such as your age, pre-existing diseases, etc. In most health insurance plans, the following eligibility criteria should be met:
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Age Criteria
All adults above 18 years can buy health insurance. However, the entry age for children can range from 90 days to 25 years. The actual entry age can vary from one medical insurance policy to another.
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Pre-medical Screening
Pre-policy medical check-ups are required if you are above the age of 45 years or 55 years. However, most senior citizen health plans require pre-medical tests before policy issuance.
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Pre-existing Diseases (PED) Disclosure
Any pre-existing illness is covered under health insurance after a waiting period of 1-3 years. All insurers will ask you about any existing medical conditions, like high blood pressure, diabetes, heart disease, kidney disease, etc., at the time of buying the policy.
All pre-existing diseases must be disclosed during policy purchase. Keeping it a secret may cause problems at the time of claim settlement and can even lead to rejection of your claims. Even if you are a smoker or an alcoholic, you must disclose it to the insurance company. Based on these criteria, the health insurance company decides to offer you medical coverage.
| Criteria | Specifications |
|---|---|
| Entry Age for Adults | 18 years onwards |
| Entry Age for Dependent Children | 90 days to 25 years |
| Pre-medical Screening | Required above the age of 45/55/60 years (depending on the plan) |
Why Compare Health Insurance Plans Online?
Comparing health insurance quotes online helps you choose the right health plan to suit your healthcare needs. Sometimes, it can also get confusing to select a good health insurance plan, as so many insurers offer different health insurance products with impressive features.
Thankfully, Policybazaar.com understands the confusion of the customers and offers a platform where you can compare different health insurance plans’ features, sum insured and quotes online. Here are some of the major advantages of comparing and buying a health insurance plan online. Read more
Access to Accurate Information
It offers easy access to all medical insurance policies available in the market. It also saves the buyers from dealing with insurance agents who may provide unreliable and biased information to achieve their professional goals.
Easy Comparison of Different Health Plans
Comparing different health insurance plans online is both time-saving and convenient. You don’t have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing health insurance plans, etc., are also easier online.
Find a Policy with Suitable Premiums
If a customer is looking to buy a health plan online, he/she will be able to compare the premiums of different 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
You can check an insurance company’s ability to meet your claim requests by comparing the Claim Settlement Ratio and customer reviews online. Doing so will help you get an overall idea of an insurer’s reputation and customer service, enabling you to make an informed decision.
Some Myths About Health Insurance
Before buying a health insurance policy, you must be aware of how it works. Mentioned below are some popular myths that most people believe about health insurance:
I Am Healthy, and I Don't Need Medical Insurance
Fact: Despite being healthy and taking good care of your health, there are numerous unforeseen circumstances, like seasonal illnesses, dengue, malaria, or an accident, that can hit anyone anytime. Nowadays, hospitalization expenses are not easy to pay off. Even 2 days of hospitalization in a tier 1 city would cost you somewhere between ₹60,000 to ₹1 lakh and even more (depending on the type of illness and hospital). With medical insurance, you can get financial assistance to pay for expensive hospitalization costs.
My Health Insurance Will Cover All My Medical Expenses
Fact: As per the IRDAI regulations, all health insurance plans come with a set of exclusions/limitations. It is advised to check all the policy details and the coverage offered by your insurer. This is because your insurer will only compensate for the expenses that are covered in the policy and up to the sum insured limit.
I Don’t Need to Declare My Pre-existing Diseases
Fact: It is essential to declare all your pre-existing diseases clearly in the proposal form while buying a health insurance policy. Inadequate information or non-disclosure of pre-existing diseases can lead to rejection of the claim and can lead to policy cancellation.
Smokers Are Not Eligible to Buy a Health Insurance Plan
Fact: Most smokers believe that they cannot get a health policy. But there are health insurance companies that offer medical insurance coverage to them as well. Considering the risks, alcohol consumers and smokers would need to undergo a stringent pre-medical examination and pay a higher premium to get health insurance coverage.
Medical Insurance Will Only Cover Hospitalization Expenses
Fact: Though most health insurance plans cover medical expenses for hospitalization of more than 24 hours, there are plans that do not have a cap on the duration of hospitalization. All insurers these days cover day care procedures, where hospitalization of at least 24 hours is not required. It includes cataract surgery, varicose veins surgery and similar medical procedures. Moreover, several health plans now cover OPD treatments that do not require hospitalization at all.
I Am Covered Under a Group or Corporate Health Insurance Plan
Fact: Most people rely on the health insurance plan provided by their employer. It is important to know that a group health insurance policy comes with a set of limitations. It will not offer coverage to all your family members in most cases, the sum insured will not be sufficient, or it will not cover critical illnesses. The coverage will cease to exist as soon as you quit your job. Getting health insurance coverage after retirement or quitting your job can be a difficult and expensive affair.
How to Calculate Health Insurance Premiums?
In order to keep a mediclaim policy in force, regular payment of a fixed premium amount is essential. The average health insurance cost ranges from ₹304/month to ₹2,146/month, depending on your age, gender, city, medical history, sum insured, coverage, etc. These factors vary from one person to another, thereby affecting the health insurance premiums payable by different people.
Naturally, you might want to calculate your health insurance price to figure out how much you would have to pay for a policy. Well! You can do that through a health insurance premium calculator. A premium calculator is an online tool that calculates the premium to be paid as per the information you provide, such as the preferred sum insured, the age of the insured, the city of residence, etc. At Policybazaar.com, you can calculate your health insurance premium online easily and free of cost.
Which Factors Affect Health Insurance Premiums?
With the advancement in medical facilities, healthcare costs have also increased. The main benefit of health insurance is that it offers financial security to you and your family in the event of an unanticipated serious illness or accidental injury that could drain all your savings. Here is how the cost of your health insurance policy is determined:
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Medical History
Your medical history is one of the major determinants of your health insurance premium. Almost all health insurers in India make pre-medical tests mandatory after a certain age for buying a health insurance policy. While some insurance companies don’t make medical screening mandatory, they do consider your current medical conditions, lifestyle-related health risks and the medical background of your family. That is why medical insurance premiums for smokers are higher than other people. That is why medical insurance premiums for smokers are higher than other people.
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Gender and Age
Age is another important determinant of medical insurance premiums. The premium increases as the age of the insured increases. That is why it is recommended to buy a policy at a young age because the premiums are lower for younger applicants. Elderly people are vulnerable to cardiovascular diseases and other critical illnesses, such as cancer, kidney problems, etc. For this reason, senior citizens medical insurance premiums are usually on the higher side. Also, the cost of health insurance for women is lower in comparison to the male candidates due to the lower risk of stroke, heart attack, etc.
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Policy Term
Premium for a 2-year health insurance plan will be higher than a 1-year plan. However, almost all insurance companies offer a discount on long-term medical insurance plans.
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Type of Health Insurance Plan
The type of health insurance policy you select also affects your premium. The wider is the coverage, the higher will be the premium. With the help of an online health insurance premium calculator, you can compare the premium for different health insurance plans before buying.
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No Claim Bonus
If you have not made any claim during your previous policy term, then you can earn an NCB or No Claim Bonus discount. With NCB, you can save 5% to 50% on your renewal premium, depending on the number of claim-free years. It is also one of the most important factors that is taken into consideration while calculating the policy premium.
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Lifestyle Habits
If you drink or smoke regularly, chances are high that you will be charged a higher premium. In severe cases, the insurer can also reject your medical insurance policy request.
How to File a Health Insurance Claim?
Health insurance plans offer two types of claims – cashless and reimbursement. Cashless health insurance claims allow the insured to get a treatment without any need to pay the medical bill upfront. However, in a reimbursement claim, the insured must initially pay the medical expenses themselves and later get the expenses reimbursed from the insurer.
Traditionally, cashless claims could be availed only at network hospitals of the insurance provider. However, with the 'Cashless Everywhere' feature, you can file a cashless claim at non-network hospitals up to the sum insured limit of your health insurance policy.
- Cashless Claim
- Reimbursement Claim
Under a cashless claim, the insurance company settles the bill directly with the hospital, eliminating the need for you to pay from your own pocket. Here is how the cashless health insurance process works:
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Inform the Insurer
You must first inform the insurer or Policybazaar.com about your hospitalization at a network hospital.
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For planned treatments: at least 48 hours before the treatment
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For emergency treatments: within 48 hours of the treatment
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Get Pre-authorized Approval
Submit the pre-authorization claim form along with the required documents to the insurer or Policybazaar.com (if you have purchased from us). Once approved, you can obtain the medical treatment.
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Pre-authorization: Reach the hospital’s insurance desk with your ID proof and policy details. Before the medical treatment begins, they will help you submit the pre-authorization form.
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Approval: Once the insurer reviews and approves your request, you can obtain the cashless treatment.
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Hospital Discharge
With a cashless claim, you do not have to pay the main medical bill out of your own pocket. At the time of discharge, you need to only:
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Sign the medical documents and the final claim form
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Pay for the items that are not covered under your medical plan, like toiletaries, non-medical disposals, gown, blankets, attendant’s food, etc.
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Claim Settlement
The hospital will send the medical bill for the approved amount directly to the insurance provider. The insurer will directly settle the payment with the hospital.
You can file a reimbursement claim for the treatment done at non-network hospitals. Here is how to file a reimbursement health insurance claim:
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Notify the Insurer
Notify the insurer about your hospitalization at a non-network hospital and obtain the required medical treatment.
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Pay the Hospital Bill
At the time of discharge, you must pay the medical bills upfront. Maintain a record of all the medical documents and receipts.
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File a Claim
Raise the claim with the insurer or initiate at Policybazaar.com if you have purchased from us and submit the required documents.
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Claim Decision
After reviewing the documents, the insurer will transfer the approved claim amount to your bank account.
Policybazaar Claim Process
Step 1
In case of emergency we are just a call away.
- Inform your Dedicated Relationship Manager
- Or, Call us on the 24x7 toll-free helpline 1800-258-5881
Step 2
Take care of your family, we will do the rest.
Our claim specialists will reach your location & complete the formalties from filing the claim to documentation to coordinating with insurer, TPA & hospital.
What are the Documents Required for Health Insurance?
Take a look at the list of KYC documents required to buy or renew health insurance in India:
- For Buying Health Insurance
- For Filing Reimbursement Claim
-
Identity Proof
Aadhaar Card, Voter ID, Passport, PAN Card, Driving License
-
Age Proof
Birth Certificate, 10th Marksheet, Aadhaar Card, Voter ID, Passport PAN Card, Driving License
-
Address Proof
Aadhaar Card, Passport, Ration Card, Telephone Bill, Electricity Bill, Voter ID, Driving License
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Medical Reports
-
Passport-size Photographs
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Duly filled and signed claim form
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Doctor’s prescriptions for hospitalization, medicines and diagnostic tests
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Original hospital documents, including final and detailed hospital bill, discharge summary and investigation reports
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Hospital bill payment receipts
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Copy of the health insurance policy
-
Valid photo ID proof
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Valid proof of named bank account, such as cancelled cheque, passbook and bank statement
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FIR (First Information Report) or MLC (Mefdico-Legal Certificate), in case of accidental cases
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Any other document(s) asked by the insurer
How to Buy the Right Health Insurance Plans Online from Policybazaar?
Buying health insurance can be easy if you approach the right channel. Having said this, Policybazaar.com can be a good platform for choosing the right insurance policy as it has made the process of comparing & buying health insurance policy easier in comparison to earlier days. A person has easy access to complete details of almost all health insurance plans available in the Indian insurance market at a competitive price. Moreover, the post-sale services are extended to the customers online as well as at the time of a medical insurance claim.
Steps to Buy a Health Insurance Plan Online from Policybazaar
To get insured from the comforts of your home, you can buy health insurance online from Policybazaar Insurance Broker Private Limited by comparing numerous health insurance plans and making online payments. Here is how you can buy a health insurance plan online from Policybazaar.com:
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Select your gender and choose the family members to be insured, along with their age.
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Enter personal details, including city, full name and phone number and pre-existing diseases.
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Compare different health insurance plans on Policybazaar.com, and choose the one that best suits your requirement.
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Once the plan is selected, pay the premium or speak to our customer care representative.
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After you buy the health insurance plan, the policy copy will be emailed to your registered email ID.
How Policybazaar Helps NRIs with Health Insurance Plans?
Policybazaar offers health insurance for NRIs to cover the medical expenses incurred by Non-resident Indians and their families in India. Policybazaar provides an exclusive NRI Care Program that provides:
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30 minutes on-ground claim support in 120+ cities
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24x7 emergency assistance
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Priority concierge services
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One-click emergency, hospitalization & ambulance support
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Dedicated relationship manager
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Home care and teleconsults
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Comprehensive healthcare management services to the families of NRIs living in India
Policybazaar provides easy comparison of multiple mediclaim policies for NRIs and their families from different insurers online to find the policy that best fulfils their health requirements. Moreover, it provides premium elderly caregiving to the parents of the NRI in partnership with EMOHA Elder Care and provides OPD and wellness services with their Visit app.
Common Health Insurance Terms
Take a look at some of the most common health insurance terms that you may come across.
-
AYUSH Treatment
AYUSH treatment refers to medical treatments taken through Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy system of medicines. Several health insurance plans cover AYUSH treatment costs.
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Bariatric Surgery
Bariatric surgery or weight-loss surgery refers to the surgery performed to treat obesity or reduce the weight of a person. A lot of health insurance policies offer coverage for bariatric surgery.
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Claim
Claim refers to the request made to the insurance company by the policyholder to pay the medical expenses incurred on an illness or hospitalization under the health insurance policy. In the absence of a claim, you will have to pay for the medical expenses on your own.
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Co-payment
Co-payment refers to a fixed percentage of the claim amount that the policyholder has to pay at the time of claim settlement. Opting for a co-payment can help to reduce your premium amount.
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Coverage
Coverage refers to the extent of benefits available under a health insurance policy. The wider is the coverage, the more will be the benefits offered under the policy.
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Cumulative Bonus
Cumulative bonus refers to an increase in the sum insured amount without a hike in premium as a reward for not raising a claim in the previous policy year.
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Day Care Procedures
Day care procedures refer to those medical procedures and surgeries that are performed using advanced medical technology and require hospitalization of less than 24 hours. Almost all basic health insurance plans offer coverage for day care procedures. For example, cataract surgery.
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Deductible
Deductible refers to a fixed amount that the policyholder agrees to pay towards the incurred medical expenses before raising a claim with the insurance company. It is a part of the total claim amount. Once the deductible is paid, the insurance company will pay for the remaining medical expenses claimed by the policyholder.
-
Dependent
Dependent refers to the family members of the policyholder who can also be covered under the same health insurance policy. It usually includes your legally wedded spouse, children, parents and parents-in-law.
Health Insurance for Other Diseases
FAQs About Health Insurance
General
Coverage
Premium
Claims
Renewal
-
Q: What are the discounts available in Policybazaar in a health insurance policy?
Ans: Health insurance plans available at Policybazaar offer various kinds of discounts to people. You can avail family discount, long-term discount, loyalty discount as well as online discount while buying a health insurance plan on Policybazaar, depending on the policy terms and conditions. Moreover, you can also avail no claim bonus during policy renewals at Policybazaar if you have not raised any claims in the last policy tenure. -
Q: What is the right age to buy health insurance?
Ans: There is no right or wrong age to buy a health insurance policy. However, it is suggested to buy it as early as possible to keep your premium low. The earlier you buy health insurance, the lesser would be the premium. This is because you have a lesser risk of health issues at a young age as compared to someone who is in their mid-50s or 60s, as they are more prone to critical illnesses. Therefore, if you buy health insurance in your 30s, you will be able to avail maximum insurance benefits that too at a lower premium. -
Q: Is a medical test mandatory to buy a health insurance policy?
Ans: Medical tests are not mandatory before buying a health insurance policy. However, most health insurance companies in India require medical test reports if the age of the applicants is above 45 years. The type of medical tests required can vary depending on the age of the applicant and the insurer’s requirement. -
Q: What does cashless hospitalization mean in a health insurance policy?
Ans: Cashless hospitalization means that the in-patient treatment charges availed by the insured are paid by the insurance company directly to the hospital. All insurance companies in India have a tie-up with a large network of hospitals where the insured/policyholder can avail cashless treatment for an illness or accidental injury. -
Q: At what age can I include my children in my health insurance plan?
Ans: You can include your children in a family floater policy from day 1, provided the child is at least 90 days old. In maternity insurance plans, newborn babies are covered from day 1 if the maternity claim was paid by the insurer. Nonetheless, you are advised to go through the terms and conditions of a health plan carefully to know about the entry age for children. -
Q: What is a freelook period in health insurance?
Ans: A free-look period in health insurance refers to the period of the first 15 days of the policy commencement. During this period, you can review your health insurance policy features, coverage, etc. and decide if you want to continue with it or not. You can also opt for add-on covers during this period. If you decide to discontinue the policy during this period, you will not attract any cancellation fee. -
Q: What is the sum insured in health insurance?
Ans: Sum insured refers to the maximum amount that the insurance company pays to the policyholder during a policy year in case a claim is raised due to an illness or accidental injury. It is also referred to as maximum coverage or coverage amount under health insurance. -
Q: What are pre-existing diseases or conditions?
Ans: Any health problems or illnesses diagnosed prior to buying a health insurance policy are called pre-existing diseases. Insurance companies are reluctant to cover such diseases as it is a costlier affair for them. Therefore, pre-existing diseases are covered mostly after a waiting period of 2 to 4 years. Besides, every insurance company has its own terms & conditions regarding such illnesses. While some companies prefer to check a person’s entire medical history to know pre-existing condition status, other insurers look for medical records over the past four years. -
Q: Can a person have more than one health insurance policy?
Ans: Yes, you can buy more than one health insurance policy in India. For example, if you are covered under a corporate health plan, then you can get an individual or family floater health insurance policy as well. Similarly, if you already have individual health insurance, you can get another top-up health plan or a senior citizen health insurance plan for your parents. -
Q: I have my employer's group policy; do I need to buy a separate health insurance plan?
Ans: Yes, you must buy a separate health insurance policy in addition to your employer’s health insurance policy for better coverage. The sum insured under an employer’s health insurance is usually between ₹2 lakh and ₹5 lakh, which might not be sufficient under the current medical inflation. To cover the various expensive treatment costs, it is important to have a separate health insurance plan of a minimum of ₹10 lakh. -
Q: How to add my family members to my existing medical policy?
Ans: You can add your family members to your health insurance policy at the time of renewal or at the time of purchase. You, your spouse, dependent children, parents and parents-in-law can be covered in a family health insurance plan as per its terms & conditions. -
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 only 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. -
Q: Can my friend buy a health insurance policy if he/she is not an Indian national but is living in India?
Ans: Yes, foreigners living in India can apply for a health insurance policy. However, the coverage will be applicable within India only. -
Q: What if I already have a health insurance policy but just want to increase my sum insured?
Ans: If you want to increase the sum insured of your existing health insurance policy, you can do so at the time of policy renewal. In case sum insured enhancement under your ongoing policy is not possible, you can buy a top-up plan or another health policy to extend the scope of coverage. -
Q: What are pre and post-hospitalization expenses in health insurance?
Ans: Pre-hospitalization expenses refer to the medical expenses incurred before getting admitted to a hospital. Post-hospitalization expenses refer to the cost of follow-up tests and consultation treatment charges incurred after getting discharged from the hospital. Health plans in India mostly cover pre-hospitalization expenses for up to 30 to 60 days and post-hospitalization expenses for up to 60 to 90 days, depending on the plan. -
Q: Which is the best health insurance?
Ans: The best health insurance for one person may not be the best for another person. This is because buying a good mediclaim policy depends on multiple factors, such as your age, medical history, premium, coverage, sum insured, etc. To find the best health insurance, you must compare different health plans online on Policybazaar.com and choose the one that best fulfils your health needs. -
Q: What is called health insurance?
Ans: The contract between an individual and an insurance company is called a health insurance policy if the insurer promises to pay for the insured’s medical expenses in exchange for a regular premium. -
Q: Is health insurance only for 1 year?
Ans: No. Health insurance plans in India are available for a policy tenure of 1 year, 2 years, 3 years, 4 years and 5 years. However, the exact policy tenure can differ from plan to plan. -
Q: How to start health insurance?
Ans: You can start the process of buying a health insurance policy by visiting Policybazaar.com and comparing different plans to choose the one that best meets your health needs. You can also call your insurance experts on 1800-208-8787 to get assistance in buying a medical insurance policy. Once you choose the plan, you need to fill out the proposal form and pay the premium amount online. The insurer will issue the policy and send you the policy document. -
Q: At what age health insurance is valid?
Ans: People of all ages can be covered under health insurance, including adults, children and senior citizens. However, to buy a mediclaim policy for children, the proposer must be an adult, or the parents should also be covered in the policy. -
Q: Is income proof required for health insurance?
Ans: No. Most health insurance companies do not require income proof from the applicant at the time of buying the policy. -
Q: How to choose a health insurance policy?
Ans: You can choose a health insurance policy by identifying your health needs, choosing an adequate sum insured, comparing multiple plans online on policybazaar.com based on coverage, premium & benefits and choosing the policy that best fulfils your needs. Besides, you must consider the coverage, sum insured, waiting period, co-payment clause, sub-limits, premium, etc., before finalizing a policy. -
Q: Should I buy health insurance?
Ans: Yes. You must buy a health insurance policy to stay financially protected against any unforeseen and planned medical treatments. It pays for your medical expenses, safeguarding your savings, in exchange for a nominal premium at regular intervals. Moreover, you can earn tax benefits under Section 80D of the Income Tax Act, 1961. -
Q: Can a 70-year-old get health insurance?
Ans: Yes. Several health insurance plans are available for people aged 70 years. However, the issuance of the policy may depend on the pre-existing conditions of the senior citizen and the underwriting guidelines of the insurance company. -
Q: Can I buy insurance in EMI?
Ans: Yes. Many health insurance companies allow policyholders to pay medical insurance premiums on EMI. -
Q: Is a PAN card mandatory for health insurance?
Ans: No. A PAN card is not mandatory for buying health insurance. Insurers may ask for your PAN card only to confirm your identity and age. -
Q: Can I buy an insurance policy without an agent?
Ans: Yes. You can buy a health insurance policy directly from the insurer or from insurance broker websites like policybazaar.com without involving an agent. -
Q: Which insurance has no waiting period?
Ans: All health insurance plans come with an initial waiting period of 30 days, except for accidental claims. However, if your policy comes with day 1 coverage for pre-existing diseases, then no waiting period will apply for such claims. -
Q: How many years do we need to pay for health insurance?
Ans: You can pay your health insurance premium as long as you want your policy to stay active. When you stop paying the premium, your medical coverage will lapse, and you will no longer be able to claim any medical expenses. -
Q: Can I insure my husband?
Ans: Yes, you can buy a health insurance policy for your husband. -
Q: Can I buy insurance for my sister?
Ans: Yes. Several health insurance plans allow you to buy a mediclaim policy for your sister by adding her to your family health policy.
Health Insurance Companies Companies
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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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