Health Insurance in India

Health insurance is an agreement in which an insurance company agrees to pay for the insured’s medical expenses incurred throughout the life of the policy.  

The insurance company establishes a regular financial framework, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits indicated in the insurance agreement by analyzing the policyholder’s health risk and health system expenditures throughout the risk pool. 

Why should you buy Health Insurance?

With escalating healthcare costs, gaining access to necessary and high-quality medical treatment can be financially exhausting. To protect yourself and your family from these costs, you must enrol everyone in a reputable health insurance plan as soon as possible. Here are the top five reasons why you should acquire health insurance right now: 

To combat lifestyle diseases: The prevalence of lifestyle diseases is increasing, particularly among persons under the age of 45. Diabetes, obesity, respiratory difficulties, and heart disease, all of which are common in older individuals, are becoming common in younger people as well. Stress, pollution, poor dietary habits, technology addiction, and unstructured living are key contributors to this. 

While adopting preventative measures can aid in the fight against and management of chronic conditions, an unfortunate incident can be financially draining. Selecting Investing in a health plan that includes routine medical testing can help detect these illnesses earlier and make it simpler to manage medical bills, giving you one less thing to worry about. 

To protect your family: When looking for the best health insurance coverage, you can choose to cover your complete family under one policy rather than purchasing individual plans. Consider your elderly parents, who may be prone to disease, as well as your dependent children. If you have enough health insurance, you won’t have to worry about ensuring they receive the best medical treatment possible if something were to happen to them. Thoroughly research your options, consult with professionals for unbiased advice, and ensure you select a plan that offers all-around coverage. 

To deal with inflation: As medical technology advances and illnesses become more prevalent, the cost of treatment grows. It is also critical to note that medical costs are not restricted to hospitals. The prices of doctor’s consultations, diagnostic tests, ambulance charges, operating room bills, medications, room rent, and so on are all rising. If you are not well prepared, any of these things might significantly burden your money. By opting for an appropriate health insurance plan, you may avoid the burden of medical inflation while receiving great care without worrying about the expense. 

To safeguard your savings: While an unexpected sickness can cause emotional pain and worry, there is another aspect of coping with health concerns that can exhaust you the costs. By purchasing appropriate health insurance coverage, you may better manage your medical expenses without depleting your funds.  

Your money can be utilized for planned reasons, such as home buying, kid education Plans, and Retirement Pension Plan. Furthermore, health insurance entitles you to tax breaks, which raises your savings even further. 

Tax Benefits: Under Section 80D of the Income Tax Act of 1961, the government of India encourages health insurance by providing tax exemptions of up to ₹. 1.5 Lakh on premiums paid for health insurance plans. You may also claim a tax deduction of up to ₹. 25,000/Rs. 50,000 for health insurance policies purchased for parents over the age of 60. 

Importance of Health Insurance Plans in India

Hospitalization Expenditures: It covers any medical expenses incurred as a result of sickness prior to being hospitalized, as well as any follow-up treatment costs after being discharged.  

Pre- and post-hospitalization expenses are covered for a specified number of days, as specified in the insurance agreement. 

ICU Charges: A health insurance plan also takes care of the expense of receiving care while in an ICU. 

Ambulance Cost: It covers the cost of ambulance services used to get to the nearest hospital during a medical emergency. 

Cashless Treatments: In India, all health insurance carriers give cashless treatment at their network hospitals. If you are hospitalized to a network hospital, you do not need to worry about finding funds to pay your hospital expenses since your insurance will cover them under cashless claims. 

Day Care Procedures: It also covers the expense of receiving day care therapy that needs less than 24 hours of hospitalization. 

Pre-existing Conditions: Pre-existing conditions are typically covered after a 2 to 4 year waiting period, or as specified in the policy terms. 

AYUSH Care: It pays for medical treatment provided by the AYUSH school of medicine, which encompasses Ayurveda, Unani, Homeopathy, Siddha, and Yoga. 

Free medical Check-ups: Depending on the policy terms and conditions, most health insurance firms in India provide free preventive health check-ups to the insured at regular intervals. 

Why Should You Buy Health Insurance Online? 

Efficient: Purchasing health insurance plans online saves you time because there is no compelling reason to meet with an agent to talk about your necessities or request proposals. You should simply finish up a citation and select the most material medical coverage strategy from the choices given on your screen. 

Simple to Compare Different Health Insurance Policies: A health insurance premium calculator simplifies it to process rates and look at various coverage plans. It is likewise easy to analyze insurances on the web, instead of doing it on paper. 

Ideal Decision: When buying health insurance plans on the web, you have the opportunity to choose the most suitable one for you as well as your family. You gain admittance to all data, including strategy quotes, inclusion advantages, avoidances, and different agreements. 

No time limitations: A health insurance plan can be purchased whenever. While getting protection on the web, there are no time limits. 

Rebate Offers: Many insurance companies give discounts if you buy their policies on the web. This empowers you to have equivalent or more noteworthy advantages at a lower cost. 

Moment Coverage: When you purchase health insurance plans on the web, you get moment venture proof, which implies your inclusion begins immediately. When buying health insurances on the web, you may likewise look over a variety of premium payment choices. You can choose your favored way and pay the premium via a secured payment gateway. 

Best Health Insurance Plans In India

The following are some of the finest and most popular health insurance plans in India, as offered by various insurance firms. 

Care by Care Health Insurance

This Care Health Insurance plan is the most comprehensive health insurance plan available to families around the country. It provides coverage for 540 day-care procedures, hospitalization charges for more or less than 24 hours. Coverage for robotic surgery is also available.  

The minimum age to avail this coverage is 91 days, with no upper age restriction. Adults aged 61 and over have the option of paying a 20% co-payment for each accepted claim, with the remaining paid by the insurance provider. For sums insured in excess of ₹. 1 lakh, the policy includes an inherent maternity cover of up to ₹. 1 lakh. Pre-hospitalization coverage is available for up to 30 days, and post-hospitalization coverage is available for up to 60 days. 

Star Comprehensive Insurance Policy 

Individuals between the ages of 18 and 65 can acquire the Star Comprehensive Insurance Policy. The comprehensive family floater plan enables the policyholder to cover their entire family, including two adults and up to three dependent children aged 3 months to 25 years. The plan offers amount insured choices ranging from ₹. 5 lakhs to ₹. 1 crore. For people who obtain this coverage at the age of 61 or older, a 10% co-payment is required for each claim. This implies that every time a claim is submitted with the firm, the insured must pay a predetermined 10% of the claim, and Star Health Insurance will process the remaining claim. 

There is a 15-day free look period from the date of receipt of the policy to evaluate the policy’s terms and conditions. If the insured is dissatisfied with the plan, they will have the opportunity to cancel the insurance within the time frame specified. In this situation, the organization will complete the premium refund after calculating the costs spent during that time period. 

Companion Health Insurance Plan from Max Bupa Health

The Health Companion is a comprehensive package that may cover up to 19 family members and is designed to meet the medical needs of Indian joint families. This health insurance plan, on the other hand, is available to both individuals and families. The insurance is divided into three variations, with the sum covered ranging from ₹. 3 lakhs to ₹. 1 crore. It offers several benefits such as in-patient hospitalization, alternative therapy, organ transplantation, refill benefit, and many more. 

Reliance Health Gain Insurance Policy

This health insurance policy provides healthcare coverage for a person as well as a family for a single premium. It provides a diverse range of sums insured ranging from ₹. 3 lakhs to ₹. 18 lakhs. The plan covers adults aged 3 months to 65 years old and has a lifelong renewability option. This plan’s characteristics include in-patient treatment, pre-and post-hospitalization expenditures, donor expenses, daycare treatments, and so on. It provides a cumulative bonus of 33.3 percent increase in the total insured for each claim-free year, up to a maximum of 100 percent. 

TATA AIG MediCare Health Insurance Plan

TATA AIG Medicare is a straightforward and all-inclusive health insurance plan. In addition to in-patient, pre-and post-hospitalization expenditures paid in India, the plan covers medical expenses incurred by the insured individual for in-patient and daycare hospitalization outside India, provided the diagnosis was made in India. TATA AIG Medicare Health Insurance also covers the costs of bariatric surgery for the treatment of obesity and weight management. The plan also includes immunization coverage and compassionate travel coverage, which covers expenditures up to ₹. 20,000 for a round-trip economy class plane ticket or first-class train ticket to allow an insured person’s close family member to be by his bedside during his hospital stay. 

Aditya Birla Activ Assure Diamond Policy

Aditya Birla Health Insurance’s Activ Assure Diamond plan is a popular health insurance option for individuals and families. If you are at least 5 years old, you are eligible for coverage under this plan. The plan provides a wide range of coverage choices, with amount insured options ranging from ₹. 2 lakhs to ₹. 2 crores. The plan provides several advantages, including health returns, a 150 percent reload of the money covered, coverage for 586 childcare operations, AYUSH medical treatments, premium discounts, and local and international emergency help, including an air ambulance. Under this plan, you may additionally purchase add-on advantages like as Super No Claim Bonus, unlimited recharge, and accidental cover. 

Bajaj Allianz Total Health Secure Goal Policy

The Bajaj Allianz Total Health Secure Goal Policy is a comprehensive plan that includes hospitalisation and life insurance. The plan covers hospitalisation expenditures incurred as a result of a sickness or an accident and is available to anybody aged 3 months to 65 years. This insurance, which is available for a policy period of one year, two years, or three years, includes a lifetime renewability option. It comes in two varieties: Silver Plan and Gold Plan, with sum insured options ranging from ₹. 1.5 lakh to ₹. 50 lakhs. 

What is covered in health insurance? 

The considerations under a particular health insurance plan may differ from one plan to the next. Most Indian health insurance firms cover the following medical expenditures as part of a health insurance policy: 

• Coverage for pre-existing conditions following a four-year waiting period. 
  
• In certain circumstances, pre-hospitalization cost up to 30 days are covered. 
  
• Post-hospitalization care expenses are reimbursed for up to 60 days. 
  
• Domiciliary Hospitalization Cover i.e., the cost of home treatment if recommended by a doctor. 
  
• Alternative medical treatments like Homeopathy, Unani, Siddha, and Ayurvedic therapies. 
  
• Day-care programs and treatments that do not necessitate hospitalisation for 24 hours.
   
• The expenses of nursing and boarding costs for X-rays, drugs, pharmaceuticals, dialysis, diagnostic materials, and so on.  
  
• Medical fees, specialists’ fees, consultants’ fees, and so on. 

What is not covered in Health Insurance? 

The following costs and circumstances are not covered in a health insurance plan: 

• Any existing disease within 30 days after the policy’s inception. 
  
• Infertility tests and treatments, including in-vitro fertilisation 
  
• Cosmetic surgery treatments  
  
• Tooth therapy or surgery, eye surgery expenses, unless it’s needed as a result of an accident that required hospitalization. The expense of a dental implant is also not covered. 
  
• Any hospitalisation for the sole purpose of gathering diagnostic information. 
  
• Injuries sustained while participating in adventure sports. 
  
• Costs of weight-control operations, including surgical procedures like as bariatric surgery or obesity treatment. 
  
• Mental, psychiatric and behavioral disorders. 
  
• Intentional self-harm, such as injuries sustained during a suicide attempt. 
  
• STDs and Venereal Diseases caused by intoxication, Chewing Tobacco, Smoking, Drug or Alcohol usage,
  
• Hospitalization as a result of War, Riot, Strike, or Nuclear Weapons. 

How to Buy Health Insurance Plan Online? 

Getting a health coverage plan that satisfies your requirements in general while remaining within the budget is a straightforward and quick process. 

• Navigate through numerous websites that contain health insurance data and begin comparing the different coverage policies. Choose the plan that best suits your budget and criteria from all of the available health insurance quotes. 
  
  
• Once you’ve decided on an insurance plan, go to the company’s website and sign in, filling out the essential information. Enter your personal information, such as your name, phone number, email address, gender, city, and so on. 
  
  
• Look for the insurance policy you’ve opted to buy and read the company’s terms and guidelines. 
  
  
• Pay the plan premium online using a secure payment gateway or a payment method of your choosing, and you will get the policy paper to your registered email address. 

Key Features of Health Insurance Policy

The following are the major aspects of health insurance programs. Before shortlisting one online, it is advisable to compare these characteristics with those of similar health insurance policies. 

Sub-Limits on Room Rent: Some insurance companies provide sub-limits on room rent. This means that an insurance company is only obligated to pay a certain amount in the event of a claim. In general, this restriction is up to 1% of the total covered, with a maximum of 2% in the event of ICU expenditures. However, there are various general insurance firms that provide health insurance plans with no room rent sub limit. As a result, such programs are advised. 

Pre-Existing Diseases: Pre-existing diseases are those that you had before purchasing health insurance coverage. This is why, instead of providing coverage from day one, health insurance policies include a waiting period. During this time, no claims are permitted. As a result, you should select a health insurance coverage with a short waiting time. 

Co-Payment: A co-payment is when the insurance company and the policyholder split the cost of a claim. A co-payment can be set as a percentage or an amount. So, in order to protect your funds, you must select a health insurance coverage that does not need a co-payment. 

Network Hospital: Network hospitals are those that have agreements with health insurance companies that allow the insured to receive treatment without having to pay anything at the hospital. This feature includes the advantage of receiving cashless treatment. If your policy does not have this provision, you will be obliged to pay the hospital bills out of your own cash, and the insurance company will refund you later. 

So, while selecting a health insurance provider, go with one that has a large number of network hospitals near your home. 

What are the factors that affect health insurance premiums? 

Health-care expenses have risen in tandem with advances in medical technology. The fundamental advantage of health insurance is that it covers medical bills. It provides financial protection to you and your family in the case of unexpected major sickness or accident that might deplete all of your money.

The following is how your insurance premium is calculated: 

Medical History: One of the key drivers of your health insurance price is your medical history. Almost all health insurers in India need pre-medical testing (after a specific age) prior to purchasing a health insurance policy. While some insurance companies do not require medical screening, they do take into account your present medical issues, lifestyle-related health risks, and your family’s medical history. As a result, smokers pay a greater medical insurance premium than non-smokers. 

Age and Gender: Another major factor in determining medical insurance premiums is age. That is why it is advisable to get insurance at a young age because the premium is minimal for young applicants. Elderly persons are more sensitive to cardiovascular disease and other important ailments such as cancer, renal issues, and so on. As a result, older folks’ medical insurance premiums are often higher. In addition, the price for women’s health insurance is cheaper than for male candidates owing to the decreased risk of stroke, heart attack, and so on. 

Body Mass Index: If your BMI is higher than usual, you are more likely to have health problems. As a result, your insurance premium will be expensive. If it’s typical, you’ll pay a lower premium. 

Policy Term: The price for a 2-year health insurance plan will be more than the premium for a 1-year plan. However, practically all insurance providers provide a discount on long-term medical insurance coverage. 

Type of Health Insurance: The amount of your premium is also affected by the type of health insurance coverage you choose. The higher the coverage, the higher the premium. 

You may compare the premiums for several health insurance plans before purchasing by using an online health insurance premium calculator. 

No-Claim Discount: If you did not file a claim during your last policy term, you may be eligible for an NCB or No Claim Bonus reduction. The premium reductions, also known as a cumulative bonus, range from 5 to 50 percent based on the number of claim-free years. It is also one of the most essential criteria considered when calculating the premium cost. 

Add-On Covers: For more comprehensive coverage, you may add add-on covers to your health insurance policy. You will be required to pay an additional premium at the time of insurance acquisition to cover this. The more add-on coverage you purchase, the higher the premium you will be obliged to pay. 

How to file a Health Insurance claim? 

Health insurance policies include extra advantages such as cashless treatment and expenditure reimbursement by the insurer. One can make a claim for expenditures incurred up to the sum covered limit of the health insurance policy. The two kinds of claim processes are as follows: 

Health Reimbursement Claims: The policyholder may make a claim for reimbursement of treatment expenditures for treatments received at non-network hospitals. Once the treatment is done, the insured must settle the bill, gather all necessary documentation, and make a claim with the Insurer or TPA for reimbursement. 

Cashless Claims: If the treatment is received at a network hospital or a cashless facility, the policyholder will be entitled for cashless treatment services. When the treatment is finished, the insurance company settles the amount directly with the hospital. 

The method for both planned and emergency hospitalisation may differ for both cashless and reimbursement claims, as shown below: 

In the event of Planned/Scheduled Hospitalization

• In the event of a scheduled hospitalisation, you must notify the insurance at least 48 hours before the treatment.  
  
• Once you have received clearance from the TPA, you may file for reimbursement and cashless claims by submitting the claim form.  
  
• Also, include any other relevant papers such as medical bills, reports, discharge summaries, and so on.  
  
• In the event of reimbursement claims, the insurer pays you the claim amount once you have received permission. 

In the event of an Emergency Hospitalization

• In the event of emergency hospitalisation, you must notify your insurance within 24 hours after being admitted.  
  
• Display your health card at the hospital. Submit the pre-authorization form to obtain TPA permission for emergency hospitalisation.
    
• If the claim is granted, the insurer will settle the claim amount directly with the network hospital. 
  
• If you do not receive TPA clearance, you will have to petition for reimbursement later.  
  
• Submit any necessary documents, including hospital records, discharge bills, and so on. Following the verification, the payment will be refunded. 

Health Insurance Plan – FAQ