health insurance plan in india

Health Insurance Plans: Best Medical Insurance Plans in India 2020

Health Insurance

Last Updated on 03/10/2020 by NM Staff

Health Insurance is a kind of insurance that provides financial coverage against the medical/surgical expenses incurred by the insured. Nowadays, several insurance companies offer health insurance plans to their customers that provide various health benefits, including cashless hospitalization, tax benefits, coverage for critical diseases, etc.

It is important to purchase a health insurance policy since medical care is expensive and can harm your life savings. With the help of a health insurance policy, you can treat yourself or your family members in a network hospital that has a link with the insurance company and recover peacefully.

Why should you Buy Health Insurance Plan?

Health insurance is extremely necessary for every individual. However, not everybody understands the importance of the same. The following points might help you understand the importance of buying a health insurance plan in India:

1. Medical Inflation

Lately, medical costs have risen exponentially. You must be aware that medical costs have risen at a faster rate than general inflation. If you don’t have medical insurance and happen to incur a sudden medical emergency, then you might have to spend your savings including your emergency fund. 

2. Income Tax Deductions

The health insurance premiums you pay are eligible for tax deductions under Section 80D of the IT Act. People up to the age of 60 years can claim a tax deduction up to INR 25,000 if they pay a health insurance premium for themselves, their spouse, children, or parents. If you pay a health insurance premium for your parents of age 60 years or above, then you can claim a deduction of INR 50,000. 

3. Pre and Post Hospitalization Expenses

The hospitalization charges can often be sky high and not everybody can afford that. The diagnostic test costs have also risen in the ongoing situations and these make it even more necessary for you to buy a health insurance policy. 

4. Additional Coverage

A medical insurance plan also provides several benefits such as ambulance coverage, health check-up cover, vaccination cover, day-care surgeries cover, etc. Besides, you can also get coverage for alternative treatments like AYUSH.

5. Employer Cover might not be sufficient

Healthcare costs are increasing exponentially. If you compare the cost of hospitalization with the healthcare coverage provided by your company, then you will get to know that it might not be enough. So, health insurance is really necessary.

6. Change in lifestyle

Medical technology is constantly evolving. But along with it, new diseases are being discovered every other day. People expose themselves to bad eating habits, hectic work routines, bad food quality, rising pollution levels, etc. These things are ruining the health of people and also making them much more prone to a plethora of diseases. So, it is better to have a mediclaim to fight off sudden health issues.

Types of Health Insurance Plans in India

1. Individual Health Insurance Plan

Individual health insurance plans provide insurance coverage with multiple benefits like cashless treatment at network hospitals, pre and post-hospitalization costs, medical test fees, etc. Premium rates under this health plan depend upon the age of the insured.

2. Family Health Insurance Plan

Family Health Insurance Plans provides cover to all the members of a family against multiple diseases under a single premium. According to this health plan, a fixed sum assured is divided among the family members in an equal manner, which can be availed by any one individual or all the family members for one or more claims during the term of the plan.

3. Senior Citizen Health Insurance Plans

This health insurance plan provides insurance coverage to senior citizens or individuals above sixty years of age. A senior citizen health plan is specifically designed to offer protection against health issues during old age.

4. Critical Illness Health Insurance Plans

Critical illness health insurance plans offer financial coverage to the insured in case he/she is diagnosed with any critical illness like kidney failure, cancer, heart attack, etc. The premium rates of these plans are high since the medical expenses of these treatments are very high.

5. Maternity Health Insurance Plans

A maternity health insurance plan provides coverage for maternity expenses like pre and post-natal care, child delivery expenses, vaccination costs of newborn babies, etc. This health plan also covers the transportation expenses for carrying the mother-to-be to the nearest network hospital of her choice.

6. Personal Accident Insurance Plan

Personal Accident Insurance Plan covers hospitalization and medical expenses in case of an accident. A fixed sum assured amount is provided in case an unfortunate event leads to a loss of income.

7. Group Health Insurance Plan

Group Health Insurance Plan is offered by an organization to its employees that cover the hospitalization expenses of the employee and his/her family members. The premium is paid by the organization depending upon the group size and the health benefits offered.

8. Unit Linked Health Insurance Plans (ULHP)

Unit- Linked Health Insurance Plans (ULHP) offers a unique combination of both health insurance and investment at the same time. ULHPs also contribute to building a corpus fund that can be used to meet those expenses which are not covered by health insurance plans. Examples of Unit- Linked Health Insurance Plans include ICICI Pru’s Health Saver, LIC’s Health Protection Plus, Birla Sunlife’s Saral Health, etc.

Read More: Top 10 Health Insurance Companies in India

Best Health Insurance Plans in India 2020

Some of the best health insurance plans in India in the year 2020 are  stated below:

Sl. No.Health Insurance PlanInsurance CompanyIncurred Claim Ratio (ICR 2018-2019)Network HospitalsSum InsuredEntry ageWaiting Period for pre-existing illnessesPre-hospitalization CoverPost-hospitalisation Cover
1Religare Care Health InsuranceReligare55%7400+INR 4 lakhs to INR 6 croresMin: 91 days , Max: No upper age Limit4 yrs3060
2Easy Health PlanHDFC Ergo Health (formerly called Apollo Munich)63%10000+INR 1 lakh to INR 10 lakhs5 yrs to 65 yrs3 yrs6090
3Optima Restore PlanHDFC Ergo Health (formerly called Apollo Munich)62%10000+Max.: INR 50 lakhs5 yrs to 65 yrs3 yrs60180
3HDFC Ergo Health Suraksha GoldHDFC Ergo Health63%10000+INR 3 lakhs to INR 75 lakhs3 months to 65 yrs3 yrs60180
4Max Bupa Health CompanionMax Bupa55%4500+INR 3 lakhs to INR 1 croreMin: 91 days4 yrs3060
5ICICI Lombard Complete Health InsuranceICICI Lombard76%5025+INR 3 lakhs to INR 50 lakhsMin: 3 months2 yrs3060
6Bajaj Allianz's Health-GuardBajaj Allianz General Insurance Company78%6000+INR 1.5 lakh to INR 50 lakhs3 months to 65 yrs4 yrs3060
7Aditya Birla Activ Assure Diamond Health InsuranceAditya Birla Health Insurance59%5700+INR 2 lakhs to INR 2 croreMin: 91 days , Max: No upper age Limit4 yrs3060
9Royal Sundaram Lifeline SupremeRoyal Sundaram61%5000+INR 5 lakhs to INR 50 lakhsMin: 91 days , Max: No upper age Limit4 yrs6090
10Manipal Cigna Prohealth Insurance- Accumulate PlanManipalCigna62%4500+Max: INR 50 lakhs18 to 40 yrs4 yrs6090

1. Religare Health Insurance – Care Plan

Religare Care Health Insurance Plan offers you to stay insured for a sum ranging from INR 4 lakhs to INR 6 crores. It is a comprehensive health insurance plan with the main aim of safeguarding you and your family from the financial burdens of medical expenses. This plan provides cover from diagnosis to recovery.

Some of the key features of the Religare Health Insurance – Care plan are:

    • During hospitalization, the expenses incurred for availing a domestic road ambulance is reimbursed. If suggested by a doctor, certain plans also provide cover to avail of an air ambulance.
    • Expenses incurred while staying in a private or single room are reimbursed under this plan.
    • All members under this policy are eligible for an annual health check-up.
    • Under this policy, there is no upper age limit of enrolment.
Inclusions of the policy Exclusions of the policy
  • Day Care Treatments
  • Global cover via cashless network hospitals
  • Pre hospitalization expenses for up to 30 days
  • Post hospitalization cover for up to 60 days
  • Domiciliary hospitalization expenses
  • Self-inflicted injury treatments
  • War-inflicted injury, or injury arising due to riot, strike, etc.
  • Injury due to substance abuse
  • Rehabilitation costs
  • Congenital and genetic disorders

2. Easy Health Plan: HDFC Ergo Health

The Health Easy Plan was one of the top health insurance plans offered by Apollo Munich. According to international accreditation bodies and global healthcare experts, Apollo and quality health have become synonymous in India. Munich Health and Apollo Hospitals Group joined hands to bring world-class healthcare to every individual.

But now, Apollo Munich Health Insurance policy is owned by HDFC ERGO.

Some of the key features of the Easy Health Plan are:

    • Hospitalization cover of up to Rs.50 lakh is available.
    • An individual can opt for additional cover for critical illnesses.
    • In easy health premium and easy health exclusive plans, maternity is covered.
    • Pre and post-hospitalization cover of 60 and 90 days, respectively, is available.
    • Hospitalization under Ayurveda, Unani, Siddha, and Homeopathy are available.
Inclusions of the policy Exclusions of the policy
  • In-patient expenses
  • Pre-hospitalisation cover up to 60 days
  • Post-hospitalisation expenses up to 90 days
  • Day-Care Procedure
  • Organ donor expenses
  • Domiciliary treatment
  • Emergency Ambulance
  • Maternity expenses before and after childbirth
  • AYUSH benefit
  • Congenital disorders
  • Mental illnesses
  • Cosmetic surgery
  • Weight control treatments
  • Substance abuse treatments
  • Treatments within the first 30 days of policy purchase (except accidental injuries)
  • Pregnancy-related expenses
  • Dental care

3. Optima Restore Plan: HDFC ERGO Health

Apollo Munich Health Optima Restore Plan was one of the best health insurance plans in India. Apollo Munich is now HDFC ERGO but the demand for this health policy remains the same.

You can purchase this policy if your age is in the range of 91 days to 65 years. You can have a sum insured of INR 3 lakhs to INR 50 lakhs, under this plan.

This plan has several benefits like domiciliary treatment, air ambulance cover, and much more.

Some of the key benefits of this plan are:

    • Pre and post-hospitalization cover of 60 and 180 days, respectively, is available.
    • Cashless claims are provided under this cover.
    • Ambulance services are provided under this cover.
    • Up to 8% discount of renewal premium is available for being active and the steps you take.
Inclusions of the policy Exclusions of the policy
  • Lifetime Renewability
  • In-patient hospitalization cover
  • Daycare procedures
  • Ambulance cover
  • Cosmetic Surgery
  • Treatment of STDs like AIDs, HIV, etc
  • Psychiatric treatments
  • Treatment within 30 days from the day of policy purchase
  • Substance abuse treatment

4. HDFC Ergo Health Suraksha Gold Plan – Regain ECB

HDFC Ergo Health Suraksha Gold is a plan that gives maximum benefit at critical times and provides comprehensive health coverage at an affordable price.

Some of the key features are:

    • There is no age limit of entry under this cover.
    • Optimized health insurance plans at an affordable cost are available.
    • A network of over 6,000 hospitals where cashless services can be availed under this plan.
Inclusions of the policy Exclusions of the policy
  • Organ Donor Expenses
  • In-Patient Hospitalisation expenses
  • Pre-hospitalization expenses up to 60 days
  • Post-hospitalization expenses up to 90 days
  • Daycare Procedures
  • Mental disorder treatments
  • Cosmetic Surgeries
  • Obesity treatment
  • Injury due to war, war-like situation, riots, etc.
  • Self-inflicted injury
  • Injury due to taking part in adventurous or risky sports

5. Max Bupa Health Companion Plan

Max Bupa Health Companion plan is a comprehensive and affordable plan keeping in mind the needs of the individual and immediate family.

Some of the key features of the plan are:

    • There is no cap on room rent charges under this plan.
    • Pre and post-hospitalization of 30 and 60 days, respectively, are covered under this plan.
    • Under Section 80D of the Income Tax Act, 1961, tax benefits are available on the premium paid.
Inclusions of the policy Exclusions of the policy
  • Lifetime Renewability
  • In-Patient hospitalization
  • Saving tax under Section 80D of the IT Act
  • 30 days of pre-hospitalization expenses
  • 60 days post hospitalization expenses
  • 15 day free look-in period
  • OPD expenses
  • Laser treatment
  • Eye-based surgeries and treatment expenses
  • Injury due to self-harm
  • Injury due to war and war-like situations

6. ICICI Lombard Complete Health Insurance Plan

ICICI Lombard’s Complete Health Insurance is one of the top health policies that provide assured cashless approval within 4 hours. Against unexpected and untoward events, ICICI Lombard provides general insurance solutions to protect you and your family. Timely medical services can also be availed in their 3,600+ network hospitals.

Some of the key features of the ICICI Lombard Complete Health Insurance are:

    • Lifelong renewability is available.
    • Cashless hospitalization at any of their network hospitals is available.
    • Under Section 80D of the Income Tax Act, 1961, policyholders can avail tax benefits on the premium paid for the health insurance policy.
    • Hospitalization under Ayurveda, Unani, Siddha, and Homeopathy are available.
Inclusions of the policy Exclusions of the policy
  • Pre-hospitalization expenses for up to 30 days.
  • Post-hospitalization expenses for up to 60 days
  • Hospitalization expenses for more than 24 hours
  • Day-care expenses
  • Pre-existing diseases after 2/4 yrs of coverage
  • Floater Benefit
  • Additional sum insured
  • Unproven treatment
  • Domiciliary Treatment expenses
  • Cosmetic surgery
  • Dental treatment if not due to accident
  • STDs or other Venereal diseases
  • Acupressure, magnetic, acupuncture, and other such therapies.

7. Bajaj Allianz’s Health-Guard Plan

Bajaj Allianz’s Health Guard plan is a reliable health insurance policy that covers medical expenses resulting from accidents or serious illnesses along with several other health expenses. The Silver Plan and the Gold Plan are the two plans available under Bajaj Allianz’s Health-Guard. Comprehensive benefits are provided under this cover for an affordable price.

Some of the key features under this cover are:

    • Pre and post-hospitalization expenses of 60 and 90 days, respectively, are provided under this cover.
    • Payment of medical expenses for In-patient Hospitalization Treatment Cover is available.
    • Reimbursement of expenses of up to Rs.20,000 for use of road ambulance is offered under this cover.
Inclusions of the policy Exclusions of the policy
  • Ambulance charges up to a maximum of INR 20,000
  • Daycare treatment expense
  • Homeopathic and Ayurvedic treatment expenses
  • Bariatric surgery expenses
  • Maternity and infant expenses
  • Preventive health check-ups after 3 years
  • No immediate cover for pre-existing illnesses. These will have a waiting period of 1 year to 3 years.
  • Naturopathy, acupuncture, magnetic therapy, acupressure, and other such therapy expenses are not covered.
  • Cosmetic surgeries
  • Dental surgeries
  • Injuries due to self-harm
  • Congenital diseases, Substance abuse treatments, STDs, etc.
  • Fertility related treatments
  • Experimental treatments

8. Aditya Birla Activ Assure Diamond Health Insurance Plan

Aditya Birla Activ Assure Diamond Plan is a pretty comprehensive plan that provides you with health returns too in addition to healthcare benefits. This plan has some of the most unique features available like health coaching, reloading of the sum insured, and several more along with some added benefits. You will also get bonuses on every claim-free year.

Some of the key features of the plan are:

    • Pre and post-hospitalization expenses of 30 and 60 days, respectively, are provided under this cover.
    • Medical expenses are covered in case treatment must be done at home. This can happen because there could be no beds in the hospital or hospital transfer is not possible due to your health condition.
    • As per your eligibility, transportation to the hospital is covered in case of an emergency.
    • The option to get admitted in any room without any restrictions is provided under this cover.
Inclusions of the policy Exclusions of the policy
  • In-patient, pre, and post-hospitalization expenses.
  • Day-care treatment
  • Domiciliary Treatment
  • Road Ambulance facility
  • Organ donor expenses
  • AYUSH treatments
  • Daily allowance
  • Health check-ups
  • Vaccination cover
  • Accidental Hospitalization
  • Room upgrades
  • Cancer hospitalization
  • Self-inflicted injuries
  • Injury due to riots, nuclear weapons, war, etc.
  • Injury due to substance abuse
  • Mental illness
  • Cosmetic surgery
  • Non-allopathic treatment

9. Royal Sundaram Lifeline – Supreme Family Floater Plan

Royal Sundaram Lifeline Supreme Plan is one of the best health insurance policies in India that offers health cover at a very low premium cost. This plan comes packed with a bunch of benefits like annual health check-ups, a second medical opinion in case of critical riders, etc.

Some of the key benefits of this plan are:

    • In-patient hospitalization expenses are covered up to the sum insured.
    • An ambulance cover of Rs.5,000 is available.
    • The second opinion for a diagnosis of 11 specified critical illnesses and treatment of them is available.
    • Up to Rs.1 lakh of emergency domestic evacuation is covered.
Inclusions of the policy Exclusions of the policy
  • In-patient hospitalization expenses
  • Pre and post hospitalization expenses
  • Day-care expenses
  • Ambulance cover of up to INR 5k
  • AYUSH treatment
  • Organ donation treatment
  • Annual health check-ups
  • Emergency domestic evacuation of up to INR 1 lakhs
  • Substance abuse treatment
  • Injury due to taking part in adventurous sports
  • Alternative treatment expenses (except AYUSH)
  • STDs
  • Psychiatric and psychosomatic treatment
  • Treatment at an unrecognized hospital
  • Unrecognized diagnosis
  • Cosmetic surgery, dental treatment
  • Self-inflicted injury, etc.

10. Manipal Cigna Prohealth Insurance Plan – Accumulate

Manipal Cigna ProHealth Accumulate health insurance plan takes care of both your present and your future healthcare needs. It offers you several unmatched benefits like healthy rewards, donor cover, daycare cover, restoration of sun, and so on.

Some of the key benefits of this plan are:

    • Up to 50% of the accumulated Health Maintenance Benefit can be used for the first renewal premium of the policy.
    • The in-hospital expenses of the donor in case of an organ transplant are covered by the plan.
    • Helps in taking care of present health expenses and helps in building a reserve for future health needs.
Inclusions of the policy Exclusions of the policy
  • Pre-hospitalization expenses up to 60 days.
  • Post-hospitalization expenses up to 90 days.
  • Free health check-up every 3rd year of the policy
  • Hospital room rent
  • Day Care Treatments
  • Ambulance Cover
  • Organ Donor Cover
  • Ambulance expenses up to INR 2000
  • STDs
  • Artificial Life Maintenance
  • Mental disorder treatment
  • Eye treatment
  • Dental/ Oral treatment
  • Congenital/ genetic disorders
  • Recovery benefit

Why should you Buy Health Insurance Plan?

A health insurance plan protects you from health-related emergencies and unforeseen high medical expenses. The constant increase in the number of diseases and healthcare prices in our country makes it important to purchase a health insurance plan since it provides financial coverage in case of any health-related issues.

Every individual must be insured under a health insurance plan that includes benefits like hospitalization expenses, medication, and laboratory test costs, critical illness covers, tax benefits, etc.

You can check out the benefits of health insurance plans that are stated below.

Benefits of Buying Health Insurance Plan

1. Coverage provided for both Pre and Post-Hospitalization Costs

Both pre and post-hospitalization costs are covered by health insurance plans up to a particular time period. However, the costs related to the diseases should meet all terms and conditions of the insurance provider.

2. Policyholders can avail Cashless Treatment

Health plans enable the policyholder to get the necessary treatment in network hospitals without wasting any cash up to the sum assured limit.

3. Tax Benefits

A health insurance policy gives you the opportunity to receive tax benefits for the premiums paid under Section 80D of the Income Tax Act, 1961.

4. Daily cash benefits

A health insurance plan also offers a certain cash amount daily (ranging between Rs 2,000 and Rs 4,000) in case of hospitalization. This amount can be used to meet the additional expenses that are not covered by the health insurance policy.

5. Transportation Expenses

Once hospitalized, the insurance companies take care of the transportation expenses of the insured.

6. Organ Transplantation Expenses

Expenses incurred on organ transplantation are borne by the insurance provider. The surgery costs associated with organ donation are covered. But, the expenses for complications arising out of the surgery, organ donor expenses, and medical tests are not covered.

7. No Claim Bonus

No claim bonus (NCB) is a bonus that you will receive from the insurance provider if you do not file for any claim in treatment during a policy year. NCB can either come as a discount on the premium cost or as a supplement in the sum assured amount at the time of renewing a policy.

8. Health Check-Up facility

Health insurance companies also offer free health check-ups to its policyholders. Depending upon an insurance company and the type of health plan, you will be eligible for free health check-ups.

9. Coverage for pre-existing diseases

Health insurance companies also provide coverage for pre-existing diseases like diabetes, hypertension, etc after your policy period has crossed two to four years. Some providers can also start covering pre-existing illness from the beginning of the insured’s policy tenure.

10. Restoration Benefit

Some health insurance companies also restore the sum assured amount of the insured when it gets fully used during the treatment, without him/her paying any extra amount for this benefit. Such kinds of health plans are expensive as compared to normal health plans and are applied according to the terms and conditions of the policy.

11. Preventive Health Care Benefits

Health insurance companies offer preventive healthcare facilities like frequent health check-ups, discounts in X-ray charges, doctor consultation fees, etc to take care of your health before you catch any disease. This is done to ensure the prevention and early detection of illnesses.

Health Insurance Inclusions

Some of the common health insurance inclusions are stated below:

  • In-patient hospitalization expenses that include room rent of the hospital, ICU room rent, OT charges, nurse’s/doctor’s/surgeon’s/anesthetist’s fee, etc
  • Pre and post hospitalization expenses
  • Ambulance fees
  • Donor expenses in case of organ transplantation
  • Maternity coverage in which the cost of childbirth is covered
  • Newborn baby coverage that is included with maternity cover
  • Alternative non-allopathic treatments like Ayurveda, Unani, Siddha, and Homeopathy are covered under several health plans
  • OPD coverage in which medical expenses are incurred on an outpatient basis is covered.
  • Free health check-ups
  • Treatment availed at home or domiciliary hospitalization
  • Pre-existing illnesses or diseases
  • Daycare treatments
  • During injuries that require overnight hospitalization

Health Insurance Exclusions

Some of the common health insurance exclusions are stated below:

  • Medical illnesses within the first 30 to 90 days of buying health insurance policy
  • Critical illnesses and pre-existing diseases are subject to a waiting period of one to four years
  • Injuries caused by war, terrorism, nuclear activity, or suicide attempt
  • Terminal illnesses, AIDS, and other similar diseases
  • Injuries due to alcohol or drug abuse
  • Self-inflicted injuries
  • Joint replacement, hernia, piles, etc treatments are not covered in the first two to four years of the Health insurance plan
  • Cosmetic or plastic surgery, hormone replacement, sex change, etc
  • Dental or eye surgery
  • Treatment abroad or by an under-qualified medical professional
  • Treatment/diagnostic tests, post-care procedures
  • Bed rest/hospitalization and rehabilitation, common illnesses, etc

Factors to keep in mind while buying a Health Insurance Plan

You should keep in mind some of the following factors before purchasing a health insurance plan:

how to buy health insurance plan

1. Coverage offered

Health insurance companies offer several health covers to the insured. Before purchasing a health plan, compare and verify the covers provided by these companies so that your treatment requirements are fully satisfied.

2. The reputation of the company

The policyholder must verify the insurance company’s credibility before choosing a health plan. Go through the official website of these insurance companies thoroughly before purchasing any health insurance plan.

3. Sum Assured provided

Before buying an insurance plan, do check the amount of sum assured offered by the insurance provider, and accordingly purchase the best plan.

4. Lifetime Renewability

There is a high chance of suffering from diseases when you become old. Hence, purchase a health plan that offers lifetime renewability.

5. Additional rider benefits

Health insurance companies provide additional rider benefits to the policyholder. These riders include maternity coverage, critical illness rider, personal accident rider, etc.

6. Cashless claim facility

Some insurance companies offer a cashless claim facility that helps a policyholder to avail of cashless treatment in network hospitals in cases of emergency hospitalization.

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What is a Claim Settlement Ratio in Health Insurance?

Claim Settlement Ratio (CSR) can be defined as the ratio of the total number of claims to the total number of Health claims received by the insurance company. With the help of this ratio, the policyholders get an idea of the ratio of claim settled by the health insurer in a financial year.

Claim Settlement Ratio 2020 Data

Health Insurance Companies Incurred Claim Ratio
Bajaj Allianz General Insurance Co Ltd 85%
Bharti AXA General Insurance Company 89%
Cholamandalam Health Insurance Company 35%
Future Generali Health Insurance Company 73%
HDFC Ergo Health Insurance Company (Previously known as Apollo Munich Health Insurance Company) 63%
Iffco Tokio General Insurance Company 102%
Liberty Videocon General Insurance Company 82%
Max Bupa Health Insurance 54%
Manipalcigna Health Insurance Company 62%
National Insurance Company 107.64%
New India Assurance Company 103.74%
Oriental General Insurance Company 108.80%
Religare Health Insurance Company 55%
Reliance General Insurance Company 94%
Raheja QBE General Insurance Company 33%
Royal Sundaram General Insurance Company 61%
Star Health Insurance Company 63%
SBI General Insurance Company 52%
TATA AIG General Insurance Company 78%
United India Insurance Company 110.51%
Universal Sompo General Insurance Company 92%

Factors that can affect your Health Insurance Premium

Before buying a health insurance plan, you should be aware of the factors that can affect your premium.

Let’s take a look at some of these following factors:

1. Pre-existing medical issues

The policyholder will have to provide their health records before purchasing a health plan. Some insurance companies may cover pre-existing diseases while others might refuse to cover it. In such cases, the policyholder will have to bear the costs, thereby increasing and affecting the premium.

2. Family medical history

If the insured’s family has any history of medical illnesses like cancer, heart diseases, or any other, then the insurance company can charge higher premium rates.

3, Body Mass Index (BMI)

High body mass index can lead to various health conditions like heart problems, joint problems, diabetes, etc. People who have a high BMI have to pay high premium rates than people with normal BMI.

4. Harmful substances

Most insurance companies increase the premium rates and even refuse to insure people who smoke, or chew tobacco since they are more susceptible to get life-threatening diseases.

5. Gender

There are differences in premium rates for both men and women in several health plans. According to experts, this is because women are more likely to visit doctors and are more prone to chronic diseases.

6. Age

Young individuals have lower premium rates as they are less likely to have health problems than their older counterparts, and are more likely not to visit a doctor.

7. Marital status

It is said that married people have a longer lifespan and are usually healthier. Hence, if you are married, your insurance premiums will be lower than those who have not married yet.

8. Work Profile

Individuals working in surroundings that deal with hazardous substances, radiation, chemicals, and doing jobs that have a high risk of injuries like constructions, end up paying higher premiums as per insurance companies since they are more prone to cardiovascular diseases.

9. Previously not insured

Insurance companies usually charge high premium rates if you are not insured previously. This is because they believe that the new policyholders will often visit doctors and hospitals to start reaping benefits of the health insurance policy

10. Your place of residence

Several insurance companies charge premiums depending upon the location where the policyholder stays. If you stay in an area that is more affected by climate or health issues, does not have much access to healthy food then you will be charged a higher premium rate.

Documents Required for Health Insurance Claim

  • Claim form duly filled and signed by the insured
  • Doctor’s prescriptions and medical store bills
  • ID proof details such as Voter’s Card/Aadhaar Card/Pan Card etc
  • Final hospital bill and payment receipt
  • Discharge card issued by the hospital/network hospital
  • Invoice implants if required in the surgery
  • Medico-Legal Certificate (MLC)/ FIR in case of road accidents
  • Any other bills/documents asked by the insurance company
  • Canceled cheque of the insured’s bank account to make the claim payment

Eligibility Criteria of  Buying Health Insurance Plan

Eligibility criteria for buying a health insurance policy are stated below:

  • Entry age for Children: 90 days to 18 years
  • Entry age of Adults: 18 to 65 years (70 and above, depending upon the health plan and insurance company)
  • People under 45 years of age are not required to go through compulsory health checkups while buying a health insurance policy. But they need to inform the insurance company about any pre-existing medical issues like diabetes or hypertension.

Conclusion

A health insurance plan assures that you don’t have to bear hospitalization expenses from your pocket. If you buy it at a young age, the premium rates will be low and it would cover the diseases coming up in life.

Health Insurance Plans FAQs

Q1: How to select the best health insurance plan in India?

Ans: Things that you should keep in mind before selecting the best health insurance plan in India are:

  • Sum Assured
  • Coverage amount
  • Entry age and renewability clause
  • Co-payment clause
  • Inclusions and Exclusions
  • Waiting Period
  • No claim bonus

Q2: How much coverage do I require in a health insurance plan?

Ans: The term coverage refers to the sum assured by the policy. The amount of coverage you need depends upon your lifestyle, medical history of your family, annual income, location of stay, age, etc.

Q3: Can I claim health insurance policy for more than one time in a financial year?

Ans: Yes you can unless any specific limit laid down by the policy. However, the sum insured is the maximum claimable limit under the health insurance policy.

Q4: What happens to the coverage amount when a claim is filed?

Ans: After an insurance claim is filed and settled, the coverage gets reduced by the amount paid on settlement. For example, you start a health policy with Rs 12 lakh in February and you make a claim of Rs 7 lakh in June, the coverage available to you for July-December would be the balance amount that is Rs 7 lakh.

Q5: If I cancel my health insurance, will I get my premium back?

Ans: Yes, a free look period of fifteen days from the date of policy receipt is available to you to review the terms and conditions of the policy. If you are not satisfied with the terms and conditions of the policy, then you may cancel it. In that case, the insurance company will enable a refund of expenses done after adjusting underwriting costs, pre-acceptance medical screening costs, etc.

Q6: What is a sum assured in a health insurance plan?

Ans: Sum Assured is a pre-determined amount paid by the insurance company. In case the policyholder dies due to an accident, the insurer pays the nominee the sum assured and the policy comes to an end.

Q7: How do I claim for cashless treatment?

Ans: You can claim for cashless treatment by:

  1. Showing your health insurance card in the hospital that contains policy number, insurance company name, and the type of insurance policy.
  2. Filling up the pre-approval form after which the person at the insurance desk will accelerate your claim process.

Q8: What is a health card?

Ans: It is a card that the health insurance company provides to an insured so that they can avail of cashless hospitalization.

Q9: Can I use and claim health insurance policy immediate basis?

Ans: Yes, you can utilize your health insurance policy immediately after you pay for the policy and complete all the paperwork and documentation with the insurance company. But, often health insurance companies offer the facilities after a certain waiting period.

Q10: If I forget to renew my health insurance plan on time, will the company refuse to renew it later?

Ans: The policy can be renewed later if you pay your premium on time or within the grace period that is generally 15 days from the date of expiry of the policy. However, you will not be getting any coverage for the period when the insurance company did not receive any premium. Also, the policy will lapse if the premium is not paid within the grace period.

Q11: What happens if I forget to pay my health insurance policy premiums?

Ans: In such cases, the insurance company will give you a grace period that typically varies from one to three months. However, if you fail to pay the premiums during the grace period, your insurance policy will lapse and you will no longer be allowed to avail of the health benefits of the policy.

Q12: What is the definition of the waiting period?

Ans: The waiting period is a stipulated time-period that the insured has to serve to cover the pre-existing illness. Other than the case of emergency hospitalization, no claim will be accepted during this period.

Q13: Can I take a policy for my child who is three years old?

Ans: Generally children are not covered individually in a policy but can be covered by either of the parents in their health plan.

Q14: Do health insurance plans cover diagnostic charges such as X-ray, ultrasound, and MRI?

Ans: Yes, only if a patient stays in a hospital for at least one day.

Q15: Can foreigners buy a health insurance plan if he/she is living in India?

Ans: Yes, foreigners living in India can purchase a health insurance plan. However, coverage will be applicable in India only.

Q16: What are the documents required for buying a health insurance plan?

Ans: There are no such documents required while buying a health insurance policy. If you are a senior citizen then you might have to go through a pre-medical check-up. However, valid identity, address, age proof details are required when you need to file a claim with your insurer.

Q17: What is the duration of health plan?

Ans: You have the option to buy health insurance either for 1/2/3 years. Buying the policy for 2 years permits you to get discounts.

Q18: Does health insurance plans offer coverage to diabetes patients?

Ans: Yes, health insurance plans cover diabetes patients and their related complications. However, it might vary among the insurance companies, and most insurers provide the same after a waiting period of four years.

Q19: What is a family floater health insurance policy?

Ans: It is a single policy that covers the hospitalization expenses of the whole family. This kind of policy has only one sum insured that can be utilized by a single individual or all members of the family.

Q20: What health insurance plans are available for women in India?

Ans: Health insurance companies have nowadays come up with unique health insurance plans that look after female medical conditions like breast cancer, ovarian cancer, pregnancy complications, childbirth, or other kinds of critical illnesses.

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