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.
Types of Health Insurance
1. Individual Health Insurance
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
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 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 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
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:
|Health Insurance Companies||Health Plans||Network Hospitals||Sum Insured (in rupees)||Incurred Claim Ratio|
|Aditya Birla Health Insurance||Activ Assure Diamond Plan||
|Up to Rs 2 crore||
|Bharti AXA Health Insurance||Bharti AXA Smart Health Insurance Plan||
|3 to 5 lakhs||
|Bajaj Allianz Health Insurance||Health-Guard Plan||
|1.5 to 50 lakhs||
|Cholamandalam Health Insurance||Chola MS Family Healthline Insurance||
|2 to 15 lakhs||
|Edelweiss Health Insurance||Edelweiss Health Insurance Plan||
|5 lakh to 1 crore||
|Digit Health Insurance||Digit Health Insurance Plan||
|2 to 25 lakhs||
|Future Generali Health Insurance||Future Generali Criticare Plan||
|1 to 50 lakhs (18-45 years)
1to 20 lakhs (46-65 years)
|HDFC Ergo Health Insurance (previously known as Apollo Munich Health Insurance Company)||Health Optima Restore Plan||
|Rs 50 lakhs||
|IFFCO Tokio Health Insurance||Health Protector Plus||
|2 to 25 lakhs||
|Liberty Health Insurance||Health Connect Supra Top-up||
|Up to Rs 1 crore||
|Max Bupa Health Insurance||Companion Individual Health Plan||
|Rs 1 crore||
|Manipal Cigna Health Insurance||ProHealth Plus Plan||
|1 lakh to 25 lakh||
|National Health Insurance||National Parivar Mediclaim Plus||
|Up to Rs 50 lakhs||
|New India Assurance Health Insurance||New India Assurance Senior Citizen Medi claim Policy||
|1 to 15 lakhs||
|Oriental Health Insurance||Individual Mediclaim Health Plan||
|Rs 10 lakhs||
|Religare Health Insurance||Religare Care Health Plan||
|Rs 6 crore||
|Reliance Health Insurance||Critical Illness Insurance||
|Raheja QuBE Health Insurance||Health QBE||
|1 to 2 lakhs
3 to 50 lakhs
|Royal Sundaram Health Insurance||Lifeline Supreme Plan||
|5 to 50 lakhs||
|Star Health Insurance||Family Health Optima Insurance Plan||
|SBI Health Insurance||Arogya Premier Policy||
|Tata AIG Health Insurance||Tata AIG MediPrime Plan||
|2 to 10 lakhs||
|United India Health Insurance||United India UNI Criticare Health Insurance||
|1, 3, 5 lakhs||
|Universal Sompo Health Insurance||Individual Health Plan||
|Up to 5 lakhs||
Why should you purchase Health Insurance Policy?
A health insurance policy 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 purchasing a Health Insurance Plan
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.
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.
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.
Daily cash benefits
A health insurance policy 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.
Once hospitalized, the insurance companies take care of the transportation expenses of the insured.
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.
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.
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.
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.
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.
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 purchasing a Health Insurance Plan
You should keep in mind some of the following factors before purchasing a health insurance policy:
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.
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.
Sum Assured provided
Before buying an insurance policy, do check the amount of sum assured offered by the insurance provider, and accordingly purchase the best plan.
There is a high chance of suffering from diseases when you become old. Hence, purchase a health plan that offers lifetime renewability.
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.
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.
What is a Claim Settlement Ratio?
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:
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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.
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 FAQs
Q: How to select the best health insurance policy in India?
A: 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
Q: How much coverage do I require?
A: 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.
Q: Can I claim health insurance policy for more than one time in a financial year?
A: 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.
Q: What happens to the coverage amount when a claim is filed?
A: 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.
Q: If I cancel my health insurance, will I get my premium back?
A: 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.
Q: What is a sum assured?
A: 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.
Q: How do I claim for cashless treatment?
A: You can claim for cashless treatment by:
- Showing your health insurance card in the hospital that contains policy number, insurance company name, and the type of insurance policy.
- Filling up the pre-approval form after which the person at the insurance desk will accelerate your claim process.
Q: What is a health card?
A: It is a card that the health insurance company provides to an insured so that they can avail of cashless hospitalization.
Q: Can I use and claim health insurance policy immediate basis?
A: 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.
Q: If I forget to renew my health policy on time, will the company refuse to renew it later?
A: 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.
Q: What happens if I forget to pay my health insurance policy premiums?
A: 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.
Q: What is the definition of the waiting period?
A: 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.
Q: Can I take a policy for my child who is three years old?
A: Generally children are not covered individually in a policy but can be covered by either of the parents in their health plan.
Q: Do health insurance plans cover diagnostic charges such as X-ray, ultrasound, and MRI?
A: Yes, only if a patient stays in a hospital for at least one day.
Q: Can foreigners buy a health insurance plan if he/she is living in India?
A: Yes, foreigners living in India can purchase a health insurance plan. However, coverage will be applicable in India only.
Q: What are the documents required for buying a health insurance policy?
A: 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.
Q: What is the duration of health policy?
A: 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.
Q: Does health insurance plans offer coverage to diabetes patients?
A: 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.
Q: What is a family floater health insurance policy?
A: 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.
Q: What health insurance plans are available for women in India?
A: 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.