A health insurance policy is a type of insurance that offers coverage for the medical and surgical expenses incurred by the policyholder when he/she is hospitalised during the policy period.
Health insurers, today, also provide coverage for day care hospitalisation, pre-hospitalisation, and post-hospitalisation. The expenses incurred are either reimbursed to the insured individual or are paid to the healthcare provider directly.
On one hand, issues with health have become unavoidable, thanks to changes in the environment and lifestyle over the past few decades. Leading a healthy lifestyle doesn’t guarantee a healthy body any more. On the other hand, medical costs have skyrocketed, which can leave you in a dire situation if you aren’t prepared. Health insurance has gained importance in today’s world due to these reasons. It is a smart investment to make but requires a bit of research to ensure the plan is affordable, offers good coverage, and will pay out sufficiently when needed.
|Types of Health Insurance Plans||Health Insurance portability||Cost of Medical Treatments in India||Health Insurance News|
There are plenty of reasons why buying a health insurance plan is not just a good idea, but in fact, necessary. The benefits provided by such plans outweigh the cost of premiums and the exclusions that are involved. Currently, the life expectancy rate has risen substantially owing to medical advancements. But many people face financial strains or even a lack of finances when it comes to funding their treatment. This results in loans, mortgages and sale of assets just to keep the person alive. This is where a health insurance plan could be a real lifesaver as the cost of hospitalisation, surgeries, treatments, medicines and so on, have risen.
India’s total expenditure on health stood at 4.7% of the country’s GDP in 2014 according to the data released by the World Health Organization (WHO). India is also a country where medical costs are surging at the rate of 15% to 20% every year. In addition to mounting medical expenses, the increase in lifestyle diseases is also affecting the people of our country.
In this time of unpredictability, medical insurance provides the much needed financial stability to an individual or family. Despite gaining popularity in the recent years, health insurance penetration is still not adequate in India. Considering the range of benefits offered, medical insurance is a must for everyone in a family.
Some of the major reasons why health insurance is important have been listed below:
Health insurance covers whole or part of the medical expenses incurred by the life insured during the policy term. Over 30 health insurance products are offered by numerous private and public sector health insurance companies in India. The 4 main type of health insurance plans are mediclaim, critical illness cover, hospital cash plan, and personal accident insurance.
Matters to be stated in a health insurance policy
According to the Insurance Regulatory and Development Authority of India (IRDAI), a health insurance policy must clearly state the following:
Free look cancellation of health insurance policies
Claim procedure in respect of a health insurance policy
According to the regulations set forth by the IRDAI, every insurer that provides health insurance service must adhere to the following procedures.
Modicare: Rs.5 Lakh Health Cover for Each Family
The Union Budget 2018 witnessed the announcement of a mega healthcare programme for the poorest segment of the society. Two new initiatives have been announced under the state-run scheme of Ayushman Bharat Programme. The new initiative named “National Health Protection Scheme” will provide health insurance coverage worth Rs.5 lakh per year for about 10 crore vulnerable families in the country. It is estimated that about 50 crore individuals will benefit from this grand scheme, which is commonly dubbed as ‘Modicare’. Finance Minister Arun Jaitley also announced the development of over 1.5 lakh health and wellness centers that will provide free medications and diagnostic services for poor families.
Tax Benefits for Senior Citizens in Union Budget 2018
Various tax rebates have been announced for senior citizens enrolled in health insurance plans. Under Section 80D of the Income Tax Act, the limit of deduction for senior citizens has been increased to Rs.50,000 from Rs.30,000. Senior citizens also received benefits under Section 80DDB of the Income Tax Act. In the previous budget (Union Budget 2015), the deductions for medical expenses was Rs.40,000 for senior citizens and Rs.60,000 for very senior citizens. As per the announcement made on Union Budget 2018, this deduction has been increased to Rs.1 lakh for both senior citizens and very senior citizens.
The Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory for all policyholders to link their Aadhar and PAN/Form 60 with their insurance policies. According to the mandate issued by IRDAI, insurance companies are now mandated to collect Aadhar and PAN/Form 60 details from their customers before issuing a policy. For existing health insurance customers, their Aadhar and PAN/Form 60 details must be linked to their policies before March 31, 2018.
The mandate also comes with a warning that all medical insurance insurance policies will cease to be operational if the required details are not submitted. It must be noted that the policies will not become void if a customer does not have Aadhar and PAN/Form 60 details. All claims during this period will be kept under abeyance, or temporary suspension, till the Aadhar details are provided to the insurer. All rules related to the submission of Aadhar and PAN/Form 60 details are framed under the Prevention of Money Laundering Act of 2002.
There are a variety of insurance plans designed to cater to different strata of society. According to your needs, you can select a plan under any of the following categories.
These policies are designed for one person. The premiums on these plans are low as the risk is borne for only one person. Premiums, however, depend on a variety of factors such as age, previous medical conditions, location, and so on. The plan will cover a number of illnesses as stated in the terms of the policy. The costs usually taken care of include in-patient care, pre and post-hospitalisation, medical examination charges, laboratory charges, maternity care expenses, and consultation fees.
These plans are designed for multiple members of a family. Instead of taking separate policies, the parents, along with minor children (usually up to 2 children) can be covered under one plan. Some family floater plans cover up to 15 people. Depending on your insurance provider, each insured member will receive an equal amount of coverage, or all members may receive a combined sum. With a combined sum, if one family member requires a substantial amount for treatment receive, they can take it from the entire sum assured. This is a big advantage as it helps balance out the cost of those who need to make a claim and those who do not. The premiums for these plans are generally higher, but will be a money saver because one need not spend on multiple policies.
Anyone who has attained the age of 60 years will be eligible for senior citizen plans. These plans usually bear lower premiums or discounts on premiums. Insurance companies might require a medical check-up before they sell the plan. There are just a handful of companies that offer exclusive senior citizen health insurance plans. These plans are designed specifically to cater to the medical needs of the aged.
These plans are designed to fund specific illnesses. A critical illness can result in permanent disability or even death. If one has a family history of a specific disease or is more prone to getting a specific illness, then these plans are suitable. Critical illnesses generally covered include cancer, organ transplant, multiple sclerosis, blindness, heart valve surgery, coma, heart attack, paralysis, kidney failure, and so on. Critical illness plans may be offered as a standalone plan or as a rider that can be attached to a base plan.
As the name states, these plans specifically cater to women who plan on bearing children. Maternity plans may be offered as a standalone plan or as a rider that can be attached to a base plan. The coverage offered under this plan covers the mother and the newborn, end-to-end pre-natal and post-natal expenses incurred, complications that may arise and hospitalisation costs.
Many companies offer health insurance to their employees to safeguard their interests, make the job position attractive and to mitigate risks. These schemes are designed to include and exclude members as they join and leave the organisation. Premiums are relatively low and the coverage offered is more lenient in terms of covering pre-existing illnesses and so on.
Preventive healthcare includes regular check-ups and care received in order to prevent a disease, cancer or illnesses. Annual physical exams are one way of checking for early symptoms and nipping any problems in the bud. Preventive health care insurance takes care of these costs associated with preventive healthcare measures.
Accidents can occur at any time and at any place. Unforeseen events can lead to major injuries that could seriously put a dent in one’s pocket. Personal accident insurance takes care of the costs that arise out of accidents. These plans provide compensation in case of death, disablement, injury, impairment or mutilation as a result of violent, hazardous, visible and external means. Accidents that are covered include road, rail, water and air. These plans may be a benefit of the base plan or could be attached as a rider.
“Based on IRDA Annual Report 2016-17 on Business Revenue of Insurers”
There are a number of insurance providers in the country and choosing between them can be a daunting task. The things to look for in a good insurance company are not just the claim settlement ratios, but also the rank in the industry, cashless benefits, the customer satisfaction levels, the benefits offered with policies and the exclusions that come with them.
During the fiscal year 2016-17, the New India Assurance has received Rs.6,335.12 crore as gross direct premiums.
Being the largest public sector general insurance company in the nation, New India Assurance Co. Ltd. occupies the top spot in terms of revenues generated in a fiscal year. In the recent years, the company has come up with many new insurance products that provide financial security against various medical threats. As of now, the company provides insurance services in over 28 nations across the world. With a global presence and a loyal customer base, the company continues to remain the market leader in general insurance for over 40 years.
New India Assurance provides an array of health insurance products for the benefit of individuals, groups, families and senior citizens. Individuals can choose a suitable health insurance policy based on their own requirements and features offered in the policy.
|Health insurance plans offered by New India Assurance Co. Ltd.|
|Asha Kiran||BMB Nirbhaya|
|BMB Parivar Suraksha||BMB Sakhee|
|Cancer Medical Expn-Individual||Family Floater Mediclaim|
|Jan Arogya Bima||Janata Mediclaim|
|New Family Floater 2012||New India Floater Mediclaim|
|New India Global Mediclaim Policy||New India Mediclaim Policy|
|New India Premier Mediclaim Policy||New India Sixty Plus Mediclaim Policy|
|New India Top-up Mediclaim||Rashtriya Swasthya Bima Yojana|
|Senior Citizen Mediclaim||Standard Group Mediclaim 2007|
|Swasthya Bima Policy||Universal Health Insurance|
|Universal Health Insurance BPL|
United India has reported gross direct premiums of Rs.5,504.14 crore for the fiscal year 2016-17.
United India is one of the largest public sector general insurance companies in India. The company is renowned for its low-cost schemes that are developed with the prime focus of providing health cover for rural masses in the country. The company also provides insurance coverage for the livestock of farmers living in rural areas. Moreover, United India is also a frontrunner when it comes to providing insurance coverage for large organisations such as ONGC Ltd, Tirupati Devasthanam, Mumbai International Airport, etc.
United India offers several insurance plans that cater to the needs of individuals, families, and senior citizens. The insurer also offers top-up plans, critical illness plans, and plans for workmen too.
|Health Insurance plans offered by United India Insurance Company Ltd.|
|Family Medicare||Family Medicare 2014|
|UNI Criticare||Workmen Medicare Policy|
For the fiscal year 2016-17, National Insurance posted gross direct premiums of Rs.5,053.93 crore.
Kolkata-based National Insurance Company is a state-owned general insurer renowned for providing insurance coverage in various domains. In the health insurance domain, this company offers multiple products that come with an affordable price tag. Similar to other state-owned general insurers in the market, National Insurance is also a top company when it comes to delivering mass schemes for low-income families across the country.
Each of the health insurance products offered by National Insurance provides various different benefits such as hospitalisation benefit, maternity benefit, critical illness benefit and so on.
|Health Insurance Plans offered by National Insurance Co. Ltd.|
|Overseas Mediclaim Business and Holiday||National Parivar Mediclaim|
|National Parivar Mediclaim Plus||Overseas Mediclaim Employment and Studies|
|National Mediclaim Plus Policy||Parivar Mediclaim|
|National Mediclaim Policy|
Oriental Insurance has generated gross direct premiums of Rs.3,846.36 crore for the fiscal year 2016-17.
Oriental Insurance has a great lineup of health insurance products and offers comprehensive coverage for people with differing requirements. The company offers medical insurance policies designed specifically for individuals, families, and groups. The company also specialises in designing innovative products that stand out from the rest of the offerings in the market. With a significant increase in gross direct premiums every year, Oriental Insurance continues to remain one of the top players in the health insurance market in India.
Each of the health insurance plans offered by the insurer offer coverage for various diseases and health conditions. Prospective policyholders can purchase policies based on the health issues they face and require coverage for.
|Health Insurance Plans offered by Oriental Insurance Company|
|Mediclaim Policy||Group Mediclaim Policy|
|Pravasi Bharatiya Bima Yojana (PBBY) 2017||Jan Arogya Bima Policy|
|Health of Privileged Elder (HOPE)||Oriental Mediclaim Policy (OBC) 2017|
|PNB 2017||Happy Family Floater Policy 2015|
|Oriental Happy Cash Policy|
During the fiscal year 2016-17, the health insurance wing of ICICI Lombard has earned Rs.2,025.40 crore in gross direct premiums.
ICICI Lombard GIC Ltd. has earned itself a top rank in the insurance market with over 17.73 million policies issued and more than 2.18 million claims settled as on 31 March 2017. ICICI Lombard has a cashless network of over 4,500 hospitals in the country giving its customers a plethora of options from which they can avail medical treatment. The insurer also ensures the processing and settling of claims is done at a fast pace. Reimbursement claims are completed within 14 days usually, while cashless claims are settled directly with the hospital.
ICICI Lombard offers three unique comprehensive health insurance plans that come with different objectives to suit the needs of the citizens.
|Health Insurance Plans offered by ICICI Lombard|
|Complete Health Insurance|
|Personal Protect Policy|
Star Health Insurance reported gross premiums worth Rs.2,960.05 crore for the fiscal year 2016-17.
Star Health Insurance hit the Indian market in 2006 with its focus solely set on the health sector. The company offers a wide cashless network of 8,200 hospitals across India which gives customers a wide choice of hospitals at which they can receive treatment and take advantage of cashless settlements. The company has a range of health insurance products designed to cater to the different needs of every individual.
Some of the plans offered have variants that people can choose from based on their requirements and affordability. Star Health offers unique health insurance plans that offer coverage for diabetes, cardiac issues, cancer, and HIV/AIDS too.
|Health Insurance Plans offered by Star Health Insurance and Allied Insurance Co. Ltd.|
|Star Special Care||Senior Citizens Red Carpet||Star Criticare Plus Insurance Policy|
|Family Health Optima||Star Family Delite Insurance Policy||Star Comprehensive Policy|
|Diabetes Safe Insurance Policy||Star Health Gain Insurance Policy||Medi-Classic Insurance|
|Star Surplus Insurance Policy||Star Care Micro Insurance Policy||Star Cancer Care Gold (Pilot Product)|
|Star Net Plus||Star Cardiac Care Insurance Policy|
Standalone health insurer Apollo Munich’s gross direct premiums for the fiscal year 2016-17 stood at Rs.1,301.93 crore.
Apollo Munich Health Insurance Company Ltd. was founded in 2007 and has since gained a sizeable market share in India. The company aims to uncomplicate the insurance process by making it simple and transparent. Customers are provided with a range of products that come with a host of benefits, backed by a good customer care service.
Apollo Munich offers comprehensive health insurance plans, special insurance plans, health wallets, etc. with several sum insured options.
|Health Insurance Plans offered by Apollo Munich Health Insurance|
|Optima Plus||Easy Health||Day2Day Care|
|Energy||Optima Cash – Daily Hospital Cash Plan||New iCan Cancer Insurance for Women|
|Dengue Care||Optima Super||Maxima|
|Health Wallet||Optima Vital||Optima Restore|
|Optima Senior||New iCan Cancer Insurance||Optima Super – Aggregate Top up Plan|
Following its acquisition of L&T General Insurance, the combined health insurance gross premiums of HDFC ERGO stood at around Rs.1,296 crore.
With a vision “to be the most admired insurance company that enables the continued progress of customers by being responsive to their needs”, HDFC Ergo has expanded its network across the country and secured a top position in the market. The insurer has over 6,000 network hospitals and offers its customers benefits such as cashless hospitalisation, no-claim bonuses, and flexible payment options. The company has a number of products that are designed to make sure all types of customers are satisfied.
The company has designed specific products for individuals, parents, senior citizens as well as families. A special plan that offers coverage for critical illnesses and a super top-up plan are also available.
|Health Insurance Plans offered by HDFC Ergo Health Insurance|
|Individual Health Insurance||Parents Health Insurance||Senior Citizen Health Insurance|
|Family Health Insurance||Critical Illness||my:health Medisure Super-top-up|
Bajaj Allianz reported gross direct premium of Rs.1,241.33 crore for the fiscal year 2016-17.
Bajaj Allianz gives people access to the best medical treatment and care by ensuring they have financial protection through their health insurance products. With over 5,700 hospitals and 1,500 diagnostic clinics in their cashless network, customers can rest assured that they can choose a suitable and convenient hospital where they can take advantage of the cashless facility. The company offers an in-house health administrative team along with a customer service that is available 24x7 for claims settlements. Customers can avail maximum coverage at affordable premiums.
The insurer offers different hospitalisation plans, personal accident plans, online plans, specific benefit plans and a bundled product. Each of these plans has a different objective and hence offer different features.
|Health Insurance Plans offered by Bajaj Allianz General Insurance|
|Health Guard Individual Policy||Global Personal Guard||Health Care Supreme|
|Premium Personal Guard||Health Guard Family Floater Option||Critical Illness|
|Personal Accident||Silver Health||Health Ensure|
|Extra Care||Extra Care Plus||Star Package|
|Tax Gain||Sankat Mochan||Hospital Cash Daily Allowance|
|Surgical Protection Plana||Women Specific Critical Illness|
For the fiscal year 2016-17, SBI General’s gross direct premium for health insurance stood at Rs.792.52 crore.
SBI General Insurance aims to be the most trusted general insurer in India by practicing fair and transparent operations. State Bank of India already has gained the trust of millions of customers in the country and has established its presence in the insurance market as well through a joint venture with Insurance Australia Group (IAG). The company offers a wider range of coverage options from Rs.50,000 up to Rs.5 lakh to cater to the masses. SBI General Insurance also has a network of 6,000+ hospitals at which customers can get cashless settlements.
SBI General Insurance offers flexible health insurance plans that individuals can avail for health insurance coverage. Each of the plans offers coverage for specific expenses such as ICU expenses, OPD expenses, critical illness, hospital daily cash and so on.
Health insurance providers in India offer a wide range of health insurance policies to meet the varying needs of their customers. Choosing the right health insurance plan from an array of options can be a challenging task. We have made it easier for you to choose a suitable health insurance plan by listing the different types of policies available in the market.
|Type of health insurance policy||Purpose of the health insurance plan|
|Individual Health Insurance Plan||If your group health insurance policy doesn’t provide adequate coverage, you can opt for an individual health insurance plan that offers cashless treatments as well as claim reimbursements.|
|Group or Employee Insurance Plan||Employers offer a group health insurance plan to their employees as an incentive to retain talent in the organisation. No medical checkup is required for a group insurance plan. All employees working in the organisation are eligible for the plan.|
|Family Health Insurance Plan||If you want to provide timely and adequate healthcare to your family, opt for a family health insurance plan. You pay a single premium but the sum insured can be shared by the entire family which includes self, spouse, children, and dependent parents.|
|Senior Citizen Health Insurance Plan||If you are 60 to 65 years of age, then a senior citizen health insurance plan is your only option for best possible health cover. Co-payment is a must in most senior citizen health insurance plans. It is more restrictive than a regular medical insurance plan.|
|Critical Illness Plan||The insurer will pay a lump sum amount if the life insured is diagnosed with any of the critical illnesses specified under the policy regardless of whether you receive treatment for the illness or not. Most critical illness plans cover 9 to 15 illnesses such as cancer of a specified variety and first heart attack.|
|Personal Accident Insurance Plan||This type of plan offers insurance coverage against illnesses or injuries resulting from an accident. The insurer will pay a lump sum amount if the life insured has been totally or permanently disabled as a result of an accident.|
|Hospital Cash Plan||Generic health insurance plans don’t cover non-medical expenses that you may incur during hospitalisation. To meet those expenses, you can opt for a hospital cash plan wherein the insurer will pay the life insured up to Rs.4,000 per day for the duration of your hospitalisation.|
|Maternity Benefit Plan||Pregnancy and childbirth treatments are not covered under as standard health insurance plan. Maternity benefit plan can be suitable for those who are planning to have a baby whether it is a normal delivery or a caesarean.|
Incurred Claim Ratio refers to the total value of all claims that the health insurance firm has paid-out in a given financial year against the total amount of premiums that they collected during the same year. The Incurred Claim Ratio is a good indication of the company’s ability/willingness to provide a payout when a claim is raised.
Thus, if a company’s Incurred Claim Ratio is higher is 100%, it would indicate the company has paid-out more in claims than what it collected as premiums during the fiscal year. Whereas, if the company’s Incurred Claim Ratio is lesser than 100%, it would indicate the insurer has paid a lesser amount of money as claims in comparison to the premiums that it collected. The Insurance Regulatory and Development Authority of India (IRDAI) publishes the Incurred Claim Ratio for all health insurance firms in India, every financial year.
The Claim Settlement Ratio (CSR) of an insurance company indicates the insurer’s capacity to settle a higher number of claims per year. For instance, if the CSR of an insurance company is 95% for FY15-16, it means that the insurer has settled 95 claims out of 100 in that financial year. The formula for calculating claim settlement ratio is as follows:
Claim Settlement Ratio = (Total Claims Settled) / (Total Reported Claims + Outstanding Claims at Start of Year – Outstanding Claims at End of Year)
Claim Settlement Ratio also lets you know the claim settlement history of an insurance provider. A new insurance company may have a lower claims ratio. The CSR of an insurance company is a parameter to consider when choosing the right insurance plan.
|Health Insurance Company||Incurred Claim Ratio*|
|United India Health Insurance||110.95%|
|Oriental Health Insurance||113.86%|
|SBI General Health Insurance||52.93%|
|Star Health Insurance||61.76%|
|Apollo Munich Health Insurance||62.47%|
|Max Bupa Health Insurance||50.19%|
|Cigna ttk Health Insurance||46.29%|
|ICICI Lombard Health Insurance||68.26%|
|Chola MS Health Insurance||39.96%|
|HDFC ERGO Health Insurance||52.58%|
|IFFCO Tokio Health Insurance||90.69%|
|Reliance General Insurance||106.54%|
|Royal Sundaram Health Insurance||61.41%|
|TATA AIG Health Insurance||60.68%|
|Bajaj Allianz Health Insurance||77.61%|
|Bharti AXA Health Insurance||98.50%|
|National Health Insurance||115.55%|
|Universal Sompo General Health Insurance||104.17%|
|Future General Health Insurance||87.42%|
|New India Health Insurance||103.19%|
|Religare Health Insurance||51.97%|
|Raheja QBE Health Insurance||18.19%|
|Liberty General Insurance||74.58%|
|Magma HDI General Insurance Company Limited||34.93%|
|Health Insurance Plan||Critical Illness Cover|
|Health insurance is a base policy offering insurance coverage against medical expenses incurred by the life insured during the policy term.||Critical illness plan is a rider or add-on cover that can be attached to your base policy. Critical illness rider covers specified critical illnesses such as first heart attack and cancer of specified severity.|
|The insurer will reimburse the life insured for medical and surgical expenses incurred during the period of hospitalisation while the policy is active.||Insurer will pay a lump sum amount if the life insured is diagnosed with any of the specified critical illnesses covered under the policy.|
|Minimum 24 hours of hospitalisation is required to claim reimbursement.||Regardless of whether the life insured undergoes treatment for the critical illness, the insurer will make guaranteed payout upon diagnosis.|
|Policy remains active even after a claim has been made until the sum assured limit is reached.||Once critical illness benefit has been paid, the policy ends.|
|The waiting period is usually 30 days for all illnesses except accidental injuries.||The waiting period for critical illness cover is usually 3 months.|
|Health Insurance||Life Insurance|
|Health insurance offers insurance coverage against unforeseen medical expenses incurred by the life insured due to an illness or accidental injury during the policy term.||With life insurance, your family is provided financial protection at different stages of their lives even in your absence.|
|The insurer will reimburse the policyholder for the medical expenses incurred by the life insured during the period of hospitalisation.||Upon the demise of the life assured, the insurer pays sum assured to the beneficiaries of the life assured.|
|You can get reimbursement for medical expenses incurred under a mediclaim policy, get a lump sum amount for being diagnosed with a critical illness, and get daily cash to meet non-medical expenses during the period of your hospitalisation.||You can secure the future of your child by investing in an endowment plan or child plan, lead a comfortable retirement life with a pension plan or increase your wealth by investing in ULIPs.|
|Under Section 80D of the Income Tax Act, 1961, you can get tax deductions up to Rs.15,000 on premiums paid towards health insurance.||Under Section 80C and Section 10(10D) of the Income Tax Act, 1961, you can get tax deductions on premiums paid and maturity proceeds of a life insurance plan.|
|Health Insurance Plan||Term Insurance Plan|
|Health insurance offers medical cover against unforeseen hospitalisation and surgical expenses to the life insured during the policy term.||Term plans are the purest form of life insurance, offering optimum life cover upon the death of the life insured without maturity benefit.|
|Health insurance premium rates vary depending on the age of the policyholder.||Term insurance premium is fixed throughout the policy term.|
|Benefit of a health insurance plan is that you can get timely and adequate healthcare.||Benefit of a term insurance plan is that you can secure the financial future of your family.|
|Health insurance cost is higher.||Term plans are affordable.|
|The sum assured is used only for medical expenses.||The sum assured can be used for any expenses like children’s education, wedding, etc.|
|Health Insurance Plan||Mediclaim|
|Health Insurance offers a comprehensive health cover. Apart from hospitalisation expenses, health insurance reimburses pre and post-hospitalisation expenses, pharmacy bills, and ambulance fees. It covers as many as 25 critical illnesses.||Mediclaim covers hospitalisation expenses and treatments toward accident and pre-specified illnesses, subject to a specific sum assured limit.|
|Flexibility to reduce the insurance premium and sum assured after a specified period.||Insurance premium for mediclaim is based on the sum assured.|
|Health insurance cover is higher, up to Rs.60 lakh.||Mediclaim cover is lower, up to Rs.5 lakh.|
|After a claim has been settled, no further claims can be made under a health insurance plan.||Any number of claims can be made under a mediclaim policy, subject to the sum assured limit.|
All health insurance providers partner with a number of hospitals across the country to make the process of insurance settlements smoother. If a policyholder chooses to avail treatment at any of these hospitals that fall under the insurance company’s network, then they can avail cashless treatment. With this facility, the insurance company will pay for the expenses through a direct channel between the insurer and the hospital. The customer will not be required to pay for anything except for any expenses not covered under the insurance plan. If expenses exceed the limits mentioned in the policy, the insurer will pay up to the amount that is covered. The remainder will have to be borne by the policyholder. This facility lightens the out-of-pocket expenses that the life insured needs to bear.
When a person first sees signs or symptoms of an illness, it is imperative to get tested and checked up. But undergoing these medical tests can cost quite a bit. If the tests reveal a diagnosis that requires hospitalisation, then you can claim for a reimbursement for these expenses. After hospitalisation, there are further check-ups that might be required, along with medication and follow-up treatments. These expenses will also be taken care of by your health insurance policy. The period for this facility ranges between 30 days and 180 days before and after hospitalisation.
When emergencies arise, an ambulance is usually the given method of transportation. In many cases, ambulances are have equipment to keep the person stable. Ambulances are also needed while shifting the person from one hospital to another whenever necessary. The insurance plan will cover these costs in most cases.
An attractive feature of health insurance policies is the no-claim bonus. If a policyholder does not make a claim for the entire year, then the insurance company rewards them with a no-claim bonus (NCB). The NCB is given in the form of a discount on the renewal premium. For every no-claim year, the NCB increases. NCB in the first year is usually 10% and goes up to a maximum of 50% over the years.
Many of us do not feel the need for health check-ups when we do not show symptoms or have any pain. A visit to the doctor usually arises when there is a problem. But regular check-ups can help detect illnesses early on and this can help doctor’s nip it in the bud and prevent it from become worse. Preventive health check-ups help minimize costs associated with health issues and also reduce chances of diseases progressing to later stages. Insurance plans cover the cost of such check-ups because it contributes to minimizing larger claims.
Under the Income Tax Act, 1961, premiums paid towards health insurance are eligible for tax deductions under Section 80D. Therefore health insurance is a good investment to make for those who want to save tax as well.
Co-payments help lower the cost of health insurance. This option stipulates that in the event of a claim, a percentage of the cost will be borne by the customer while the insurer will take care of the rest. Co-payment reduces the premium of the plan but will not affect the sum assured.
The life insured is allowed to switch between health insurance providers without losing certain benefits such as the waiting period for pre-existing illnesses, no-claim bonuses and other advantages earned in the previous policy. If a policyholder is not satisfied with the current insurer or finds a more suitable plan, switching is an easy option available from almost all insurance companies.
Many health insurance providers offer this benefit under which if the total sum assured amount is exhausted, it will be replenished. Usually, the restored amount can be used on a completely different ailment from the one that the insurance was used for before. Some companies offer restoration options of up to 3 times in one policy period. This means the life insured can claim the sum assured thrice for three different ailments without having to pay extra premiums.
Healthy Lifestyle Benefits:
Insurance companies reward those who opt to live healthier lifestyles. For non-smokers and teetotalers, the insurance premium may be discounted. Furthermore, for those who quit smoking during the policy, there are rewards in the form of discounts on premiums awarded for making the healthier choice.
Having global coverage in case of emergencies is a great benefit for those who travel out of the country. If anything were to happen while you are abroad, cost of medical expenses can be very high. An insurance plan that covers you anywhere in the world can really be helpful financially in case anything untoward were to happen while you are abroad.
In health insurance, the primary focus must be on whether the coverage is adequate for you and your family. It is not a wise idea to take health insurance just for the tax saving benefit. However, the added benefit of income tax relief need not be ignored when you subscribe for a health insurance plan.
Like life insurance, health insurance also provides tax benefits. The policyholder can get tax deductions on the premiums paid towards health insurance under Section 80D of the Income Tax Act, 1961. Hindu Undivided Families (HUF) can claim tax deductions for insuring members of the HUF. Insurance premiums paid using cash cannot be claimed for tax deduction. However, you can pay in cash for preventive health check-ups and make claims for tax deduction. No tax deductions applicable for group health insurance premiums. The tax deduction limits for FY2017-18 are:
|Type of health insurance||Tax deduction limit|
|Individual health insurance premium||Up to Rs.25,000|
|Family health insurance premium paid for self, spouse, and children under the age of 60||Up to Rs.25,000|
|Family health insurance premium paid for members above the age of 60||Up to Rs.50,000|
|For expenses incurred for preventive health check-up each year||Up to Rs.5,000|
|Tax deduction for health insurance premiums paid under Section 80D of the Income Tax Act, 1961||Up to Rs.65,000|
|Tax deduction for expenses incurred from nursing, treatment, and rehabilitation of a disabled dependent under Section 80DD of the Income Tax Act, 1961||Up to Rs.75,000|
|Tax deduction for expenses incurred for serious disability treatment under Section 80DD of the Income Tax Act, 1961||Up to Rs.1.25 lakh|
|Disabled individual can claim benefits under Section 80U of the Income Tax Act, 1961||Up to Rs.75,000|
|Tax deduction for serious disability under Section 80U of the Income Tax Act, 1961||Up to Rs.1.25 lakh|
The deadline to declare tax-saving investments for the FY 2017-18 is March 31, 2018. Apart from Equity-linked savings schemes, Public Provident Fund, Five-Year Fixed Deposit, and the National Pension Scheme, insurance policies, too, offer tax deductions and exemptions. It is important to be aware of the maximum cap of deductions that can be enjoyed for each policy type and the section of the Income Tax Act under which the taxpayer is entitled to such benefits.
An individual can avail a deduction of Rs.25,000 on the premiums paid towards a health insurance policy under section 80D of the Income Tax Act. The deductions for parents below the age 60 is Rs.25,000 and above the age 60 is Rs.50,000. An exemption of up to Rs.5,000 can be availed for parents above the age of 60 for preventive health check-ups too. if a taxpayer as well as his parents are above 60 years of age and are covered under the same policy, the taxpayer enjoys tax benefits up to Rs.1 lakh.
Ideally, the tax benefits offered by insurance policies should be the secondary reason for purchasing the policies. The primary reason for purchase should be for health cover or life cover.
Customers who are not fully satisfied with their insurance provider or policy have the option to change their insurance provider, if they find it beneficial. Health insurance portability is defined as the ability of individuals to switch between various insurers at their own free will and without losing out on benefits like no-claim bonus, waiting periods, etc. People switch between insurers for a number of reasons such as better claim settlement process, cashless claim facility, coverage of specific illnesses, better premiums, no-claim bonus options, and so on.
In order to maximise the benefits of a health insurance plan, one must do regular research especially at the time of renewal. This would ensure that you are well aware of any updated policy schemes available. Transferring your health insurance policy to another provider with a better plan can be done under certain conditions:
If you want to get treated at one of the good hospitals in India, the costs will be much higher than it is at a Government hospital. The treatment and doctor’s fees will be higher and to add to that, the room rent will also be exorbitant. Many private hospitals have become money making machines and it is important to do your own research before getting fooled into paying through your nose. Let’s take a look at the current average cost of some of the general treatments in India:
|Specialty||Treatments||Estimated duration of hospitalisation||Approximate cost for the treatment in India (in Rs.)|
|Check-up||Master Health Check-up||Outpatient||Rs.6,350 to Rs.12,700|
|Tests||Colonoscopy Test||Outpatient||Rs.9,525 to Rs.22,225|
|Endoscopy||Outpatient||Rs.38,100 to Rs.1,27,000|
|Capsule Endoscopy||Outpatient or 1 day||Rs.63,500 to Rs.1,27,000|
|Therapy||Hyperbaric Oxygen Therapy||Outpatient||Rs.1,52,400 to Rs.2,22,250|
|ENT||Cochlear Implant||2 days||Rs.8,25,500 to Rs.14,60,500|
|Sinus||2 days||Rs.1,14,300 to Rs.2,22,250|
|Larynx Removal/Laryngectomy||2 days||Rs.2,85,750 to Rs.5,71,500|
|Eardrum Reconstruction/TympaNoplasty||2-3 days||Rs.76,200 to Rs.2,22,250|
|Nephro||Kidney Removal/Nephrectomy||4-6 days||Rs.95,250 to Rs.1,27,000|
|Infertility||IVF Package||Outpatient||Rs.1,14,300 to Rs.3,17,500|
|Gynecology||Myomectomy-Hysteroscopic||3-4 days||Rs.63,500 to Rs.4,57,200|
|Lap Hysterectomy||3-4 days||Rs.95,250 to Rs.3,81,000|
|Urology||TURP||4 days||Rs.44,450 to Rs.3,17,500|
|Bladder Neck Incision||2 days||Rs.1,58,750 to Rs.2,22,250|
|Surgery||Cholecystectomy/LaparOscopic||2 days||Rs.95,250 to Rs.1,90,500|
|Appendectomy/Laparoscopic||3 days||Rs.76,200 to Rs.1,77,800|
|Inguinal Hernioplasty||2 days||Rs.57,150 to Rs.1,90,500|
|Neuroscience||Peripheral Nerve Surgery||3-4 days||Rs.2,54,000 to Rs.4,12,750|
|Parkinson's(Deep Brain Stimulation)||7-10 days||Rs.12,70,000 to Rs.14,60,500|
|Bone and Spinal Cord||Spinal Fusion||5 days||Rs.3,81,000 to Rs.8,25,500|
|Laminectomy||6 days||Rs.1,27,000 to Rs.4,12,750|
|Eye||Vitrectomy||2 days||Rs.69,850 to Rs.1,27,000|
|Glaucoma||2 days||Rs.38,100 to Rs.1,27,000|
|Corneal Transplant||Outpatient or 1 day||Rs.50,800 to Rs.76,200|
|Retinal Detachment||2 days||Rs.95,250 to Rs.2,54,000|
|Cataract Surgery with Lens||Outpatient or 1 day||Rs.50,800 to Rs.1,27,000|
|Dental||Root Canal Treatment||Outpatient in 3 - 4 sittings||Rs.7,620 to Rs.12,700|
|Ceramic Crown Setting||Outpatient||Rs.8,890 to Rs.15,240|
|Dental Implant||Outpatient in 2 stages over 3 months||Rs.63,500 to Rs.1,27,000|
|Cosmetic||Abdominoplasty||1-4 days||Rs.1,27,000 to Rs.3,81,000|
|Breast Lift||1 day||Rs.1,84,150 to Rs.4,12,750|
|Breast Reduction||1-2 days||Rs.95,250 to Rs.4,44,500|
|Breast Augmentation with implants||1-2 days||Rs.1,58,750 to Rs.4,12,750|
|Lip Reduction/Cheiloplasty||Outpatient||Rs.50,800 to Rs.63,500|
|Face Lift – Face and Neck||1 day||Rs.1,90,500 to Rs.3,17,500|
|Face Lift – Face, Neck, Upper Eyelids and Lower Eyelids||Outpatient or 1 day||Rs.3,81,000 to Rs.5,08,000|
|Rhinoplasty||2 days||Rs.92,250 to Rs.3,17,500|
|Weight Loss||Gastric Bypass||4-5 days||Rs.2,85,750 to Rs.5,71,500|
|Sleeve Gastrectomy||4 days||Rs.2,85,750 to Rs.6,03,250|
|Gastric Banding||2 days||Rs.3,68,300 to Rs.5,39,750|
|Oncology||IGRT||Outpatient or 1 day hospitalisation||Rs.3,17,500 to Rs.4,76,250|
|Chemotherapy||Outpatient, multiple times within a 15-day time period||Rs.63,500 to Rs.1,90,500|
|Stereotactic Radiosurgery||Outpatient or 1 day hospitalisation||Rs.2,22,250 to Rs.6,35,000|
|Prostate Cancer Surgery||6-8 days||Rs.3,49,250 to Rs.6,35,000|
|Breast Cancer Surgery||3-4 days||Rs.1,90,500 to Rs.4,25,450|
|IMRT||Outpatient or 1 day hospitalisation||Rs.2,22,250 to Rs.3,81,000|
|Joint Replacement||Single Hip Replacement||5-7 days||Rs.3,81,000 to Rs.6,35,000|
|Double Hip Replacement||7 days||Rs.5,08,000 to Rs.9,33,450|
|Single Knee Replacement with Implants||5-7 days||Rs.2,22,250 to Rs.5,39,750|
|Double Knee Replacement with Implants||7-9 days||Rs.3,81,000 to Rs.9,20,750|
|ACL Reconstruction||3 days||Rs.1,90,500 to Rs.2,85,750|
|Cardiology||Angiogram||1 day||Rs.15,875 to Rs.63,500|
|Angioplasty||1-2 days||Rs.1,90,500 to Rs.4,12,750|
|Bypass Surgery||4-6 days||Rs.1,90,500 to Rs.6,03,250|
|Heart Transplant||8-15 days||Rs.14,60,500 to Rs.25,40,000|
|Valve Replacement||2-5 days||Rs.3,81,000 to Rs.7,62,000|
|Valve Replacement (minimal invasive procedure)||2-8 days||Rs.4,95,300 to Rs.5,20,700|
|Double Valve Replacement||10 days||Rs.3,04,800 to Rs.7,93,750|
|Permanent Pacemaker Implant (Single Chamber)||2-3 days||Rs.1,58,750 to Rs.2,85,750|
|Permanent Pacemaker Implant (Double Chamber)||2-3 days||Rs.1,14,300 to Rs.3,17,500|
|Bentall's Surgery||2-5 days||Rs.3,81,000 to Rs.7,62,000|
|ASD/VSD Closure for congenital heart defects||2-5 days||Rs.1,90,500 to Rs.6,35,000|
|Heart Rhythm Correction – Radio Frequency Ablation||2-3 days||Rs.63,500 to Rs.3,17,500|
|Abdominal Aortic Aneurysm||5-10 days||Rs.4,12,750 to Rs.5,08,000|
|Transplants||Liver Transplant||28-30 days||Rs.25,40,000 to Rs.35,56,000|
|Heart Transplant||10-20 days||Rs.14,60,500 to Rs.25,40,000|
|Kidney Transplant||7-9 days||Rs.3,17,500 to Rs.13,97,000|
|Lung Transplant||10-20 days||Rs.13,97,000 to Rs.15,87,500|
|Bone Marrow Allogeneic Transplant||40 days||Rs.18,41,500 to Rs.20,95,500|
|Bone Marrow Autologous Transplant||25-30 days||Rs.10,16,000 to Rs.17,78,000|
Source: India Healthcare Tourism
Looking at the average cost of medical procedures, one must realise how important health insurance is and the need for it. Health insurance is available from a number of insurers in the market at affordable premiums. Anything can happen to anyone at anytime, it is best to be prepared.
Upon realising just how many people do not have access to insurance, the Government of India took steps to provide affordable solutions to help include the masses under insurance schemes. Some of these schemes have been listed below:
The Pradhan Mantri Suraksha Bima Yojana is designed to help the low income groups access personal accident insurance at affordable rates, and through an easy and transparent process. If the life insured under this scheme incurs permanent or partial disablement due to an accident, they will receive compensation. In case of death due to an accident, then the family is entitled to receive the compensation.
Through this scheme, the government extended insurance cover to the poor sections of society. Beneficiaries of this scheme can receive cover of up to Rs.30,000 p.a. on a family floater basis for almost all the diseases that require the person to be hospitalised. The most beneficial features of this Rashtriya Swasthya Bima Yojana is that there is no limit on the eligible age and all pre-existing illnesses will be covered from the first day. Insured people under this scheme are also entitled to transport expenses. The scheme only requires a registration fee of Rs.30 making this one of the most affordable schemes available to the masses.
This scheme was introduced by the Government of India to provide the rural areas of the country with access to social security and financial aid. This scheme provides cover to the earning member or head of a rural landless household. Aam Aadmi Bima Yojana is designed specifically for people living below the poverty line and any one living in rural areas where there is minimal access to facilities like hospitals and pharmacies. Anyone between the age of 18 years to 59 years can enrol in this scheme. The premium of Rs.200 per annum is contributed by the State and Central Government.
The Government of India introduced the Universal Health Insurance Scheme to help families and individuals that live below the poverty line gain access to healthcare facilities. Those who fall above poverty line can also apply for this scheme but is available only for families. Through this scheme, people can benefits from a number of features that helps improve the overall quality of life such as hospitalisation cover, maternity cover and personal accident insurance.
The Government of Rajasthan introduced an innovative solution to help IPD patients get cashless medical treatment. All families that are covered under the RSBY (Rashtriya Swasthya Bima Yojana) and NFSA (National Food Security Act) are eligible for this scheme. By providing financial assistance against illnesses, the government hopes to reduce the financial strain on the people through the Bhamashah Swasthya Bima Yojana. This policy also helps in creating a health database which can be used in the future to help make policy related changes.
This scheme helps provide farmers across the state with inexpensive medical facilities. Launched by the former chief minister of Karnataka, the scheme became operational in 2013. The Yeshasvini Health Insurance Scheme is designed for workers who belong to a co-operative society and fall in the lower middle income and middle income groups. It provides cover against several ailments like neurosurgery, angioplasty, surgical oncology, neonatal intensive care, orthopaedic surgeries, animal bites, paediatric surgeries, drowning, etc. More than 30 lakh people benefit from this scheme.
The West Bengal Cashless Medical Treatment Scheme is an all-round health scheme that was introduced in 2014 for all employees and pensioners of the state government. The scheme is designed to provide cashless medical facilities of up to Rs.1 lakh to all officers, employees, IAS officers and pensioners working under the state government. Family members of the eligible people can also avail benefits under this scheme. The facilities are available at all hospitals which are a part of the panel of this scheme.
Introduced by the Government of Gujarat, the Mukhyamantri Amrutum Yojana is a health coverage scheme. It aims at providing medical facilities, including the cost of surgeries and hospitalization, to all families with an income below Rs.1.5 lakh p.a. There is no fee for enrolment and the cover offered is Rs.2 lakh per family of 5 members. The cost of this scheme is fully borne by the government.
In April 2017, the Maharashtra government renamed its Rajiv Gandhi Jeevandayee Arogya Yojana scheme to Mahatma Jyotiba Phule Jan Arogya Yojana. With so many people falling out of the realm of insurance, the Maharashtra government introduced this state government health insurance scheme to ensure quality healthcare access to the below poverty line section of the society. For those who are economically underprivileged, the plan provides free healthcare. Anyone who holds an Orange Ration Card or a Yellow Ration Card can be a part of this scheme. If a member of this scheme was to seek any treatment at government hospitals, the cost will be covered by this plan.
The Chief Minister's Comprehensive Health Insurance Scheme was introduced to provide the benefits of health insurance to the economically weaker sections of society in Tamil Nadu. The scheme is offered in association with United India Insurance Co. Ltd., a public sector insurance provider. Over 1 crore households benefit from this scheme. Some of the benefits include cashless medical facilities and surgical treatments, not only from public but also private sector hospitals. All expenses arising due to illnesses, follow-up treatments, consequent diagnostic procedures, etc., are covered.
The Rajiv Aarogyasri Health Insurance scheme was designed for individuals below the poverty line in Andhra Pradesh. The benefits of the scheme are available on a floater basis and an individual or a family as a whole can make health insurance claims up to Rs.1.5 lakh. In case the Rs.1.5 lakh benefit is exceeded, an extra amount equal to Rs.50,000 can also be availed. The treatments for a wide variety of serious ailments that require hospitalisation or surgery are covered. All in all, 938 treatments are covered under the scheme. Pre-existing diseases of specific conditions are also covered.
Named after a former Chief Minister, Biju Patnaik, Biju Swasthya Kalyan Yojana is a health coverage scheme launched by the Government of Odisha. The scheme is expected to offer medical protection to 70 lakh families in the state. The scheme will offer coverage for secondary and tertiary treatments up to Rs.5 lakh per family. The coverage amount is extended to Rs.7 lakh in the case of women.
Ayushman Bharat is an ambitious universal health insurance scheme that will cover 50 crore Indians and provide Rs.5 lakh coverage to the underprivileged families of the country. This free government-backed health insurance scheme will provide coverage for secondary and tertiary medical treatment services. The services can be availed in government hospitals as well as private hospitals. One of the highlights of the scheme is that it covers all pre-existing diseases.
Depending on your insurance provider and the plan selected, you can be covered for a variety of expenses related to medical care, surgeries and treatments. Given below are some of the major expenses covered under health insurance plans.
These include expenses incurred during hospitalisation for at least 24 hours. Expenses covered include room charges, ICU charges, operation theatre charges, surgeon’s fee, doctor’s fee, anaesthesia, oxygen, blood and so on.
Any medical expenses incurred for usually 30 days to 60 days before hospitalisation will be covered. These expenses can include diagnostic tests, reports, prescribed medication, investigative tests, et cetera.
Any medical expenses incurred for usually 30 days to 180 days after hospitalisation will be covered. These expenses can include follow-up visits with the doctor, additional diagnostic tests, reports, prescribed medication, et cetera.
Day Care Procedures:
Day care procedures include chemotherapy, dialysis, appendectomy, angiography, colonoscopy, radiotherapy, hydrocele, lithotripsy, eye surgery, piles or fistula, prostate, sinusitis, liver aspiration, sclerotherapy. Insurance plans can cover anywhere between 70 to 400 day care treatments. Some high-end policies may cover every single day care procedure.
Organ Donor Costs:
Medical expenses incurred by organ donors might be covered under insurance plans. This means that if someone is donating an organ to you, their expenses will be covered under your health insurance plan.
Any treatments taken at home that exceeds a period of 3 days will be covered.
The health insurance plans usually cover up to a certain sum for the ambulance service.
General health check-ups might be covered under health insurance plans depending on the insurance provider. Preventive health check-ups are encouraged to catch illnesses at early stages so that it can be treated with minimal expenses.
Some plans cover vaccinations required in case of dog bites, bee stings, etc.
Treatment of critical illnesses can be exorbitant. The coverage of these illnesses might be inbuilt in the base plan or can be added as a rider option. Critical illnesses include heart attack, stroke, multiple sclerosis, blindness, AIDS, coronary artery disease, cancer, viral hepatitis, major organ transplant, paralysis, major burns, coma, terminal illness, motor neurone disease, loss of speech, loss of hearing, Parkinson’s, encephalitis, meningitis, chronic lung disease, chronic liver disease, etc.
Alternative medicine has always held an important place in the field of medicine. In India, many people turn to alternative methods quite often. AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. Health insurance providers have understood the need to cover such treatments and offer coverage to those who opt for it.
Expenses incurred in getting a second opinion may be covered under your plan. This greatly depends on the insurer and the type of plan you have selected. Second opinions are very much necessary when getting treated as they provide either confirmation of the illnesses or question whether the treatment is unnecessary. In some cases, the insurance provider will arrange for a second opinion from their own panel of medical practitioners.
When you are hospitalised, there will be day-to-day expenses that need to be met for yourself and for your caretaker. These expenses include food, toiletries, and anything that might be required for your hospital stay. Insurance plans provide hospital cash as an inbuilt feature or a rider plan. The insurer will provide a set amount of money per day of admission in the ICU and the hospital to help meet these expenses and compensate for the loss of income during this period.
In case of emergencies, if the patient needs to be transported to another hospital, the insurance plan will cover the costs associated with shifting hospitals in order to get the suitable treatment.
Under certain circumstances, the health insurance providers are not liable to pay for the costs of treatment. These exclusions are mentioned upfront in the policy document. It is very important to read what is not covered under your policy and the limits imposed on certain illnesses and facilities. While the exclusions different between policies and insurance companies, the general exclusions have been listed below:
When it comes to taking a health insurance policy, there are a number of things that could influence the cover you get, the premiums you pay and the overall satisfaction of the policy.
How much cover you need: While choosing a policy, you need to take into consideration the rising costs of medical treatment, the premiums you can afford and how much cover would you be satisfied with. Choose a policy that will take care of most of your expenses if any illnesses were to arise.
What is Excluded: Ensure that the policy offers substantial cover without too many exclusions. General exclusions are acceptable as the insurance companies are willing to bear the risk only up to a certain extent depending on the policy you choose and the premium you are willing to pay. If you have pre-existing illnesses, you can try to find a policy that will specifically cater to your needs while eliminating a number of other unnecessary things covered.
Restoration of Sum Assured: Many insurance providers are now offering the option of restoring the sam assured. Under this option, if the insured person has exhausted the sum assured for one illness and then contracts another unrelated illness, then the full sum will be restored to cover the next illness. Some policies allow restoration for up to 3 illnesses. Choosing a plan with restoration benefits might cost more initially, but the restoration is granted at no additional cost later.
Co-payments: Co-payment is the amount that you are willing to pay in case of a claim, while the insurance provider will pay the remainder. Co-payment options help reduce the premiums charged. However, at the time of a claim, the insured person will be required to pay a percentage of the bill.
Premium payment frequency: Premiums can either be paid as a single payment or in instalments. Instalments offered are monthly, quarterly, semi-annually, and annually. It is important to pay these premiums as per your schedule and on time. This will avoid hassles involved with lapsed policies.
Portability: Every now and then, a new insurer may step into the market with a better offer, or a current insurer might come up with an innovative idea. In these cases, you might want to shift your insurance plan to a better provider. Having a portable insurance policy will allow you to make the shift without compromising on no-claim bonus and waiting periods.
No-claim bonus (NCB): If you do not make a claim during the policy year, then you might be eligible for a no-claim bonus. The bonus is offered as discount on the premium when renewing the health insurance plan. Every year, the NCB will increase and go up to a maximum of 50%.
NCB can be availed even while transferring the policy to another insurance provider but cannot be transferred from one person to another. No-claim bonuses discourage people to make petty claims as the discount might prove to be more valuable.
Lifelong renewability: This is an important feature of health insurance plans because this ensures that you will be allowed to renew your policy even after facing illnesses and especially during old age. It is difficult to get an affordable insurance policy once you become a senior citizen, especially if you have faced health issues.
Claim settlement ratio: The claim settlement ratio indicates the number of claims that an insurer has rejected versus the number of claims the insurer has settled. This plays a small role in determining which health insurance company you should choose. It is important to see how many claims a company settles, however, this should not be your sole deciding factor. An insurance company can reject claims for a number of reasons. It is important to note how many policies were issued by the company, the features and benefits that they offer, and the reviews received.
In the past, insurance policies were sold. Pushy agents would be able to get people to purchase policies whether they liked the policy or not, after being convinced it was the best! However, times have changed and things have changed. Nowadays, the power of finding the best policy is in the hands of the individual. Access to the internet, a plethora of insurance companies and a vast number of products, customers are now faced with a daunting task of choosing the best health insurance company. Spoilt for choice, finding the best health insurance provider is something that can be done through research and comparisons, along with the help of agents as well. While researching, these are a few factors you should keep in mind:
Reviews of the Insurance Company:
There are a number of websites that allow customers to write reviews and complaints about a particular insurance company. One must bear in mind that people have a tendency to take to the internet and write a review mostly when one is upset and needs an outlet. Customers who are satisfied rarely get online and write good reviews unless prompted. An overall outlook of online reviews can help a person decide whether the insurance company has established a good rapport with its customers.
Reputation of the Health Insurance Provider:
Some companies have been around for so long that they have established a trusting relationship with the society they cater to. However, there are also new insurance providers that are establishing themselves in the market through additional benefits and care for customers. Checking out their status in the market can help determine whether you’d be satisfied with the health insurance provider.
The number of years a company has been in existence can make a difference as they will have more experience in the industry. These companies may have better and more innovative solutions as a result of long-term market research. Again, this may not be applicable if an up-and-coming company has a better offer. Many companies tie-up with each other or with banks to combine their experience and take on the insurance industry together.
A good insurance provider changes and updates their product portfolio to keep up with the ever-changing market and needs of customers. A wider range of policies can help a person choose one that caters to their needs the best. Opting for an outdated plan might not bode well when an insurance claim needs to be made.
Having the option to renew your policy online is highly beneficial as it will save time and the hassle of visiting a branch or meeting with the agent. Online renewals enable the customer to quickly pay the premium and get their renewal done within minutes.
A quick and easy claims settlement process will reduce the hassle involved in make an insurance claim. The option to submit a claim online will help reduce time and paperwork. Furthermore, the option of cashless settlements can help reduce the financial burden on the insured. At the same time, the option of reimbursement claims would allow you to get treated at any hospital, not just at one that is within the insurance network. You can then claim for insurance after the treatment is done and you have paid the bill.
A good customer support team is a must when it comes to insurance. Customer service is important when it comes to resolving queries, complaints and claims. Round-the-clock assistance is necessary when it comes to health insurance because you do not know when the need may arise. However, some companies provide customer support only during regular work hours. In this case, you should be able to contact your agent or designated manager. Multiple avenues to contact the customer care such as phone, email, online chat and branch assistance also makes a difference.
There are different parameters that one must take into consideration while determining which health insurance plan would be best for them. Nowadays there are many third-party websites with the facility to compare different policies from insurance providers. This is a very useful tool as it shows you what you would get and wouldn’t get compared to other policies in the market.
Considering the overwhelming number of health insurance plans available in the market, choosing the right plan suitable for you can be a little tricky. The best way to find a health insurance plan is by comparing the plans offered by different insurers in the market. When you compare health insurance plans, you must do your research based on the range of features offered by service providers.
You can check out the features of different plans and pick the best one suitable for you. When you compare health insurance plans, you may take various factors like cost, features, service quality, value-added benefits, availability of add-on covers, etc. into consideration. Once you have narrowed down to a few best plans, you can choose the health insurance company by considering its incurred claim ratio and online reviews from existing customers.
In order to find a health insurance policy that provides you adequate coverage at a competitive premium rate and is well suited to your needs, it is essential to do your due research and compare a few different policies before purchasing one. Thus, if you are looking to invest in a health insurance policy, make sure to consider the parameters mentioned below when comparing various plans:
Purchasing the right health insurance policy will help you manage your healthcare costs and medical expenses in a hassle-free manner. Given just how important a health insurance plan can be, you should make sure to compare various plans and purchase one that is suited to your needs.
There is an abundance of health insurance plans in the market today. Each of the several health insurance companies present in India offer various individual, group, and special health insurance plans that prospective policyholders can purchase as per their demands. While the great amount of plans gives more opportunity for individuals to opt for the perfect plan, finding ‘the one’ could prove to be an ardent task.
Here are a few pointers that could help you filter the plethora of health insurance plans.
This is a very important and relatively simple task to carry out. If you’re buying a policy for yourself, you will have to look only at the individual plans available. If, however, you also have to cover your spouse, children, or parents even, you’ll have to look at the family floaters offered by health insurance companies.
Choose a sum insured amount based on how much you think will be required to cover your medical expenses and your family’s medical expenses in case you plan to buy a family floater. While choosing the sum insured, keep in mind the rising medical costs and the number of people who you plan to include in the policy. Once you’ve chosen the sum insured, you can rule out the plans that do not fit the sum insured bracket you’re looking at.
Insurance companies decide the premium payable depending on various factors such as the age of the proposer, the number of people covered, plan type, etc. Insurance companies may choose to hike the premium amount in the future after the individual crosses the age of 45 or if he/she chooses to change the plan type. Find out what could cause such hikes and how you could manage such hikes.
Each insurance company boasts of myriad hospitals they have tie-ups with but what you need to understand is that it is not the number of hospitals that are empanelled that matter but whether nearby hospitals and hospitals you frequent to are partnered with the insurance company. Accordingly, you can choose the insurer from whom you want to buy a plan.
When you buy a health insurance policy, it is important to buy one from a company that provides good services. So, go through the claims procedure as well as the claims history of the company. The Insurance Regulatory and Development Authority of India (IRDAI) publishes a report that presents the claims incurred ratios of general insurance companies. Refer to the data to pick the best-suited insurer from the plethora of companies out there.
Apart from the regular benefits offered by insurers such as coverage for hospitalisation, domiciliary treatment, pre-hospitalisation, post-hospitalisation, etc., look for additional benefits that will further enhance your plan such as coverage for medical check-ups, specific treatments, maternity expenses, surgeries, etc. A few insurers also offer a sum insured restore option or top-ups that boost the base plan.
If you keep in mind the above-mentioned pointers, choosing a health insurance policy might not be all that hard after all.
Making a claim for insurance used to be a cumbersome task involving a lot of paperwork and multiple visits to the insurance office. Now claims have been simplified through online facilities and dedicated agents. If you hold a valid insurance policy and need to make a claim, there are usually two options available:
Under this facility, the insured person can get treated at any hospital, pay the bill and then later file for insurance reimbursement within the stipulated time period. This option requires the customer to settle the bill in full which can result in financial burden. In case of planned hospitalisation, the insurance company should be informed in advance. If it is an emergency, a period of time is granted before the event that might lead to a claim needs to be intimated to the insurance company. To make a reimbursement claim, you need to follow these steps:
Cashless claims allow the customer to receive medical treatment and walk out without paying for the bill. This can be done if the insurance provider offers cashless facilities and if the insured person avails treatment at a network hospital. Insurance companies tie up with a number of hospitals across the country to make the insurance claim settlement process easier and faster. The customer will only be required to pay for anything that is not covered under the policy such as non-medical items, or any treatment specifically excluded as per the policy document. The hospital and the insurer will communicate directly and the bill will be settled by the insurer. To avail this facility, one can follow the steps below:
After this is done, the hospital will seek approval from the insurance provider. The insurance provider will verify the claim and if satisfied will send an approval. This generally takes no more than 24 hours. If the insurer requires more information, a query will be sent for the same. If you are not eligible for cashless claims, the insurance company will send a rejection. You might be eligible to make a reimbursement claim later. Even under cashless claims, it is important to collect a copy of all bills, discharge summary, reports, prescriptions and so on.
Buying health insurance used to involve a tedious process or meeting with an agent, trying to understand his over enthusiastic pitch, and being convinced to pay a premium without knowing what you’re getting into. It also involved a lot of paperwork and documentation. However, now with technological advancements, the whole process has become much easier. The paperwork needed is minimal and the policy is issued instantly online if everything is in order. Some of the benefits of buying a health insurance plan online are listed below.
When you buy a policy online, you have access to the brochure and a sample policy document. You can read up on all the details of your policy instead of being told what they are. Nothing is hidden from you, unlike dealing with agents who might not give you the crucial details.
These handy tools are available across the web. By simply putting in a few details, you can get an estimate of your premium. You can toggle between different sums assured and different benefits to see what option would suit you best.
The overall time taken to purchase a policy online is just a few minutes, not even an hour. You simply need to provide your details, and the insurance company will get back to you. If you are eligible for an instant policy, you simply need to make the premium payment and the policy will be issued. If necessary, you might be required to do some medical tests before the policy is issued.
Insurance companies can offer you lower premiums when you buy your policy online because it costs less to acquire you as a customer and to deliver the policy to you. With the elimination of middlemen, the cost is reduced, so the companies have the bandwidth to offer lower rates and more discounts.
Once you make the premium payment, the policy will come into effect. This allows you to get instant cover as soon as you opt for an online policy. When you purchase a policy through agents or distance marketing, it may take a few days for application to be processed and for the policy to be issued.
There are a ton of mistakes that can be made when buying a health insurance policy and many people make them on a daily basis. This ends in the customer being dissatisfied with the terms and conditions, the coverage, the customer care and ultimately leads to a bad review for the insurance company. By choosing the ideal health insurance plan, both the customer and the company can have a mutually beneficial relationship.
Some of the reasons people make mistakes is lack of information, blindly trusting the agent, lack of time, skipping the terms and conditions, and so on. Some of the most common mistakes that you can avoid while buying a health insurance plan are as follows:
Not Reading the Fine Print:
This is the biggest mistake majority of people make when they purchase health insurance. It’s tedious and boring to read the fine print, and moreover, it’s insurance jargon that some people cannot understand. Luckily nowadays, the internet has made it possible to understand these terms and conditions. Many blog posts and articles help simplify insurance terms and explain it in easy layman terms. The terms and conditions, the brochure and the policy document will detail the coverage provided, limits of cover on items, exclusions, grace period, and other important information which you must be aware of.
Not Opting for Adequate Insurance:
Sometimes to save money on premiums, one might opt for a lower sum assured. This may prove to be a mistake later on when the cost of the medical treatment exceeds the sum assured under the insurance plan. It is important to consider rising medical costs, inflation and future needs while deciding the sum assured.
Buying the First Policy Offered:
Some people just buy the first policy they see because they might be under the impression that all policies are the same. Many people opt for the policy their friend or family member has. But what is good for one may not be good for another. It is imperative to check out different offers from various insurance providers. Making comparisons and doing a little research can go a long way in the satisfaction you have with your policy.
Lying About Important Information:
Misinformation or omission of important information can lead to a rejection of your insurance claim. If you have been diagnosed with a condition or have a pre-existing illness, it should be disclosed. If you do not do so, and the insurance company does its research into your claim and finds out the truth, your claim will be rejected, your policy will be in jeopardy of being terminated and you will also lose the premium you paid. It is also important to disclose lifestyle habits such as smoking, tobacco chewing, drinking alcohol and so on.
Not knowing the Network Hospitals:
Choose a health insurance provider with good network hospitals around you. Having 4,500+ hospitals for cashless hospitalisation will mean nothing if the hospitals close to you are not included in that list. Always get an insurance that offers cashless hospitalisation as this will lighten the financial burden. Be sure to check the list of network hospitals.
Opting for a High Co-pay:
Co-payment is the amount of the hospital bill you are willing to pay. The remainder will be paid by the insurance company. Co-pay reduces the premium payable, but this also means that in the event of a claim, you will be liable to pay a portion of the bill. So in the long run opting for a high co-pay may not be beneficial.
Opting for too Much Insurance:
Buying too much insurance, adding too many riders, and getting unnecessary add-ons might just simply put a dent in your pocket when there is absolutely no need for it. Out of paranoia, we might think it’s better to be safe than sorry, but sometimes this might lead to purchasing too much insurance. It would be smart to use a premium calculator or the help of an agent to determine an adequate amount. The remainder you save on premiums could be diverted to more fruitful investment avenues.
Getting Insurance too Late:
Realising the importance of medical insurance may dawn upon you too late in life. Usually when our health is good, we don’t think about the future. Unfortunately, the world has evolved into a dangerous place swarming with chemicals and plastic. No matter how healthy a life you lead, cancer might be inevitable these days and so are other health problems. It is important to get health insurance early so that the premiums are lower and you will exhaust the waiting periods well before you run into any health issues.
Banking Solely on Employer’s Insurance:
Most companies and employers provide insurance to their employees. These plans usually do not have waiting periods and exclusions. Furthermore, these policies also cover dependent parents and children. This is an extremely attractive feature of working for such a company. However, it is always better to have your own safety net. This is because if you leave your job or if you are terminated, you will suddenly find yourself without insurance. You will have to begin the waiting periods afresh.
“The data listed above is as per the report released by IRDAI (2017-18).”
Some health insurance providers like Reliance General Insurance (Reliance HealthGain Policy is available in 4 easy installments) offer health insurance policies in easy installments for those who can't afford to pay the insurance premium in one shot. Premium payment via installments every month is known as Equated Monthly Installments (EMI). Here is everything you need to know about health insurance EMI
Grace period is the specified period of time usually 15 days from the premium due date within which a payment can be made to renew or continue an active policy without losing out on benefits such as waiting periods and coverage of pre-existing illnesses. Here is how grace period works in health insurance:
A network hospital is a medical facility with which the insurance company has an agreement to provide cashless treatment to its customers. The life insured can avail cashless treatment only at a network hospital of the insurer. The list of network hospitals of the insurer can be found on the insurance provider's website. You can also visit a third-party website like BankBazaarInsurance.com to locate a network hospital near you. The payment for medical expenses incurred by the life insured during the period of hospitalisation is made by the insurer directly to the hospital. The expenses include cost of treatment, admission charges, doctor's fees, room fees, and ambulance fees.
Cashless claim is subject to the sum assured chosen at the time of policy inception. The policyholder has to provide e-card and ID card at the hospital desk. The hospital will fill the pre-authorisation form and get approval from the insurer's TPA. After verification of the cashless claim, the insurer will pay for the medical expenses directly to the hospital. If you get treatment at a non-network hospital, you will have to pay the medical bills upfront, and the reimbursement claim settlement may take 2 to 3 months.
As per the IRDA standards, if a policyholder has a pre-existing illness, the cover for that illness begins only after the completion of 4 years, called the waiting period.
Claims made after the completion of the waiting period cannot be rejected by the insurer. If the policyholder is diagnosed with an illness during the waiting period for the first time, then the illness will not be considered as a pre-existing disease or condition. Therefore, the treatment expense towards that particular illness will be covered under the policy. For an additional premium, some insurers give the option to minimise the waiting period.
If a policyholder does not make a claim during the policy term, the insurance company rewards him/her with a bonus known as No-Claim Bonus. This bonus is given in the form of a discount on the next premium paid to renew the health insurance policy. The intention of the NCB is to discourage policyholders from making petty claims. Discount for the 1st claim-free year starts at 5% and increases every subsequent year. The maximum amount allowed as NCB is 50%.
Yes, if the proposer of the policy adds additional members or takes a family policy, then the premiums per person would be reduced. Under family policies, one can add their spouse, dependent parents and up to two dependent children. There are family policies that allow up to 15 members to be insured under one policy.
Claim settlement ratio is the number of claims that have been settled by an insurance company against the number of claims that have been processed and rejected. A very high or very low ratio indicates a skewed process. A positive CSR indicates that the company has settled many claims. A low CSR should indicate that the company has rejected many claims, however, this does not indicate that the company is not good. Claims can be settled or rejected for various reasons.
Buying health insurance online is safe because the feature purchase these policies is available on their own secure website. A number of other third-party websites also offer online policies through safe and secure websites. Always look for “https” in the address bar to ensure that the website is secure. Making the payment for the premium is done through online payment gateways that are safe and require your authentication and verification to carry out the transaction. Never give out your OTP and CVV to anyone.
It is cheaper than going through an agent because the middleman viz. the agent does not play a part in the process and the cost of the policy is reduced by the amount of commissions paid (to the agent).
Switching and porting are synonyms which refer to when a policyholder moves or ports from his/her current provider to another. If a policyholder is unhappy with the current insurance company, then at the time of renewal, they can renew the policy with a different insurer. Under this facility, the policyholder will not have to compromise on the time lapsed on waiting periods and no-claim bonuses earned.
For premiums paid towards health insurance plans, you can claim deductions under Section 80D of the Income Tax Act, 1961.
A free-look period is the time given by the insurance company to the policyholder to view the terms and conditions of the plan. If the policyholder is not satisfied with the policy, they can return it and get a refund of the premium paid. The insurance company will deduct the money spent on medicals, stamp duty and also for proportionate risk borne by them. The free-look period granted is usually 15 days to 30 days.
Yes, effective 1 July 2017, GST is applicable to health insurance premiums. The current rate of GST on these premiums is 18%.
If the original policy is lost, you need to inform the health insurance provider. A duplicate policy will be issued to you. There may be a fee charged for this service depending on the insurance company.
Dependents are usually the immediate family that includes spouse, parents and children. Some policies cover up to only 2 children. Children are covered up to the age of 18 years. This is sometimes extended to 25 years if they are unemployed or unmarried.
Premiums vary between people and based on the age and location of the insured member and the sum assured chosen. Other factors that influence premiums include co-pay options, riders, pre-existing illnesses, hazardous occupations, etc. In case of plans on a family floater basis, premiums are calculated based on the age of the oldest member. Premiums in this case are also affected by the family size i.e. the number of family members covered under the policy.
A cashless claim is a facility provided by the insurance company through tie-ups with various hospitals. If the insured decides to get treated at one of these hospitals, then they are not required to pay the bill. The insurer and the hospital will deal directly between themselves regarding all matters of documentation and bill settlement. The insured might be required to pay any portion of the bill that is not covered under the policy.
Some insurance companies require or provide the option of co-payment. This means the portion of any claim the insured is willing to pay should a claim arise. This option reduces the premium according to the deductible sum chosen. However, this will also mean that at the time of a claim, the insured will be able to claim a smaller amount.
The sum assured is the absolute amount the insurance company is liable to pay in the event of a claim. You cannot claim an amount higher than the sum assured.
Sub-limits are caps placed on different kinds of claims. This cap defines the maximum amount the insurance company will pay for certain expenses covered under the policy. For example, the insurer might pay only 40% of the room rent charges, or 60% in case of specific illnesses. Sub limits are imposed usually on room charges, medical tests, operation theatre expenses, medicines costs, and hospitalisation expenses.
If a person exhausts the total sum assured under the insurance policy within the policy period for one particular illness, the sum assured will be restored fully in case of another illness. For example, if a person is diagnosed with a heart condition and uses the full sum assured to get treated, and later he is diagnosed with a liver condition, then the sum assured will be restored. The insured can claim the same amount for the second time in the same period. Insurance companies sometimes offer three restoration benefits.
Both terms are often used synonymously, however, there is a difference between the two. Mediclaim covers specific things such as hospitalisation expenses, particular illnesses and hospitalisation/treatment in case of accidents. Health insurance plans has a broader base of coverage and can be customised to include expenses pertaining to pre/ post-hospitalisation, ambulance charges, critical illnesses, etc.
Day care is an important part of your insurance plan because most of the time, medical expenses do not end when you leave the hospital. You will be required to take further medication, diagnostic tests (without hospitalisation), and various other treatments that fall under day care. Under these circumstances, it is beneficial to have day care insurance as it will cover these costs.
Day care treatments usually include those procedures that can be done within a few hours to a day and do not require hospitalisation. There are hundreds on day care treatments and depending on your insurer, it may or may not be covered. Some of the common day care treatments include:
Many health insurance policies have inbuilt coverage of day care treatments. When choosing your health insurance plan, it is important to read the fine print and check the number of day care treatments covered. This information is usually available in the plan brochure or will be provided to you upon request. Many companies list the number of treatments they cover. However, it is also important to check the coverage department-wise such as oncology, urology, or cardiology. Another important measure to take is to read the exclusions of the policy.
Domiciliary hospitalisation refers to the treatment of a certain illness that can be done at home. A hospital or nursing home is not required or cannot be given as the patient may be immobile. This can also happen due to non-availability of accommodation in the hospitals. Treatment is considered domiciliary hospitalisation if it occurs for 3 continuous days for a certain disease or injury.
Many health insurance providers in India do not cover dental treatments. However, now a few insurance plans do offer coverage of dental procedures. There may be a waiting a period from the commencement of the policy before the dental cover starts.
Floater policies are those that cover multiple people under a single insurance plan. The sum assured can either be used entirely by one person, or there may be a fixed sum assigned for each person.
Individual plans are designed to cater to a single person whereas a floater plan caters to multiple people. Floater options are suitable for families and groups. Premiums between the two policies will differ. Floater plans usually carry higher premiums, but it will average out to lesser person as it is a group plan.
Under reimbursement claims, the policyholder needs to settle the hospital bill once they are discharged. They can later fill up the insurance claim form, submit the required documents and get a reimbursement of the money spent at the hospital. This is usually done when the patient receives treatment at a non-network hospital where cashless facility is not available.
In the past, health insurers did not provide any coverage for alternative treatments. However, in 2014, the central government made it mandatory for all health insurers to provide coverage for AYUSH treatments. AYUSH treatments include Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. The percentage of coverage may differ from one insurer to another. You may check with your insurer to determine the level of coverage available for homeopathy treatment.
Some insurance plans offer special benefits for personal accidents. This covers hospitalisation, consultation fees, and so on. Apart from this, you will also be covered in case of permanent disability or dismemberment. In case of death due to accident, your nominee can claim a death benefit.
Switching health insurance providers would be ideal under the following circumstances:
If you insurer covers pre-hospitalisation expenses, the following will be covered:
Post-hospitalisation cover usually pays for:
With the technological advancement in the medical industry, many surgeries and treatments which usually required a prolonged hospitalisation in the past can now be completed within 24 hours. Health insurance companies now provide insurance coverage for day-care procedures like angiography, chemotherapy, radiation therapy, dialysis, and more.
Although you avoid prolonged hospitalisation in the case of day-care procedures, the expense of day-care treatments is still high. With a day-care health insurance cover, you can meet these expenses easily without putting a dent in your pocket.
Gastroenterology, Chemotherapy, Thoracic surgery, Radiotherapy, Tonsillectomy, Auroplasty, Cataract, Hydrocele, Lithotripsy, Oncology, Stapedotomy, Neurology, Tympanoplasty, Urology, Myringotomy, Ophthalmology, Plastic Surgery, and ENT are some of treatments included under day-care procedures. Any treatment received on an outpatient basis is not considered a day-care treatment.
Insurance providers list a huge number of day-care procedures to attract customers. However, it is important to check out the broad categories of procedures covered under the day-care health insurance rather than just the number of treatments. Choose a health insurer who provides insurance coverage for numerous broader categories such as cardiology, oncology, urology, and ophthalmology.
Domiciliary hospitalisation is when the life insured receives treatment for an illness or injury while confined at his or her home due to the lack of accommodation at the hospital or the physical inability to move to a hospital for treatment.
When the stipulated 24-hour hospitalisation is not possible due to the lack of accommodation at the hospital or the life insured’s inability to move to a hospital, domiciliary hospitalisation benefit will cover the expenses incurred from treatment taken in the confines of his or her home.
Due to the technological advancement in dentistry, the cost of dental treatments have risen over the years. Most standard health insurance plans don’t offer insurance coverage for dental treatments. You can opt for a dental health insurance plan to supplement your base health insurance policy.
First, determine the type of health insurance plan you require (individual, group, family, critical illness, etc). Second, compare the features and benefits of various health insurance policies across top health insurance providers. Comparison can be easily carried out for free on third-party websites like BankBazaarInsurance.com. Beside insurance premium, make note of the inclusions and exclusions of the policy, co-payment, insurance coverage, sub-limit, waiting period, diseases covered, etc. The best health insurance policy is one that offers a comprehensive health cover at an affordable premium.
Reading the fine print of your health insurance policy document carefully is important to avoid any problems when making a claim. Read the inclusions and exclusions of the policy. Focus on the cancellation and renewal guidelines. Check for waiting period for initiating a reimbursement claim.
Certain myths about health insurance results in you being either underinsured or overinsured. Some of the top myths about health insurance are:
The documents required for health insurance claim reimbursement are:
A family floater plan offers health insurance cover to the entire family under one policy, wherein you pay a single premium but the sum insured is shared by the entire family. Insured members under a floater option usually includes self, spouse, children, and dependent parents.
Reimbursement works on the indemnity principle wherein the medical expenses incurred by the life insured during the policy period is paid back by the insurance company after the policyholder makes a claim for reimbursement.
Individual health insurance covers only one person whereas the family floater plan covers the entire family under a single policy. The sum insured of a family floater plan will be shared by the insured members whilst paying single premium.
Sub-limit is the limited amount or percentage of the sum insured that the insurer will pay for certain expenses like room rent, pre and post-hospitalisation, cost of surgery, cost of medicines, etc.
Homeopathy treatment received at a government hospital or any medical facility accredited by the government is covered under health insurance. Usually, up to 10% of the sum insured is used to cover homeopathy treatments.
In the case of health insurance, the premiums paid will not be refunded even if you don’t make any claim during the policy period.
Health insurance portability allows you to transfer your existing health insurance policy from the current insurance provider to another without losing the policy benefits provided by your current insurer.
Pre and post-hospitalisation expenses includes medical expenses incurred by the life insured 30 days prior to and 60 days after hospitalisation.
The premium for a family floater plan is calculated based on the age of the oldest insured member of the family.
Cashless hospitalisation - If you receive treatment at one of the network hospitals of your insurer, you can avail cashless facility wherein the medical expenses incurred by the life insured will be directly paid by the insurer to the hospital. Show your health card at the hospital desk and get approval from your insurer’s TPA to avail cashless treatment. You don’t have to pay the medical bill upfront out of your pocket. Check the insurer’s website for the list of network hospitals.
The minimum entry age to apply for a health insurance policy is 18 years and the maximum is 65 years. Children from the age of 3 months and above can be insured under the parent’s policy.
Any illness or disease for which the life insured showed symptoms, was diagnosed or took treatment prior to the inception of the policy is considered a pre-existing disease or condition.
With the steady increase in healthcare costs and lifestyle diseases, it is advisable to have a suitable health cover handy. Health insurance offers financial protection to you and your family against unexpected medical expenses incurred during the policy period. In addition, you can also maintain good health with preventive healthcare cover.
A family floater plan provides insurance coverage against medical expenses incurred by any of the insured members of the family during the policy period. Critical illness plan provides a lump sum amount to the policyholder if the life insured is diagnosed with any of the specified critical illnesses under the policy regardless of whether the person receives treatment for the illness or not. Hospital cash plan provides daily cash of up to Rs.4,000 to the life insured to meet non-medical expenses during the period of hospitalisation.
For a group or employee health insurance plan, you don’t need to undergo a medical checkup. For an individual health insurance plan, people under the age of 45 don’t have to undergo medical checkup. For senior citizen health insurance plan, the policyholder will have to undergo medical checkup. Some insurance providers will share the cost of medical checkup. It is advisable to get a medical checkup done when applying for a health insurance policy to avoid any hassle when making a claim.
Health insurance policies can be cancelled if no claims have been made during the policy period. Policy can be cancelled during the free-look period and you can get premium refund based on the cancellation policy specified in the policy document.
Medical insurance is important because without it you may have to borrow money to pay your medical bills. With a suitable health insurance plan, you can get access to timely and adequate healthcare, network hospitals, cashless treatment, and enhanced financial protection against unexpected medical expenses.
The types of health insurance plans available in India today are individual health insurance plans, group or employee health insurance plans, family floater plans, senior citizen plans, critical Illness plans, personal accident covers, and maternity insurance plans.
Critical illness plan provides guaranteed payout when the life insured is diagnosed with any of the critical illnesses specified under the policy regardless of whether the person receives treatment for the illness or not.
The parameters for calculating health insurance premium are age, gender, location, occupation, lifestyle habits, sum insured, coverage, pre-existing conditions, etc.
You must intimate the insurer within 48 hours of hospitalisation. You will have to pay for the medical expenses out of your pocket. The duly-filled and signed claim form should be submitted to the insurer along with the supporting documents such as the original medical bills (hospitalisation, medicines, tests), discharge card, and cancelled cheque. After the insurer-appointed surveyor verifies and confirms your claim, the claim settlement amount will be sent you.
If no claim has been made in the previous year, you can renew the policy. Renewal has to be done on time or the policy will lapse.
Health card is an identity card provided by the insurance company to the life insured to avail cashless treatment at a network hospital. The health card will contain the health policy and contact details of the insurer’s TPA.
If you show the health card at the network hospital desk, the hospital will immediately confirm your identity and policy details. You can get cashless treatment instantly without any hassle. You can contact the insurer’s TPA for any policy-related queries or assistance on the helpline numbers listed on the health card.
Aditya Birla, Iffco Tokio, Reliance General Insurance, and ICICI Lombard, based on the latest claims incurred ratios, are some of the best health insurance providers of 2018 in India.
To select the best health insurance plan, you must consider certain parameters such as premium, waiting period, diseases covered, No-Claim Bonus, co-payment, sub-limit, network hospitals, and claim settlement ratio of the insurer. Apollo Munich Easy Health, Religare Care Health Insurance Plan, ICICI Lombard Complete Health-iHealth, Max Bupa Health Companion, and Apollo Munich Optima Restore are some of the best health insurance plans of 2018.
Visit the insurance company’s website, login with your username and password, provide your policy number, upload proof of your new contact address, and make the changes in your profile. If you want to make the change offline, you can request a change of address in the policy documents by providing proof of address and policy number to your insurance agent.
During policy renewal, you can increase the sum insured if needed.
Yes, an individual can have more than one health insurance policy. If you aren’t receiving sufficient insurance coverage under your group health insurance policy, you can opt for an individual health insurance plan.
You can get tax deductions on premiums paid towards a health insurance policy under Section 80D of the Income Tax Act, 1961:
The various factors that affect health insurance premium are:
Exclusions of a health insurance policy includes:
There is a 30-day waiting period starting from the policy inception date for the policy benefits to begin, except for unexpected hospitalisation due to an accident. The waiting period for pre-existing disease claims is 4 years.
You can pay the premium due within 15 days from the due date. This period is called the grace period. If you fail to make premium payments within the grace period then your policy will lapse.
Health insurance portability allows you to transfer your health insurance policy from the current insurance provider to another without losing the policy benefits offered by your existing insurer.
After a claim has been settled, the policy coverage will reduce by the settled amount till the end of the policy term.
Any number of claims can be made over a year during the policy term until you reach the specified limit mentioned in the policy document. Sum insured is the maximum limit one can claim under the policy.
Some insurers pay for health check-ups of the life insured once every 4 years. This is called ‘health check’ facility.
Some insurance companies appoint a Third Party Administrator (TPA) to process all the claims made by the policyholders. The hospital needs to receive approval from the TPA to provide cashless treatment to a life insured. The contact details of the TPA will be available on your health card or the insurer’ website.
A medical examination may be required based on the age and medical condition of the life insured.
No, you don't have to undergo a medical check-up every year if the policy is renewed continuously without fail and if there are no changes in the policy terms and conditions.
Usually, the customer pays for the pre-policy medical checkup. However, some insurance providers share the cost of the medical examination on a claim reimbursement basis.
Any person registered with the medical council of any state of India and thereby entitled to practice medicine within its jurisdiction is called a medical practitioner, can be a physician, specialist, surgeon, etc.
Medical expenses are the expenses incurred by the life insured for medical treatments received on the advice of a medical practitioner due to an illness or accident during the policy period.
The medical expenses can be indemnified through reimbursement claims or by availing cashless services at a network hospital of the insurer.
No, cashless facility is available only at the network hospitals of the insurer. For the list of network hospitals in your location, visit the insurance provider’s website.
Use the network hospital locator available on your insurer’s website for the list of network hospitals available in your area.
No, cashless treatment cannot be availed at government institutions.
Yes, the insurer will pay the entire amount for the medical expenses incurred at the network hospital subject to the sum insured limit. However, you may have to pay for the non-medical expenses that are not covered under the policy before your discharge from the hospital.
The cheque will be sent directly to the network hospital where the life insured received treatment.
Co-payment is a cost-sharing requirement for certain health insurance policies wherein the policyholder will bear a specific percentage of the admissible costs.
It is the specified period of time, usually 30 days from the date of policy inception, after the completion of which full or partial health insurance coverage will begin. The waiting period varies from insurer to insurer based on the type of disease and policy.
The group or employee health insurance policy provided by your employer offers basic liability cover which will not fully cover your insurance needs. Also, If you quit the organisations, the insurance cover will cease.
Most foreign countries insist on seeing a valid travel insurance policy upon entry. Sometimes even visa approval depends on having a suitable travel insurance plan. Healthcare costs in a foreign country can be expensive. With an overseas travel insurance plan, you can receive timely and adequate healthcare without putting a dent in your pocket.
Treatment for critical illness is not only expensive but the probability of contracting a critical illness has become higher with the sedentary lifestyle habits. Critical illness plan will pay a lump sum amount if the life insured is diagnosed with any of the specified critical illnesses under the policy regardless of whether the person receives treatment for the illness or not. Most policies cover 9 to 15 critical illnesses like first heart attack, cancer of a specified severity, stroke, multiple sclerosis, etc.
Unit Linked Health Plans (ULHP) are developed to provide insurance and investment benefits for users. This is a relative new product offered by health insurers in the market. Similar to ULIPs, these products come with a market-linked investment plan that provides returns on maturity. The premium amount paid towards a ULHP has both insurance component and savings component. After deducting the premium amount for insurance coverage, the balance amount will be invested in the investment plan. The return generated from the investment plan is subject to market conditions, and this plan is ideal for people who are already familiar with similar investment products like ULIPs.
Pre-existing disease cover is offered by most of the top health insurance companies in the market. There is a specific waiting period for pre-existing diseases before they get covered under an insurance plan. During this waiting period, insurance coverage will not be available for any treatment costs incurred due to these ailments. The policy on waiting period varies from one insurer to another. Typically, most insurers have at least 2 years of waiting period for pre-existing illnesses.
A top-up health insurance plan is taken to provide additional insurance coverage over the existing insurance policy. The key thing here is the deductible amount chosen by the insured. The deductible amount for the top-up policy can be chosen based on the basic health insurance coverage. If a person has a basic health cover for Rs.2 lakh, the deductible can be chosen for Rs.2 lakh. Any medical expenses beyond Rs.2 lakh will be covered by the top-up policy (within the sum insured limit). Higher the deductible opted, lower the premium charges for the top-up policy.
This refers to the fixed percentage of sum insured amount available for room rent expenses within a health insurance policy following the hospitalisation of the insured. Room rent sub-limit is an important criteria when it comes to getting claim settlement. If the actual room rent exceeds the sub-limit, the overall compensation for other hospitalisation expenses will be reduced proportionately. This proportional reduction in hospitalisation expenses based on room rent charges may not be explicitly stated in the brochures. It is better to check the policy document or enquire with the insurer directly in order to get clarity on the connection between room rent sub-limit and hospitalisation settlement.
Premium loading refers to the hike in renewal premium after a claim is made in a policy. With the loading charges, the premium amount on health insurance will be increased by a certain percentage. Following the introduction of Health Insurance Regulations in 2013, health insurers in India are prevented from charging claim-based loading. Most health insurance policies typically have fixed premium charges for a certain number of years.
In health insurance terms, ‘Any one illness’ refers to the continuous period during which an illness takes place. This continuous period may also include the relapse of the same illness within a particular number of days. The typical period of consideration is 45 days.
WANT TO TAKE ACTION?
Looking to purchase a health insurance policy? Buying a health insurance policy is one of the most important decisions you may come across. Considering the number of insurers in the market, it is essential to compare premium quotes from leading health insurers in the market before making the final decision. You can compare policies, features, get instant premium quotes through, and do a lot more on Bankbazaarinsurance.com! We’ve got you covered!
WANT TO DIVE DEEPER?
If you come across a better health cover in the market while already enrolled in a policy, you have the option of porting your policy to the other company without losing your accumulated benefits. Some of these accumulated benefits including no claim bonus, waiting period for pre-existing illnesses, waiting period for specific illnesses, etc. can now be transferred between insurers with ease. Health insurance portability is available with almost all top health insurers in the market.
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A life insurance policy is something that provides coverage against the unexpected death of the policyholder. In life insurance, death benefit is paid as a lump sum amount to the family member (beneficiary) nominated by the policyholder. This cover provides financial security for the family of the policyholder against his/her unfortunate death. There are different types of life insurance covers including term plans, ULIPs, endowment plans, whole-life plans, etc.
Cancer care is a disease-specific medical insurance cover that provides coverage against all kinds of cancer. Since the coverage is limited only to cancer, this policy is available for a cheap price. This policy offers the much needed financial security if the policyholder is diagnosed with cancer.
Star Health and Allied Insurance Company Ltd. is in the process of completing its sale deal by the first quarter of FY 2019-20. The CEO of the company, Dr. S Prakash said that the sale process and transition are likely to happen between April to June this year. Last year, a consortium of investors – Rakesh Jhunjhunwala, WestBridge AIF, and Madison Capital made agreements with the insurer’s shareholders to take over shares from the company. In October last year, the Competition Commission of India approved the complete acquisition of the health insurance company by Safecrop Holdings and others.
Star Health Insurance was established in the year 2006 and offers health insurance, personal accident plans, and overseas mediclaim policies. The company has tied up with 8,500 hospitals, set up 461 branches and has a network of 2.4 lakh agents.
22 March 2019
According to data released by the Insurance Regulatory and Development Authority of India, public and private general insurance companies, together with standalone health insurers, have witnessed a 23% year-on-year growth in terms of total gross direct premiums. While private insurance companies have grown by 26% this fiscal, public insurers have grown by 1% and general insurers have grown by 13%. Standalone private insurance companies, on the other hand, have grown by a whopping 40% this year. The largest market share gainers among the many health insurance companies are ICICI Lombard and Bajaj Allianz. ICICI Lombard is the only listed non-life insurer and has been reporting consistent growth.
The recent regulations introduced and proposed by the IRDAI are beneficial to general insurance companies. This year, the IRDAI made it compulsory for all two-wheeler owners to get a five-year motor insurance plan and car owners to get a three-year motor insurance plan. This has only helped the insurance companies gain high premiums. Also, another regulation is expected to be passed under the Motor Vehicles (Amendment) Bill which will improve the profitability prospects of the company.
20 March 2019
The IRDAI recently allowed Private Equity (PE) companies to promote insurance companies. However, the regulator wants to be sure that the companies are prepared to commit and invest, and not make quick money in a short period and sell the stake. For each new deal that involves a PE firm and an insurer, the apex insurance regulator will look into the history of the company to ascertain if the company is reliable and will understand the exact objective for buying a stake in the specific insurance company. In order to be eligible to promote an insurance company, the PE company should have been invested for at least 5 years. Also, the PE firm should set up a Special Purpose Vehicle (SPV) to be able to invest in insurance companies.
The IRDAI has made the process of a PE being able to buy a stake in an insurance company stringent so that money doesn’t flow in or out abruptly and so that stability is maintained throughout. The insurance sector requires a longer gestation period and is highly cyclical in terms of its performance. A company can incur losses in the first three quarters and make profits in the last quarter. Hence, stability is required in the sector.
15 March 2019
In a recent report, it was learnt that many companies in the country offer medical insurance coverage to same-sex partners. IBM, Godrej, Accenture, Tech Mahindra, Cognizant, and ADP are a few of the companies that allow their LGBTQ employees to extend their health insurance covers to same-sex partners. Aditya Birla Health Insurance and SBI General Insurance have stated that they do offer coverage for same-sex partners of LGBTQ customers but said that the probable hesitation of people from the community to state their orientation could be a reason why they do not receive many requests to cover their same-ex partners. A few companies even request the insurance companies they have tie-ups with to allow their employees to undergo gender re-assignment surgeries even though they are usually not listed under necessary treatments in the policy.
Though same-sex partners can avail health insurance coverage together, not may firms provide coverage for live-in or unmarried partners of straight employees. Though insurance experts say that if the intention of the couple is to live together, they can be considered a family, legal experts opine that the uncertainty of their legal status could be a reason health insurance coverage is not extended to them.
15 March 2019
Launched last year, the Ayushman Bharat scheme is currently the largest healthcare service in the country. Labelled as ModiCare after America’s Obama Care, the Ayushman Bharat scheme has brought more than 500 million people under healthcare and since its launch, millions of citizens especially from the economically backward classes have availed the health care coverage offered by the Ayushman Bharat scheme. However, with the cost of offering free healthcare services, with each family getting a coverage of Rs.5 lakh a year, the Government of India is making a financial evaluation before it funds the scheme to ensure that they know exactly how much the scheme is going to cost them. The Government is assessing the cost of both the administrative and infrastructure demands of the scheme. The president of the National Health care said, we have involved several government healthcare institutions and private stakeholders in our finance evaluation, including the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, and the Insurance Regulatory and Development Authority (IRDA). He added by saying that they are attempted to determine the unit cost of an outpatient consultation, inpatient bed-day of hospitalization, surgical procedure, and overall per-capita cost of providing secondary care through district hospitals.
14 March 2019
With the Insurance Regulatory and Development Authority of India (IRDAI) reporting that the most complaints from policyholders are coming from the health care sector, the chief of the IRDAI, Chandra Kuntia, has said that health insurers need to be a lot more sincere and transparent and help policyholders solve claims instead of rejecting them. Of course, the chief of the IRDAI is addressing the concern with the backdrop of improving the penetration of health insurance in the country. He said, this is one major area of concern. Many people realise afterwards at the time of making claim that certain things are excluded and feel they could have bought other products. We need simple products for the general public. Kuntia believes that servicing policyholders is the key to improving health insurance in the country and said, there is huge potential for growth. We must grow sustainably, and we must grow in such a manner that all stakeholders benefit together. We cannot think of quick gain at the expense of somebody else. Clients must benefit, otherwise businesses will not sustain.
14 March 2019
As per data collected for the year 2017-18, the health insurance penetration in the states of Punjab and Haryana and the Union Territory, Chandigarh, remain extremely low due to lack of awareness about the importance and need of insurance. Only about 1.53 crore people which is equal to 26% of the population of these regions are covered under health insurance. Majority of people who have health insurance covers are those included in social insurance schemes or government-funded schemes. Though the private sector of health insurance was expanded, only the urban households avail services from private health insurers. The penetration of individual health insurance plans is extremely low. As per the survey, only 22 lakh people have purchased individual plans. Insurance companies are of the opinion that lack of knowledge about health insurance is the prime reason for low penetration.
Due to the scarce number of people covered under health insurance, IRDAI urged private health insurance companies to reach out to the people in rural areas who do not have access or lack awareness about these products. Also, healthcare institutions have been advised to keep a tab on the costs of treatment in such areas.
14 March 2019
The health insurance penetration in India is abysmally low and is a cause for concern. Thus, the insurance regulator of India, IRDAI, urged health insurers to make their products accessible to those residing in remote areas where people do not have sufficient information or access to health insurance. Also, given the rise in out-of-pocket expenditures, the regulator asked healthcare institutions to make treatments more affordable. At present, 62% of the average expenditure on healthcare, in the country, is borne out of pocket. The percentage of average out-of-pocket expenditure on healthcare on a global basis is only 18%. The chairman of IRDAI, Subhash Chandra Khuntia, said that rates and procedures offered by healthcare providers should be standardised. Such measures will have to be taken on self-regulation basis until an apex regulator is set up for the healthcare sector.
Only 43 crore people or 34% of Indian citizens have health insurance cover, as per a survey conducted in 2016-17. Experts believe that the situation has improved after the Central government introduced the Pradhan Mantri Jan Arogya Yojana (PMJAY), popularly called Ayushman Bharat. Even so, the percentage merely goes up to 40%.
14 March 2019
Aditya Birla Health Insurance is a prominent health insurance company that was established in the year 2016 and aims to break even by FY 2022-23. Insurance companies are said to take about six to seven years to break even. Therefore, the CEO of the company, Mayank Bathwal, believes that the company is on track. The firm is a partnership between Aditya Birla Holdings and a financial services company, MMI Holdings. Bathwal said that the company wishes to become a health partner or a health influencer more than a health insurer.
During the first three quarters of the fiscal year, Aditya Birla Health Insurance witnessed a growth of gross written premium at Rs.316 crore, which is an 83% increase from the year-ago period. The company has bancassurance partnerships with various banks like HDFC Bank, Deutsche Bank, KVB, AU Bank, etc. The company has adopted a multi-channel distribution plan.
14 March 2019
The Karunya Arogya Suraksha Padhathi (KASP), the health insurance scheme which will be launched on 1 April by the Kerala Government will also cover alcohol-related diseases and injuries due to suicide attempts.
Kerala has become the first state to introduce a health scheme which covers these two risks which generally is not incorporated under a general health insurance policy.
The policyholder will receive a maximum health coverage of Rs.5 lakh. KASP will integrate all the insurance and healthcare scheme in Kerala including the Central Government backed Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY) and Karunya Benevolent Fund.
12 March 2019