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    Health Insurance

    Car Insurance
    • Premiums as low as Rs10/day for coverage of Rs.5 Lakhs
    • 10,000+ hospitals for cashless treatment
    • Get plans with no limit on room rent

    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.

    What is Health Insurance?

    Health insurance is a plan offered by insurance providers that is designed to protect you financially when health problems arise. 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 these days. 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.

    Why Health Insurance is Important?

    Health Insurance
    Health Insurance

    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. Some of the major reasons why health insurance is important have been listed below:

    • Health issues can suddenly arise and catch you off guard.
    • In today’s world, the chances of contracting cancer and other illnesses is high.
    • If you are not rolling in dough, chances are you will need to figure out how to fund your treatment.
    • Medical costs have risen substantially over the past few years.
    • A health insurance plan will take care of most of the expenses associated with treatment and lighten the financial burden.
    • Cashless facility offered by all insurers can help reduce out-of-pocket expenses. The patient can focus on recovering and be at peace knowing that the finances are taken care of.
    • The financial burden will not fall on the family of the insured person.
    • Insurance companies provides added benefits such as emergency assistance, ambulance cover, critical illness cover, hospital cash and so on.

    Cost of Medical Treatments on the Rise in India:

    If you want to get treated at one of the good hospitals in India, the costs will be much higher than 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.9,500 to Rs.22,000
    Endoscopy Outpatient Rs.38,000 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.1,50,000 to Rs.2,22,000
    ENT Cochlear Implant 2 days Rs.8,25,000 to Rs.14,60,000
    Sinus 2 days Rs.1,14,000 to Rs.2,22,050
    Larynx Removal/Laryngectomy 2 days Rs.2,85,000 to Rs.5,71,000
    Eardrum Reconstruction/TympaNoplasty 2-3 days Rs.76,000 to Rs.2,22,200
    Nephro Kidney Removal/Nephrectomy 4-6 days Rs.95,200 to Rs.1,27,000
    Infertility IVF Package Outpatient Rs.1,14,000 to Rs.3,17,000
    Gynecology Myomectomy-Hysteroscopic 3-4 days Rs.63,000 to Rs.4,57,000
    Lap Hysterectomy 3-4 days Rs.95,000 to Rs.3,81,000
    Urology TURP 4 days Rs.44,450 to Rs.3,17,000
    Bladder Neck Incision 2 days Rs.1,58,000 to Rs.2,22,000
    Surgery Cholecystectomy/LaparOscopic 2 days Rs.95,200 to Rs.1,90,000
    Appendectomy/Laparoscopic 2-3 days Rs.76,200 to Rs.1,77,800
    Inguinal Hernioplasty 2 days Rs.57,100 to Rs.1,90,000
    Neuroscience Peripheral Nerve Surgery 3-4 days Rs.2,54,000 to Rs.4,12,000
    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.4,12,000
    Eye Vitrectomy 2 days Rs.69,000 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.76,000
    Retinal Detachment 2 days Rs.95,000 to Rs.2,54,000
    Cataract Surgery with Lens Outpatient or 1 day of hospitalisation 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.15,000
    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.1,84,000 to Rs.4,12,750
    Breast Reduction 1-2 days Rs.95,000 to Rs.4,44,500
    Lip Reduction Outpatient. Rs.50,800 to Rs.63,500
    Face Lift 1 day Rs.1,90,500 to Rs.3,17,000
    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 1 day 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
    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
    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
    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.

     

    • IRDA Regulations - Things Policyholder should know about Health 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:

      • The name of the policyholder, the address of the policyholder, the name of all beneficiaries, the Unique Identification Number (UIN) of the product, code number, and contact details of the person involved in selling the policy
      • The age of the insured along with his/her date of birth
      • The sum insured amount for the policy, sub-limits for specific illnesses, proportionate deductions (if applicable), and package rates (if any)
      • Periodicity of premium payment (monthly, quarterly, half yearly, or yearly)
      • Policy period
      • The period of insurance and the date from which the policyholder has been continuously insured in India (including cover from other health insurers)
      • Any co-pay limits applicable for a policy
      • Waiting period for pre-existing diseases and waiting period for specific illnesses
      • Specific and general terms associated with deductibles
      • Cumulative bonus available for every claim-free year
      • All conditions, exclusions, terms, and warranties related to a specific policy
      • Claim procedure on what actions to take for cashless treatment and reimbursement options
      • Whether or not a third-party administrator (TPA) is used for policy administration, details about the TPA (if applicable), toll free number, other contact details, etc.
      • Grievance redressal mechanism that can be used by the insured
      • Conditions related to free look period and policy portability
      • Conditions related to policy migration facility
      • Provisions involved in cancellation of the policy
      • Terms and conditions about renewal including details about the possible change in premium rates at the time of renewal
      • Address and other contact details of Ombudsman within whose territorial jurisdiction the policyholder is located

     

    • Healthcare Initiatives Announced in Union Budget 2018-19

        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.

    Free look cancellation of health insurance policies

    • IRDAI regulations require an insurer to mention clearly about the free look cancellation period of 15 days for a policy. This free look period must be clearly stated in the letter forwarding the policy. For electronic policies and policies obtained through distance mode, the free look period is increased to 30 days. During this period, the policyholder can review the terms and conditions of the policy and decide whether or not to continue with the policy. If there is any disagreement with the terms, the policyholder can cancel the policy by stating the reason for cancellation. Upon cancellation within the free look period, the insurer may refund the money obtained for the premium charges. Certain deductions such as proportionate premium for the period of cover, charges incurred by the company for medical examinations, stamp duty charges, etc. may apply during the return of premium.
    • Any request received by an insurer for free look cancellation must be processed and refunded within 15 days.

    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.

    • According to the provisions of Regulation 27 of IRDAI regulations, 2016, an insurer must provide the settlement amount within 30 days upon receipt of all necessary documents.
    • If there is any delay in payment of settlement, the insurer shall be liable to pay interest at 2% above the bank rate from the date of receipt of the last necessary document.
    • If a claim warrants an investigation, the insurer must initiate and complete the investigation within a maximum of 30 days from the date of receipt of last necessary document.
    • For claim settlement following an investigation, the insurer must settle the claim within a maximum of 45 days from the date of receipt of last necessary document. If the delay is beyond 45 days, the insurer must pay interest at 2% above the bank rate from the date of receipt of last necessary document.
    • According to the provisions of Regulation 14 of IRDAI regulations, 2016, return of premium following cancellation during free look period must be processed and refunded within a maximum of 15 days.

    Types of Health Insurance Plans in India:

    There are a variety of insurance plans designed to cater to different stratas of society. According to your needs, you can select a plan under any of the following categories.

    Health Insurance Plans
    Health Insurance Plans

    Individual Health Insurance Policies:

    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.

    Family Floater Health Insurance Policies:

    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.

    Senior Citizen Health Assurance Plans:

    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.

    Critical Illness Plans:

    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.

    Maternity Health Insurance:

    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.

    Group/Employee Health Insurance Schemes:

    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:

    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.

    Personal Accident Covers:

    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.

    Top 10 Health Insurance Companies in India:

    Based on IRDA Annual Report 2015-16 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.

    ICICI Lombard Health Insurance:

    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.

    Star Health Insurance:

    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.

    HDFC ERGO Health Insurance:

    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.

    Apollo Munich Health Insurance:

    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.

    Bajaj Allianz Health Insurance:

    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.

    SBI Health Insurance:

    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.

    Max Bupa Health Insurance:

    Max Bupa is on a mission to help customers secure healthier lives by establishing long-term relationships rather than just an annual transaction. Bupa brings in over 6 decades of expertise with a customer base of over 29 million, while Max brings in domestic expertise and excellent service in the industry. With a wide range of network hospitals, customers can access cashless facility near them. The company won the Innovation of the Year 2015 award for its Heartbeat Insurance Policy. In addition to his, Max Bupa also signed up with Mastek to offer India’s first instant policy issuance to bank partners.

    Religare Health Insurance:

    As a specialist in health insurance, Religare Health ranks as one of the top health insurance providers owing to its diversified services and products. With over 5,420 network hospitals in the country, the insurer enables customers to gain easy access to cashless facilities. Religare has a unique edge in the market as they have an expertise in delivering health care, preventive solutions and financial services through a robust distribution model.

    Royal Sundaram Health Insurance:

    Royal Sundaram caters to over 5.2 million customers across the country through a comprehensive system of agents, distribution partners, brokers and affinity partners. Catering to such a large customer base, the company offers a variety of products designed to meet different needs of individuals. Royal Sundaram was the first insurer to partner with banks to sell retail insurance products and the first to provide cashless mode of claim settlements. The insurer also introduce innovations such as hospital cash benefit into the market. The company also was the first insurance provider to tie-up with banks to issue a co-branded credit card to customer who could then avail additional benefits.

    Bharti AXA Health Insurance:

    Bharti AXA strives to be the preferred general insurance company in the country through a constant endeavour to innovate and improve products, services and the value offered to customers. The company has over 4,300 hospitals in its network that can provide cashless settlements to customers. In addition, Bharti AXA ensures an easy claim settlement process with 24x7 assistance. With over 1.3 million policies issued and a claim-settlement ratio of 98.27%, the company has earned its spot among the top ranking insurance providers in India.

    Health Insurance Schemes by Government of India and Various States:

    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:

    Pradhan Mantri Suraksha Bima Yojana:

    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.

    Rashtriya Swasthya Bima Yojana:

    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 scheme 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.

    Aam Aadmi Bima Yojana by Government of India:

    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. This scheme 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.

    Universal Health Insurance Scheme by Government of India:

    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.

    Bhamashah Swasthya Bima Yojana by Government of Rajasthan:

    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.

    Yeshasvini Health Insurance Scheme by Government of Karnataka:

    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.

    West Bengal Cashless Medical Treatment 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.

    Mukhyamantri Amrutum Yojana by Government of Gujarat:

    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.

    Rajiv Gandhi Jeevandayee Arogya Yojana, Maharashtra:

    With so many people falling out of the realm of insurance, The Maharashtra government introduced the Rajiv Gandhi Jeevandayee Arogya Yojana health insurance scheme. 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.

    Chief Minister’s Comprehensive Scheme by Government of Tamil Nadu:

    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.

    What Expenses Do Health Insurance Plans Cover?

    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.

    Inpatient Care:

    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.

    Pre-hospitalisation Expenses:

    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.

    Post-hospitalisation Expenses:

    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.

    Domiciliary Hospitalisation:

    Any treatments taken at home that exceeds a period of 3 days will be covered.

    Ambulance Cover:

    The health insurance plans usually cover up to a certain sum for the ambulance service.

    Health Check-up:

    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.

    Vaccinations:

    Some plans cover vaccinations required in case of dog bites, bee stings, etc.

    Critical Illnesses:

    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.

    AYUSH Treatment:

    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.

    Second Opinions:

    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.

    Hospital Cash:

    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.

    Emergency Evacuation:

    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.

    Benefits of a Best Health Insurance Plan

    Cashless Treatment:

    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.

    Pre-hospitalisation and Post-hospitalisation:

    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.

    Ambulance:

    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.

    No-Claim Bonus:

    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.

    Preventive Check-ups:

    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.

    Tax Benefits:

    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:

    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.

    Portability:

    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.

    Restoration Benefits:

    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.

    International Cover:

    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.

    Exclusions: What Your Health Insurance Won’t Cover

    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:

    • There is a waiting period of 30 days from the inception of the policy. After this period, the risk coverage will come into effect. Some insurance providers waive this period, especially for group policies.
    • A waiting period is imposed for coverage of pre-existing diseases and other specified ailments. Depending on the disease, the plan selected and the provider, this period could range between 2 to 4 years.
    • Although most policies now cover AYUSH Treatment:s since it has gained importance and recognition, some policies will not cover such treatments. AYUSH includes Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy,.
    • Dental treatments
    • Certain optical procedures
    • Genetic disorders
    • Psychiatric disorders
    • Injuries resulting from suicide attempts
    • Injuries or ailments resulting from hazardous activities, criminal acts, acts of negligence and so on
    • AIDS and HIV
    • STDs and other related illnesses/illnesses of similar nature
    • Treatments taken against the recommendations of doctor
    • Unnecessary diagnostic tests, treatment, post-care procedures
    • Cosmetology, plastic surgery, gender change, hormonal replacements, etc.
    • Treatment/diagnosis undertaken outside India or by an unqualified medical professional
    • Expenses for rest and rehabilitation of common illnesses of mild severity
    • Nuclear risks
    • War, civil unrest, terrorism and related acts
    • Maternity, newborn, complications arising out of childbirth, complications with the child, but there are specific policies to cover such costs

    Who is Eligible for Health Insurance?

    In order to avail a health insurance policy, there is usually a certain criteria that must be met. Insurance companies set eligibility requirements according to risk assessment and ability to pay premiums. Under insurance, there are two parties that can be insured - the proposer and the dependent.

    • Proposer/Policyholder: The minimum entry age is set at 18 years/21 years. The maximum age for the policy could be anywhere between 60 years to 100 years, or could be extended for the whole life.
    • Dependents: The spouse, parents or children may be allowed to be protected under the same policy depending on the type of policy. For children, the entry age can be from as young as 90 days. Children can usually be insured under the parent’s policy for up to the age of 18 years which may be extended to 25 years.
    • Renewability: Health insurance policies are usually renewable for a lifetime, but this may be subject to medical screening beyond a certain age and an increase in premium.

    While taking a policy, it is important to declare all health issues upfront. If the insurance provider finds falsified or hidden information later, they can reject your health insurance claim. If you are a smoker and/or drinker, you need to disclose this information as well. Any pre-existing conditions should also be disclosed so as to not risk being rejected for financial cover later on.

    Things to Consider while Choosing a Suitable Health Insurance Plan:

    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.

    How to Choose the Right Health Insurance Company?

    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.

    Market Experience:

    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.

    Product Portfolio:

    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.

    Online Renewals:

    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.

    Claims Process:

    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.

    Customer Service:

    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.

    Procedure to File Insurance Claims:

    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:

    1. Reimbursements
    2. Cashless claims

    Reimbursement Claims:

    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:

    • Inform the company of the claim.
    • Receive the treatment and settle the bill. Ensure you collect all bills, invoices, discharge summary, reports, prescriptions and so on.
    • Fill up the insurance claim form and submit it along with the necessary documents.
    • The insurance company will process your claim and verify the documents.
    • If everything is in order, the reimbursement will be paid.
    • If there is more information required, the company will send a query for the same.
    • If the company finds good enough reason, the claim can be rejected.

    Cashless Claims:

    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:

    • Locate a network hospital or ensure the hospital you wish to receive treatment falls under the insurance company’s network.
    • Intimate the claim to the insurance provider as per the stipulated timeline.
      • Planned hospitalisation - usually 24-48 hours prior to admission.
      • Emergency hospitalisation - immediately or up to 48 hours of hospitalisation.
    • Present the insurance card and a valid ID to the hospital at the designated insurance desk.
    • Procure and fill out the claims form, and submit it to the concerned person at the hospital.

    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.

    Health Insurance Portability:

    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.

    Features of Health Insurance Portability:

    • Customers can choose to renew their policy with a different insurance and get better benefits.
    • For insurance companies, they may lose customers but they also gain others who want to port from another insurer.
    • Individual policies as well as family floaters can be transferred.
    • The time lapsed on waiting periods will also be transferred. For example, if you have to wait for 2 years to be covered for pre-existing illnesses, and have completed 1 year with the old health insurance provider, you only need to complete 1 more year with the new insurer.
    • Any no-claim bonus accumulated will also be transferred to the new health insurance provider.
    • The minimum sum assured on the old policy should be retained.
    • Porting of policy should be completed by the two insurance providers, old and new, under guidelines and timelines prescribed by IRDA

    Conditions for Health Insurance Portability:

    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:

    • The portability option is available only at the time of renewal. You cannot change insurance providers in the middle of the policy term.
    • Start the renewal process 45 days before the due date. The minimum time required is 30 days, but it is better to have a buffer.
    • Inform the current insurer as well as the new insurance provider about your intention to port.
    • Read the terms and conditions on porting policies and ensure that you are aware of any requirements and formalities.
    • If you are transferring your health insurance policy, a 30-day grace period might be provided if the process is underway.
    • Under the new policy, you can opt of individual or family cover.
    • If the old premiums have not been paid to date, or there has been a discontinuation of coverage in between, the new insurance provider may reject the request.

    Comparison of Health Insurance Plans Online:

    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.

    Benefits of Comparing Health Policies Online:

    • Comparing policies helps you determine which policy gives you the maximum benefits.
    • Through comparisons, you can find out which policy would be ideal based on premiums you can afford.
    • Comparing health insurance policies online can help simplify the search for a suitable medical plan.
    • It saves time, money and effort.
    • It eliminates middlemen and insurance agents who might convince you to take a plan that gives them the highest commission.
    • You do not have to visit multiple websites to make comparisons. All the data is available in one window.

    Why Buy Medical Insurance Plans Online?

    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.

    Crucial Information:

    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.

    Premium Calculator:

    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.

    Time Saver:

    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.

    Lower Premiums:

    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.

    Instant Coverage:

    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.

    Mistakes to Avoid when Buying Health Insurance:

    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.

    Which Type of Health Insurance Policy will Best Suit You?

    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 illness 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.

    Health Insurance History of India:

    After independence, the government sector had been primarily serving as the backbone of the Indian healthcare system. The most popular type of insurance in India back then was life insurance. People sought to secure their future with a life insurance due to the low life expectancy and prevalent joint family structure in the country. Life Insurance also aided as a tax planning instrument. Health insurance gradually evolved along with other general insurance products. After economic liberalisation in 1991, healthcare delivery and insurance has become mainstream.

    With the increase in healthcare costs and disposable income, the life expectancy of Indians has increased. The establishment of the Insurance Regulatory and Development Authority legislation in 2000 is an important milestone in the health insurance industry as it opened up market to private insurers. By 2010, more than 25% of the population had access to health insurance. The General Insurance Corporation of India and the IRDAI has launched several awareness campaigns to reach all segments of the population. Currently, it is one of the fastest growing segments in the general insurance industry in India.

    A Look at the Basics of Health Insurance Industry in India:

    Here is a general overview of health insurance in India. Health insurance falls under the non-life insurance category. There are numerous private insurers, government sponsored health insurers, and standalone insurers offering a wide range of health insurance products to meet the varying needs of the customers. Despite a steady growth, health insurance companies face a huge challenge due to the losses faced over rising healthcare costs. Assessing health risks and obtaining a suitable health cover to prepare for a secure future is yet to become a major priority in India.

    Currently, more than 30 different health insurance products are offered by life insurance as well as non-life insurance companies in India. Reliance General, ICICI Lombard, and Bajaj Allianz are some of the leading private general insurance providers while Star Health and Allied Insurance is a leading standalone player in the country. Due to the low penetration of health insurance products in India, the insurance companies have set up an array of distribution channels like insurance agents, brokers, bancassurance, direct mailing, and online shopping to reach the masses.

    There is an urgent need for health insurance in India with the steady increase in healthcare costs and lifestyle diseases. According to a study conducted by the National Sample Survey Organisation, 40% of the patients resort to borrowing loans or selling their assets to pay their medical bills. There is a significant portion of the population that forgoes treatment as they don't have the means to cover the medical expenses. The government of India with the help of the public, private, and standalone insurance companies is raising awareness for the need of health insurance in India. The government has launched several healthcare schemes to provide adequate healthcare to the unorganised sectors and people who fall under the below poverty line category.

    Incurred Claim Ratio and Claim Settlement Ratio in Health Insurance:

    What is Claim Settlement Ratio?

    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.

    What is Incurred Claim Ratio?

    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.

    Incurred Claim Ratio of Health Insurance Companies for FY2016-17:

    Health Insurance Company Incurred Claim Ratio*
    United India Health Insurance 138.51%
    Oriental Health Insurance 118.23%
    SBI General Health Insurance 53.43%
    Star Health Insurance 60.51%
    Apollo Munich Health Insurance 54.99%
    Max Bupa Health Insurance 51.96%
    Cigna ttk Health Insurance 48.14%
    ICICI Lombard Health Insurance 90.22%
    Chola MS Health Insurance 40.07%
    HDFC ERGO Health Insurance 50.76%
    IFFCO Tokio Health Insurance 104.30%
    Reliance General Insurance 98.49%
    Royal Sundaram Health Insurance 62.09%
    TATA AIG Health Insurance 57.20%
    Bajaj Allianz Health Insurance 78.50%
    Bharti AXA Health Insurance 76.88%
    National Health Insurance 126.98%
    Universal Sompo General Health Insurance 86.14%
    Future General Health Insurance 78.93%
    New India Health Insurance 102.94%
    L&T Health Insurance 41.57%
    Religare Health Insurance 50.52%
    Raheja QBE Health Insurance 126.70%
    Liberty Videocon General Insurance 74.37%
    Magma HDI General Insurance Company Limited 181.20%

    What is Health Insurance Coverage?

    Healthcare insurance coverage is the extent of financial protection given against medical expenses under a policy to the policyholder by the insurer. The policy document will contain the limit of insurance coverage provided by the insurer. Insurance coverage depends on the types of insurance plan and always differs from insurer to insurer. A good health insurance plan will offer adequate insurance coverage to cover all your medical expenses at an affordable premium.

    • Mediclaim: This type of plan provides reimbursement of all the medical expenses incurred during the period of hospitalisation.
    • Critical Illness cover: If the life insured is diagnosed with any of the critical illnesses specified under the policy, the insurer will pay a guaranteed lump sum amount to the policyholder regardless of whether the life insured undergoes treatment for the illness or not.
    • Hospital cash benefit cover: The life insured will be paid up to Rs.4,000 per day for the duration of the hospitalisation to meet non-medical expenses that are not covered under the policy.
    • Maternity benefit cover: This type of plan provides insurance coverage against maternity related expenses for normal delivery as well as caesarean.

    Tax Benefits in Health Insurance:

    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 65 Up to Rs.25,000
    Family health insurance premium paid for members above the age of 65 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

    Health Insurance EMI:

    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

    • To calculate your health insurance premium, use the online premium calculator available on the insurer's website.
    • EMI is an ideal option for those who prefer a higher sum insured but don't have the capacity to pay a higher premium upfront.
    • The total premium paid in the case of EMI payments will be higher than paying the full premium upfront.
    • EMI facility is available for sum assured above certain amount and long-term policies. Future Generali offers the EMI facility for policies with a sum assured of Rs.3 lakh and above.
    • If you opt for EMI, you may lose out on premium discounts.
    • EMI option is available on a monthly, quarterly, and half-yearly basis like in the case of Health Total from Future Generali.
    • If a claim is made before the entire EMI is paid, the remaining EMIs will be deducted before the claim amount is paid.

    A Complete Guide to Health Insurance:

    Health insurance terminology can be difficult to understand. It helps to be aware of some essential health insurance terms in order to choose a plan that best serves your insurance needs. Get an understanding of the basic health insurance jargons with the below list:

    • Insurance coverage: Healthcare insurance coverage is the extent of financial protection given against unforeseen medical expenses to the policyholder. The limit of healthcare insurance coverage provided can be found in the policy document. The insurance coverage depends on the type of plan and differs from insurer to insurer.
    • Types of health insurance plans: There are 4 types of health insurance plans available in India:
      • Mediclaim: It is the most common and basic health insurance policy available in the market. It provides reimbursement for all medical expenses incurred by the life insured during the period of hospitalisation.
      • Hospital cash plan: The insurer provides daily cash of up to Rs.4,000 per day for the duration of hospitalisation so that the life insured can meet non-medical expenses that are not covered under the base policy.
      • Surgical benefit plan: It provides cover for certain surgeries undergone by the insured member.
      • Critical illness plan: If the life insured is diagnosed with any specified critical illnesses covered under the policy like cancer of specified severity or first heart attack, the insurer will pay a lump sum amount regardless of whether the person undergoes treatment for the illness or not.
    • Floater plan: A family floater plan covers all the members of your family from spouse and children to dependent parents and in-laws under one health insurance policy. Pay single premium for the policy and the sum insured can be shared by the entire family.
    • Group health insurance: This type of plan is offered by an employer to the employees as an incentive to retain talent in the company. It doesn’t require medical examinations or have any age limit as long as you are an employee of the organisation, you are eligible for the group plan. The cost of insurance is comparatively lower than individual insurance. Similarly, the insurance coverage is basic when compared to individual insurance.
    • Waiting period: There is a waiting period of 30 days for all illnesses except injuries due to an accident before the policy coverage begins. It is the specified period of time from the date of policy inception, after the completion of which full or partial insurance cover will begin. The waiting period for a senior citizen health insurance plan is higher, from 1 to 4 years for certain illnesses.
    • Pre-existing conditions: Any symptoms, diagnosis, treatments or illnesses that existed before policy inception is considered pre-existing condition. Standard health insurance plans don’t cover pre-existing diseases. Some health insurance plans offer coverage for pre-existing conditions after the completion of a waiting period of 4 years. Only up to 50% of the claim will be payable in the case of pre-existing conditions. Always disclose any pre-existing condition you may have at the time of policy inception to avoid hassle at the time of making a claim.
    • Network hospital: Insurance companies have tie-ups with a number of hospitals across the country where the life insured can avail cashless treatment. Such medical facilities and hospitals are known as network hospitals.
    • Co-payment: It is a cost-sharing requirement wherein the policyholder will have to pay a certain percentage of the claim amount for covered healthcare services.
    • Sub-limit: It refers to a fixed percentage of sum insured that the insurance company will pay for certain hospital expenses and illnesses such as room rent, doctor fee, cataract treatment, cardiovascular treatment, etc. Always check the cap or sub-limit on these costs before choosing a plan.
    • Claim process: For cashless facility, TPA approval is required to get cashless treatment in a network hospital of the insurer. For reimbursement claims, initiate the claim within 48 hours of hospitalisation and submit the duly-filled and signed claim form along with original medical bills and discharge summary to support your claim. The insurer will take 15 to 21 days to assess the claim, verify the furnished documents, and settle the claim. A cheque for reimbursement will be sent to the insured member. In the case of cashless treatment, the insurer will pay the hospital directly.
    • Tax Benefits: You can get tax deductions up to Rs.15,000 (Rs.20,000 for senior citizen health insurance) on premiums paid towards a health insurance policy under Section 80D of the Income Tax Act, 1961.

    Grace Period in Health Insurance:

    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:

    • Failure to pay the insurance premium within the grace period will result in policy. No insurance coverage is available for the duration of non-payment.
    • If your policy lapses, no-claim bonus, loyalty discounts, waiting period, and other benefits that you had accrued over the years will no longer be available. You will end up purchasing a new policy and go through the waiting period again.
    • Some insurers may give you the option to revive the policy within 6 months from the date of lapse. You have to pay all the outstanding premiums with interest and reinstatement fees, and submit proof of insurability.

    How Does Health Insurance Work?

    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.

    • Individual or group health insurance: Before purchasing a health insurance policy, assess your insurance needs and decide whether you require an individual health insurance plan or if insurance coverage from a group health insurance plan will suffice.
    • Family Floater Plan: Floater option comes in handy if you want to provide health cover for your entire family under a single policy. The sum assured is shared by all the insured members which can include self, spouse, children, and parents.
    • Insurance coverage: The extent of financial protection an insurer is ready to pay for medical services covered under the policy is called insurance coverage. The best health insurance policy is one that offers adequate health cover at affordable premium.
    • Buying a policy online: Compare the features and benefits of various policies on a comparison website, select the one that best serves your need, get an instant quote on the chosen policy, calculate the insurance premium using the online premium calculator, purchase the insurance policy through the insurer’s website. Payment can be made via net banking, credit card or debit card.
    • Claim process: For reimbursement claims, you have to intimate the insurer within 48 hours of hospitalisation. The medical bills have to be paid by you upfront. Submit the duly-filled and signed claim form along with the medical bills and discharge summary to the insurer. The insurer will verify your claim and settle the claim within 21 days. For cashless claims, show your e-card and ID card at the network hospital desk. The hospital will submit a pre-authorisation form to get TPA approval. Once the claim is verified, the insurer will pay the hospital directly. You don’t have to pay the medical bill upfront.
    • Renewal: A health insurance policy is active for 1 year. You have to renew it each year to avoid losing out on the policy benefits. If you fail to the pay the premium on time, the policy will lapse. Usually, a grace period of 15 days is given within which you have to pay the due premiums. The policy benefits aren’t available for the duration of non-payment. If a policy lapses, some insurer’s give you the option to revive it within 6 months provided you pay all the outstanding premiums and reinstatement fees. You will also have to provide proof of insurability for reinstatement.

    Health Insurance Network Hospital:

    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.

    Difference between Health Insurance and Critical Illness Cover:

    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.

    Difference between Health Insurance and Life Insurance:

    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.

    Difference between Health Insurance and Term Insurance:

    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.

    Difference between Health Insurance and Mediclaim:

    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.

    Waiting Period in Health Insurance:

    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.

    • Waiting period for critical illnesses is usually 3 months.
    • Waiting period for all illnesses except for accidents or on renewal of the policy under standard health insurance plan is 30 days.
    • Waiting period for pre-existing diseases is usually 4 years.
    • Waiting period for senior citizen health insurance plans is nil if you opt for co-pay.
    • Waiting period for group health insurance plans offered by an employer to his or her employees is nil.
    • Waiting period for maternity benefits is 9 to 36 months. For newborn babies, it is 90 days.

    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.

     

    • Linking Aadhar and Pan to Health Insurance Policies

        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.

    Health Insurance Frequently Asked Questions:

    1. What is a no-claim bonus?

    2. 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%.

    3. Are there family discounts given on health insurance policies?

    4. 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.

    5. What is meant by claim-settlement ratio? Is it important?

    6. 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.

    7. Is it safe to buy insurance online?

    8. 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.

    9. Why are online health insurance policies cheaper?

    10. 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).

    11. What is meant by switching?

    12. 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.

    13. Are there tax benefits or deductions available on health insurance plans?

    14. For premiums paid towards health insurance plans, you can claim deductions under Section 80D of the Income Tax Act, 1961.

    15. What is a free-look period?

    16. 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.

    17. Is GST applicable to premium payments?

    18. Yes, effective 1 July 2017, GST is applicable to health insurance premiums. The current rate of GST on these premiums is 18%.

    19. What should I do if I have lost my original health insurance policy?

    20. 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.

    21. Who can I add as a dependent under my policy?

    22. 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.

    23. How are premiums calculated?

    24. 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.

    25. What is meant by cashless claim?

    26. 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.

    27. What is Co-payment? What are deductibles?

    28. 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.

    29. What is ‘sum assured’?

    30. 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.

    31. What is meant by sub limits? What is included under sub limits?

    32. 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.

    33. What is meant by ‘restoration’ or ‘reinstatement’ of sum assured?

    34. 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.

    35. What is the Difference between Health Insurance and Mediclaim:?

    36. 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.

    37. How beneficial is day care health insurance?

    38. 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.

    39. What falls under day care treatments?

    40. 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:

      • Sinusitis
      • Colonoscopy
      • Eye Surgery
      • Prostate
      • Liver aspiration
      • Dialysis
      • Sclerotherapy
      • Radiotherapy
      • Lithotripsy
      • Hydrocele
      • Piles / Fistula
      • Appendectomy
      • Angiography
      • Chemotherapy
    41. How to choose a good day care health insurance plan?

    42. 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.

    43. What is domiciliary hospitalisation?

    44. 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.

    45. What are the benefits of having coverage of domiciliary hospitalisation?

      • Domiciliary hospitalisation can be expensive as the nurse or doctor will have to do house visits. Equipment and other necessary implements/medication will also have to be brought home. If your insurance plan covers domiciliary hospitalisation, then you will most likely receive cover for the following:
      • Home nursing service expenses
      • Consultation fees, doctor charges, and specialist fees
      • Expenses incurred to get blood, anaesthesia, and oxygen
      • Diagnostics tests and X-ray charges
      • Medicines and drugs
    46. Can I claim insurance for dental treatment?

    47. 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.

    48. How do I choose the best health insurance plan for myself?

      • Choosing a suitable health insurance plan can be a difficult task. Here are a few things to keep in mind while buying a health insurance policy:
      • Always take your time to read the brochure and policy document.
      • Buy a comprehensive health insurance plan that suits your requirements.
      • If you a have a family history of a specific illness, you should find a policy that will offer coverage for that.
      • Ensure you are fully aware of the exclusions.
      • Keep your co-pay options at a moderate level so as to pay an affordable premium but also so that you don’t have to shell out huge sums at the time of a claim.
      • No-claim bonuses are beneficial when it comes to renewing your policy.
      • Make comparisons of policies online.
      • Do your research on the health insurance company and its reviews.
    49. The fine print of the policy document is not easy to read. Any tips?

      • Often, insurance documents contain jargon that is not easily understood by the public. To help make it easy, you can use the following:
      • The terms and conditions will have a list of definitions of such words. You can go through this list and learn the meaning of these terms. This will make it easier to understand the document.
      • If you still have trouble, you can call the customer care and ask them to explain any part that you have difficulty in understanding.
      • Talk to a friend or an advisor to get more information.
      • Internet advice maybe helpful but it is not recommended as it may confuse you even more.
      • You can also do your own research on third-party websites like BankBazaar that have a lot of information on simplifying insurance.
    50. What are some of the top myths about health insurance?

      • I will pay high premiums only to have my claim rejected later - This is not true. Majority of health insurance claims go through smoothly. There are many people who have not read the terms and conditions, exclusions and coverage of the policy and therefore have difficulty when it comes to making a claim. Furthermore, if you have not provided accurate information, your claim can be rejected.
      • I can hide information about smoking, they will never find out - It is important to disclose your lifestyle habits and pre-existing illnesses. If you are lucky, you may not get caught. But if you do, then your entire premium will be wasted as your policy will be void or your claim will be rejected.
      • All insurance plans are the same - No, each insurance plan offers something different. They may cover the basics but it is important to compare and do your own research before buying a plan. Plans are designed differently to suit the needs of various people.
      • I don’t need insurance because I live a healthy lifestyle - Just because you do not smoke and drink, does not mean health insurance is not for you. There are various health problems that can arise due to the nature of our environment, occupation, stress, diet, weight and so on. Health insurance is for everyone.
      • A high claim-settlement ratio determines the best health insurance provider - Claim-settlement ratio is the number of claims settled against the number of claims made in a year. A high claim-settlement ratio means the insurer has rejected very few claims. This is an important factor to consider, but should not be the sole determining factor when choosing your health insurance provider. You must take into consideration the cover offered, the exclusions, waiting periods, reviews and so on.
    51. What are the documents required when you submit a reimbursement claim?

      • When you make a reimbursement claim, you will be required to submit the following:
      • Health card and identity proof of the insured
      • Duly-filed reimbursement claim form
      • A copy of the discharge summary
      • Original hospital bills
      • Original pharmacy bills
      • Original cancelled cheque
      • A bill for ambulance charges, if it is covered by your insurer
      • Any medical investigation report like ECG, X-ray, MRI, CT scan, or any other reports.
    52. What are floater health insurance policies?

    53. 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.

    54. What is the difference between individual and floater options?

    55. 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.

    56. What do you mean by reimbursement?

    57. 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.

    58. Can I claim insurance for Homeopathy treatments?

    59. This depends on your health insurance plan. Earlier, many policies excluded alternative treatments. But as it has gained importance, health insurance companies now offer cover for AYUSH Treatment:s that includes Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. You can make a claim for homeopathy treatment if your policy covers it.

    60. If I am hospitalised due to an accident, are there are special benefits?

    61. 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.

    62. When is it a good idea to switch health insurance providers?

    63. Switching health insurance providers would be ideal under the following circumstances:

      • You are getting the same cover for lesser premium.
      • You are not satisfied with your current insurance provider and feel another company might serve you better.
      • You require cover for a specific illness that is not covered by your provider.
      • The sum assured on the new plan is more than the current policy.
      • You need to change your plan from individual to family floater and vice versa.
      • You should also make sure you can carry forward the waiting period already completed under the current policy.
    64. What is covered under pre-hospitalisation and post-hospitalisation expenses under a health insurance plan?

    65. If you insurer covers pre-hospitalisation expenses, the following will be covered:

      • Doctor or physician consultation fees
      • X-rays
      • Blood tests
      • Scans
      • Urine tests
      • Pharmacy expenses

      Post-hospitalisation cover usually pays for:

      • Consultation fees
      • Pharmacy bills
      • Acupuncture
      • Physiotherapy
      • Diagnostic charges
      • Cost of medicines
    66. Can I get a refund of the premium if I do not make a claim during the policy period?

      • Premiums paid are not refundable if you do not make a claim. If you have not made a claim on your insurance policy, then you will be eligible for a no-claim bonus which is given in the form of a discount on the premium you have to pay to renew your policy. You may also receive the benefit of an enhanced sum assured.
      • When you purchase a health insurance plan, you are paying for the risk borne by the insurance company. The company is not liable to pay you back if you do not make a claim.
    67. What is day-care health coverage?

    68. 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.

    69. What is the benefit of day-care health insurance?

    70. 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.

    71. What treatments day-care procedures include?

    72. 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.

    73. How to choose health insurance on basis of day-care procedure?

    74. 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.

    75. What is domiciliary hospitalisation?

    76. 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.

    77. Domiciliary hospitalisation benefit?

    78. 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.

    79. Is dental treatment covered?

    80. 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.

    81. How to select the best health insurance plan?

    82. 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.

    83. How to read the fine print of the policy document?

    84. 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.

    85. Top myths about health insurance?

    86. Certain myths about health insurance results in you being either underinsured or overinsured. Some of the top myths about health insurance are:

      • Cheap insurance premium means the best insurance plan.
      • Younger generation doesn’t fall sick often, thus, don’t need a health insurance plan.
      • Health insurance policy benefits begin from the time of policy inception.
      • Group insurance plan is adequate for your insurance needs.
      • Purchasing health insurance policy online can be unsafe.
    87. What are the documents required for health insurance claim reimbursement?

    88. The documents required for health insurance claim reimbursement are:

      • Duly filled and signed claim form.
      • Cancelled cheque.
      • Discharge card or summary.
      • Hospital bill with payment receipt and pharmacy bills with prescription.
      • Doctor’s consultation papers.
      • Photo ID proof.
      • A copy of the health card.
    89. What do you mean by floater option?

    90. 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.

    91. What do you mean by reimbursement?

    92. 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.

    93. What is the difference between individual and floater options?

    94. 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.

    95. Which expenses are included in sub-limit amount?

    96. 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.

    97. Does health insurance policy cover treatment by homeopathy method?

    98. 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.

    99. If I don’t claim in a policy period, can I get a refund of my money?

    100. 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.

    101. What are the benefits of the health insurance portability for the policyholders?

    102. 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.

    103. What are the covers offered under pre and post-hospitalisation expenses?

    104. Pre and post-hospitalisation expenses includes medical expenses incurred by the life insured 30 days prior to and 60 days after hospitalisation.

    105. How is the premium for a family floater policy calculated?

    106. The premium for a family floater plan is calculated based on the age of the oldest insured member of the family.

    107. What do you mean by cashless hospitalisation?

    108. 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.

    109. What is the minimum and maximum age at which one can enter and buy this policy?

    110. 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.

    111. What do you mean by pre-existing disease?

    112. 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.

    113. Why do I need health insurance?

    114. 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.

    115. What is the difference between a family floater and critical illness or hospital cash insurance?

    116. 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.

    117. Do I need to undergo a medical check-up while buying a health insurance policy?

    118. 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.

    119. How do I cancel my health insurance policy?

    120. 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.

    121. Why is medical insurance important?

    122. 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.

    123. What type of health insurance plans are available today?

    124. 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.

    125. What are the covers offered under critical illness?

    126. 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.

    127. What parameters are considered for calculating the premium?

    128. The parameters for calculating health insurance premium are age, gender, location, occupation, lifestyle habits, sum insured, coverage, pre-existing conditions, etc.

    129. What is the procedure for reimbursement settlement?

    130. 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.

    131. What is the process for claim?

      • For planned hospitalisation: Contact the helpline number of your insurance provider and submit the pre-authorisation form filled by the hospital for approval. Carry your ID card, health card, and policy document with you at all times. The hospital will get approval from your insurer’s TPA for cashless claim.
      • For unplanned hospitalisation: Contact the helpline number of your insurer immediately after hospitalisation and submit the duly-filled pre-authorisation form. In the case of reimbursement claim, pay the medical bills out of your pocket and furnish all the original medical bills along with the reimbursement claim form to the insurer for claim settlement.
    132. What are the steps for cashless claim?

      • Show your e-card at the network hospital desk.
      • The hospital will verify your identify and confirm if you can avail cashless treatment.
      • The hospital will submit pre-authorisation form to the insurer.
      • After receiving approval from your insurer’s TPA, cashless settlement will be made directly to the hospital.
    133. What if I want to renew my health insurance policy after one year?

    134. 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.

    135. What is a health card?

    136. 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.

    137. What are the benefits of a health card?

    138. 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.

    139. What are the best health insurance companies of 2017 in India?

    140. Max Bupa Health Insurance, Bajaj Allianz General Insurance, Bharti Axa General Insurance, Religare Health Insurance, and HDFC ERGO General Insurance are some of the best health insurance providers of 2017 in India.

    141. How to select the best health insurance plan of 2017 in India?

    142. 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 2017.

    143. What is the procedure for change of address for medical insurance?

    144. 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.

    145. I already have health insurance and want to increase sum insured, what should I do?

    146. During policy renewal, you can increase the sum insured if needed.

    147. Can a person have more than one health policy?

    148. 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.

    149. What are the tax benefits I get if I opt for health insurance?

    150. You can get tax deductions on premiums paid towards a health insurance policy under Section 80D of the Income Tax Act, 1961:

      • Annual tax deduction of up to Rs.15,000 for individual and family health insurance premiums.
      • Up to Rs.20,000 for senior citizen health insurance premium.
      • Up to Rs.15,000 for health insurance premiums paid on behalf of your parents. Up to Rs.20,000 if your parent is a senior citizen.
    151. What are the factors that affect health Insurance premium?

    152. The various factors that affect health insurance premium are:

      • Gender
      • Age
      • Occupation
      • Location
      • Pre-existing diseases
      • Family medical history
      • Lifestyle habits
    153. What does a health insurance policy not cover?

    154. Exclusions of a health insurance policy includes:

      • Pre-existing diseases, subject to a long waiting period.
      • Cost of spectacles, contact lenses, and hearing aids.
      • Dental treatments.
      • Venereal diseases.
      • Self-inflicted injuries.
      • Drugs and alcohol abuse.
      • AIDS.
      • Diagnosis, x-ray, and laboratory test costs that are not consistent with the disease requiring hospitalisation.
      • Treatments relating to pregnancy or childbirth.
      • Naturopathy treatment.
    155. Is there any waiting period for claims under a policy?

    156. 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.

    157. If my policy is not renewed in time before expiry date, will I be denied for renewal?

    158. You can pay the premium dues within 15 days from the expiry date called the grace period. If you fail to make premium payments within the grace period then your policy will lapse.

    159. Can I transfer my policy from one insurance company to another without losing the renewal benefits?

    160. 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.

    161. What happens to the policy coverage after a claim is filed?

    162. After a claim has been settled, the policy coverage will reduce by the settled amount till the end of the policy term.

    163. What is the maximum number of claims allowed over a year?

    164. 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.

    165. What is ‘health check’ facility?

    166. Some insurers pay for health check-ups of the life insured once every 4 years. This is called ‘health check’ facility.

    167. Who is a health TPA?

    168. 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.

    169. Do I have to undergo any medical examination?

    170. A medical examination may be required based on the age and medical condition of the life insured.

    171. Do I have to undergo a medical checkup every year?

    172. 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.

    173. Who pays for the medical examination?

    174. 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.

    175. Who is a medical practitioner?

    176. 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.

    177. What do you mean by medical expenses?

    178. 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.

    179. How can I indemnify or claim benefits under the policy?

    180. The medical expenses can be indemnified through reimbursement claims or by availing cashless services at a network hospital of the insurer.

    181. Is cashless facility available across all hospitals?

    182. 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.

    183. Are all the major corporate hospitals on the network?

    184. Use the network hospital locator available on your insurer’s website for the list of network hospitals available in your area.

    185. Will I get cashless treatment at government institutions like AIIMS/TMH/ARMY Referral hospitals?

    186. No, cashless treatment cannot be availed at government institutions.

    187. If I avail cashless facility, will you pay the entire amount or will I be required to bear part of the bill at the hospital?

    188. 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.

    189. In case of cashless treatments, in whose favour are cheques settled or who gets the payments?

    190. The cheque will be sent directly to the network hospital where the life insured received treatment.

    191. What is co-payment?

    192. Co-payment is a cost-sharing requirement for certain health insurance policies wherein the policyholder will bear a specific percentage of the admissible costs.

    193. What is a waiting period?

    194. 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.

    195. Why should I take a health policy if I already have health insurance from my employer, or if my family and I are already covered by my corporate?

    196. 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.

    197. What is the basic difference between individual and group health insurance coverage?

      • Group insurance package is purchased by the employer for the benefit of the employees. Individual insurance is bought by individuals for themselves or their families.
      • Group health insurance policy can be availed at a low or no cost to the employee. The premium for group insurance is deducted directly from the employee's salary. Individual health insurance cost is borne fully by the individual.
      • All employees of the organisation are granted approval for group insurance whereas in the case of individual insurance, there are possibilities of rejection.
      • Group insurance cover lasts only as long as you work with that employer which is not the case when it comes to individual health insurance.
      • Individual insurance can be customised to suit your medical needs which is not possible with group health insurance.
      • Unlike group health insurance, you can benefit from No-Claim Bonus only in the case of individual insurance.
    198. Why should I buy overseas travel insurance?

    199. 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.

    200. Why should I buy a critical illness cover?

    201. 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.

    202. What is a Unit Linked Health Plan (ULHP)?

    203. 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.

    204. What type of coverage is offered for pre-existing diseases in health insurance?

    205. 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.

    206. What is a top-up health insurance plan?

    207. 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.

    208. How the sub-limit on room rent affects health insurance coverage?

    209. 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.

    210. What is premium loading?

    211. 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.

    212. What is ‘Any one illness’?

    213. 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.

    What's next?

    • WANT TO TAKE ACTION?
      • Compare Health Insurance Quotes
      • 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?
      • Health Insurance Portability
      • 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.

    • WANT TO EXPLORE RELATED?
      • Cancer Care
      • 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.

      • Life Insurance
      • 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.

    • News About Health Insurance

      • Karnataka does not wish to adopt Modicare

        On February 1st, during the Union Budget 2018 session, Arun Jailtely announced what is said to be the largest healthcare scheme in the world – National Health Protection Scheme, also known as Modicare. It aims to cover 50 crore vulnerable families by offering Rs.5 lakh health coverage for each family.

        The Chief Minister of West Bengal, Mamata Bannerjee opted out of the scheme stating that their own state medicare scheme covers 5 million people. Karnataka, too, does not wish to adopt the Centre’s scheme for similar reasons. The state is all set to announce a medicare scheme on the 26th of February. The State Health Minister, Ramesh Kumar, stated that the state doesn’t intend to have a maximum coverage limit and called the NDA’s healthcare scheme a “pretension”. He also stated that the Centre may wish to copy Karnataka’s medicare scheme that will be announced soon.

        20 February 2018

      • Modi to introduce more welfare schemes for the underprivileged

        Prime Minister Narendra Modi attended the Mahamastabhisheka of Bahubali in Shravanabelagola. In his address, he spoke about the largest healthcare scheme, National Health Protection Scheme (NHPS) that has been designed to help the poor when they are in the need for financial support in times of medical contingencies. Each underprivileged family is said to receive Rs.5 lakh medical coverage under the scheme every year.

        The NHPS is part of the Ayushman Bharat Yojana and Modi promised to introduce more such welfare plans for the economically backward classes.

        20 February 2018

      • Modicare may provide more funds to NABH accredited hospitals

        A member of Niti Aayog said that hospitals accredited by NABH (National Accreditation Board for Hospitals) may receive more funds from the NHPS (National Health Protection Scheme) for the quality medical treatment they are expected to offer. The government has decided to fuel such hospitals financially as providing quality care costs more. Also, OPD (Out Patient Department) expenses are not covered under the NHPS.

        The accreditation of hospitals is monitored by the Quality Council of India. The accreditation is based on the quality of healthcare and patient safety.

        19 February 2018

      • State unwilling to replace state government health insurance schemes with Modicare

        Arun Jaitley, earlier this month, announced the introduction of the National Health Protection Scheme (NHPS) which offers a coverage of Rs.5 lakh to vulnerable families across the country. Though the state governments have the option of providing both, the state scheme and Modicare, or merging theirs with Modicare, or providing only Modicare, they are not very excited about this scheme that is expected to be the largest in the world.

        They are expected to bear 40% of the costs and do not wish to shell out funds for their separate plans as well as Modicare. They are of the opinion that beneficiaries might opt for both plans and hence the state government will have to fund both. Modicare offers coverage only to poor identified in the Socio-economic caste census, 2011. While states like Gujarat and Maharashtra covers a larger number of individuals. K R Ramesh Kumar, the Health and Family Welfare Minister of Karnataka, states that the state government schemes are “an assurance model, theirs insurance.”

        16 February 2018

      • Sania Mirza throws light on the importance of health insurance

        Sania Mirza, the former champion of Tennis doubles became the first person to purchase GoActive, a health insurance plan by Max Bupa. She is of the opinion that making an investment in a health insurance plan to protect oneself from medical contingencies is as important as staying physically fit. She lists out the unique features of GoPlan and reasons why it is beneficial to her. The plan helps the life insured manage regular health needs and helps track their health too. The plan also encourages the youth to purchase health insurance plans early.

        15 February 2018

      • Max Bupa introduces a new health insurance plan – GoActive

        The new health insurance plan launched by Max Bupa is digitally enabled and can be used to track health every day. The new technologically advanced product has been designed with the idea to bring about a revolution in the health insurance industry.

        The health insurance plan will offer coverage for Out-Patient Department, counselling, health coaching, medical opinion, etc. Max Bupa has been offered support from 1mg, Practo and GOOii to form a technologically advanced system to track health.

        The CEO of NITI Aayog, Amitabh Kant and tennis player, Sania Mirza were present at the launch. Sania Mirza was the first one to purchase GoActive.

        15 February 2018

      • RSS affiliate opposes Modi’s new healthcare scheme

        The National Health Policy Scheme (NHPS) is expected to be the world’s largest healthcare scheme. However, a trade union of ESIC (Employees State Insurance Corporation) that is affiliated to RSS (Rashtriya Swayamsevak Sangh) opposes the introduction of this new scheme. The members are led by BMS (Bharatiya Mazdoor Sangh).

        The existing ESI scheme covers 29 million workers and 0.9 million employers of an array of industrial establishments and happens to be one of the oldest social security schemes. A letter written by an ESIC member to Santosh Gangwar, the Union Labour Minister stated that the scheme would only benefit private hospitals and insurance companies, and affect the ESI scheme that covers 120 million beneficiaries.

        While a few more unions support the idea of developing the ESI scheme, a few experts believe that the new NHPS scheme has not been made mandatory and that workers will be given a choice to choose between the two.

        14 February 2018

      • More than half of Orissa’s households don’t have health insurance coverage

        According to a survey conducted by Mumbai-based International Institute for Population Sciences (IIPS), it is estimated that more than half the households in Orissa do not have any kind of health insurance coverage. While there are plenty of government-backed health insurance plans and schemes, only 48% of Orissa’s households were found to have health insurance coverage for at least one family member.

        The report showed that health insurance coverage is higher among the rural population than the urban population. One of the worrisome facts disclosed by this report is that people with 12 or more years of schooling had lower coverage than people with little or no schooling. In other words, health insurance awareness is lesser even among the educated population.

        While health insurance penetration is low in the state, the report showed that there is a significant improvement in the number of families covered over the last 10 years. A report released in 2005-06 revealed that only 2% households in the state had health insurance coverage for at least one family member.

        13 February 2018

      • AP State Government to provide health insurance to around 20,000 rural women, says Kamineni

        Mr. Kamineni Srinivas, the Health Minister of Andhra Pradesh, has announced that the state government will be providing a health insurance cover to around 20,000 women living in rural parts of the state. Further, it has also been reported that cancer and other critical illnesses have been included under the NTR Vaidya Seva Scheme.

        The Health Minister also mentioned that the government was concerned about the rising infant and maternal mortality rates within the state. Thus, the government has provided training to over 1,300 nurses to help them conduct the Mahila Master Checkup (a diagnostic test). The government is also planning to distribute around 16,000 tablets to certain segments of the society in an effort to help them digitise their health records.

        13 February 2018

      • The new health protection scheme to be technology driven

        The Union Health Minister, J.P. Nadda said that the government will use the best of technologies to make sure the National Health Protection Scheme (NHPS) is transparent. The NHPS is a health scheme that was announced during the Union Budget 2018 session that will provide up to Rs.5 lakh coverage for 10 crore families.

        Nadda emphasised that infrastructure should be given prime importance. The private sector will also be given an opportunity to play a part in the scheme but the centre will monitor the role they play. The centre plans to bring about developments in the insurance model and healthcare facilities.

        9 February 2018

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