Health Insurance

Health Insurance: Compare and Evaluate Health Insurance Plans Online

A Health Insurance Policy serves as a financial safeguard, covering the medical expenses of the policyholder. It constitutes a legal contract between the insurance company and the policyholder. The insurer offers benefits such as eligibility for cashless treatment at network hospitals for covered illnesses or injuries, as well as reimbursement of medical expenses. Additionally, policyholders can benefit from tax deductions on health insurance premiums under Section 80D of the Income Tax Act of 1961.

What is Health Insurance?

Health insurance plans are essential indemnity-based insurance products designed to provide financial assistance for medical expenses incurred during hospitalization or in the event of critical illnesses.

In India, health insurance operates as a contractual agreement between an insurance provider and a policyholder, offering coverage for medical bills arising from future injuries or illnesses that necessitate hospitalization.

Health insurance encompasses a wide range of medical expenses, including hospitalization, treatment costs, surgical procedures, and various other healthcare expenditures.

Typically, leading health insurance plans in India are affiliated with extensive networks of hospitals, ensuring that policyholders have convenient access to cashless treatment.

Furthermore, a health insurance policy helps mitigate the financial impact of lost income during treatment, preventing any disruption to family finances. In essence, having the best health insurance in India provides a means to access high-quality medical care without depleting your savings.

What are the Categories of Health Insurance Plans? 

Outlined below are the various categories of health insurance plans available to cater to your specific needs:

• Individual Health Insurance
• Family Floater Health Insurance
• Senior Citizen Health Insurance
• Critical Illness Health Insurance
• Maternity Health Insurance
• Group Health Insurance
• Preventive Healthcare
• Personal Accident Insurance

What are the Top Health Insurance Companies in India? 

Below is a table listing some of the leading insurance companies that provide health insurance policies. The table includes details such as Sum Insured, Network Hospitals, and Key Benefits.

Note: A GST rate of 18% is applicable to all financial services effective from July 1, 2017.

Necessary Documents For Purchasing Health Insurance In India 

The following documents are required when purchasing health insurance in India:

• Proof of identity: Aadhaar card, PAN Card, Voter’s ID, Passport, Driving license, Passport-sized photographs.
• Age proof: Birth Certificate, Passport, 10th or 12th class marks card, Voter’s ID, PAN Card, Aadhaar card, Driving license.
• Proof of residence: Telephone bill, Passport, Electricity Bill, Driving license, Ration Card, Voter’s ID, Aadhaar card.

Please note that some health insurance companies may also require applicants to undergo medical examinations as part of the application process, and additional documents may be requested by insurers.

What are the Qualification Requirements for Health Insurance? 

In India, the typical eligibility criteria for health insurance include the following:

• Minimum Entry Age: Health insurance plans for children usually require the insured to be between 16 days and 18 years of age to start receiving benefits. For adult policies, the entry age ranges from 18 to 65 years, although it might extend to 70 years or older depending on the specific plan and insurance provider.
• Pre-Existing Medical Conditions: Individuals aged 45 and above may be required to undergo a series of medical examinations before being eligible for health insurance coverage. If not prompted for medical tests, policyholders must provide a declaration disclosing any pre-existing medical conditions. These preconditions or the results of medical examinations are used to determine the policyholder's eligibility for coverage.

What Does a Health Insurance Policy Include? 

Health insurance policies typically cover the following:

• In-patient Hospitalization Expenses: Medical expenses incurred during treatment for an illness or injury, provided the hospital stay exceeds 24 hours.
• Pre-existing Illnesses or Diseases: Costs related to pre-existing conditions can be claimed after the waiting period.
• Pre and Post-Hospitalization Expenses: This includes charges for medical tests, X-rays, and check-ups before hospitalization, as well as the cost of medicines and follow-up health assessments after discharge.
• Ambulance Charges: Emergency ambulance expenses are generally covered, though the limits may vary.
• Maternity Cover: Expenses related to pregnancy, childbirth, and newborn care are commonly part of the coverage.
• Preventive Health Check-ups: Some plans offer regular health check-ups for preventive care.
• Daycare Procedures: Treatments requiring less than 24 hours of hospitalization, such as eye surgeries or dialysis, are usually covered.
• Home Treatment Cover: Medical treatment received at home, based on a medical practitioner's advice, may also be included.
• AYUSH Benefit: Coverage extends to medical expenses for Ayurveda, Unani, Siddha, or Homeopathy treatments within specified limits.
• Mental Healthcare Cover: Mental illnesses are covered as per the Mental Healthcare Act 2017. Insurers are mandated by IRDAI to include treatment for mental health conditions like acute depression, bipolar affective disorder, schizophrenia, etc., in their policies by 31 October 2022.

What is Excluded from Health Insurance Coverage? 

Health insurance policies often do not cover the following:

• Claims within the initial 30 days of policy purchase, except for accidental emergencies.
• Pre-existing diseases, typically subject to a waiting period of 2 to 4 years.
• Critical illness coverage often involves a waiting period of 90 days.
• Injuries resulting from war, terrorism, or nuclear activities.
• Self-inflicted injuries or attempted suicides.
• Terminal illnesses, AIDS, and similar diseases.
• Cosmetic or plastic surgery, hormone replacement surgery, and related procedures.
• Expenses for dental or eye surgeries.
• Charges for bed rest, hospitalization, rehabilitation, and common illnesses.
• Costs associated with treatment, diagnostic tests, and post-care procedures.
• Claims arising from injuries during adventure sports.

Please note: It is advisable to refer to your policy documents for a comprehensive list of exclusions.

What Factors Should You Consider Before Purchasing Health Insurance? 

Before you buy a health insurance plan, it's essential to carefully evaluate these key factors:

• Scope of Coverage: Review the policy's coverage and sum insured to understand which illnesses and surgeries are eligible for claims. Consider benefits such as hospitalization expenses, daily cash benefits, COVID hospitalization coverage, critical illness coverage, and maternity benefits when making your selection.
• Adequate Sum Insured: The sum insured is a crucial factor. To account for inflation, it's advisable to opt for a policy with a minimum sum insured of Rs. 10 lakh, which can go up to Rs. 1 crore. Higher coverage is especially beneficial for family floater or senior citizen policies.
• Policy Type: Choose from various policy types, including individual health insurance, senior citizen coverage, family floater plans, or critical illness plans. Consider adding top-up or super top-up insurance to supplement your coverage if your base sum insured is exhausted during treatment.
• Waiting Period Clause: Understand the waiting period clause, which delays coverage until a specified period elapses. This applies to claims beyond accidental hospitalizations and includes pre-existing conditions, specific illnesses, treatments, and maternity coverage.
• Co-payment Clause: Some policies include a co-payment clause, requiring you to contribute a percentage of the claim amount. While this reduces premiums, it increases out-of-pocket expenses. Opt for this option only if you can manage the additional cost.
• Room Rent Sub-limits: Be aware of sub-limits, such as restrictions on room rent. Ensure that the plan has minimal sub-limits to avoid extra expenses for medical treatments.
• Network of Cashless Hospitals: Check the list of network hospitals for cashless claims. A larger number of nearby network hospitals enhances your options for cashless hospitalization.
• Lifelong Renewability Option: Select a plan with a lifelong renewal option for continuous coverage, as most medical insurance policies are renewed annually.
• Premium Loading Factor: Be cautious of premium loading for higher-risk policyholders, particularly for senior citizen plans. Choose plans with no loading to avoid additional premium charges.
• Claim Settlement Ratio: Evaluate the insurer's claim settlement ratio, a crucial indicator of their credibility. Opt for a company with a ratio exceeding 80% for a more favorable claims experience.

How to Initiate a Health Insurance Claim? 

Health insurance policies offer the convenience of two primary claim processes: cashless treatment and expense reimbursement by the insurer. The process for both types of claims depends on the policy's sum insured limit. Here's an overview of how to make health insurance claims:

• Health Reimbursement Claims:

• If you receive treatment at a non-network hospital, you can claim reimbursement for the treatment expenses.
• After completing your treatment, settle the hospital bill and collect all relevant documents.
• File a claim with the insurer or Third-Party Administrator (TPA) for reimbursement.
• Include necessary documents like medical bills, reports, discharge summaries, etc.
• Upon approval, the insurer will reimburse the claim amount.

• Cashless Claims:

• When you receive treatment at a network hospital, you are eligible for cashless treatment services.
• After completing the treatment, the insurance company directly settles the bill with the hospital.

The claim procedures for both cashless and reimbursement claims may vary based on whether the hospitalization is planned or due to an emergency:

For Planned Hospitalization:

• Notify the insurer at least 48 hours before the planned hospitalization.
• Obtain approval from the TPA if necessary.
• File reimbursement and cashless claims by submitting the required claim form and documents.
• Include additional documents such as medical bills, reports, discharge summaries, etc.
• Upon approval, the insurer will either reimburse the claim amount for reimbursement claims or directly settle the hospital bill for cashless claims.

For Emergency Hospitalization:

• Alert the insurer within 24 hours of hospitalization for emergency cases.
• Present your health insurance card at the hospital.
• Submit a pre-authorization form for TPA approval in emergency cases to facilitate cashless claims.
• If approved, the insurer will directly settle the claim with the network hospital.
• If TPA approval isn't obtained, you can file for reimbursement subsequently.
• Provide all necessary documents such as hospital bills, discharge summaries, etc.
• The claim amount will be disbursed to you upon approval.

These steps will guide you through the health insurance claim process, ensuring that you receive the appropriate coverage for your medical expenses.

How to Determine Health Insurance Premium Costs? 

Health insurance premiums are subject to various factors, such as your medical history, your family's medical history, the insured amount, accumulated bonuses, and other relevant considerations. To estimate your insurance costs accurately, you can use a health insurance premium calculator. This online tool takes into account essential information like the desired coverage amount and the insured person's age, then calculates the required premium accordingly based on the data you provide.

What Factors Influence Your Health Insurance Premium? 

Your health insurance premium is determined by a combination of various factors, including:

• Age - Younger individuals tend to have lower premiums due to better overall health and shorter waiting periods for specific illnesses and coverage.
• Lifestyle - Your health insurance cost is influenced by lifestyle choices, such as smoking, as lifestyle-related illnesses are a significant contributor to health issues.
• Pre-existing Conditions - If you have pre-existing health conditions or a family history of specific ailments, your premium is likely to be higher due to increased risk.
• Location - Your city of residence impacts your premium because different locations carry distinct health risks and varying medical expenses. For example, areas with high pollution levels may lead to increased premiums.
• Additional Coverage - The option to customize your health insurance plan with additional benefits, such as Maternity or AYUSH coverage, can raise your premium slightly based on your specific needs and health conditions.

What Are the Advantages of Health Insurance? 

Health insurance offers several significant benefits, including:

• Cashless Treatment: Health insurance allows you to access medical treatments without the need to pay for them out of your own pocket, thanks to cashless treatment facilities.
• Coverage for Pre & Post-Hospitalization Expenses: Effective insurance policies provide coverage for both pre-hospitalization (up to 60 days before hospitalization) and post-hospitalization (up to 60 days after hospitalization) expenses.
• Transportation Expenses: Health insurance plans often cover ambulance expenses for transporting you to and from the hospital.
• Medical Check-ups: Many health insurance policies offer complimentary health check-ups, often contingent on your No Claim Bonus status.
• No Claim Bonus: Maintaining a health insurance policy without filing any claims for an entire policy year can earn you a No Claim Bonus as a reward.
• Room Rent: Health insurance policies typically cover a significant portion of your room rent expenses during hospitalization.
• Tax Benefits: Health insurance premiums are eligible for tax deductions under Section 80D of the Income Tax Act, providing you with potential tax savings.
• Online Purchasing Convenience: Technological advancements enable you to purchase health insurance online, eliminating the need to visit a physical insurance company branch.
• Renewal Flexibility: Health insurance policy renewal can also be conveniently done online, offering flexibility in adjusting coverage terms to suit your needs.
• Outpatient (OPD) Expense Coverage: Some health insurance plans extend coverage to outpatient expenses, allowing you to seek reimbursement for medical expenses without the requirement of a 24-hour hospitalization.

Common Mistakes to Avoid When Buying a Health Insurance Policy 

When purchasing a health insurance policy, it's crucial to steer clear of these common mistakes:

• Inadequate Coverage: Opting for policies with minimal coverage to save on premiums may seem cost-effective initially but can result in higher expenses in the long run. It's essential to strike a balance between affordability and comprehensive coverage.
• Ignoring the Fine Print: Neglecting to review the policy's fine print can lead to misunderstandings about coverage and exclusions. Thoroughly examine the policy details to understand what is included and what isn't.
• Failure to Compare Insurers: Rushing to choose the first insurance provider you come across is a common error. Take the time to compare multiple insurance plans to identify the one that best suits your specific needs.
• Providing False Medical History: Falsifying your medical history to lower premiums can backfire if the insurer discovers the deception. Honesty about your medical background is essential to avoid claim rejections later.
• Overlooking Cashless Hospitals: The availability of cashless hospitalization facilities is a critical factor when selecting a health insurance policy. Ensuring your insurer offers this option ensures prompt medical attention during emergencies.
• Carefully Selecting Premiums and Co-pays: Understand the implications of co-pay options. Choosing co-pay means you'll contribute a predetermined amount during a claim, with the remainder covered by the insurer. This doesn't affect the sum assured.
• Adding Unnecessary Riders: While additional riders can enhance your policy's protection, be cautious not to add them indiscriminately. Choose riders that are genuinely beneficial for you and your family.

What Are the Advantages of Purchasing Health Insurance Plans Online? 

Acquiring a health insurance policy through online channels offers numerous advantages. Here are the key benefits:

• Streamlined Plan Comparison: Online platforms like Policybazaar.com simplify the process of comparing health insurance plans from various insurers, empowering you to make well-informed decisions.
• Enhanced Convenience: Purchasing insurance online eliminates the need for physical visits to insurance company branches or meetings with agents, providing greater convenience and flexibility.
• Exclusive Online Discounts: Online purchases often come with premium discounts that can enhance the overall value of your policy.
• Lower Premiums: Online health insurance plans frequently feature lower premiums, thanks to cost efficiencies gained by insurers in their online operations.
• Minimal Paperwork: The online health insurance buying process typically involves minimal to no paperwork, streamlining the entire experience for policyholders.
• 24/7 Accessibility: You can buy a health insurance policy online at any time, including weekends and holidays, ensuring accessibility whenever it's convenient for you.
• Digital Payment Options: Secure digital payment methods are available for paying premiums online, eliminating the need for cash transactions and simplifying financial transactions.
• Instant Policy Issuance: Online purchases result in immediate policy issuance, providing a swift contrast to potential delays associated with offline methods.
• Time Efficiency: Online policy procurement saves significant time, with policies being issued within minutes of purchase, making it a hassle-free and time-efficient process.

What Are the Key Motivations to Invest in a Health Insurance Plan? 

As healthcare costs continue to rise, ensuring access to medical treatments has become increasingly expensive. The risk of depleting your savings due to hospitalization for critical illnesses or lifestyle-related diseases is a genuine concern. The most effective solution to navigate these challenges and secure top-notch medical care is to invest in a health insurance policy. Here are the pivotal reasons to consider for obtaining a health insurance plan:

• Tackling Medical Inflation: Health insurance helps you manage current and future medical expenses, including pre and post-hospitalization costs, in the face of soaring medical inflation.
• Access to Quality Healthcare: It enables you to afford high-quality medical treatment and attention, allowing you to focus solely on your recovery without financial worries.
• Addressing Lifestyle-Related Ailments: Health insurance covers extended treatments for lifestyle-induced conditions like cancer and heart diseases, which are becoming more prevalent due to evolving lifestyles.
• Safeguarding Your Savings: Protect your hard-earned savings by having your medical expenses covered, providing financial relief when seeking essential treatments.
• Convenient Cashless Hospitalization: Benefit from the convenience of cashless hospitalization at network hospitals affiliated with your insurance provider, streamlining the claims process and minimizing financial hassles.
• Utilizing Tax Benefits: Enjoy tax deductions on your health insurance premiums under Section 80D of the Income Tax Act, optimizing your financial planning while securing your health.
• Peace of Mind: Experience peace of mind knowing that the heavy burden of exorbitant hospital bills is alleviated, allowing you to focus on your recovery with a sense of security.

Is COVID-19 Treatment Covered by Your Health Insurance Policy? 

Your existing health insurance policy includes coverage for expenses related to the treatment of COVID-19. Many health insurers and general insurance providers have introduced specific health insurance plans tailored to cover the medical costs associated with COVID-19 treatment. In line with the guidelines established by the Insurance Regulatory and Development Authority of India (IRDAI), two distinct standard health insurance products have been introduced to address this need: the Corona Kavach policy and the Corona Rakshak policy. These policies are gaining popularity among individuals seeking coverage for COVID-related expenses. Let's explore these two COVID insurance offerings and how they differ from basic health plans.

• Corona Kavach Policy: This indemnity-based health insurance plan provides coverage for expenses related to COVID-19 hospitalization, home treatment, and AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) treatment costs. Additionally, it covers expenses for items such as masks, gloves, ventilators, oxygen cylinders, and personal protective equipment (PPE) kits.
• Corona Rakshak Policy: The Corona Rakshak policy operates on a benefit-based model, offering a lump sum payment for hospitalization expenses (minimum of 72 hours) upon the diagnosis of COVID-19 during the policy's term. The policy term ranges from a minimum of 3.5 months to a maximum of 9.5 months.

What Are Some Common Misconceptions About Health Insurance? 

Before purchasing a health insurance policy, it's essential to debunk certain misconceptions and gain a clear understanding of how these policies function. Here are several prevalent myths that many individuals harbor about health insurance:

• 'I don't need medical insurance; I am healthy': Despite maintaining good health, unforeseen circumstances like seasonal illnesses, accidents, or diseases such as dengue and malaria can occur at any time. Hospitalization expenses can be significant, making health insurance crucial for covering such costs.
• 'All medical expenses are covered by my health insurance': Health insurance plans come with specific exclusions and limitations as per IRDAI regulations. It's crucial to thoroughly review policy details and coverage terms. The insurer will only reimburse expenses that fall within the policy's coverage and sum insured limit.
• 'Declaration of pre-existing diseases': Transparently disclosing pre-existing diseases in the proposal form is essential. Failing to provide accurate information can lead to claim rejection and additional costs.
• 'Smokers cannot buy a health insurance plan': Some health insurance companies do provide coverage to smokers and alcohol consumers, although they may undergo stringent medical exams and pay higher premiums due to associated risks.
• 'Medical insurance will only cover hospitalization expenses': While many health insurance plans cover hospitalization exceeding 24 hours, some also cover daycare procedures that do not require extended hospital stays, such as cataract surgery or varicose veins treatment.

'I am covered under a corporate or group health insurance plan': Solely relying on an employer-provided group health insurance plan has limitations. Coverage may not extend to family members, the sum assured may be inadequate, and critical illnesses might not be covered. Additionally, post-retirement or job loss can lead to costly insurance gaps.