Health Insurance

What is health insurance? – The Basics

Health insurance is an insurance product that covers your medical expenses. Just like a car insurance that provides financial coverage for your car if you get into an accident, health insurance offers you financial assistance if you fall sick or get injured.

Just like all other insurance policies, health insurance is an agreement between an individual or a group of persons and the insurance company. The individual pays annual premiums to the insurer, who in return, offers financial assistance to the insured during a medical crisis, subject to terms and conditions mentioned in the policy.

Generally, health insurance cover offers coverage for the following expenses – hospital room and boarding expenses, fees of surgeon, physician, specialist, anaesthetist, consultant, nurses, costs of blood, oxygen, surgical appliances, anaesthesia, x-ray, dialysis, drugs, medicines, operation theatre charges, radiotherapy, chemotherapy, pacemaker, transplant organs, artificial limbs and many more.

Apart from these expenses, a health insurance plan also offers coverage for pre and post hospitalisation expenses, preventive care, diagnostic tests, ambulance charges, hospital cash allowance, domiciliary care and much more, depending upon the terms and conditions of your policy.

Who should purchase a health insurance?

Though health insurance is not mandatory like car insurance, it’s highly recommended that everyone avails a health insurance policy. With mounting medical costs and an increase in the number of lifestyle diseases, it’s not possible or practical to pay out-of-pocket for medical emergencies.

Medical expenses are one of the major reasons for families to fall into debt traps. With a health insurance cover, you can protect your family’s finances during a medical crisis.

Why is health insurance important for all?

It’s no surprise that healthcare costs across the country have increased significantly. That compounded with our hectic lifestyle, takes a toll on our health, making health cover critical for all, irrespective of one’s income levels. When you have health insurance, it offers you financial assistance in times of medical emergencies.

Without a health insurance plan, you would be forced to dip into your life’s savings to pay for your medical expenses or worse to avail a loan. Both these options dent your family’s finances, jeopardizing your current savings and future investments. A medical insurance plan acts as a financial net, assisting you during a medical emergency.

Top Reasons Why You Need A Health Insurance

The rising cost of medical treatment in India

Medical costs in India have been increasing year-on-year. According to data released by the WHO, India’s annual spend on public healthcare is just 4.7% of the GDP. This means the vast majority of the citizens have to rely on private treatment for various health issues.

Additionally, the average costs of medical expenditures in India are increasing by 15 to 20% every year. Specialist treatment, new advances in medical sciences, and inflation all make healthcare expensive. Very often, when an individual in a family faces a medical emergency, the entire family’s finances are in a toss.

Lack of finances could even lead to delayed or insufficient treatment. Most families today take loans, sell assets, dip into their personal savings, or mortgages to provide healthcare for their family member. A health insurance plan acts as a real lifesaver providing you the cost of hospitalisation, pre and post hospitalisation expenses, surgeries, doctor fees, other treatments, and more.

Increase in lifestyle diseases and critical illnesses

Our lifestyle has undergone a drastic change in the last couple of decades. We have moved from labour intensive jobs to sedentary jobs that have led to an increase in lifestyle diseases like blood pressure, diabetes, obesity, cardiac problems, and more.

Not just lifestyle diseases, the cases of critical illnesses like cancer, cardiac arrest, and kidney failures also have increased steadily over the years. Hectic lifestyles, chronic stress, irregular eating habits, improper diets, lack of exercise, and not to forget urban pollution – are all making us ill. Health issues can arise at any time and to anyone.

A medical insurance plan will provide your family with much-needed financial stability during a medical crisis. It will take care of most of the expenses, and you can focus on providing your loved ones with support and attention. Additionally, cashless facilities offered by several health insurance plans make it possible to get treated at network hospitals without paying a single rupee out of your pocket.

With health insurance, your family is not burdened financially during a medical crisis. The huge range of benefits offered by health insurance plans far exceed the nominal premiums you have to pay for the plan.

Today, health insurance has transcended from a good-to-have option to a must-have option.

Benefits of Health Insurance Policies

Are you still debating whether you should get a health insurance policy or not? A health insurance plan offers several obvious benefits like – protects you from medical contingencies, helps you avail cashless treatment at hospitals, prevents you from burning a hole in your pocket paying for medical expenses and safeguards your family from money problems during medical emergencies.

Apart from these, there are several other benefits offered by health insurance policies. They are:

Provides you with best-in-class medical treatment

Today, medical expenses can very well run into lakhs of rupees. This makes it difficult for regular families to pay out-of-pocket. The result – they either delay treatment or compromise on the treatments.

With a health insurance policy, you don’t have to worry about the costs of treatment as it is handled by your insurance company. You can avail cashless treatment at the best-in-class hospitals in India, without burning your life savings.

Most health insurance policies offer coverage for – in-hospital expenses, pre and post hospitalisation expenses, medical expenses, surgery costs, equipment costs, medical practitioner fees, ambulance charges, room costs, daily cash allowance, cost of medicines and pills, and much more.

Tax Saver

Paying for health insurance premiums is a great way to save tax. You can avail tax deductions under Section 80D of the ITA on the premiums you pay for your health insurance plan. When you pay the premium using any mode other than cash, it is tax deductible. You can avail tax exemptions on the premium you pay for yourself and your family – including spouse, dependent children, your parents, and the parents of your spouse.

Here’s a detailed explanation of the available tax deductions:

• You can avail up to Rs. 25,000 as a tax deduction on the premium if none of the family members (for whom you are paying health insurance premiums) are more than 60 years.
• The tax deduction on the premium is up to Rs. 30,000 if one or more members of your family (for whom you are paying health insurance premium) are aged 60 years or more.

Convalescence Benefit

Also known as recovery or recuperating benefit, health insurance policies also provide you coverage for expenses that occur after discharge from the hospital like – further diagnostic tests, physiotherapy charges and more.

Alternative Treatment

Apart from regular allopathy treatment, several health insurance policies today offer coverage for alternative modes of treatment like Ayurveda, Unani, Siddha, Homeopathy, Naturopathy, and many more.

Expenses Incurred by the Organ Donor

Today, the cost of a kidney transplant ranges from Rs. 3 lakhs to Rs. 5 lakhs. A medical insurance policy offers coverage for the expenses incurred by the organ donor – like room costs, surgery costs, medicines for the donor and more. Additionally, a few health insurance policies even cover the costs of harvesting the organ.

Domiciliary Treatment

Medical insurance policies may cover the costs of treatment provided to critically ill patients at their home. Most health insurance policies have a limit on the amount and number of days for domiciliary treatment.

Attendant Allowance

When a health insurance policy offers an attendant allowance, the insurance provider covers the expenses incurred by the attendant of the patient (usually a family member) for the duration of hospitalisation.

Daily Hospital Cash Allowance

Apart from the medical expenses, certain healthcare policies also provide coverage for personal expenses – like food, dress, etc., for the patient during their stay in the hospital. However, there is a cap on the number of days for the daily hospital cash allowance.

Free Health Check-up

This is another major perk of health insurance policies. Majority of health insurance policies offer free periodic health check-ups to the insured once every 3 to 5 years. The policyholders can avail full-body master health check-ups for free at any one of the network hospitals or diagnostic partners.

Dental Treatment

Though most health insurance companies don’t offer dental coverage, a few health insurance companies now include dental treatments as part of their coverage limits. For instance, Apollo Munich’s Maxima Health and Easy Family Health Insurance plans include outpatient dental treatments as part of their cover. However, most dental treatments come with a waiting period of 3 to 5 years.

Cosmetic and Bariatric Surgeries

Bariatric surgeries (weight loss surgeries) and cosmetic surgeries are also covered under special health insurance plans.

How does health insurance work?

Here, you can find a simple explanation of the working of a standard health insurance policy.

First, you have to purchase a health insurance policy from your preferred insurance provider. Once you pay the premium, the insurer issues the policy. Generally, the tenure of all health insurance plans is one year. During this period, if you face any unexpected medical emergency, your insurer takes care of the expenses.

Let’s say, you fall sick and require hospitalisation. If you get admitted at a partner hospital belonging to your insurer’s network, you need to quote your health insurance policy number. The hospital verifies the details and proceed with your treatment after informing the insurer. The medical bills raised by the hospital are sent directly to the insurer by the hospital or TPA. The insurance provider settles the bill up to the sum assured, and if there are any excess expenses, you have to pay it out of pocket.

Now, consider the scenario where you get treated at a hospital not belonging to the insurer’s network. When you get admitted, you or your family members have to intimate your health insurance provider. You are treated as usual, and the hospital raises the bills to you. You pay these bills out of your pocket and then send the bills to the insurance company for reimbursement.

The insurance provider verifies your claims and then reimburses the amount to you. As above, the insurance company pays only up to the sum assured after deducting the deductibles (if any). If there are any excess charges beyond the sum assured, you have to pay it out of your pocket.

At the end of one year at the time of renewal, you can continue your policy with the same insurer if you are satisfied with the terms and conditions or switch to a new provider if you find better deals elsewhere.

This is the basic principle of health insurance policies. Apart from this, there are several other factors to be considered like whether a particular treatment is covered in your policy, the copayment terms, etc.

Classification of Health Insurance Plans

Health insurance plans can be broadly classified into two categories:

• Indemnity Plans
• Defined Benefit Plans

Let’s take a closer look at both these categories.

Indemnity Plans

The meaning of the word “indemnity” is providing compensation for loss or damages. When it comes to health insurance, it can be explained as follows – the insurance company provides financial assistance to the insured, to help him/her retain the same financial position before the loss.

Indemnity health insurance plans provide compensation to the policyholder for hospitalisation and other medical expenses, up to the sum assured. For instance, let’s assume a policyholder purchases an indemnity health insurance plan with a sum assured up to 2 lakhs. The medical expenses are Rs. 1,20,000. Then the insurance company would pay Rs. 1,20,000 as compensation to the policyholder. On the other hand, if the hospital bill runs up to Rs. 2.5 lakhs, the insurance company will pay 2 lakhs, and the rest has to be borne by the policyholder.

Indemnity plans can be further classified into three sub-categories:

Mediclaim Plans

This is the most common and popular health insurance plan. Mediclaim plans provide compensation for hospitalisation expenses, expenses for surgeries, doctor and specialist fees, ambulance costs, pre and post hospitalisation costs, and more. The premium varies depending on the sum assured.

Top-up Plans

As the name implies, these plans provide added coverage to your standard Mediclaim plan. Top-up plans help to increase the coverage of your basic health insurance plan for minimal costs. All top-up plans come with a deductible limit. This is the amount up to which the top-up plan will not meet your claim.

When a medical claim exceeds this deductible limit, the top-up plan is triggered, and the insurance provider pays the excess. Top-up plans are beneficial when you already have a standard health insurance plan and want extra coverage, and when the deductible limit of the top-up plan matches the sum assured of the standard plan.

For instance, in the above example, the Mediclaim plan offered coverage of 2 lakhs. And if you purchased a top-up plan with a deductible limit of 2 lakhs, the extra Rs. 50,000 would be paid by the insurance company of the top-up plan and not out of your pocket.

Super Top-up Plans

As the name implies, super top-up plans are a move top-up plans. While it’s similar to the top-up plan, there’s a major difference between the two. In a top-up plan, every time you file a claim, it triggers the top-up plan. If each individual claim falls below the deductible limit, but beyond the sum assured by your basic plan, then your top-up plan would not pay for it.

In super top-up plans, claims are not considered individually, but as an aggregate during the policy year. Let’s say, you file two claims in a policy year for Rs. 80,000, and Rs. 70,000. If the deductible limit of your top-up plan is Rs. 1 lakh then it won’t be triggered.

On the other hand, a super top-up plan would consider the total claims you file in a year, in this case, 1.5 lakhs. It would pay you the excess Rs. 50,000 beyond the deductible limit.

Defined Benefit Plans

This is the other classification of health insurance plans. It’s also known as fixed benefit plans and is the opposite of indemnity plans. Defined benefit plans pay a pre-decided fixed amount for all approved claims, irrespective of the actual medical bills incurred.

For instance, if a particular fixed-benefit plan offers daily hospital cash, then the plan would pay you a fixed benefit of say Rs. 5000 per day of hospitalisation, irrespective of the actual hospital expenses incurred on a particular day.

There are several types of fixed-benefit plans like:

• Critical illness plans – These plans offer a lump sum payment to the insured if and when they are diagnosed with a particular critical illness mentioned in the policy document. You don’t have to submit any medical bills to avail the lump sum.
• Hospital Daily Cash Plans – As explained in the above paragraph, a hospital daily cash benefit plan provides a fixed amount of cash for every day you are hospitalised. The amount does not vary based on the actual hospital expenses. It’s pre-fixed as per the policy documents.

Popular Types of Health Insurance Plans in India

There are several types of health insurance plans in India designed to meet the specific requirements of different types of customers. Make sure to understand the different health insurance policies, so that you can pick the best one that suits your specific requirements.

1. Individual Health Insurance Policies

As the name implies, these are health insurance policies that have been designed to meet the healthcare needs of an individual specifically. Generally, the premium for individual health insurance policies is lower as the coverage is for only one person. The final premium you have to pay depends on several factors like – age of the insured, medical condition, coverage required, added benefits, etc.

Most individual health insurance plans cover a range of diseases and illnesses, as well as all hospital bills,  include room costs, medical equipment costs, doctor fees, in-patient care, specialist fees, pre and post hospitalisation, laboratory charges, medical examination charges, nurse fees, consultation fees, etc.

2. Family Floater Health Insurance Policies

These are specific health insurance policies that have been designed to meet the healthcare needs of various members of a family. Instead of taking separate health insurance policies for each member of your family – parents and minor children, you can take a single family floater health insurance plan to cover all your healthcare needs. The number of members covered under family floater plans varies from one insurance provider to another. Some insurance companies even offer coverage for up to 15 family members.

You can choose from different types of family floater plans like – equal coverage for all family members, a combined sum that can be used by one or more family members. For instance, if a family has smaller children and senior members, then taking a large combined sum family floater plan is an ideal choice as small children are not likely to need as much medical care as senior members.

While the premium for family floater plans is higher, it still presents a significant savings advantage as you need not spend on individual policies for all members.

3. Senior Citizen Health Insurance Plan

These are special health insurance plans to meet the requirements of seniors – individuals aged above 60 years. These plans generally have lower premiums or offer significant discounts on premium during renewal.

However, remember that not all insurance companies offer senior citizen health insurance plans. Bajaj Allianz Silver Health Plan, Star Health Senior Citizen Red Carpet Plan, Apollo Munich’s Optima Senior Health Plan, National Insurance Varishtha Mediclaim, New India Senior Citizen Mediclaim Policy are some of the popular senior citizen health insurance plans in India.

4. Critical Illness Plans

These are plans that offer coverage for specific critical illnesses. Treating critical illnesses like cancer cost high, and having a plan to offer coverage for it is a good idea, especially if you have a family history of critical illnesses or you are prone to getting it.

Some of the critical illnesses covered by these plans include heart valve surgery, multiple sclerosis, cancer, coma, organ transplant, blindness, kidney failure, heart attack, paralysis, and more.

You can opt for standalone critical illness plans or add it as an add-on cover to your regular healthcare plan.

5. Maternity Health Insurance

As the term implies, these are health insurance plans specifically designed to offer coverage for all maternity and childbirth-related expenses. Most regular health insurance plans do not offer coverage for maternity and related expenditures.

This plan applies only to women of child-bearing age. Just like critical illness plans, you can choose this as a stand-alone health insurance plan or add it as an add-on cover to your standard health insurance plan.

Maternity health plans offer coverage for both the mother and newborn and take care of all prenatal and post-natal expenses, along with hospitalisation costs for any complications that may arise.

6. Group Health Insurance Plans

These are health insurance plans offered by employers to their employees. Most companies include health insurance coverage as part of their pay package to attract talented employees as well as to reduce the risks of employees in the workplace.

Most group health insurance plans lose effect once an employee quits his/her job. Generally, the premiums for these plans are low as the coverage offered is minimal. It’s highly recommended that employees take added health cover apart from the group health insurance offered by their employer.

7. Preventive Health Insurance Plans

The term preventive healthcare refers to regular health checkups and other diagnostics taken to prevent the occurrence of a disease or illness. Annual health checkups are an efficient way to catch any early symptoms and take the right measures to prevent diseases before they reach critical stages.

Preventive health insurance plans take care of all the costs for preventive health checkups and other related costs.

8. Personal Accident Cover

An accident can occur to anyone at any time and at any place. Unforeseen events like accidents that cause disability, hospitalisation, or even death of a family member can strain a family’s finances.

With personal accident insurance, you can protect yourself from these expenses. This plan takes care of all medical costs for treating the insured in case of an accident. Additionally, these plans also provide compensation for permanent disability, injury, mutilation, or death of the insured due to road, rail, air, or water accidents. You can opt for personal accident cover as an add-on cover to your standard health insurance plan or choose it as a stand-alone plan.

9. Overseas Mediclaim Policies

Also known as travel insurance, an overseas Mediclaim policy takes care of your health insurance needs while travelling abroad. The policy provides you hospitalisation, medical treatments in case you meet with an accident overseas or fall sick all of a sudden while on a trip. Overseas Mediclaim policies are highly beneficial for frequent travellers and students going abroad for higher education.

Popular Add-On Health Covers in India

Sometimes the coverage provided by your health insurance plan may not be sufficient, or it may fail to provide coverage for specific situations. In such cases, choosing add-on covers (riders) to your standard health plan is a huge benefit.

Add-on covers are offered as optional choices along with your basic health plan. You can choose one or more add-on covers based on your requirements and your plan’s scope of coverage. You have to pay an additional premium, for every add-on cover you choose. However, the extra premium is nominal and is worth the benefit offered.

Benefits of Add-on Covers in a Health Insurance Plan

• Customize your health plan to suit your specific coverage requirements
• Since riders are optional, you can choose only those benefits that you require
• Helps to extend the coverage of your health plan for a nominal cost

The actual add-on covers offered vary from one insurer to another. Here, are a few common add-on covers offered by several health insurers:

1. Critical Illness Rider

This is one of the most popular health insurance add-on covers. This rider covers a specific set of critical illnesses like multiple sclerosis, organ failure, cancer, etc. When you choose this rider, if you get diagnosed with any of the critical illnesses mentioned in the plan, the insurer offers you a lump sum for treatment. This is in addition to the regular health coverage provided by your basic plan.

2. Hospital Cash Rider

When you choose this add-on cover, you are paid a fixed amount on a daily basis, when you are hospitalised for more than 24 hours. This helps your family members handle daily expenses while you are at the hospital.

3. Maternity and New Born Rider

Most health insurance policies do not offer maternity cover. When you choose this add-on cover, it handles all maternity related expenses – like pre and post-natal checkups, the delivery fee, doctor fees, surgeon fees in case of c-section, room rent and much more.

4. Personal Accident Rider

When you choose this add-on cover, the insurer pays a lump sum amount to your family members if you die in an accident. Additionally, the insurer also pays a lump sum if you suffer permanent disability in an accident.

5. Room Rent Waiver

Most health insurance plans put a cap on the room rent that you can avail during hospitalisation. This causes many people to choose shared dormitories, which are highly inconvenient and do not provide you and your family members with privacy.

When you choose this add-on cover, your insurer waives the room rent limit. This means you can choose VIP ac rooms and other higher category of hospital rooms, as per your convenience.

List of Leading Health Insurance Companies in India

The number of health insurance companies in India has steadily grown over the last few years, as the demand for health insurance plans rises among the general populace. With an increase in medical costs and hectic lifestyles that lead to an increase in illnesses, more and more people today are getting covered under health insurance plans.

A recent study by WHO reveals that nearly 25% of India’s population is covered by health insurance plans. The first health insurance scheme in the country was launched in 1986, but it was reserved only for central and state government employees. Today, there are over 25 health insurance companies in India registered under the IRDAI.

Here are the top health insurance companies that are operating in India in alphabetical order:

1. Apollo Munich Health Insurance Company

When it comes to healthcare, Apollo is a household name in India with a large number of multispecialty hospitals and pharmacies located all across the country. The Apollo Munich Health Insurance Company is a joint venture between the Apollo Hospitals Group, Asia’s largest integrated healthcare provider and a Munich-based health insurance company from Germany.

Apollo Munich Health Insurance Company offers a range of health insurance plans to meet the needs of all consumers. The tagline of the company is “Let’s Uncomplicate.” The company has over 5000+ network hospitals and has settled claims worth over 4059 crores (until September 2018).

Popular Health Insurance Plans:

• Optima Restore
• Easy Health
• Health Wallet
• Energy Plan for Diabetes

2. Bajaj Allianz General Insurance Co Ltd

Bajaj Allianz is one of the most popular general insurance companies in India and is a joint venture between Bajaj Finserv Ltd and Allianz SE. 74% of the company’s shares are held by Bajaj Finserv, and the remaining 26% is with Allianz SE.

Bajaj Allianz health insurance policies offer cashless claim settlements within an hour (the fastest claim settlement turnaround among Indian insurance companies) and cashless treatment at a network of over 6000 hospitals spread all across the country.

The company offers a wide range of health insurance plans to meet the requirements of different types of customers – individuals, families, senior citizens, and corporates.

Popular Health Insurance Plans:

• Individual Health Guard Insurance
• Health Guard Family Floater Insurance Policy
• Global Personal Guard
• Critical Illness Health Insurance
• Extra Care Plus Cover

3. Bharti AXA General Insurance Co Ltd

Bharti AXA General Insurance Company is a partnership between Bharti Enterprises of India, one of India’s leading business powerhouses and the AXA Group of Europe, a global leader in financial protection. Bharti AXA General Insurance Company was started in 2008, and today it has grown to have over 79 branches across the country. Bharti AXA is the first general insurance company in India to hold a dual certification of ISO 27001:2005 and ISO 9001:2008. The highlight here is that the company managed to obtain both these prestigious certifications within one year of operations.

24 x 7 call assistance for claims, free look-in period of 15 days, cashless treatment at over 4300 network hospitals, renewal discount that increases every year are some of the highlights of choosing health insurance policies from Bharti AXA.

Popular Health Insurance Plans:

• Smart Health Insurance
• Smart Health Critical Illness Insurance
• Smart Individual Personal Accident Insurance

4. Chola MS General Insurance Co Ltd

Chola MS General Insurance Company is a partnership between the famous Murugappa Group from India and Mitsui Sumitomo Insurance Company from Japan. The company has over 100+ branches spanning the length and breadth of the country and employs over 9000 insurance agents in India. Chola MS General Insurance Company offers a mix of individual and corporate insurance products and covers a wide array of sectors including health, engineering, marine, property, motor, travel, accident cover, and much more.

89,000+ happy customers, 2,20,000 claims settled every year, 8000+ network hospitals are some of the highlights of Cholamandalam MS general insurance company. The company also offers doorstep insurance services to those who request it. A licensed insurance advisor arrives at your doorstep and helps you choose the right policy that meets your specific requirements.

Popular Health Insurance Plans:

• Value Healthline Plan
• Freedom Healthline Plan
• Enrich Healthline Plan
• Swasth Parivar Health Plans
• Family Health Plan

5. Future Generali India Insurance Company Ltd

One of the leading general insurance companies in India, Future Generali is a partnership between India’s Future Group (the group behind Big Bazaar, one of India’s leading retailers) and Generali Group, a leading global insurance company from Italy.

The company has over 125 branches across India and has sold over 82 lakh policies in the country and has over 2000 corporate clients from across verticals. The in-house servicing team for health insurance plans provides quick and easy claim settlements, and the company has over 5100 network hospitals for cashless treatments. It’s an ISO 9001:2008 certified company offering excellent customer service and the best products.

Popular Health Insurance Plans:

• Health Total Mediclaim Policy
• Future Vector Care
• Accident Suraksha
• Future Advantage Top Up
• Future Varishta Bima
• Future Criticare

6. HDFC ERGO General Insurance Co Ltd

HDFC banking corporation is one of the two leading private sector banks in India. The HDFC ERGO General Insurance Company is a partnership between HDFC, India’s leading housing loan institution and ERGO International AG, a global insurance entity from Munich. The partnership between HDFC and ERGO is 51:49. The company offers a wide range of insurance policies to meet the varying requirements of different customers.

One crore+ happy customers, 24 x 7 customer support, wide range of insurance products catering to the specific requirements of different customers, transparent and hassle-free claim settlements, Best Customer Experience Award for 2016 – are some of the reasons to choose HDFC ERGO as your health insurance provider.

Popular Health Insurance Plans:

• Individual Health Insurance
• Family Health Insurance
• Parents Health Insurance

7. IFFCO Tokio General Insurance Co Ltd

IFFCO Tokio General Insurance Company is a leading general insurance provider in India. The company is a JV between IFFCO (Indian Farmers Fertiliser Cooperative) and Tokio Marine and Nichido Fire Group, the largest insurance company in Japan. IFFCO Tokio was started in India in 2000 and offers a wide range of general insurance policies catering to all segments and for various requirements.

The key benefits of health insurance policies from IFFCO Tokio are 4800+ network hospitals, pre and post hospitalisation expenses coverage, emergency cover, cover for newborn babies, daycare surgeries, lifelong policy renewal, and unlimited family members.

Popular Health Insurance Plans:

• Family Health Protector Policy
• Individual Health Protector Policy
• Swasthya Kavach Policy
• Individual Medishield Policy
• Critical Illness Insurance Policy
• Health Protector Plus Policy

8. Kotak Mahindra General Insurance Co Ltd

Kotak Mahindra General Insurance Company is a 100% subsidiary of Kotak Mahindra Bank Ltd, one of India’s fastest growing banks. The company offers a wide range of non-life insurance products to meet the requirements of different categories of customers. Service, innovation, and quality are the three cornerstones of Kotak Mahindra General Insurance Company. As of 2017, the company had over 13 branches in major cities across India and a strong core team of 350+ insurance professionals.

Quick and hassle-free claim settlements, customer-centric operations, customised products and services, digital operations are some of the distinct features of Kotak Mahindra General Insurance Company.

Popular Health Insurance Plans:

• Kotak Secure Shield
• Kotak Health Care
• Kotak Accident Care
• Kotak Health Super Top Up
• Kotak Health Premier

9. Liberty General Insurance

Liberty General Insurance is a joint venture between the popular Videocon Group and Liberty Mutual Insurance Group, based in the US. This company specialises in two-wheeler insurance, car insurance, and health insurance. Liberty General Insurance Company has a wide network of partner hospitals spanning the entire length of the country – over 4000 hospitals and a high claim settlement ratio of 95%. The company has won several prestigious awards like the “Rising Star Insurer of India,” “Best Emerging Organisation in BFSI,” and several more.

One of the biggest advantages of availing a comprehensive health insurance plan from Liberty General Insurance is that it’s not only reasonably priced but also offers cashless treatment at any network hospital in the country.

Popular Health Insurance Plans:

• Liberty Health Connect
• Health Connect Supra Policy

10. Magma HDI General Insurance Co Ltd

Magma HDI General Insurance Company is a JV between Kolkata’s Magma Fincorp Ltd and Germany’s HDI-Gerling Industrie Versicherung AG. The company offers a wide range of insurance policies like marine insurance, liability insurance, motor insurance, fire insurance, engineering insurance, health insurance, and many more.

The company has a high claim settlement ratio – 94.1% for the fiscal year 2017 – 2018. Another huge draw of Magma HDI General Insurance company is that claim settlements are super quick, and nearly 87.17% claims are settled within 30 days.

Popular Health Insurance Plans:

• One Health Insurance Policy for Individuals
• One Health Insurance Policy for Families

11. Manipal Cigna Health Insurance Company

Started in 2012, Manipal Cigna Health Insurance Company is a partnership between Cigna Corporation a global health services company that is present in over 30 countries and the Manipal Group, a leading higher education and healthcare delivery company in India. Manipal Cigna Health Insurance Company was formerly known as Cigna TTK Health Insurance Co Ltd.

When you avail a health insurance policy from Manipal Cigna, you can avail cashless treatment at 4500+ network hospitals pan India. The unique feature of health insurance policies from Manipal Cigna is that it offers worldwide emergency cover, free access to healthcare services at wellness partners, wellness programs that help you earn reward points, and much more.

Popular Health Insurance Plans:

• ProHealth Insurance Plan
• Lifestyle Protection Critical Care
• Lifestyle Protection Accident Care
• ProHealth Select
• ProHealth Cash
• Lifestyle Protection Group Policy

12. Max Bupa Health Insurance Co Ltd

Max Bupa Health Insurance Co Ltd is a well-known health insurance provider in India. The company is a partnership between the famous Bupa Finance, from the UK and Max India Ltd. The company offers the perfect blend of international expertise and local knowledge to provide customers with some of the best health insurance policies in India.

With over six decades of experience in the insurance industry and with a large customer base of over 29 million policyholders across 30 countries, Max Bupa is one of the leading health insurance providers in India. Not just health insurance, the company also specialises in life insurance, clinical research, and a vast network of hospitals.

The company is focussed on building a lifelong relationship with its customers and offers excellent health insurance products.

Popular Health Insurance Plans:

• Health Companion Individual
• Health Companion Family Floater
• Health Companion Family First
• Hospital Cash Plan
• Critical Illness Plan
• Personal Accident Policy
• Heartbeat Insurance Policy for Individuals

13. National Insurance Co Ltd

It’s a state-owned general insurance company that has been operational for more than a century. The country was started in 1906 in Kolkata and was nationalised in 1972. It’s the first company in India to introduce the concept of mobile offices aka offices on wheels. The company offers 24 x 7 live chat support for easy claim settlements and to deal with customer queries.

The company makes it easy for policyholders to renew their existing policies or purchase new policies using their online portal. With offices in all major cities across the country, claim settlements are quite easy with National Insurance.

Popular Health Insurance Plans:

• National Mediclaim Plus Policy (Individual Plan)
• National Mediclaim Policy (Individual Plan)
• Overseas Mediclaim Business and Holiday
• Overseas Mediclaim Employment and Studies
• Parivar Mediclaim Policy

14. Raheja QBE General Insurance Co Ltd

It is again a joint venture between QBE Holding Pvt. Ltd – a completely owned subsidiary of QBE Insurance Group, Australia and Rajan Raheja Group, India. The company offers well-designed health insurance plans to meet the needs of different consumers. The company has a strong product offering for both individual and corporate customers.

One of the most diversified business groups in India, Raheja Groups understand the specific requirements of Indian customers. The global expertise of QBE, along with the local knowledge provided by Raheja Group, help the insurance provider offer excellent health insurance products for Indian consumers.

Popular Health Insurance Plans:

• Health QuBE
• Cancer Insurance

15. Reliance General Insurance Co Ltd

One of the most popular private sector general insurance companies in India, Reliance General Insurance Company offers a wide range of insurance products like motor, travel, health, commercial, and much more. The company has over 139 branches across the country and 28,900+ intermediaries with a large number of clients including individuals, SMEs, and Corporates.

Reliance General Insurance Company offers a wide range of health insurance plans that meet the requirements of different individuals. Cashless treatment, no waiting period, no claim bonus benefits, amazing discounts on premiums are some of the reasons to choose health insurance plans from Reliance General.

Another huge reason why health insurance plans from Reliance General are a big hit is that the company allows policyholders to pay their premiums as EMIs.

Popular Health Insurance Plans:

• Reliance HealthGain Policy
• Personal Accident Insurance
• HealthWise Health Insurance
• Reliance Critical Illness Policy

16. Religare Health Insurance Co Ltd

Religare Health Insurance Company is a stand-alone health insurance provider that is backed by a team of strong businesses in India, including Religare Enterprises, Union Bank of India, and Corporation Bank. The company is promoted by Fortis Hospitals, one of the leading multi-specialty hospital chains in India and SRL Diagnostics, another leading healthcare provider in India.

Religare has a wide network of hospitals in India – 5420+. The company has over 72 branches located all across the country and offers a wide range of health insurance products to meet varying requirements like critical illness, personal accident cover, maternity, top-up health cover, international travel insurance and more. Customer-centric services and ease of claims have won Religare several international and national awards in the field of general insurance.

Popular Health Insurance Plans:

• Care
• Care Enhance
• Care Heart
• Care Senior
• Care Freedom
• Joy

17. Royal Sundaram Alliance Insurance Co Ltd

The Royal Sundaram Alliance Insurance Company is a joint venture between Sundaram Finance, one of the most trusted non-banking financial corporations (NBFC) in India and RSA – the second largest general insurance company in the UK. Royal Sundaram Alliance Insurance was the first health insurance provider in India to provide cashless treatment at network hospitals and other innovative products like hospital cash. Royal Sundaram is India’s first private general insurance company to be approved by the IRDAI and was incorporated in the year 2000.

The company has 2000+ employees across 143 branches and has over 5.20 million customers. The policies of Royal Sundaram Alliance are distributed via various channels – affinity partners, insurance agents, brokers, distribution partners, and online.

Popular Health Insurance Plans:

• Lifeline plan
• Family Plus plan

18. SBI General Insurance Co Ltd

SBI is one of the leading banks in India and has grown to become a household name. It’s the largest bank in India and has over 23000 branches across the country and 5500 RRBs (Regional Rural Banks). The SBI General Insurance Company is a joint venture between SBI and IAG (Insurance Australia Group), a leading insurer from Australia. The JV is split as 74:26, with SBI owns 74% of the total capital and IAG holding the remaining 26%.

The SBI General Insurance Company has a multi-channel distribution model – insurance agents, bancassurance, broking, direct, and retail channels.

Currently, SBI General Insurance Company offers insurance products for health, travel, personal accident, motor, home insurance, group health, construction and engineering, marine package, and more.

Wide coverage, family floater plans, a free medical check-up for every claim free four years, no medical tests required for applicants less than 45 years are some of the draws of SBI health insurance policies.

Popular Health Insurance Plans:

• Plan A (for policyholders living in Mumbai and Delhi)
• Plan B (for policyholders living in Chennai, Bangalore, Hyderabad, Ahmedabad, and Kolkata)
• Plan C (for the rest of India)

19. Shriram General Insurance Company

Shriram General Insurance Company was incorporated in 1974 as a JV between India’s Shriram Group and South Africa’s Sanlam Ltd. Shriram Group holds a 74% stake in the company, while the remaining 26% shares are under the control of Sanlam Ltd. The company has over 60,000 employees spread across 3000+ offices pan-India and manages assets worth more than 90,000 crores, making it one of the biggest and fastest growing multi-line general insurance companies in India.

One of the biggest distinguishing factors of Shriram General Insurance Company is its excellent and quick customer service. The company has zero pending customer complaints as of March 2019.

Popular Health Insurance Plans:

• Personal Accident Insurance
• Individual Travel Insurance Policy

20. Star Health and Allied Insurance Co Ltd

Star Health and Allied Insurance Co Ltd is the first stand-alone health insurance company in India, offering a wide range of health insurance policies. Apart from health plans, the company also specialises in personal accident plans and travel insurance.

Hassle-free claim settlement and a wide network of hospitals covering the length and breadth of the country make Star Health and Allied Insurance one of the popular health insurance companies in India. 9300+ hospitals, over 6 lakh claim settlements for the year 2018 to 2019 are some of the highlights of Star Health and Allied Insurance company.

Popular Health Insurance Plans:

• Star Comprehensive Insurance Policy
• Star Health Gain Insurance Policy
• Senior Citizens Red Carpet Health Insurance Policy
• Family Health Optima Insurance Plan

21. TATA AIG General Insurance Co Ltd

TATA AIG is another trusted general insurance company in India and is backed by two famous companies – the Tata Group of India and AIG (American International Group) from the USA. TATA AIG General Insurance Company was incorporated in 2001, and the company today offers a wide range of insurance products across sectors like – motor, travel, health, and lifestyle.

TATA AIG General Insurance Company’s AUM (Assets Under Management) was valued around 0.6 billion in June 2016. Currently, the company employs 2800+ employees at 152 branches pan India. The company has 347 licensed brokers and over 10,000+ licensed agents.

Popular Health Insurance Plans:

• Tata AIG Medicare
• Tata AIG Medicare Premier
• Tata AIG Medicare Protect
• MediPrime
• MediSenior
• MediPlus
• MediRaksha
• Wellsurance Executive
• Wellsurance Women
• Wellsurance Family

22. The New India Assurance Co Ltd

This is another popular public insurance company in India. The New India Assurance Co Ltd operates not just in India but in 28 countries across the world. The company was started in 1919 and today has nearly 2500 offices across the country. The biggest draw of The New India Assurance Company is that it offers a wide range of insurance policies at the most affordable premiums, thereby providing healthcare support to people across all economic levels.

Quick hassle-free claim settlements via third-party administrators, comprehensive coverage, and individual and family floater policies are some of the highlights of health insurance plans from the New India Assurance Co Ltd.

Popular Health Insurance Plans:

• Asha Kiran Cashless Policy
• New India Floater Mediclaim
• New India Mediclaim Policy
• New India Premier Mediclaim Policy
• New India Top Up Mediclaim

23. The Oriental Insurance Co Ltd

Founded in the year of our independence (1947), The Oriental Insurance Company has been offering a wide range of healthcare plans to suit the needs of different customers. It’s a central government run business and offers policies catering to the needs of both rural and urban consumers. The headquarters of The Oriental Insurance Company is in New Delhi, and the company has operations in other countries like Dubai, Kuwait and Nepal.

One of the biggest benefits of health insurance policies from Oriental Insurance Company is that the company requires no initial health screenings for applicants up to the age of 55 years. This helps people with pre-existing illnesses avail comprehensive health cover. Wide network of cashless treatment hospitals, affordable premiums are the other draws of health insurance plans from Oriental Insurance Company.

Popular Health Insurance Plans:

• Individual Mediclaim Plan
• Jan Arogya Plan
• Happy Family Floater Plan
• Overseas Mediclaim Plan
• Health of Privileged Elders Plan (HOPE)

24. United India Insurance Co Ltd

This is another nationalised insurance company in India and has over one crore policyholders. The company offers a wide range of insurance products covering all sectors from rural to urban. The company was started way back in 1938, and in 1972 it was nationalised by merging 12 Indian insurance companies, 5 Indian operators of foreign insurers, 4 Co-operative insurance societies and the general insurance wing of LIC. Today, the company employs a massive workforce of over 18,000+ personnel, and 1340 offices and micro-offices in tier-I, tier-II, and tier-III cities, towns and villages across the country.

The Medicare plans from United India Insurance Company offer comprehensive health coverage at affordable premiums.

Popular Health Insurance Plans:

• Family Medicare
• Gold Plan
• Individual Mediclaim
• Overseas Mediclaim
• Platinum Plan
• Senior Citizen Plan

25. Universal Sompo General Insurance Co Ltd

This is a private-public joint venture between three leading banks in India  IOB, Allahabad Bank, Karnataka Bank,  Dabur a leading FMCG (Fast Moving Consumer Goods) company and Sompo Japan Nipponkoa Insurance Inc, the largest insurance company in Japan for casualty and property insurance. Universal Sompo General Insurance Company offers a wide range of healthcare products and also has extensive insurance policies in motor and commercial insurance.

The company offers several robust health insurance policies that suit the needs of all income groups.

Popular Health Insurance Plans:

• Universal Sompo Individual health insurance plan
• Universal Sompo Group health insurance plan
• Pravasi Bhartiya Bima Yojana plan
• Surva Vidyarti Bima Yojana plan
• Swarna Gramin Bima Yojana plan
• Universal Sompo Hospital Cash Insurance plan
• Complete Healthcare Insurance plan
• Senior Citizen Healthcare Insurance plan

How to choose the best health insurance company?

As mentioned above, there are more than two dozens of health insurance providers in India. Finding the best health insurance provider who meets your specific requirements is a huge task. To simplify the selection process, here we list out the key features you have to consider while comparing and evaluating health insurance providers.

Claim Settlement Ratio

This is one of the biggest factors you have to consider. You invest in a health insurance plan, with the hope that the plan will provide you financial assistance at times of medical emergencies. Remember, that the insurance provider does not accept all claims.

You need to choose a health insurance company that has a high claim settlement ratio (CSR). The higher the CSR, the higher are the chances of your claims getting approved. Most insurance companies publish their CSR numbers on their site. Make sure to consider this factor while evaluating health insurance providers.

Solvency Ratio

This is another number that you have to consider. A higher solvency ratio denotes that the insurer has a higher proportion of asset holdings. This is good news for customers as the company has strong financials that it can dip into for resolving customer claims.

Claim Settlement Procedures

Apart from the numbers discussed above, this is another essential factor. During medical emergencies, there isn’t much time to spend with the insurer. Look for health insurance companies that offer quick and hassle-free claim settlement procedures.

The company must have a dedicated claim settlement team that can be reached easily via call, online chat, or mail. It’s better if the company has a smoother claim settlement formality as you don’t have to spend much time filing and getting your claims approved.

Claim Settlement Turnaround Time

Apart from the ease of claims submission, the insurance provider must settle claims quickly, especially in the case of medical emergencies. If the company takes a long time to approve your claims, you have to bear the financial burden – hospital bills, doctor charges, and other medical fees, which can run to lakhs of rupees out of your pocket. Look for health insurance providers who have low claim settlement time.

Number of Network Hospitals and Location

This is another huge deciding factor. Earlier, policyholders had to foot the medical bills out of their pocket and then submit reimbursement claims from the insurance provider. However, most health insurance providers offer cashless treatment facilities at hospitals. With cashless treatment, you can get treated at any network hospital (up to the sum insured) without paying any fee out of your pocket.

The hospital has tie-ups with the insurance provider, and they get the bills settled directly with the insurance provider. Today, almost all health insurance providers have tie-ups with several hospitals that are part of their Preferred Provider Network.

While choosing health insurance providers, look for network hospitals in your area that have tie-ups with your preferred insurance provider. Additionally, take a look at the overall number of network hospitals offered by the provider to get an idea of their extensive coverage.

The volume of Policies Sold

This refers to the number of health insurance policies sold by the insurance provider. Generally speaking, a company with a high number of policies sold is trusted by a large number of customers and has a significant market share. However, evaluating insurance companies based on this sole criterion is not a smart choice, as newer companies will have a lower market share compared to older health insurance providers.

Availability of Different Types of Plans

Look for health insurance providers who offer a large number of plans. For instance, if your family has a history of critical illnesses like cancer, then opting for a specific health insurance plan that offers coverage for critical illnesses is a smart choice. List out your specific needs and choose healthcare policies that meet your specific requirements.

Easy of Policy Purchase and Renewal

Long gone are the days, when customers had to seek the help of intermediaries – insurance brokers and insurance agents – to purchase and renew insurance policies. Today, purchasing or renewing an existing policy takes just a few minutes, and the entire process can be completed online.

Several health insurance providers have robust online portals where you can select and choose health insurance policies that meet your specific requirements. Online purchase and renewal is a huge boon as you can complete the formalities without leaving your home, and the entire process is handled digitally, with zero to minimal paperwork.

Use the above factors to help you pick the right health insurance company that meets your family’s healthcare needs.

How to choose the best health insurance policy for you and your family?

There are dozens of health insurance policies in India from several health insurance providers. Finding the right policy that meets your specific requirements is a huge challenge. Here, in this section, we offer you smart tips on how to make the right choice.

1. Understand your Needs

Before you start comparing different health insurance policies, you need to analyse and understand your specific requirements. Start by listing out the members in your family for whom health insurance is essential. This includes yourself, your spouse, dependent children, dependent seniors – parents, and in-laws.

Next, analyse your family’s medical history. Check if there are any hereditary diseases that your family members are likely to contract, their current health levels, their ages, and so on. This way, you get a clear idea of how much cover you require and your family’s specific needs.

2. Deciding the Coverage Amount

It’s highly recommended that you choose a health insurance plan that offers you maximum health coverage, more than you predict that you would require. With medical inflation, health care expenses are increasing significantly. So, you need to have adequate cover to protect you from the costs of inflation, a few years down the line.

For instance, right now, any regular surgery costs around 3 to 5 lakhs. You can expect this amount to rise 1.5x times or even triple, after a few years. The coverage amount should be calculated after factoring in inflation.

3. Choosing the Type of Plan – Individual or Family Floater

Again, this is a personal choice and depends on your specific requirements. Work out the actual costs of both these types using online insurance premium calculators. This way, you get a clear idea of the right type of plan to choose.

If you are a family person, then we highly recommend that you choose a family floater plan that offers health insurance coverage for your entire family. This way, you don’t have to go through the hassles of purchasing a separate policy for each family member. Also, the premiums for family floater plans are lower when compared to individual plans.

Another big benefit is that the sum assured for family floater plans are higher than the sum assured for individual plans. Any member of your family, who is included in the family floater plan can avail this sum assured during a medical emergency.

4. Calculating the Sum Insured

The required sum insured varies depending on several factors like your age, your health conditions, and more. For instance, when you are younger, the risk factor is lesser. On the other hand, as you grow older, you have a family who is dependent on you, and you are more prone to contracting several illnesses like diabetes, high blood pressure and more, so the risk factors are high. You have to consider all these factors to calculate the required sum insured.

5. Pre-existing Illness Coverage

Most health insurance policies do not offer coverage for pre-existing illnesses before the completion of the waiting period. Pre-existing illnesses refer to diseases that you have at the time of purchasing the policy.

Some plans offer coverage for pre-existing diseases, while others do not. Further still, other policies require you to wait for a period of 2 – 4 years, before you can avail coverage for pre-existing illnesses.

Look for health insurance policies like Mediclaim policies that have a minimum waiting period for pre-existing diseases.

6. Lifelong Renewal

Different health insurance policies have varying conditions until it offers coverage. Generally, your body is prone to contracting several illnesses as you grow older. Hence, look for health insurance policies that offer lifelong renewal option.

7. High Claim Settlement Ratio (CSR)

As mentioned above, the claim settlement ratio is the number of claims settled by the insurance company compared with the total number of claims received. Look for health insurance policies that have high claim settlement ratios. The higher the CSR, the higher are the chances of getting your claim accepted.

With that said, high CSR does not automatically mean your claim will be approved. You have to ensure that you have submitted all the relevant documents, adhered to the terms and conditions, to ensure that your claim is approved.

8. Analyse the Sub-Limits

Almost all health insurance plans offer sub-limits on each medical expense. For instance, a particular plan may provide only for non AC hospital accommodations on a sharing basis, and a private hospital room may not be covered.

At initial glance, it may appear that choosing a plan with maximum values for sub-limits as the right choice. However, remember that you may not require all the deals offered. So, make a shortlist of plans that suit your needs, compare them online, evaluate the sub-limits and choose the right one that offers the best deal for you at the most affordable prices.

9. Consider the Location and Reputation of Network Hospitals

Most health insurance plans today provide you with cashless treatment facilities at network hospitals. For instance, if you are taking a health plan from Apollo Munich, you can avail cashless treatment up to the sum assured at any Apollo Hospital in India.

While choosing a health insurance plan, it makes the most sense to choose one that has a wide network of partner hospitals, and consider the location and reputation of the partner hospitals before making a decision.

10. Consider the Inclusions and Exclusions

Very often, most policyholders fail to read the policy document carefully, ending up experiencing disappointments during claims. You can find a complete list of the policy inclusions and exclusions in the policy document or prospectus. Make sure to go through this list carefully before choosing a particular plan.

Most health insurance plans do not offer coverage for diseases like HIV/AIDS, drug abuse, alcohol abuse, dental treatment, cosmetic surgeries, joint replacement, STD, etc. Make sure to go through the inclusions and exclusions and choose a policy with less number of exclusions.

11. Compare Premium Costs

While choosing health insurance plans, you have to consider the premium as well. Several online health insurance comparison tools let you compare different policies based on the premium, features, benefits, the sum assured, etc.

Make sure to use an online calculator to weigh all the options available to you before deciding on the right plan. Failing to do a comprehensive comparison may cost you paying more for a sub-par policy.

12. Read Reviews

Finally, make sure to read reviews of your shortlisted health insurance policies before purchasing it. Reading reviews of other policyholders provides you an accurate insight into the benefits and services of a particular health plan.

Finally, make sure to read the policy document carefully and get all your doubts clarified with a licensed insurance agent, to get a clear idea of what you are signing up for.

Health Insurance Glossary – Terms to Know

Before you purchase health insurance for yourself and your family, you have to go through the policy document, to get a clear picture of the various terms and conditions. Here are the popular terms that you will come across in a health insurance policy document.

Add-on Cover

Also known as rider covers, these are extra insurance coverage that can be purchased separately. Add-on covers offer added coverage on top of the coverage offered the regular policy. Some of the popular add-on covers include critical illness cover, air ambulance cover, personal accident cover, restoration of the sum insured, etc.

Agent

It refers to the insurance professional, who acts as an intermediary between the insured and the insurance provider. However, remember that the insurance agent’s role is purely administrative. He/she is responsible for providing the right forms to the customer, help with the filling in of the application and other paperwork. Insurance agents earn a commission from the insurance company for every policy they sell.

The insurance agent is not liable for helping you choose the appropriate health insurance policy. Finding the right policy, ensuring that the policy fits your requirements, and understanding the terms and conditions of the policy is the responsibility of the insured.

Age Limit

Most health insurance policies have specific minimum and maximum age limits. If you do not meet the age limits, then the insurance provider will not issue the policy to you.

Alternative Medicine

Any other methods of treatment apart from allopathy are considered as alternative medicine. Some of the common alternative treatments include AYUSH – Ayurveda, Unani, Siddha, and Homeopathy. Generally, most insurance companies don’t provide health coverage for AYUSH treatments. However, of late, a few insurance providers have started including AYUSH treatments in their plans.

Amount Charged and Amount Allowed

The amount allowed refers to the amount up to which the insurance company will reimburse your medical claims. The amount charged denotes the actual bill provided by the healthcare provider (hospital). This may be more or less than the amount allowed. If you get treatment at a network hospital, the hospital usually considers the amount allowed before deciding the course of treatment.

APS (Attending Physician Statement)

This denotes the detailed medical statement issued by the doctor treating the patient. The APS contains the insured’s health conditions. Your insurance company may require you to provide the APS for reimbursements and while filing claims.

Balance Billing

If the amount charged exceeds the amount allowed, the amount allowed is billed to the insurance provider and the remaining to the policyholder. This process of splitting the bill is referred to as balance billing.

Bed Days / 1000

This refers to the number of inpatient hospitalizations covered by a specific health insurance plan for every 1000 people.

Benefit Package

This refers to the total range of benefits provided by a specific health insurance plan. Most policies list out the benefits offered by them in the policy document.

Cashless Treatment

With this feature, the insured can get treated at any network hospital of the insurance provider without spending any money. Generally, the insured gets treated and then submits the bills from the hospital to reimburse the treatment amount.

With cashless treatment, the insured does not have to pay any money out of his/her pocket. Instead, the hospital settles the bill directly with the insurance provider. Cashless treatment is a huge benefit for the insured and his /her families as you don’t have to frantically run around trying to raise money for treatment during an emergency. However, cashless treatment requires prior authorization from the insurance provider before commencing treatment.

Chronic Condition

It refers to a permanent or long-lasting condition. While some health insurance policies include cover for chronic conditions, others do not.

Claim Amount

This refers to the total bill and other medical expenses charged to the insured during his/her stay at the hospital. Based on your health insurance policy, the claim amount may or may not include pre and post hospitalization expenses, day care treatment expenses, domiciliary hospitalization expenses, and more.

Copayment

This refers to the part of the claim amount that the insured must pay out of his/her pocket. For example, health insurance policies for senior citizens require a copayment of 10%. This means, the policyholder must bear 10% of all claims, and the rest will be reimbursed or settled by the insurance provider.

Cumulative Bonus

This is the bonus offered to the policyholder for not making any claims during the policy tenure. The cumulative bonus increases with the number of claim-free years. The bonus reduces the premium for the subsequent year and can be accumulated to a maximum of 50%.

Deductible

This refers to the amount that a policyholder must pay out of his/her pocket for every claim filed. The deductible is used to prevent policyholders from filing minor claims frequently. For instance, if the deductible is Rs. 1 lakh, then the insurance provider will only reimburse or pay for expenses that exceed Rs. 1 lakh. Let’s say the overall expenses is Rs. 5 lakhs, the policyholder has to pay Rs. 1 lakh and the remaining Rs. 4 lakhs will be borne by the insurance company.

A deductible is of two types:

• Involuntary deductible – this is mandatory and is fixed.
• Voluntary deductible – this is optional and varies based on the policyholder’s preferences.

Dependent

The dependent refers to the policyholder’s family members who are financially independent. Generally, dependent refers to spouse and minor children. Certain health insurance plans also include the parents of the insured as dependents.

Domiciliary Hospitalisation

When a patient is too weak to get admitted to a hospital, he/she can take medical treatment from his/her home. The process of treating the insured from home refers to domiciliary hospitalisation. Some health insurance plans provide cover for domiciliary hospitalisation expenses.

Eligibility Criteria

This refers to the conditions that an applicant must meet before he/she can apply for a specific health insurance plan.

Employee Contribution

In group health insurance policies, employers pay a part premium for the health insurance policy of the employee. The part premium paid by the employee is known as an employee contribution.

Exclusions

Most health insurance policies do not offer coverage for certain illnesses and conditions. These are referred to as exclusions. For instance, injuries caused by drug abuse, alcohol abuse, and suicide attempts are not covered.

Experimental Procedures

These refer to medical procedures that have not yet been approved by authorised medical councils. Generally, most health insurance plans do not offer coverage for treatments using experimental procedures.

Grace Period

This refers to the extra period provided by the insurance provider to renew a health plan after the expiry period. The grace period can range from 15 days to 45 days or more, depending upon the insurance provider.

Group Health Insurance Plan

This refers to health insurance plans that apply to groups of people. For example, most employers take a group health insurance plan to offer health insurance cover to their employees. The various factors of group health insurance plan like policy term, the sum insured are determined by the employer.

Hospice Care

This is a special type of care provided to terminally ill patients. Apart from their healthcare needs, hospice care also takes care of their emotional needs. Generally, hospice care is provided to patients who have less than six months to live.

Indemnity

This refers to the compensation provided to the policyholder for any loss.

Inpatient Treatment

This refers to medical treatments where the patient is admitted in a hospital for more than 24 hours. Most health insurance policies cover all the expenses of inpatient treatments. Inpatient treatments require policyholders to be admitted in a hospital room for the duration of the treatment and after recovery.

IRDAI

Insurance Regulatory and Development Authority (IRDAI) is the governing body for all insurance providers in the country. All insurance companies must comply with the rules and regulations set by the IRDAI regarding insurance services and coverage.

Lapse

A health insurance policy is said to lapse when the policyholder does not pay premiums on time. Lapsed policies do not offer any coverage.

Lifetime Limit

This is the maximum claim that a policyholder can make during his/her lifetime. However, in India, almost all health insurance policies do not have any lifetime limit, and the policyholder can submit claims as long as the policy is in effect.

Maternity Coverage

As the term implies, this offers coverage for all pregnancy and childbirth-related expenses. Most health insurance companies offer maternity coverage as an add-on cover to existing health insurance policies. On the other hand, there are a few health insurance policies that have maternity coverage included in the regular cover.

Moral Hazard

When a policyholder provides misleading information to the insurance provider to gain undue advantage, it is referred to as a moral hazard.

Named Illness

This refers to all illnesses covered by the insurer. Coverage is provided only to named illnesses mentioned in the policy document.

Network Hospital

A network hospital is a hospital that is a part of the insurance provider’s cashless treatment feature. A policyholder can avail cashless treatment at any network hospital offered by the insurance company, anywhere in the country. Most insurance companies have tie-ups with a large number of hospitals in each city and town across the country. While choosing an insurance company, look for insurance providers who have a large list of network hospitals and hospitals that are located near you.

Outpatient Treatment

An outpatient treatment refers to hospital procedures that don’t require the patient to be admitted in the hospital. Some health insurance policies offer coverage for outpatient treatment, while others don’t.

Overseas Mediclaim Policy

This is a special health insurance policy that offers health coverage for the policyholder while he/she is travelling overseas. It’s also known as a travel insurance policy.

The majority of health insurance policies in India do not offer coverage for overseas medical expenses. Hence, it’s highly recommended that frequent travellers, vacationers, and foreign exchange students avail an overseas Mediclaim policy to stay protected on their travels outside the country.

Personal Accident Cover

This is a fixed benefit of a health insurance policy. It offers a lump sum payment when the policyholder is involved in an accident that leads to permanent disability or death. The sum assured under the personal accident cover is paid as a one-time payment to the policyholder or the beneficiary (in the death of the policyholder).

Portability

This is the feature that lets you transfer an existing healthcare policy from one insurance company to another. When a policy is portable, you can switch over to a new insurance company without losing out on the accumulated benefits under your previous health insurance plan. If you have built no claim bonus, it is retained. Most insurance companies allow for portability of health insurance policies at the time of renewal.

Pre-Existing Disease

This is a disease that the policyholder already has at the time of applying for health insurance policies. Most health insurance providers require policy applicants to disclose pre-existing health conditions while applying for the policy. The coverage for pre-existing diseases can be availed only after the completion of a specific waiting period.

Say, the waiting period for all pre-existing diseases in your health insurance plan is six months, and you have declared diabetes as pre-existing disease, you can get treated for it only after six months from the policy commencement date.

Premium Amount

This is the amount you pay every year to avail the benefits of the health insurance plan. The premium amount is determined by several factors like – policy chosen, age of the insured, number of family members included in the plan, coverage, add-on covers, etc.

Proposer

This is the official term for the policyholder. It denotes the person seeking health insurance cover from the insurance company. Furthermore, the proposer can also take health insurance cover for his/her family. For instance, if a father takes a health insurance policy for his minor child, the father is the proposer, and the minor child is the beneficiary of the policy.

Reimbursement Benefit

Generally, the policyholder pays for the medical expenses out of his/her pocket and files the claim to the insurance company. The insurance provider reimburses the expenses for hospitalisation and other medical expenses to the policyholder. The maximum amount reimbursed is up to the reimbursement benefit mentioned in the policy.

Renewal

Renewal is the process of paying the policy premium for coverage for the next term. When a policy is not renewed within the due date or grace period if available, the policy lapses and the coverage terminates.

Standalone Health Insurer

This refers to insurance companies who specialise in health insurance policies. Generally, standalone health insurers also issue travel and personal accident insurance policies. Standalone health insurance companies do not offer insurance policies for home, motor, commercial insurance, etc. like general insurance companies.

Rider Policy

This is another term for add-on insurance cover.

Sum Insured

This refers to the maximum amount the insurance company is liable to pay to the policyholder during a claim. All reimbursement and cashless treatments claims must be within the sum insured. If the claim exceeds the sum insured, the insurance company will pay the sum insured, and the rest will have to borne by the policyholder.

Second Opinion

This refers to the process of reaffirming a diagnosed illness with another medical practitioner. Most patients consider a second opinion, especially for the treatment of critical illnesses.

TPA (Third Party Administrator)

TPAs are authorised third-party agents of insurance companies who perform various administrative tasks on behalf of the insurance company. They are authorised for handling premium collection, claims processing, claims settlement, etc. TPAs charge a commission for the services they provide and have to obtain a license from the IRDAI.

Tertiary Care

This denotes specialised procedures for treating critical illnesses. Tertiary care refers to specialists and sophisticated medical facilities.

Top-up Policy

Let’s say that the sum insured offered by your primary healthcare policy is not sufficient for your needs. You can increase the sum insured with the help of a top-up policy. Top-up policies offer coverage beyond the sum insured by your primary insurance policy.

Let’s illustrate this with an example. Your primary health insurance policy offers a sum insured of 3 lakhs. You can top-up this with a top-up policy of 5 lakhs, which makes your total coverage 8 lakhs. The first 3 lakhs will be provided by your primary policy, and the remaining 5 lakhs will be offered by your top-up plan.

Underwriting

This refers to the process of assessing a proposer based on their levels of risk. Depending on the outcome of the underwriting, the insurance company will decide whether to provide you with health coverage or not.

Waiting Period

This is the period that the policyholder has to wait before availing claims for pre-existing conditions. Generally, the waiting period for pre-existing conditions is around 2 to 4 years, depending on the insurance provider.

Income Tax Relief

The premium you pay for health insurance for yourself and your dependent family members are eligible for tax relief under Section 80D of the ITA (Income Tax Act).

Waiver of Premium

Under certain conditions, the insurance company will exempt you from paying future premiums. For instance, if you have critical illness cover, you need not pay future premiums for continued coverage of the policy, when you have been diagnosed with any of the named illnesses mentioned in the policy document.

Health Insurance: FAQs

Planning to purchase a health insurance policy? Do you have plenty of questions running on your mind? Worry not! Here, in this section, we have compiled a list of frequently asked questions on health insurance. Browse through this section to find concise answers to all your queries.

1. I already have a health insurance plan. I wish to increase the sum assured. What should I do?

You can increase the sum assured at the time of renewal. Get in touch with your insurance provider stating the same. Alternatively, you can switch your medical insurance policy to a new insurance provider, to increase the sum assured at the time of renewal.

2. What happens if the primary proposer of the family floater plan dies?

If the primary proposer of the family floater plan dies due to a medical issue, then the hospital expenses claimable under the plan are settled by the insurance provider. If the deceased person is the eldest member of the family, then subsequent premiums are decided based on the age of the next senior member in the family.

3. If I cancel my health insurance policy, will I get back my premium?

Most health insurance policies offer a free look-in period of 15 days from the date of commencement. You can use this period to go through the policy terms and conditions in detail. When you cancel a policy within the 15-day mark, the insurance provider deducts the charges of stamp duty, medical check-ups if any, and the proportionate risk premium for the number of days and refunds the remaining premium to you.

However, remember that for this procedure to happen, you shouldn’t have made any claims during the interim period.

4. Can I apply for more than one health policy?

Yes. You can choose several health policies if needed. However, it’s recommended that you opt for one standard health insurance plan, and choose add-on covers or top-up plans to reduce your overall premium payments.

5. If I renew my health insurance policy with the same provider, am I eligible for premium discounts?

Most health insurance providers offer premium discounts to their customers who renew policies with them, to boost customer loyalty. Check with your insurance provider to find out if there are such features.

6. What happens if my policy lapses while I am hospitalised?

If you are hospitalised and your policy lapses during your stay at the hospital, make sure to inform your insurance provider regarding the expiry date. Most insurance companies continue to provide coverage, as per the terms and conditions, if your policy lapses, while you are hospitalised.

7. How is my health insurance premium determined?

Several factors affect your premium rates. Age is a crucial factor. The older you grow, the higher will be the cost of your health insurance policy. This is because as we grow older, we are more prone to illnesses.

Apart from age, your medical history is another major factor in determining your premium. For instance, if you have no previous medical history and pre-existing diseases, then your premiums are likely to be lower.

A number of claim free years, add-on covers, sum assured, and type of policy are some other factors that determine your premium rates.

8. Is my health insurance policy valid all over India?

Generally, most health insurance policies are valid all over the country. However, you need to make sure whether your policy comes with geographical limitations.

9. Whom should I intimate at the time of a medical emergency?

A medical crisis or emergency is an emotionally draining and stressful period. On top of that, you don’t want to spend hours on the phone trying to contact your health insurance provider. If you have a cashless treatment facility included in your policy, then all you have to do is contact the insurance department or administration team at the hospital. The team at the hospital connects with the insurance provider and takes care of the process.

If no such facilities are provided, then you will have to contact the customer care team of your insurance provider to help you out. So, it’s highly recommended that you choose an insurance company who is easy to contact during emergencies.

10. What are the documents I have to submit while filing claims?

Generally, most insurance companies require you to submit an identity proof of the policyholder, the health card issued by the insurance company at the time of policy commencement, the hospital bills, and proof of other medical expenses. Additionally, most insurance providers require you to submit a pre-authorisation form for cashless treatments.

While this is the general list of documents, the actual documents required may vary from one insurance provider to another.

11. What if I don’t remember by policy number, card number in an emergency?

In such cases, the TPA can access your policy details using the following:

Name, address, date of birth, insurance provider, underwriting office code

12. Can I avail health insurance claims for treatments that don’t require hospitalisation?

It depends on your policy type. Some policies include cover for daycare treatments (treatments less than 24 hours and not requiring hospitalisation), while other policies don’t offer coverage for daycare treatments.

Any treatment that requires the patient to be operated under local or general anaesthesia, without requiring an overnight stay at the hospital is known as daycare treatments. Some of the common day care procedures include – angiography, colonoscopy, chemotherapy, cataract surgeries, radioscopy, piles/fistula, sinusitis, dialysis, and more.

13. What is the maximum number of claims allowed in a policy year?

There are no restrictions on the number of claims you make in a policy year. However, the total amount of claims will not exceed the sum assured in a policy year.

14. My wife and children reside in my native town while I reside elsewhere. Can I cover all of us in a single family floater plan?

Yes. Health insurance policies are applicable all over India. So, the location of the members included in the policy doesn’t matter.

15. What is the health card?

This is similar to an identity card and is issued by the insurance provider while you apply for a health insurance policy. The card contains contact numbers that you have to call during an emergency. Additionally, the card contains information about the policyholder like name, policy number, etc.

16. I am a foreigner residing in India. Can I take a health insurance policy in India?

Yes. Few health insurance providers also offer coverage to non-Indian nationals.

17. What’s the difference between health insurance and Mediclaim?

Very often, most people confuse Mediclaim and health insurance and use the terms interchangeably. While they may seem similar, there are distinct differences between the two.

Mediclaim Policy – It’s a pure health insurance policy. You can consider it as the basic vanilla medical insurance policy. It offers financial coverage for hospitalisation and treatment for specific illnesses and accidents, up to a sum assured.

Health Insurance – This is a comprehensive term that is used to denote all types of health insurance plans. Apart from the coverage offered by Mediclaim, health insurance also offers extra features like critical illness cover, post, and pre-hospitalisation expenses, annual health check-ups, and more.

18. What is the difference between overseas health insurance and travel insurance?

Though both overseas health insurance and travel insurance are intended for individuals travelling abroad, the features and purpose of both the plans are different.

Overseas Health Insurance Policy – As the name implies, it offers medical coverage and assistance for policyholders while they travel beyond India.

Travel Insurance – It is designed primarily to offer you coverage against travel issues like:

• Delayed/cancelled flights
• Delayed/loss of luggage
• Loss of passport
• Emergency medical treatment while overseas

19. If I have some complaints regarding my health insurance provider, what do I do?

You can file your grievance at IRDAI. You have to register your complaint with the insurance provider initially and if you receive no or inadequate response, you can escalate the issue to IRDAI using the IGMS (Integrated Grievance Management System) portal. Alternatively, you can call the toll-free number 155255 to reach IRDAI grievance centre.