If you think you do not need health insurance plans, think again! There are a lot of valid reasons to why to buy health insurance plans for you and your family.
Let us share with you some of the most important ones :
- To Assure the Cost of Hospitalisation
Private medical care is usually beyond the means of most of the population and government hospitals do not promise excellent medical care. To meet the rising cost of good medical aid, it is very important to buy health insurance. - To Take Care of Medical Emergencies
In case of medical emergencies like an accident, sudden health disorder or some serious terminal disease, you might find yourself short of cash or funds. For those times, health insurance plans are necessary. - To Avail Tax Benefits
Premiums paid for medical insurance bring tax benefits under Section 80D of the Income Tax Act. The Finance Act, 2018 offers higher deductions for medical premiums paid for senior citizens.
If you want to stop getting worried about the health and well-being of your family, the best idea is to compare health insurance plans and buy the best-suited one.
A health insurance plan is an important part of your financial planning for a safe, secure and healthy life for you and your family.
Health Plans come with a lot of benefits that cover all your medical needs as well as emergencies:
- Cashless Hospitalisation : Medical insurance comes with cashless hospitalisation in network hospitals of your insurance provider.
- Pre-hospitalisation Expenses : Expenses incurred before a patient is moved to a hospital for inpatient treatment are covered in health insurance plans. These expenses can be medical tests, medicines, vaccinations, and doctor’s fee. Subject to conditions.
- Post Hospitalisation Expenses : Medical expenses incurred by the insured to recover from illness, injury or medical condition are covered by the health insurance policy. These expenses could be medicines, vaccinations, OPD charges etc. Subject to conditions.
- Expenses for Critical Illness : Critical illness cover is given if you are diagnosed with life-threatening diseases like cancer, tumour or kidney failure etc. In such cases the insurance company pays a lump-sum amount at the time of diagnosis, to start the treatment at the earliest.
- Hospital Cash During Hospitalisation : Hospital cash of INR 1000 to 5000 per day is given as a part of the health insurance plan (subject to the type of policy or the rider). This cash amount also depends on the medical facility (normal room or ICU) taken by the insurer. Extra premium is charged for hospitalisation cash benefit.
- Insurance Against Accidental Injuries : Personal accident cover provides compensation against the losses incurred in an accident, such as accidental death, permanent total disability (loss of both the limbs, eyes, speech and hearing), permanent partial disability (loss of one limb, one eye and one ear) and temporary total disability (fractures in limbs and temporary loss of eyesight).
Apart from the above, the other expenses that can be covered under your health plan, based on the type of plan and additional riders, are :- Maternity Benefits
- Prescription Drugs Benefits
- Dental Treatment Benefits
- OPD Benefits
- Annual Health Check-ups
- Day Care Benefits
- Senior Citizen Health Benefits
Compare the health insurance plans at Cover 360 and buy the best-suited one, today! Safeguard your health!
There are different types of health insurance plans that come for individual health requirements and lifestyle needs.
You can select from:
- Individual Health Insurance Policy
This insurance policy helps you to cover your personal health-related expenses and to cover medical bills during hospitalisation. The plan can be customised based on your age and lifestyle habits. - Family Floater Policies
These policies are for complete family's medical needs including spouse and children and in some cases it includes parents too. These are comparatively cheaper than individual plans but come with their own set of restrictions. - Critical Illnesses Plan
This plan is to provide health benefits for critical illnesses like cancer, paralysis, heart attack, and other terminal diseases. Under these plans, the insured is paid the entire sum assured at the time of diagnosis itself rather than waiting for the treatment to get over. - Maternity Policies
These are the health insurance plans that take care of maternity-related expenses including hospitalisation, delivery charges and in some cases cover even the newborn baby for a certain period. - Senior Citizen Plan
These medical policies are designed especially for Senior citizens keeping in view the extensive medical care they need. These are often on a high premium than usual medical plans. - Fixed Benefit Medical Insurance Plans
These are the insurance plans only for a particular condition and the compensation is paid accordingly. The entire health is not insured under these plans. The example of these medical insurance plans are :- Critical Illness Insurance Plans
- Personal Accident Insurance Plans
- Hospital Cash Insurance Plans
- Surgical Benefit Insurance Plans
- Plans for Specific Illnesses - Cancer, Dengue
- Cardiac Care Plan
These are cardiac special health insurance plans since the cost of heart treatments has risen drastically in the last few years. These plans cover all heart-related ailments and surgeries. - Diabetics Plan
These plans, after a waiting period, cover the insured for diabetes and its related complications. There are only a few insurance companies in the market providing such medical plan. - Dengue Care Plan
These insurance plans provide cover against expensive treatment for Dengue as it keeps coming back as an epidemic every year. - Personal Accident Plan
The personal accident plan helps to cope up with the expenses incurred due to injuries in an accident. It could be a disability, partial disability and long periods of recovery and rehabilitation. Hospitalisation expenses and routine household expenses are covered in this plan. - Top-up Plans
This plan offers financial coverage for hospitalisation expenses after the basic sum assured is used in a given policy year subject to a capped limit. Top-up can be used only once in a year - Super Top-up Plans
These plans provide financial coverage for hospitalisation after the basic sum assured is used. The benefit of this plan is that you can use it multiple times in a year until the extended cover limit is not used completely. - Cancer Care Plans
Even though cancer is part of critical illnesses plan, a health policy dedicated to cancer is more beneficial if the insured has a genetic history. This gives access to a substantial amount of funds for managing and treating the disease. - Extended Family Plans
Certain insurance companies also provide health insurance coverage to siblings and extended family including the family of spouse etc. This gives comprehensive health coverage to the entire family. - Worldwide Emergency Cover Plan
For those travelling frequently all over the world for business or leisure purposes can avail such plans to take care of the medical expenses in a foreign country. - OPD Cover Plans
These plans provide health coverage for expenses incurred on getting counselling, tests and medications from an Out Patient Department (OPD). - Without Pre-policy Medical Check-up Plan
Many insurance companies offer health plans in which you do not have to undergo any medical tests. You can buy them online by providing only basic health information about yourself. - AYUSH Cover Plans
AYUSH stands for Ayurveda, Siddha, Unani and Homeopathy. These alternative modes of treatment are also covered by certain health plans offered by the major insurance companies.
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While a health insurance plan is a shield for all your healthcare needs, it also comes with its own restrictions. Some covers are included and there are some which are excluded by the insurance companies providing health insurance in India.
Let us take a look at the inclusions and exclusions of health care insurance:
Inclusions
A basic health insurance policy usually covers the following :
- In-patient Hospitalisation Cover : If you as the insured have to hospitalised for 24 hours or more, the expenses will be covered by your health plan. The insurance will pay for the room rent, ICU rent, OT charges, nurse fee, doctor’s fee, surgeon’s fee, anaesthetist’s fee, cost of medicine, blood bank, and oxygen.
- Pre and Post Hospitalisation Expenses : Your medical policy covers the expenses made before the hospitalisation and after the hospitalisation such as medicines, OPD visits, and vaccinations etc.
- Ambulance Costs : If the insured needs an ambulance to reach the medical facility, the cost is covered in the health plan, but there is a capped limit to it.
- Day Care Treatments : The treatments that need no overnight hospitalisation but the insured has to stay in for a few hours, the cost is covered in the medical insurance policy.
- Organ Transplant Expenses : If the insured is undergoing transplant surgery, the expenses for harvesting the organ from the donor and the surgical procedure are covered under the medical policy.
- AYUSH Treatment Costs : Cost for alternative non-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy is covered under many (not all) health plans. This is optional with many health insurance providers.
- Domiciliary Treatment Expenses : If there is no room available in any of the network hospitals of the insurance company, or the patient is not in the condition to be transferred to hospital, the patient is entitled to take treatment at home and the cost is covered by the health insurance company.
- Free Health Check-ups : The insured person can avail complete free health check-up once in 1-4 claim-free policy years.
- Restore Benefit : With the restored benefit included in the policy, the insured can request back the sum used in a given year, whether used partially or completely. The point to note is that restore benefit can be used only once in a year for a particular illness.
- Other Inclusions : Some of the popular health plans offered by reputed insurance companies in India also cover the following :
- Maternity Cover (Childbirth Expenses) After a waiting period of 1-2 Years.
- OPD Coverage (medical costs incurred on an outpatient basis)
*Please note that these covers usually come with the additional riders that come at an extra premium.
Exclusions
- Pre-existing Illness : If the insured is suffering from some disorder or disease at the time of buying the policy, it is not covered immediately. However, there is a clause of a waiting period, which can be from 1 to 4 years depending on the plan.
- Immediate Illness : Medical illnesses that occur within the first 30 days of buying the policy are not covered in the health insurance policy.
- Specific Treatment : Some treatments like joint replacement, hernia, piles, etc. are not covered in the first 2-4 years of buying the health insurance plan.
- Self-inflicted Injuries : If the patient is hospitalised due to injuries given to self, then the cover is not provided.
- Medical Condition Due to Alcohol or Drug Abuse : There is no cover provided in any health insurance policy for the health conditions or injuries that happen due to the intake of excessive drugs or alcohol.
- Cosmetic Treatments : Surgeries which are specifically for beautification such as facelifts, BOTOX, breast-lift, etc. are not covered in any health insurance policy.
- Dental Treatments : Any treatment related to dental problems is not included in the health plans provided by any insurance provider.
- HIV Aids and Experimental Treatments : There is no cover provided for the illness that occurs due to HIV or any experimental surgery or treatment people may undergo.
- Natural Calamities or Riots : Injuries or illnesses that occur due to war, riots or natural disasters such as tsunami etc., are not covered in the medical insurance.
Various factors can make your premium on health insurance go high or low. Before you buy the best health insurance, you must know and understand those factors.
The factors that affect your premium towards health insurance are :
- Age
Younger the age, lower the premiums as young people are less likely to have diseases and they visit hospitals less, comparatively. - Gender
Often women are charged higher premiums on medical policies as they are more likely to have medical conditions, visit doctors, take prescriptions, and be subjected to chronic or gynae related diseases. - Choice of Profession
If you are in an adventurous or hazardous profession like bungee jumping instructor or construction worker, or you are working in environments with hazardous substances, radiation, and chemicals, you will have to buy the policy at a higher premium. It is simply because you are more prone to injuries or diseases and your chances of availing medical help are higher. - Pre-existing Medical Conditions
There must be no serious or terminal pre-existing medical condition at the time of buying the policy. If there is, you will have to pay a higher premium on your policy. The decision to sell the policy to the person with pre-existing medical condition remains with the insurance company. - Marital Status
Health insurance premium for married people is generally lower as they are believed to have lesser health conditions. - You Do Not Have Insurance
If you do not have any medical policy earlier, the insurance company will charge a higher premium. It is believed that as soon as the policy is bought, the insurer starts making frequent trips to doctors and hospitals to reap the benefits. - Family Medical History
If there is any history of a serious or regular/genetic medical condition in the family, for instance, cancer, diabetes, heart-related issues or neuro-disorders; you will have to pay a higher premium. - Body Mass Index (BMI)
People with high BMI pay a higher premium than people with normal BMI. The reason again being that obesity or overweight problem can lead to various ailments such as heart problems, joint problems, and diabetes etc. - Substance Abuse
Alcoholics, smokers or drug abusers will definitely have to pay a higher premium. Some insurance companies even refuse to give medical insurance policy to people in substance abuse.
Now that you have understood the importance of having a health insurance policy, the next step is to know how to buy the best health insurance plan.
Here, we list out important things you must consider if you wish to buy the most effective health insurance plan for yourself or even if you are buying health plans for the family:
- Understand Your Medical Care Needs : You must know the medical attention that you or your family may need in the future. Based on that, you can avail family floater health insurance plan or a basic medical policy for your individual needs.
- Look Out for Larger Expenses : You must check the bigger expenses that are covered in the policy like room rent, doctor’s visiting charges, ICU charges, and surgery cover etc. Smaller services like ambulance service or daily cash expense can be overlooked if you wish to buy a better and effective medical policy.
- Decide the Appropriate Sum Assured : Just to save the premium, do not go for an inadequate medical policy. You must take a sufficient policy to help you bear the expenses in times of medical emergencies.
- Research and Find out the Best Insurer : It is important to put in a little research to find out which insurance provider has a higher claim settlement ratio and better customer services. It is always advisable to buy medical insurance from the company with good market standing.
- Compare and Choose : Before finalising a policy, you must compare health insurance plans offered by different insurance companies, benefits, riders and premium values. This way you can make the best choice as per your individual needs.
- Network Hospitals of the Insurance Company : While buying a health insurance plan it is important to check all the hospitals associated with the insurance company. You must buy from the one who has reputed and well equipped medical facilities on their list.
- Read Terms and Conditions Carefully : Do not finalise medical insurance blindly. Read the terms and conditions carefully and thoroughly to understand the text and subtext of the policies. Claims are settled strictly based on the terms, especially in the finer print
Many non-reputed and reputed insurance companies in India offer health insurance policies based on the individual needs of the people. Not every health plan is the same in terms of benefits and payouts. Therefore, it is very important to compare health insurance plans to get the best as per your specific needs and medical conditions.
When you are comparing health plans on Cover360, you must keep the following in mind to get the best benefits from the medical policy :
- Check the Coverage Amount/Sum Insured (SI)
Sum insured can be different as per the coverage offered in every plan. The factors that affect sum insured are age, health conditions, marital status, lifestyle etc. You can choose the best based on your financial conditions and risk-taking abilities. - Find the Capping Limit
When you make a good comparison based on capping limit offered by different insurance providers, you can choose the one with the highest. Capping limit is the restriction put on the amount that you can use for a particular service such as room rent, doctor visits, OPD charges etc. Certain plans have no capping at all. To find out the best amongst many, compare all health plans! - Get the Best Co-Pay
The insured can choose to pay a certain percentage of the medical expenses from his pocket while the health insurance company pays the rest. This type of arrangement is offered in certain health insurance plans. It is good to compare and choose the most suitable co-pay benefits. - Check the Exclusions
If you do not compare health insurance plans, you will not know the exclusions (costs not covered) mentioned. You must go for a plan, which offers minimum exclusions. - Find Out the Pre-existing Illness Cover
Insurance companies stipulate a waiting period for pre-existing illnesses, which means they start to pay for the treatment of existing diseases only after a certain time, which can be anything from 1 year to 4 years. Comparing the health plans is beneficial to find out the most suitable waiting period. - Check Network Hospitals
Insurance providers have a list of network hospitals associated with them where the insured can opt for a treatment. It is good to check this list before opting for a medical policy with the company to ensure there is a good number of fully equipped medical facilities and to avail a cashless hospitalisation with easy paperwork. - Compare the Sub-limits
Insurance companies put a limit on the expenses covered for certain expensive treatments. For example, a kidney transplant that costs a few lakh rupees may not be entirely covered in your policy. Only a certain amount will be paid by the insurance provider. It is always better to compare and find one with no sub-limits or most suitable ones.
Comparing health insurance plans brings a lot of benefits. You must invest a little time and make thorough comparisons here in Cover360.
It is most important to understand how to claim health insurance even before you buy the policy.
There are different claim processes based on the type of claim you are making with your health insurance provider.
- Claiming Cashless Hospitalisation
Here you can get the medical treatment without paying anything upfront. You just need to get approval from the third-party administrators (TPA) of your insurance company, who are usually present at the hospitals or can come on call. Once you are discharged from the hospital, you have to submit all the necessary documents with the insurer or TPA to get the claim. - Claiming Reimbursement
In such a case, you pay the bills on your own and insurance company reimburses later through a documented insurance claim. Here, you may need to make a single claim from a single insurer or multiple claims with multiple insurers, depending on how many insurance providers are covering you for various health-related needs. - Claim Process for Cashless Hospitalisation :
- Inform your insurance provider about the need for hospitalisation.
- Get admitted to a network hospital and present your health insurance id card to the third-party administrator (TPA) present in the hospital to access your insurance details.
- TPA will get in touch with hospital authorities to fill up a pre-authorisation form with the all treatment details, medical scans, other required documents, etc. and send it to the insurer for approvals.
- The insurer will check the documents, once satisfied with documents and eligibility for the cashless claim; they will send a go-ahead to the network hospital to give the treatment.
- At patient discharge, the medical facility will send all the bills along with complete health and medical records and any other documents, if needed, to the insurer for final claim settlement.
- The insurer will not pay the deductibles, co-payments and other exclusions mentioned in the policy, and make the rest of the payments to the hospital.
- Claim Process for Reimbursement from Single Insurer :
- At the time of hospitalisation, send the information to your insurer.
- Once over with the treatment, fill the claim form available at insurer's website.
- Attach all relevant and required documents such as medical reports, hospital bills, discharge summary and any other supporting documents in original, with the claim form and submit to the insurer.
- The insurer may enquire about all the medical documents or past and present. Keep them ready.
- Follow up and coordinate with TPA to make sure all the documentation is complete and the claim is processed.
- If everything remains in order, insurer approves your health insurance claim within 30-40 days.
Remember, if your documentation is in order and you have taken care of all the requirements, no insurance company can deny or reject your health insurance claims.
What is Health Insurance Portability?
You may need to shift your health insurance from your existing insurance provider to another. For such cases, Insurance Regulatory and Development Authority of India (IRDAI) launched the concept of Health Insurance Portability in 2011. Through this facility, you can easily port (shift) your medical insurance without losing any existing credit points, waiting period and benefits like no-claims bonus and free medical check-ups. With portability, you may also enjoy some added benefits.
Why do you need health insurance portability?
There could be various reasons that you need to shift your medical from one insurance provider to another. The primary ones are :
- The services and features provide by your current insurer are not sufficient.
- The list of network hospitals with your health insurance provider is not meeting your needs.
- The sum assured is not sufficient to meet your current medical expenses.
You as an insured hold every right to have your medical insurance shifted to another insurer if you have been maintain all the documents and following all the terms and conditions stipulated by your current insurer.
Process of Applying for Medical Insurance Portability
You can only apply for portability when your existing policy is due for renewal. You can submit a written application to new insurance provider. This must be done at least 45 days before expiry of existing medical plan.
- On receiving your application, the insurance company will send you a proposal form, a portability form, and a detailed document with all the features and benefits of health insurance provided by them.
- You have to fill in all the forms after reading carefully the offerings and terms & conditions.
- Once the insurance companies receives all the filled forms form you, they will obtain your medical records and claim history from your current insurer.
- The existing or current insurer is bound to furnish all the details within 7 working days through a common data-sharing portal developed by IRDA.
- Once the details are received, the new insurance company will have to release the medical insurance for you within 15 days.
What are the benefits of Medical Insurance Portability?
- Competitive or lower premiums for the same sum assured
- Better services on offer than the previous insurance provider
- Smoother claim settlement process
- Tie up with an insurer with good claim settlement ratios
- Option to buy an upgraded health plan, which was not available when you bought the policy
- Existing health insurance benefits like bonuses, waiting periods for pre-existing diseases etc. are carried forward to the new plan with new insurer.
- The stipulated waiting period of 30 days from the commencement of policy to enjoy the benefits of health plans gets waived off in a ported policy
Insurance Company’s Rights in the Matter of Health Insurance Portability
If you fail to apply for portability 45 days before the renewal date of your existing policy, the insurance company holds the right to make a decision whether to accept your portability request or not. Every application for portability is considered new by the insurance company and goes under a tight scrutiny before being finalized. The insurance provider will examine the risk involved in changing the premium amount and offering other benefits. If there are any risks posed during this examination, the company can reject your portability application. You may continue with existing policy in that case. Also, portability is easy in early age. As you grow older, insurance providers hesitate to approve portability as the health hazards are greater.
Please note that terms and conditions of every insurance company offering health insurance in India are different. It is important to read carefully before applying for health insurance portability.
Here is a list of some reputed health insurers in India. The list is no particular order.
- Bajaj Allianz Health Insurance
- Max Bupa Health Insurance
- SBI Health Insurance
- ManipalCigna Health Insurance
- Religare Health Insurance
- Edelweiss Health Insurance
- Aditya Birla Health Insurance
- Kotak Mahindra Health Insurance
- Bharti AXA Health Insurance
- IFFCO Tokio Health Insurance
- Tata AIG Health Insurance
- Future Generali Health Insurance
- Apollo Munich Health Insurance
- Raheja QBE Health Insurance
- Universal Sompo Health Insurance
- Star Health Insurance
- HDFC Ergo Health Insurance
- Cholamandalam Health Insurance
- United India Health Insurance
- Royal Sundaram Health Insurance
- Reliance Health Insurance
- New India Health Insurance
- National Health Insurance
- Oriental Health Insurance
- Liberty Health Insurance
- Digit Health Insurance
There are so many options to choose from when it comes to buying the best health insurance plan in India. The factors to be considered while making the comparisons are offered insurance coverage, features, rider benefits and premium payout. Ideally, the best health insurance policy that you can buy should be offering maximum benefits in a reasonable and affordable premium. Hence, the cheapest health plans are not always the best ones; please remember that. Make comparisons, read about the benefits offered, go through the terms and conditions and make sure you reach the right plan for yours and your family’s health needs.
Here are some of the top trending health insurance plans in India :
| Plan Name | Entry Age | Sum Assured | Policy Renewability | Features |
|---|---|---|---|---|
| Star Family Health Optima | Minimum- 16 Day Maximum- | Rs. 2 Lakh, Rs. 3 Lakh, Rs. 4 Lakh, Rs. 5 Lakh, Rs. 10 Lakh, and Rs. 15 Lakh | Lifetime |
|
| Max Bupa Health Companion Individual | Minimum - 90 days Maximum - Age no bar |
For Variant 1 - Rs. 1 Lakh, Rs. 2 Lakh, Rs. 3 Lakh, Rs. 4 Lakh, Rs. 5 Lakh and Rs. 10 Lakhs For Variant 2 - Rs. 5 Lakh Rs. 7.5 Lakh, Rs. 10 Lakh and Rs. 12.5 Lakh. For Variant 3 - 15 Lakh, Rs. 20 Lakh, Rs. 30 Lakh, Rs. 50 Lakh and Rs. 1 Crore |
Lifetime |
|
| Manipal Cigna Prohealth Plus | Minimum- 91 days Maximum- No limit as such | Rs. 4.5 Lakh, Rs. 5.5 Lakh, Rs. 7.5 Lakh and Rs. 10 Lakh. | Lifetime |
|
| HDFC ERGO Health Suraksha Gold Regain | Minimum- No limit as such Maximum- | Rs. 3 Lakh, Rs. 4 Lakh, Rs. 5 Lakh, Rs. 7.5 Lakh and 10 Lakh | Lifelong |
|
| Star Senior Citizen Red Carpet | Minimum-60 Maximum-75 | Rs. 7.5 Lakh and 10 Lakh | Lifetime |
|
| Apollo Munich Optima Restore | Minimum-91st day Maximum-65 years | Rs. 3 Lakh – Rs. 50 Lakh | Lifelong |
|
| Source : IRDAI | ||||
Cover 360 is here with absolute commitment to your health insurance needs. We guide you, assist you and take you through the journey right from selecting the best health insurance plan up to the final stage of filing your claims. We strive to make the buying and documentation processes easier for you.
At this equipped and comprehensive insurance platform, you can make all possible comparisons related to features, premiums, the best sum insured and claim settlement ratios for all the best health insurance plans in India.
Here is how we help you buy the best-suited medical policy:
- We make the comparing health insurance and buying processes easy for you
- Our website is easy to navigate and gives you access to information in a few clicks.
- We provide complete assistance while filing the documentation for buying health insurance plans.
- We help you with your health insurance claim process.
- We make sure all the paperwork related to buying, porting or claiming health insurance with any insurance company is easy for you.
- We offer the facility to pick documents from your doorstep.
- We have a policy tracker that keeps the track of activities on your health insurance policy and keeps giving you alerts on renewals and other actions to be taken.
- The advanced features and filters on the website help you make the right choice.
Buying, executing and comparing the best of health insurance was never that easy. With Cover 360 you do not have to worry about anything. We give you poora support! We are here to hold your hand at every step.
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