What is Health Insurance?
Health insurance is an insurance policy that protects the policyholder and his/her family against the medical costs that arise due to an accident, illness or on the diagnosis of any serious disease. Today, several companies offer health insurance plans to their customers that provide various benefits such as cashless treatment at network hospitals, tax benefits, etc.
Why is Health Insurance Important?
Today, quality healthcare treatment is expensive. A decent hospital has the potential to finish up your savings in a few days. Instead of worrying about the hospital bills, you need to concentrate your entire energy on the recovery. A health insurance policy can help you with that. You can approach any of the network hospitals which has a tie-up with your insurance provider and recover peacefully.
Top Health Insurance Plans in India
Table Data updated on 28-09-2020
Apart from the above-stated plans, we have prepared a detailed list of the top 10 health insurance plans in India 2020.
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Benefits of Health Insurance Policy
Cashless Treatment
It allows the insured to get the required treatment in network hospitals without paying a single penny during hospitalization (up to the sum insured limit). The insurance company pays on your behalf and allows you to focus on your treatment.
Pre & Post Hospitalization Expenses
The expenses prior to hospitalization and after discharge from the hospital (up to a specific period) are covered by health insurance policy only if the expenses are associated with the illness subject to terms and conditions of the insurance policy.
Tax Benefits
On buying a health insurance policy, you will be liable to receive tax advantages for the premiums paid under Section 80D of the Income Tax Act, 1961.
Daily Hospital Cash
This benefit is very useful during hospitalization as this will provide daily cash to a certain limit to take care of the additional expenses in the hospital like food, traveling, etc. Usually, the benefit amount is up to Rs. 2,000 per day but it may vary in case of accidents and ICU procedures.
Organ Transplant Expenses
The cost for the transplantation of an organ is bearable by the insurance company. Health insurance covers the surgery expenses related to organ donation.
No Claim Bonus (NCB)
It is a discount that you will receive from the insurer for every claimless year. NCB comes as a discount on the payable premium at the time of the renewing policy or whenever you want to increase the Sum Insured amount. At the time of renewal, you must check for No Claim Bonus benefit.
Free Health Check-Ups
To motivate the policyholders towards a healthy lifestyle, insurance companies offer free occasional medical check-ups. Depending on the company and the type of policy, you will be eligible for a master health check-up.
Lifelong Renewability
This keeps you insured for the long term. Most of us try to follow a healthy lifestyle but illness or accidents could take us by shock. Therefore, having a health insurance policy acts as a blessing in hard times.
Restoration Benefit
Once the sum insured amount is completely used, the insurance company will restore the amount automatically and you don't have to pay any additional cost for the benefit. The plans with restoration benefits are expensive as compared to normal health/medical insurance policies and are applicable as per the clauses of the policy.
Types of Health Insurance Plans
To deal with the different needs of customers, there are multiple forms of health insurance plans available. Such plans are mentioned below:-
1. Critical Illness Plan
Critical Illness plan offers a fixed benefit/payout in case of any critical illnesses specified under the policy. With the lump sum benefit, you will be able to pay the huge hospitalization costs and get the treatment on time. Learn More
2. Senior Citizen Health Plan
Senior Citizen Health Plan is designed especially for the old age people who are above 60 years of age. This plan covers medical contingencies (may vary as per the policy) during old age. Learn More
3. Maternity Health Insurance
Maternity health insurance is offered by almost every health insurance company that covers pre and post-natal care, child deliveries, and sometimes vaccination expenses of newborn babies.
4. Individual Health Insurance
Individual health insurance covers the health expenditure of a single person or an individual and there's always flexibility of availing the bigger sum insured. The premium that we pay annually depends on the amount of sum insured.
5. Family Floater Health Insurance
Family Floater Health Insurance allows to insure all family members under a single policy. All the family members can enjoy the benefit of the entire sum insured. The amount of the premium paid is less as compared to individual plans. The policyholder along with the spouse, dependent children and the parents can be included in the plan. Learn More
6. Corona Health Insurance Plan
Coronavirus Health Insurance Plan offers the required financial coverage for the treatment of COVID-19. Once the waiting period is over, the plan will cover the coronavirus specific expenses and allow you to recover in peace. COVID-19 is a new disease, hence it does not cover under the category of pre-existing disease.Learn More
7. Unit Linked Health Plan (ULHP)
Unit Linked Health Plan (ULHP) is a combination of health insurance and investment. Along with the health protection, ULHPs will help you in building a corpus that can be used by the investor to meet expenditures that do not get covered under medical insurance plans.
Does Health Insurance Cover COVID-19?
Yes, standard health insurance offers coverage against COVID-19. The insurance will pay off in-patient and outpatient expenses incurred during the treatment of COVID-19. Just a few month's back, IRDAI launched COVID-19 specific plans like Corona Rakshak and Corona Kavach for the Indian consumers. Though existing health insurance covers COVID-19, you can still invest in a COVID-19 specific plan for added benefits. Let's find out more about these plans.
1. Corona Rakshak
Corona Rakshak Policy is an affordable health insurance policy that offers lump sum benefit to the policyholder if diagnosed with COVID-19. The plan offers 100% sum insured if the diagnosis confirms the presence of COVID-19 & requires hospitalization for 72 hours.
Eligibility
| Product type | Individual |
| Waiting period | 15 days |
| Sum assured | 50k, 1 Lac, 1.5 Lacs, 2 Lacs, 2.5 Lacs |
| Policy tenure | 105 Days, 195 days and 285 days |
| Entry age | 18 years to 65 years |
2. Corona Kavach
Corona Kavach is an affordable health insurance plan, which is designed to safeguard you and your loved ones from COVID-19. This policy aims at covering hospitalization, pre-post hospitalization, home care treatment expenses, and AYUSH treatment in case the policyholder is tested positive of COVID-19.
Eligibility
| Product type | Individual/family |
| Waiting period | 15 days |
| Home care treatment | Up to the sum insured |
| Sum assured | 50k- 5 Lacs |
| Policy tenure | 105 Days, 195 days and 285 days |
| Entry age | 18 years to 65 years |
Arogya Sanjeevani Plan: Standard Health Insurance Plan
The Insurance Regulatory and Development Authority of India (IRDAI) launched the Arogya Sanjeevani Health Insurance Policy on April 1, 2020. The main objective of this plan is to make health insurance more accessible, affordable, and less confusing for policy buyers.
The Insurance Regulatory and Development Authority of India (IRDAI) has now allowed all general and standalone health insurers to offer the Arogya Sanjeevani Policy as a group insurance product.
Key Features/Benefits
- Pre & Post Hospitalization Cover: The plan provides coverage against pre and post hospitalization expenses associated with any medical treatment caused by an illness/injury.
- No Health Checkup: To invest in this plan, there is no need for any medical screening up to the age of 45 years.
- COVID-19 Cover: It also offers coverage against coronavirus treatment.
- Ayush Benefit: It offers coverage against hospitalization expenses incurred on getting alternate treatment such as Ayurveda, Homeopathy, Siddha, etc.
- Free Look Period: Free look period of 15 days is only applicable at the inception of the policy and not on renewals or at the time of porting/migration.
- Lifelong Renewability: The plan comes out with the lifelong renewability option.
- ICU/ICCU Charges: The plan pays up to 5% of charges (up to Rs.10000/day) for the treatment taken in the ICU/ICCU. The coverage is based on the total sum insured.
- Other Coverages: The plan offers ambulance service, daycare treatment, cataract surgery, new age/modern treatment, plastic surgery, dental treatment, among others.
Eligibility
| Product type | Individual/family |
| Sum assured | 1 Lac, 1.5 Lacs, 2 Lacs, 2.5 Lacs, 3 Lacs, 3.5 Lacs, 4 Lacs, 4.5 Lacs, 5 Lacs |
| Policy tenure | 1 year |
| Entry age | 18 years to 65 years |
Things to Keep in Mind While Buying Health Insurance
To choose the best health insurance plan, there are a few factors that should be kept in mind before finalizing your decision. They are as follows:
Coverage Provided
It is vital to check all the facilities and the coverage provided so as to fulfil the requirements of the treatment. Compare policies and make a checklist for your needs and choose the best plan accordingly.
Reliability of the Company
The policyholder should go through the insurance company's website and its details before choosing a medical insurance plan. The profile and the history of the company should be checked along with the customer reviews to make the right choice.
Sum Insured Amount
The principal point to be noticed while buying medical insurance is the Sum Insured offered by the insurer to the insured. If you or your family members are suffering from any specific disease, you might have a fair idea of the amount to be chosen for future health costs.
Co-pay & Deductible
You should keep an eye out for the clause of co-pay & deductible, which insurance companies attach with some of their plans. Just to be clear, It is a predefined amount (in %), which the insured agrees to pay for medical services. For example, if the co-pay is 10% and the claim amount is Rs. 2 Lakhs, Rs. 20,000 will be paid by the insured and the rest will be taken care of by the company.
On the other hand, a deductible is the fixed amount which the policyholder has to pay each year before his/her plan begins to pay for covered expenses. For example, a person's deductible is Rs.1,00,000. In March, the person has a viral infection and the doctor's bill is Rs.10,000. Since this is the first payment of the year, the entire amount will be paid by the person (insured). In June, the person runs into an accident and has minor surgery. The total bill comes out to be Rs.1,50,000. Here the person will pay Rs.90,000 and the rest is paid by the company. In October, the person has 2 fractures and the bill is Rs.40,000. Since the person has paid the yearly deductible, the entire expense will be paid by the company. Learn More
Add-On Benefits
Companies offer numerous riders and additional benefits to the customer that actually boosts the coverage, scope and advantage of the policy resulting in a complete health cover protection shield. You may also add a top-up plan with the respective coverage by paying an extra premium. Make sure that the company (you choose) offers such benefits.
Option For Cashless Claim
If the insurance company has tie-ups with network hospitals, it will provide a cashless claim facility. It proves to be useful during emergency hospitalization when it's hard to arrange for funds.
Why Compare Health Insurance with PolicyX.Com?
PolicyX.com is a one-stop-shop for all your insurance-related needs. It is the Insurance Regulatory and Development Authority of India (IRDAI) certified web insurance aggregator company (License Number: IRDA/WBA17/14).
You can compare health insurance plans from top insurance companies with PolicyX.com and buy the best plan as per your needs. Our team makes sure that you are getting the best deal within your budget; away from fake promises and products. We try to provide the easiest buying process. Our systems and teams are well-equipped to help you with the buying procedure from starting till the end. Let us look at the following key highlights about PolicyX.com:
- PolicyX.com offers a free comparison service with unbiased quotes.
- Allows a person to compare health insurance plans from over 10 companies within 30 seconds. You can buy the best medical insurance policy according to your needs in 5 minutes.
- By providing basic information, we will search for the most suitable health plans for you and offer relevant quotes on the basis of features, cost, riders, exclusions, benefits, and much more.
- It allows the customer to buy the desired plan from the comfort of home in a few minutes by filling up the online proposal form. Now, all the health plans are available online and you can get your policy instantly by making an online payment.
- PolicyX.com provides plans comparison of leading brands such as Care Health, Max Bupa, Bharti Axa, Tata AIA, Apollo Munich, Star Health, etc.
Steps to Buy Health Insurance Plan From PolicyX.com
- STEP 1: Go to the top of this page and fill the form 'Compare health insurance quotes online'.
- STEP 2: Provide the basic details like name, date of birth and "Select Cover for" from the drop-down tab i.e. for 1 adult, 2 adults and 1 child, etc. Click on 'continue'.
- STEP 3: Fill in your mobile number, city and click on 'proceed'.
- STEP 4: Compare quotes of different insurers and select the desired plan as per requirements.
- STEP 5: Click on 'buy this plan' and fill the form with your medical history, identity proof, and necessary documents. Click on "Save & Continue".
- STEP 6: Make the payment via different available online payment methods.
- STEP 7: Done! You are insured now.
The team of PolicyX.com will instantly share policy documents over email. (*Note: Medical tests would be done according to the plan features and insurance company's norms and conditions).
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How to Choose the Right Health Insurance Company?
With the available health insurance companies in the market, a lot of research is required to select the best among them. That research mainly depends on a few factors which are listed below:
Reputation of the Company: The reputation of the company plays an important role. It is advisable to go for a company that carries a good brand image. Sound research will be required that will help you to choose the right health insurance provider.
Financial Stability: You must check the financial stability of the company. You can check the Credit Rating Information Services of India Limited (CRISIL) rating. Go for a company with AAA Rating as it is considered to have the highest financial strength to meet its obligations.
Product Portfolio: Don't forget that insurance is a vast industry, which keeps on changing with time. It does not remain the same and neither does your needs. That's why it is important to go for a company that offers a wide range of helpful insurance policies, which cater to the different needs of customers.
Smooth & Quick Claim Settlement Process: It is advisable to search for an insurance company that follows a simple and easy claim settlement process. During emergencies, it is crucial to settle the claims on time so as to seek proper healthcare facilities.
Customer Support Service: Pay attention to the quality of customer services of an insurance company, for that you need to check for the ratings and reviews of the customers for the services provided. Choose the company that offers online chat, email assistance, and phone assistance.
Insurance Advisor: Insurance plans are filled with a bunch of terms and conditions, which are tough to understand. But now many insurance companies appoint insurance advisors who will help you in choosing an appropriate insurance plan according to your needs.
Feedback and Reviews: You can go through the Insurance Regulatory and Development Authority of India (IRDAI) website to check the number of complaints and resolutions against the insurance company.
Health/Medical Insurance Claim Settlement Process
The most important part of an insurance policy is the claim settlement process. People often worry about the claim settlements. Some insurance companies offer a direct claim settlement process and some take the help of TPAs (Third Party Administrators) for claim settlement. The claim settlement process takes place in two forms which are mentioned below:
1. Cashless Claim
You can avail cashless treatment facilities only in the network hospitals of the insurance company. The TPA must be notified beforehand in case of planned hospitalization, or within a specified timeframe in case of an emergency. The hospital's insurance desk helps with all the paperwork. The TPA has to approve the mediclaim amount, and the hospital will settle it with the insurer. There are likely to be exclusions i.e., expenses that the TPA won't pay. Such expenses must be settled by the patient directly at the hospital's cash counter.
Steps to follow:-
- Inform the insurance provider through a call or email.
- Show the health card as provided by your insurance company along with the identity proof at the hospital.
- The hospital will examine the identity of the policyholder and will submit the pre-authorization form to the insurance company.
- The insurance company will examine all documents, and if everything is fine according to their norms, then they will settle the bill with the hospital.
- A few health insurance companies provide a field doctor to help you with the whole procedure.
Note- In the case where the company is not responding through any mode of communication; contact PolicyX.com, call at toll-free number 1800-4200-269 or write an email to helpdesk@policyx.com. PolicyX.com will help and guide you to settle your claims without facing any troubles.
2. Reimbursement Claim
The insurer can avail the treatment in a non-network hospital and pay the bills. Once that is done, he/she can file for reimbursement via the below steps.
Steps to Follow-
- Inform the insurance company about your hospitalization as soon as possible.
- Keep all your documents ready with the hospital bills.
- Submit the documents along with the claim form.
- The insurance company will check all the submitted documents.
- After the completion of all formalities, the claim is settled as per the terms and conditions of the policy. The amount will be transferred into the claimant's bank account.
Note- In the case where the company is not responding through any mode of communication; contact PolicyX.com, call at toll-free number 1800-4200-269 or write an email to helpdesk@policyx.com. PolicyX.com will help and guide you to settle your claims without facing any troubles.
Claim Settlement Ratio Of Health Insurance Companies
Claim Settlement Ratio (CSR) is the ratio of the total number of claims to the total number of death claims received by the insurance company.
It is considered as an important factor because it shows the number of claims that an insurer has settled versus the rejected ones. With this ratio, you will be clear in choosing the right insurance company for your health plan. Always ensure that you are going for a high claim settlement ratio of an insurance company.
Claim Settlement Ratio of 2018-19*
| Insurance Companies | Incurred Claim Ratio (2018-2019) |
| HDFC ERGO Health Insurance Company (formerly known as Apollo Munich Health Insurance Company) | 63% |
| Bajaj Allianz General Insurance Co Ltd | 85% |
| Bharti AXA General Insurance Company | 89% |
| Cholamandalam MS General Insurance Company | 35% |
| Manipalcigna Health Insurance Company | 62% |
| Future Generali India Insurance Company | 73% |
| HDFC ERGO General Insurance Company | 62% |
| Iffco Tokio General Insurance Company | 102% |
| Liberty Videocon General Insurance Company | 82% |
| Magma HDI General Insurance Company | 90% |
| Max Bupa Health Insurance | 54% |
| National Insurance Company | 107.64% |
| The New India Assurance Company | 103.74% |
| The Oriental General Insurance Company | 108.80% |
| Raheja QBE General Insurance Company | 33% |
| Reliance General Insurance Company | 94% |
| Care Health Insurance Company(formerly known as Religare Health Insurance) | 55% |
| Royal Sundaram General Insurance Company | 61% |
| SBI General Insurance Company | 52% |
| Shriram General Insurance Company | 53% |
| Star Health Insurance Company | 63% |
| TATA AIG General Insurance Company | 78% |
| United India Insurance Company | 110.51% |
| Universal Sompo General Insurance Company | 92% |
Table Data updated on 28-09-2020
*Source IRDAI (Insurance Regulatory and Development Authority of India)
Documents Required for Claim Settlement
- Proof of Age: PAN Card, School or College Certificate, Driving License, Passport, Voter ID, etc.
- Photo Identity Proof: Aadhaar Card, PAN Card, Driving License, Passport, Voter's ID, etc.
- Proof of Address: Ration Card, Bank A/C Statement, Electricity Bill, Passport, Voter's ID, Telephone Bill, etc.
- Proof of Income: Employer's Certificate, Salary Slip, Form 16, etc.
- Medical Checkup: If asked by the insurance company.
- Photo Proof: Passport size photograph of the policyholder.
Health Insurance News
Be ready to pay extra health insurance premiums from October
From October, health insurance premiums are about to increase. Since last year, IRDAI introduced a list of changes to make health insurance more 'Customer-oriented'. Finally, the IRDAI has directed all insurance providers to follow the rules and implement the changes, starting this October.
To dissolve uncertainties, IRDAI directed insurers to equalize the exclusions (medical ailments or diseases) that aren't listed under a policy. If a physician detects an ailment/disease 48 months before the issuance of health insurance, it will come under pre-existing diseases. Also, any condition whose symptoms are detected within three months of health policy issuance will come under pre-existing diseases. Lastly, treatment for stress and mental illness will be covered by health policies.
Such standardized clauses will help the customers and should be incorporated in the new policies on/after 1st October 2020 and for existing policies (due for renewal) from 1st April 2021.
Besides this, IRDAI also asked insurers to guarantee telemedicine coverage. Thanks to COVID-19, it has gained a lot of popularity. And as always, the insurance regulatory advised them to offer more rational claim deductions to policyholders.
Will your existing health insurance pay for COVID vaccine?
With the ever-growing scare of COVID-19 around the globe, countries have accelerated the process of vaccine development. Many have seen positive results with multiple candidates entering the Phase-III trials. Soon, the world can hope to see a safe vaccine for COVID-19. But as the time comes closer, an important question needs to be answered- Will your existing health insurance pay for the vaccine?
A standard health insurance policy generally pays for hospitalization charges along with pre-admission and post-discharge expenses. If you test positive for COVID, gets hospitalized and need a vaccine, all health insurance policies will pay for the vaccine expenses. However, if you only need to get a dose of COVID vaccine (as a preventive measure) and no hospitalization is required, only those health insurance policies will pay for the vaccine that covers out-patient department.
Right now, it's not safe to say that all health insurance policies will cover COVID vaccine. Luckily, new policies have emerged in the market that happily pay for the cost of consumables like home treatment and PPE kits. With this, we can only hope that the cost of the vaccine may also be covered in the future.
ReAssure, a new health insurance plan, launched by Max Bupa
Max Bupa health insurance has come up with a new health insurance plan (ReAssure) whose main objective is to offer an unlimited sum insured to the policyholders and their family. Be it any kind of hospitalisation (including COVID-19), the policy will provide the necessary coverage all year. The policyholders can claim as many times as they wish to, without paying an extra cost. This is beneficial for those individuals who struggle with critical illnesses like cancer or kidney dialysis and require multiple treatments in a single year.
The policy has introduced a 'Booster Benefit, where the sum insured will double in two claim-free years. Meaning, for one no-claim year, the sum insured will increase by 50%. For another claim-free year, the sum insured will increase by 50%, which comes out to be 100% in total. Also, if you only make a claim (in a year) for COVID-19, your booster benefit will remain safe.
Speaking of COVID-19, the policy has an initial waiting period of 15 days. It will only take 30 minutes for cashless claim processing, and if the policyholder dies due to this virus, the policy will cover the expense for non-payable items.
To enhance the coverage, ReAssure will take care of the financial expenses related to medical bills, protective equipment kit, oxygen masks, gloves, etc. This is a part of the policy's 'Safeguard Benefit', which ensures that policyholders won't have to pay any expense from their pockets.
Other benefits of the policy include- up to 30% off on renewal under 'Live Healthy' by walking, 10% off if two or more people are protected under an individual policy, 5% off for doctors, 7.5% off on second policy year's premium (for 2-year policy term) and additional 15% off on premium for the third policy year (for three-year policy term).
As private treatment grows, COVID related claims inch closer to 1 lakh
COVID related health insurance claims are moving closer to 1 lakh mark. As per a survey conducted by the General Insurance Council, 85K cases were recorded on 4th August 2020, with the value of the claims at approx Rs.1400 crore. Out of 50K positive cases, almost 2000 claims (on average) are reported per day.
As per insurers, private hospitalization is the main reason for the rising number of claims. Earlier COVID positive cases (in Bengaluru) were being treated at government hospitals. But now, around 5000 patients are being treated at private hospitals. These claim figures are still low in comparison to Rs.51,000 crore health insurance market of the country.
But insurers are not worried about the rising number of claims due to two major reasons. Firstly, metros are witnessing a decline in COVID positive cases. The wrath of COVID is spreading to areas, where there is low insurance penetration. Secondly, local governments are promoting home treatments. Though home treatments are covered by the insurance, policyholders will only file claims after recovery with complete documents. But in case of hospitalization, cashless treatments are done and the claims are released immediately.
Government Proposing To Increase The Maternity Benefit
The Employees' State Insurance Corporation (ESIC) has proposed to change Rule 56A of the Employees' State Insurance (Central) Rules, 1950, and have decided to increase the maternity expenses paid to an insured woman or an insured person for his wife under its health insurance scheme to Rs. 7,500 from Rs. 5,000.
The benefit is given to those cases where the confinement occurs at a place where necessary medical facilities under the ESI scheme are not available. However, the expenses are paid for two deliveries only.
Before taking the final call, the ministry of Labour and Employment has issued a draft notification and have been given 30 days time for providing their feedback on the proposal to hike maternity benefit under the ESI insurance scheme after which the government would consider the feedback and issue it publicly.
Fantastic service providers, My details got changed within few days after the policy issuance. Efficient employees really.