Health Insurance Plans

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Health Insurance

Health insurance is basically an insurance policy that allows a person to deal with medical contingencies of future. It offers the require financial cover to the insured to deal with medical expenses associated with the treatment, hospitalization, etc.

Under the same, the company promises to pay for all medical expenses incurred by policyholder in case of any medical emergencies. The insurance company will reimburse the amount or will make sure that the policyholder is getting the cashless treatment for all illnesses or injuries that are covered under the policy.

Apart from the health cover, on buying an effective health insurance plan, you will be liable to receive tax benefits under Section 80D of the Income Tax Act- 1961, on the premium paid towards your policy.

To take advantage of a health insurance policy, the policyholder has to pay premium regularly. From the starting of the insurance policy, if the policyholder has any medical expenses to bear then the insurance company will be liable to pay them according to the features, benefits, terms & conditions of plan. It is important to keep in mind that some insurance companies have a waiting period under which no claims will be entertained for a specific time frame. The waiting period varies from insurer to insurer.

Health insurance is also included in the benefits provided by the employers to their employees. However, the features and benefits of such policies would be limited. That's why it is always advisable to go for a separate health insurance policy for complete safety.

Health Insurance Eligibility Criteria

There is no doubt in saying that a health insurance plan is an important thing that people should have. It is also advisable for all to invest in it at an early age as there are multiple benefits of the same such as wider cover, fewer exclusions,etc. With an effective health insurance plan, there will be no financial strains and you can avail needful treatment on time.

You can easily invest in the best health insurance plan just by comparing several plans online. You can go for an individual plan or can also choose a family floater. Here are the eligibility criteria:-

  • Entry age(Adults)- 18 to 65 years(Exclusive plans are there for 70 age and above)

  • Entry age (Children)-90 days to 18 years.

  • Renew-ability- Lifelong renew-ability(varies from plan to plan).

Health Insurance Plans in India

According to, below are a few best health insurance policies in India that you can buy-

Insurance CompaniesPlanCoverFeaturesRenewa-bilityPremiumPolicy Term
Religare Health InsuranceCare with Smart Select2 Adults & 2 Children
  • Co-Pay - You pay 0% of claim
  • Maternity - Not Covered
  • Hospital Room - Single Private Room
  • No Claim Bonus - Rs 1L per year upto Rs 5L
  • Restoration - Upto Rs 10L
Lifelong renewabilityRs. 16365/Year1 year
CignaTTK Health InsuranceCignaTTK ProHealth Protect Policy2 Adults & 2 Children
  • Co-Pay - You pay 0% of claim
  • Maternity - Not Covered
  • Hospital Room - Covered up to any Room except Suite
  • No Claim Bonus - Rs 0.5L per year upto Rs 20L
  • Restoration - Unlimited
Lifelong renewabilityRs. 18813/Year1 year
Aditya Birla CapitalDiamond with Unlimited Reload2 Adults & 2 Children
  • Co-Pay - You pay 0% of claim
  • Maternity - Not Covered
  • Hospital Room - Single Private Room
  • No Claim Bonus - Rs 1L per year upto Rs 5L
  • Restoration - Upto Rs 10L Unlimited times
Lifelong renewabilityRs. 20733/Year1 year
Star Health Insurance Family Health Optima2 Adults & 2 Children
  • Co-Pay - You pay 0% of claim
  • Maternity - Not Covered
  • Hospital Room - Single Private Room
  • No Claim Bonus - Upto Rs 15L
  • Restoration - Upto Rs 15L
Lifelong renewabilityRs. 21659/Year1 year
HDFC ERGOComprehensive Plan2 Adults & 2 Children
  • Co-Pay - You pay 0% of claim
  • Maternity - After 3 Years- Upto Rs 20K
  • Hospital Room - Single Private Room Actual
  • No Claim Bonus - Rs 5L per year upto Rs 10L
  • Restoration - Upto Rs 10L
Rs. 24686/Year1 year
Apollo MunichHealth Wallet2 Adults & 2 Children
  • Co-Pay - You pay 0% of claim
  • Maternity - Not Covered
  • Hospital Room - Actual - No capping on room rent
  • No Claim Bonus - 50% Multiplier Benefit is Applicable
  • Restoration - Upto Rs 10L
Lifelong renewal Rs. 35398/Year1 year

*Cover- 10 Lacs

Importance Of Health Insurance Plans

Medical urgencies can give goosebumps to an average middle-class person. Considering the increasing inflation, treatment of even the basic diseases are becoming out of reach. Thankfully, we have reached an advanced level of technology and science where almost every disease can be cured. However, any surgery or remedy can leave a dent in the pocket. We often get alert when we meet with such unforeseen situation.

There are many diseases like Heart Attacks, Strokes, Cancer, Kidney failures etc that needs immediate attention. As soon as any of our close relative including us are attacked by these deadly diseases we get panic attacks. More than the illness it's the stress of recovery that bothers us. All these can be managed if we have suitable Health Insurance plan. In absence of it, we surely can invite many other additional psychological ailments

A health insurance policy, commonly known as mediclaim in India, comes in picture to cover your expenses up to a great extent and help you retain the peace of mind. Health insurance plans will be there to support you financially in case of medical emergencies. It will provide the required financial assistance through which you will be able to pay for all medical bills.

The benefit of cashless treatment makes it more awesome as under the same you can completely focus on treatment without worrying about the medical bills. A health insurance policy will allows you to get the treatment at top hospitals of India and the best thing is that the insurance company will take care of all medical bills.

At, which is an IRDA approved website, you can freely compare and select the best plans to take care of your health needs and expenses in just a few minutes.

How to Choose Best Health Insurance Plan in India?

The best way to safeguard yourself against huge medical expenses is buying a good health insurance plan. Not only we can cover the risk of any critical illness but can buy a customized plan as per our requirements. Good treatment comes with the price. If an illness is not cured on time because of lack of money then it can lead to the serious ailment.

In worst cases, it can turn deadly. Alternatively, if we do the treatment on our own it may lead to a huge financial crisis as well. This is where the whole concept of medical policies comes into play. Best health insurance plans cover medical costs during hospitalization as well as pre and post stages of hospitalization.

The level of coverage mostly depends upon the type of the medical insurance policy. A lot of companies now offer health insurance in India and therefore as a consumer, you have multiple choices from leading brands.

To choose the best health insurance policy you should take advantage of our comparison services. Some of the brands offering health plans are MaxBupa, Bharti-AXA, Tata AIG, Apollo Munich, Star Health etc. helps you compare and choose the best health insurance plan for you.

You just have to compare health insurance plans provided by top insurance company on our website. With the basic information that you fill on our website, we will search for the most suitable health plans for you and offers the relevant quotes which make the whole process of buying health plan easier for you.

With the available free quotes, it will be easier for you to compare plans on the basis of features, cost, riders, exclusions, benefits and much more.

Different Forms of Health Insurance

People have their own choices and needs and to cater them insurance companies are offering multiple forms of health insurance. It is important to invest in a health insurance plan but it is more important to go for an appropriate cover that can easily go well with your needs.

So for choosing the right one, you should first learn how many forms are there that you can explore. Following are major types of health insurance policies available in India.

Types Of Health Insurance

1. Individual Health Insurance

Individual Health Insurance One of the basic health insurance plans that every person must have is an Individual health insurance. Though it covers a single person but there's always flexibility of availing the sum assured. Family members can also be chosen easily but we need to pay a separate amount. The premium that we pay annually is dependent on the amount of sum assured.

2. Family Floater Health Insurance

Family Health Insurance Family Health Insurance is best suited for an individual willing to cover more than one family members. All the family members can enjoy the benefit of the entire sum assured. It's rare situation when any 2 members of the family fall ill simultaneously. As a result, complete amount of policyholder, the sum assured can be utilized by a single member. The amount of premium paid for such kind of policies is quite less as compared to other plans. Members that can be easily covered is your spouse, children who are dependent and the parents.

3. Critical Illness Plan

Critical Illness Plan Under the same, the policyholder will be liable to receive a fixed benefit payout in case any critical illnesses specified under the policy. With the lump sum benefit you will be able to pay the hospitalization cost.

4. Senior Citizen Health Plan

Senior Citizen Health Plan The plan is designed especially for the old age people, particularly the age above 60 years. This plan is a great to fight against medical contingencies during old age. As per the IRDAI regulations, every insurance company must include people up to age of 65 years.

5. Maternity Health Insurance

Maternity Health Insurance Nowadays, almost every health insurance company cover pre and post natal care, child deliveries and sometimes vaccination expenses of new born babies as well. In short, it provide cover to all your maternity expenses. However, features and exclusions can vary from insurer to insurer.

6. Unit Linked Health Plan (ULHP)

Unit Linked Health Plan Health insurance companies have recently introduced ULHPs. It is basically a combination of health insurance and investment. Along with the health protection, ULHPs will help you in building a corpus which can be used by the investor to meet expenditures that do not get covered under health insurance plans. The return, of course, depends upon the market conditions at that time. But these plans are still in the development stage and are recommended for those who can handle products like unit linked insurance plans (ULIPs) and unit linked pension plans (ULPPs).

Key Advantages & Features of Health Insurance Policy

We all are aware of the fact that the healthcare cost is rising day by day and our earnings are not able to deal with any big medical emergency. With such rise in the healthcare industry, it become important to own an appropriate health insurance policy that would be able to deal with such drastic medical emergencies which can easily create a hole in anyone's pocket.

A comprehensive health insurance plan is all what we need. With the understanding of following features, buying an effective health insurance plan will become easier for you.

● Cashless Treatment

India is going digital and you can see such changes in the healthcare industry as well. Nowadays, people do not prefer to carry cash. In case of hospitalization if you own a health insurance policy with the feature of cashless facility, then you don't have to worry about the payment of medical bills as the insurance company will pay the same on your behalf and allows you to have complete focus on your treatment. It will be a big help in case of hospitalization as you do not have to arrange funds during medical emergency and can pay more attention towards the treatment.

● No-Claim Bonus (NCB)

No claim bonus or NCB refers to the amount that you will receive from insurer for every claimless year. It motivates a lot of policyholders to not file any petty medical claims. You should keep in mind that NCB comes as a discount on the payable premium at the time of renewing policy or whenever you want to increase the sum assured amount. At the time of renewal you must check that you are getting your no claim bonus or not.

● Family/Loyalty Discounts

It is a discount that you will receive on enrolling family member or any person in the health insurance policy. It is a form of reward that insurance company pay to existing policyholder on referring people to them.

● Round-The-Clock Customer Support

There is no doubt that the concept of insurance policy seems difficult for a few people. To provide more ease to them and to solve their queries, all health insurance company provide 24/7 customer service.

● Sum Assured Restoration

It is a matter of concern for many people that their existing health insurance policy will get exhausted if a person from their family is critically ill. To provide ease to them and to offer optimum use of their sum assured, insurance companies offer sum assured restoration benefit. The benefit of sum assured restoration is that once the sum assured amount is completely used, the insurance company will restored the amount automatically any you don't have to pay any additional cost for it. Usually, health insurance plans with restoration benefit are expensive as compared to normal health insurance policies.

● Online Application and Renewal Facilities

As discussed above, India is getting digital and so the insurance companies. These days' insurance companies have their online presence. All of them own websites and updated the same regularly to stay in touch with their customers, to make new ones, to sell and to introduce new insurance products. With such great services, it become easier for a customer to buy new plan within few seconds from the comfort of your home and can also renew the existing one.

● Free Health Check-Ups

To motivate all policyholders towards a healthy life, insurance companies offers free medical check-up facility once in a while. Depending on the company and the type of policy that you hold, you may be eligible for a master health check-up.

● Lifelong Renewability

Whenever you are planning to buy a health insurance policy you should always look for this feature. It is vital for you to go for a policy that offers protection for a very long time, especially during old age. This is the reason why most of the health insurance plans come out with the facility of lifelong renewability. Just to keep your policy active, you have to renew the same at end of every policy term.

● Co-payments/deductibles

While buying a health insurance policy, you will see an option of co-pay. At the time of claim, if the policyholder has opted for co-payment, then he/she will pay a pre-agreed percentage of the claim amount and the insurance company will take care of rest of the claim. The sum assured amount under your insurance policy will not be affected by co-payments.

● Tax Benefits

No doubt, it is a plus point of investing in a health insurance plan. On buying any insurance policy you will be liable to receive tax benefits and the same thing is here with the health insurance plan. With a health insurance policy, you will get tax advantages for the premiums under Section 80D of the Income Tax Act, 1961.

● Portability

Usually, we tend to change our insurance provider and switch to new company which is offering better plans and benefits. Under the same, the policyholder will be allowed to switch from one insurer to another. The plus point is that you don't have to compromise with the waiting period or any other features and benefits that you are receiving with the existing the insurer.

What Should Be The Ideal Health Insurance Cover?

As discussed above, the cost mediclaim, as already said, depends upon the sum assured, the age of the policyholder, present health condition and previous medical history. A higher sum assured attracts a higher premium. Well, there's no one-size-fits-all amount or a thumb rule here. Factors to consider in this regard includes a person's health condition, age, lifestyle, family's illness history and of course affordability. Remember that most mediclaim policies extend "additional benefits" like ambulance charges, daily allowance, and other expenses for hospitalization. You can explore them.

● Health Insurance by Employer

Several companies provide mediclaim for their staff. It also often covers hospitalization expenses of the spouse, dependent children, and parents. It's advisable to take the mediclaim irrespective of the amount covered because you don't have to pay any premium for that. Now, whether you need to take another health insurance policy will depend on a few factors. Is the cover provided by your employer sufficient? Is the insurance company good enough? What will happen when you change jobs?

Mediclaim is provided as an incentive to employees. So it's important that you understand the insurance policy is details and also check the coverage. Ask your human resource (HR) department for the details; what's covered and what's not. In many cases, employees are satisfied over the fact that their company is providing health insurance, but later found that several things are not included at all or were covered only in parts.

● Health Insurance For Senior Citizens

Even about a decade back, mediclaim companies were unwilling to extend cover to the aged and senior citizens. But of late, several insurers are providing health insurance policies for them. Insurance cover paid to an individual aged 65 years or above can lead to an additional tax relief of up to Rs 20,000. But remember that premium payable for senior citizens are much higher.If you are employed and have a mediclaim cover from your employers, approach your HR manager and negotiate with the insurance company to provide an additional cover for your parents. The insurer may provide the cover at an attractive premium because the volume will be high.

● Tax Exemptions

Section 80D of the Income Tax Laws covers healthcare insurance. You can get up to Rs.15,000 off for premiums paid for yourself, spouse and dependent children; and up to Rs.15,000 for parents (Rs.20,000 if the parents are aged above 60). So, if you pay the medical insurance premiums of your parents, you can save up to Rs.35,000 in taxes.

Health Insurance Claims Settlement Process

Most people, though aware of how TPAs work, don't know how health insurance claims are settled. Once a mediclaim policy is sold, the TPA takes up the baton from insurance company. For claims settlement, the policyholder must approach the TPA for all verification and formalities. TPAs settle claims in two ways.

● Cashless

You can avail cashless treatment facilities only in the networked hospitals of the insurance company. The TPA must be notified beforehand in case of a 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 party directly at the hospital cash counter.

● Reimbursement

The insurer can avail the reimbursement facility both at networked and non-networked hospitals. Here, you can avail treatment facilities and settle the bill directly with the hospital. You can then claim reimbursement of the expenses from the TPA by submitting the relevant bills and receipts.

Why You Should Buy an Health Insurance Plan?

Nowadays, investing in a comprehensive health insurance plan has become vital. It is very important as the health cover provided by your employer would not be sufficient to meet all healthcare needs. Most of the Indians think that the insurance policy provided by their employee is sufficient to meet the expenses of medical emergencies but that is not true and you will realize the same only when the health emergency strikes.

Most of the employers are providing basic health insurance plan that would not be enough to go well with your needs. For instance, a basic health insurance plan would not provide cover against critical illnesses.

It is always advisable to go for a plan that do not cover your hospitalization expense only but will also be there to deal with day care procedure, OPD charges, consultations, and other such expenses. If you are not aware of the fact that a person who is not terminally ill or hospitalized, can also take advantage of insurance plan for your normal doctor visits.

An effective health insurance plan is important as the cost of medical treatments are rising day by day and savings of a normal person would not be enough to deal with huge medical emergencies. Apart from the above features, if you are looking for any tax saving option then an investment in a health insurance plan is all you need. Under the Section 80D of Income Tax laws, with an investment in health insurance plan you will get good tax benefits that will help you in saving more.

Things to Keep in Mind When Buying Health Insurance Plan Online

The best health insurance for you is something that can go well with your needs. While buying a health insurance plan there are a few things that you should keep in mind such as

● Understand your Policy

Understand your PolicyBefore taking any final decision, it is important for you to understand what it would cover and what would not. Check what it offers exactly. Look for all the coverage options against pre-existing illness, accident-related expenses, day care procedures, and maternity expenses. Then, go for a plan which is enough for you and your family.

● Check Exclusions

Check ExclusionsNormally people look for features and benefits, they forget that exclusions plays a much important role as it helps you in getting a clear image that where your insurance policy wouldn't support you. You can easily get the same on your policy's documents. But people normally avoid reading it, but you should read it thoroughly. Exclusions varies from insurer to insurer and plan to plan. Some of the popular exclusions are:

  • Dental services

  • Pregnancy

  • Cosmetic surgeries

  • Injuries caused by a war, terrorism, commotion, protest, or strike

  • Joint replacement surgery

  • Homeopathy

  • Ayurveda

  • Injuries caused when under the influence of any drug/alcohol

● Think About Co-Pay

Think About Co-PayWhile you are searching for a health insurance plan you will often get the option of Co-pay. You have to take decision that whether you need it or not. For this you have to first understand what is co pay? At the time of filing claim, if you have opted for a co pay then you have to pay a pre-agreed percentage of the claim and the insurer will take care of the remaining.

You should keep in mind that the sum assured amount under the plan will not be affected by co-payments. So, before taking final decision makes sure that you need a co-insurance policy or not.

● Premium payment frequency

Premium payment frequencyIt is true that all insurance policies comes along with a renewal date. You have to renew your policy regularly to keep it active. You will get the option of paying premium either monthly/quarterly/semi-annually/annually. However, before taking final decision, check that you will be able to pay the premiums and renew the policy on time.

● Claim Settlement Ratio

Claim Settlement RatioIt is one of the most important thing that you should look for. If you check the report online, then you would come to know that the claim settlement ratio of many insurance companies have gone up in the last few years.

It is an important thing as it shows the number of claims that an insurer has settled versus rejected. With this ratio, you will be clear in choosing the right insurance company for your health plan. Ensure that you are going for high claim settlement ratio.

● Portability Option

Portability OptionIt is normal that sometimes we are not happy with the current insurer and want to switch to other insurance company. In such cases you can take advantage of portability option. Under the same, the policyholder will be allowed to switch insurer and the best thing is that he/she do not have to compromise with the waiting period or any other features and benefits which were available with the existing insurer.

● Lifelong Renewability

Lifelong RenewabilityIt is normal that people look for a plan that offers protection for a long term especially when it comes to old age. That's why the health insurance companies starts offering lifelong renewability option.

● No-claim bonus (NCB)

No-claim bonus (NCB)NCB or no claim bonus is the percentage of discount that the policyholder receive on completion of every claimless year. It motivates people to not make petty claims. Insurance companies offer this as discount on the premium or the policyholder may choose to increase sum assured amount at the time of renewal. At the time of buying policy, look for the no claim bonus option and percentage that the company offers.

● Restoration Option

Restoration OptionIn most cases, the policyholder with a family floater cover are afraid that the entire assured amount available under the plan will be exhausted if one person is critically ill. To offer optimum use of their sum assured, insurance companies these days offer sum assured restoration benefit. Under a plan with restoration option, once the sum assured amount is completely used, it get automatically restored without paying additional cost. Health insurance plans with restoration benefit are expensive than the regular health insurance policies.

How to Choose The Right Health Insurance Company?

In the last few years, the health insurance industry of India has witnessed a great rise. Now customers has multiple options of health insurance companies to explore. With this great number of health insurance companies in India, it become difficult to choose the best insurance company according to your needs. There are a few things that you should keep in mind while choosing an insurance company. Listed below are few of them that can help you:

● Reputation

The reputation of the company plans an important role. It is advisable to go for a company that carries a good brand image. Word of mouth recommendation and a sound research will help you choose the right health insurance provider.

● Financial Stability

It is important for you to understand that research is important before finalizing things. You must check the financial solidity of the company and you can do the same by taking help of the Credit Rating Information Services of India Limited (CRISIL) rating. Go for a company with AAA rating as it considered to have the highest financial strength to meet its obligations.

● Product Portfolio

Don't forget that insurance is a vast industry and keeps on changing by the time. It do not remain same all the time and so your needs. That's why it is important to go for a company that offers a wide range of helpful insurance policies to cater needs of all types of customers.

● Smooth And Quick Claim Settlement Process

You buy an insurance policy for your future emergencies and there is no doubt that you expect claim on time as well. Filing a claim can be a tedious job. It is true that no one wants to go through the long claim process that include submitting papers along with supporting documents and a long wait for approval. It will get worse if company rejected your claim. Hence, it is advisable to search for an insurance company that follow the simple and easy claim settlement process.

● Customer Service

Buying an insurance is like building a new relation and thus you always need someone who can help you in hard time and can support you to clear your queries. For the same, you will need d to contact your insurer's customer service centre from time to time. So, it is also important to pay attention to the quality of customer service of your insurance company. Choose the company that offers online chat, email assistance, or phone assistance.

● Insurance Advisor

Insurance is tough to understand by a common person. But now many insurance companies start appointing an insurance advisor to every consumer just to provide ease to them. Insurance advisors will help you in choosing anappropriate insurance plan according to your needs. When it comes to claim-related queries, they can provide the prompt assistance. 24/7 customer support will be there with a toll-free helpline number to resolve customer queries.

● Customer feedback and reviews

On of the most important and common aspect. Before buying anything, you must look for the customer ratings and feedbacks of an insurance company. For the same, you can take help of IRDAI website to check the number of complaints and resolutions against the insurance company.

Documents Required for Medical Insurance Policy

If you have decided to buy health insurance online, then there are few documents that you need to provide such as:

  • Age proof - Any one of Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter ID, etc

  • Identity proof - Driving License, Passport, Voter ID, PAN Card, Aadhar Card, which proves ones citizenship

  • Address proof - Electricity Bill, Telephone Bill, Ration Card, Driving License, Passport, should clearly mention the permanent address.

  • Some plans require a medical check-up usually for elder people above the age of 45 years in order to make sure that the insured does not suffer from any chronic illness.

  • Passport Size Photo to have a record of the insured person`s identity for future references.

Buy Health Insurance Online in Few Easy Steps

If you have decided to buy health insurance online, then there are few documents that you need to provide such as:

  • Very easy to buy, hassle free buying without going through heaps of paperwork

  • Takes less than 10 minutes to complete a purchase.

  • Simply enter basic requirements details as per the need and preference to find the best insurance plan for you.

  • Compare plans from various companies in less than 30 seconds and take a wise decision for your insurance investment.

  • Choose a plan which fulfills your criteria of insurance and be insured within minutes.

  • Complete online proposal form in 5 minutes, which asks you for your basic details for further reference.

  • Upload your documents and make payment towards the plan you want to opt for.

  • Bingo: You are now covered under the policy.

Health Insurance vs Mediclaim Policy

Those people who do not have much knowledge about health insurance often get confused between health insurance and mediclaim. Basically a mediclaim policy provides coverage for hospitalization expenses for a definite pre specified illness till a certain time as per the sum policyholder. Under mediclaim policy, the maximum limit for all claims is fixed at a definite amount.

It works on the principle of indemnity in which hospitalization is a specific requirement to think about any claim. Even those people who are policyholder under a mediclaim policy need to pay hospitalization expenses from their pocket and the insurer will pay them later. Under a health insurance policy, policyholders will get the comprehensive coverage that will cover pre and post hospitalization as well.

The policyholder can also get coverage on ambulance charges, compensation for lost income, etc, but that all depends upon the riders associated with the health insurance policy. The upper limit of a health insurance policy can go to as far as Rs 60 lakhs. Normally, health care policies also offer discounts on a regular basis over a definite period of time.

There is also a difference between health insurance policy and mediclaim on the basis of tax deduction. Health insurance premium paid towards a health insurance policy provides a tax exemption under section 80D of Income Tax Act, the funds paid towards mediclaim premium paid for self or spouse or children are appropriate for tax exemption of Rs 15,000 under section 80D.

Some Important Health Insurance Terms

Here are some of the important terms that you will come across while subscribing to a health insurance policy.

● Sum Assured

The sum assured, in simple terms, is the maximum coverage amount you can get in a policy year. It forms the basis of all your claims. Consider the increasing costs of hospitalization, medicines, and treatment before you decide on your sum assured. It's advisable to select a higher cover. At the same time, the cover shouldn't be high enough for you to dig into your pockets for paying the premium.

● Co-pay and Sub-Limits

Some health insurance companies have introduced the co-pay and sub-limit system to prevent hospitals from billing unreasonable room rents to patients. In a co-pay policy, you need to pay a part of the expenses irrespective of the sum assured. For instance, if a policy has 10% co-pay, then the insurance company will pay 90% of the expenses and you have to bear the rest.

Besides, some insurers cap the expenses of treatments to reduce the claims of hospitals. This is known as sub-limit. While buying a mediclaim, choose a policy which has fewer sub-limits. Some mediclaim policies have no co-pay or sub-limits. Try to select such a plan.

● Comprehensive Cover

Some employers provide health insurance to their staff under group insurance plan. But you can still have a mediclaim of your own which covers the entire family. You may not consider having a second mediclaim policy if your employer allows you transfer the policy if you leave your job. It's important that you compare several policies before buying one.

● Critical illness

Majority of the comprehensive mediclaim policies cover critical illness. You don't need to purchase another policy. It's advisable to subscribe to a comprehensive plan and then top it up with an accident insurance plan which doesn't cost much. In most cases, these two policies are enough to serve your mediclaim needs.

If there's a family history of a certain illness like thyroid or blood sugar, you should ideally buy a separate critical illness mediclaim. If your family has no such history, then there's no need for a critical illness plan.

● Restore benefit

The restore benefit feature allows reinstating your basic sum assured, if you have already exhausted the same as well as the multiplier benefit within your policy year. But in most cases, the benefit is not available on the same illness if the limit is already used up.

But a restoration benefit can be useful if you have subscribed to a family floater plan where the full sum assured is exhausted for treating only a single family member. The remaining members will have no cover to fall back upon in case of hospitalisation for the rest of the policy year.

The rest of the members, in such a case, can get covered for other ailments than the one for which expenses have been already paid by the insurance company.

● No claims bonus (NCB)

Insurers usually extend a NCB to a policyholder if there has been no claim in the preceding year. While buying a mediclaim, check the NCB amount before signing on the dotted lines. NCBs can range from 5% to even 100% of the sum policyholder. A high NCB gives cover against medical inflation and you don't need to worry about increasing your coverage year-on-year.

● Pre-existing illness, waiting period, exclusions

Pre-existing diseases are the ones you have while subscribing to the mediclaim policy. Most health insurance companies specify a waiting period for these illnesses. If you have a pre-existing illness, the insurance company is unlikely to give a cover against the same. In most cases, a pre-existing illness is covered after at least two years of buying the policy.

● Exclusions

It simply mean the diseases that are not covered under the mediclaim. For instance, if you suffer from diabetes while taking the policy, then kidney ailments are likely to be excluded from cover if the same happens because of the diabetes. Never hide any pre-existing ailments from your insurer while buying a mediclaim policy. It may reduce your hospitalization claims.

● Free Check-up

Most health insurers provide free health checkup to the policyholder. But what's termed "free" is actually not such. The cost of the checkup is included in the premium. Buy such a policy only when you are keen to get the facility each year. Also check whether the mediclaim policy, renewed every year, gives coverage for the entire life. This is important because life expectancy is increasing due to improved medical technology. While most insurance companies give full life coverage, some provide cover only up to 75-80 years.

● Maternity and Daycare

Some newly launched Medical insurance policies provide cover on hospitalization that doesn't require overnight stay. These are called daycare procedures. Check out how many procedures are covered in the plan. Also, most insurers don't consider maternity as medical emergency. So don't look for a maternity cover if you have no plans for a baby.

● Top up Plans

Medical costs are increasing. It calls for large covers. But not all can afford a high premium. A top up plan can come useful in such a case. It reduces cost of deductibles i.e. the amount you pay before the insurance company pays up. The insurance company will only pay up to the sum assured. A top up plan, on the other hand, doesn't pay until the hospital bill breaches a specific limit.

Suppose, if the hospital bill is Rs.8 lakhs with Rs3 lakhs as deductible, you need to pay the latter, while the insurer pays the balance Rs5 lakhs. But you can use your individual/group policy to pay the deductible amount. This is usually helpful because combination of a basic mediclaim plan along with a top up plan is much cheaper than a single cover. For instance, premium for a Rs5 lakhs regular cover for a 26-year old male, will be around Rs6,500. A top up with Rs15 lakh cover will entail an additional premium of Rs5,000, which is far cheaper than a standalone policy of identical amount.

Mistakes to Avoid When Buying Medical Insurance Plan Online

There is no doubt in saying that choosing the right insurance company for your health insurance needs is a daunting task. Today, all internet facilities and several options of health insurance plans have made it easy for a person to buy the same in a few seconds, but this doesn't mean that you should become an impatient buyer. Just because of our busy schedule and the long list of terms and conditions, we should not skip the same in a rush to make a decision. Just because of this hustle and bustle we ended up in doing a mistake while buying a health insurance plan. Ome of the common mistake that usually people do and you should avoid are as follows:-

● Insufficient coverage:

The cost that person pay towards his/her health insurance plays a vital role in deciding that which policy you should go for. Hence, just because of saving an amount, people end up in choosing a plan with less coverage or you can say insufficient coverage. It is true that cost plays an important role in choosing the health insurance plan but it should not be the only element that you are looking for.

● Avoiding the fine print:

While many of the individuals are aware of different treatment and expenses that will get the needful cover under your health insurance policy. There is no doubt in saying that having an idea about the coverage area of your health insurance plan but you should not skip the exclusions part of the same. It is equally important as much knowing the coverage part.

● Compare insurance providers:

Don't go with the first insurer that you got. While buying, or renewing the existing health insurance plan it is vital for you to understand that comparison of several plans will help you in getting the best and most suited plan which can easily go well with your needs.

If you get something better than your existing health insurance plan then you should switch the insurer without any hesitation. There are many companies that are offering exciting health insurance plans just to remain at the top and to attract consumers from time to time. Just take advantage of the same and get yourself enroll in the most suited plan according to your needs and budget.

● Be truthful about your medical history:

This is the most common mistake that usually people do and this becomes the biggest reason behind the rejection of health insurance claims by the insurer. While looking for a health insurance plan it is very important to be transparent about your medical history, don't hide anything and let your insurer know about all your medical problems in advance.

● Cashless hospitalization:

This is one of the most attracted features that as a consumer you must look for while searching for a health insurance plan. But what people usually do, they ignore this with the thinking that they will arrange the funds at the time of need and later they will get it reimbursed by the insurer. But have you ever thought that if you take money from others you might have to pay huge interest for the same. You must always go with the plan that offers the helpful cashless hospitalization benefits so you don't have to worry about the medical bills as the insurer will get it to settle the same with the hospital.

● Choose premiums and co-pays wisely:

While buying a health insurance plan, you will get the option of co-pay. According to the same, while you are filing the claim so you have to pay a pre-decided amount and the insurance company will take care of the rest of the amount. Please keep in mind that the co-pay amount will not affect the sum assured.

● Don't be over-policyholder

There is no need of buying many additional riders if you don't need it. Purchasing too many extra riders will only lead you towards the stage of over policyholder. Spend a few minutes on understanding your needs first, write it down and then go for a plan that can easily go well with your needs. Make sure you are not over-policyholder.

● Get policyholder early:

It is true that many people don't realize the importance of having a health insurance plan early in their life. But it is also a plus point that most of the health insurance companies offer many benefits along with the low premium to the buyer. The older you get, the less will be the options to explore as not all insurance companies will be ready to entertain you.

● Don't get satisfied with the insurance offered by employer:

There is a possibility that you might be getting health insurance coverage by your employer but it is not necessary that it would be sufficient for you as it is not customized as per your needs. You should also keep in mind that the health insurance coverage that you must be getting from your employer will stop once you changed the company. It is always necessary to opt for a supplemental health insurance plan that would be enough for you. You can also use your employer's health insurance plan to make a claim and enjoy no-claim bonus on your personal health insurance plan.

● Not having the required riders:

If over-policyholder is a mistake then under policyholder is also. As discussed above, it is important for you to understand your needs first and then go for a plan which can easily go well with your needs.

Health Insurance Portability

A person who ends up with a bad health insurance plan will only suffer when he needs it the most. But at the time of renewal, you can save yourself from such a bad plan and switch to any other health insurance plan by top insurance companies of India with the help of health insurance portability. The Insurance Regulatory and Development Authority of India (IRDA) has kept these individuals in mind when designing this convenient mode for consumers. The option of health insurance portability allows you to transfer your current health policy to a new health insurance company without compromising with the benefits. With the same, the consumers are getting complete freedom to change insurer whenever they want. It basically acts as a safety net for the accrued benefits accumulated by a customer on their current health insurance policy.

  • Inadequate cover for a specific health issue.

  • Poor service quality.

  • Late reimbursements.

  • Slow or incompetent claim settlement.

  • Lack of transparency.

  • Co-payment clauses.

  • Hiked premiums in case of a claim.

  • Room rent limit.

  • Wish to switch to a health insurance company that provides personalized services that are in sync with the needs and requirements of the customer.

  • Better deals provided by another health insurance company.

  • Hidden conditions and clauses.

  • Health Insurance Portability Guidelines.

In the context of health insurance portability, the IRDA has set some rules that will surely help the consumers to change the insurer whenever they need it. These rules will have to be followed diligently just to make that the policyholder's Health Insurance Portability request does not get rejected.

  • Same health insurance policies - Only same health insurance policies have the power to be ported. An policyholder can easily migrate from one plan to another by another health insurance company.

  • The form of company - An policyholder have the power to switch from any specialized or general insurance company to any other specialized or general insurance company.

  • Renewal Period - A Health Insurance Portability can only take place at the time of renewal. But if there is any form of discontinuity in the policy because the insurance comes of delays that occur from the insurance company's end then it shall not be considered as discontinuity.

  • Acknowledgment - Both concerned insurance companies will have to acknowledge any portability applications which are made by an insured in three days.

  • Intimation - A policyholder who wishes to opt for a Health Insurance Portability will have to inform their current health insurance company while mentioning the health insurance company they wish to port with. The policyholder should inform both insurers 45 days before the policyholder's existing policy is up for a renewal.

  • Porting Charges - There are no charges levied on Health Insurance Portability.

  • Grace Period - A policyholder is granted a 30 - day Grace Period for the renewal of a policy in case the policyholder's application for porting is still under process or the new insurer's decision has not yet been made.

  • Porting in the Same Company - Policyholders are allowed to port out of one plan into another plan within the same insurance company.

Advantages of Health Insurance Portability

  • A customer can easily get customized health insurance plan that can easily go well with their needs.

  • IN case of health insurance portability, the new Sum Assured will comprise of the old Sum Assured, No Claim Bonus (if applicable), and Accrued Bonus.

  • The policyholder does not have to think about any time-bound exclusions when applying for Health Insurance Portability.

  • Insurance companies have started to provide health insurance at lower premiums to be a step ahead of their competition.

  • An insured can avail a better claim settlement procedure with a new insurance company

  • A policyholder can opt for a health insurance provider that offers a policy without any hidden clauses or conditions.

Disadvantages of Health Insurance Portability

  • Policyholders are restricted to changing insurers at the time of renewal of the policy.

  • An insured does not have the power to change the health insurance policy that is vastly different from their current plan. They have to switch to a similar policy which is provided by a different insurance company.

  • Additional benefits that come with the new policy can attract higher premiums. This could erase any monetary benefits that a policyholder is entitled to.

Dos and Don'ts of Health Insurance

Here is a list of dos and don'ts you should keep in mind when purchasing a health insurance policy:

Fiest understands your health insurance needs and they go for a customized plan. There are basically 4 types of policies; mediclaim, critical illness, hospital cash benefit, and surgical benefit plan. Go for a plan that suits youDon't be underinsured or over-insured. Go for an adequate health cover which is enough to get the needful assistance on time.
Read the policy document thoroughly. Check out all inclusions and exclusions of the policy. Exclusions may include pre-existing conditions. The waiting period for certain illnesses can be 3 to 4 years.Don't go for a plan just because of it cheap premium. It may not offer your sufficient coverage to cover all your insurance needs.
You can go for customized health insurance plan that goes well with your needs. Hence, pay the premium only after the insurance provider accepts your proposal. You can negotiate or opt out of policies with co-payment or sub-limit.Don't let your policy lapse. Make sure to renew the policy on time. Don't delay in making payments by a day.
Check the list of network hospitals. You don't want yourself to be stuck with a medical facility that offers basic healthcareDon't conceal pre-existing situations. Disclose any pre-existing illness you may have to avoid policy termination or hassle when making a claim. Concealing facts or furnishing falsified documents gives the insurance provider the right to terminate your policy.

Top Health Insurance Schemes By Government Of India

The central and state government of India has come out with several health insurance schemes just to improve the healthcare access for the unorganized sectors and for those who come under the Below Poverty Line (BPL) category. Here is a list of health insurance schemes provided by the government:

● Ayushman Bharat:

Ayushman Bharat is basically a National Health Protection Scheme that will provide coverage to 10 crore poor and vulnerable families. It means it will provide coverage to 50 crore beneficiaries. Under the same, a cover of around 5 lakh rupees per family per year for secondary and tertiary care hospitalization will be there. This effective health programme will subsume the current centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

● Rashtriya Swasthya Bima Yojana (RSBY):

This helpful scheme launched by the Ministry of Labour and Employment just to offer the needful health insurance coverage especially for BPL families. All the beneficiaries under this plan can easily avail hospitalization whenever it requires the cover of up to Rs.30,000. To get enroll under this effective health insurance plan, there is no specific age limit and you will be liable to get the cover of pre-existing diseases from the day 1 of the policy. This plan is designed in a way that can offer the coverage to maximum 5 members of the family that includes spouse, children, and dependents. Beneficiaries have to pay only Rs.30 as registration fee. Rest of the premium will be paid by the central and state government to the insurance company.

● Pradhan Mantri Suraksha Bima Yojana:

There is no doubt in saying that accidents are an unfortunate occurrence that does not discriminate against people on the basis of rich and poor. However, in India accident insurance are simply doing great with the rich and middle class as well. The one who suffers the most is the poor section of the society, who are unable to afford an effective and adequate health insurance policy. To provide ease to the poor section, the government has come out with this effective health insurance plan called Pradhan Mantri Suraksha Bima Yojana. The plan offers great coverage at affordable premiums and offers compensation to the family of the deceased or if the policyholder has been disabled partially or permanently following an accident.

● Central Government Health Scheme (CGHS):

This insurance policy was launched the same in 1954 in New Delhi. It is now available in CGHS covered cities like Allahabad, Bhopal, Chandigarh, Ahmedabad, Lucknow, etc. It offers the needful comprehensive health coverage to all the central government employees and pensioners. Dependents of these employees are also included as long as they reside in the CGHS cities. The insurance policy provides coverage against domiciliary care, specialist consultation facilities, laboratory tests, hospitalization, and health education to beneficiaries.

● Aam Aadmi Bima Yojana (AABY):

It is basically a social security scheme that was launched in October 2017 just to provide the needful healthcare facilities to all the rural and landless households. The head of the household or the earning member of the family will be covered under the scheme. The insurance premium of Rs.200 per year is paid by the central and state government. The beneficiary should be between 18 to 59 years of age. An add-on benefit under the policy comprises of scholarship for children of the nominee. The beneficiary will receive Rs.30,000 upon natural death of the policyholder member, Rs.75,000 upon accidental death or permanent disability, and Rs.37,500 on partial permanent disability.

● Janashree Bima Yojana (JBY):

This insurance policy was launched in 2000 on 10th August. It replaced the Social Security Group Insurance Scheme (SSGIS) and Rural Group Life Insurance Scheme (RGLIS). This policy is specially designed for those people who come under the BPL category and slightly above BPL category in 45 occupational groups covered under the scheme. Some of the occupations that would be liable to get the cover are Beedi workers, carpenters, power loom workers, cobblers, handicraft artisan, agriculturists, construction workers, etc. Aam Admi Bima Yojana and Janashree Bima Yojana have been merged into one scheme and called as Aam Admi Bima Yojana since 2013.

● Employment State Insurance Scheme (ESIS):

Again a social security scheme that is designed especially to offer the socio-economic protection to the working class and their dependents. The policyholder and his family who will receive complete medical care from day one. Under the policy, the beneficiary will receive cash benefits in times of sickness and temporary or permanent disablement that leads to the loss of earning capacity. This policy will also be covered by the policyholder's dependents as if the dependant is disabled on the job, a monthly pension called the dependent benefit is provided under the ESI scheme. The scheme is applicable to non-seasonal factories, theatres, shops, restaurants, hotels, road motor transport undertakings, and newspaper establishments employing more than 20 people. Recently, private medical and educational institutions employing more than 20 people in certain states and union territories have also been included under the scheme.

● Universal Health Insurance Scheme (UHIS):

A new health insurance plan that is specially designed to provide needful healthcare services to a wide area of the country and to cover poor section effectively. Under this plan, beneficiaries will receive reimbursement for medical expenses up to Rs.30,000 and accidental death cover up to Rs.25,000. This policy is there for the BPL families only. The insurance premium for this scheme is Rs.200 per person, Rs.300 for a family of 5, and Rs.400 for a family of 7. The four public sector/government health insurance companies in India are The New India Assurance Co. Ltd, United India Insurance Company, National Insurance Co. Ltd, and Oriental Insurance.

● Health Insurance Tax Deductions:

Here are few things that you should know about tax deductions for health insurance premium:

  • Premiums that you paid towards medical insurance qualify for tax deduction under Section 80D of the Income Tax Act, 1961.

  • Tax deduction claim of up to Rs.5,000 can be made for expenses that take place for the preventive health check-up for each year.

  • Individual policyholders can claim the deduction for premiums paid towards health insurance for self, spouse, children, and dependent parents. Hindu Undivided Families (HUF) can claim tax deductions for insuring members of the HUF.

  • Tax deduction of up to Rs.25,000 can be claimed for health insurance premium paid for self, spouse, and children under the age of 65. For members above the age of 65 years, tax deduction can be claimed about Rs.30,000.

  • There will be no tax deductions for group health insurance premiums.

  • Insurance premiums paid using cash cant be claimed for the tax deduction. Pay insurance premium via debit card, credit card, cheque or net banking. You can pay in cash for preventive health check-ups and make claims for the tax deduction.

  • The maximum tax exemption limit under Section 80D of the Income Tax Act, 1961 is Rs.65,000.

  • GST paid on insurance services can’t be claimed for the tax deduction.

  • Under Section 80DD, the policyholder member can claim benefits up to Rs.75,000 for expenses that take place because of nursing, treatment, and rehabilitation of a disabled dependent and Rs.1.25 lakh for serious disability.

  • Under Section 80U of the Income Tax Act, 1961, a disabled individual can claim advantages up to Rs.75,000 and Rs.1.25 lakh for serious disability.

Health Insurance FAQs

Before buying health insurance, we are sure you must be having a lot many questions in your mind. Do not worry as we at are here to help you figure out the best insurance policy for you.

1. What is health insurance?

As the name implies, health insurance is a type of insurance which covers your medical bills. It's also popularly known as mediclaim in India and is a contract between an insurer and a person or a group of individuals, where the insurer pledges to provide specific medical insurance cover, against a fixed amount of "premium", which is usually paid annually.

2. What forms of health insurance are available in India?

The most popular form of health insurance policy available in India is the one that covers expenses incurred in case of hospitalization. However, several other products are available from various insurance companies that offer an exhaustive range of health covers, depending upon the choice and need of an individual. The insurer, in most cases, directly pays off the hospital (known as cashless facility). It may also reimburse the cost associated with injuries or illnesses or disburse a fixed amount on occurrence of an illness. The amount and type of healthcare costs to be provided by the insurer under the plan is specified in advance in the offer document.

3. Why is Medical insurance important?

Every individual must buy a health insurance policy for all the members of his/her family, according to need and capacity. Subscribing to Medical insurance will cover you from sudden and unexpected cost of hospitalization, and other serious health issues, like critical illness. Not having a health insurance policy could hugely impact your income and household savings, and may even land you in debts.

All of us are exposed to different types of health hazards. Medical emergencies are known to strike sans any warning. Healthcare, at the same time, has become increasingly expensive. New procedures, technological development, and better medicines have triggered a rise in the cost of healthcare. These expenses are beyond the reach of most of us, and buying a health insurance policy is much more affordable, to pay off the medical bills.

4. What type of health insurance plans is available today?

Health insurance is available from as low as Rs5,000 sum policyholder in case of micro-insurance policies to as high as Rs50 lakhs or even more than that in case of some critical illnesses. Most insurance companies offer health covers between Rs1-5 lakhs sum policyholder. With cabin rent and other costs payable by insurance companies being increasingly linked to the sum policyholder, it's advisable to take an adequate cover as early as possible, especially because the sum policyholder may not be increased in the event of a claim. Besides, while most Medical insurance policies are for an one year duration, there are schemes that cover for up to five years as well. Longer duration policies are also available. A hospitalization policy either covers partly or fully the treatment cost incurred because of hospital admission during the policy period. .

There's also a wider coverage that includes expenses both before and after hospitalization. Such policies are usually available on family floater basis, or personal sum policyholder basis. In the former, the sum policyholder is spread over the family members. Another scheme, the hospital daily cash benefit policy, extends a daily fixed sum of money for each day in hospital. There could also be a higher daily benefit cover for some specific illnesses or ICU admissions.

A critical illness policy extends a lump sum amount when an individual is diagnosed of a particular illness. The amount is used to pay off several direct and indirect monetary consequences because of a critical illness. The plan ceases to be in operation once the lump sum is paid off.

5. What is cashless mediclaim?

These days, most insurers have arrangements with various hospitals spread across the country as part of a network. An individual, if policyholder under a policy which offers cashless facility, can get treated in any hospital of the network without paying hospital bills because the same is paid directly by the third party administrator (TPA), on behalf of the insurer. However, all expenses beyond the sum policyholder or the ones not covered under the policy, have to be paid by the policyholder directly to the hospital. Cashless facility is not available if the hospital is not included in the network. In such cases, payment by the insurance company to the hospital, is usually carried out on reimbursement basis.

6. What are the tax benefits of health insurance?

You can claim several tax benefits if you subscribe to a health insurance scheme. Such benefits are extended by section 80D of the Income Tax Act. Presently, subscribers to a health insurance, who purchased the policy by a payment mode other than cash, are eligible for Rs15,000 annual deduction from their taxable income for payment of health insurance premium for self, dependent children, or spouse. The deduction is higher for senior citizens at ?20,000. Also, since the 2008-09 financial year, an additional deduction of Rs15,000 can be claimed for mediclaim premium paid for parents. It's Rs20,000 if parents are senior citizens.

7. What factors affect the premium payable for a health insurance policy?

Age is the biggest factor which determines the premium payable. The older you are, the higher will be your premium, because you'll be more prone to illness. Your medical history is another factor that will go into determining the premium. If you don't have any medical history, the premium would be naturally lower. You are eligible for a discount on further premium payable for the years for which there has been no claim of the insurance money. Some insurance companies cover add-on benefits like free medical checkups and/or diagnostic tests in case of no claim.

8. What are the things not covered under a health insurance policy?

Read the offer document/prospectus and understand it fully before signing on the dotted lines. What's not included will be clearly written in the prospectus. Any pre-existing illness, usually, is not covered under a policy. But read the offer document to understand what the insurer means by pre-existing illness. Also, majority of the policies generally exclude certain types of diseases in the first year of coverage. A waiting period is also often imposed on such diseases. Some expenses not covered under most health insurance policies include cost of contact lenses, spectacles and hearing aids, dental surgery (unless it requires hospitalization), general debility, convalescence, venereal disease, congenital external defects, use of drugs and alcohol, intentional self-injury, expenses for diagnosis, AIDS, X-ray and/or laboratory tests not connected with the illness requiring hospitalization, treatment related to pregnancy or childbirth, including C-section, naturopathy treatment and others as deemed exclusive by the insurer.

9. What about the waiting period?

As already said, there is usually a 30-day waiting period when you buy a new policy, starting from the day you enrolled in the health insurance scheme. During this period, the insurance company won't pay any hospitalization charges. But this is not applicable in case of an emergency hospitalization arising out of an accident. The waiting period is not applicable for renewal of the policy for subsequent years.

10. What is a pre-existing condition?

It's a medical condition or an ailment that existed before you took the health insurance policy. This is a significant point in all policies because insurers don't cover such conditions within 48 months prior to taking the first policy. It means a pre-existing condition may be considered for payment, only after the completion of 48 months of continuous insurance cover.

11. If I don't renew my policy before the expiry date, can I be denied renewal?

The policy can be renewed if you pay your premium within the grace period, which is usually 15 days from the date of expiry of the policy for most insurance companies. However, you will not be entitled to any coverage for the period during which the insurance company did not receive any premium. Also, the policy would lapse if premium is not paid within the grace period.

12. Is my health insurance policy transferable, sans losing renewal benefits?

Yes. According to a circular issued by the Insurance Regulatory and Development Authority (IRDA), with effect from 1 October, 2011, the insured can transfer a policy from one insurer to another, and also from one plan to another. The insured will lose no renewal credit for pre-existing health conditions which he/she enjoyed in the incumbent policy. But the credit would be limited to sum insured and the bonus eligible under the present policy. Check with your insurance company for the detailed clauses in this regard.

13. What happens to the coverage amount when a claim is filed?

Once an insurance claim is filed and settled, the coverage gets reduced by the amount paid on settlement. For instance, if you take an Rs5 lakh mediclaim policy in January, and in April, the insurance company pays? 3 lakhs towards your hospitalization and treatment, then you will be eligible for the balance Rs2 lakhs as coverage for the remaining duration i.e. May to December

14. What about "any one illness"?

This means a continued period of illness and includes relapse within a specified number of days, subject to the terms and conditions written in the policy. It's usually 45 days.

15. How many claims are allowed in a year?

There's no limit to the number of claims in a single year, unless there's a specific cap laid down in the policy. The sum insured, however, is the maximum claimable limit under the mediclaim policy.

16. What is a family floater?

In a family floater scheme, a single policy covers the hospitalisation expenses of the entire family. Such a policy has only one sum insured which can be utilised by a single or all members collectively in the family. The limit of coverage is capped at the sum assured. Family floater plans are considered better than buying a separate health policy for each member of the family. It takes care of all medical expenses including surgeries, sudden illness and accidents.

17. What is a health checkup facility?

Some insurance companies reimburse general health checkup expenses usually once in every four years.

Latest Health Insurance News

Mental Ailments to be a Part of Health Insurance Now

November 12, 2018

Mental Healthcare Bill 2017 has a positive impact on the health insurance company. IRDAI has passed new rule for the inclusions of all mental illnesses as a part of health insurance plan. With the increase in the rate of mental ailments, this reform was much needed. This will force many people to buy a health insurance plan for themselves. As per the National Mental Health Survey 2016, almost 15% Indian population suffers from depression that is close to 150 million people. Out of this section, most of them are in the age group of 30 to 49 years. Amidst worsening situation of mental health, access to the right treatment is what a mental patient need.

The inclusion of mental illness in the health insurance plan can provide patients with much-needed access for the right treatment. Latest Health Wellness Survey highlighted the preference of many people for seeking mental wellbeing to lead a stress-free life. With the inclusions of mental ailments in the health plans, they can get access to psychologists and counselors which may be beyond the reach of many because of their exorbitant cost now. People can expect a customized solution for any sort of mental illnesses. This new amendment in health insurance is expected to curb mental illness growing at a rapid rate. Above details were shared by Ashish Mehrotra, Managing Director & Chief Executive Officer – Max Bupa to the Financial Express team.

IRDAI Permits Health Insurance Sector to Standardize Disease Exclusions

November 05, 2018

According to the latest amendments in the Insurance Regulatory and Development Authority of India (IRDAI) health insurance industry is permitted to exclude certain pre-existing diseases. Some of the diseases that can be excluded are Epilepsy, Stroke, Chronic liver diseases, Kidney diseases, Hepatitis B and a few others. Recently IRDAI has made it mandatory to include a few diseases such as Alzheimer, Parkinson disease, AIDS, Morbid Obesity etc.

However, if these diseases are pre-existing than it can be excluded as well. In case of non-disclosure of any pre-existing disease, there’s a waiting period of 4 years. Currently, the waiting period is of 2 years, but insurance companies got the authority to lay a hiatus of up to 8 years as well. The proposal made by IRDAI is subject to review on an annual basis.

Ayushman Bharat Marching Ahead With Coverage of One Lakh Beneficiaries

October 23, 2018

Within a span of just one month time after its launch Ayushman Bharat has got 1 lakh people covered under its umbrella. Ayushman Bharat- Pradhan Mantri Jan Aarogya Yogna (AB-PMJAY) is a revolutionary nationalized health insurance plan launched for rural Indians and selected urban population. Its primary motive is to cover people under the poverty line and helpless Indians. Prime Minister Shri Narendra Modi announced this plan almost one month ago i.e. on 23rdSeptember 2018.

His vision of introducing this useful health insurance plan is to cover at least 50 crore people. This health insurance plan has no cap on the age and size of the family. The plan is designed to include more women and older people in the family. The scheme was launched on 23rd September in Ranchi; Jharkhand by the Prime Minister. It was proposed way back on the eve of 72nd Independence day by our honorary Prime Minister Narender Modi.

AB-PMJAY assures to facilitate sum insured of Rs. 5 lakh per family. The objective of this plan is to provide an affordable hospital for the poor. A 46th old person from Rewa, MP complete the counts of one lakh beneficiary for AMPMJAY plan. The latest beneficiary got admitted in Vindhya Hospital and Research Center for the treatment of Posterior Cervical recently.

Customer Reviews

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Hari, Delhi
- Reviewed On 15-02-2019
"Hari, Delhi"

The sales agent others were knowledable enough to convince me to buy a policy and help me understand how to get health insurance claims and various formalities .

himanshu kumar sinha, Bengaluru
- Reviewed On 14-02-2019
"himanshu kumar sinha, Bengaluru"

2825100421061000002 policy has been purchased from you but the card is not received.\ni am fully satisfied with your service. till this time i am in dubious mind, god knows whether they will send the card \nwithin a month as said by them. other reviews are very alarming. people are crying for last 4 months, they have not received the card\n. if they are sending the card in time it is ok ,one has to rely on others so iam waiting for card now. if it remains ok we will purchase other insurance like car and bike.

Sumit Kumar, Ahmedabad
- Reviewed On 26-07-2018
"Sumit Kumar, Ahmedabad"

I buy a health insurance but the guy who assist me it was good but till now from last 4-months waiting for my insurance-card trying to call but no response from your guest attendant only taking time. Worst just they sale and forget the guest bad company never buy from them.

Arjun, Thane
- Reviewed On 10-07-2015
"I've a very bad claim experience with the Universal Sompo General Insurance."

Grateful to be a customer of Universal Sompo General Insurance.

Vihaan, Rohtak
- Reviewed On 08-04-2018
"Average Service"

I've a very bad claim experience with the Universal Sompo General Insurance.

Samiksha, Dehradun
- Reviewed On 06-05-2018
"Good insurance"

I have used the Universal Sompo General Insurance service two times, first time they provided 100% cashless and the second time it was 80% overall it was good.

Diwan, Hisar
- Reviewed On 02-05-2018

Excellent support from Live Chat.

Ajay, Udaipur
- Reviewed On 04-04-2018
"Good Policy to hold"

I have my Platinum health insurance policy with United India Health Insurance. I have this health insurance since last 4 years, and happy with the services.

Pawan, Kochi
- Reviewed On 05-05-2018
"Does what they promise"

very good online service. I have Individual Mediclaim Health Insurance with United India Health Insurance. They have very decent policy. They provide with good claim record and very easy to apply.They have good cashless options too.

Rupali, Cuttack
- Reviewed On 06-04-2018
"Good Policy"

I have my Wellsurance Family Policy with Tata Aig Health Insurance from past 3 years. The policy coverage will be for 5 lakhs rupees. This policy have the coverage for my family as well.

Neeraj, Ajmer
- Reviewed On 06-05-2018
"Great Service"

Thank you for easy cashless hospitalization.

Vivek, Jamshedpur
- Reviewed On 19-04-2018

Good Approach And Response from Tata Aig Health Insurance agents.


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