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
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 assured limit. The insurance company pays on your behalf and allows you to have a complete 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 company.
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. One can avail tax benefits up to a certain limit depending upon the age of the policyholder and his/her parents (if any).
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 costs for the transplantation of an organ are bearable by the insurance company. Health insurance covers the surgery expenses related to organ donation. However, the costs for complications after surgery, organ donor expenses, and medical tests are not covered under the same.
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 Assured 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 life, 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 assured 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 is to fight against all medical contingencies during old age. As per the Insurance Regulatory and Development Authority of India (IRDA) regulations, every insurance company must insure people up to the age of 65 years. 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, but there's always flexibility of availing the bigger sum assured. The premium that we pay annually depends on the amount of sum assured.
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 assured. 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. 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.
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
Different insurers provide a variety of facilities and covers to the policyholder. It is vital to check all the facilities and the coverage provided so as to fulfill the requirements for 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 Assured Amount
The principal point to be noticed while buying medical insurance is the amount of Sum Assured 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. Hence, it is important to choose the sum assured wisely.
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 2 Lakhs, 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 & Plans
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.
Option For Cashless Claim
Check whether the insurance company is providing the cashless claim facility as it is an important feature of the policy that will help in times of emergency hospitalization.
Why Compare Health Insurance With PolicyX.Com?
PolicyX.com is a one-stop shop for all your insurance related needs. PolicyX is 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 and buy the best health insurance plan as per your needs. The team of PolicyX 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:
- PolicyX.com offers a free comparison service with unbiased quotes.
- Allows the insured 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 plan comparison from leading brands such as Religare Health, Max Bupa, Bharti Axa, Tata AIA, Apollo Munich, Star Health, etc.
Steps To Buy Health Insurance Plan From PolicyX
- STEP 1: Click on the "Get Quotes" section present on the bottom-right side of this page.
- STEP 2: Fill in the basic details like name, mobile number and click on "Proceed".
- STEP 3: Choose the desired option from the drop down tab showing "Select Cover for" i.e. for 1 adult, 2 adults and 1 child, etc.
- STEP 4: Fill in your 'Date of Birth', 'Email ID', 'City' to proceed and click on "View Quotes".
- STEP 5: Compare and select the desired plan and click on "Buy This Plan".
- STEP 6: Fill the form with your medical history, identity proof, and necessary documents and click on "Save & Continue".
- STEP 7: Make the payment via different available online payment methods.
- STEP 8: 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 and keeps on changing by time. It does not remain the same all the time and so does your needs. That's why it is important to go for a company that offers a wide range of helpful insurance policies caters 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 is tough to understand by a common person. 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: One of the most important and common aspects are customer ratings and feedback received by an insurance company. 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 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 on a call or through email.
- In the case where the company is not responding through any mode of communication; contact PolicyX, call at toll-free number 1800-4200-269 or write an email to helpdesk@policyx.com.
- PolicyX will help and guide you to settle your claims without facing any troubles.
- Show the health card as provided by your health insurance company along with the identity proof.
- The hospital will examine the identity of the policyholder and will submit the pre-authorization form to the health insurance company.
- The insurance company will examine all documents, and if everything is fine according to their norms, then they will process the claim.
- A few health insurance companies provide a field doctor to help you with the whole procedure.
- After the completion of all formalities, the claim is settled as per the rules of the company.
2. Reimbursement Claim
The insurer can avail of the reimbursement facility both at networked and non-networked hospitals. Here, you can avail of treatment facilities and settle the bill directly with the hospital. You can then claim reimbursement of the expenses from the TPA by submitting relevant bills and receipts of treatment.
Steps to Follow- Reimbursement Claim
- Inform the insurance company about your hospitalization as soon as possible.
- In the case where the company is not responding through any mode of communication; contact PolicyX, call at toll-free number 1800-4200-269 or write an email to helpdesk@policyx.com.
- PolicyX will help and guide you to settle your claims without facing any troubles.
- Keep all your documents ready with the bills of hospitals.
- Submit the documents along with the claim forms. Don't forget to attach the bills of hospitals.
- The insurance company will check all the submitted documents and process the claim according to the terms and conditions of the medical insurance policy.
- After the completion of all formalities, the claim is settled as per the terms and conditions of the policy.
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 Health Insurance Company | 35% |
| Manipalcigna Health Insurance Company | 62% |
| Future Generali Insurance Company | 73% |
| HDFC ERGO Health Insurance | 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% |
| New India Assurance Company | 103.74% |
| Oriental General Insurance Company | 108.80% |
| Raheja QBE General Insurance Company | 33% |
| Reliance General Insurance Company | 94% |
| Religare Health Insurance Company | 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% |
*Source IRDAI (Insurance Regulatory and Development Authority of India)
Documents Required For Claim Reimbursement
- 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
Coronavirus: IRDAI Issues New Guidelines For Settling Claims
The coronavirus is spreading very fast globally and many cases have been reported in India as well. Those who are insured under the health insurance plan have a question- whether their claims related to coronavirus will get settled or not? Insurance companies confirm that all cases related to coronavirus will be treated/covered as any other illness only. Such claims will be processed as per the regular norms.
Recently, IRDAI has issued a set of guidelines to be followed by the insurance companies when it comes to handling claims associated with coronavirus.
- As hospitalization is covered under the health insurance plan, insurance companies should ensure to handle coronavirus cases expeditiously.
- The associated cost of the medical treatment during the period of treatment or the quarantine period need to be settled as per the terms and conditions of the policy agreement only.
- All the cases related to the COVID 19 need to be reviewed thoroughly by the claims review committee before rejecting any claim.
The IRDAI has also asked insurance companies to come out with a product that will exclusively cover the treatment of coronavirus and multiple specific diseases that includes vector-borne diseases. Many health insurance plans do not offer cover against a pandemic disease. However, to date, WHO has not declared Coronavirus as pandemic disease, but the risks exist. Right now, coronavirus can get the complete cover as it is not even considered as a pre-existing disease. Hence, there is no waiting period in such ailments.
New Rules of Pre-existing Diseases To Favour Policyholders. Check Out The Details
Pre-existing diseases have always been an easy excuse for insurance providers to reject the claims of their customers. Even after being fully-insured, the policyholders lose to insurance providers. Finally, IRDAI has changed the rules of the game and now, the ball is in the court of policyholders. In the latest circular, the Insurance Regulator And Development Authority Of India has deleted the 'modified/additional clause' from the definition of pre-existing diseases. Examples of such diseases include anxiety, diabetes, lupus, etc.
As per the definition of pre-existing diseases in September 2019 circular, if any critical illness is diagnosed within 3 months of purchasing the health insurance policy, it would fall under the category of pre-existing diseases and will be covered under the insurance policy. However, as per the latest circular, no illness will be a part of pre-existing diseases, even if, it is diagnosed after 3 months of purchasing the medical insurance policy. This modification will soon be updated in the standardisation of health policies.
This move by IRDAI is a step in the right direction. It will help in reducing the claim rejection rates in health policies. As far as insurance providers are considered, they have to abide by this modification on an immediate basis.
A Standard Health Policy (Arogya Sanjeevni) to Roll Out Soon. Here Are Its Details.
Today, the cost of a basic operation is like buying a budget four wheeler car. To protect investments, people prefer to buy health insurance. But they face a mammoth task of selecting one provider among the 100s. Different names/terms & conditions can mess with your head. To counter the problem, IRDAI has introduced a standard health policy- Arogya Sanjeevi. It will look after your essential health needs without adding many changes to policy's wordings.
All insurance providers have to roll out this policy from 1st April 2020. To distinguish themselves, they have to add the wording (Arogya Sanjeevni) before their name. For example, Arogya Sanjeevani Policy Birla Sun Life Insurance. It's not just the name that this policy will attend. It will bring key features that are stated below:-
- The minimum & maximum sum assured amount will be INR 1 Lakh & INR 5 Lakh.
- The entry age will be 18-65 years & in family floater plans (for children), the entry age will be 3 months to 25 years.
- The policy will allow an annual renewal period with 30 days of the grace period.
- All the mandatory expenses such as Ayush treatment, hospitalization, cumulative bonus, etc will be covered by the policy.
- No optional covers & add-ons are available.
- The policy will only operate based on reimbursement. For example, the claim for the hospital bill will depend on the sum assured.
- The policy can be bought on two basis- individual & family floater.
- Each provider will offer mandatory covers in this policy that will be the same in the market. However, they can set the premium on their terms.
Apart from them, the providers can be generous and offer additional benefits such as higher sum assured & wellness. It will certainly make their customer happy.
I met with an accident on 23rd Nov and the Star health Insurance Co settled the claim within a month though the hospital was not in Network. PolicyX. Com helped in this in early settlement.