Health Insurance Policies To Now Come With Color Codes
October 09, 2020
Health insurance protects the policyholder and his/her family against the medical costs that arise due to an accident, illness, or 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.
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 invest your entire energy in 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. Apart from the medical coverage, health insurance offers tax benefits on premiums paid under the Income Tax Act, 1961.
Let's understand the importance of having health insurance through an example.
There are two friends Vinay and Aman. In the mid of 2019, Vinay decided to buy a health insurance policy and even told Aman to buy one for him and his family. However, Aman denied the idea and thought it was a waste of money.
At the start of 2020, the outbreak of Coronavirus affected many people, and Vinay and Aman were one of them. They both lost their jobs and had to get hospitalized for the treatment.
Thanks to health insurance bought by Vinay, his insurance company paid for all the expenses, whereas Aman had to pay from his pocket, draining all his savings in the end.
Therefore, to secure your family and finances at a time of medical emergency, you need to have health insurance.
At PolicyX.com, we assure you to provide the right health insurance plan to suit your needs and requirements. Check out the list of best health insurance plans in India.
|Plan Name||Minimum Entry Age||Maximum Sum Insured||Network Hospitals|
|Care (Formerly Religare Care Health Insurance)||Adult- 5 years |
Child- 91 days
|Star Family Health Optima||Adult- 18 years |
Child- 16 days
|My: health Suraksha Silver Smart||Adult- 18 years |
Child- 91 days
|Aditya Birla Activ Assure Diamond||Adult- 5 years |
Child- 91 days
|HDFC ERGO General Optima Restore||Adult- 5 years |
Child- 91 days
Table Data updated on 22-01-2021
Apart from the above-stated plans, we have prepared a detailed list of the top 20 health insurance plans in India 2021.
To deal with the different needs of customers, there are multiple forms of health insurance plans available. Such plans are mentioned below:-
Critical Illness plan offers a fixed benefit/payout for critical illnesses specified under the respective policy. With the lump sum benefit, you will be able to pay the huge hospitalization costs and get the treatment on time. Learn More
Senior Citizen Health Plan is designed especially for the old age people who are above 60 years of age. This plan covers medical contingencies (may vary as per the policy) during old age. Learn More
Maternity health insurance is offered by several health insurance companies that cover pre and post-natal care, child deliveries, and vaccination expenses of newborn babies.
Individual health insurance covers the health expenditure of a single individual and there's always flexibility of availing the bigger sum insured.
Family Floater Health Insurance covers all family members under a single policy. All the family members can enjoy the benefit of the entire sum insured. The amount of the premium paid is less as compared to individual plans. Learn More
Coronavirus Health Insurance offers the required financial coverage for the treatment of COVID-19. Once the waiting period is over, the plan will cover the coronavirus specific expenses and allow you to recover in peace. COVID-19 is a new disease, hence it does not come under the category of pre-existing disease. Learn More
Unit Linked Health Plan (ULHP) is a combination of health insurance and investment. Along with health protection, ULHPs will help you in building a corpus that can be used to meet expenditures that are not covered under medical insurance plans.
Cancer is one of the leading causes of worldwide deaths. If your family has a history of cancer, you should invest in cancer insurance. It covers several types of expenses associated with cancer treatment such as hospitalization, chemotherapy, surgery, radiation, etc. Learn More
Group health insurance is a comprehensive health insurance plan, specially designed to offer complete protection to a group of employees of an organization. The plan offers coverage to the employees and their families against sudden illness, diseases, accidents, and unexpected hospitalization, etc. Learn More
Health insurance allows the policyholders to get the required treatment in the network hospitals without paying a single penny during hospitalization (up to the sum insured limit). The insurance company pays on their behalf and allows them to focus on their treatment.
The expenses before hospitalization and after discharge from the hospital (up to a specific period) are covered by health insurance policy only if the expenses are associated with the illness subject to terms and conditions of the insurance policy.
On buying a health insurance policy, you will be liable to receive tax advantages for the premiums paid under the Income Tax Act, 1961.
It provides daily cash (to a certain limit) to take care of the additional expenses of the hospital like food, traveling, etc.
The cost of the transplantation of an organ is bearable by the insurance company. Health insurance covers the surgery expenses related to organ donation.
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.
To motivate the policyholders towards a healthy lifestyle, insurance companies offer free occasional medical check-ups. Depending on the company and the type of policy, you will be eligible for a master health check-up.
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.
Once the sum insured amount is completely used, the insurance company will restore the amount automatically and you don't have to pay any additional cost for the benefit. The plans with restoration benefits are expensive as compared to normal health/medical insurance policies and are applicable as per the clauses of the policy.
Yes, your standard health insurance will offer coverage against COVID-19. The insurance will pay off in-patient and outpatient expenses incurred during the treatment of COVID-19.
However, looking at the prevailing condition of COVID-19, IRDAI has launched COVID-19 specific plans like Corona Rakshak and Corona Kavach for the Indian consumers. Let's find out more about them.
Corona Rakshak is an affordable health insurance policy that offers lump sum benefit to the policyholder if diagnosed with COVID-19. The plan offers 100% sum insured if the diagnosis confirms the presence of COVID-19 & requires minimum continuous hospitalization for 72 hours.
|Waiting period||15 days|
|Sum insured||3 months 15 days, 6 months 15 days & 9 months 15 days|
|Policy tenure||105 Days, 195 days and 285 days|
|Entry age||18 years to 65 years|
Corona Kavach is an affordable health insurance plan, which is designed to safeguard you and your loved ones from COVID-19. This policy aims at covering hospitalization, pre-post hospitalization, home care treatment expenses, and AYUSH treatment in case the policyholder is tested positive for COVID-19.
|Waiting period||15 days|
|Home care treatment||Up to the sum insured|
|Sum insured||50k- 5 Lacs|
|Policy tenure||3 months 15 days, 6 months 15 days & 9 months 15 days|
|Entry age||18 years to 65 years|
Since the COVID-19 has been declared as a pandemic, IRDAI has instructed health insurance companies to prioritize the coronavirus claim settlement. As usual, the policyholder needs to inform the insurer about the hospitalisation/treatment and submit the documents required. On proper verification, the respective insurance company will settle the claim.
The Insurance Regulatory and Development Authority of India (IRDAI) launched the Arogya Sanjeevani Health Insurance Policy on April 1, 2020. The main objective of this plan is to make health insurance more accessible, affordable, and less confusing for policy buyers.
The Insurance Regulatory and Development Authority of India (IRDAI) has now allowed all general and standalone health insurers to offer the Arogya Sanjeevani Policy as a group insurance product.
|Sum insured (In Rs.)||1-5 lakhs|
|Policy tenure||1 year|
|Entry age||18 years to 65 years|
Today, health insurance companies in the market provide a feature of portability. In simple terms, it means that you can switch from your existing provider to another one or from one plan to another (within the same insurer) if you are not satisfied with it. And the best part is that you don't have to lose the benefits (like the waiting period). Contact your respective provider for more information. Learn More...
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:
It is vital to check all the facilities and the coverage provided so as to fulfil the requirements of the treatment. Compare policies and make a checklist for your needs and choose the best plan accordingly.
Reliability of the Company
The policyholder should go through the insurance company's website and its details before choosing a medical insurance plan. The profile and the history of the company should be checked along with the customer reviews to make the right choice.
Sum Insured Amount
The principal point to be noticed while buying medical insurance is the sum insured offered by the insurer to the insured. If you or your family members are suffering from any specific disease, you might have a fair idea of the amount to be chosen for future health costs.
Room Rent Sub-limits
Insurance companies offer maximum coverage up to the sum insured, but at times, they deliberately trim down their liability by introducing the sub-limit clause in the coverage for hospital room rent.
Co-pay & Deductible
You should keep an eye out for the clause of co-pay & deductible, which insurance companies attach with some of their plans. Just to be clear, it is a predefined amount (in %), which the insured agrees to pay for medical services. For example, if the co-pay is 10% and the claim amount is Rs. 2 Lakhs, Rs. 20,000 will be paid by the insured and the rest will be taken care of by the company.
On the other hand, a deductible is the fixed amount, which the policyholder has to pay each year before his/her plan begins to pay for covered expenses. For example, a person's deductible is Rs.1,00,000. In March, the person has a viral infection and the doctor's bill is Rs.10,000. Since this is the first payment of the year, the entire amount will be paid by the person (insured). In June, the person runs into an accident and has minor surgery. The total bill comes out to be Rs.1,50,000. Here the person will pay Rs.90,000 and the rest is paid by the company. In October, the person has 2 fractures and the bill is Rs.40,000. Since the person has paid the yearly deductible, the entire expense will be paid by the company. Learn More
Companies offer numerous riders and additional benefits to the customer that boosts the coverage, scope, and advantage of the policy. You can also add a top-up plan with the respective coverage by paying an extra premium. Make sure that the company (you choose) offers such benefits.
Option For Cashless Claim
If the insurance company has tie-ups with network hospitals, it will provide a cashless claim facility. It proves to be useful during emergency hospitalization when it's hard to arrange for funds.
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:
Claim Settlement Ratio: While selecting the health insurance company, assessing the claim settlement ratio is an important criteria. Always select a company with a good claim settlement record.
Reputation of the Company: The reputation of the company plays an important role. It is advisable to go for a company that carries a good brand image. Sound research will be required that will help you to choose the right health insurance provider.
Financial Stability: You must check the financial stability of the company. You can check the Credit Rating Information Services of India Limited (CRISIL) rating. Go for a company with AAA Rating as it is considered to have the highest financial strength to meet its obligations.
Product Portfolio: Don't forget that insurance is a vast industry, which keeps on changing with time. It does not remain the same and neither does your needs. That's why it is important to go for a company that offers a wide range of helpful insurance policies, which cater to the different needs of customers.
Smooth & Quick Claim Settlement Process: It is advisable to search for an insurance company that follows a simple and easy claim settlement process. During emergencies, it is crucial to settle the claims on time so as to seek proper healthcare facilities.
Customer Support Service: Pay attention to the quality of customer service of an insurance company. For that, you need to check the ratings and reviews of the customers for the services provided. Choose the company that offers online chat, email assistance, and phone assistance.
Insurance Advisor: Insurance plans are filled with a bunch of terms and conditions, which are tough to understand. Today, many insurance companies appoint insurance advisors who help you to choose an appropriate insurance plan according to your needs.
Feedback and Reviews: You can go through the Insurance Regulatory and Development Authority of India (IRDAI) website to check the number of complaints and resolutions against the insurance company.
PolicyX.com is a one-stop-shop for all your insurance-related needs. It is the Insurance Regulatory and Development Authority of India (IRDAI) certified web insurance aggregator company (License Number: IRDA/WBA17/14).
You can compare health insurance plans from top insurance companies with PolicyX.com and buy the best plan as per your needs. Our team makes sure that you are getting the best deal within your budget; away from fake promises and products. Our systems and teams are well-equipped to help you with the buying procedure (from starting till the end). Let us look at the following key highlights about PolicyX.com:
The policy documents will be mailed to your registered email id. (*Note: Medical tests would be done according to the plan features and insurance company's norms and conditions).
The most important part of an insurance policy is the claim settlement process. Some insurance companies offer a direct claim settlement process, while others take the help of TPAs (Third Party Administrators) for claim settlement. The claim settlement process takes place in two forms, which are mentioned below:
You can avail of cashless treatment facility only in the network hospitals of the insurance company. Stick to the below-listed steps for the same.
Note: If the insurance company doesn't respond through any mode of communication, contact PolicyX.com. Call at our toll-free number 1800-4200-269 or write an email to firstname.lastname@example.org. We will help and guide you to settle your claims without facing any troubles.
The insurer can avail of the treatment in a hospital and pay the bills. Once that is done, (s)he can file for reimbursement via the below steps.
Note- If the insurance company doesn't respond through any mode of communication, contact PolicyX.com. Call at our toll-free number 1800-4200-269 or write an email to email@example.com. We will help and guide you to settle your claims without facing any troubles.
Health plans are indeed comprehensive in their scope of coverage. However, some things are excluded from health insurance. Below are a few instances that aren't covered under health insurance-
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.
|Insurance Companies||Incurred Claim Ratio (2018-2019)|
|Bajaj Allianz General Insurance Co Ltd||85%|
|Bharti AXA General Insurance Company||89%|
|Cholamandalam MS General Insurance Company||35%|
|Manipalcigna Health Insurance Company||62%|
|Future Generali India Insurance Company||73%|
|HDFC ERGO General Insurance Company||62%|
|Iffco Tokio General Insurance Company||102%|
|Liberty Videocon General Insurance Company||82%|
|Magma HDI General Insurance Company||90%|
|Max Bupa Health Insurance||54%|
|National Insurance Company||107.64%|
|The New India Assurance Company||103.74%|
|The Oriental General Insurance Company||108.80%|
|Raheja QBE General Insurance Company||33%|
|Reliance General Insurance Company||94%|
|Care Health Insurance Company(formerly Religare Health Insurance)||55%|
|Royal Sundaram General Insurance Company||61%|
|SBI General Insurance Company||52%|
|Shriram General Insurance Company||53%|
|Star Health Insurance Company||63%|
|TATA AIG General Insurance Company||78%|
|United India Insurance Company||110.51%|
|Universal Sompo General Insurance Company||92%|
Table Data updated on 22-01-2021
*Source IRDAI (Insurance Regulatory and Development Authority of India)
October 09, 2020
To make health insurance an easy and considerable job for the customers, IRDAI has come up with 'colour coding' for individual health insurance policies. This means that policyholders can now figure out the complexity level while purchasing health insurance. According to the regulator, health and general insurance companies will use red, green, and orange colors to specify the complexity level of the offered products.
Green colour will indicate that the health policy offered is easy and simple to understand. The orange colour will denote that the policy is a little complex to comprehend. Lastly, the red colour will indicate that the policy is complex and needs your full attention to understand its basics.
These colours will be specified on the health insurance policies and insurers need to state them on their websites to make it convenient for customers while buying health insurance. Now more than ever, health insurance has become a necessity and the IRDAI wants to help people in every possible way to make an informed decision. Surely, color coding will help to achieve this objective.
September 21, 2020
From October, health insurance premiums are about to increase. Since last year, IRDAI introduced a list of changes to make health insurance more 'Customer-oriented'. Finally, the IRDAI has directed all insurance providers to follow the rules and implement the changes, starting this October.
To dissolve uncertainties, IRDAI directed insurers to equalize the exclusions (medical ailments or diseases) that aren't listed under a policy. If a physician detects an ailment/disease 48 months before the issuance of health insurance, it will come under pre-existing diseases. Also, any condition whose symptoms are detected within three months of health policy issuance will come under pre-existing diseases. Lastly, treatment for stress and mental illness will be covered by health policies.
Such standardized clauses will help the customers and should be incorporated in the new policies on/after 1st October 2020 and for existing policies (due for renewal) from 1st April 2021.
Besides this, IRDAI also asked insurers to guarantee telemedicine coverage. Thanks to COVID-19, it has gained a lot of popularity. And as always, the insurance regulatory advised them to offer more rational claim deductions to policyholders.
September 08, 2020
With the ever-growing scare of COVID-19 around the globe, countries have accelerated the process of vaccine development. Many have seen positive results with multiple candidates entering the Phase-III trials. Soon, the world can hope to see a safe vaccine for COVID-19. But as the time comes closer, an important question needs to be answered- Will your existing health insurance pay for the vaccine?
A standard health insurance policy generally pays for hospitalization charges along with pre-admission and post-discharge expenses. If you test positive for COVID, gets hospitalized and need a vaccine, all health insurance policies will pay for the vaccine expenses. However, if you only need to get a dose of COVID vaccine (as a preventive measure) and no hospitalization is required, only those health insurance policies will pay for the vaccine that covers out-patient department.
Right now, it's not safe to say that all health insurance policies will cover COVID vaccine. Luckily, new policies have emerged in the market that happily pay for the cost of consumables like home treatment and PPE kits. With this, we can only hope that the cost of the vaccine may also be covered in the future.
August 14, 2020
Max Bupa health insurance has come up with a new health insurance plan (ReAssure) whose main objective is to offer an unlimited sum insured to the policyholders and their family. Be it any kind of hospitalisation (including COVID-19), the policy will provide the necessary coverage all year. The policyholders can claim as many times as they wish to, without paying an extra cost. This is beneficial for those individuals who struggle with critical illnesses like cancer or kidney dialysis and require multiple treatments in a single year.
The policy has introduced a 'Booster Benefit, where the sum insured will double in two claim-free years. Meaning, for one no-claim year, the sum insured will increase by 50%. For another claim-free year, the sum insured will increase by 50%, which comes out to be 100% in total. Also, if you only make a claim (in a year) for COVID-19, your booster benefit will remain safe.
Speaking of COVID-19, the policy has an initial waiting period of 15 days. It will only take 30 minutes for cashless claim processing, and if the policyholder dies due to this virus, the policy will cover the expense for non-payable items.
To enhance the coverage, ReAssure will take care of the financial expenses related to medical bills, protective equipment kit, oxygen masks, gloves, etc. This is a part of the policy's 'Safeguard Benefit', which ensures that policyholders won't have to pay any expense from their pockets.
Other benefits of the policy include- up to 30% off on renewal under 'Live Healthy' by walking, 10% off if two or more people are protected under an individual policy, 5% off for doctors, 7.5% off on second policy year's premium (for 2-year policy term) and additional 15% off on premium for the third policy year (for three-year policy term).
Before buying a health insurance plan, we are sure you must be having a lot many questions in your mind. Don't worry PolicyX.com is here to figure out the queries at its best. Let's go through some common queries:
Let's understand this with an example:
In your health insurance policy, the daily room rent limit is Rs. 5000. If room cost incurred during your hospitalization is Rs. 8000 per day, then the company is not liable to pay the additional Rs. 3000. You will have to pay it from your own pocket.
If the total cost incurred during the hospitalization is Rs.10 Lakhs, the table shown below illustrates the expenses that are expected to be borne by your insurer and you, respectively.
|Policy Sum Insured||10 Lakhs|
|Room-Rent as per sub-limit (in Rs)||5000|
|Room Rent per day (in Rs.)||8000|
|Total number of days for treatment (in days)||10|
|Actual Hospital Bill (in Rs.)||Reimbursed Amount (in Rs.)||To be borne by you (in Rs.)|
|Room Rent Charges(in Rs)||80,000||50,000||30,000|
|Doctor's Fee (in Rs)||30,000||18000||12000|
|Medical Test's Cost (in Rs)||30,000||18000||12000|
|Operation/Surgery cost (in Rs)||3,00,000||180000||120000|
|Total Expenses Incurred (in Rs)||4,40,000||2,66,000||1,74,000|
In the above case, the total cost borne by the policyholder is Rs. 1,74,000 out of Rs. 10,00,000. Therefore, before buying a policy, make sure to check whether your policy has sub-limits.
In India, the insurance providers use factors like age, health condition, coverage and number of individuals to be covered to determine the premium of a health plan. Let's take the help of an example for better understanding.
At the age of 25, if you want to purchase an individual health plan of the sum insured (Rs.10 lakhs), your premium amount will be Rs.608/month. Whereas, if you want to purchase an individual health plan of the sum insured (Rs.10 lakhs) at the age of 50 with smoking habits, your premium amount will be Rs.1831/month.
If you want to opt for a higher sum insured or require a family floater plan, take the help of our health insurance premium calculator to know the correct amount.
Note - The premium values keep on changing. Please check the amount first before investing in a plan.
Following is the list of documents needed to apply for health insurance:
Yes, your existing health insurance plan is liable to offer the required coverage against COVID-19 treatment. The plan will be there to assist the insured with the regular cover on hospitalization for any viral infection, including coronavirus. All the features that you get under the chosen health insurance policy will apply to COVID-19 treatment.
If you are a smoker, you will end up paying higher premiums as you are subjected to greater medical risks.
Most companies allow you to avail health insurance after a certain waiting period. You must check your policy document for the same.
Yes, Coronavirus health insurance comes out with a waiting period of 15 to 30 days from the date of commencement of the policy. Hence, it is advisable to check with your insurance company regarding any initial waiting period. Moreover, if you already have a regular health insurance plan, then you don't have to serve any waiting period under the same.
It varies from insurer to insurer. Some companies do not provide cover for pre-existing diseases, while others cover the same after a waiting period of 4 years (this may vary as per the company).
It is important to buy health insurance at an early stage of life. The early you invest, the better coverage you get, and the less premium you have to pay.
As coronavirus specific insurance is almost similar to standard health insurance, it can be claimed via cashless and reimbursement means.
A health insurance plan safeguards your finances against the future mighty medical expenses. It is necessary but not mandatory to buy health insurance in India.
Yes, there's no limit to the number of claims in a single year unless there is a specific cap laid down in the policy.
Yes, every insurance company has a network of hospitals in which cashless treatment facilities are available to the policyholders. To get the information about the nearest network hospital, you should check the policy document or respective insurance provider's website.
Most insurance companies will not deny the renewal within the grace period, which is usually of 15-30 days from the date of expiry of the policy. 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 the premium is not paid within the grace period.
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. Check with your insurance company for the detailed clauses in this regard.
Some insurance companies promise to reimburse general health checkup expenses once every 4 years. But it can vary from insurer to insurer. You need to check for the same with your respective insurer.
health insurance provides cover to diabetes patients and related complications. However, it may vary from insurer to insurer. Most of the companies provide the same after a waiting period of 4 years. For more details, please click here
Yes, health insurance covers the medical tests and scans for the inpatient treatment, i.e., during hospitalization for at least 24 hours.
A waiting period of 48 months applies to avail of maternity insurance benefits. A cover of Rs. 25,000 in cesarean delivery and Rs. 15,000 is usually provided in a maternity benefit of health insurance plans. To get more information, please visit this link.
Age is the biggest factor that determines the premium payable. The older you are, the higher is your premium, as 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 also eligible for a discount on the future premium payable if you have not claimed in the previous years.
Goods and Services Tax (GST) - implemented in 2017 - is an indirect tax levied on the sale of goods and services in India. It has replaced many indirect taxes imposed on goods and services by the State and Central Government. Before the new tax regime, the service tax rate applicable to health insurance was 15%. However, with the implementation of GST, the tax rate has been raised by 3% placing health insurance in the 18% tax bracket.
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Last updated on 22-01-2021