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What Is Health Insurance?

Health insurance, also called Mediclaim, is a way to pay for advanced medical treatments that typically require you to be in hospital overnight. It also covers certain other day care procedures like cataract surgery, etc. that don’t require you to be hospitalized but are expensive nevertheless. A health insurance policy, therefore, covers your medical expenses and gives you financial relief.

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Why is health insurance policy important & why should you buy it?

Medical insurance is a form of insurance which covers the medical costs incurred in case of medical emergencies. These plans, thus, take care of the financial burden associated with medical contingencies. In today’s age, when illnesses and diseases are on the rise, a health insurance plan becomes necessary. Though medical developments have provided a cure for most of the illnesses, such as cures and treatments come at very expensive costs. These costs become unbearable for the common middle-class man. A health plan, by covering these costs, takes off the financial strain caused by frequently occurring illnesses. It, therefore, proves to be an essential requirement for every individual looking to secure his finances against medical contingencies.

Why is health insurance policy important & why should you buy it?

  • Individual health insurance plans:
    Individual health insurance plans which cover a single individual under the cover
  • Family floater health insurance plans:
    Family floater health insurance plans which cover the entire family under the plan. A family consists of the policyholder, spouse, dependent children, and dependent parents. One plan covers the entire family on a floater basis. The sum insured is shared by the family members. Any member can make a claim up to the sum insured.
  • Critical illness health insurance plans:Critical illness health insurance plans which cover major critical illnesses. If the insured is diagnosed with any covered illness, the sum insured is paid. The policyholder can use the sum insured to meet the cost of advanced treatments or pay for any other financial obligations
  • Top-up health insurance plans: Top-up health insurance plans which provide supplemental coverage at minimal rates of premiums. If individuals feel that their coverage is low, they can buy top-up plans to increase the coverage. There is a deductible limit under these plans. Any claim which is in excess of the deductible limit is paid.
  • Super top-up health insurance:Super top-up health insurance plans which are also called aggregate health plans. These also help to enhance the sum insured at affordable premium rates. Super top-up plans are like top-up plans. They also have a deductible limit and claims exceeding the limit are only paid. However, while top-up plans consider each instance of claim separately, super top-up plans aggregate the total claims made in a policy year and then apply them against the deductible limit. If the aggregate claims exceed the deductible, the claim is paid
  • Senior citizen health insurance plans: Senior citizen health insurance plans which are meant to cover individuals in their older ages. Individuals who are 61 years and above can be covered under senior citizen health insurance plans. The sum insured under these plans are limited and premiums are affordable.
  • Hospital cash plans:Hospital cash plans which pay a fixed benefit for each day of hospitalisation. If the insured is hospitalised, a daily allowance would be paid every day up to a maximum period.
  • Disease-specific health plans These can be indemnity oriented or fixed benefit health insurance plans which cover specified illnesses like diabetes, cancer, heart-related ailments, dengue, etc.You should understand the types of medical insurance plans before choosing the best plan suiting your requirements.

Why should you buy health insurance online?

There has been a constant rise in the percentage of health-related risks over a few decades. This has made it more and more necessary for us to get ourselves insured and avoid any financial crisis during medical emergencies. Buying insurance policies online has a number of benefits over traditional mode of investing in policies-

  • Time Saving
    The availability of so many policies online has made it easy to get quotations for the policies of your choice and it also helps you in saving the time you would have spent talking to an insurance agent.
  • Easy Comparison
    With all the information available within the reach of your hands, you can compare the policies, calculate the premiums and choose the best plan for your budget.
  • Lot of ChoicesWhen you come to an insurance platform like Turtlemint, you have a lot of options, making it easy to go through a range of plans and products.
  • 24*7 AvailabilityYou can get policy-related information and service all round the clock
  • Instant CoverageOnline health insurance providers provide you with an policy document and thereby making your insurance active immediately. Although the method is so fast, it is extremely reliable and safe. At Turtlemint, we make sure that your transactions are kept safe and private.
  • Discounts Most insurance companies offer premium discounts when you buy a policy online. You must always be on a lookout for the best deals that are easily available online.

Top plan of health insurance in India

Here is a list of some of the best plan of health insurance in India which you can buy for a comprehensive scope of coverage–

Name Of The PlanEntry Age LimitSum Insured LevelsSalient Features
Star Health Family Health Optima PlanChildren – 16 days onwards

Adults – 18 years to 25 years
INR 3 lakh to INR 25 lakhsAuto recharge of the sum insured free of cost
Coverage for assisted reproductive treatments
Annual free health check-ups
Religare (Now known as Care Health) Care Plan91 days onwards. No maximum entry ageINR 4 lakhs to INR 6 croresWide range of coverage variants to get the best fit
Free annual health check-ups
Range of optional add-ons with add-ons specifically for COVID coverage
HDFC ERGO Optima Restore91 days to 65 yearsINR 3 lakhs to INR 50 lakhsDoubling up of the sum insured through Multiplier Benefit within 2 claim-free years
Sum insured restoration
Premium discounts for developing the habit of walking
ICICI Lombard Complete Health Insuranceindividual coverage – 6 years onwards

Floater coverage – dependent children 3 months to 5 years

Adults – 18 years onwards
INR 3 lakh to INR 50 lakhsThe benefit of sum insured restoration
A range of optional additional coverage benefits for all-round protection
Value-added and wellness benefits
Free annual health check-ups
Aditya Birla Activ Health Platinum – Enhanced91 days onwards. No maximum entry ageINR 2 lakhs to INR 2 croresThe inbuilt benefit of sum insured restoration
Lump-sum recovery benefit for hospitalisation exceeding 10 days
Health Returns for a healthy lifestyle
Future Health Suraksha90 days to 70 yearsINR 50,000 to INR 10 lakhsHospital daily allowance for senior citizens
Additional 25% sum insured for accidental hospitalisation
Sum insured recharge benefit
Universal Sompo Complete Healthcare Insurance1 day to 70 years
INR 1 lakh to INR 10 lakhs
Accidental dental expenses are covered under the policy
Coverage for OPD expenses
Vaccination coverage against animal bites

How to buy health insurance online?

When investing in a health insurance plan, it is recommended that you first browse through the wide range of policies that are available online. You would like to choose a policy which is hassle free and serves your unique needs. There are a few factors that you should consider while buying an insurance online:-

  1. Check For The Insured Sum
    Many companies limit the amount that you can invest in a policy. If you wish to invest a higher sum, look for insurance that suits your requirements. Generally, having a cover that is six times of your annual salary is good. If you have plans of starting a family in a few years, don’t forget to explore the maternity coverage option.
  2. Check For The Hospitals
    Different companies have tie ups with different hospitals. Make sure that your insurer provides cashless coverage at the top hospitals in your city. This would make the entire process smooth.
  3. Check The Policy Terms
    Different plans have different limits and sub-limits. Hence, before making any investment be sure that you have read and completely understood the guidelines. Be very sure regarding how much cost would be covered by your insurance per hospitalization.And what are the pre and post limits of the plan as well. Some companies provide 30 day pre and 60 day post hospitalization costs while some companies provide 60 and 90 days period.
    Certain exclusions are included in each and every plan. Make sure you read through them carefully. Check for the waiting periods and co-pay. Shorter waiting period and voluntary co-paying is ideal.
  4. Don’t forget Additional Benefits
    Most health insurance companies offer additional benefits with the policies to hold themselves up in the competitive market. The no claim benefits and restoration benefit are the most popular ones. Make sure that the company you are choosing has a good market reputation, is trusted and provides good customer care service 24*7 throughout.

Key features of health insurance

The notable key features of any health insurance in present market are-

  1. Coverage
    The coverage includes the comprehensive expense of everything that can happen during a health emergency. It includes pre-hospitalization, post-hospitalization and ambulance charges. Most insurances also cover critical health diseases like cancer, stroke, heart attack, etc.
  2. Renewal Benefits
    Most companies offer a no claim bonus benefit to its customers if no claim request is made by them in the previous year. Some companies also offer benefits in the form of discounted premiums or increased cover or a complete free health check up every year as well.
  3. Co-payment
    It is one of the great features offered by good health insurance companies, helping to reduce the yearly premium. You have to pay a percentage of the total expense while the company will pay the balance.
  4. Cashless Treatment
    Most health insurance companies have a collaboration with a number of healthcare centres and hospitals. When you seek treatment in a network hospital, the insurance company will pay your bills directly and you will have to pay only for the uncovered expenses.
  5. Tax Benefits
    Under section 80D of Tax Act 1961, you will enjoy tax exemptions for paying premiums on health insurance. The tax benefit can be enjoyed both by you and your family members.
  6. Flexibility
    You can change the premiums to be paid every month or the term life of your policy after a certain period.

Benefits of comparing health insurance plans online

  • It is Easy and Convenient
    To compare the different policies on Turtlemint, all you have to do is go through the different options, compare and then choose the best plan. The added advantage is you can do it at your convenient time since the information is always available. You don’t need to visit the providers or agents again and again for details.
  • It is Free
    You can compare the policies online for absolutely free of cost. It means you can get a quote from the insurance policy companies as many times as you want without fearing to get charged for it.
  • It is Economical
    Most of the companies offer policies at reasonable rates and thus charge lower premiums on the insurances purchased online in comparison to the offline insurances, without compromising on the coverage.
  • It helps you Calculate The Premium
    The online premium calculators help you in determining the premiums to be paid based on the policy you plan to buy and the amount you want to invest. You can try different permutations and combinations and choose the best plan for yourself. Hence, it helps you in making a proper financial plan.
  • You Can Choose Desired Coverage
    Online health insurance calculator is a great tool to help you in understanding the different coverage options you can opt for, be it for your family health insurance plan or personal health insurance. You can go through different plans’ inclusions and exclusions before choosing the best for you.
  • You Can Choose Your Add Ons
    Apart from the coverage amount and premium amount, you should also know about the claim settlement ratio. You can opt for a policy that offers annual medical check ups, free emergency ambulance service, shorter waiting period and similar benefits so that your out-of-the-pocket treatment cost is minimised.

Benefits of health insurance plans & policies

Medical insurance policies offer various advantages and come with unique features which are as follows –

  • Medical insurance plans cover all medical costs incurred right from the time the insured falls sick to his hospitalisation and also after being discharged from the hospital. Thus, the plan has a wide scope of coverage for medical costs
  • There are value-added coverage benefits in medical insurance policies too. These include free health check-ups after a specified period, second medical opinion for serious illnesses, etc.
  • Health plans allow tax advantages. Premiums paid for medical insurance policies for self, family and dependent parents qualify for tax deduction under Section 80D. The limit of deduction if INR 25, 000 for covering self and family and another INR 25, 000 for covering dependent parents. Moreover, if either the policyholder and/or dependent parents are senior citizens, the maximum limit increases to INR 50, 000 in each instance. Thus, a maximum of INR 1 lakh can be claimed as tax deduction though health insurance plans
  • No Claim bonus is allowed in all medical insurance plans if no claim is made in a policy year. This bonus is either allowed as an increase in the sum insured or additional benefits can be availed like gift vouchers, annual health check-ups, etc. 
  • Lifelong renewals are offered by health plans with no maximum cover ceasing age
  • The term of the plan can be for one, two or three years. Moreover, if long term plans are chosen, a premium discount is also allowed
  • Individuals can claim premium discounts for covering two or more family members, by choosing a longer duration, by choosing voluntary co-payment, etc.
  • Cashless claims are settled by the health insurance company if the policyholder seeks treatments at a hospital which is tied-up with the insurance company. In cashless claims, the policyholder does not have to bear the burden of medical expenses. The expenses are settled directly by the insurance company with the hospital.

Does my existing health insurance policy include coronavirus (COVID-19) treatment?

Yes, your existing plans of health insurance in India would cover Coronavirus treatments if you are hospitalised. However, the policy would exclude the costs of consumables incurred on such treatments. Since the cost of consumables is high, you can opt for COVID-specific medical insurance policies which are available. IRDAI has launched these plans of health insurance in India for providing complete coverage against COVID. The plans are as follows –

  • Corona Kavach This is an indemnity oriented health insurance plan which covers all medical expenses incurred on COVID treatments. The policy covers hospitalisation costs as well as home quarantine expenses without any deductibles or sub-limits.
  • Corona Rakshak This is a fixed benefit health insurance plan which covers COVID. If you suffer from Coronavirus and are hospitalised for 3 days or more, the policy would pay the sum insured in a lump sum to provide you with the financial assistance needed for COVID treatments.

Health insurance policy inclusions

A basic medical insurance plan provides all the essential coverage features. You would find coverage for the following – 

  • Inpatient hospitalisationthis includes coverage for room rent, ICU room rent, cost of treatments, doctor’s fees, surgeon’s fees, nurses’ fees, etc.
  • Pre and post hospitalisationexpenses incurred before being actually hospitalised and after being discharged from the hospital are covered under this head
  • Ambulance costscosts incurred in transporting the insured to the hospital is covered up to a specified limit
  • Daycare treatmentstreatments which do not require hospitalisation for a minimum of 24 hours are covered under this section
  • Organ donor expenses expenses incurred on harvesting an organ from a donor are covered
  • Domiciliary treatments treatments taken at home because the insured cannot be moved to the hospital or because there are no vacant beds in the hospital would be covered
  • AYUSH treatments these treatments are alternative, non-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy. Most health plans cover medical expenses incurred on these treatments.

Besides these common coverage features, different medical insurance policies provide different coverage features too which make the plan comprehensive in nature.

Health insurance policy exclusions

Though medical insurance plans provide coverage for most of the medical expenses, there are some expenses which are not covered. These are called plan exclusions. Some common ones include the following –

  • Pre-existing illnesses during the waiting period
  • Illnesses occurring within the first 30 or 60 days of buying the policy
  • Congenital ailments and diseases
  • Cosmetic treatments
  • Pregnancy-related treatments, unless specifically covered
  • HIV/AIDS infection
  • Illnesses or injuries occurring due to war or related perils, aviation, nuclear contamination, self-inflicted injuries, alcohol or drug abuse, etc.

To know the exact exclusions, you should read the policy document. Different medical insurance policies have different inclusions and exclusions. So, understanding the policy details before buying the policy becomes essential. It’s best to disclose your medical history truthfully before you buy a policy to ensure your claim expectations are met. Discuss this with our expert to figure out your best options – we will maintain strict confidentiality.

What is the difference between health insurance and mediclaim policy?

BasisMediclaimHealth insurance
Coverage OfferedA mediclaim plan covers only hospitalisation, accident-related treatment and pre-existing diseases up to a pre-specified limit.A health insurance plan provides comprehensive medical coverage for pre-hospitalization charges, hospitalisation charges, post-hospitalization charges, ambulance expenses, and more. On top of it, the plan offers compensation in case of loss of income due to an accident.
Add-on CoversNo add-on cover is available.It may offer multiple add-on covers, including critical illness cover, personal accident cover, maternity cover, etc.
FlexibilityMediclaims are not flexible in terms of coverage.Health insurances are flexible when it comes to coverage and premium. The premium can be increased or decreased, especially for long term plans..
Critical Illness CoverMediclaims do not cover critical illnesses.Health insurance covers more than 30 critical diseases, such as cancer, stroke, kidney failure, etc. depending on the policy.
ClaimsClaims can be made multiple times until the assured sum is exhausted.Claims can be made multiple times until the assured sum exhausts and sometimes with restoration benefit, even beyond that.
HospitalisationTo avail mediclaim benefits, getting hospitalised is necessary.To avail health insurance benefits, it is not necessary for the insured to get hospitalised. Health insurance provides pre-hospitalization, post hospitalisation and daycare coverage too.

Health insurance riders

  1. Accidental Disability Rider
    Critical illness policy adds coverage if you are disabled due to an accident. If completely disabled, the total assured sum is provided. However, you’re partially disabled only a percentage(depending on severity) of the assured sum is provided.
  2. Hospital Cash Rider
    Under this rider, you will receive a cash amount for every day that you spend in hospitalisation. For most policies, you must spend at least 24 hours before availing the coverage.
  3. Room Rent Waiver
    Certain policies come with a cap on room rent. For example, if the room you rented charges you INR 4,000 everyday but your insurance covers only INR 2,000, you’ll have to pay the rest of the amount from your pocket. To avoid this you can avail this waiver. One added benefit is, you can choose your own room (subject to certain conditions).

Factors to consider while deciding the health insurance company and its plan

  • Understand the type of coverage required first and foremost, individuals should understand the type of health plan which would suit their needs. If they don’t have any health insurance, a family floater or individual plan is recommended. If there is an existing health plan, a top-up plan is good for enhancing coverage at low health insurance quotes. Critical illness plans are also a must for protection against major illnesses while disease-specific plans are helpful in protecting against specified ailments. Individuals should assess their requirement and choose the most suitable plans for themselves.
  • Ensure that all family members are covered health contingencies can strike anyone and so individuals should endeavour to cover all of their family members under health insurance plans.
  • The sum insured should be optimal the sum insured of the medical insurance plan should be sufficient to pay for the high medical costs which would incur in an emergency.
  • Look for comprehensive coverage features the medical insurance plan which provides the most inclusive coverage benefits would be the best health plan. Individuals should look for such comprehensive plans and see if the coverage benefits are relevant to their needs.
  • The premium rate should be reasonable besides the coverage benefits which should be all-inclusive, the premium of the best health insurance plan should also be reasonable and affordable. If the plan has very high premiums, it would not be the best health insurance plan.
  • Compare before buying to choose the best health insurance plan in India, the best way is to compare the different plans and then buy one. Comparing lets you see the available plans and helps you in choosing one plan which is the best from the rest.

Health Insurance claim settlement procedures

To make a successful claim in a health insurance policy, policyholders are required to follow the below-mentioned process –

  • The policyholder should inform the insurance company of the claim. This information is to be given by filling up and submitting a pre-authorisation form. The insurance company analyses the form and approves cashless claim settlements. The form should be submitted at least 4-5 days before a planned hospitalisation. If, on the other hand, the hospitalisation was an emergency, the form should be submitted within 24 hours of hospitalisation
  • The health card or the policy bond should be produced to the hospital along with the identity proof of the insured
  • The company would then take care of the medical expenses
  • All medical documents, reports and bills should be submitted to the insurance company along with the claim form.

In case of reimbursement claims

  • The insured should get admitted to a non-network hospital and avail the necessary medical treatments. Payment for the treatments would have to be done by the policyholder himself
  • Once the insured is discharged from the hospital, the discharge summary or discharge certificate should be collected
  • The claim form should be filled and submitted with the discharge certificate, medical reports and all original medical bills
  • The insurance company analyses the documents submitted and reimburses the claim amount to the policyholder’s bank account.

Why buy A health insurance plan at an early age?

There are too many reasons to justify the point why an individual must start investing early in his life:-

  1. Comprehensive cover
    If you make the wise decision of buying a health insurance plan early in life then you’ll enjoy the benefit of a much more comprehensive coverage. You will get more security and enhanced coverage that would be difficult at a later stage.
  2. Cheaper Premiums
    The company charges less premiums from younger individuals as they are expected to be in the pink of health and thus less chance of claim.
  3. Tax benefits for long
    Under section 80D of Tax Act 1961, you will enjoy tax exemptions for paying premiums on health insurance. If you purchase it at a younger age, you’ll enjoy the benefit for a longer time.
  4. Long tenure of coverage
    Taking health insurance at a young age assures more coverage in the longer period of time.
  5. Bonus
    Most insurances provide a ‘no-claim’ bonus when the policy is renewed and the cover is not availed in the previous year. If you buy the insurance at a young age and keep collecting the no-claim bonuses on policy renewal, it will increase your coverage amount when you’re old and grey.
  6. Waiting period
    Most coverage features come with a waiting period of 30 days to 4 years, if you invest early in the policy, you may avail the facilities when required instead of stumbling on the waiting period.

Tax benefits of health insurance

What’s better than enjoying two facilities with one investment? Under the section 80D of Tax Act 1961, if you invest in the premiums of a health insurance, you can enjoy tax exemption upto a certain limit. The following table shows the tax breakdown-

EligibilityExemption Limit* as per the Budget Bill FY 2022-23
For self and family (spouse, dependent children)Up to INR 25,000
For self, family + parents (all below 60 years of age)Up to (INR 25,000 + INR 25,000) = INR 50,000
For self and family (where the eldest member is below 60 years of age) + parents (above 60 years)Up to (INR 25,000 + INR 50,000) = INR 75,000
For self and family (eldest member is above 60 years of age) + parents (above 60 years of age)Up to (INR 50,000 + INR 50,000) = INR 1,00,000

List of documents required for health insurance claim settlement

For successful claim settlement in your health insurance policies, you have to submit a set of documents. These documents include the following –

  • The claim form, filled and signed
  • Pre-authorization form for cashless claims
  • Doctor’s recommendation for advice on hospitalisation
  • All original medical bills
  • All investigative and diagnostic reports in original
  • All hospital records in original 
  • Consulting medical practitioner’s certificate 
  • All pharmacy and medicine bills

Eligibility criteria for health insurance

Here are some of the important eligibility criteria of health insurance plans –

  • A health insurance policy can be bought by an adult aged 18 years and above. The maximum entry age under many plans is 65 years or 70 years while some plans allow lifelong entry. Children can be covered under health insurance plans on an individual basis from 5 years onwards. Under floater coverage, though, dependent children can be covered from 91 days onwards till a maximum of 23 or 25 years of age till they are considered to be dependent on their parents
  • Health insurance plans are renewable for life and there is no coverage ceasing age
  • The sum insured starts from INR 50, 000 and the maximum limit depends on the policy that you choose
  • Under floater plans, you can cover yourself, spouse, dependent children and parents. Many plans also allow extended coverage for parents-in-law, grandparents, siblings and other close relatives of the family
  • The term of health insurance plans is one year but many plans allow you to buy a multi-year policy where the term can be taken for a continuous period of 2 or 3 years

Understand terms included in your health insurance policies

Before investing in any policy be confident that you have understood every term and condition mentioned over there. There might be certain formal words that could make it tough for you to understand the policies. Let us quickly discuss them one by one-

  • AYUSH treatment
    For those who wish to opt for alternate treatment, companies also offer AYUSH treatment that covers Ayurveda, Yoga, Unani, Sidha and Homeopathy.
  • Claim
    The amount of money requested by the insured person due to payment settlement at the hospital.
  • Claim Settlement
    The procedure of you filing a claim and the company paying you the money/ paying it on your behalf is the claim settlement.
  • Co-payment
    Cost payment is sharing the cost under a health insurance policy. When the policyholder agrees to bear a specified percentage of the payment of hospital bills, then the premiums charged are lessened by the insurance company, while the sum insured remains the same.
  • Cumulative Bonus
    Cumulative bonus, also known No-claim bonus is offered on every claim free year, provided the policy is continuously renewed. The sum insured increases by a fixed percentage however, it cannot exceed more than 50% of the main sum insured.
  • Daycare Procedures
    Most policies only cover expenses of hospitalisation that is for over 24 hours. However, certain companies also offer coverage for procedures that do not require a long hospitalisation. For example dialysis, chemotherapy etc.
    IRDAI stands for the Insurance Regulatory and Development Authority of India. This apex body regulates the Indian insurance industry.
  • Premium
    A fixed amount of money that has to be paid in order to avail the insurance coverage benefit.
  • Policy It is the legal contract between the insurer and the insured person.
  • Network Hospitals
    A health insurance company has a tie-up with hospitals where their customers can seek cashless treatment. Such healthcare centres are called network hospitals.
  • Sum insured
    It is the payout amount that the insurance company is liable to pay in case of any eventuality. It works on the indemnity principle.
  • Waiting period
    It is the period of time during which you cannot enjoy certain benefits of a policy, if the policy is new. It is usually a fixed period of time that commences from the date of commencement of policy. After the waiting period is over, those benefits become available to you.

How to calculate health insurance policy premium online?

Using a health insurance policy calculator is really easy. All you need to do is enter certain details and choose the plan that suits your requirements the best, include add ons if necessary and submit.
If you are looking for buying a insurance policy from an online portal, please follow the steps given below-

  • Visit the website and under Health Insurance choose the compare plans option.
  • hen include your details and of the people you want to secure. Details like age of the eldest member, pin code, mobile and other relevant pieces of information.
  • Once you click the ‘Get Quote’ button, all the options will be available to you.
  • Then pick the plan that best suits your needs and proceed forward.
  • Based on your choice, now the calculator will display the premium you need to pay for availing the health insurance.
  • Now, you can customise your plan based on your requirements and to maximise the coverage amount.

What are the factors that affect health insurance premiums?

  1. Age
    The general rule of thumb is, higher the age, higher the premium. It is because older people are more likely to suffer and claim the insurance than young people who are in the pink of their health.
  2. Past Medical History
    It highly affects the amount of premium you are going to pay. If you have a pre-medical condition, then the premium charged is higher. However if you are relatively healthy, the premium is less.
  3. Occupation
    Your occupation highly influences your premium rates. For example, if you are a corporate employee or a teacher, the premium would be less, however, if you work at a construction site or factory, premiums are generally high. This happened due to the degree of risk factor that is involved with both kinds of task.
  4. Body Mass Index (BMI)
    People with a higher BMI are prone to more ailments like heart diseases, type 2 diabetes, breathing problems, high blood pressure and cancer than people with lower body mass index. Hence the premium is higher for the people with more BMI.
  5. Smoking habits
    Insurance companies view smokers as high-risk insurance buyers since they are more inclined towards health risks. Therefore, smokers are charged more premium in comparison to non-smokers.
  6. Geographical Location
    The location where you stay affects your premium cost since certain regions lack proper healthy food options, climate and health facilities.
  7. Policy Duration
    If you choose a longer term plan, the premium would be less that is why investing earlier in health insurance is always suggested.
  8. Co-insurance feature
    If you choose the co-insurance feature of the company while purchasing the policy, your premiums reduce to a great extent.

Some myths about health insurance

When it comes to health insurance, there are still many who are not very well versed with its components. Due to lack of information, often myths can arise. Here are some of the most common myths regarding health insurance and its coverage-

  1. Myth:   I am young and fit. I don’t need health insurance.
    Reality   It is the best time to invest in a health policy while you are young and fit. Companies will charge you a lower percentage of premium and you will receive a greater amount of coverage over a long period of time.
    Certain diseases do not show early symptoms and by the time they become critical and evident, it becomes too late to invest in a policy and avail the benefits because pre-existing health conditions come with a waiting period of 36 to 48 months generally from the day of buying the policy.
  2. Myth:   24-hour hospitalisation is mandatory for making a claim
    Reality No, it’s not. With the rapid improvement in medical technology, certain surgeries/ daycare procedures get completed within 24 hours and do not require hospitalisation. Such coverage is offered by most companies, yet make sure your policy contains all such benefits.
  3. Myth:   My health insurance policy will cover 100% of my hospital bills
    Reality Every policy has different caps and limits when it comes to claim settlement. Hence, a certain amount of the entire expense is usually provided by the insurance companies at every claim settlement. There are certain exclusions in every policy, these uncovered expenses are to be borne by the policyholder.
  4. Myth:   I do not have to disclose all my medical details.
    Reality Disclosing all the medical details to the insurer is required in order to confirm that your medical condition falls under the coverage terms of the company. It is also necessary to give proof of expense for making claims. Hiding information can lead to rejection of claims and even legal trouble.
  5. Myth:   If I have a health issue, I will not be able to buy health insurance.
    Reality You can buy special health insurance if you have pre-existing conditions. There are certain health insurance products specially made for people who have some medical issues. However, the effect of your health condition will directly affect the premium to be paid.
  6. Myth  A health plan does not cover maternity benefits.
    Reality Not all health plans cover maternity benefits, so be sure to check the same while investing in a policy. However, most insurances offer that add-on and maternity benefits can be enjoyed only after the completion of the waiting period. There are companies that have especially made health insurance products for women.
  7. Myth  Buying health insurance through an agent is the best way to buy.
    Reality Nowadays, with so much information available online, it is best to invest in health insurance after proper comparison with all the other companies. You can use the premium calculators to find policies online and compare. Buying health insurance online will not only save you time and effort, but can also help you get a good deal.

Health insurance portability

Porting can be done using the following ways –

  • The medical insurance company should be informed about the porting request, in writing, at least 45 days before the renewal date
  • A porting request should be sent to the insurance company
  • Apply with the new insurance company and provide the details of the existing policy
  • The company checks the existing policy details and then allows porting
  • A new proposal form of the new policy should be filled and submitted with the new insurance company
  • The premium should be paid
  • The plan would be ported and a new insurance policy would be issued containing the renewal benefits of the existing policy

Only if the above steps are followed will the health plan be ported.

Frequently Asked Questions

Health insurance, also called as Mediclaim, is way to pay for advance medical treatments, that typically require you to be in-hospital overnight. It also covers certain other day procedures like cataract surgery, etc that don’t require you to be hospitalized but are expensive nevertheless.

Online premium calculators are available for calculating the premiums payable for health insurance plans. These calculators are available both on insurance companies’ websites and also on insurance aggregators’ websites. Insurance aggregator websites calculators are better because they let individuals compare the health insurance quotes of different plans at once.

The calculator works on the input provided by individuals. Individuals have to enter the following details in the calculator to arrive at the health insurance quotes –

  • The number of members to be covered
  • The age of all the members who are being covered
  • The sum insured which is required
  • Any additional coverage benefits which are to be added. Additional coverage benefits, if chosen, would attract an additional premium
  • The term of the plan
  • If the insured or any other members suffer from any pre-existing illness or not
  • Any discounts which are applicable to the premium

When all the above-mentioned details are put in the calculator, the calculator calculates and lists the health insurance quotes of different medical insurance plans available in the market. Individuals can, then, compare the premium rates and coverage benefits and select a health insurance plan.

Health insurance claims are of two kinds –

  • Cashless claims
  • Reimbursement claims

In cashless claims, the insurance company settles the medical bills directly with the hospital. The policyholder does not have to pay for any medical costs himself. Cashless claim settlement can be availed if the policyholder chooses to get admitted to a hospital which is tied-up with the insurance company.

In the case of reimbursement claims, the medical expenses are to be borne by the policyholder initially. Thereafter, when the insured is discharged from the hospital, the claim is submitted to the insurance company with all the relevant bills and medical documents. The company analyses the claims and then reimburses the policyholder for the medical expenses incurred. Reimbursement claims are applicable if the policyholder does not choose a networked hospital for treatments.

Yes, the online medium provides not only an easy way to buy health insurance, it is safe too. If you choose reputed and trusted websites, you can buy a health plan online without worrying about safety.

Pre-existing illnesses are covered after the first few years of the plan. This period, when pre-existing illnesses are not covered, is called the waiting period. Health insurance plans have a waiting period ranging from one year to four years.

No, exclusions are those expenses which are not covered by the health insurance plan. Thus, you would not get a claim for an excluded expense.

A family floater plan covers the entire family in one plan. Thus, the entire members get coverage jointly as well as independently. The premiums are lower compared to individual health plans for individual members.

Yes, there is no restriction on buying health insurance plans. You can buy more than one health plan without any limitations

Women can buy all types of health insurance plans available in the market. However, there are special critical illness health insurance plans which have been specifically designed for women keeping their needs in mind. Such plans cover women-centric critical illnesses and offered by a few health insurance companies.

Yes, there are separate cancer care plans which are designed to cover cancer. These plans pay a fixed amount in case the insured is diagnosed with any form of cancer.

Health plans which provide cover internationally are called overseas health plans. International travel insurance plans are usually called overseas health plans as they cover international hospitalisations and also other travel-related contingencies.

No, a personal accident policy would cover only accidental death and disablements. Health insurance plans, on the other hand, have a wider scope of coverage. They not only cover accidental injuries but hospitalisation due to illnesses as well. However, coverage for accidental death is not available in health insurance plans.

Yes, minors can be covered in health insurance plans. In case of family floater plans, they are covered as dependents from the age of 3 months onwards. In the case of individual plans, minors would be covered only if either of the parents is also covered under the same individual plan.

Yes, some family floater health plans allow coverage for dependent parents. Moreover, there are separate senior citizen health insurance plans which can be taken for covering parents.

Yes, the sum insured can be increased when the health plan is being renewed.

Yes, smoking is a health hazard and so it increases the premium being charged under the plan.

Health insurance plans come with a term of one, two or three years, as chosen by the policyholder. After the term of the plan comes to an end, the coverage can be continued by renewing the policy. To renew, the renewal premium should be paid and the policy coverage would continue.

Health plans allow lifelong renewals. Thus, there is no limiting age at which renewal would not be allowed.

If the health plan is not renewed on time, the coverage would lapse once the term is over. Any claims made in a lapsed policy would be rejected by the insurance company. Renewal benefits of health insurance are also lost. However, the insurance company provides a grace period for renewing the policy after it has lapsed. If the policy is renewed during the grace period, the renewal benefits continue. However, if the grace period also lapses, the renewal benefits also lapse.

The policy can be renewed online or offline. If you choose the offline mode you either have to approach a health insurance intermediary or get the policy renewed from the office of the insurance company. Online renewals, on the other hand, can be done from anywhere using the phone or computer.

Online renewals are better because of the following reasons –

  • They are simple and convenient
  • When you renew online, you can see other available plans too. Then you can compare the available plans with your current plan. If you find better coverage in another plan at a lower rate of premium, you can port your health plan and enjoy better benefits of health insurance.

So, renewing online is always better than renewing offline.

When renewing the plan, the following factors should be considered –

  • The sum insured and whether it is sufficient
  • The members covered and whether any new members are to be added or old members to be deleted
  • The premium across different health plans vis-a-vis the coverage offered

The plan should be renewed only after these factors are weighed in.

There are two renewal benefits which are allowed to be ported. One is the accumulated no claim bonus in the existing policy and the other is the reduction in the waiting period.

The requirement for medical check-up depends on your age, medical health and sum insured. Usually, health plans don’t require medical check-ups if the age is up to 45 years and the sum insured is INR 5 lakhs. For higher ages and/or sum insured levels, medical check-ups might be necessary.

Health plans consider diabetes to be a pre-existing illness and provide coverage after a waiting period. If diabetes is severe, coverage might be restricted or not available at all. There are diabetes-specific health plans too which allow coverage even if the individual is suffering from diabetes.

TPA stands for Third Party Administrator. TPA is the bridge between the insurance company and the insured in case of a claim. The claim is coordinated by the TPA.

Dental treatments are not covered in health insurance plans. However, accidental injuries which require dental treatments might be covered. Moreover, there are health insurance plans which provide OPD coverage benefit. Dental treatments might be covered under this benefit up to a specified limit.

The Government has launched some health insurance plans for the economically weaker sections of society. These plans are, therefore, available to individuals who belong to the backward class. Moreover, even if you qualify for the health plan, the coverage is limited and not sufficient to take care of the high medical costs which incur in recent times.

Yes, come health insurance plans cover Ayurvedic and alternative treatments taken by individuals. However, there might be a limit to the coverage allowed.

There are many health insurance plans which allow coverage for maternity-related expenses. Expenses incurred in childbirth, prenatal and postnatal treatments are covered. In many plans, the newborn baby is also covered for any medical complications till the first 90 days. However, maternity treatment is available only after a waiting period of 2 to 6 years across plans.

Hospitalisation due to dengue is covered in all health insurance plans. However, OPD expenses might not be covered. There is a dengue plan offered by Apollo Munich which specifically covers dengue and all its related expenses whether incurred on an inpatient or on an outpatient basis.

Under top-up plans, there is a deductible limit. If the claim exceeds the deductible limit, the top-up plan pays the excess medical costs incurred. For instance, in a top-up plan of INR 5 lakhs, there is a deductible of INR 2 lakhs. Now, in this case, if the claim exceeds INR 2 lakhs, the plan would pay the benefits. So, if the claim is INR 2.5 lakhs, the top-up plan would pay INR 50, 000 as a claim.

Super top-up plans, like top-up plans, have a deductible limit. However, the aggregate claim made in a policy year is considered when the deductible limit is applied. If the aggregate claim exceeds the deductible limit, the claim is paid. For instance, in a super top-up plan of INR 5 lakhs, the deductible is INR 2 lakhs. Now, there are three claims in a policy year of INR 1 lakh, INR 1.5 lakhs and INR 2 lakhs respectively. The first claim would not be paid by the super top-up plan. However, in the second claim, the total claim becomes INR 2.5 lakhs. Since this is higher than the deductible, INR 50, 000 is paid as claim. Similarly, in the third instance, the aggregate claim is INR 4.5 lakhs. The super top-up plan would, therefore, pay INR 2.5 lakhs as a claim.

The policy can be renewed online or offline. If you choose the offline mode you either have to approach a health insurance intermediary or get the policy renewed from the office of the insurance company. Online renewals, on the other hand, can be done from anywhere using the phone or computer.

Claim settlement ratio determines the number of claims settled by the insurance company against the total claims made on it in a financial year. A higher ratio is better as it shows that the company settles most of its claims.

Yes, a health insurance policy, once bought, can be cancelled during the free-look period allowed under the plan. Upon cancellation, the premium paid is refunded after deducting the costs incurred in issuing the policy.

The waiting period is the period during which coverage is not allowed for specified illnesses.

Co-pay means that the policyholder would have to pay the specified claim from own pockets. Co-pay is applicable if the insured is 61 years and above and the co-pay ratio ranges from 10% to 25% across different health insurance plans.

NCB stands for No Claim Bonus. This bonus is allowed if no claim is made in a policy year. Insurance companies usually allow NCB as an increase in the sum insured without increasing the premium. Some plans also allow a discount in the renewal premium while some offer gift vouchers. In case of increase in sum insured, NCB is cumulative in nature. The sum insured is increased every year till a claim is made.

Pre-existing illnesses are illnesses which the insured suffers from when buying a health insurance plan. Since the illnesses are already present, the insurance plan covers such illnesses after a waiting period.

Yes, health insurance plans allow various discounts which can be used to reduce the premium outgo. Discounts are offered for the following –

  • For buying a multi-year policy and paying premiums at once
  • For covering 2 or more family members under the same plan
  • If a voluntary deductible limit is chosen
  • If the plan is bought online
  • In some plans, discounts are also allowed for making no claim in the previous policy year

*Prices will vary on the basis of your individual profile