What is a health insurance policy?

Health insurance also called as Mediclaim, is a 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. 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.

Types of health insurance we offer

  • 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.

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 plan
Entry age limit
Sum insured levels
Salient features 
Star Health Family Health Optima Plan 
Children – 16 days onwards 
Adults – 18 years to 25 years
INR 1 lakh to INR 25 lakhs
  • Auto recharge of the sum insured free of cost
  • Coverage for assisted reproductive treatments
  • Annual free health check-ups
Religare (Now known as Care) Care Plan 
91 days onwards. No maximum entry age
INR 4 lakhs to INR 6 crores
  • Wide 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 Restore
91 days to 65 years
INR 3 lakhs to INR 50 lakhs
  • Doubling 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 Insurance 
Individual coverage – 6 years onwards
Floater coverage – dependent children 3 months to 5 years
Adults – 18 years onwards
INR 3 lakh to INR 50 lakhs
  • The 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 – Enhanced 
91 days onwards. No maximum entry age
INR 2 lakhs to INR 2 crores 
  • The inbuilt benefit of sum insured restoration
  • Lump-sum recovery benefit for hospitalisation exceeding 10 days
  • Health Returns for a healthy lifestyle
Future Health Suraksha 
90 days to 70 years 
INR 50,000 to INR 10 lakhs
  • Hospital daily allowance for senior citizens
  • Additional 25% sum insured for accidental hospitalisation
  • Sum insured recharge benefit
Universal Sompo Complete Healthcare Insurance 
1 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

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 hospitalisation – this includes coverage for room rent, ICU room rent, cost of treatments, doctor’s fees, surgeon’s fees, nurses’ fees, etc.
  • Pre and post hospitalisation – expenses incurred before being actually hospitalised and after being discharged from the hospital are covered under this head
  • Ambulance costs – costs incurred in transporting the insured to the hospital is covered up to a specified limit
  • Daycare treatments – treatments 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.

Factors to consider while deciding the Health Insurance Company and its plan

Since medical insurance plans are important in providing financial security, they are quite popular. Almost all general insurance companies in India offer a wide variety of health insurance plans for individuals. Among the hundreds of plans available, it becomes very difficult for individuals to understand which plan would be the best health plan for them. So, here is a guide to choose the best health insurance in India –
  • 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 –
In case of cashless claim settlement
  • 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.

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

Health Insurance Portability

Health insurance portability means switching to another health insurance plan either offered by the same insurance company or by another insurance company but retaining the no-claim benefits of the earlier plan.
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.

All you need to know about health insurance in India

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.

Room rent is the rent paid to the hospital for occupying a hospital bed. Some health plans have a limit on the maximum room rent which is covered. You should, therefore, choose a room whose rent is within the specified sub-limit. If the actual room rent exceeds the sub-limit, the total health insurance claim is reduced.

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