In today’s era of escalating medical expenses, securing a comprehensive health insurance policy has become an indispensable financial safeguard. With a multitude of options available, navigating the intricate landscape of health insurance can be daunting task. Fear not, as we unveil India’s top health insurance frontrunners, meticulously evaluated and curated to empower you in making an informed decision for you and your loved ones.
Table of Contents:
- Decoding the Evaluation Criteria
- India’s Top 10 Health Insurance Companies and Plans
- Identifying Top Health Insurance Plans
- Choosing the Right Health Insurance Plan
- Common Terms Unveiled
- Addressing Common Misconceptions: Debunking Myths
- Calculating Health Insurance Premiums
- Filing Health Insurance Claims
- Buying Health Insurance Plans Online
- Frequently Asked Questions
Ø Decoding the Evaluation Criteria
Defining the best health insurance companies and plans is a multifaceted endeavor, encompassing several pivotal factors. We have closely scrutinized each contender, ensuring a thorough assessment based on the following key parameters:
- Claim Settlement Ratio (CSR): A high CSR is the hallmark of a reliable insurer, reflecting their commitment to promptly settling policyholders’ claims.
- Network Hospitals: A vast network of cashless treatment facilities across the nation ensures seamless access to quality healthcare.
- Solvency Ratio: This metric gauges an insurer’s financial stability and their ability to meet long-term obligations, providing peace of mind to policyholders.
- Incurred Claim Ratio (ICR): An indicator of an insurer’s claim-paying ability, the ICR measures the proportion of premiums utilized for settling claims.
- Product Portfolio: A diverse range of health plans catering to varied needs, from individual to family floater options, critical illness coverage, and more.
- Customer Satisfaction: Evaluating customer reviews and feedback to gauge the insurer’s responsiveness, transparency, and overall service quality.
By meticulously analyzing these pivotal factors, we have curated a comprehensive list of India’s top health insurance companies and their standout plans, empowering you to make an informed choice that aligns with your specific requirements.
Ø India’s Top 10 Health Insurance Companies and Plans
1. Star Health and Allied Insurance Company
Renowned as a leading standalone health insurer, Star Health has amassed a loyal customer base by providing unwavering financial security during medical emergencies. Their extensive product portfolio includes a 360-degree wellness system, encompassing AYUSH treatment, a vast network of over 14,000 hospitals, and expedited cashless claim settlements within two hours.
2. Care Health Insurance
Formerly known as Religare Health Insurance, Care Health Insurance is a specialized standalone entity dedicated to making quality healthcare accessible to all. With a strong emphasis on customer satisfaction and ethical business practices, they offer innovative health plans tailored to diverse healthcare needs, backed by a network of over 9,747 hospitals nationwide.
3. Niva Bupa Health Insurance
Founded in 2008, Niva Bupa Health Insurance is a standalone insurer committed to providing comprehensive protection against medical expenses. Their flagship Niva Bupa Reassure plan 2.0 stands out, offering coverage for ambulance charges, doctor consultations, organ donors, and daycare procedures, with premiums starting as low as ₹20 per day.
4. HDFC ERGO Health Insurance
A joint venture between HDFC Limited and ERGO International AG, HDFC ERGO Health Insurance is a prominent player renowned for its customer-centric approach. With a network of over 12,000 branches across 170+ locations, they offer comprehensive coverage, including 100% restoration of the base coverage after the first claim and free health check-ups within 60 days of renewal.
5. ICICI Lombard Health Insurance
ICICI Lombard Health Insurance, a joint venture between ICICI Bank Limited and Fairfax Financial Holdings Limited, has carved a niche in the Indian insurance sector. Their family floater plan allows coverage for up to five members, and their super top-up plan provides additional coverage for you and your family, ensuring financial protection against escalating medical costs.
6. Aditya Birla Health Insurance
A subsidiary of Aditya Birla Capital, Aditya Birla Health Insurance offers a range of plans to safeguard you during medical emergencies. Their Activ Health app supports and motivates policyholders to maintain a healthy lifestyle, complementing their comprehensive health plans that cater to individuals, families, senior citizens, critical illness patients, and women.
7. ManipalCigna Health Insurance
India’s second-largest healthcare chain, Manipal Group, introduced ManipalCigna health insurance plans in 2014 to provide financial protection during medical emergencies. With a customer base of over 1 lakh policyholders, they offer top-notch products, including free health check-ups, employer-employee coverage, and recognition as the Best Innovation for Products in 2024.
8. TATA AIG Health Insurance
A joint venture between the TATA Group and AIG Group, TATA AIG health insurance plans cater to the diverse needs of individuals, families, women, senior citizens, and children. Their comprehensive coverage includes hospitalization expenses, accident benefits, global coverage, and maternity expenses, with the option to opt for a sum insured of up to ₹3 Crore.
9. SBI Health Insurance
As the nation’s trusted banking option, SBI Health Insurance is one of the fastest-growing private general insurance companies, carrying forward the legacy of trust and security. Their transparent and affordable health plans offer a superfast claim settlement process within six hours, along with the option for several add-on covers for enhanced coverage.
10. Acko Health Insurance
Established in 2016, Acko Health Insurance has rapidly emerged as a prominent player in the Indian healthcare insurance world. They offer innovative and customer-centric insurance products, with a mission to make insurance accessible and hassle-free. With a strong digital presence, Acko streamlines the insurance process, from purchasing policies to claim processing, ensuring simplicity, transparency, and customer satisfaction.
Ø Identifying Top Health Insurance Plans
While the aforementioned companies have established themselves as industry leaders, selecting the best health insurance plan requires a comprehensive evaluation of your unique needs and circumstances. To aid you in this endeavor, we have compiled a list of key factors to consider:
1. High Claim Settlement Ratio (CSR)
A high CSR is the hallmark of trust and reliability for any health insurance provider. It indicates the number of claims settled by the insurer in a financial year compared to the number of claims filed. Opt for insurers with a CSR above 95% to ensure prompt claim settlements.
2. Vast Product Portfolio
The top health insurance companies offer a wide range of health insurance products to suit your every need, from individual and family plans to critical illness, senior citizen, and maternity coverage. A diverse product portfolio ensures you find the perfect plan tailored to your requirements.
3. Brand Legacy
Opting for legacy brands that have built customer trust over the years is a wise choice. Such companies have a long-standing service record, offering comprehensive health plans, exceptional customer service, and efficient claim settlements, solidifying their position as trusted names in the Indian market.
4. Efficiency
The hallmark of a top health insurance company is prompt and efficient customer support, not only during claim settlements but also during queries. Recognizing insurers that offer unwavering support, especially in emergencies, can make all the difference in your healthcare journey.
5. Minimal Limitations
Renowned health insurance companies design plans with minimal limitations, such as no room-rent limits or disease-specific sub-limits. Such comprehensive coverage offers peace of mind and satisfaction to the insured individual, ensuring they receive the full benefits of their policy.
By carefully evaluating these pivotal factors, you can navigate the intricate landscape of health insurance and select a plan that aligns seamlessly with your specific needs, budget, and preferences, empowering you to safeguard your well-being with confidence.
Ø Choosing the Right Health Insurance Plan: A Comprehensive Guide
Selecting the best health insurance plan requires careful consideration of several factors to ensure you make an informed decision that aligns with your unique requirements. Here are some essential points to keep in mind:
1. Understand Your Needs
Before embarking on your search, determine what coverage is suitable for your needs and how much you can afford to pay in premiums. This will help you narrow down your options and focus on plans that truly cater to your specific circumstances.
2. Research Your Options
Thoroughly research the health insurance companies and plans available in the market. Check for reviews, CSR reports, and customer feedback to gauge the insurer’s reputation and service quality.
3. Compare Plans
Gather detailed information on the plans offered by different insurance companies, paying close attention to the coverage details, including in-network and out-of-network providers. Compare the premiums, deductibles, co-pays, and out-of-pocket maximums to find the most cost-effective option.
4. Check Provider Networks
Ensure that your preferred doctors, specialists, hospitals, and healthcare facilities are within the network of the insurance company you are considering. This will allow you to avail cashless treatment and avoid any inconvenience or additional costs.
5. Read Reviews and Ratings
Check customer reviews and ratings of the insurance companies you are considering. Pay attention to the satisfaction level of customers and their experiences with claim processing. This will provide you with an overall idea of an insurer’s reputation and customer service quality.
6. Assess Financial Stability
Research the financial stability of the insurance company by reviewing its ratings and financial statements. A financially stable insurer will have the capability to meet its obligations and settle claims promptly.
7. Understand Exclusions and Limitations
Carefully review the policy documents and understand the coverage, exclusions, and limitations. This will help you avoid any surprises or disappointments when raising a claim.
8. Customer Service
Try interacting with the customer care team of the selected company by asking questions and evaluating their response, willingness to assist, and overall helpfulness.
9. Check for Additional Benefits
Some insurance plans offer additional benefits like wellness programs, telehealth services, and more. Consider whether these extras are valuable to you and align with your healthcare needs.
10. Seek Professional Advice
If you have doubts or queries, consider consulting with an insurance expert for guidance. They can provide valuable insights and help you navigate the complex world of health insurance.
By following these guidelines, you can make an informed decision and choose a health insurance plan that provides comprehensive coverage, financial security, and peace of mind for you and your loved ones.
Ø Demystifying Health Insurance: Common Terms Unveiled
Navigating the world of health insurance can be difficult, with numerous terms and jargon that may seem confusing at first glance. To empower you with a better understanding, we have compiled a glossary of common health insurance terms:
- AYUSH Treatment: Refers to medical treatments taken through Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy systems of medicine.
- Bariatric Surgery: Weight-loss surgery performed to treat obesity or reduce a person’s weight.
- Claim: A request made by the policyholder to the insurance company to pay medical expenses incurred due to an illness or hospitalization.
- Co-payment: A fixed percentage of the claim amount that the policyholder has to pay at the time of claim settlement.
- Coverage: The extent of benefits available under a health insurance policy.
- Cumulative Bonus: An increase in the sum insured amount without a premium hike, rewarded for not raising a claim in the previous policy year.
- Day Care Procedures: Medical procedures and surgeries performed using advanced technology that require hospitalization of less than 24 hours.
- Deductible: A fixed amount the policyholder agrees to pay towards medical expenses before raising a claim with the insurance company.
- Dependent: Family members of the policyholder who can be covered under the same health insurance policy.
- Domiciliary Treatment: Medical treatment taken at home under the supervision of a medical professional when hospital admission is not possible.
- Entry Age: The age at which a person can buy a health insurance policy.
- Exclusions: Conditions or circumstances that are not covered under a health insurance policy.
- Family Floater: A type of coverage where a single sum insured amount is shared by all insured family members on a floater basis.
- Free Look Period: The first 15 days of buying the policy, during which the policyholder can change the insurance company or cancel the policy without paying any cancellation fee.
- Grace Period: A fixed period that begins after the due date of a health policy, during which the policyholder can pay the due premium amount without losing continuity benefits.
- Indemnity Plan: A type of insurance policy where the claim amount is paid based on actual medical expenses incurred.
- Insured: The person eligible to receive medical coverage under a health insurance policy.
- Insurer: The insurance company responsible for paying medical expenses of the insured under a health insurance policy.
- Network Hospitals: Empanelled hospitals of the insurance company that offer cashless hospitalization benefits to policyholders.
- No Claim Bonus: A renewal premium discount offered by insurance companies to policyholders for not raising a claim in the previous policy year.
- Portability: The procedure of changing the existing insurance company or health insurance policy without losing continuity benefits.
- Pre-existing Diseases: Diseases or medical conditions diagnosed up to 4 years before buying the health policy.
- Premium: The cost of an insurance policy, paid by the policyholder at regular intervals to obtain coverage and benefits.
- Preventive Health Check-up: A series of medical tests undertaken to assess a person’s health and take preventive measures.
- Restoration Benefit: The facility of refilling the sum insured amount before the policy renewal date if the original amount is exhausted due to claims.
- Riders/Add-on Covers: Additional covers that the policyholder can purchase to expand the coverage of a basic health insurance policy.
- Room Rent Limit: The limit up to which the insurance company will pay for hospital room charges incurred by the policyholder.
- Sub-limits: The limit set on the coverage amount of a benefit under a health insurance policy.
- Sum Insured: The maximum coverage amount the insurance company will pay in a policy year.
- Top Up Plan: A type of health insurance plan that offers a higher sum insured and can be bought to enhance medical coverage, with a deductible amount to be paid.
- Underwriting: The process where an insurance company evaluates an application to determine whether the policy should be issued and how much premium should be charged.
- Waiting Period: The time period from policy commencement during which the policyholder is not allowed to make claims.
By familiarizing yourself with these common terms, you can navigate the world of health insurance with confidence, making informed decisions and ensuring you fully understand the coverage and benefits you are entitled to.
Ø Addressing Common Misconceptions: Myths Debunked
Before embarking on your journey to secure the best health insurance plan, it’s essential to address and dispel some common misconceptions that often cloud the decision-making process. By shedding light on these myths, we aim to empower you with accurate information and a clear understanding of the realities surrounding health insurance.
Myth 1:
“I’m Healthy, So I Don’t Need Health Insurance”
Despite maintaining a healthy lifestyle and taking good care of your well-being, unforeseen circumstances like seasonal illnesses, accidents, or even unexpected medical emergencies can strike anyone at any time. In today’s world, where hospitalization expenses are soaring, even a short hospital stay can result in staggering costs that could deplete your savings. With a comprehensive health insurance plan, you can gain financial assistance to pay for these unexpected medical expenses, safeguarding your financial stability.
Myth 2:
“My Health Insurance Will Cover All My Medical Expenses”
It’s crucial to understand that all health insurance plans come with a set of exclusions and limitations as per IRDAI regulations. Before purchasing a policy, it’s advisable to thoroughly review the coverage details and the list of exclusions provided by your insurer. Your insurance company will only compensate for the expenses that are explicitly covered within the policy’s terms and up to the sum insured limit.
Myth 3:
“I Don’t Need to Declare My Pre-existing Diseases”
Failing to declare pre-existing diseases or providing inadequate information during the application process can have severe consequences. Non-disclosure of pre-existing conditions can lead to claim rejection or even policy cancellation. It is essential to be transparent and clearly declare all pre-existing medical conditions in the proposal form while buying a health insurance policy.
Myth 4:
“Smokers Are Not Eligible to Buy Health Insurance Plans”
While it’s true that smokers and tobacco users are at a higher risk of developing various health complications, most health insurance companies in India do offer coverage to them as well. However, considering the elevated risks, smokers and alcohol consumers may be required to undergo stringent pre-medical examinations and pay higher premiums to obtain health insurance coverage.
Myth 5:
“Medical Insurance Will Only Cover Hospitalization Expenses”
While most health insurance plans primarily cover medical expenses for hospitalizations lasting more than 24 hours, many insurers have expanded their coverage to include day care procedures, where hospitalization for at least 24 hours is not required. Additionally, several health plans now cover OPD treatments that do not necessitate hospitalization at all.
Furthermore, some health insurance plans even cover domiciliary treatments, which involve medical care provided at home under the supervision of a qualified medical professional, in cases where hospitalization is not feasible.
Myth 6:
“I’m Covered Under a Group or Corporate Health Insurance Plan”
While many individuals rely on the health insurance plans provided by their employers, it’s crucial to recognize that group health insurance policies often come with a set of limitations. These plans may not offer coverage for all family members, the sum insured may be insufficient, or they may not cover critical illnesses. Moreover, the coverage will cease to exist as soon as you quit your job or retire. Securing an individual health insurance policy can be a wise decision to ensure continuous coverage and avoid the potential challenges of obtaining insurance after retirement or job transition.
By addressing these common myths and misconceptions, we aim to equip you with accurate information and a clear understanding of the realities surrounding health insurance. Armed with this knowledge, you can make informed decisions and navigate the process of securing the best health insurance plan with confidence.
Ø Calculating Health Insurance Premiums: Unveiling the Factors
When it comes to securing a health insurance policy, one of the key considerations is the premium amount – the cost you’ll have to bear to obtain coverage. Understanding the factors that influence premium calculations is crucial in making an informed decision and budgeting effectively. Let’s delve into the various elements that play a role in determining your health insurance premium:
1. Medical History
Your medical history is a significant determinant of your health insurance premium. Most insurers in India make pre-medical tests mandatory after a certain age for buying a health insurance policy. While some companies may not require medical screening, they do consider your current medical conditions, lifestyle-related health risks, and the medical background of your family. This is why medical insurance premiums for smokers and tobacco users are typically higher than those for non-smokers.
2. Age and Gender
Age is another pivotal factor influencing medical insurance premiums. Generally, the premium increases as the age of the insured individual increases. This is because elderly individuals are more susceptible to cardiovascular diseases, critical illnesses like cancer, kidney problems, and other age-related health issues. For this reason, senior citizen health insurance premiums are usually higher compared to plans for younger individuals.
Additionally, the cost of health insurance for women is often lower in comparison to male candidates due to the lower risk of stroke, heart attack, and certain other medical conditions.
3. Policy Term
The policy term also plays a role in determining the premium amount. Typically, a two-year health insurance plan will have a higher premium than a one-year plan. However, most insurance companies offer discounts on long-term medical insurance plans to incentivize policyholders.
4. Type of Health Insurance Plan
The type of health insurance policy you select also influences your premium. The wider the coverage, the higher the premium will be. Online health insurance premium calculators can be a valuable tool to compare premiums for different health insurance plans before making a purchase decision.
5. No Claim Bonus
If you have not made any claims during your previous policy term, you may be eligible for a No Claim Bonus (NCB) or a discount on your renewal premium. The NCB can range from 5% to 50% of the premium, depending on the number of claim-free years. This is an important factor considered while calculating policy premiums.
6. Lifestyle Habits
Your lifestyle habits, such as smoking or consuming alcohol regularly, can significantly impact your health insurance premium. Insurers consider these habits as potential risk factors, and in severe cases, they may even reject your policy request or charge a substantially higher premium.
By understanding these factors, you can gain valuable insights into the premium calculation process and make informed decisions when selecting a health insurance plan that aligns with your budget and requirements.
Ø Filing Health Insurance Claims: A Comprehensive Guide
One of the primary reasons for securing a health insurance policy is to ensure financial assistance during medical emergencies or planned hospitalizations. When the need arises, it’s essential to understand the claim process to avail the benefits of your policy effectively. Here’s a comprehensive guide to filing health insurance claims:
1. Types of Claims
Health insurance plans typically offer two types of claim processes:
Reimbursement Claims
For treatments availed at non-network hospitals, the policyholder can file a claim for reimbursement of the treatment charges. Once the treatment is completed, the insured needs to settle the bill, collect all the necessary documents, and submit them to the insurer or the Third-Party Administrator (TPA) to initiate the reimbursement process.
Cashless Claims
If the treatment is availed at a network hospital of the insurer, the policyholder is eligible to avail cashless treatment services. In this case, the insurance company settles the bill directly with the hospital, eliminating the need for the policyholder to pay upfront.
2. Planned vs. Emergency Hospitalization
The procedure for filing claims may vary slightly depending on whether the hospitalization is planned or an emergency:
Planned Hospitalization
- Inform the insurer at least 48 hours before the planned treatment.
- Once you receive approval from the TPA/insurer, file for reimbursement or cashless claims by submitting the claim form and other required documents like medical bills, reports, and discharge summaries.
- For reimbursement claims, the insurer will pay the claim amount directly to you after document verification.
- In the case of cashless claims, the hospital bill will be settled directly by the insurer.
Emergency Hospitalization
- Inform the insurer within 24 hours of getting hospitalized.
- Present your health card at the hospital.
- Submit the pre-authorization form to obtain TPA approval for emergency hospitalization for cashless claims.
- If approved, the insurer will settle the claim amount directly with the network hospital.
- If you fail to get TPA approval, you will need to file for reimbursement later by submitting all the required documents like hospital bills, discharge bills, etc., after getting discharged from the hospital.
- After verification of documents, the claim amount will be paid to you.
3. Documents Required for Claim Reimbursement
In the event of hospitalization, the policyholder needs to submit the following documents to file a reimbursement claim with the insurer:
- Discharge card issued by the hospital
- In-patient hospitalization bills signed by the insured for authenticity
- Doctors’ prescriptions and medical store bills
- Claim form with the insured’s signature
- Valid investigation reports
- Bills for consumables and disposables prescribed by doctors
- Bills for doctors’ consultations
- Copies of the health insurance policy from the previous and current years
- Copy of ID card
- Any other document(s) requested by the TPA
By understanding the claim process and having the required documents ready, you can ensure a smooth and efficient claim settlement, allowing you to focus on your recovery without worrying about financial burdens.
Ø Buying Health Insurance Plans Online
In today’s digital age, the convenience of purchasing health insurance plans online has become increasingly appealing. Online platforms offer a seamless and hassle-free experience, allowing you to compare and purchase policies from the comfort of your home or on-the-go. Let’s explore the advantages of buying health insurance plans online and the steps to navigate this process effectively.
Advantages of Buying Health Insurance Online
- Easier Comparison: Online platforms enable you to compare health insurance plans from different insurers, making it easier to find the best plan that suits your needs and budget.
- Convenience: You can purchase a policy online without the need to visit an insurance company’s branch or schedule an appointment with an agent, saving you time and effort.
- Online Discounts: Many insurers offer discounts on premiums for buying policies online, providing cost savings.
- Lower Premiums: Health plans are often available at lower premiums online as insurance companies save on operational costs.
- Minimal Paperwork: The process of buying a health insurance policy online involves minimal to no paperwork, streamlining the process.
- 24/7 Availability: You can purchase a health insurance policy online at any time of the day, even on public holidays, which is not always possible with offline purchases.
- Digital Payment Options: Online platforms allow you to securely pay premiums using various digital payment methods, eliminating the need for cash transactions.
- Time-saving: The policy issuance process is typically faster online, with policies often issued within minutes of purchase.
Steps to Buy Health Insurance Online
- Select Members to be Insured: Choose the family members you wish to include in the health insurance policy, such as yourself, spouse, children, parents, or parents-in-law.
- Enter Personal Details: Provide personal information like your city, full name, and phone number.
- Disclose Pre-existing Conditions: Indicate if you or any family members have existing illnesses or conditions that require regular medication.
- Check for Existing Coverage: If your employer provides medical insurance, disclose the coverage amount to ensure you obtain adequate additional coverage.
- Choose the Best Plan: Select the health insurance plan that best suits your needs from the available options. You can also seek advice from customer care representatives if needed.
- Compare and Customize: Compare different health insurance plans, customize your search, and choose the right plan for yourself or your family.
- Make the Payment: Once you have selected the plan, proceed to pay the premium online using your preferred payment method.
- Policy Issuance: After completing all the steps, the policy will be emailed to your registered email address.
By following these steps and leveraging the convenience of online platforms, you can streamline the process of buying a health insurance plan, ensuring a seamless and efficient experience tailored to your specific needs.
Ø Frequently Asked Questions (FAQs)
When it comes to health insurance, it’s natural to have numerous questions and concerns. To help you navigate this complex landscape with confidence, we’ve compiled a comprehensive list of frequently asked questions (FAQs) and their respective answers. These FAQs cover a wide range of topics, from understanding policy details and coverage to claims, premiums and renewals, ensuring you have the information you need to make informed decisions.
What are the discounts available in the market for a health insurance policy?
Health insurance plans available in the market offer various discounts, including family discounts, long-term discounts, loyalty discounts, and online discounts, depending on the policy terms and conditions. Additionally, you can avail of a No Claim Bonus during policy renewals if you have not raised any claims in the previous policy tenure.
What is the right age to buy health insurance?
There is no definitive “right” age to buy a health insurance policy. However, it is generally suggested to purchase it as early as possible to keep your premiums low. The earlier you buy health insurance, the lower the premium will be, as you have a lesser risk of health issues at a younger age compared to someone in their mid-50s or 60s, who may be more prone to critical illnesses.
Is a medical test mandatory to buy a health insurance policy?
Medical tests are not always mandatory before buying a health insurance policy. However, most health insurance companies in India require medical test reports if the age of the applicants is above 45 years or a specific age limit set by the insurer. The type of medical tests required can vary depending on the age of the applicant and the insurer’s requirements.
What does cashless hospitalization mean in a health insurance policy?
Cashless hospitalization means that the in-patient treatment charges availed by the insured are paid directly by the insurance company to the hospital. All insurance companies in India have a network of hospitals where policyholders can avail cashless treatment for an illness or accidental injury.
At what age can I include my children in my health insurance plan?
You can typically include your children in a family floater policy from day one, provided the child is at least 90 days old. In maternity insurance plans, newborn babies are often covered from day one if the maternity claim was paid by the insurer. However, it’s advisable to carefully review the terms and conditions of a health plan to understand the entry age for children.
What is a free-look period in health insurance?
A free-look period in health insurance refers to the first 15 days of the policy commencement. During this period, you can review your health insurance policy features, coverage, and decide whether to continue with it or opt for add-on covers. If you decide to discontinue the policy during this period, you will not attract any cancellation fee.
What is the sum insured in health insurance?
The sum insured refers to the maximum amount that the insurance company pays to the policyholder during a policy year in case a claim is raised due to an illness or accidental injury. It is also referred to as the maximum coverage or coverage amount under health insurance.
What are pre-existing diseases or conditions?
Pre-existing diseases or conditions refer to any health problems or illnesses diagnosed prior to buying a health insurance policy. Insurance companies are often reluctant to cover such diseases initially, as they can be costlier to treat. Therefore, pre-existing diseases are typically covered only after a waiting period of 2 to 4 years. Every insurance company has its own terms and conditions regarding pre-existing conditions.
Can a person have more than one health insurance policy?
Yes, you can buy more than one health insurance policy in India. For example, if you are covered under a corporate health plan, you can also obtain an individual or family floater health insurance policy. Similarly, if you already have individual health insurance, you can purchase an additional top-up plan or a senior citizen health insurance plan for your parents.
I have my employer’s group policy then also do I need to buy a separate health insurance plan?
Yes, it is advisable to buy a separate health insurance policy in addition to your employer’s health insurance policy for better coverage. The sum insured under an employer’s health insurance is usually between ₹2 lakh and ₹5 lakh, which might not be sufficient under the current medical inflation. To cover various expensive treatment costs, it is important to have a separate health insurance plan with a minimum sum insured of ₹10 lakh or more.
How to add my family members to my existing medical policy?
You can typically add your family members to your health insurance policy at the time of renewal or at the time of purchase. Your spouse, dependent children, parents, and parents-in-law can often be covered under a family health insurance plan, subject to the policy’s terms and conditions.
What are the documents required for purchasing a health insurance policy?
There are typically no documents required for purchasing a health insurance policy initially. However, you may need to undergo a pre-policy medical check-up if you are a senior citizen. When filing a claim, you will need to provide valid proof of your identity, address, age, and other relevant documents as requested by the insurer.
Can my friend buy a health insurance policy if they are not an Indian national but are living in India?
Yes, foreigners living in India can apply for a health insurance policy. However, the coverage will typically be applicable within India only.
What if I already have a health insurance policy but want to increase my sum insured?
If you want to increase the sum insured of your existing health insurance policy, you can usually do so at the time of policy renewal. If sum insured enhancement is not possible under your ongoing policy, you can consider buying a top-up plan or an additional health policy to extend the scope of coverage.
What are pre and post-hospitalization expenses in health insurance?
Pre-hospitalization expenses refer to the medical expenses incurred before being admitted to a hospital. Post-hospitalization expenses refer to the cost of follow-up tests and consultation treatment charges incurred after being discharged from the hospital. Health plans in India typically cover pre-hospitalization expenses for up to 30 to 60 days and post-hospitalization expenses for up to 60 to 90 days, depending on the specific plan.
Which diseases are not covered in health insurance?
Most health insurance policies typically do not cover HIV/AIDS treatment, except for a few companies. Claims arising from external congenital disorders, venereal diseases, general debility, sexually transmitted diseases, and dental treatment/surgery (unless required as part of treatment) are often excluded from health insurance coverage. However, it’s essential to review your policy wordings to understand the detailed list of exclusions.
Does my health insurance policy cover healthcare expenses related to COVID-19?
Yes, most health insurance plans cover COVID-19 hospitalization expenses. You can also purchase COVID-19-specific health plans like Corona Kavach and Corona Rakshak if you want coverage for COVID-19 treatment, including the cost of consumable items like PPE kits, ventilators, and more.
How much health insurance coverage do I need?
The amount of health insurance coverage you need depends on various factors, including your city of residence, lifestyle, pre-existing health conditions, your family’s medical background, annual income, age, health risks, and the premium you can afford to pay.
Is ₹5 lakh health insurance enough?
A ₹5 lakh health insurance policy may be sufficient for an individual living in a tier-3 city