It’s terrible enough to get sick, but it’s even worse when you have to pay medical fees on top of it. While you may not be able to avoid health problems, you can certainly protect yourself from financial losses as a result of them by purchasing a health insurance policy. In the event that you become ill, a good health insurance plan will cover your medical bills.

According to the sum insured chosen and the premium paid, health insurance plans cover the insured for a variety of healthcare expenses. Popular insurance firms with a high claim settlement ratio offer some of the best health insurance policies on the market.

What Are Health Insurance Plans?

A health insurance plan is a contract between an insurance company and a policyholder in which the insurer agrees to pay for the insured’s medical expenses as specified in the policy document for a specified period of time. There are numerous health insurance plans available in India, each with its own set of features and coverage benefits.

What Are Health Insurance Plans?

Medical insurance policies reimburse insured individuals for medical expenses such as surgery, hospitalization, therapies, and other medical expenses incurred as a result of injuries, diseases, or accidents. When a health insurance claim is settled, the insurer, or insurance company, pays the benefits to the insured according to the policy’s terms and conditions.

In other terms, a medical insurance policy is a contract between an insurance company and the insured in which the former commits to pay the latter the set amount for medical expenditures if the latter becomes ill and requires hospitalization. In most situations, health insurance firms have tie-ups with hospitals, referred to as network hospitals, where the insured can receive care for free.

Types of Health Insurance Plans in India

When you are aware of the various types of health insurance plans available, it becomes much easier to decide which one to purchase. In India, you can choose from seven different types of health insurance policies to meet your specific needs. These are described in detail below, along with the best-selling plans in each category:

  1. Individual Health Insurance Plans

Individual health insurance policies only cover one person, the policyholder, who receives all of the coverage benefits available. In an individual health insurance plan, the insurance company pays for the insured’s medical expenses based on the sum insured chosen and the premium paid. In-patient hospitalization expenses, pre-hospitalization and post-hospitalization charges, childcare expenses, domiciliary hospitalization expenses, organ donor expenses, and so on are some of the common coverage benefits offered under these plans.

Individual health insurance policies, which are best suited for persons with higher health risks, usually have no upper age limit for policy renewal. This means that the insured will be able to renew the plan for the rest of his or her life. On an individual sum insured basis, one can also cover their parents and immediate family members in the insurance. Individual health insurance policies cover people on an individual sum insured basis, therefore the number of claims made throughout the policy term is unrestricted.

The following are some of the most popular individual health insurance policies on the market:

  • Star Health And Allied Insurance’s Young Star Policy
  • Aditya Birla Health Insurance’s Activ Assure Diamond Policy
  • GoDigit General Insurance offers a Super Care Policy.
  • Aditya Birla Health Insurance’s Activ Health Policy
  1. Family Floater Health Insurance Plans

A family floater health insurance plan, unlike individual health insurance plans, covers the entire family on a floater amount insured basis. One of the most appealing features of family floater health insurance plans is that they allow an individual to cover himself as well as his or her family members under a single health insurance plan, making it easier to administer for the insured.

A family floater health insurance policy is a more affordable option than a senior citizen health insurance policy when it comes to protecting your parents under a health insurance policy. A family floater health insurance policy covers all members of your family, including your legally married spouse, dependent children, parents, parents-in-law, brother, sister, and other relatives, at affordable premiums that vary by plan. These plans are best for young families because the possibilities of filing many claims are lower. This allows the member filing a claim to have more coverage for less money.

The following are some of the most popular family health insurance floater plans on the market:

  • Star Health & Allied Insurance provides Family Health Optima.
  • HDFC General Insurance’s Optima Restore policy.
  • Max Bupa Health Insurance offers the Reassure Policy.
  1. Senior Citizens Health Insurance Plans

Senior citizen health insurance plans are designed specifically for adults aged 60 to 75 years old to meet their specific insurance needs. Most individual or family floater health insurance plans do not cover persons beyond the age of 65, thus getting a senior citizen health insurance policy is suggested. They only accept renewals after 65 years. Daycare charges, domiciliary hospitalization expenses, cashless hospitalization, coverage for pre-existing disorders, and coverage for specific diseases are some of the distinctive coverage benefits of senior citizen health insurance policies.

The following are some of the most popular senior citizen health insurance policies on the market:

  • HDFC Ergo General Insurance offers My Health Suraksha.
  • Care Health Insurance offers a Care Plan.
  • Star Health & Allied Insurance’s Senior Citizen Red Carpet Policy
  1. Critical Illness Insurance Plans

Heart attack, stroke, paralysis, cancer, renal failure, and other life-threatening, serious, and long-term illnesses are covered by critical illness insurance. On the first diagnosis of one of the serious illnesses covered by the plan, the insured receives a lump sum payment. The insured can spend the money not just to get the care he or she needs in India, but also outside the country.

The insured can also use the money to pay off debts, put money towards their child’s education, or use it in any other way they see fit. Because critical illness treatments are costly, it is suggested that you be insured by a critical illness policy. If someone is diagnosed with severe disease, it may put a strain on their finances if they must cover the costs on their own.

The following are some of the most popular critical illness health insurance policies on the market:

  • Care Health Insurance offers a Care Freedom Policy.
  • Star Health & Allied Insurance offers a comprehensive health insurance policy.
  • Max Bupa Health Insurance offers a health companion policy.
  1. Women-Specific Health Insurance Plans

Women’s health insurance plans are specifically tailored to satisfy the insurance needs of women at various phases of their lives. These plans, for example, protect women against healthcare costs when they retire, pregnancy costs, newborn baby coverage, child education coverage, and so on. They also cover women after a certain age for specific diseases to which they are predisposed.

Even if a woman is insured by her employer’s individual women health insurance policy, it is still advised that she be covered by a women-specific policy. This is because, unlike a women-specific health insurance plan, an individual health insurance policy does not always respond to the special needs of women, and so they miss out on coverage benefits. In addition, these plans have low premiums and typically provide the insured with lifetime renewal benefits.

The following are some of the most popular particular health insurance policies on the market:

  • Bajaj Allianz General Insurance’s Health Guard Policy
  • Star Health & Allied Insurance’s Comprehensive Health Insurance Policy
  • Care Health Insurance’s Care Joy Policy
  1. Top-Up Health Insurance Plan And Super Top-up Health Insurance Plans

In the event that hospital expenditures surpass the limit, top-up and super-top-up health insurance plans allow the insured to increase the sum insured of their base health insurance policy to cover the deficit. In the event of a single hospitalization, a top-up health insurance policy kicks in when the cost of the claim exceeds the deductible value and the sum insured of the base health insurance policy within the policy term.

In these programs, each claim is handled separately. In contrast, when claims for cumulative healthcare expenses within a policy period surpass the deductible and sum insured maximum of the base health insurance plan, the insured receives payment. A super top-up policy pays for expenses that your top-up or basic policy doesn’t cover. The main distinction is that in the super top-up strategy, repeated hospitalizations are taken into consideration. Regardless of the insurance company’s basic policy one has, super top-up insurance coverage can be purchased from any insurance company.

The following are some of the most popular top-up and super-top-up health insurance plans on the market:

  • Max Bupa Health Insurance’s Health Recharge Policy
  • Royal Sundaram Health Insurance’s Lifeline Supreme Super Top-Up Policy
  • Bajaj Allianz General Insurance’s Extra Care Plus Policy
  1. Disease-Specific Health Plans

Disease-specific health insurance policies are designed to cover a specific illness, such as cancer, diabetes, or heart disease. It is appropriate for folks who require comprehensive coverage for a specific ailment. Even if you are currently covered by a corporate health insurance plan or a standard health insurance plan, you can choose this plan. This is due to the fact that those plans may not always provide adequate coverage for specific conditions.

If you have a disease-specific health insurance plan, you won’t have to wait as long as you would if you had a conventional health insurance plan. The approach is excellent for persons who have a family history of a condition, such as hypertension or diabetes.

The following are some of the most popular critical illness health insurance plans on the market:

  • Star Health & Allied Insurance’s Diabetes Safe Policy
  • Star Health & Allied Insurance offers a comprehensive health insurance policy.
  • Care Health Insurance’s Care Freedom Policy

How to Choose the Best Health Insurance Plans in India?

There is no single health insurance plan that meets everyone’s needs. When shopping for health insurance online, you should look for a plan that not only fits your budget but also provides comprehensive coverage.

The following are some things to think about while purchasing health insurance coverage online:

  1. Adequate Cover: When purchasing health insurance online, the first thing you should do is review the policy’s provisions. Ascertain that the policy maintains you covered at all times by providing coverage for a variety of medical bills. It’s also a good idea to consider your family’s medical history and get coverage for any diseases that run in your family. For example, diabetes, heart disease, and so forth.
  2. Affordability: You will be needed to pay health insurance premiums on a regular basis in order to continue receiving covered benefits under the policy. So, while choosing a health insurance plan for yourself and your family, go with the one that is most cheap to you so that you can pay the cost over time.
  3. Flexibility: In a health insurance plan, flexibility means that you should be able to increase covered benefits as needed. You can choose from a variety of add-on features under your health insurance policies by paying an additional premium at the time of policy acquisition.
  4. Comparison With Similar Health Insurance Plans: When choosing the correct health insurance policy, it’s also crucial to compare it to other similar health insurance plans. This allows you to see if you can get greater or more useful benefits under different insurance at a lower cost, allowing you to make an informed decision.

Why Comparing Health Insurance Plans is Important?

It’s understandable that selecting the best health insurance plan from a plethora of options on the market can be tough. This is why you should use InsuranceDekho’s health insurance premium calculator to compare health insurance plans. The free application not only allows you to calculate health insurance rates, but it also allows you to compare premiums and coverage benefits.

Comparing health insurance plans is thus recommended rather than purchasing the first plan you see, as it allows you to select the most appropriate plan for your needs and make an informed decision.

How to Compare Health Insurance Plans Online?

In the market, there are over 25 insurance providers offering over 200 health insurance policies. Selecting the most appropriate one from among them, based on your budget and requirements, can be a difficult task. Here are some helpful hints to assist you to make an informed decision when purchasing a policy.

  1. Choose an Appropriate Sum Insured: You must choose a health insurance coverage with an adequate sum insured, taking into account the annual rate of healthcare inflation. True, health insurance plans with a bigger sum covered have higher rates, but you must not sacrifice the sum insured to save money. This is due to the fact that a health insurance policy with insufficient coverage may be useless when the time comes.
  2. Provide Correct Details to The Insurer: In the proposal form, you must include all of the requested information regarding your health. This is because any distortion of information can cause problems when it comes to settling a lawsuit. If you do not give comprehensive information, the insurer may reject your application.
  3. Consider Factors Affecting Health Insurance Premium: Premiums for health insurance policies are affected by a number of things. The number of members covered under the policy, the sum insured chosen, the policy term chosen, the insurance company’s claim settlement ratio, add-on benefits, premium, and inclusions and exclusions are all examples.
  4. Reviews: You should not only evaluate the insurance company’s reliability by looking at its Claim Settlement Ratio and Incurred Claim Ratio, but you should also look at how policy customers feel about the coverage. You can read reviews for various health insurance plans written by people who have already been covered by them on InsuranceDekho. This will assist you in making an educated selection.

Best Health Insurance Plans in India

Popular insurance firms in India offer a wide range of health insurance coverage. The finest health insurance policies to buy for maximum coverage features are listed below:

 

Health Insurance Companies

Health Insurance Plans

Network Hospitals

Maximum Sum Insured Amount

Star Health & Allied Insurance Young Star Policy 9,900+ Rs. 1 Crore
Aditya Birla Health Insurance Activ Assure Diamond Policy 5,700+ Rs. 2 Crore
Star Health & Allied Insurance Family Health Optima 9,900+ Rs. 25 Lakh
HDFC Ergo General Insurance Optima Restore 10,000+ Rs. 50 Lakh
HDFC Ergo General Insurance My Health Suraksha 10,000+ Rs. 75 Lakh
Care Health Insurance Care Policy 7,400+ Rs. 6 Crore
Care Health Insurance Care Freedom Policy 7,400+ Rs. 5 Lakh
Bajaj Allianz General Insurance Health Guard Policy 6500+ Rs. 50 Lakh
Max Bupa Health Insurance Health Recharge Policy 4,500+ Rs. 25 Lakh
Star Health & Allied Insurance Diabetes Safe 9,900+ Rs. 10 Lakh

Claim Settlement Process in Health Insurance Plans

You have two options when it comes to health insurance claims: a cashless claim or a reimbursement claim. When you make a cashless claim, you don’t have to pay anything at the hospital for the services you received. In a reimbursement claim, you must first pay for the care received at the hospital, and the insurance company will reimburse you later. The procedures for filing a claim for them are listed below:

Cashless Claim

You must follow the steps outlined below in order to make a cashless claim:

  • If you are admitted to a network hospital of your choosing, notify your insurance company right away. In most cases, you must notify your insurance carrier within 24 hours of your hospitalization if it is an emergency, and 48 hours in advance if it is a planned hospitalization.
  • At the network hospital, you will be expected to share your health insurance information. At the hospital’s front desk, present your Health ID card or policy number together with valid photo ID evidence.
  • Once you’ve been identified, the network hospital will email you a pre-authorization request form to submit to your insurance carrier.
  • The insurance company will next examine and analyze the records, and if necessary, will request additional information from the network hospital.
  • Once the formalities are completed, the insurance company will pay the medical charges straight to the network hospital, excluding any co-payments. Within the time frame specified, you will be notified. Even if your claim is denied, you will be notified about it.

Reimbursement Claim

You must complete the steps outlined below to receive reimbursement treatment:

  • If you are admitted to the hospital, notify your insurance carrier as soon as possible. You can also contact the insurance company directly by email.
  • If your insurance covers it, get the treatment you need at the hospital. To share with the insurance provider, gather all medical test reports, discharge summaries, medical invoices, and other necessary papers from the hospital.
  • Submit the claim documents to the insurance provider, along with any relevant medical records.

In the event of a reimbursement claim, you will be asked to submit the following documentation to the insurance carrier:

  1. A valid photo ID
  2. A letter from a medical practitioner recommending hospitalization
  3. Medical practitioner’s signature on original hospital bills and discharge certificate
  4. A prescription from a medical practitioner for consultation, drugs, and medical testing
  5. Pharmacy bills from the beginning
  6. Original diagnostic test reports, reports, etc.
  7. In a police case, the First Information Report (FIR)
  8. If applicable, a post-mortem report.

Benefits of Health Insurance Plans

Health insurance programs protect your money from being wiped out if you have a major illness that requires hospitalization during the policy time. However, the majority of individuals believe that health insurance policies solely cover hospitalization costs, which is not the case.

The main goal of health insurance plans is to provide comprehensive coverage to their members, which they do by covering a variety of medical expenses. In-patient hospitalization expenses, pre-hospitalization and post-hospitalization charges, daycare expenses, domiciliary treatment expenses, organ donor expenses, and so on are only a few of them. Health insurance programs provide additional benefits in addition to coverage. Read on to learn more about them in-depth:

  1. Cashless Treatment

In most cases, health insurance companies have agreements with hospitals that allow the insured to receive treatment without paying anything other than non-medical charges or expenses not covered by the policy. Network hospitals are located throughout India, and you can receive treatment at any of them as long as the treatment you receive complies with the terms and conditions of your health insurance plan.

  1. Comprehensive Coverage

Health insurance policies provide comprehensive coverage by covering a variety of medical expenses. The following are some of them:

  • In-Patient Hospitalisation Expenses: These expenses include those incurred while in the hospital for at least 24 hours. The majority of health insurance policies cover room rent, nursing, boarding expenditures, ICU/ICCU charges, doctor’s fees, and other expenses under this benefit.
  • Pre-Hospitalisation And Post-hospitalisation Expenses: These are the costs incurred for a given number of days prior to and after admission to the hospital. These costs include things like a doctor’s consultation charge, x-rays, and other testing. Different insurance companies reimburse these fees for different amounts of time.
  • Ambulance Expenses: These are the costs associated with transporting a patient to a nearby hospital in the event of an emergency. Typically, insurance companies set a cap on these costs, which varies from one company to the next.
  • Domiciliary Expenses: These are the costs incurred as a result of receiving treatment at home due to a lack of hospital beds. Generally, health insurance companies will reimburse these costs.
  • Daycare Treatments: Therapies that can be completed in less than 24 hours are referred to as daycare treatments. Radiotherapy, dialysis, chemotherapy, cataract surgery, and other treatments fall under this category. From one insurance company to the next, the number of childcare treatments covered may differ.
  • Organ Donor Expenses: The majority of health insurance plans pay the costs of harvesting organ donors. These costs include the costs of surgery and organ storage.
  1. Portability Benefits

Another advantage of health insurance is the ability to switch from one health insurance policy to another if you are unhappy with the advantages provided by the current one. It not only gives customers options, but it also protects them from being taken advantage of by insurance firms.

  1. Financial Security Even During Rising Healthcare Expenses

Even in the face of escalating healthcare costs, a health insurance plan can help you avoid financial stress in the event of an emergency. Even in times of inflation, it provides comprehensive coverage. As a result, purchasing suitable health insurance coverage is advised.

  1. Tax Benefits Under Section 80D of the Income Tax Act, 1961

Under Section 80D of the Income Tax Act, 1961, the Indian government encourages people to buy health insurance by providing tax deductions on the premiums they pay. Refer to the table below to learn more about the tax advantages:

Situations Premium Paid (Self, Family, Children) Premium Paid (Parents) Deduction under Section 80D of the Income Tax Act
When Policyholder and Parents are below 60 years Rs. 25,000 Rs. 25,000 Rs. 50,000
When Policyholder and family members are below 60 years with parents above 60 years Rs. 25,000 Rs. 50,000 Rs. 75,000
When Policyholder, family members, and parents are above 60 years Rs. 50,000 Rs. 50,000 Rs. 1,00,000
Members of HUF Rs. 25,000 Rs. 25,000 Rs. 25,000
Non-resident Individuals Rs. 25,000 Rs. 25,000 Rs. 25,000

The value of health insurance plans is determined not only by the features and benefits provided but also by the insured’s ability to take advantage of them. So, if you don’t want your health insurance policy to go unused, you should learn everything there is to know about its benefits and how to get them.

Top Coronavirus Health Insurance Plans in India

Everyone will be covered for COVID-19 therapy under their existing health insurance coverage, according to the Insurance Regulatory and Development Authority of India’s regulations. In addition to the COVID-19 coverage provided by existing health insurance policies, insurance firms have developed two new conventional health insurance programs that cover the disease. Corona Kavach and Corona Rakshak are the two plans available.

Corona Kavach Policy

Corona Kavach is an indemnity-based health insurance policy that pays for hospitalization expenditures (for at least 24 hours) if you have a positive COVID-19 test. Anyone between the ages of 18 and 65 can acquire coverage, which is available in three different lengths: 3.5 months, 6.5 months, and 9.5 months.

Corona Kavach is an indemnity-based health insurance policy that pays for hospitalization expenditures (for at least 24 hours) if you have a positive COVID-19 test. Anyone between the ages of 18 and 65 can acquire coverage, which is available in three different lengths: 3.5 months, 6.5 months, and 9.5 months.

Corona Rakshak Policy

On a positive diagnosis of COVID-19, the Corona Rakshak Policy is a benefit-based short-term policy that pays you a lump sum payment equivalent to 100% of the money insured. The diagnosis must be performed at a government-approved diagnostic facility, and the hospitalization must last at least 72 hours. The policy can be purchased for 3.5 months, 6.5 months, or 9.5 months, with premiums varying depending on the policy period. If you are between the ages of 18 and 65, you can purchase this policy for a sum insured of between Rs. 50,000 and Rs. 2.5 lakh (in multiples of Rs. 50,000).

Arogya Sanjeevani Policy: A Health Insurance Policy For All

Arogya Sanjeevani Policy is a type of health insurance that protects you and your family from catastrophic medical bills. The policy, which was launched by the Insurance Regulatory and Development Authority of India (IRDAI), is available from all insurance firms in India that offer health insurance coverage.

You must be between the ages of 18 and 65 to purchase this policy, and you can purchase it on an individual or family floater basis for a one-year term. It has sum insured options ranging from Rs. 1 lakh to Rs. 5 lakh, depending on your needs. In-patient hospitalization, pre-hospitalization and post-hospitalization charges, daycare expenses, AYUSH treatment expenses, road ambulance expenses, cataract surgery for a set duration, new age treatments, and so on are all covered by the policy. All claims that are admissible are subject to a 5% co-payment.

Common Inclusions Under Health Insurance Plans

In terms of benefits, each health insurance plan is distinct. The following are some of the most typical inclusions in most Indian health insurance plans:

  • In-patient hospitalization expenses
  • Pre-hospitalization expenses
  • Post-hospitalization expenses
  • Daycare expenses
  • Domiciliary hospitalization expenses
  • Road ambulance expenses
  • Organ donor expenses
  • Critical illnesses
  • Health check-up
  • Outpatient expenses

Common Exclusions Under Health Insurance Plans

  • While most healthcare expenses are covered by health insurance plans, there are a handful that aren’t, and the insured will have to pay for them out of pocket if they happen. The following are some examples of common exclusions:
  • Cosmetic procedures
  • Dental procedures
  • Expenses related to treatment are required due to the insured committing any breach of law
  • Expenses related to treatment are required due to participation in adventure sports such as mountain climbing, parasailing, bungee jumping, etc.
  • Congenital diseases
  • Supplements that can be purchased without prescription
  • Pre-existing diseases (covered after waiting period in some plans)
  • Treatments took outside the geographical boundaries of India

Role of Health Insurance Plans During the COVID-19 Outbreak

Many people in India have been affected by the coronavirus pandemic. Having a health insurance policy comes in helpful during times like these when medical problems might strike at any time. You must have dependable health insurance coverage that covers you in the event of serious illness, sickness, disease, or an accident, whether you are married, single, have children, are young, old, or do not have any children. Whether you choose individual or family health insurance plans, keep in mind that your decision will impact not only the quality of your healthcare but also your wallet.

During coronavirus outbreaks, policyholders are frequently perplexed as to whether or not the coverage they have covers them from hospitalization costs caused by the virus. The answer is clearly ‘YES.’ After the initial 30-day waiting period, all new health insurance plans on the market will cover the insured for coronavirus cases. COVID-19-related claims will be handled in the same way as other virus-related claims, such as chikungunya, pneumonia, or any other virus. The good news is that no one has been excluded thus far.

If you and your family have not yet been covered by coronavirus health insurance, you should do so as soon as possible.