- What Is the Importance of Health Insurance?
- India’s Best Health Insurance Plans
- Health Insurance Premium
- Health Insurance Plan Types
- What are the health insurance coverage’ exclusions?
- Is Coronavirus Covered by Health Insurance?
- How do you pick the best health insurance plan?
- What is the Arogya Sanjeevani Plan, and how does it work? What is the significance of the term “standard health plan”?
- Benefits and key features
- Is it possible for me to modify my health insurance policy? (Portability of health insurance)
- Documents needed to purchase
- The Procedure for Resolving a Health Insurance Claim
- Claims made without the use of money
- Claim for Reimbursement
- Documents needed to resolve a dispute –
Health insurance protects you and your family against medical expenses incurred as a result of an accident, illness, or urgent disease. Most health insurance policies include features such as cashless treatment, pre-and post-hospitalization expenses coverage, ambulance coverage, and so on.
What Is the Importance of Health Insurance?
Medical inflation in India was 7.14 percent in 2018-2019, according to the government of India’s economic survey report, which was double the CPI for the same period. A decent hospital has the capacity to wipe out your money in a matter of days, and most of the time, costs prevent people from even affording reputable hospitals or doctors. Having health insurance coverage might be a lifesaver in such times. Instead of worrying about medical fees, you may focus all of your energy on recovering from illness.
Furthermore, the cashless capability provided by network hospitals is a fantastic benefit because you don’t have to bother about organizing funds. Your insurance company pays the hospital directly for the bills. To use the cashless facility, go to any of the network hospitals that have a contract with your insurance carrier.
India’s Best Health Insurance Plans
We’ve included a few of the best plans available in India based on the lowest premiums for coverage of Rs.5 lakh. You can review the entire list of the best health insurance policies and then make an informed decision.
|Plan Name||Minimum Entry Age||Premium Amount (in Rs.)||Unique Features|
|Care Health Insurance||Adult – 5years
Child – 91days
|ICICI Lombard Complete Health Insurance Plan||Adult – 5 years
Child – 91days
|Star Family Health optima||Adult – 18 years
Child – 16days
|HDFC Ergo My: health Suraksha Silver Smart||Adult – 18years
Child – 91days
Health Insurance Premium
Premiums for health insurance are determined by the number of people you wish to cover in a single policy, the eldest member’s age, the sum assured, and the kind and characteristics of the plan you select. We’ve aggregated plans from the top 6 health insurance carriers for various age groups and sum assured in the table below to get an idea of rates. This will give you an estimate of how much a 5 lac or 10 lac sum guaranteed plan will cost per year for someone who is 26, 36, 46, or 56 years old. So, if you’re 30 years old, you can get a rough estimate of the premium by averaging 26 and 36.
|Age||Sum Assured||1A||2A||2A+1C||2A+2C||Average premium|
We have also constructed a few plans from some of the provisions for a 30-year-old man with coverage of ten lacs for himself, his wife (aged 28), and two children (10&5 years old). As you can see, the premium varies a lot depending on the company and the plan. This is due to a variety of factors such as plan features, company claims, and so on.
|Plan Name||Premium Amount (in Rs.)|
|Bajaj Allianz Health guard – Gold||19,191|
|ICICI Lombard Complete Health Insurance Plan||20,208|
|Max Bupa Health Companion||21,631|
|Star health Family health optima||21,659|
|Care Health Insurance Plan||21,690|
|SBI Aarogya Premium||31,752|
Health Insurance Plan Types
There are many different types of health insurance policies on the market. We’ve divided the plans into four categories:
- Family Floater Health Plan
A family floater health plan is single insurance that covers everyone in the family. On a floater sum insured basis, you can insure yourself, your children, your spouse, and others, and your family can claim up to the whole sum insured. When compared to individual health plans, the premium paid is less.
- Critical Illness Health Plan
A serious illness health plan provides a fixed benefit/payout for critical illnesses like cancer, kidney failure, and Brain Tumour, among others. When a policyholder is diagnosed with a designated critical condition, the plan pays him a lump sum payment, allowing him to receive intensive medical care without worrying about the cost.
- Top-up Health Plan
A top-up health plan is a supplement to your existing health insurance policy that will help you if your policy’s threshold limit is reached. These plans come to your aid if your current health insurance is insufficient to cover your medical expenses. These plans are also appealing to people who have medical coverage through their employer and need to bridge the gap by purchasing a top-up plan. These plans are highly cost-effective because they only kick in after the base policy sum assured has been depleted.
- Senior Citizen Health Plan
A senior citizen health plan is specifically created for adults over the age of 60. The plan is designed to cover medical emergencies (which may vary according to the insurance) as people get older, allowing them to receive healthcare treatments without having to worry about hefty medical bills. Because these plans are aimed at the elderly, they frequently have a co-payment clause (meaning some percentage of expenses has to be borne by the insured)
- Health Insurance for Individuals
Individual health insurance policies are tailored to the needs of people, with a separate Sum Insured for each of the policy’s participants. These plans do not force members to wait until the buyer’s waiting period is through before filing claims. It also enables adjustments based on the needs of individual family members rather than the entire family. Individual Health Plans are very beneficial for persons who are at high risk because they provide independent coverage allowance. These plans include coverage for hospitalization, daycare, and domiciliary treatment costs, among other things.
What are some of the advantages of health insurance?
Health insurance policies provide you and your family with a wide range of advantages and comprehensive coverage. We’ve included a few key advantages below that can help you better comprehend health insurance.
- Cashless Care –
A policyholder can receive necessary treatment at any network hospital (registered with his insurance carrier) without having to pay for it (up to the sum insured limit). How? The corporation pays on his behalf, allowing him to concentrate on his recovery.
- Pre & Post Hospitalization Expenses:
Pre- and post-hospitalization expenses are covered by health insurance (up to a certain duration) if the treatment is in accordance with the terms and conditions of the chosen policy.
- Tax advantages
Health insurance premiums are tax-deductible under Section 80D of the Internal Revenue Code of 1961. If you are under the age of 60, you may be eligible for a yearly exemption of up to Rs. 25,000, and if you are above 60, the benefit increases to Rs. 50,000.
- Daily Hospital Cash
It offers daily cash (up to a specified amount) to cover additional hospital expenses such as food, travel to and from the hospital, and so on. For example, the Star Comprehensive plan pays up to Rs. 2500 in hospital cash for up to 7 days each occurrence and up to 120 days for the policy year.
- Bonus with no claim (NCB)
NCB is a discount that you will earn from your insurer for each year in which you have not filed a claim. It aids in the reduction of the payable premium (by a particular percentage) when the policy is renewed.
- Free health examinations –
Many insurance companies offer free medical check-ups to encourage policyholders to live a healthy lifestyle. You may be qualified for the same benefits depending on the company and the type of insurance you have.
- In-Home Hospitalization
If you are unable to receive treatment at a hospital due to a lack of beds or if your doctor recommends medical care at home, insurance companies are responsible for covering the costs.
- Lifetime Renewability
Many health insurance plans now include a benefit called “Lifetime Renewability.” This ensures that one’s insurance can be renewed indefinitely, regardless of age or other restrictions.
- AYUSH Treatment
According to IRDAI guidelines, insurance companies must cover Ayurveda, Yoga, and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) treatments if they are received at a government-approved hospital that is accredited by the Quality Council of India of the National Accreditation Board.
- Recuperation of the Insured Amount –
You won’t have to worry about your sum insured running out if you have this function. Most health insurance policies include a sum insured restoration benefit, which returns the sum insured according to the policy’s terms and conditions.
- Coronavirus coverage –
Coronavirus is covered by most health insurance policies. The insurer will cover in-patient and out-patient costs associated with COVID-19 treatment.
Other advantages of having health insurance
Additional benefits can be added to your coverage by paying additional premiums when purchasing a new policy or renewing an existing policy.
The following are some of the extras that health insurance companies provide –
- Coverage for Maternity Leave –
It is developed specifically for policyholders who are preparing to start a family. After a specified waiting period (which varies by insurer), coverage for pre-and post-natal care, childbirth, and newborn vaccine costs can be obtained.
- Hospital Cash
The insurance covers any additional cash expenses incurred during the hospitalization, such as transportation fees, attendant costs, and so on. The amount and duration of coverage vary by the health plan.
- Personal Accident Coverage
This provides protection against unforeseen events such as accidental fatalities, permanent partial or total disability. Depending on the nature of the incident, your insurance policy will reimburse you a set sum.
What are the health insurance coverage’ exclusions?
The scope of coverage provided by health plans is definitely extensive. Some things, however, are not included. These exclusions, however, differ from one company to the next. The following are some of the most prevalent health insurance exclusions –
- Pre-existing Illness (prior to the waiting period) – You must report any pre-existing illnesses, such as diabetes or depression, at the time of purchase. These proclaimed illnesses are prohibited for a period of time, referred to as the “Waiting Period.” Depending on the insurance, this could be anywhere from two to four years. All ailments are covered after the waiting period.
- Self-inflicted injuries — a self-inflicted injury occurs when a policyholder intentionally causes oneself pain. Most health insurance companies do not cover this kind of charge.
- Injuries resulting from alcohol or drug usage – Injuries resulting from a drug or alcohol overdose are not covered by health insurance programs.
- Cosmetic treatments — Cosmetic procedures to enhance the appearance of body parts are often not covered. However, in some cases, such as an accident resulting in deformity of body parts, the policy may provide coverage. This differs from one insurer to the next.
Yes, COVID-19 will be covered by your usual health insurance. In-patent and outpatient expenses incurred during COVID-19 treatment will be covered by the insurance.
Is, however, the coverage provided by ordinary health insurance sufficient? The answer is a resounding no.
The two most common difficulties that individuals had while being treated were:
- Consumables (gloves, facemasks, etc.) were not covered by conventional health insurance policies, and the expense of PPE kits added a significant burden to policyholders in the case of coronavirus treatment.
- The treatment costs were quite costly, far beyond the coverage provided by health insurance.
As this deadly illness spreads over the world and the costs of treatment and testing rise, you may require more than conventional health insurance to protect you.
As a result, if you want comprehensive coverage against the coronavirus, you can purchase Corona-specific health insurance from a provider. These two policies are developed expressly to address COVID-related claims and provide comprehensive coverage.
- Corona Kavach
Corona Kavach is an indemnity-based policy that covers all COVID-related hospitalization bills and is designed to protect you and your loved ones from COVID-19.
If the policyholder tests positive for COVID-19, this insurance will cover hospitalization, pre-and post-hospitalization expenses, home care treatment expenses, and AYUSH therapy.
Aside from hospitalization fees, the coverage covers anesthesia, blood, oxygen, operating room charges, surgical appliances, ventilator charges, medicines and drugs, diagnostic prices, diagnostic imaging modalities, PPE kit, gloves, mask, and other similar items.
|Sum insured||Rs. 50 thousand to 5 lakhs|
|Policy tenure||3.5months, 6.5months & 9.5 months|
|Entry age||18years to 65years|
- Corona Rakshak
Corona Rakshak is the first in the series of Corona Rakshaks.
Corona Rakshak is a low-cost health insurance plan that pays out a lump amount if the policyholder is diagnosed with COVID-19. If the diagnosis confirms the existence of COVID-19 and a minimum of 72 hours of continuous hospitalization is required, the plan offers a 100 percent sum insured.
|Sum insured||Rs.50 thousand to 2.5 lakhs|
|Policy tenure||3.5 months, 6.5 months & 9.5 months|
|Entry age||18 years to 65years|
You can choose from either of the two plans to get complete coverage and protect yourself and your family against this dangerous illness. These policies, which have cheap rates, can save you if COVID-19 strikes.
How do you pick the best health insurance plan?
Individual health requirements differ, and what works for one individual may not work for another. However, in order to satisfy your ever-changing needs, you must be cautious while choosing your ideal health plan.
Step 1: Decide on your ideal health insurance provider.
Choose a company that provides a cashless service, has excellent customer service, has a sizable market share, and offers a diverse choice of health items to meet the needs of its clients.
You can also look for a list of all health insurance providers. You can look over the entire list of health insurance providers, together with all essential selection characteristics, to see which ones you should choose for your needs.
Step 2: Assess your requirements and needs
After you’ve found your perfect company, carefully assess your family’s health needs and choose the type of plan you wish to purchase. If you have a nuclear family (you, your wife, and a child), a family floater plan with Rs.5-10 lakhs in coverage for your parents (over 60 years old) under health insurance, senior citizen plans will be a decent alternative.
Step3: Comparing coverage and premiums is the third step.
After you’ve narrowed down a few options based on your demands and requirements, simply compare their benefits. It’s best to choose a plan that provides the most benefits (including enough coverage) while still being affordable.
For your convenience, we’ve compiled a comprehensive list of the best health plans on the market to assist you in making an informed decision.
What is the Arogya Sanjeevani Plan, and how does it work? What is the significance of the term “standard health plan”?
The Insurance Regulatory and Development Authority of India (IRDAI) has given all insurance companies till April 1, 2020, to launch the Arogyaa Sanjeevani Health Insurance Policy. The plan’s major goal is to make health insurance more accessible, affordable, and understandable for policyholders.
All general and standalone health insurers can now offer Argogya Sanjeevani Policy as a group insurance product, according to IRDAI.
Although the plan has many of the same features and benefits as most insurers’ existing plans, it also specifies the minimal minimum of benefits that the insurer must provide in these plans. This is to safeguard policyholders from unfavorable clauses and unexpected costs during a claim.
Benefits and key features
- Pre- and post-hospitalization coverage: The plan covers pre-and post-hospitalization charges related to any medical treatment required as a result of an illness or accident.
- No medical screening required: Up to the age of 45, no medical screening is required to invest in this plan.
- COVID-19: No medical screening is required to invest in this plan until you reach the age of 45.
- AYUSH benefits: It covers hospitalization costs for alternative treatments such as Ayurveda, Homeopathy, Siddha, and so on.
- 15-day free look period: The 15-day free look period applies only at the start of the policy, not on renewals or at the time of porting/migration.
- Everlasting Renewability: The plan is available with the option of lifelong renewability.
- ICU/ICCU Charges: The plans cover up to 5% of the charges (up to Rs.10000 per day) for ICU/ICCU treatment. The amount of coverage is determined by the total amount insured.
|Sum insured (in Rs.)||1-5 lakhs|
|Policy tenure||1 year|
|Entry age||18 years to 65 years|
Is it possible for me to modify my health insurance policy? (Portability of health insurance)
Many health insurance providers now provide the option of portability. In layman’s terms, it means that if you are unhappy with your current provider or plan (within the same insurer), you can change it. The best part is that you won’t have to forego the benefits of continuity (like the waiting period). We’ve produced a detailed post on the benefits and drawbacks of health insurance portability that may help you decide whether or not to pursue it.
Documents needed to purchase
The following is a list of documents that are required to purchase health insurance:
- Identification (PAN Card, Driver’s License, Passport, Voter ID, etc.) as proof of age.
- Photo identification, such as an Aadhar card, a PAN card, a driver’s license, a passport, or a voter’s ID.
- Ration card, bank account statement, electricity bill, passport, voter’s ID, telephone bill, etc.
- Employer’s certificate, salary slip, Form 16, etc. as proof of income
- Medical examination: If the insurance company requests it.
- Photo proof: A passport-sized photo of the policyholder is required.
- If necessary, the company may request more papers.
The Procedure for Resolving a Health Insurance Claim
The claim settlement process is the most crucial aspect of an insurance policy. Some insurance firms handle claim settlements directly, while others use the assistance of TPAs (Third Party Administrators). The claim settlement process is divided into two stages, as shown below. These are general guidelines that may differ from one insurance company to the next.
Claims made without the use of money
You can only use the cashless treatment facility in the insurance company’s network hospitals. For the same, follow the instructions stated below.
- Call or email the insurer/TPA (for planned treatment – before 48 to 72 hours of hospitalization, according to the insurer’s timeline). Within 24 hours of hospitalization, notify for emergency care.
- At the hospital, present your health card (issued by your insurer) along with identification.
- The hospital will verify the policyholder’s identity before submitting the pre-authorization form to the insurer/TPA.
- The insurer/TPA will review all of the paperwork and give their permission (if everything is in order).
- After the treatment is completed, the insurer will pay the hospital’s treatment fees.
- There will almost certainly be exclusions or expenses that the TPA/insurer will not cover. Such costs must be paid directly at the hospital by the patient or family.
Claim for Reimbursement
The insurer can receive hospital treatment and pay the fees. After that, she can file for compensation using the processes outlined below.
- Notify your insurance carrier of your hospitalization according to your insurer’s guidelines.
- Have all of your documentation, including hospital bills, on hand.
- Attach the documents to the claim form and send it in.
- All of the documents that have been supplied will be examined by the insurance company.
- Once all processes have been completed, the claim is settled according to the policy’s terms and conditions. The money will be deposited into the claimant’s account.
Documents needed to resolve a dispute –
The paperwork you’ll need to file a health insurance claim are listed below:
- Completed claim form
- A doctor’s certificate that has been authorized by the hospital, as well as an attached diagnosis report.
- The claimant’s photo identification.
- Prescription and pharmacy/hospital cash invoice.
- FIR (in the event of an accident)
*Other documents may be requested by the insurance company (if required).