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An overview

About India health insurance

As humans, we are vulnerable to falling sick or getting a disease due to our hectic and stressful lifestyle. Sometimes even a minor change in weather can cause sickness. Health care of late is very expensive and more than the disease itself, it is often the cost of treatment that takes its toll on our peace of mind. The solution to these health related expense worries lies in having a good Health Insurance Policy which covers medical expenses incurred during pre and post hospitalization stages.

eindiainsurance is the best platform for you to compare various policies and the benefits offered by leading Insurance Companies in India and to buy the best suitable mediclaim policy online for your family and you.

So why wait? Compare and Buy a plan today and leave your health care worries to your Health Insurance policy..!!

The simple steps to follow to buy a health insurance plan online are below:

As per the IRDA regulations on Health Insurance, the insurance companies should have an entry age restriction for Health insurance policies. Hence almost all the health insurance plans do not have any restriction in the entry age. This means that an insured of any age can purchase a health insurance policy.

Similarly, almost all plans come with a Lifelong Renewability feature (again directed by IRDA) and this ensures once an individual is enrolled with an insurer, they can renew their policy till they are alive, either with the same insurance company or port their policy. They only need to ensure payment of renewal premium within the stipulated timeframe to ensure timely renewals.

The free look period is the time period provided to the insured during which they can review the terms and conditions of their newly purchased health insurance policies and if not satisfied can terminate the policy without penalties, such as surrender/closure charges. A free look period normally lasts 14 or more days (depending on the insurer), allowing the insured to decide whether or not to keep the insurance policy; if he or she is not satisfied and wishes to cancel, the policy purchaser can receive a full refund.

Log on to website https://www.eindiainsurance.com/
Go to the health insurance section / Landing page
Fill in basic details like Individual / Family, Name, DOB / Age, Sum Insured etc
Go through the comparison table displayed and review all plans / premiums
Choose the best plan (benefit / premium) give the insured's needs
Make premium by any mode through the payment gateway
Fill in an online application form requiring policy related information
Policy document will be issued and dispatched to the insured directly

Insurance policies are legal contracts that grant rights and responsibilities to both the insurance company and insured policyholder. Hence if the insured is not satisfied with the terms and conditions of the policy purchased, they can cancel and return the policy within this specified period after receiving it, and premiums will be fully refunded. During the free look period, the purchaser can continue to ask the insurer questions regarding the insurance policy contract in order to better understand the policy.

Coronavirus (COVID-19)

Health insurance for Coronavirus (Covid 19)

Also known as SARS-CoV-2, nCov, 2019 Novel Coronavirus, COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus. There’s no specific treatment for coronavirus (COVID-19). Treatment aims to relieve the symptoms until you recover. It's not known exactly how coronavirus (COVID-19) spreads from person to person, but similar viruses are spread in cough droplets. While the majority of cases result in mild symptoms, some progress to severe pneumonia and multi-organ failure. As of 20 March 2020, the rate of deaths per number of diagnosed cases is 4.1%; however, it ranges from 0.2% to 15% depending on age and other health problems.
COVID-19 Covered

Best Health Insurance in India

  • Available for age 3 months - 75 yrs
  • Life long renewal.
  • Suitable plan for middle class
  • Floater basis and individual basis
  • Available for age 0 - 99 yrs
  • Life long renewal.
  • Free health check up on renewal
  • Maternity up to Rs. 1Lac and new born baby coverage from day one
  • Choose sum-insured 2-60 lacs
  • Automatic policy free recharge
  • Direct claim settlement
  • Covers maternity after 4/6 years of waiting period
  • Pre-existing benefits are covered after 4 years of continuous renewal
  • Renewal for life
  • Pre-existing dieseases covered after 2/4 years of continuous renewal.
  • No Copayment, No room rent or ICU restrictions
  • No loading on renewal premium
  • Coverage for the entire family
  • Gives comphrehensive coverages
  • Available for age 3 months - 65 yrs
  • Life long renewal.
  • Available for age 90days - 70 yrs
  • Life long renewal.
  • An medical ailment or an injury can arrive at any time when you are totally unprepared. Health Insurance helps you pay for this high quality healthcare.
  • Available for age 18 years - 65 years.
  • Pre and post hospitalization expenses covered for 60 days and 90 days respectively.
  • This Insurance Policy you can be in control making medical expenses more manageable. This ensures your family's quality health and happiness.
  • Min Entry Age: Child - 91 days, Adult - 18 years
  • Max Entry Age: No limit
  • Cover Type: Individual and Family Floater
  • Policy Period: 1, 2 and 3 years
  • Universal Sompo Health Insurance provides coverage on hospitalization expenses, domiciliary hospitalization, accidental injury and provides several add on benefits..
  • Royal Sundaram provides affordable health insurance plans with a comprehensive range of benefits to take care of you and your family.
  • New India Mediclaim is a Policy specially designed to cover Hospitalisation expenses.
  • Oriental Health Insurance plans can be chosen for individuals and an entire family.
  • Health insurance is designed to cover your medical expenses and give you the freedom to avail quality healthcare.
  • Health QuBE is a comprehensive health insurance policy which gives you and your family members a complete health cover.
  • Kotak Health Care is a comprehensive individual health insurance or family health insurance plan by Kotak General Insurance.
  • A health insurance or a medical insurance is a type of general insurance that safeguards you against financial losses by covering for you when you’re faced with a health condition or medical emergency such as due to a disease, illness or even an accident.
  • Aditya Birla Health offers their health insurance customers the option of availing quality treatment at more than 7,000+ leading hospitals across the country.

Arogya Sanjeevani Mediclaim Insurance

The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a pandemic and a Public Health Emergency of International Concern.

Time from exposure to onset of symptoms is generally between two and 14 days, with an average of five days. The standard method of diagnosis is by reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab. The infection can also be diagnosed from a combination of symptoms, risk factors and a chest CT scan showing features of pneumonia. There is no vaccine or specific antiviral treatment for COVID-19. Management involves treatment of symptoms, supportive care, isolation, and experimental measures.

Common symptoms include fever, cough, and shortness of breath. Muscle pain, sputum production and sore throat are less common. The virus is typically spread from one person to another via respiratory droplets produced during coughing. It may also be spread from touching contaminated surfaces and then touching one's face.

Healthcare in India

Health is a human right. It’s accessibility and affordability has to be ensured by the Government but the escalating cost of medical treatment is beyond the reach of common man especially in Tier II and Tier III cities (Rural areas). Health care has always been a problem area for India, a nation with a large population and larger percentage of this population living in urban slums and in rural area, below the poverty line. Under this situation, one of the ways for the government to reduce funding and augment the resources in the health sector was to encourage the development of health insurance. Currently (according to the Health Vertical Specialist team at Cognizant Technology) some of the challenges being faced in the Health Sector are :

  • Increase in health care costs due to better quality treatment, more qualified doctors and other facility maintenance Costs in Urban Areas
  • The poor are finding the escalating medical costs a huge financial burden
  • Need for long term and nursing care for senior citizens because of increasing nuclear family system
  • Increasing burden of new diseases and health risks - There have been disruptive lifestyle changes in the country over the past two decades mainly due to the rapidly evolving urban economy and the Indian middle class. It is estimated that around 130 million people may suffer from lifestyle diseases such as diabetes and obesity in the next few years, leaving a $160 billion hole in the national economy during the next few years
  • Preventive and primary care and public health functions in Rural India have been neglected. Affordable care (government hospitals or community-based care) suffers from quality issues and is unable to cater to the basic healthcare needs of the growing population. While some private care delivery centers and professionals are accessible to the needy, they are not affordable for a majority of the population.
  • Medical health insurance penetration is very low. Health insurance is a minor contributor in the healthcare ecosystem. Insurance payment structures are based on an almost indemnity-based payments. Indian insurance has been limited to critical illness coverage for inpatient surgical procedures.
The India Healthcare Industry is estimated to row to $280 billion by 2020 from the $79 billion that was the size in 2012. This is despite the per capita spending on Healthcare in India (according to WHO Report 2012) amongst the lowest in the world.

In India the Per capita spending is just $109 per person against the world average of $863, this highest being in the USA who have this number pegged at $7,285.

The focus of the India Healthcare Industry thus has to focus on Access, Cost and Quality to ensure we correct this alarming situation.
health graph

According to a detailed study by the Global Conference of Actuaries a few years ago, almost 78% of the Healthcare spend is borne Out of the Pocket of the individuals... this presents perhaps the biggest gaps that the Health Insurance players must fill aggressively over the next decade or so as well as being the biggest opportunity for Health Insurers and Distributors to capitalise upon…this is significantly higher than most developed nations across the world.

health graph
You will note in the tables below (in the same study by the Global Actuaries), that India and China lag behind the other developed nations in terms of their Government’s allocation to Healthcare overall. In India this stand at currently around 2.9%, which China is slightly higher at 10.10%. But very importantly as a % of the overall GDP, the Health spends in India is around 5%, a marginal step ahead of China. But even then when we compare this to the largest economy like USA, the Government spend is a whopping 15.4% of their massive GDP. So there is a long way to go for India in the Healthcare space.
health graph
health graph

What are the Illness plaguing India today?

Almost 38 million deaths occurred due to non-communicable diseases ( NCDs) each year. In that 16 million deaths occur before the age of 70 & 82% of these premature deaths occurred in low- and middle-income countries including India. The World Health Organisation (WHO) indicates that India ranks very high among the nations affected by the rising wave of premature deaths caused by non-communicable diseases, which account for 60% of all deaths in India.

Non-communicable diseases, also known as chronic diseases, which are impacting India today. They are long duration illnesses and have slow progression like cardiovascular diseases, cancers, chronic respiratory diseases and diabetes which are not passed from person to person. In India, roughly 5.8 million Indians die because of diabetes, cancer, stroke, heart and lung diseases each year. In other words, out of 4 Indians 1 has risks dying from an NCD before the age of 70.
  • About 1.7 million Indian's deaths caused by heart diseases every year, according to the World Health Organisation.
  • Roughly 16 lakh people suffer from stroke throughout the India and health has found that 55 to 60 per cent men are prone to stroke as compared to women.
  • In 2014, the incidence of cancer in India was 70-90 per 100,000 populations and this has been growing steadily year on year. And cancer prevalence is established to be around 2,500,000 (2.5 million) with over 800,000 new cases and 5,50,000 deaths occurring each year.
  • Latest statistics provides that diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic. And it is predicted that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India. According to International Diabetes Federation (IDF) 1 in every 10 adults will have diabetes in 2030. Study to find prevalence of diabetes & hypertension discovers 80% people had abdominal obesity.
According to the World Health Organisation (WHO) Statistical Profile for India in 2012, the Top 10 causes of death amongst Indians are presented in a chart below.

Price-Waterhouse-Coopers predicts that in 2025, an estimated 18.9 crore people in the country (more than 60 years of age), will be needing higher healthcare spends. By the end of 2025, India will need as many as 17.5 crore additional beds according to a combined study by an industry body and Ernst & Young. In India, 3.2 crore people go below the national poverty line because of their spending on healthcare out of their own pockets for themselves and their family members. Out of total expenditure on healthcare, more than 78% goes out of the patient's pocket and the rest is paid by the Government and insurance companies.
Another challenge is the underinsurance percentage of people between 61-65 years which is currently hovering around 75%. This means that the persons in this age category, while having an insurance policy, have a very low SI which will not completely cover their medical expenses and again they will need to cough up from their pocket all their hard earned savings.
health graph
One of the main reasons for this alarming underinsurance statistics is that people must understand that health insurance is not just a tax saving tool, and therefore be mindful while choosing an appropriate sum insured based on their lifestyle for themselves and their family. At 52% men are more underinsured than women at 46%. Also, underinsurance is more prevalent in higher age brackets as 62% of policyholders above 45 years of age.

The positive news for the India market is that between the Stand Alone Health Insurance players and the General Insurance companies offering Health Insurance, almost all policies cover such Lifestyle Illnesses and some of them have products specifically for Cancer, Diabetes etc. The Sum insureds offered by the Health insurers have also significantly increased and with options like “Sum Insured Restore” the customer really is spoilt for choice today. This means that individuals can insure themselves against financial stress in case they are effected by any of these NCD’s.

Some data around the Health Insurance Market (as put together by IBEF in June 2018) :

  • Only 18% of people in urban areas and 14.1% in rural areas are covered under any kind of health insurance scheme and this is primarily driven by Government Sponsored and Corporate Health schemes.
  • Gross direct premium from health insurance reached Rs 37,897 crores (US$ 5.88 billion) in FY17-18 and contributed 25.2% per cent to the gross direct premiums of non-life insurance companies in India.
  • Absence of a government-funded health insurance makes the market attractive for private players
  • Introduction of health insurance portability was expected to boost the orderly growth of the health insurance sector ut has not created the desired impact in the India market (much like the Telecom sector)
  • In July 2016, IRDAI issued Health Insurance Regulations, 2016. These regulations replace the Health Insurance Regulations, 2013. As per these new norms, companies will provide better data disclosure, pilot products, coverage in younger years, etc.
  • Government-sponsored programmes expected to provide coverage to nearly 380 million people by 2020, driven by initiatives such as RSBY and ESIC
  • RSBY is a centrally sponsored scheme to provide health insurance to Below Poverty Line (BPL) families and eleven other defined categories of unorganised workers, namely building and other construction workers, licensed railway porters, street vendors, MGNREGA workers, etc.

So what is Health Insurance?

Health Insurance is a policy which covers the insured for Medical Expenses post hospitalisation, whether it be a Sickness or Accident. This treatment could have major financial impact on the insured and their family and hence it is prudent for every individual to have sufficient Health Insurance in place. Some of the main coverages under the Health Insurance policy include:
  • In-patient treatment (Cashless) including room rent, ICU, nursing, medicines drugs & consumables covered without as per the policy terms and conditions upto the Sum insured mentioned on the policy. Covered expenses include:
    • Room, Boarding expenses
    • Nursing expenses
    • Fees of surgeon, anesthetist, physician, consultants, specialists
    • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
  • Pre and Post Hospitalization medical expenses: Medical expenses incurred normally upto 30 days immediately before hospitalization and normally upto 60 days immediately post hospitalization remain covered. The coverage period can be extended by submitting relevant documents to the insurer at least 5 days before the Hospitalisation.
  • Day Care Procedures: Most policies covers medical expenses for 120-150 different day care treatments which do not require 24 hours hospitalization
  • Domiciliary Treatment: The policy also covers for the medical expenses incurred for availing medical treatment at home on the advice of the attending Medical Practitioner which would otherwise have required Hospitalisation.
  • Organ Donor: The policy covers Medical Expenses on harvesting the organ from the donor for organ transplantation.
  • Dental Treatment (in case of Accident): The insurance company will reimburse Medical Expenses of any necessary dental treatment from a Dentist provided that the Dental treatment is required as a result of an Accident. Maximum liability shall be limited to the amount specified in the Schedule of Benefits.
  • Ambulance Charges - In most cases the ambulance charges are paid by the policy and the policy holder usually doesn't have to bear the same
  • Cover for Pre-existing Diseases - Health insurance policies have the option of covering pre-existing diseases after 3 or 4 years of continuously renewing the policy without any break in period, i.e. if someone has hypertension, then after completion of 3 or 4 years of continuous renewal with the same insurer (depending on the plan offered and his age), any hospitalisation due to hypertension will also be covered)
  • Other Terms to be aware of:
    • Sum Insured : The Sum Insured offered may be on an individual basis or on floater basis for the family as a whole.
    • Cumulative Bonus (CB) : Health Insurance policies may offer Cumulative Bonus wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal subject to a maximum percentage (generally 50%). In case of a claim, CB will be reduced by 10% at the next renewal.
    • Cost of Health Check-up : Health policies may also contain a provision for reimbursement of cost of health check up. Read your policy carefully to understand what is allowed.
    • Minimum period of stay in Hospital : In order to become eligible to make a claim under the policy, minimum stay in the Hospital is necessary for a certain number of hours. Usually this is 24 hours. This time limit may not apply for treatment of accidental injuries and for certain specified treatments. Read the policy provision to understand the details.
    • Pre and post hospitalization expenses : Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness. Go through the specific provision in this regard.
    • Cashless Facility : Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
    • Additional Benefits and other stand alone policies : Insurance companies offer various other benefits as "Add-ons" or riders. There are also stand alone policies that are designed to give benefits like "Hospital Cash", "Critical Illness Benefits", "Surgical Expense Benefits" etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
    • Key Points to Remember when Choosing your Health Insurance Plan
      • Sum Insured by the policy
      • Co Pays / Deductibles / Sub Limits
      • Waiting Period for Pre Existing Diseases
      • Insurer’s List of network hospitals across India and Claim Settlement Ratio
      • Reputation and Claims paying capacity of the insurer
      • Premium to be paid for the coverage
The most important things to consider while choosing an optimum health insurance plan include:
  • The Optimum Sum Insured – every individual should first decide on the sum insured / coverage that they need given their current health exposure, age, risk factors etc.
  • Exclusions and Waiting Periods under the Plan – these are critical features to be considered while choosing the right plan. Eventhough most plans have comparable exclusions and waiting periods, one must still do a quick comparison to be aware and opt for the plan with the lowest waiting periods and minimal exclusions.
  • Benefits under the Plan – this is the key factor that decides the premium. It is strongly recommended to opt for a plan with more comprehensive benefits, even if it comes at a slightly higher premium. If one considers only premium, the coverage could be reduced significantly which may cause financial duress at the time of a claim.
  • The Right Insurance Partner – the insured should opt for an insurance partner based on their claim settlement capabilities and claims settlement ratio.
  • Strong and Wide Cashless Network - One must also ensure the insurance company has a reasonable strong cashless network across India because the insured could be hospitalised anywhere in India.
  • Day Care Procedures / Pre & Post Hospitalisation – these are also a few important features that must be present in the proposed plan. Day Care procedures are those surgeries and medical interventions that don’t require hospitalisation.
  • Co Payment by the insured – plans where the premium is low for a comparable sum insured could have a higher co pay, which is the % of the claim expense payable by the insured and vice versa, where a higher co pay will mean a lower premium. So whatever the insured is saving on premium will need to be paid as part of the co pay at the time of a claim.
  • Lifetime Renewability.
This is where a website like Eindiainsurance are useful and present to the customer all plan details and premiums allowing them to make an informed decision.

There are two possible scenarios possible if one is employed in India and the employer is providing a Health Insurance coverage. The employer could be providing a Group Health Insurance plan covering their employees and dependants or have an Individual Health insurance plan for each of their employees. Let us look at each scenario separately.

Group Insurance Plan Coverage of Employees – this is typically a family floater coverage for all the members of the family. In this case, if the employee is leaving the organization, he/she can approach the existing insurance company and request them to offer a family floater for the family with the same sum insured limits. The only difference in this case will be that the premium payable will be higher than the Group policy offered by the employer and hence the insured will need to agree to pay the higher premium. Secondly and importantly, the insured should request the insurer to provide a pre existing continuity benefit under the new plan. This will avoid the insured and his family going back to a 48 month pre existing waiting period. For example, if the employee was employed for 2 years and covered under the Group Plan of the Employer, then he/she can request the insurance company to continue the waiting period already crossed and hence under the new plan, the waiting period will only be 24 months, rather than starting from the first month and having a 48 month waiting period all over again.

Individual Insurance Plans for Employees –this is a far more easier option where all the insured will need to do is to apply for a portability of the existing policy to the same insurance company or another insurer. Assuming that the individual premiums earlier were being paid by the employer, the individual will now be required to pay the premium after leaving the organization. This same process holds good for the dependants also. Since the policies are ported from the earlier insurance plan, the pre existing waiting period continuity will be ensured.

The health insurance sector is easily one of the fastest growing segments in the insurance space in India. Ever increasing medical costs and increasing awareness levels are contributing to this growth, especially over the past few years. India is one of the most uninsured markets across the world with less than 20% of the population having some type of insurance coverage and in rural areas this falls to as low as 15%. Given this growth of health insurance, the industry is seeing significant changes in the range of plans which insurers are offering to customers. This is precisely why the IRDAI also offered licenses to insurance companies only focussed on Health Insurance, known as Standalone Health insurance companies (SAHI). These SAHI companies are leading the product innovation game and are at the forefront of unique product launches. So one shouldn’t be surprised to see a diabetes care or plans specially designed for cardiac patients. As mentioned earlier, the rising cost of medical treatments, inflation and the increased incidence of diseases (given the sedentary lifestyle) today have made health insurance a much needed insurance policy. A health insurance plan covers hospitalization expenses of the insured. Some of the more popular plans are :

Indemnity Plans

This is clearly to most popular and preferred insurance policy. Also known as “Mediclaim” these policies compensate the policyholder by reimbursing the actual hospitalization costs incurred by him/her subject to a maximum opted Sum Insured. The word ‘indemnity’ means compensation for losses or damages and hence this plan covers hospitalization cost, pre and post hospitalization cost, expenses on surgeries, ambulance costs, etc. Under the Indemnity Plan, the insured can opt for an Individual Policy or a Family Floater policy depending on their requirement.

Top-up Plans

A top-up health insurance policy is an additional coverage for insureds who have an existing individual plan or a mediclaim provided by their employer. These plans increase the insured’s coverage amount at lower incremental premium costs. Top-up plans can be taken as supplementary plans for enhancing the coverage if the existing plan does not provide adequate coverage. Each top up plan has a deductible limit in the plan which is the minimum sum insured up to which the plan will not provide cover to the insured. If the claim exceeds the deductible limit, the plan is triggered and the excess claim amount above the deductible sum insured is paid.

Benefit Plans

Also known fixed benefit plans, they pay a specific fixed sum insured amount for a claim irrespective of the actual expense incurred by the insured. For instance, in the event of a Critical Illness, if the SI is ₹2 lacs, the policy will pay the insured ₹2 lacs on diagnosis of the Critical Illness irrespective of whether the insured spent ₹1 lac or ₹5 lacs for the treatment of the illness. Some benefit plans include:

  • Critical Illness plans - Critical illness plans provide coverage against a list of defined critical illnesses. Although the list of illnesses covered varies from insurer to insurer, yet on the diagnosis of any of the covered illness, the insurer pays a lump sum amount to the policyholder irrespective of the subsequent treatment costs.
  • Hospital Daily Cash Plans – If the insured is hospitalised, and taken this plan, the policy will provide a fixed sum of money for each day of hospitalization and this does not depend on the actual hospitalization expense but is pre-fixed amount as per the plan.

Specialized Plans

These are specific plans offering coverages relating to only specific illnesses like Cardiac Care or Diabetes Care. So if a Diabetic wants to avail of a Health Insurance plan, regular plans will not offer coverage since diabetes will be treated as a pre existing condition. But under a Diabetes Plan, the insured even with a pre existing Diabetes condition will be offered coverage. Similar is the case for Cardiac Care. Persons with heart related complications can purchase this plan.

Corona Rakshak COVID Insurance Policy

Corona Rakshak is a single-premium Covid19 health insurance plan that will pay 100% of the sum insured as lump-sum to the policyholder ones being tested COVID-19 positive that requires hospitalization of 72 hours or more.

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Corona Kavach Insurance Policy

Corona Kavach is a disease-specific plan, it will pay for things that a regular insurance plan would not. This policy can be availed by persons between the age of 18 Years and 65 Years.

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Health Insurance Frequently Asked Questions

Please find below some relevant FAQ’s for Individual Health Insurance.
What is Health Insurance?

The health insurance policy is a type of insurance policy that covers your medical expenses in case of sickness or accident. A health insurance policy is a contract between an insurer and an individual /group in which the insurer agrees to provide specified health insurance cover at a particular “premium”.

Every individual should buy health insurance and for themselves and members of their family, based on their requirements. Buying health insurance protects individuals from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent into household savings. Each person is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advancements, new procedures and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.

Today the Health insurance industry is flooded with various options to choose from. Under a vanilla Indemnity Plan Sum insureds ranging from Rs 5000 in micro-insurance policies to even a sum insured of Rs 50 lakhs or more in certain critical illness plans are being offered to individuals. Most insurers offer policies between 1 lakh to 5 lakh sum insured. Also, while most non-life insurance companies offer health insurance policies for a duration of one year, there are policies that are issued for two, three, four and five years duration also. Another product, which is the Hospital Daily Cash Benefit policy, provides a fixed daily sum insured for each day of hospitalization. A Critical Illness benefit policy provides a fixed lumpsum amount to the insured in case of diagnosis of a specified illness covered under the policy or on undergoing a specified surgery. There are also other types of products, which offer lumpsum payment on undergoing a specified surgery (Surgical Cash Benefit), and others catering to the needs of specified target audience like senior citizens.

The individual must read the prospectus/policy wordings (terms and conditions) to understand what is covered and not covered under the plan opted for. Generally, pre-existing diseases are excluded under a Health Insurance policy for the first 3-4 years. There would generally be certain standard exclusions such as cost of spectacles, contact lenses and hearing aids, dental treatment/surgery, congenital defects, intentional self-injury / suicide, use of intoxicating drugs/alcohol, AIDS, treatment relating to pregnancy or child birth. Please read the policy terms and conditions.

Age is the most important factor that determines the premium, the older the person is, the premium cost will be higher because older persons are more prone to illnesses. Previous medical history is another major factor that influences the premium. If no prior adverse medical history exists, premium will automatically be lower. Claim free years also come with certain percentage of discount on premium.

Some health insurance policies pay for specified expenses towards general health check up once in a few years. Normally this is available once in four years and is mainly offered as a value add to their corporate customers.

Insurance companies, through Third Party Administrators (TPA’s) have arrangements with several hospitals all over the country as their network to offer cashless treatment for individuals. This means that the insured can get treatment without having to pay the hospital bills as the payment is made to the hospital directly by the Third Party Administrator, on behalf of the insurance company. However, expenses beyond the limits or sub-limits as per terms and conditions of the policy and expenses not covered under the policy have to be settled by the insured directly with the hospital. Cashless facility, however, is not generally available if you take treatment in a non network hospital.

Yes. When the insured buys a new policy, generally, there will be a 30 days waiting period starting from the policy inception date, during which period any hospitalization charges will not be payable by the insurer. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable for subsequent policies under renewal.

Yes. The Insurance Regulatory and Development Authority of India(IRDAI) has issued a circular in October, 2011, which allows the insurance companies to allow Portability from one insurance company to another and from one plan to another, without making the insured to lose the renewal benefits for pre-existing conditions, enjoyed in the previous policy.

Any number of claims are allowed during the policy period unless there is a specific cap prescribed in any policy. However the sum insured is the maximum limit under the policy.

The policy will be renewed provided the insured pays the premium within 15 days (called as Grace Period) from the date of renewal. However, coverage would not be available for the period for which no premium is received by the insurance company. The policy will lapse if the premium is not paid within the grace period.

Health insurance comes with attractive tax benefits as an added incentive. There is an exclusive section of the Income Tax Act which provides tax benefits for health insurance, which is Section 80D, and which is unlike the section 80C applicable to Life Insurance wherein other form of investments/ expenditure also qualify for the deduction. Currently, purchasers of health insurance who have purchased the policy by any payment mode other than cash can avail of an annual deduction of Rs. 15,000 from their taxable income for payment of Health Insurance premium for self, spouse and dependent children. For senior citizens, this deduction is higher, and is Rs. 20,000.

Why should we buy India health insurance?

Why should we buy India health insurance?

Why should we buy India health insurance?

Why should we buy India health insurance?

Indian Mediclaim Insurance Benefits

Benefits of buying health insurance plans

Mediclaim Insurance Factors

Factors to consider while buying health insurance plan

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Top reasons for health insurance claims rejection

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India health insurance coverage, factors and premium calculator

Factors for medical insurance in India, How much is the premium and the coverage offered by India health insurance plans.
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Portability Information for Mediclaim Insurance in India

India health insurance Blogs

Health Insurance Blogs - Information on health or medical insurance coverage in India.

Health insurance FAQ

FAQ related to Indian health insurance. Get answers for any health insurance questions.

Indian Health Insurance Resources

Individual Health Insurance

Every individual must buy insurance and for themselves and members of their family, based on their requirements.

Family Floater Health Insurance

Family Floater is one single policy that takes care of the hospitalization expenses of your entire family.

Top Up Plans

A typical Top Up Health Insurance plan is an additional coverage for an individual who is already covered under an existing Health policy.

Benefit Plans under Health Insurance

Buy Benefit Plans under Health Insurance

Accident Plans under Health Insurance

Accident, is an unexpected event, typically sudden in nature and associated with injury, loss, or bodily harm.

Health Insurance for Maternity and Pregnancy

What are the normal coverages under a Maternity Insurance Plan?