Tips and Guide to Choose Best Health Insurance Plans

Health Insurance

Health insurance policy is a contract between the health insurance companies and the insured individual. The best health insurance plans state disbursal of sum assured under various predetermined circumstances. It includes the premium of insurance policy, its tenure, coverage, the sum-insured, etc. Moreover, it has a few terms & conditions under which the health insurance companies take care of the hospital expenses of the insured person and his/her family members.

What is Health Insurance?

Like any other insurance, the best health insurance plans in India provide financial support and shield the primary insured person from hospitalisation expenses incurred due to sudden illness, an accident, or even a planned treatment.

The best health insurance companies in India collaborate with a group of hospitals, known as network hospitals through which the policyholders can avail cashless treatment benefits for medical expenses. Besides, in the case of non-network hospitals, the top 10 health insurance companies in India offer to reimburse the hospitalisation expenses. The Indian Government also pushes people to opt for the best health insurance plans in India as policyholders can avail tax exemptions under Section 80D of Income Tax Act 1961 by purchasing the best health insurance plan. 

Every day, medical expenses are rising exceedingly. Therefore, a comprehensive health insurance plan has become one of the essentials for everyone. There are numerous best health insurance plans in India, each providing coverage for costs related to diagnosis, critical illness, surgeries, hospitalisation, etc.

Popular Terms Related Health Insurance Policy

Below-cited are the few general terms related to health insurance:

  • Pre-Existing Conditions: These are health issues that have been diagnosed before the purchase of a health insurance plan.
  • Network Hospitals: It is a group of hospitals that the best health insurance companies in India collaborate with to offer medical treatments through the cashless process.
  • Waiting Period:  It is the time post which you can avail facilities of the best health insurance plans in India.
  • Inclusions: Everything that is covered by your health insurance, and is mentioned in the policy document.
  • Exclusions: Everything that is not covered by your health insurance plan and is also mentioned in your policy document.
  • Sum Insured: It is the total amount that the health insurance companies pay to the insured person for his/her medical treatments.
  • Claim Request: It is a request by the insured person for the health insurance companies to pay for his/her medical expenses.
  • Premium: It is the money you pay to the health insurance companies either every month, quarter, or year, to avail the benefits of an insurance policy.
  • Add-ons: The additional benefits that enhance your primary insurance plan with an added premium.

Significance of Best Health insurance Plans in India

It’s not just an excellent thought to opt for a health insurance plan, but it is a necessity because of the ever-rising expenses of medical treatments. A health insurance plan offers financial protection that could arise out of emergency hospitalisation of you or your loved ones.

Ignoring the need for a health insurance cover could probably result in a dip in your savings. Medical emergencies are unpredictable & unforeseen, and with medical treatments becoming more costly, it’s crucial to opt for a health insurance policy that will cover you and your family members.

Also read: Things to know before purchasing a Coronavirus Health Insurance Cover

Health Insurance Plan: Advantages & Features

To cater to your needs, different health insurance plans are offered by the top 10 health insurance companies in India. The below-described are a few advantages of buying health insurance:

  • Pre/Post-Hospitalisation Costs: The medical expenses a month before and three months after your hospitalisation is covered under health insurance.
  • Hospitalisation Cover: Covers the costs arising out of hospitalisation due to an accident or sudden health issues. A minimum of 1 day of hospitalisation is required to avail this cover.
  • Ambulance Related Costs: Covers expenses of ambulance related services.
  • In-house Treatment Expenses: The top 10 health insurance companies in India cover the medical expenses for the treatment that an insured person undergoes at home.
  • Frequent check-ups: Some health insurance companies also cover the expenses of general medical check-ups. However, there might be a waiting time before you can opt for this benefit.
  • Daycare Expenses: Treatments such as chemotherapy, radiotherapy, eye surgery, dialysis, angiography, etc. are also covered.
  • Critical Illness: Illnesses such as paralysis, artery diseases, stroke, cancer are the critical illnesses that are also covered by the best health insurance companies in India.

Health Insurance Plans: Tax-Benefits

As per Section 80D of Income Tax Act, the premium you pay for the health insurance offers tax relief. Moreover, the Finance Act, 2018 offers higher tax benefits for the policy premium paid by senior citizens towards their health insurance plan.

  1. Below 60 years: INR 25,000 for self + INR 25,000 for parents
  2. Policyholder below 60 years and parents above 60 years: INR 25,000 for self + INR 50,000 for parents
  3. All above 60 years: INR 50,000 for self + INR 50,000 for parents

Steps to Buy Health Insurance Online

  1. Visit the official website or mobile application of any of the best health insurance companies in India.
  2. Fill in a few details such as your name, age, email address, details of the dependent and select from different types of health insurance plans based on your requirements.
  3. Make the payment for the health insurance premium and instantly get your policy documents on your registered email address.

Steps to Renew Health Insurance Online 

  1. Visit the official website or mobile application of any of the best health insurance companies in India.
  2. If you are renewing your policy with the same insurer, log in using your username & password.
  3. Once you successfully log in, you will get a pop-up to renew your health insurance. Make the payment towards your health insurance premium and get your renewed policy documents on your email address.
  4. In case you want to change your insurer, visit the official website/app of that insurer and opt for policy port/transfer.

Buy Health insurance Online: Benefits

One of the primary purposes of health insurance is to ensure the availability of financial aid for you in the event of critical illness or emergency hospitalisation. It is even more convenient to buy health insurance online. Below-cited is a few benefits when you buy health insurance online in India:

  • Easy comparison of health insurance plans amongst the top 10 health insurance companies in India
  • Select different types of policy plans.
  • At a lower health insurance premium, choose maximum benefits.
  • Evaluate claim ratios and several other components of different health insurance companies.
  • You can buy it from the comfort of your home or while on the go.
  • No insurance agent is required, thereby reducing the insurance cost.
  • Convenient & time-saving to buy/renew the policy.

Pick Best Health Insurance Plan: Top Tips

There is an extensive range of health insurance companies in India. Hence while choosing the best one, you should thoroughly assess the top 10 health insurance companies in India based on your preferences. Below-described are few tips to opt for the best health insurance plans:

1. Choose the Apt Health Insurance Cover

Best health insurance plans cover you with a wide range of medical issues and enhanced advantages such as pre/post-hospitalisation, hereditary illnesses, ambulance expenses, in-house treatments, daycare costs, etc. Therefore, it would be best to opt for health insurance that offers a comprehensive cover at a low health insurance premium.

2. Family Floater over Individual Health Policy

Those individuals who want health insurance just for themselves, it would be best if they opt for individual health insurance. However, if you are searching for the best health insurance plans that can protect your family too, then we suggest buying the family floater health insurance as it provides maximum coverage at a competitive cost.

3. Compare Health Insurance Quotes Online

Through a health insurance premium calculator, you can know the elements that impact the policy cost. Moreover, you can choose from different health insurance companies and their prices for the best health insurance plans that suit you and your loved ones.

4. Check Coverage of Network Hospitals

At the time of emergencies, health insurance policy with an extensive range of hospitals and specialities will be of great help to you. Therefore, it would be great to select the best health insurance companies in India that have collaboration with excellent hospitals across the world.

5. Health Insurance with Least Waiting Time

Similar to every insurance policy, the best health insurance plans include a few terms & conditions. We suggest you select health insurance that has the lowest waiting time for pre-existing health problems. Usually, for such situations, mediclaim insurance policies come with a lesser waiting period.

6. High Claim Settlement Ratio

The top 10 health insurance companies in India with high claim settlement ratios provide an insight into how the insurer evaluates its claim requests. This act means that without a valid reason, the insurer will not reject any claim request. Nevertheless, it is also the insured person’s responsibility to go through the terms & conditions of claim settlements carefully.

Health Insurance Policies in India

There are numerous health insurance policies available by the top 10 health insurance companies in India to cater to different customer requirements.

1. Individual Health Policy

This health insurance offers financial protection to an individual policyholder. Usually, it covers some specific illnesses and offers cashless treatment facilities, pre/post-hospitalisation cover, reimbursement claims, and several other add-on benefits.

2. Family Floater Health Policy

This health insurance allows you to include you & your family members in one insurance policy. Kindly note that the family members comprise of you, your parents, spouse, and dependent kids. The sum assured is shared with each insured family member. However, this type of health insurance has a higher health insurance premium compared to individual health insurance. Still, buying separate policies for each family member is quite costly. 

3. Senior Citizen Health Policy

This health insurance is solely designed for senior citizens, i.e., persons above 60 years. Before health insurance is offered to senior citizens, they might possibly have to go through a health check-up. Moreover, the Indian Government provides tax exemptions for senior citizen health insurance, thereby making it a significant investment.

4. Critical Illness Health Policy

Typically, this plan is an add-on to your existing health insurance. It covers critical illnesses such as coma, blindness, kidney failure, stroke, heart attack, loss of limbs, organ transplant, cancer, etc. Moreover, this type of health insurance comes with a higher policy premium due to high risk.

5. Maternity Health Policy

This policy is the pregnancy health insurance that covers hospitalisation costs for all pre-natal services and post-natal services in some cases. Note that the delivery charges(normal/caesarean), pre/post-natal expenses, as well as any complications that may occur, are separate.

6. Personal Accident Health Cover

Personal accident health insurance acts as an add-on to the primary policy and provides hospitalisation and compensation in the event of injuries, disability, death, impairment, or mutilation. Besides hospitalisation due to an accident, it offers extra coverage to the insured person.

7. Employee/Group Health Policy

Several employers offer health insurance to their employees in the form of Employee/Group policy. This type of policy covers accidents/illness, pre/post-hospitalisation, in-house treatments and daycare expenses.

8. Pre-Existing Illness Cover

Some health insurance policies come with a waiting period of up to 4 years before they offer the benefit of pre-existing diseases to the policyholders. To cut down this duration and get your first “hands-on” at a lower health insurance premium, you may go for the pre-existing illness add-on cover. Besides your primary health insurance, doing this will offer you cover for pre-existing illnesses, right from the moment your policy becomes active.

9. Preventive Health Check-Ups Cover

The top 10 health insurance companies in India also cover health check-ups as a part of their health insurance policy. You can claim a certain amount towards your health check-up expenses during the policy’s term. Both you and your loved ones can take advantage of this facility. Usually, new-gen health insurance companies provide extra coverage for health check-ups. Furthermore, the Indian Government offers tax exemptions towards medical check-up expenses.

Inclusions of Health Insurance 

Health insurance covers most hospital & doctor visits, wellness care, medicines & medical devices, and surgical expenses. It additionally covers the treatment of severe health issues and critical illnesses. However, it covers certain ailments. A typical health insurance policy includes the following:

  • In-Patient Hospitalisation Expenses: It covers medical expenses such as doctor/surgeon fee, medicine expenses, room rent, etc., incurred during hospitalisation for more than a day.
  • Pre/Post-Hospitalisation Expenses: It covers expenses incurred before 30 days and after 60 days of the patient’s hospitalisation.
  • Day-Care Expenses: It includes a few day-care/treatment-related expenses for severe health conditions.
  • Certain Pre-Existing Conditions: After two/four years of consecutive coverage with the best health insurance companies in India, some pre-existing health conditions are covered under health insurance.
  • Cashless Treatment: The top 10 health insurance companies in India offer cashless treatment facilities at any of their network clinics/hospitals.
  • Preventive Medical Check-ups: Once your waiting period is over, you can use the health check-ups facility offered by a few insurers using your primary health insurance policy.
  • Ambulance Related Charges: Emergency ambulance services are covered.

Exclusions of Health Insurance

Below-cited are certain health conditions and treatments that are not covered under health insurance.

  • Cosmetic Surgeries: Non-dangerous surgeries such as botox, liposuction, etc. are not included in a health policy.
  • Pre-Existing Diseases: Some health insurance companies do not cover pre-existing ailments such as high BP, diabetes, while a few insurers do provide cover for them with a waiting time. In some situations, with a payment of extra policy premium, the best health insurance companies in India might cover pre-existing health conditions.
  • Diagnostic Costs: Expenses incurred due to CT scans, X-rays, blood tests, performed at a hospital, nursing home, or diagnostic centre, are not included in health insurance.
  • Miscellaneous Expenses: Admission fee, registration & service charges are not covered.
  • Some Specific Drugs: Certain medicines used during hospitalisation are not covered under primary health insurance.
  • Illnesses due to Substance Abuse: Some critical illnesses occurring due to substance abuse such as alcohol or intoxicating drugs are not covered.
  • OPD Charges: Out-patient treatment is generally not covered in a health insurance policy. However, the top 10 health insurance companies in India offer this feature on an additional health insurance premium.
  • Self-inflicted Injuries: Insurers do not cover injuries/illnesses due to any suicidal act.
  • STDs: Ailments occurring due to STDs are not covered in the best health insurance plans in India.

Eligibility Criteria for Best Health Insurance Plans

The eligibility criteria for health insurance varies from one insurer to another. However, the below-described is the general eligibility criteria for health insurance:

  • Policyholder’s Entry Age: The entry age for the primary insured person is between 18 & 65 years. However, the top 10 health insurance companies in India might increase this limit.
  • Family Members’ Entry Age: For adults, the entry age is between 18 & 65/70 years. In the situation of dependent children, the minimum entry age is three months. However, the best health insurance companies in India may include dependent children between the age group of 1month- 25 years.
  • Health Conditions:  If you are willing to buy health insurance after 45 years of age, you may have to undergo a health examination to get the health policy. The best health insurance companies in India prefer to know your health conditions before offering a policy to you. Moreover, you also have to mention any pre-existing diseases to health insurance companies.

Buy Health Insurance Online: Documents Required

Below-cited is the list of documents required to get health insurance:

  • Age Documents: Certificate of Birth, Voter’s Card, Passport, DL, etc.
  • Identity Documents: PAN, DL, Voter’s Card, Passport, etc.
  • Address Documents: Utility Bills, Bank Statements, Passport, UID, Ration card, etc.
  • Health Test Report: You might also be asked to undergo a health check-up and submit its report.
  • Photos: You are also required to present your passport size photos.

Individual vs Family Floater Policy

The individual health policy covers the medical expenses of the primary insured individual only. Hence, for each member of the family, you will require a separate policy. Kindly note that there will be a dedicated insurance premium & sum assured for each member.

On the other front, the family floater insurance policy includes every member of the family under single insurance. All the family members share the entire sum assured of the policy. Besides this, below-cited are a few differences that you must know about:

  • Sum Insured: A family floater health insurance covers all the family members with a single sum assured amount that can be utilised by any or all the family members. It will decrease whenever it is claimed during the policy term. However, in individual health insurance, the sum insured is restricted only to one individual and will reduce as and when the individual will claim it.
  • Coverage: The family floater policy covers the insured individual, spouse, and a maximum of two dependent kids. The best health insurance companies in India also offer coverage for individual’s parents, parents-in-law, siblings, and three-four children. On the other front, only one person is covered under an individual policy.
  • Health Insurance Premium: In family floater health insurance, health insurance companies determine the policy premium by considering the age of the eldest family member. Whereas in individual health insurance, the policy premium is calculated by considering the age of the individual insured person.

Both individual and family floater policies cater to different groups of people. The individual insurance premium for each family member is higher in contrast to a family floater policy. However, that should not be the only criteria for you to go for a family floater policy. For a family with more young people, family floater policy is an ideal choice. Whereas, individual health policy suits best for  individuals with high-risk health conditions.

Health Insurance Claim

The claim settlement of a policy is one of the primary aspects of health insurance. As an insured person, you can make a claim request in the following two ways:

  • Cashless Mediclaim Policy Settlement

To avail the cashless treatment benefits, it would be great if you get yourself hospitalised at any of your insurer’s network hospitals.

  • Reimbursement Claim Settlement

In the case of reimbursement claim settlement, you first need to pay the medical expenses incurred due to hospitalisation from your pocket and then raise a claim for the reimbursement of those expenses. Moreover, you need to submit all the hospitalisation-related documents such as original invoices, bills, prescriptions, payment receipts, etc. to your insurer.

How to make a claim request for Health Insurance?

Step 1: Your doctor will advise you hospitalisation.

Step 2: Immediately inform your insurer about the hospitalisation.

Step 3: In case of a cashless mediclaim policy, you can get yourself hospitalised at any of your insurer’s network hospitals. However, for reimbursement claims, you may undergo medical treatment at any hospital and pay the expenses.

Step 4: Under the cashless treatment, the hospital contacts your insurer to arrange cashless hospitalisation and other processes. In case of reimbursement claims, you need to submit the claim form along with all the necessary documents such as payment receipts, original bills, prescriptions, etc. to your insurer within the given time.

Details to be Kept Handy While Making a Claim request

When you inform your insurer about the hospitalisation, you need to have the below-mentioned details ready to initiate the claim settlement process. Have a look:

  • Policy number.
  • Contact details of the insured person
  • Patient’s Name
  • Relationship of the patient.
  • Name of the Hospital.
  • in case of health claims, mention the nature of the ailment
  • In case of an accident, mention the nature, time, and date of the accident.

Claim Process for Cashless Health Insurance

You are required to follow the below-cited steps to make a cashless claim request:

Step 1: Get yourself hospitalised to any of the insurer’s network hospitals.

Step 2: Present your health insurance policy’s ID card.

Step 3: Duly fill & sign the cashless mediclaim policy form and submit it to the hospital authorities.

Step 4: The hospital will then get in touch with your insurer regarding your treatment.

Step 5: If approved, your cashless treatment process will be initiated.

Step 6: Upon discharge, carefully examine and sign all the medical bills.

Documents Required for Health Insurance Claim

Below-described is the list of documents required while making a claim request to the health insurance companies:

  • Duly filled & signed claim form.
  • Discharge Summary of Patient
  • Original Invoices and Prescriptions
  • CT Scan/ECG/X-Ray Reports
  • In case of an accident, MLC/FIR is required.
  • Your policy card’s copy
  • In case of reimbursement, a cancelled cheque is required.
  • Original bills and payment receipts

Wrapping Up

Hopefully, the above given information has made you understand the health insurance basics. However, it would be best if you go through all the terms & conditions of health insurance plans carefully before selecting one. It is suggested to opt for a health policy once you are entirely convinced with its benefits. 

FAQs

For availing the benefits of health insurance, you are required to pay the amount to the insurer that is known as health insurance premium.
Family floater health insurance offers coverage for the policyholder, the spouse, and dependent children. Although, some insurers cover policyholder’s parents too. In contrast to individual plans that cater to the primary insured person, a family floater health insurance is comprehensive, offering complete coverage for the entire family.
Your health insurance comes with a grace period of 15 days. You can choose to renew your health insurance to resume the policy validity before the grace period ends. However, during this period, all the claim requests will be rejected by your insurer until you pay the policy premium. Moreover, your health insurance will lapse if you do not renew it within the grace period.
Some insurers offer coverage for routine medical check-ups as well. However, there is a waiting period before you can opt for this benefit.
Indeed! Dependent children between the age group of three months and 25 years are eligible to be covered under health insurance policies.
Below-cited are the factors that affect the calculation of policy premium:
1.Type of Insurance: Individual or Family Floater
2.Amount of Sum insured
3.Age of the eldest family member
4.Add-ons(if opted)
5.Sub-limit(if opted)
Indeed! As per IRDAI’s regulations, you may transfer your health insurance from one insurer to another. This process is known as health insurance portability.
As per Section 39 of the Insurance Act, you can nominate an individual for health insurance. During your lifetime and while the health insurance is active, you can appoint any individual as a nominee to whom the insurer will offer benefits of your health insurance upon your unfortunate demise.
Generally, most insurers require a health examination for individuals above 45 years of age.