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What is Health Insurance?

Health Insurance is a product by Insurance Companies to cover the medical and surgical expenses incurred by the insurer. Health is the most unpredictable aspect of one's life. Anybody can encounter a serious health issue at any stage of life. Health problems need not crop up only in old age.

If not any health issue, it could be hospitalisation due to an accident. Meeting medical expenses which appear out-of-the-blue is not in the reach of everyone. At least not at present times, when the cost of medical treatment is soaring high day by day.

The product that covers the expenses that arise out of such emergencies is Health Insurance. Periodical payment of premium as stipulated by the Insurance Company has to be made. The payment of the premium could be either monthly, quarterly, half-yearly or yearly.

The insurance company either pays the medical expenses incurred directly to the hospital or will reimburse the expenses to the insured individual. Flexible coverage for ailments/disease is provided. Some Health Insurance companies offer a cover for as many as 80 and above surgical procedures and as many as 30 and above critical illness.

Health Insurance can be a saviour when such critical emergencies emerge at the eleventh hour. If you have a huge family responsibility with regard to every member of the family, then going in for Health Insurance for the entire family is recommended.

Features and Advantages of Health Insurance Policy

  • With a Health Insurance Policy, you will be able to get medical treatment in the best of hospitals without being worried about the cost of the treatment.
  • Any medical emergencies can be handled with great ease even at times when you are in a disastrous financial situation.
  • Imagine you come across a situation when you are diagnosed with a health issue which can be treated in specialised hospitals whose cost of medical treatment seems unaffordable. This is at such times that Health Insurance comes handy.
  • The cashless facility of the Health Insurance policy is the best feature. All the expenses incurred in the course of your medical treatment will be directly remitted to the hospital and you will not have to worry about paying the hospital first and then claiming reimbursement from the Insurance Company.

The main features of a Health Insurance policy are:

Cover for expenses incurred prior to hospitalisation and post hospitalisation

The expenses incurred 30 to 60 days prior to hospitalisation and post hospitalisation will be reimbursed upon submission of relevant bills and receipts.

Treatment without payment - Cashless treatment

Under this feature, treatment will be provided in the hospitals listed in the insurance policy without the payment of cash. This relieves you of the burden of arranging for cash to meet the expenses. The hospital authorities will send a pre-authorisation request with the details of treatment and the cost. Pre-authorisation from the company will be as good as paying cash for the treatment. The insurance company will remit the treatment expenses directly to the hospital.

 

Various Plans

  • There are plans that cover the medical expenses of an insured individual along with the pre and post hospitalisation expenses. The treatment can be undergone without making any payment as the cashless treatment facility of the plan will take care of the payment. Top-up plans available with these plans also can be opted for if required.
  • Plans for treatment of critical diseases like the brain tumour, cancer, kidney problems, heart- related issues, etc., for which the treatment expenses will be very high. This plan can be taken as a top-up on theexisting policy or can be taken as a separate policy. The premium collected for this policy will be very high since the cost involved is proportionately high.
  • Plans that cover pre-existing diseases like diabetes, hypertension, kidney problems, heart- related problems, cancer that might be diagnosed even before obtaining the policy.
  • Plan to cover the medical expenses of all the family members. All the members will be covered under a single policy. The amount of cover can be different for each individual. In case of need, the extent of cover available for each individual can be collectively used for the treatment of one individual if the treatment is a very expensive one.
  • Some plans cover the medical expenses of senior citizens up to the age of 65

Best Health Insurance Policies in India by Top Insurance Companies

Some of the best insurance policies by top insurance companies in India are:

Best Health Insurance Policy by Max Bupa Insurance Company

Max Bupa Health Companion

The above plan is designed to cover an individual or provide cover for the entire family.

The features of the policy are:

  • It is a policy suitable for an individual or the entire family. It offers a comprehensive cover up to 1 Crore.
  • Wide network of hospitals for cashless treatment. Around 4,000 hospitals are listed for cashless treatment.
  • The benefit of the tax deduction for the premium paid can be availed under Section 80D of the Income Tax Act.
  • An option for lifetime renewal is available
  • A facility for a top-up on the existing policy is available
  • There is no cap on the room charges on hospitalisation
  • The entire treatment cost of the insured on hospitalisation is borne by the Company
  • The room rent charges are borne by the company and there is no cap on the room rent
  • Pre and Post hospitalisation expenses are also reimbursed provided there is an Inpatient Care hospitalisation claim.
  • If the entire base amount and the no-claim bonus amount are exhausted, you will be eligible for an additional sum insured provided it is for an unrelated ailment.
  • All day-care treatments except the outpatient treatment will be covered
  • Hassle-free claim settlement process with an excellent customer service team on board
  • The turn-around time for cashless claim processing is very less and the pre-authorisation will be received within 30 minutes.

Royal Sundaram Health Insurance Policy

Lifeline Health Insurance Plan

The Lifeline Health Insurance Plan has three categories depending on the sum insured.

  • Lifeline Classic with a sum insured between 2 Lakhs to 4 Lakhs in multiples of one lakh
  • Lifeline Supreme with a sum insured between 5 Lakhs to 50 Lakhs in multiples of 5 Lakhs.
  • Lifeline Elite with a sum insured between 25 Lakhs to 1.50 Lakhs in steps of 25, 30, 50, 100 and, 150 Lakhs.

The features of the Lifeline Plan are as follows:

  • Pre and Post hospitalisation expenses covered for a period of 30 to 60 days for Lifeline Classic, 60 to 90 days for Lifeline Supreme and 60 to 180 for Lifeline Elite.
  • The Inpatient Care is covered up to the sum insured for all the three categories
  • For all the three categories day care cover up to the sum insured is available
  • Ambulance cover up to 3,000 for Lifeline Classic, 5,000 for Lifeline Supreme and, 10,000 for Lifeline Elite is available.
  • The expenses of the organ donor are covered up to the sum insured for all the three categories
  • No claim bonus to the extent of 10% of the base sum insured with a maximum of 50% of the sum insured for Lifeline Classic. For both Lifeline Supreme and Lifeline Elite 20% of the base sum insured with a maximum of 100% of sum insured.
  • Domiciliary hospitalisation cover up to the sum insured is available for all the three categories
  • The facility of refilling the sum insured up to the base sum insured for all the three categories in case the base sum insured along with the no claim bonus is exhausted.
  • Ayush Treatment undergone at Government hospitals will be covered up to sum insured for all the three categories and up to 20,000 for Lifeline Classic, up to 30,000 for Lifeline Supreme and up to 50,000 for Lifeline Elite for Ayush treatment at other hospitals.
  • Cover up to 2,500 for Lifeline Classic, up to 5,000 for Lifeline Supreme and up to 7,500 for Lifeline Elite for vaccination in case of Animal Bites.
  • Emergency medical expenses coverage worldwide except at the US and Canada is available only for Lifeline Elite up to 50% of the base sum insured with a maximum of 20 Lakhs at $1000/- per hospitalisation.
  • Cover for treatment of eleven crucial diseases abroad except at the US and Canara only for Lifeline Elite up to the base sum insured with a cover for return airfare up to 3 Lakhs.
  • Maternity cover up to 2 deliveries for Lifeline Elite Category up to 2 Lakhs for a sum insured up to 50 Lakhs. For a sum insured above 50.00 lakhs the maternity cover available is up to 2.50 Lakhs.
  • Cover for medical expenses for the newborn baby available to the extent of 25% of the sum insured only for the Lifeline Elite category.
  • Vaccinations for the newborn are covered up to 10,000 only for the Lifeline Elite category
  • The benefit of hospitalisation cash for hospitalisation beyond 2 days available at 1,000 per day for Lifeline Classic, 2,000 per day for Lifeline Supreme and 5,000 per day for Lifeline Elite. This facility is available for a maximum of 30 days.
  • The hospitalisation cash facility is included for treatment worldwide except the US and Canada for 11 critical illness for Lifeline Elite Category only.

Apollo Munich Health Insurance

Optima Restore

  • This plan is applicable for both individual and family. The sum insured can be between 3 Lakhs to 50 Lakhs.
  • The cover is available 60 days before hospitalisation and 180 days after hospitalisation
  • It is one of the most popular plans of Apollo Munich with its Multiply, Restore, and Stay Active Benefits.
  • In case the sum insured and the no claim bonus accrued are all exhausted then the facility of 100% restoration of the sum insured is available.
  • If no claim is made for a period of 2 years, the Multiply facility will give a 100% increase in the sum insured.
  • The Stay Active benefit gives the insurer the benefit of discount in the premium if the insurer leads an active lifestyle.
  • Cashless treatment access at more than 4500 listed hospitals

Optima Senior

  • This plan is exclusively designed for Senior Citizens. Senior Citizens above 61 years of age are eligible. It can be taken individually or with the spouse. A 5% discount is available if both the individual and the spouse are covered.
  • Hospitalisation expenses for over 24 hours, expenses incurred for treatment at home, pre-hospitalisation expenses 30 days prior to hospitalisation and post-hospitalisation expenses for 60 days after hospitalisation, expenses incurred for day-care treatment for more than 140 listed ailments are all covered by the above plan.
  • The treatment expenses incurred for an organ donor is also covered
  • Expenses incurred for ambulance services up to 2,000 are covered under the plan
  • Portability facility, i.e., if you want to switch over the insurance policy to Apollo Munich from any other insurance company, the same is allowed.
  • Tax benefit under Section 80D of the Income Tax Act is applicable for the premium paid
  • Sum insured can be enhanced only at the time of renewal of the policy
  • A pre-authorisation has to obtained 48 hours prior to admission or at least 24 hours after admission.

Star Health and Allied Insurance Company

Myself for Individuals

  • This plan is meant for individuals aged between 18 years to 65 years
  • No cap on room rent
  • Cash facility on hospitalisation on a per-day basis is available
  • Daycare treatment expenses covered for 400 plus treatments
  • For every 3 years of no claim, free health check-up will be made available

My family for families

  • Cover under floater basis at an affordable premium
  • Outpatient expenses covered for dental and ophthalmic treatments
  • The sum insured will be enhanced by 100% for a claim-free renewal
  • Cover for expenses incurred on ambulance services is available
  • No cap on room rent

My Parents for Senior Citizens

  • Senior Citizens in the age group between 60 to 75 years are eligible
  • Cover for pre-existing diseases available from the second year onwards
  • No medical test required prior to applying for insurance
  • OPD expenses also covered
  • Lifetime renewal is guaranteed

New India Assurance Company

New India Premier Mediclaim Policy

  • An individual and the entire family can be covered under the policy
  • Anybody in the age group between 18 years to 65 years can avail this policy
  • There are two types of policy. Plan A with the sum insured between 15 Lakhs to 25 Lakhs and Plan B with the sum insured between 50 Lakhs to 1 Crore.
  • Pre-insurance medical check-up for anybody over 50 years of age
  • The room rent, nursing charges, ICU charges, expenses incurred for treatment of the organ donor, Surgeon, Anaesthetist, Consultant, and Medical Practitioner's fees are covered.
  • All expenses relating to the treatment are covered
  • Hospital cash will be paid at 2,000 per day for Plan A and 4,000 per day for Plan B, which is applicable if the hospitalisation is for over 24 hours.

Which Medical Insurance is Best for Family?

The following medical insurances are best for the family:

  • Star Family Health Optima
  • Max Bupa Health Companion
  • HDFC Health Suraksha
  • Apollo Munich Optima Restore Family Plan
  • SBI Life Smart Health Insurance
  • Oriental Insurance Happy family floater Policy
  • Bajaj Allianz Family Floater Family Health Guard

What is the Difference Between Mediclaim and Health Insurance?

The following are the differences between Mediclaim and Health Insurance:

Health Insurance Mediclaim

Health Insurance covers pre and post hospitalisation expenses including the hospitalisation cover.

Mediclaim covers only the hospitalisation expenses.

Expenses incurred for ambulance services and lost income cover is provided by some of the insurance companies.

It takes care of only hospitalisation cover

Cover for critical illness for over 30 plus ailments like cancer, kidney failure, paralytic stroke, heart-related problems etc. is available.

Critical illness not covered

The maximum sum assured is 6 Crores

The maximum sum assured is 5 Lakhs

Only one single claim can be made in respect of Health Insurance with a critical illness or accidental disability cover.

Multiple claims can be made until the amount is exhausted.

How to Choose the Best Health Insurance Policy?

Here are a few tips to choose the best Health Insurance policy:

  • Maximum coverage and maximum amount for treatment should be the prime concern while choosing a health plan.
  • If you have a family, then the family floater policy that covers all the members of the family is the ideal one. You need not have a separate policy for each member of the family and yet the entire family is covered for any medical emergencies.
  • If you are a married person while deciding the sum insured you should consider the health of your spouse as well and choose a sum that would cover both of you sufficiently.
  • All the Health Insurance policies have a waiting period for covering the pre-existing diseases, i.e., the diseases that exist before taking a plan. Generally, the waiting period is 2 to 4 years and some of the insurance companies do have a lesser waiting period. So, before you opt for a plan you should consider the waiting period for pre-existing diseases if you have any.
  • Consider the maximum age up to which the policy can be renewed. Choose the policy which gives the best benefit as far as the age limit for renewal of the policy is concerned. Take a plan that can be covered up to at least 80 years of age. Even better if lifetime renewal option is available without any upper age limit for renewal of the policy. This can take care of medical emergencies throughout the old age.
  • Choose a Health Insurance company which the highest claim settlement ratio which means the maximum number of claims settled out of the claims received. It is to ensure that your claim will not be rejected without a valid reason. Also, submit all the relevant documents as required by the insurance company to get the claims settled faster.
  • Choose a plan that carries maximum sub-limits. Sub-limits for medical expenses on a per day basis, sub-limit for room rent and other expenses. The best would be the one which has a maximum sub-limit for health care expenses. Even consider the premium that goes with such benefits. Go in for the plan that has the lowest premium and the maximum benefit, sub-limit wise.
  • Look for the net work of hospitals for cashless treatment. Choose the one with the maximum number of networks for cashless treatment.
  • Do research and go for the best deal. Consider a Health Insurance plan with the least premium with maximum benefits in terms of the post and pre hospitalisation expenses, a cap on room rent, other health care expenses, etc.
  • Go through the reviews about the insurance companies. It will give an insight into the pros and cons of each insurance company. Choose the company which has made the experience of dealing with them delightful to maximum customers.
  • Make a study of the exclusions that different policies carry and choose the one with the minimum number of exclusions. Exclusions mean the ailments that are not covered.
  • By giving an extra premium you can get a rider for critical illness added to the existing policy. With this, you will be getting a cover for a critical illness like cancer, kidney failure, heart diseases, etc.
  • Study the policy details carefully and check whether there is a cover for Maternity Expenses and the waiting period to avail the same. With the soaring cost associated with pregnancy, it is better to look for a policy which will cover even the OPD expenses in respect of maternity treatment.
  • Some insurance companies offer free medical check-up for policyholders during the renewal of the policy. Look for such an offer before making a decision.

Making a decision while taking Health Insurance is crucial and following the above tips will help you choose the best policy.

Importance of Health Insurance in India

With the soaring prices for medical treatments, it is very vital to have Health Insurance plans to provide for medical expenses that crop up out of the blue.

The reason to have Health Insurance is:

  • The insurance will take care of all the medical expenses
  • It will keep you prepared for any medical emergencies
  • The premium payable for these Health Insurance policies is very nominal while they give you financial security in respect of any medical emergencies.
  • The process of claim is simple and hassle-free
  • The chances of your claim being rejected are very bleak unless there is a very valid reason

Claim Ratio and Claim Settlement Ratio in India

The claim ratio is nothing but the claims settled versus the premium collected. If the claim settled is 95% then the Company would have settled claims up to 95% of the premium collected and 5% would be the profit for the Company. The higher the claim ratio the lesser will be the profit earned by the Company. If the claim ratio crosses 100%, it means that the Company may be providing funds for claim settlement out of their reserves which is not good for the Company. The higher claim ratio is good for the customers since it indicates that the company is successfully meeting the claims made.

Claim settlement ratio is nothing but the number of claims received by Insurance Company and the number of claims settled. While choosing the best deal for a Health Insurance plan, the claim settlement ratio should also be a part of your checklist. Go for an insurance company that has the highest claim settlement ratio to ensure that your claim will not be rejected without a valid reason.

Given below is the statistics of the claim ratio of different Health Insurance companies.

Name of the Health Insurance Company Claim ratio

Bharathi Axa General Insurance

96.85%

Cholamandalam MS General Insurance

72.91%

Bajaj Allianz General Insurance

76.88%

Apollo Munich Health Insurance

54.99%

Future General Health Insurance

77.31%

Cigna TTK Health Insurance

48.14%

Royal Sundaram General Insurance

78.13%

ICICI Lombard General Insurance

80.38%

Max Bupa Health Insurance

51.96%

Star Health and Allied Insurance

60.51%

Frequently Asked Questions

How will the claim settlement be made if treatment is taken in a hospital which is not in the network list of the insurance policy?

When treatment is taken in a hospital which is not included in the cashless treatment hospital list, the claim settlement will by reimbursement only. You will have to initially bear the medical expenses and then claim for reimbursement from the insurance company.

How to ascertain whether the policy covers treatment all over the country?

You should ascertain before availing the policy if there are any geographical limitations stated in the policy. Some of the policies offer cover for treatment abroad. So, you should be looking for a policy which is PAN India and also which provides for cover for treatment abroad if required.

How to avail cashless treatment?

To avail cashless treatment, you should take treatment in the hospital that is in the network list of the policy for cashless treatment. If so, then a pre-authorisation 48 hours before admission to the hospital for a certain treatment has to be obtained from the insurance company or if it is an emergency then, at least 24 hours after admission the pre-authorisation has to be obtained. Thereafter, the expenses will be directly dealt with by the Insurance Company.

Do Health Insurance policies cover pre-existing illness?

Yes. Pre-existing illness is covered by Health Insurance policies but there is a certain waiting period from the effective date of the policy. Normally the waiting period is 2 to 4 years. However, there are insurance companies that stipulate lesser waiting period. If you are looking compulsorily for the inclusion of pre-existing illness, then it is better to go for a policy that has a lesser waiting period.

Who is the contact person at the time of emergency hospitalisation?

Before signing in for the Health Insurance policies make enquiries about the emergency hospitalisation policy and whom to contact at such a situation to get help with respect to documentation, etc. There will be an exclusive representative or a customer service desk handling these issues. Be aware of the contact persons who will guide you through such situations.

Give a list of documents necessary for a claim settlement?

The documents required are identification documents of the member insured, hospital bills, health card, claim form, etc. at the time of the claim. In the case of cashless treatment, a pre-authorisation from the insurance company has to be submitted to the TPA.

How to ensure the claim settlement process of an insurance company?

Before availing the Health Insurance, ascertain the claim settlement process and the time taken for such processing. Find out if the insurance company is offering cashless treatment wherein you need not bear the burden of the medical bills. There are insurance companies who offer claim settlement only by reimbursement. Avoid such policies and go for a policy which has cashless settlement process.

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