Health Insurance

Heath Insurance

Benefits of Health Insurance:

The following are the main benefits of being covered by a health insurance policy:

Cashless Treatment:

When you are covered under a health insurance policy, you can avail cashless treatments which essentially means that you can receive medical treatments without having to pay the hospital from your own pockets.

Cover for Pre- as well as Post-Hospitalisation Expenses:

Effective insurance policies offer coverage for pre- as well as post-hospitalisation expenses for a period of 60 days before and after an insured individual is hospitalised.

Transportation Expenses:

In case you hold a health insurance policy and get hospitalised the plan will cover the costs incurred on using an ambulance to transport you from your home to the hospital or vice-versa.

Medical Check-ups:

Most health insurance policies offer free health check-ups. However, most insurance companies only offer these check-ups for free depending on your No Claim Bonus.

No Claim Bonus:

If you hold a health insurance policy and do not make any claims over the course of an entire policy year, you will be rewarded in the form of a No Claim Bonus.

Room Rent:

In case you are hospitalised, you will have to incur costs on room rent. Having a health insurance policy will ensure that these costs are covered to a significant extent.

Tax Benefits:

Having a health insurance policy can offer tax benefits as well. The premium payments you make towards your health insurance plan qualify for tax deductions under Section 80D of the Income Tax Act.

Online Purchasing Facility:

Thanks to the advancements in technology, you no longer need to visit a branch of the health insurance company in order to purchase a plan. You can do so from the comfort of your own home or office.

Renewal:

The renewal of your health insurance policy can also be done online. There is also a lot of flexibility when it comes to renewing your insurance plan. You can alter the terms of coverage based on what you think will work best for you.

Cover for OPD Expenses:

Most of the traditional health insurance plans require the insured individual to be hospitalised for a minimum of 24 hours if they are to be eligible for reimbursements.

Types of Health Insurance Plans in India:

Mentioned below are the different types of health insurance plans you can choose to meet your specific requirements:

  • Individual Health Insurance
  • Family Floater Health Insurance
  • Senior Citizen health Insurance
  • Critical Illness Health Insurance
  • Maternity Health Insurance
  • Group Health Insurance
  • Preventive Healthcare
  • Personal Accident Insurance
  • Individual Health Insurance: As the name suggests, Individual health plans are made for individual policyholders. The premiums might be low under such plans, but there are a variety of factors that contribute to the price of a policy. Previous medical conditions, age, location, etc. are a few of the parameters that influence the premium.
  • Family Floater Health Insurance: Instead of buying separate policies for every member, a family floater plan covers the entire family under one plan. Typically, parents and children (up to 2 children) can be covered under this plan. Some insurers even provide coverage for up to 15 family members. Under such plans, the sum insured is shared by all the included family members. Even though family floater plans have a higher premium than individual plans, the price is still cheaper when compared to the expenses involved in buying a different policy for each member.
  • Senior Citizen Health Insurance: Designed to cater to the needs of the senior citizens, such plans are only for the ones who are 60 years old and above. Senior citizen plans usually come with discounts. Though only a few insurers provide such policies, they might ask for a medical check-up before selling the plan. Also, these policies may cost a lot higher than the health covers for younger consumers as senior citizens are more prone to diseases and illnesses.
  • Critical Illness Health Insurance: Critical illness plans cover life-threatening illnesses. Cancer, heart attack, organ transplant, kidney failure, etc., are a few of the illnesses covered under such policies. A critical illness cover is especially useful if the insured has a history of certain critical illnesses in the family.
  • Maternity Health Insurance: Maternity plans are designed to cover women who are expecting a child. It covers the expenses incurred in the pre-natal stage, delivery, and post-natal stage. Both the mother and the newborn are covered under such plans. Maternity plans can also be bought as a rider to an existing basic policy.
  • Group/Employee Health Insurance: Such plans are usually offered by employers and are designed to include and exclude members as they join and leave the company. Group health policies are generally low in premiums due to the reduced risks involved. Such plans also allow leniency in terms of covering pre-existing illnesses among other things.
  • Preventive Healthcare: A preventive healthcare policy covers the expenses incurred during treatments/measures taken to prevent a certain disease, illness, or cancer. Annual check-ups and screening tests are few of the services that are covered under preventive healthcare.
  • Personal Accident Insurance: Personal accident plans specifically cover the expenses related to unforeseen accidents. Such policies provide compensation in cases of disablement, death, injury, or impairment caused by road, rail, water, or air accidents.

Documents required for health insurance in india

The following are the documents you will require to purchase health insurance in India:

  • Age proof: When purchasing a health insurance policy, you will be required to submit the age proof of all individuals who are going to be covered by the plan. The following documents are acceptable as proof of age:
    • Birth certificate
    • Passport
    • 10th or 12th class marks card
    • Voter’s ID
    • PAN card
    • Aadhaar card
    • Driving license
  • Proof of identity: The following documents can be submitted as ID proof when applying for a health insurance plan:
    • Aadhaar card
    • PAN card
    • Voter’s ID
    • Passport
    • Driving license
  • Proof of residence: A permanent address proof must also be submitted when applying for health insurance. The following documents can be used for this purpose:
    • Telephone bill
    • Passport
    • Electricity bill
    • Driving license
    • Ration card
    • Voter’s ID
    • Aadhaar card
  • Passport-sized photographs

Certain health insurance companies will require applicants to undergo medical examinations in order to qualify for coverage. Also, insurers can also request other documents apart from the ones mentioned above.

Best Health Insurance Companies in India in 2020

Listed below are some of the top insurance companies offering health insurance policies. The insurance companies have been ranked based on the Incurred Claims Ratio of every insurer. This is the ratio between the premium earned and the total claims incurred by the insurer.

This is the ratio that is generally used to determine how an insurance company is performing. A higher incurred claims ratio means the insurance company has a better track record of settling the claims they receive. It is always good to opt for an insurance company with a high Incurred Claims Ratio.

Health Insurance CompaniesIncurred Claims Ratio (ICR)Grievances Resolved
National Health Insurance115.55%97.07%
Oriental Health Insurance113.86%73.83%
United India Insurance110.95%96.59%
Reliance General Insurance106.54%98.49%
Universal Sompo General Insurance104.17%100.00%
New India Assurance Health Insurance103.19%99.94%
Bharti Axa General Insurance98.50%99.69%
IFFCO Tokio General Insurance90.69%98.47%
Aditya Birla Health Insurance89.05%57.54%
Future Generali Health Insurance87.42%99.73%
Bajaj Allianz General Insurance77.61%99.78%
Liberty Videocon General Insurance74.58%100%
ICICI Lombard General Insurance68.26%98.91%
Star Health and Allied Insurance61.76%98.96%

Source: IRDA Annual Report 2017-18

Common Mistakes to Avoid when Purchasing a Health Insurance Policy:

Choosing the right insurance plan can be a difficult task, but thanks to advancements in technology, the internet can now grant you access to a large number of options .This can be assessed and compared before you pick the plan that best suits your needs. People tend to make common errors when purchasing health insurance, and avoiding these mistakes can help you make the most of your health insurance policy. The following are the common mistakes you must avoid when purchasing health insurance:

  • Inadequate CoverThe amount for which you are covered plays a crucial role in determining which policy will best suit your needs. Most people tend to choose plans with lower coverage as it helps them save some money. Lower coverage will help reduce the amount you pay as premium for your insurance policy. While it is important to save money, it is also crucial to ensure that you don’t be too stingy when it comes to buying health insurance as it could prove to be a hassle later.
  • Missing the Fine Print
    • It is important to have a look at the fine print before choosing the insurance policy. Going through the fine print will tell you all about the coverage offered by your health insurance policy
    • It will also tell you about the exclusions so you are aware of what you can and cannot claim
  • Comparison of InsurersMany people tend to go with the first insurance company they find. When purchasing a health insurance plan, it is crucial to compare as many plans as possible as it will help you identify which one best suits your needs.
  • Falsified Medical HistoryPeople tend to lie about their medical history when purchasing health insurance as it tends to lower their premiums. When you purchase a health insurance plan, it is essential to be truthful about your past medical health and situations. When you lie about your medical history, there is a chance that your claims could be rejected if the insurer finds out about the same.Ensure that you submit the correct records so that you do not have to encounter a problem later.
  • Cashless HospitalThe cashless facility is one of the most important things to look for when purchasing a health insurance plan. However, many people tend to even consider this facility when looking for policies. By finding an insurance provider that offers the cashless facility, you can rest assured that you will receive immediate treatment in case of emergencies and the insurer will cover the costs.
  • Careful Selection of Premiums and Co-paysWhen you purchase a health insurance policy, the insurer will provide with an option of co-pay. If you choose this option, you will have to contribute a certain pre-determined amount at the time of making a claim, and the remainder will be paid by the insurance company. The sum assured will not be affected by the co-pay amount.
  • Choosing Too Many Additional Riders
    • It is good to buy additional riders at the time of purchasing an insurance policy. This will enhance the protection you receive from the insurer at the time of a claim.
    • Make sure you do not opt for add-on covers just to add more protection to your policy. Purchase add-on covers that will be of use for you and your family.How to choose the right insurance policy

How to choose the right insurance policy

  • Understanding the Needs Analyzing the health insurance needs of your family is the most important step in buying a health insurance policy. Evaluating the health problems affecting the family can give a good idea of the coverage you require.
  • Picking the Right Coverage Amount Try to choose a health insurance policy that offers the highest coverage amount. You can decide the coverage you need based on the health conditions of you and your family. Try to opt for higher coverage if you are prone to many diseases.
  • Extent of Illnesses Covered Pick a health insurance policy that covers the highest number of illnesses. Look out for critical illnesses covered. Choose the plan that covers the most critical illnesses as the treatment for these diseases is very expensive. Review the illnesses not covered by the policy before.
  • Higher Sum Assured A health insurance policy reimburses expenses up to the sum assured of the insurance policy. Higher sum assured will mean that you will be covered for a larger amount. This can be of great use if you are residing in a higher tier city.
  • Higher Renewal Age Health insurance policies will be of more use only when you get older. This is why it is advisable to choose a health insurance policy that has a higher age limit for renewal. Pick a policy having a maximum renewal age ranging between 70 and 75 years.
  • Higher Claim Settlement Ratio Claim Settlement Ratio is the ratio of the number of claims received and the number of claims settled by the insurer. Always pick an insurer with a higher claim settlement ratio. This increases the chances of your claim getting approved at the time of an incident as companies with a higher ratio have a good track record of settling claims.
  • Network Hospital Coverage Network hospital coverage is offered by almost all the insurers in many of the big cities in the country. If you are residing in a rural area, make sure to pick the company with the widest hospital network.Lower Co-pay amount Co-pay is the percentage of amount you will have to pay at the time of a claim incident. This amount can range between 10% and 30%. Make sure to pick the health insurance plan having low or no co-payment.

Health Insurance Claim Process:

Health insurance acts as a safety net for an individual’s finances in case he/she meets with an unforeseen accident. The insurance policy ensures that the insured gets the best treatment available without worrying about clearing the costs at the time of discharge. Knowing about the claim process is an important piece of information that the insured should be armed with at all times. There are certain procedures that the insured will have to follow at the time of making a claim.

There are two main types of claim process which an individual can choose when making a claim on their health insurance. These are:

  • Cashless Claim Process
  • Reimbursement Claim Process

For all the illnesses covered under the health insurance policy, the insured can receive treatment from the hospital by providing the details of the health insurance policy along with some proof for the policy.The hospital will then approach the insurance company with the bills. The insurance company will settle the total amount with the hospital after evaluating all the expenses incurred. There is a separate claim process for planned treatments and emergency treatments. In the reimbursement claim process, the policyholder will have to initially pay for the treatment. The money will then be reimbursed by the insurer after the required documents are provided.

Find out more about the claim process to make sure you are aware of all the steps to take at the time of a claim incident.

Health Insurance Network Hospitals:

Cashless facility is available only if you receive treatment in one of the network hospitals of your insurer. A network hospital is a medical facility with which your insurer has a tie-up to provide healthcare to its customers. If you opt for cashless treatment, you don’t have to pay the medical bills upfront from out of your pocket. The insurer will pay the network hospital while you receive treatment without any hassle. All you have to do is show your e-card upon arrival at the network hospital to avail cashless treatment.

Health Insurance Tax Benefits:

You are eligible for tax benefits on the premium you pay for your health insurance. You can avail tax benefits for the premium paid for the health insurance policy according to Section 80D of the Income Tax Act, 1961. Click here to find out all the tax benefits you can avail for a health insurance policy.

Health Insurance Portability

Portability is the option of switching from one health insurance provider to another. Opting for portability earlier resulted in a loss of all the benefits you may have accumulated with the previous insurer. IRDA made a change to this rule and you can now transfer your insurance from one insurer to another without losing the benefits you gained with the previous insurer. You can also use this option to port from one plan to another plan provided by the same insurer.

Health Insurance Vs Mediclaim:

Mediclaim covers only hospitalization expenses whereas health insurance reimburses pre and post-hospitalization expenses, pharmacy bills, and ambulance fees besides hospitalization expenses. Often, mediclaim and health insurance are used interchangeably even though they aren’t the same thing.

Health Insurance PlanMediclaim
Health insurance plans offer a comprehensive cover against medical expenses incurred by the life insured due to an illness or accidental injury.Mediclaim provides reimbursement for hospitalization expenses incurred by the life insured.
Critical illness cover, personal accident cover, and accidental disability cover are some of the add-ons or riders that can be attached to the base health insurance policy, wherein the life insured is paid a lump sum amount as benefit.Mediclaim works on the indemnity principle, wherein the life insured is reimbursed his or her hospitalization expenses.
Once the claim is made and the sum assured is paid, no further claims can be made under a health insurance plan.Any number of claims can be made under a mediclaim policy until the sum assured is exhausted or paid in full.
The payout in a health insurance plan can be enormous, usually up to Rs.60 lakh.Mediclaim insurance cover is limited, usually up to Rs.5 lakh.