A Health Insurance Policy pays for the medical expenses of the life insured. That's how an insurance company and a policyholder enter into a legal contract. The insurer will either make sure you are eligible for cashless treatment for illnesses or injuries covered by the insurance at one of the network hospitals or reimburse your medical expenses.
Tax deductions for health insurance premiums are also allowed under Section 80D of the Income Tax Act of 1961.
Health insurance plans are fundamental indemnity-based insurance products specifically crafted to offer financial support for medical expenses that arise due to hospitalisation or critical illnesses.
Listed below in the table are some of the top insurance companies offering health insurance policies. The table comprises of Sum Insured, Network Hospitals, and Key Benefits.
Health Insurance Plans | Sum Insured |
Aditya Birla Activ Assure Diamond Plan | Min – Rs. 2 lakh, Max – Rs. 2 crore |
Bajaj Allianz Health Guard Policy | Min – Rs. 1.5 lakh, Max – Rs. 1 crore |
Care Health Insurance Plan | Min – Rs. 3 lakh, Max – Rs. 75 lakh |
Cholamandalam Flexi Health Supreme Plan | Min – Rs. 5 lakh, Max – Rs. 5 crore |
Digit Health Insurance Plan | Min – Rs. 2 lakh, Max – Rs. 3 crore |
Future Generali Health Total Policy | Min – Rs. 3 lakh, Max – Rs. 1 crore |
IFFCO Tokio Individual Health Protector Plan | Min – Rs. 50,000, Max – Rs. 20 lakh |
Kotak Mahindra Health Premier Policy | Min – Rs. 25 lakh, Max – Rs. 2 crore |
Liberty HealthPrime Connect Policy | Min – Rs. 10 lakh, Max – Rs. 1 crore |
Magma HDI OneHealth Insurance Plan | Min – Rs. 2 lakh, Max – Rs. 1 crore |
ManipalCigna ProHealth Insurance Policy | Min – Rs. 2.5 lakh, Max – Rs. 1 crore |
National Mediclaim Policy (Individual) | Min – Rs. 1 lakh, Max – Rs. 10 lakh |
New India Assurance Mediclaim Policy | Min – Rs. 1 lakh, Max – Rs. 15 lakh |
Niva Bupa (Formerly Max Bupa) ReAssure 2.0 Plan | Min – Rs. 5 lakh, Max – Rs. 1 crore |
Oriental Happy Family Floater Policy | Min – Rs. 1 lakh, Max – Rs. 50 lakh |
Raheja Health QuBE Insurance Policy | Min – Rs. 1 lakh, Max – Rs. 50 lakh |
Reliance Health Infinity Insurance Policy | Min – Rs. 3 lakh, Max – Rs. 5 crore |
Royal Sundaram Lifeline Insurance Plan | Min – Rs. 2 lakh, Max – Rs. 1.5 crore |
SBI Arogya Supreme Policy | Min – Rs. 1 lakh, Max – Rs. 5 crore |
Star Comprehensive Insurance Policy | Min – Rs. 5 lakh, Max – Rs. 1 crore |
Tata AIG Medicare Premier Policy | Min – Rs. 5 lakh, Max – Rs. 50 lakh |
United India Individual Health Insurance Policy | Min – Rs. 2 lakh, Max – Rs. 20 lakh |
Universal Sompo Complete Healthcare Insurance Plan | Min – Rs. 1 lakh, Max – Rs. 50 lakh |
Zuno (Formerly Edelweiss) Health Insurance Policy | Min – Rs. 1 lakh, Max – Rs. 1 crore |
Note: GST rate of 18% applicable for all financial services effective July 1, 2017.
Mentioned below are the different types of health insurance plans you can choose to meet your specific requirements:
The following are the documents you will require to purchase health insurance in India:
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.
The common eligibility criteria for Health Insurance in India are as follows:
Criteria | Specifications |
Age | 18 to 65 years |
Pre-Existing Conditions | Required above the age of 45 years |
Nationality | Only citizens or legal residents may be eligible for certain types of health insurance. |
Inclusions | Exclusions |
In-patient Hospitalisation Expenses | Claims within the initial 30 days of purchasing the policy, unless due to accidental emergencies |
Pre-existing Illnesses or Diseases | Coverage for pre-existing diseases usually requires a waiting period of 2 to 4 years |
Pre and Post-Hospitalisation Expenses | Critical illness coverage often involves a waiting period of 90 days |
Ambulance Charges | Injuries resulting from war, terrorism, or nuclear activities |
Maternity Cover | Self-inflicted injuries or attempted suicides |
Preventive Health Check-ups | Terminal illnesses, AIDS, and similar diseases |
Daycare Procedures | Cosmetic or plastic surgery, hormone replacement surgery, and related procedures |
Home Treatment Cover | Expenses for dental or eye surgeries |
Ayurveda, Unani, Siddha, or Homeopathy treatments | Charges for bed rest, hospitalisation, rehabilitation, and common illnesses |
Mental Healthcare Cover | Claims arising from injuries during adventure sports |
Note: It's advisable to review your policy documents for a comprehensive list of inclusions and exclusions.
Here are the key factors you should carefully consider before purchasing a health insurance plan:
Check - For Future Generali Health Insurance Hospicash Hospital Cash Plan
Health insurance policies offer the convenience of cashless treatment and expense reimbursement by the insurer. Claims can be filed based on the sum insured limit of the policy. There are two main types of claim processes:
Claim procedures for both cashless and reimbursement claims can vary for planned and emergency hospitalisations:
The following are some of the best health insurance policies offered by the Government of India:
The cost of health insurance can vary depending on a number of variables, including your own medical history, your family's medical history, the amount insured, cumulative bonuses, and other considerations. You may want to calculate your premium based on it to ascertain how much the insurance would cost. To achieve it, utilize a health insurance premium calculator. The preferred sum covered, the insured's age, and other details are entered into a premium calculator, an online tool that determines the necessary premium depending on the information you provide.
Based on a combination of various factors, your health insurance premium is defined by the following:
Age - Younger individuals generally pay lower premiums due to lower health risks and longer waiting periods for specific illnesses.
Lifestyle - Health insurance costs may vary based on lifestyle choices such as smoking, as lifestyle-related illnesses contribute significantly to healthcare expenses.
Pre-existing diseases or conditions - Individuals with pre-existing diseases or family history of specific conditions may face higher premiums due to increased risk.
Location - The city of residence impacts premiums, with areas facing higher pollution or distinct health risks potentially leading to higher costs.
Additional Covers - Customizing your plan with additional benefits like maternity coverage or alternative therapy benefits can increase premiums slightly to accommodate added coverage.
Confirm that you hold the status of a Non-Resident Indian (NRI). This is a fundamental requirement for eligibility. Choose a health insurance plan that aligns with your needs. Ensure that the plan is eligible for GST refunds. To secure a Goods and Services Tax (GST) refund on health insurance policies as a Non-Resident Indian (NRI), follow these steps:
The following are the main benefits of being covered by a health insurance policy:
1. 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.
2. Cover for Pre & 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Tax Benefits: Tax advantages can also come from having health insurance. Under Section 80D of the Income Tax Act, you are entitled to a tax deduction for the premium payments you make toward your health insurance plan.
8. Online Purchasing Facility: You can now acquire a plan online without going to a health insurance company branch thanks to technological improvements. From the convenience of your home or workplace, you can accomplish this.
9. 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.
10. 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.
The following are the common mistakes you must avoid when purchasing health insurance:
Acquiring a health insurance policy through online channels offers numerous advantages. Explore these benefits:
With medical costs escalating steadily, securing medical treatments has become a costly affair. The risk of depleting your savings due to hospitalisation for critical illnesses or lifestyle diseases is a pressing concern. The optimal solution to navigate these challenges and ensure access to top-notch medical care is by obtaining a health insurance policy. Consider the following pivotal reasons for acquiring a health insurance plan:
Your existing health insurance policy includes coverage for the expenses related to COVID-19 treatment. Many health insurers and general insurance providers have introduced specific health insurance plans designed to cover medical costs associated with treating COVID-19. Following the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), two distinct standard health insurance products, namely the Corona Kavach policy and the Corona Rakshak policy, have been introduced. These are gaining popularity among individuals seeking coverage for COVID-related expenses. Let's explore these two COVID insurance offerings and their differences compared to basic health plans.
Before purchasing a health insurance policy, it's crucial to dispel certain myths and understand how these policies actually work. Here are several prevalent myths that many individuals have about health insurance:
Health insurance offers broader coverage, including hospitalization, surgery, and various medical expenses, while mediclaim primarily focuses on reimbursing hospitalization expenses.
Yes, it's good to buy health insurance for financial protection against medical expenses.
To claim health insurance, notify your insurer within 24 hours of emergency hospitalization and 48 hours before planned admission. Submit reimbursement documents within 30 days post-discharge and follow up on the status.
In many cases, dental treatment is not covered under standard health insurance plans. However, some health insurance policies may offer optional dental coverage or dental insurance plans that specifically cover dental treatments. It's essential to review the policy details or inquire with the insurance provider to understand what dental services, if any, are covered under your plan.
‘No-Claim Bonus’ is a benefit offered to the policyholder for every claim-free year. It is awarded upon renewal and comes in the form of discounts on premiums or enhancements in the chosen sum assured. Discounts/enhancement range between 5% - 50%.
There is no right or wrong age to purchase health insurance coverage. However, it is advised to purchase it as soon as possible to keep your premium low. The earlier you acquire health insurance, the lower the rate.
This is because you are less likely to experience health problems at a young age than someone in their mid-50s or 60s, who are more susceptible to catastrophic illnesses. As a result, if you acquire health insurance in your 30s, you will be able to receive the maximum insurance benefits while paying a reduced price.
Anyone who depends on the primary member for their livelihood, commonly the proposer’s spouse, children and parents, are considered dependents. Children are often considered dependents beyond 18 years up to the age of 25 years if they are still students (sons) or unmarried (daughters) or mentally challenged. Dependent children are often covered only if a parent is concurrently covered under the same plan.
Under some plans, the insurer and the insured are jointly liable to meet expenses. The policyholder will pay a certain percentage towards expenses incurred. If policyholders exercise this option, they are often given reductions in premiums.
Day care procedures ate those medical treatments that do not require the patient to be hospitalised for a minimum of 24 hours. Day care treatments can be done in few hours so it is done as an outpatient procedure. There are many insurers who offer health insurance coverage specially designed for day care treatments.
Domiciliary hospitalisation means that the policyholder is being treated for a certain ailment within the confinement of his/her home and not in a hospital or a nursing set up. Usually, domiciliary hospitalisation is allowed when they aren’t able to move the patient from home to the hospital or when the patient cannot be taken to the hospital due to lack of accommodation. In other words, domiciliary hospitalisation refers to the treatment given to a patient for a certain disease or injury for more than 3 continuous days due to non-availability of accommodation in the hospitals or because the patient cannot be moved to the hospital.
Generally, not all health insurance plans cover homeopathy treatments. You will have to check with your insurer if homeopathy is covered under the plan. However, if you are looking for insurers who offer health insurance plans that cover AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatments, visit - Medical insurance for AYUSH.
A health card is like an identity card given by the insurer to the policyholder. It contains information like the policyholder’s insurance account number, the name of the insured, the age of the insured, gender, policy expiry date, and other such vital information. It is mandatory for an insured person to show the health card at the hospital in case of hospitalisation.
Medical testing is not required before purchasing a health insurance policy. However, most health insurance firms in India need medical test records if the applicant is over the age of 45. The type of medical tests necessary can vary depending on the applicant's age and the insurer's specifications.
The sum insured is the maximum amount an insurance company will pay a policyholder during a policy year if a claim is filed due to illness or accidental harm. It is also known as the maximum coverage or coverage amount in health insurance.
A free-look period in health insurance refers to the first 15 days of the policy's inception. During this time, you can study the features, coverage, and other aspects of your health insurance policy and decide whether to renew it. You can also choose add-on covers now. If you decide to cancel the insurance during this term, you will not be charged a cancellation fee.
You can add family members to your health insurance coverage at the time of renewal or purchase. A family health insurance plan can cover you, your spouse, dependent children, parents, and parents-in-law, according to the terms and restrictions.
Pre-hospitalization expenses are medical expenses incurred before being admitted to a hospital. Post-hospitalization fees include the costs of follow-up testing and consultation treatment charges incurred after being discharged from the hospital. Health insurance in India typically covers pre-hospitalization expenses for 30 to 60 days and post-hospitalization charges for 60 to 90 days, depending on the plan.
On Wednesday, the Union Cabinet approved health coverage for senior citizens under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. Union Minister Ashwini Vaishnaw stated that the scheme will benefit close to six crore senior citizens, providing eligible beneficiaries with coverage of up to Rs. 5 lakhs. It is anticipated to benefit around 4.5 crore families across India.
PhonePe and Star Health and Allied Insurance Company have tied up to provide comprehensive health insurance policies. Under the plans, the premium can be paid either monthly or yearly. Coverage of up to Rs.1 crore is provided. An announcement regarding the same was made on 3 April 2024. UPI Autopay mandate can be set up to make the payments.
To offer quality health insurance with flexible payment option, the PhonePe app is offering health coverage of Rs.1 crore with monthly EMI (Equated monthly installment) option. This industry-first initiative empowers users to avail themselves of Star Health Insurance's comprehensive policy of health coverage along with either traditional annual payment plan or EMI option on PhonePe application.
The premium can be paid through UPI AutoPay that ensures hassle-free payment, thereby making it pocket-friendly and enables the users to meet their wellness needs. Users need to click on the Health Insurance option in PhonePe application and select the members to be insured. Then select the payment system and ‘Star Comprehensive Insurance policy’. Fill in the required details as mentioned; fill in the regulator mandated Know Your Customer (KYC) form and declaration; and make payment to purchase the policy.
Suryoday Bank and Magma HDI General Insurance Company have signed a Corporate Agency Agreement to offer health insurance. The insurance cover will be provided to Commercial Vehicle Loan customers of the bank. The signing ceremony of the MoU was conducted in Mumbai. Following the agreement, Commercial Vehicle Loan customers of the bank will be able to access and customise health insurance policies.
The parliament has decided to cut down the Goods and Services Tax (GST) rate from 18% for insurance products, such as health and term insurance. This initiative has been taken to reduce the premium amount as the high GST rate increases it.
The Holistic Healthcare Summit was inaugurated in Gandhinagar by Chief Minister Shri Bhupendra Patel as a prelude to the tenth edition of the Vibrant Gujarat Global Summit, further strengthening Gujarat's global image. During the inauguration, Chief Minister Shri Bhupendra Patel complimented the Vibrant Gujarat Global Summit for achieving global recognition and distinction under Prime Minister Shri Narendra Modi's leadership.
The Indian government is contemplating the creation of a health sector regulator to extend affordable health insurance coverage to all citizens citing senior officials. The health and finance ministries have deliberated on the need for a watchdog as part of the "Insurance for All" vision. With over 400 million individuals lacking access to adequate health insurance, the initiative aims to address the growing risks associated with rising healthcare costs. Discussions also highlighted challenges and opportunities, emphasizing the potential role of a sectoral regulator in standardizing treatment costs and streamlining health claims settlement.
The Department of Health and Family Welfare, under the Ministry of Health, is expected to convene a meeting with stakeholders, including insurance companies, to formulate a detailed plan. The envisaged health regulator could enhance the National Health Claims Exchange's scope and assume additional powers, functioning as an industry watchdog. While the Insurance Regulatory and Development Authority of India (IRDAI) oversees insurance providers offering health coverage, market forces currently determine health insurance pricing. The proposed regulator aims to bring standardization and affordability to the sector, addressing variations in policy terms and claim-related restrictions across insurers.
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