Health Insurance

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Health Insurance-Definition

Health Insurance is an insurance product that covers. the whole or part of the risk of person incurring medical expenses.

Health Insurance is estimated by the overall risk of health care and health system expenses over the risk pool, to provide the money to pay for health care benefits specified in the insurance agreement, a routine finance structure can be developed.

Importance of Health Insurance

For every individual in India, These days health insurance has become a necessity. It provides risk coverage against expenditure which is caused by unforeseen medical emergencies.

Today, failing to hold an adequate health cover can prove costly financially when the medical inflation rates are so high. However, awareness about health insurance is on the rise in urban India.

A study jointly conducted by Max Bupa and Nielsen in 2014-15 covered 1500 consumers. revealed that 70% of the respondents felt that health insurance was more important than life insurance.

 60% of the consumers were aware that health cover provided by the employer may prove to be inadequate.


  • Covers. Room and boarding expenses

  • Nursing expenses

  • Fee of doctors, surgeons, other specialists and consultants, etc.

  • Health check up, laboratory fee and charges Sum insured for individual/family Cumulative bonus

  • Health check up, laboratory fee and charges Sum insured for individual/family Cumulative bonus

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Documents Required for Medical Insurance Policy

List of Medical Insurance Companies in India

There are few documents that you need to provide if you have decided to buy health insurance online such as:

  • Aic Of India Health Insurance
  • Apollo Munich Health Insurance
  • Bajaj Allianz Health Insurance

  • Bharti Axa Health Insurance

  • Cholamandalam Ms Health Insurance

  • Ecgc Health Insurance

  • Cigna TTK Health Insurance

  • Future Generali Health Insurance

  • Hdfc Ergo Health Insurance

  • Iffco Tokio Health Insurance

  • L & T Health Insurance

  • Max Bupa Health Insurance

  • National Health Insurance

  • New India Health Insurance

  • Oriental Health Insurance

  • Reliance Health Insurance

  • Religare Health Insurance

  • Royal Sundaram Health Insurance

  • Sbi Health Insurance

  • Shriram Health Insurance

  • Star Health Insurance

  • Tata Aig Health Insurance

  • United India Health Insurance

  • Universal Sompo Health Insurance

Compare and Decide

Insurance Bucket allows you to compare the best deal on insurance and let you choose by yourself which will help you in saving more money.

To protect yourself and your family from unwanted medical costs health plans are the best way. Buying health plans provide risk coverage against expenditures caused by unforeseen medical emergencies.

Insurance Bucket helps you to compare and choose the best health insurance plan for you.

The level of coverage mostly depends upon the type of medical insurance policy. A lot of companies now offer health insurance in India and therefore as a consumer, you have multiple choices from leading brands.

 You should take advantage of our comparison services to choose the best deal. Some of the brands offering health plans are MaxBupa, Bharti-AXA, Tata AIG, Apollo Munich, Star Health, etc.

Choose the best health insurance in India

In current times of high medical inflation rates, failing to hold an adequate amount of health insurance cover can prove to be a major personal finance disaster. This could lead to either poor health care because of non-affordability or spiral an individual into financial distress due to high medical bills.

This is where the whole concept of medical policies comes into play. Best health insurance plans cover medical costs during hospitalization as well as pre and post-stages of hospitalization.

Types of Health Insurance in India:

  • Individual Medi-claim-This is the simplest type of all health insurance schemes and is called the individual healthcare policy. Such a scheme covers. Hospitalization expenses for a person up to the sum assured. The yearly premium payable is usually directly proportional to the sum assured.

    Example- All the policies are independent of each other if there are three members. in your family, each of them can buy a standalone cover of Rs.2 lakhs each. If all three members require hospitalization, all can get their hospitalization expenses covered by up to Rs. 2 lakhs.

  • Family Floater Policy- These are enhanced versions of the individual medi-claim policy. Here, the sum assured is floated among family members. named in the policy. That is, it covers. the medical expenses of the full family, up to your sum assured.

    Family floater policy is usually less than individual policies taken by each family member. Suppose, there are four members. in your family; you can buy a family floater medi-claim for? 6 lakhs. Now anyone of the four insured can claim up to the full amount for expenses.

    But the cover will come down by the claimed amount for that policy year. So when a member of your family gets hospitalized and expenses in this regard is? 4.5 lakhs, the cover for the family floater policy would be reduced to? 1.5 lakhs.

    The policy will again resume from? 6 lakhs, upon renewable. A family floater medi-claim policy makes sense because each member gets a big cover. Also, the chance of more than one member getting hospitalized in the same year is quite low.

  • Unit Linked Health Plan (ULHP)-Health insurance companies have recently introduced ULHPs that combine health insurance and investment, and return an amount once the term of insurance ends. The return, of course, depends upon the market conditions at that time.

    But these plans are still in the development stage and are recommended for those who can handle products like unit-linked insurance plans (ULIPs) and unit-linked pension plans (ULPPs).

Note- It is advisable to stay away from ULHP’s for some reasons. Treat health insurance just as an expense. This is because, unlike life insurance, you don’t get back the premium you pay at the end of the term if there’s no claim.

Select an individual healthcare policy if you are single and a family floater if you have a family. You can get a tax exemption of up to Rs.15,000 under section 80D of the Income Tax (IT) Act if the amount of premium is paid by credit/debit card or cheque.

  • Health Insurance by Employer

Several companies provide medi-claim for their staff. It also often covers the hospitalization expenses of the spouse, dependent children, and parents. It is always advisable to take the medi-claim irrespective of the amount covered because you don’t have to pay any premium for that.

Now, whether you need to take another health insurance policy will depend on a few factors. Is the cover provided by your employer sufficient? Is the insurance company good enough? What will happen when you change jobs?

Medi-claim is provided as an incentive to employees. So it’s important that you understand the insurance policy is details and also check the coverage. Ask your human resource (HR) department for the details; what’s covered and what’s not covered.

Employees are satisfied over the fact that their company is providing health insurance, only to find out later that several things were not included at all or were covered only in parts.

  • Health Insurance For Senior Citizens

Medi-claim companies were unwilling to extend cover to the aged and senior citizens, a decade back. But of late, several insurers are providing health insurance policies for them.

Insurance cover paid to an individual aged 65 years. Or above can lead to additional tax relief of up to Rs.20,000 but remember that premium payable for senior citizens are much higher.

If you are employed and have a medi-claim cover from your employers, approach your HR manager and negotiate with the insurance company to provide an additional cover for your parents. Because of the high volume, the insurer may provide the cover at an attractive premium

  • Third-Party Administrators.

A third-party administrator, commonly known as TPA, is an organization that processes claims and extends cashless facilities to the insured as a separate entity. TPAs, in effect, act as a middleman between the insurance company and the insured.

A customer can deal directly with the TPA for settlement of claims and the organization will help the insured with the process. TPAs are specialized healthcare service providers and render a variety of services that include networking with hospitals and arranging for hospitalization.

The TPA concept was introduced by the Insurance Regulatory and Development Authority of India (IRDAI), to benefit both the insurer and the insured.

While insurers benefit via reduction of their overheads and administrative costs, fake claims, and ultimately reducing claim ratios, the insured can take advantage of better and prompt healthcare service.

An insurer may have several TPAs. Similarly, a TPA can serve as an agent of multiple insurance companies.

TPAs settle claims in two ways.

  • Cashless:

You can avail cashless treatment facilities only in the networked hospitals of the insurance company. The TPA must be notified beforehand in case of planned hospitalization, or within a specified timeframe in case of an emergency.

All the paperwork will be done by the hospital’s insurance desk. The TPA has to approve the medi-claim amount and the hospital will settle it with the insurer. There are likely to be exclusions i.e. expenses that the TPA won’t pay.

Such expenses must be settled by the patient party directly at the hospital cash counter.

  • Reimbursement:

The insurer can avail of the reimbursement facility both at networked and non-networked hospitals. Here, you can avail of treatment facilities and settle the bill directly with the hospital. You can then claim reimbursement of the expenses from the TPA by submitting the relevant bills and receipts.

Let’s Compare- Health Insurance Vs Medi-claim

Health Insurance Medi-Claim
Policy holders will get the comprehensive coverage that will cover pre and post hospitalization as well. The upper limit of a health insurance policy can go to as far as Rs. 60 lakhs. Normally, health care policies also offer discounts on a regular basis over a definite period of time. When it comes to tax deduction, there is also a difference in health insurance and medi-claim. A medi-claim policy provides coverage for hospitalization expenses for a definite pre specified illness till a certain time as per the sum insured. The maximum limit for all claims is fixed at a definite amount under medi-claim policy. It works on the principle of indemnity in which hospitalization is a specific requirement to think about any claim. Even those people who are insured under a medi-claim policy need to pay hospitalization expenses from their pocket and the insurer will pay them later.
Health insurance premium paid towards a health insurance policy provides a tax exemption under section 80D of Income Tax Act. The funds paid towards medi-claim premium paid for self or spouse or children are appropriate for tax exemption of Rs. 15,000 under section 80D.

Some Important Health Insurance Terms

Here are some of the important terms that you will come across while subscribing to a health insurance policy.

  • Sum Assured:

The sum assured, in simple terms, is the maximum coverage amount you can get in a policy year. It forms the basis of all your claims. Consider the increasing costs of hospitalization, medicines, and treatment before you decide on your sum assured.

It’s advisable to select a higher cover. At the same time, the cover shouldn’t be high enough for you to dig into your pockets for paying the premium.

  • Co-pay and Sub-Limits:

The co-pay and sub-limit system is introduced by some health insurance companies to prevent hospitals from billing unreasonable room rents to patients. In a co-pay policy, you need to pay a part of the expenses irrespective of the sum assured.

If a policy has 10% co-pay, then the insurance company will pay 90% of the expenses and you have to bear the rest. Besides, some insurers cap the expenses of treatments to reduce the claims of hospitals.

This is known as sub-limit. While buying a medi-claim, choose a policy that has fewer sub-limits. There are some medi-claim policies that do not have co-pay or sub-limits. Try to select such a plan.

  • Comprehensive Cover:

Some employers provide health insurance to their staff under the group insurance plan. But you can still have a medi-claim of your own which covers the entire family. The second medi-claim policy may not consider if your employer allows you to transfer the policy if you leave your job. It’s important that you compare several policies before buying one.

  • Critical illness:

The majority of the comprehensive medi-claim policies cover critical illness. You don’t need to purchase another policy. It’s advisable to subscribe to a comprehensive plan and then top it up with an accident insurance plan which doesn’t cost much.

To serve your medi-claim needs, there are two policies that are enough. If there’s a family history of a certain illness like thyroid or blood sugar, you should ideally buy a separate critical illness medi-claim. If your family has no such history, then there’s no need for a critical illness plan.

  • Restore benefit:

If you have already exhausted the same as well as the multiplier benefit within your policy year. But in most cases, the benefit is not available on the same illness if the limit is already used up.
But a restoration benefit can be useful if you have subscribed to a family floater plan where the full sum assured is exhausted for treating only a single family member. The remaining members will have no cover to fall back upon in case of hospitalization for the rest of the policy year.

In such a case, some of the members can get covered for other ailments than the one for which expenses have been already paid by the insurance company.

  • No claims bonus (NCB):

If there has been no claim in the preceding year Insurers usually extend a NCB to a policyholder. Check the NCB while buying medi-claim, amount before signing on the dotted lines.

NCBs can range from 5% to even 100% of the sum insured. A high NCB gives cover against medical inflation and you don’t need to worry about increasing your coverage year-on-year.

  • Pre-existing illness, waiting period, exclusions:

Pre-existing diseases are the ones you have while subscribing to the medi-claim policy. Most health insurance companies specify a waiting period for these illnesses. The insurance company is unlikely to give a cover against the same.

In most cases, a pre-existing illness is covered after at least two years. of buying the policy.
Exclusions simply mean the diseases that are not covered under the medi-claim. For instance, if you suffer from diabetes while taking the policy, then kidney ailments are likely to be excluded from cover if the same happens because of diabetes.

Never hide any pre-existing ailments from your insurer while buying a medi-claim policy. It may reduce your hospitalization claims.

  • Free Check-up:

Most health insurers provide free health check-ups to the policyholder. But what’s termed “free” is actually not such. The cost of the check-up is included in the premium. Buy such a policy only when you are keen to get the facility each year.

Also check whether the medi-claim policy, renewed every year, gives coverage for the entire life. This is important because life expectancy is increasing due to improved medical technology.

While most insurance companies give full life coverage, some provide cover only up to 75-80 years.

  • Maternity and Daycare:

Medical insurance policies provide cover on hospitalization that doesn’t require overnight stays. These are called daycare procedures. Check out how many procedures are covered in the plan.

Also, most insurers don’t consider maternity as a medical emergency. So don’t look for a maternity cover if you have no plans for a baby.

  • Top up Plans:

Medical costs are increasing. It calls for large covers, but not all can afford a high premium. A top-up plan can come useful in such a case. It reduces the cost of deductibles i.e. the amount you pay before the insurance company pays up.

The insurance company will only pay up to the sum assured. A top-up plan, on the other hand, doesn’t pay until the hospital bill breaches a specific limit. Say, if the hospital bill is? 8 lakhs with Rs.3 lakhs as deductible, you need to pay the latter, while the insurer pays the balance of Rs.5 lakhs.

But you can use your individual/group policy to pay the deductible amount. A combination of a basic medi-claim plan along with a top-up plan is much cheaper than a single cover.

For instance, the premium for an Rs.5 lakhs regular cover for a 26-year old male, will be around Rs.6,500. A top-up with Rs.15 lakhs cover will entail an additional premium of Rs.5,000, which is far cheaper than a standalone policy of an identical amount.

FAQ’s On Health Insurance

Get answers to all your questions

Is health Insurance is better than medi-claim?
Why do I need Health Insurance?
What is cashless medi-claim?
What factors. affect the premium payable for a health insurance policy?
What about the waiting period?
Will I get covered for my pre-existing illnesses?
What to do if I am admitted in a non-network hospital?
What happens to the coverage amount when a claim is filed?
Is my health insurance policy transferable, sans losing renewal benefits?
What is the basic difference between individual and group health insurance coverage?