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Instant Coverage Health insurance plans in India are policies that provide coverage for medical expenses incurred by individuals or families and give access to avail quality healthcare services without having to bear the full burden of expensive medical treatments and procedures. These plans can be offered by employers, government programs, or purchased directly by individuals from insurance providers. Many plans now offer coverage for preventive services, such as vaccinations, screenings, and annual check-ups, with no out-of-pocket costs. Regardless of the type of health insurance plan, individuals must understand their coverage details, network providers, and any limitations or exclusions.
A Health Insurance Plan is a contract between a policyholder and an insurer, providing financial coverage for medical expenses up to a specified limit. Policyholders pay regular premiums, and in return, the insurer covers a portion or the entire cost of healthcare, ranging from emergencies to planned hospitalizations. Beyond offering crucial financial protection, health insurance policy allows for tax savings under Section 80D of the Income Tax Act, 1961.
| Categories | Specifications |
|---|---|
| Sum Insured | Rs.50,000 to up to Rs.6 crore |
| Maternity Cover | Available |
| Pre & Post-hospitalization Expenses | Covered |
| OPD Cover | Available |
| ICU Charges | Covered |
| Free Health Check-ups | Available |
| Pre-existing Diseases | Covered |
| Ambulance Cover | Available |
| Day Care Procedures | Covered |
| Tax Benefits | Up to Rs.75,000 per financial year |
Health insurance plans in India offer several benefits to the insured, to meet diverse healthcare needs and cover pre-existing disease, day care procedures, and many more.
Here are the benefits of purchasing a health insurance plan in India:
Hospitalization Expenses Coverage
The health insurance policy covers the expenses incurred during hospitalization, extending coverage to room rent, doctor’s fees, medication costs, and diagnostic test fees.
Pre & Post Hospitalization Expenses
Comprehensive coverage extends to re-hospitalization and post-hospitalization expenses are reimbursed for a fixed number of days, as specified in the policy document.
ICU Charges Inclusion
Health insurance policy also covers the costs associated with availing treatment in an Intensive Care Unit (ICU) during hospitalization, easing the financial burden of critical care.
Ambulance Cost Reimbursement
Coverage extends to the expenses incurred for availing ambulance services during a medical emergency, ensuring transportation to the nearest hospital without financial strain.
Cashless Treatments at Network Hospitals
All health insurance providers in India facilitate cashless treatment at their network hospitals. This eliminates the need to arrange funds for hospital bills.
Day Care Procedures Coverage
Health insurance plans in India also cover the costs associated with daycare treatments that necessitate hospitalization for less than 24 hours, reflecting the evolving landscape of medical care.
Pre-existing Diseases Coverage
The best health insurance plans in India policies extend coverage for pre-existing diseases, subject to completion of a waiting period.
AYUSH Treatment
The health insurance policy covers the costs of medical treatments offered by AYUSH (Ayurveda, Unani, Homeopathy, Siddha, and Yoga) schools of medicine, promoting holistic healthcare options.
Health insurance plans in India offer several features to the policyholder and their insured families to cover medical expenses such as maternity coverage, no-claim bonus, and many more.
Here are the features included with purchasing a health insurance plan in India:
Critical illness coverage
A health insurance policy may also provide coverage for critical illnesses, such as cancer, heart disease, or stroke, and the policyholders receive a lump sum amount.
Maternity coverage
Some medical insurance plans cover maternity-related expenses, including prenatal care, childbirth, and postnatal care.
No-claim bonus
Insurance companies often provide a no-claim bonus to policyholders who do not make any claims in a policy year. This bonus can come in the form of a premium discount or an increase in the sum insured.
Wellness programs and preventive care
Some of the best health insurance plans in India often offer wellness programs and preventive care services to policyholders such as check-ups, vaccinations, etc.
Portability
Medical insurance plans often come with the option of portability, allowing individuals to switch insurance providers without losing the benefits of their existing policy.
Medical Check-ups
Many health insurance companies in India provide free preventive health check-up facilities at regular intervals, following the policy terms and conditions.
A health insurance policy typically covers a variety of medical expenses and services. The specific coverage may vary depending on the insurance company and the plan chosen.
Below, we have mentioned the common covers in most medical insurance plans:
Expenses related to inpatient care, such as room charges, nursing care, surgical procedures, and medications, are usually covered by health insurance policy.
This includes expenses for consultations, examinations, diagnostic tests, and treatments provided by physicians or specialists.
Medical insurance policy often covers visits to the emergency room for sudden and unexpected medical conditions or accidents..
Coverage may include a wide range of prescribed medications, either in generic or brand-name form, depending on the plan.
This covers costs associated with different lab tests, including blood tests, imaging studies (like X-rays, CT scans, MRIs), and pathology examinations.
A Medical insurance policy often includes coverage for preventive services, such as vaccinations, screenings, and preventive screenings like mammograms, pap smears, or colonoscopies.
A health insurance policy provides coverage for prenatal care, maternity consultations, delivery, and postnatal care for both the mother and the newborn.
Health insurance plans in India may provide coverage for counseling, therapy sessions, and treatment related to mental health disorders and substance abuse.
This includes coverage for physical therapy, occupational therapy, and other types of rehabilitation services needed for recovery from illness, injury, or surgery.
Some health insurance plans in India include coverage for medical care or nursing services provided at home, particularly for individuals who are unable to leave their homes due to medical conditions.
A health insurance policy typically covers a wide range of medical expenses, but certain services are generally not covered. These exclusions can vary depending on the insurance company and the specific policy.
Below, we have mentioned the common covers in most that are typically not covered in a health insurance policy:
Health insurance plans In India typically do not cover elective or cosmetic procedures, such as facelifts, liposuction, or breast augmentation, unless deemed medically necessary for reconstructive or therapeutic purposes.
If a medical treatment is considered experimental, unproven, or not widely accepted within the medical community, health insurance is unlikely to cover it.
Some health insurance plans may not cover alternative or complementary therapies, such as acupuncture, chiropractic care, naturopathy, herbal medicine, massage, energy healing, or homeopathy.
Health insurance policies are generally not designed to cover long-term care, including services provided in nursing homes or assisted living facilities.
Unless specified in the policy, health insurance usually doesn't cover medical services received outside your home country, except in cases of emergencies.
Health insurance plans In India typically cover prescribed medications, but they usually do not cover over-the-counter drugs or medications not prescribed by a healthcare professional.
Insurance companies may exclude coverage for pre-existing medical conditions for a certain period, especially in individual or private health insurance policies.
Riders in the health insurance policy refer to additional coverage options that can be added to a base policy. These riders provide extra benefits and coverage to meet the unique needs of individuals and families. There are various types of riders available in health insurance plans in India, each offering specific coverage enhancements.
Here are some common riders that policyholders can consider before buying health insurance plans in India:
Maternity rider
This rider provides coverage for prenatal, childbirth, and postnatal expenses. It covers costs associated with doctor visits, hospital stays, laboratory tests, and delivery-related services.
Dental and Vision rider
This rider adds coverage for dental treatments like regular check-ups, fillings, extractions, and vision-related expenses such as eye exams, glasses, and contact lenses.
Critical illness rider
Critical illness riders offer coverage for life-threatening conditions such as cancer, heart attack, stroke, and kidney failure. The rider pays a lump sum benefit upon diagnosis of any covered critical illness.
Hospital cash rider
Hospital cash riders offer a fixed daily cash benefit for each day spent in the hospital due to illness or injury. This rider helps cover incidental expenses like transportation, meals, and lodging.
Saving taxes is a common goal for many individuals, and one way to achieve this is by buying a health insurance policy. Health insurance plans in India not only provide financial protection against healthcare expenses but can also offer tax benefits.
One way to save taxes with a health insurance policy is by taking advantage of tax deductions. In India, health insurance premiums are tax-deductible. By looking at your deductions, you can include the amount you paid for health insurance premiums throughout the year.
Lastly, some governments offer tax credits for those who purchase health insurance plans through government exchanges. These credits are meant to make medical insurance plans more affordable for individuals and families, ultimately reducing the tax burden for those who qualify. Overall, having a health insurance policy can provide various tax-saving benefits while also ensuring you have comprehensive coverage for your medical needs.
At Okbima, we're here to assist you in finding the perfect health insurance plans in India for your needs. Below, we have provided a list of medical insurance plans from leading companies in India.
| Health Insurance Plans | Sum Insured Rs. | Network Hospitals | Claim Settlement Ratio (CSR) | |
|---|---|---|---|---|
| Aditya Birla Activ Assure Diamond Plan | Min – 2 lakh | Max – 2 crore | 10500+ | 99.41% | Get a Quote |
| Future Generali Health Total Policy | Min – 3 lakh | Max – 1 crore | 8000+ | 98.76% | Get a Quote |
| Care Health Insurance Plan | Min – 3 lakh | Max – 75 lakh | 21100+ | 98.66% | Get a Quote |
| Liberty HealthPrime Connect Policy | Min – 10 lakh | Max – 1 crore | 5800+ | 98.50% | Get a Quote |
| Bajaj Allianz Health Guard Policy | Min – 1.5 lakh | Max – 1 crore | 58000+ | 98.31% | Get a Quote |
| Kotak Mahindra Health Premier Policy | Min – 25 lakh | Max – 2 crore | 7000+ | 98.28% | Get a Quote |
| IFFCO Tokio Individual Health Protector Plan | Min – 50,000 | Max – 20 lakh | 7000+ | 98.02% | Get a Quote |
| Magma HDI OneHealth Insurance Plan | Min – 2 lakh | Max – 1 crore | 7200+ | 97.99% | Get a Quote |
| Cholamandalam Flexi Health Supreme Plan | Min – 5 lakh | Max – 5 crore | 10500+ | 97.39% | Get a Quote |
| Digit Health Insurance Plan | Min – 2 lakh | Max – 3 crore | 7200+ | 96.44% | Get a Quote |
Health insurance plans in India offer various benefits to cater to the diverse healthcare needs of individuals and families. Understanding the types of medical insurance plans can help individuals make informed decisions based on their specific requirements
Here are the common types of health insurance plans in India:
These plans offer coverage to an individual against medical expenses due to illness or accident. The premium & sum assured amount are determined based on age, medical history & other factors.
This type of plan provides coverage to the entire family by covering the sum assured amount. It offers a single policy covering all family members, including spouses, children, and parents.
These plans are specifically designed for individuals above a certain age, usually 60 years and above. They offer coverage for age-related illnesses and provide higher sum assured amounts.
This type of plan covers specific critical illnesses such as cancer, heart attack, stroke, kidney failure, etc. The sum assured is paid as a lump sum if the insured is diagnosed with any covered critical illness.
Maternity Health Insurance Plans in India offer coverage for maternity-related expenses, including pre and post-natal care, delivery charges, prenatal vitamins, and newborn baby care.
Group Health Insurance Plans In India are provided by employers to their employees as a part of their employee benefits package. They cover all employees under a single policy.
These plans provide additional coverage over and above an existing health insurance policy. They come into play when the sum assured or coverage limit of the primary policy is exhausted.
Anyone who meets certain eligibility criteria can buy health insurance plans in India.
The following are common categories of people who can purchase a health insurance policy:
Individuals
People who are not covered by an employer-sponsored health insurance policy or a government-funded healthcare program can purchase individual health insurance plans in India. This includes self-employed individuals, freelancers, students, or those who are unemployed.
Families
Health insurance plans In India often cover not only an individual but also their dependents, such as a spouse and children. The specific terms and coverage options may vary depending on the insurer and the policy chosen.
Employees
Many employers provide health insurance coverage to their employees as part of their employee benefits package. Employees typically have the option to enroll in a health insurance policy during an open enrollment period or when they are newly hired.
Businesses
Companies, regardless of size, can purchase group health insurance plans In India for their employees. Group health insurance policy often includes more affordable premiums and comprehensive coverage options compared to individual plans.
Health insurance plans in India are essential for individuals for several reasons such as rising healthcare costs, tax benefits, and many more.
The following are common categories of people who can purchase a health insurance policy:
In recent years, medical treatments, hospital expenses, and prescription medications have become more expensive. A health insurance policy ensures that you can afford quality medical care without worrying about bills.
A major illness or injury can lead to substantial financial and a health insurance policy provides financial protection by covering the costs of hospitalization, surgeries, diagnostic tests, and other medical treatments.
Many health insurance plans in India have tie-ups with a network of hospitals and healthcare providers. This enables policyholders to access quality healthcare services at these authorized centers
Health insurance premiums paid towards individual or family policies are eligible for tax deductions under Section 80D of the Income Tax Act, 1961. This means that policyholders can claim deductions while calculating their taxable income.
Buying Health Insurance Plans In India Online offers many benefits such as lower premiums, better customer support, and many more.
Here are some of the key advantages of buying a health insurance policy online:
Convenience: Buying health insurance plans in India online is much more convenient than the traditional method of visiting an insurance office or agent. It can be done from the comfort of your own home, at any time that suits you.
Comparison and Research: Online platforms provide the ability to compare different health insurance plans in India from various providers, such as the coverage or features, allowing you to make informed decisions.
Lower Premiums: Online medical insurance plans often offer lower premiums compared to traditional plans due to reduced administrative costs for the insurance providers.
Customer Support: Online insurance companies provide comprehensive customer support through various channels such as live chat, email, or helpline numbers.
Renewal and Claims Process: Online health insurance plans in India often have a simplified renewal process. You can renew your medical insurance policy online without any paperwork, saving time and effort.
There are some important factors that you should look at before deciding to buy health insurance plans in India.
Below, we have mentioned those factors to look at before buying a health insurance policy:
Coverage and Benefits
When buying health insurance plans in India online, it is important to carefully review the coverage and benefits offered by the insurance provider.
Cost
Compare the cost of different health insurance plans in India online. Look at the monthly premium, deductible, co-payments, and out-of-pocket maximums
Network of Healthcare Providers
Check if the health insurance policy has a wide network of healthcare providers in your area. Make sure your preferred doctors, hospitals, and specialists are included in the network.
Prescription Drug Coverage
Make sure the health insurance policy sufficiently covers prescription medicines if you take them frequently.
Policy Exclusions and Limitations
Pay close attention to the policy exclusions and limitations mentioned in the terms and conditions of the health insurance plan. Certain treatments may not be covered or may have specific limitations.
Financial Stability of the Insurance Provider
Research the financial stability and solvency of the health insurance provider. Financial stability ensures that the insurance provider will be able to cover your medical expenses.
Eligibility criteria to buy a health insurance policy may vary from one insurance provider to another. However, there are certain common factors that most insurance companies consider when determining an individual's eligibility for purchasing a health insurance policy.
These criteria typically include:
Eligibility criteria to buy a health insurance policy may vary from one insurance provider to another. However, there are certain common factors that most insurance companies consider when determining an individual's eligibility for purchasing a health insurance policy.
Often, health insurance plans in India are limited to citizens or residents of a specific country. Insurance providers usually require individuals to provide proof of nationality or residency to be eligible for coverage.
Insurance companies generally assess an applicant's medical history to determine their eligibility for coverage. Pre-existing medical conditions and certain chronic ailments may lead to exclusions or higher premiums.
Health insurance plans in India require regular premium payments. Insurers usually evaluate an individual's financial ability to pay premiums before coverage is granted.
To buy health insurance plans in India, certain documents are commonly required by insurance companies. These documents are necessary to authenticate your identity and assess the risk involved in providing you with coverage.
Here are the documents typically required to buy the health insurance policy:
You will need to provide a valid identification document such as an Aadhaar card, PAN card, passport, voter ID card, or driver's license.
You are required to submit proof of your residential address, which can include documents like an Aadhaar card, voter ID card, passport, or driver's license, in your name.
To validate your age, documents like a birth certificate, passport, Aadhaar card, PAN card, voter ID card, or school leaving certificate can be submitted.
Some health insurance plans in India may ask for income proof to determine the premium to be charged. This can include salary slips, bank statements, income tax returns, or Form 16.
If you already have a health insurance policy, the insurance company may want to see your previous policy documents to assess your claims history, waiting period, or any pre-existing illness coverage.
You may be required to disclose your medical history, including any pre-existing illnesses, hospitalizations, surgeries, or ongoing treatments. This helps the insurance company understand your health condition and any potential risks.
Health insurance premiums are the amount of money you pay periodically to your insurance provider to maintain your coverage. The premium you pay is determined by various factors, such as your age, medical history, location, and the type of coverage you choose.
Here is a step-by-step guide on how to calculate health insurance premiums:
Calculate Health Insurance Premium
Choosing the right health insurance policy is crucial to ensure quality healthcare and financial security.
Here are a few key points to consider when choosing the best health insurance plans in India:
Identify your needs
Begin by identifying your healthcare needs, such as pre-existing conditions, age, family history, and the potential need for maternity or specialized treatments.
Coverage amount
Determine the sum assured or coverage amount you require. This should be based on factors like your city of residence, anticipated medical expenses, and the general cost of living in your area.
Network hospitals
Check if the health insurance policy has an extensive network of hospitals and healthcare providers in your area. This will ensure easy access to quality medical services.
Benefits and features
Look for the various features and benefits of health insurance plans in India. Look for services like cashless hospitalization, reimbursement for ambulance charges, and critical illness coverage.
Waiting period
Understand the waiting period for pre-existing conditions, maternity benefits, and specific treatments. Compare waiting periods among different insurance companies to select a plan that offers the shortest duration.
Exclusions
Look at the policy document to understand the exclusions. Certain treatments, illnesses, and procedures may not be covered by health insurance policy.
Premiums and deductibles
Compare the premiums and deductibles of different health insurance plans in India. Ensure that the premium is affordable and within your budget.
Customer reviews and ratings
Read customer reviews and ratings of the insurance company to check the customer satisfaction levels. This will give you insights into their claim settlement ratio, and customer service experience.
Filing a health insurance claim can be a hard task, but it is essential to ensure that you receive reimbursement for your medical expenses.
For treatments in non-network hospitals, policyholders opting for health reimbursement must personally settle the medical expenses, and collect comprehensive documentation including bills, prescriptions, and discharge summaries.
Subsequently, a claim is submitted to the insurer or Third-Party Administrator (TPA) for reimbursement. The insured completes a claim form, attaches the supporting documents, and submits the package through designated channels. Once approved, the reimbursement is credited to the insured's bank account.
On the other hand, cashless claims are applicable when seeking treatment in-network hospitals. The insured informs the hospital about their health insurance coverage, and the hospital obtains authorization for cashless treatment from the insurer.
Following treatment, the insurer settles the bills directly with the hospital. Both processes emphasize adherence to documentation guidelines and clear communication with the insurance provider for a seamless and efficient claims experience.
When filing a health insurance claim for reimbursement following hospitalization, specific documents are required to ensure a smooth and efficient process.
The essential documents include:
Discharge Card
A copy of the discharge card issued by the hospital or network hospital, providing details about the duration and nature of the hospitalization.
In-Patient Hospitalization Bills
Original bills for in-patient hospitalization, signed by the insured to verify authenticity.
Doctors’ Prescriptions and Medical Store Bills
Prescription documents from the treating doctors along with corresponding bills from the medical store for medications prescribed during the hospital stay.
Claim Form
A completed claim form with the insured's signature, providing necessary details about the hospitalization and treatment.
Valid Investigation Report
Any relevant investigation reports, such as diagnostic tests or laboratory reports, supporting the medical treatment undergone.
Bills of Doctors’ Consultation
Original bills related to doctors’ consultations during the hospitalization period.
Insurance Policy Copies
Copies of the insurance policy from the previous year and the current year, or a copy of the ID card of the Third-Party Administrator (TPA).
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