Health Insurance

Name: Health Insurance Plans
Brand: Elephant.in
Rating: 5 (138 reviews)

Health insurance, also known as medical insurance, is a vital form of coverage that provides financial protection to individuals in the event of illness or accident. By paying a regular premium, policyholders gain access to comprehensive medical treatments & services, including hospitalization, day-care procedures, critical illness treatments, and much more.

Understanding Health Insurance

Health insurance or medical insurance, falls under the category of general insurance, providing individuals with essential financial security when faced with health-related issues or unexpected medical emergencies. Whether it’s due to a disease, illness, or accident, health insurance stands as a reliable shield to cover incurred expenses.

If you believe that you don’t need health insurance? Then you must read this

The current medical inflation rate in India is 14% which is the highest among Asian countries.
An unhealthy and sedentary lifestyle affects almost 61% of women and 47% of men in India.
Cancer cases are estimated to increase by 12.8% in 2025 as compared to 2020.
Mental health disorders as compared to other diseases stood at around 14.3% of adults.
For over two decades, diseases like heart attack, cancer and diabetes have been the leading cause of death in India.

Types of Health Insurance Policy

There are many options when it comes to health insurance, so it can be challenging to select one that best fits your needs. To make the right choice, it’s important to understand each policy and find the one that suits your needs.

Individual Health Insurance

Individual health insurance, also known as Personal health insurance, is a type of health coverage that individuals purchase to provide healthcare coverage for individuals.

Family-floater Health Insurance Plan

Family floater health insurance covers the whole family under one plan, using a collective sum insured for any member during a medical emergency. It includes spouses, parents/in-laws, and dependent children, making it cost-effective with premiums based on the oldest family member’s age.

Senior Citizen Health Insurance Plan

A senior citizen health insurance plan is a specialized health insurance policy that ensures adequate coverage designed to meet the healthcare needs of elderly individuals who are typically aged 60 or older.

Top-up Plan

If you already have basic health insurance or you can afford to pay for your medical expenses up to a certain amount, then you may want to consider a Top-up Health Plan. This type of plan offers additional health coverage beyond a predetermined limit called a ‘deductible’ in insurance terms.

Group Health Insurance Plan

Group Health insurance provides coverage to a group of individuals who are affiliated with a common organization or employers. This type of insurance is commonly offered by employers to their employees as part of their employee benefits, but it can also be provided to members of other organizations such as professional associations, trade unions, or affinity groups. Group health insurance offers several advantages, including cost savings and easier access to coverage.

Critical Illness Insurance Plan

Critical illnesses such as cancer, stroke, kidney failure, major organ transplantation, heart attack, and others are highly dangerous and often require long-term medical treatments. One vital way to secure coverage for these illnesses is through a Critical Illness Insurance Plan, also known as a Fixed Benefit Health Plan. These plans offer a fixed lump sum payout in the event of the diagnosis of critical illness. This payment is made regardless of the actual medical expenses incurred and can be used at the policyholder’s discretion.

Health insurance encompasses a range of policies, each with its unique features and coverage. By examining the various options available, one can make an informed decision.

Features and Benefits of Health Insurance

Health insurance plays a crucial role in safeguarding the well-being and financial security of individuals. In India, health insurance plans offer a wide range of benefits to policyholders. Below are some of the advantages that make health insurance a wise investment for everyone.

Hospitalization Expenses

The primary purpose of a health insurance policy is to offer financial coverage in the event of a medical crisis resulting from illnesses, accidents, or hospitalization. Thus, making it important to make a part while planning financial goals.

Pre and Post-Hospitalization Expenses

Health insurance covers both pre and post-hospitalization expenses, including screening tests like CT-scans, X-rays, and MRIs before hospitalization. Post-discharge care, involving follow-up treatments and medication, is also covered. Policyholders can seek reimbursement for a fixed number of days, as specified in the policy document.

Coverage for Pre-existing Diseases

One of the major benefits of health insurance is the coverage it provides for pre-existing diseases. However, this coverage becomes effective only after the completion of the waiting period mentioned in the policy certificate. It can typically be between two years to four years. With this provision, policyholders can access necessary medical care and treatment without worrying about the burden of pre-existing conditions.

No Claim Bonus / Cumulative Bonus

Health insurance not only supports those requiring hospitalization due to illness or accidents but also offers rewards to those who remain claim-free throughout the policy period by increasing their coverage without extra premiums. Now, Health insurance also offers Guaranteed Cumulative bonus irrespective of the claim.

Cashless Treatment

Health insurance eliminates the need for arranging immediate cash for hospital bills during the time of hospitalization. If the hospital is in the insurance company’s network, the policyholder can avail cashless treatment on themselves. This means that the insurance company directly settles the medical expenses with the hospital, easing the financial burden and ensuring a seamless hospital experience.

Tax Benefits Under Section 80D

Health insurance policyholders can avail tax deductions for the premium paid under section 80D of the Income Tax Act, 1961. This provides a significant incentive for individuals to invest in health insurance plans while enjoying tax benefits, thus contributing to their overall financial well-being. Policyholders can avail of maximum benefit of Rs. 75,000 against their policy.

Health insurance is a vital investment, offering comprehensive coverage for medical expenses, including pre and post-hospitalization, pre-existing diseases, cashless treatment, tax benefits, and additional sum insured for a healthy lifestyle. It provides a robust safety net, ensuring preparedness for any medical challenges that may arise, providing security and peace of mind.

How to Choose the Right Health Insurance Plan

Choosing the right health insurance plan is crucial for securing your well-being in times of medical emergencies. With several factors to consider, it can be overwhelming to make an informed decision. Here are some of the insights that will help you choose the right one.

Scope of Coverage

Understanding your health insurance is crucial. Details like limitations, copayments, deductibles, and claimable illnesses and surgeries depend on the coverage and sum insured. Examine benefits closely, including hospitalization, pre-post hospitalization, day care treatments, critical illness, maternity cover, etc. Knowing exclusions is as vital as knowing coverage these conditions prevent claims, so a comprehensive understanding of your policy is essential.

Adequate Sum Insured

When choosing a medical insurance policy, the sum insured amount is a significant factor to consider. The sum insured is the maximum financial coverage provided to the policyholder in their health insurance plan. Hence, the sum insured in your health insurance should be chosen carefully, considering it covers you and your family for medical expenses throughout the policy term. Given the current inflation rate, choosing the appropriate sum insured becomes increasingly crucial.

Policy Type

Choose from various medical insurance policies available in India based on your specific requirements. Options include individual health insurance, family floater, and multi-individual health insurance policy. When choosing among these options, consider the following factors : Family composition, Individual needs, Budget, Policy Inclusion & exclusion & network hospitals.

Waiting Period Clause

The health insurance policy becomes active only after the initial waiting period. Note that claims filed during this period, except for accidental hospitalization, may be rejected. Waiting periods also apply to pre-existing diseases, specific illnesses, treatments, and maternity cover. Opt for a plan with minimal waiting periods.

Copayment & Sublimits

Some medical insurance policies involve a co-payment clause, requiring you (the insured) to bear a certain percentage of the claim amount out of your own pocket. This doesn’t affect the sum insured but can reduce your premium while increasing out-of-pocket expenses. Sub-limits may also limit coverage for particular medical procedures. Choose the co-payment option only if you can comfortably handle the financial burden of paying a portion (10% or more) of your hospitalization bills.

Room Rent Restriction

The type of room (private, semi-private, shared room category) you get at the time of hospitalization depends a lot on the type of policy you have purchased. Always go for a policy that provides you with a higher room rent limit so that you don’t end up paying an extra amount from your pocket.

Network of Cashless Hospitals

Verify the insurer’s list of network hospitals where you can file cashless claims. Higher numbers of network hospitals in your area provide better chances of availing cashless hospitalization benefits.

Lifetime Renewability Option

Consider a health insurance plan with a lifetime renewal option, Paying the insurance premium at the time of renewal becomes essential for maintaining insurance coverage year after year.

Claim Settlement Ratio

Evaluate the insurer’s claim settlement ratio, which indicates their credibility in processing claims. Consider choosing an insurance company with a higher claim settlement ratio for a reliable and hassle-free claims experience.

Riders/Add-ons and Optional Features in Health Insurance

When it comes to health insurance, riders play a crucial role in providing additional coverage and making your policy more comprehensive. These add-ons allow you to avail extra benefits and safeguard your health more comprehensively.

Critical Illness Cover
This add-on cover offers a lump-sum payout upon diagnosis of covered critical illnesses, such as cancer, stroke, or kidney failure, regardless of the treatment expenses incurred.
Personal Accident Cover
This add-on protects against accidental injuries, providing compensation for permanent or partial disability, temporary disability, or death resulting from accidents.
Room Rent Waiver
Room Rent waiver add-on extends hospital room rent limits or eliminates restrictions, allowing policyholders to opt for superior rooms without financial concerns.
Hospital Cash Cover
Offers an additional daily cash allowance over & above your health insurance cover during hospitalization lasting over 24 hours or one day.
Maternity Cover
This insurance provides coverage against delivery expenses for both caesarean and normal delivery. It also includes coverage for new born baby-related expenses and pre & post natal expenses.
Global Coverage
This add-on extends coverage to treatments received abroad, including cashless services when obtained at a network hospital.
International Second Opinion
This add-on cover offers coverage for costs associated with consultations with international medical experts.
Air Ambulance
The air ambulance add-on cover ensures coverage for treatments necessitating air ambulance transport, particularly useful when treatment is outside the insured’s city.
OPD Care
This add-on covers expenses for OPD visits, diagnostics, and prescriptions, requiring policyholders to submit a reimbursement claim to access this benefit.
AYUSH Treatment
It offers coverage for expenses related to alternative treatment methods like Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
Unlimited Sum insured Recharge
This add-on restores the full sum insured for future medical expenses, unlimited automatic recharge of sum insured optional is available.
Reduction in PED Waiting Period
The Reduction in PED Waiting Period add-on is advantageous for minimizing the waiting period associated with pre-existing diseases, allowing quicker access to coverage for such conditions.

In conclusion, to enhance your health insurance coverage, it is essential to consider these add-on riders. The flexibility they offer, combined with their specific benefits, can provide you with comprehensive protection.

Health Insurance Premiums

Managing and understanding premiums are the key for continuous coverage and financial security against medical expenses. Let us understand more about Health Insurance Premium.

What is Health Insurance Premium?

Health insurance premiums is an amount paid periodically to the insurance company to cover the risk of the comprehensive medical coverage. Regular payment of the premium will ensure the activeness of the health insurance plan. By understanding the ins and outs of health insurance premiums, you can make informed decisions when it comes to selecting the ideal plan for your needs.

How to Calculate Health Insurance Premiums?

Calculating your health insurance premium has never been easier. You can use online premium calculator, a handy tool designed to provide quick and accurate results. By simply inputting your basic details – including family details, age of the members, place of residence, and desired coverage amount – you can obtain an estimate of your premium within moments. Remember, various factors such as family member combinations, age, city, lifestyle choices, BMI, and occupation type influence your policy premiums.

Factors Affecting Health Insurance Premiums

Learn about what affects your health insurance costs. Understanding these factors helps you make smart choices for your healthcare budget, ensuring you have clear financial insights.

Pre-existing Diseases

One major factor that affects health insurance premiums is a pre-existing illness. Most health insurance plans cover pre-existing illnesses after 2 to 4 years. The duration of this waiting period can impact your premium.

Type of Health Insurance Policy

The health insurance plan you choose influences your premium cost. Whether it’s individual, family, senior citizen, or benefit-based (like Personal Accident, Critical Illness), each has its premium structure. Critical illness plans often have higher premiums. Use the health insurance calculator for quick and easy online premium calculations.

Age

Age plays a crucial role in determining the premiums. As age progresses, the risk of health issues increases, lead to the increase in the medical insurance premiums. Consequently, higher premiums are charged to applicants of older age groups.

Location

The location or city or region of your residence may affect the premium. Considering, the health care cost & the cost of living are different & vary from city to city. So your location can influence the health insurance premium.

Lifestyle Choices

Regular smoking or excessive alcohol consumption may lead to denial of health insurance coverage by certain insurers. Nevertheless, some medical insurance providers offer coverage even in such cases, compensating the risk with a higher premium cost. The detrimental effects of alcohol and tobacco use have long-lasting consequences. Consequently, individuals who quit these habits remain susceptible to subsequent diseases.

Health Condition

An insurer will consider your current & past medical history when determining your premium costs. Insurers may require pre-medical screenings for applicants of specific age groups or even make them mandatory for all applicants and the results of these check-ups can affect the premium. If the pre- medical screening reveals any condition or risk factors, the premium may be higher. Health condition also includes any pre-existing condition & family medical history.

Understanding health insurance premiums is crucial in navigating the complex world of medical coverage. By comprehending the factors that influence premiums and how they are calculated, individuals can make informed decisions when selecting appropriate health insurance plans. Remember, the right health insurance coverage is not just a safeguard for your well-being but also offers peace of mind for you and your loved ones.

Health Insurance Claims and Reimbursement

Understanding health insurance involves knowing the types of claims available for planned treatments or emergencies. Explore the two primary types for a clear understanding of your coverage.

Cashless Claims

As the name suggests, cashless claims provide a hassle-free experience where you don’t need to worry about paying from your pocket at the time of hospitalization. When you opt for cashless claims, the burden of payment is lifted off your shoulders. The hospital takes care of the bills directly with your health insurer, sparing you the need to pay upfront and seek reimbursement later. It simplifies the entire process and ensures that you receive the necessary medical care without financial stress.

Reimbursement Claims

With reimbursement claims, you pay for the treatment costs at the time of hospitalization. Subsequently, after receiving the necessary medical care and being discharged, you can contact your health insurer to get your hospital bills reimbursed. This process typically takes anywhere between 2 to 4 weeks after submission of the complete list of documents, depending on your insurer.

Tips for Buying Health Insurance Online

When it comes to buying health insurance online, there are a few key tips to keep in mind. This convenient and efficient way of finding the right coverage can be made even more successful by following these guidelines:

Understand your Needs

Before diving into the process of shopping for health insurance online, take the time to assess your specific healthcare needs. Consider important factors such as your age, current health condition, budget, and the coverage required for both you and your family.

Research Different Plans

Familiarize yourself with the various types of health insurance plans available to you. This includes Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and High Deductible Health Plans (HDHPs). Each plan has its advantages and disadvantages, so it’s crucial to choose one that aligns with your preferences and needs.

Compare Plans

Utilize reputable insurance comparison websites that allow you to compare different plans from multiple providers. These platforms enable you to filter plans based on coverage, cost, and the network of healthcare providers available.

Check In-Network Providers

If you have specific doctors, hospitals, or specialists in mind, ensure that they are in-network for the plan you are considering. Staying in-network can help save money on out-of-pocket expenses.

Understand Costs

Take note of both the premium and the out-of-pocket costs, which include deductibles, copayments, room rent limits and more. Sometimes, plans with lower premiums can have higher out-of-pocket costs, so it’s important to consider your budget and healthcare usage.

Review Coverage & Exclusion

Thoroughly read and understand the coverage details of the plan you are interested in. This includes identifying which services are covered, any exclusions, and limitations. It’s crucial to have a clear understanding of what is and isn’t covered.

Consider Additional Benefits

Some health insurance plans offer additional benefits such as prescription drug coverage, dental and vision coverage, mental health services, and wellness programs. Evaluate these additional benefits to ensure they meet your specific needs.

Understand Deductibles

Familiarize yourself with how deductibles work and what the out-of-pocket maximum is for the plan. This knowledge will help you understand when your insurance coverage will come into effect and how much you may be required to pay out of your policy scenario.

Check for Preventive Care Coverage

A significant number of health insurance plans provide free preventive care services, which can include vaccinations, screenings, and annual check-ups. Ensure that the plan you choose includes these important benefits.

Read Reviews and Ratings

Before deciding, research the reputation of the insurance provider by reading customer reviews and checking ratings from reliable sources such as the Better Business Bureau or J.D. Power.

Seek Professional Advice

If you are uncertain about which plan is best for you or if you have complex healthcare needs, consider consulting with an insurance broker or financial advisor who specializes in health insurance. Their expertise can provide valuable guidance.

Read the Fine Print

Before finalizing your purchase, carefully review the policy documents, terms, and conditions. It’s important to fully understand all the details of your coverage to avoid any potential surprises.

Ask Questions

If you have any questions or need clarification on any aspect of the policy, don’t hesitate to reach out to the insurance provider’s customer service or support team. They are there to help and ensure that you have a clear understanding of your coverage.

Be Aware of Deadlines

Pay close attention to enrollment deadlines, particularly if you are shopping for coverage during the open enrollment period or if you have experienced a qualifying life event that allows for a special enrollment period.

Keep Records

Make sure to keep copies of all communications and documents related to your health insurance. This includes your policy, payment receipts, and any correspondence with the insurer. Having organized records can be extremely helpful in the future.

By following these useful tips, you can navigate the process of buying health insurance online with confidence. Remember to prioritize your needs and choose a plan that provides the necessary coverage for you and your loved ones. Health Insurance and Medical Insurance are vital aspects of safeguarding your well-being, so ensure that you make a well-informed decision.

Health Insurance FAQs

How do I decide which health insurance plan I should purchase?

Evaluate health needs, budget, and the network of hospitals covered. Opt for a plan with adequate coverage for critical illnesses and features that align with your health requirements.

What if I have any queries or doubts while buying a health insurance plan?

You can get in touch with our team of health insurance experts which are also IRDAI Certified. Our team can guide you through the entire process making your entire buying journey seamless and cakewalk.

What if I have any queries or doubts post making the purchase?

Elephant.in provides dedicated Digital Relationship Managers to each individual buyer to cater all your issues any time after you buy a policy. Someone's always there to rescue!

How do I decide which insurance company to select while buying a health insurance policy?

At Elephant.in, insurance companies have been handpicked basis their service, prices and claims paying capability to create a smooth experience.

Do I need to compulsorily buy health insurance at an early stage?

It is not mandatory to get health insurance at a younger age. However, it is always recommended to get yourself insured at a younger age, since the insurance premiums are lower, thus it is advisable. It provides financial support and access to medical supervision when required and ensures you have the proper coverage before any medical issues arise.

What is the difference between health and Mediclaim insurance?

In India, the terms health insurance and mediclaim insurance are frequently used interchangeably, encompassing policies that address medical expenses. Mediclaim focuses on hospitalization expenses, while health insurance is a broader term, incorporating additional benefits like preventive care and maternity coverage.

Where can I learn more about common health insurance terminologies?

You can use online resources offered by insurance firms, insurance regulatory bodies, and reliable financial websites to gain additional knowledge about popular terms used in health insurance.

What is the right age to buy health insurance?

Because health insurance prices are lower when you're younger, it's advised. It is best to start looking for health insurance policies when you are in your 20s or early 30s. Purchasing early guarantees that you obtain coverage before the emergence of any pre-existing conditions.

Is a medical test mandatory to buy a health insurance policy?

Medical tests are not always mandatory for every health insurance policy. The necessity for a medical test depends on factors like age, sum insured amount, and medical history. Younger individuals with lower coverage may not undergo a medical test, while older individuals with higher coverage might be required to take tests for risk assessment by insurers.

At what age can I include my children in my health insurance plan?

Children can be added to family floater policies as soon as they are born. Many health insurance policies offer coverage for newborns from day one. An additional premium against the coverage plan will have to be given after intimating the insurer about your newborn child.

I have my employer's group policy; do I need to buy a separate health insurance plan?

While having your employer's group health insurance is beneficial, it's advisable to consider purchasing a separate health insurance plan. Employer-provided policies may have limitations, such as coverage ending upon retirement or job change. A personal health insurance plan ensures continuous coverage, offers customization based on individual needs, and provides a financial safety net beyond what the group policy may offer.

How to add my family members to my existing medical policy?

Contact your insurer, provide details and documentation for the family members, and expect a possible premium adjustment to add them to your existing medical policy.

Can my friend buy a health insurance policy if he/she is not an Indian national but living in India?

Yes, non-Indian nationals living in India can buy health insurance policies. Insurance providers often offer specific plans designed for foreign nationals residing in the country.

What are pre and post-hospitalization expenses in health insurance?

Pre-hospitalization expenses in health insurance cover medical costs incurred before hospitalization and post-hospitalization expenses cover costs after discharge, including follow-up treatments or medications. Both are crucial components of comprehensive health coverage.

What does free-look period mean in basic health insurance?

The free-look period in basic health insurance is 15 days allows policyholders a specified duration from the policy start date to review the terms and conditions. During this period, policyholders can cancel the policy if dissatisfied, and the insurer will refund the premium after deducting any incurred costs.

What is the waiting period in a health insurance plan?

The waiting period is the time you must wait before certain health conditions are covered by your insurance, usually ranging from 30 days to 4 years. Know and understand this waiting period in your policy.

What do you mean by cashless hospitalisation?

Cashless hospitalisation in health insurance allows policyholders to receive medical treatment at network hospitals without making upfront payments. The insurer settles the bills directly with the hospital, provided the treatment falls within the policy coverage.

What does the Family Floater policy mean?

A Family Floater policy in health insurance covers the entire family under a single plan, with a fixed sum insured. It provides flexibility, as the total coverage amount can be used by any individual family member or shared among them as needed. This type of policy is cost-effective and convenient for families with multiple members.

What are the documents required for purchasing a health insurance policy?

Typically, documents required for purchasing a health insurance policy include address proof (Aadhar card), age proof (Birth Certificate, PAN Card), passport-sized photographs, and a medical report.

How much health insurance cover should I need to buy?

Customize your health insurance to match your needs – consider factors like age, health, and potential medical requirements. Secure coverage up to 50% of your annual income.

What does Critical Illness insurance mean?

This insurance provides the lump sum amount to the policyholder if they are diagnosed with a critical illness listed under the policy. The list includes major health problems like cancer, a heart attack organ transplants & many more. The insurance policy is designed in a way to provide financial support during the treatment and recovery phases irrespective of the actual medical costs.

What are pre-existing diseases or conditions?

Any illness that a person has at the time of applying for health insurance is considered a pre-existing condition and might include a wide range of ailments. People must disclose any pre-existing medical conditions when applying for health insurance to prevent future claim rejections.

What if I already have a health insurance policy, but just want to increase my sum insured?

If you want to increase your sum insured in an existing health insurance policy, you can typically do so during the policy renewal. Contact your health insurance provider, express your intention to increase the sum insured, and they will guide you through the process. You can also consider top-up plans or add-on covers to increase the sum.

How do I ensure that I do not have to struggle while making a claim?

Yes, things do go wrong but at Elephant.in we provide best-in-class claims service through our experienced and dedicated claims experts who will help you manage your claims effortlessly.

Disclaimer: ₹25 lakh Health coverage is calculated using ₹5 Lakh base Health Insurance plan and ₹20 lakh Super Top-up Health Insurance plan. Market offering taken for comparison is from Care Health Insurance Limited’s retail product ‘Care NCB’ for the same age and sum insured option, and benefits may vary. The premium of ₹5,838 per year (inclusive of 18% GST) has been calculated for a 35-year-old healthy life on an individual basis for a cover amount ₹5 lakh base health and ₹20 lakh super top-up with ₹5 lakh deductible. Premium may vary as per the selection made by the customer in any part of the digital journey including the sum insured opted. Premium is subject to change by the insurance company selected by the customer. Employees can enjoy the discount by entering their Work Email ID. All discounts provided by insurers as per IRDAI approved insurance plans. Standard T&C apply.

Our 4.9-star customer experience rating, sourced from direct feedback collected on the Elephant.in website, mirrors user experiences with our health products from June 2023 to November 2023.

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