Health insurance is also known as Medical Insurance provides Medical Coverage to the policyholder. With the help of health insurance, you can control your medical expenses. The current pandemic has taught us the importance of medical coverage.

Health insurance companies cover the medical bills of the Policyholder.  With the help of health insurance, one can also go for expensive and quality treatment. By buying a health insurance policy, you choose a financial backup in case of any medical emergency. This article will cover important points of Health insurance.

What is Health Insurance?

Health insurance offers medical coverage to the policy buyers. Insurance companies provide necessary financial assistance to the insured in case of any medical emergency. In return, the Policy buyer has to pay a definite amount of premium to activate the medical coverage.

Health insurance policies cover the Hospitalization fee, ICU charges, Daycare procedures, and critical illness. Buying Health Insurance also provides tax benefits to the Policyholders.

Health Insurance Plan: Reason to Buy one

The rise of medical treatment costs has made it imperative to purchase a health insurance plan. If you want to have quality treatment in good hospitals for any diagnosed disease in the future, you will have to bear a heavy financial strain

Any critical illness can lead to the exhaustion of your savings. The only way out from this is buying a Health Insurance plan for yourself and your family members. Here are some of the reasons that are necessary to consider for a health insurance Policy-

1. Overcome Medical Inflation: You can cover your medical expenses with the help of medical/health insurance. From pre-hospitalization charges to post-hospitalization care charges are covered by Health insurance. The cost of treatment will be borne by the insurance company thus giving you financial relief.
2. Get Quality Treatment in Good Hospitals: Health insurance will prove you with the best medical treatment available. You do not need to worry about medical expenses.
3. Get a Treatment for Lifestyle Diseases: Under a health insurance policy, Policyholders can pay for the long-term treatment of diseases caused by their Lifestyles. Some of the diseases covered under the Health Insurance Policy are Heart attack, Cancer, etc.
4. Save your Money: Due to the inflation in medical treatment costs, patients and their family members can lose their hard money. When you buy Health insurance, you do not have to pay major expenses out of your pocket. You can save your hard-earned money while getting the best treatment.
5. Go for Cashless Hospitalization: With the help of Health insurance, you can opt for cashless hospitalization service at the network hospitals of Insurance Providers. You can raise a cashless claim in partner hospitals.
6. Avail Tax Benefits: Buying Health insurance offers you tax benefits under the Income Tax act 1961. This tax benefit applies to the premium.
7. Peace of Mind: A medical emergency can be quite shocking for the family members and the patients. In such cases, having health insurance provides you peace of mind. You can focus on getting the treatment instead of worrying about the medical bills.

Health Insurance Plans in India: Key Benefits

Many benefits are offered under health insurance plans available in India. These Benefits depend on the nature of your health plan, age, and tenure of your health policy.

Some of the major benefits of having health insurance are mentioned below:

1. Hospitalization Fee: Your health insurance can easily cover your in-hospitalization charges for more than 24 hours. This covers the cost of your room, medicine cost, Doctor’s fee, and test-related expenditure.
2. Pre & Post-Hospitalization Cost Coverage: Health insurance covers the pre-and post-hospitalization cost of the policyholder. This means that the insurance company will bear the cost of expenses that occurred before and after medical care. The coverage under health insurance policies is offered for the pre-mentioned specified time/days.
3. ICU Cost: Your health insurance will also cover the ICU charges if you are getting treatment there.
4. Ambulance Cost Coverage: At the time of medical emergency, the cost of an Ambulance is also covered by Health Insurance plans in India.
5. Cashless Treatment Service: The network hospitals that have a collaboration with your insurance provider offer cashless treatment services in case of a medical emergency. This means you do not have to worry about money while visiting a network hospital for treatment.
6. Day Care Procedures: Health Insurance plans also cover any expense arising due to daycare medical treatment and hospitalization costs for a day.
7. Pre-existing Disease cost coverage: After you purchase Health insurance, you have to wait for a few months or years to get cover for any pre-existing disease. The waiting period of pre-existing disease coverage is 2-4 years.
8. AYUSH: Many health insurance policies offer treatment coverage for AYUSH. This includes Ayurveda, Homeopathy, Unani, Siddha, and Yoga treatment cost coverage.
9. Routine Check-ups: Under health insurance, one can go for a preventive health care check-up to prevent any potential disease. This facility depends on the terms and conditions of your health insurance policy.

Best Health Insurance Plans in India in 2021

Many health insurance providers provide the best Insurance health insurance plans. The top ten Health Insurance Plans are mentioned in the table ahead:

Health Insurance Plans	Sum Insured (INR)	Network Hospitals	Key Benefits (Coverage)
Aditya Birla ActivAssure Diamond Plan	Min – 2 lakhsMax – 2 Crore	8700+	Coverage for Pre- and post-hospitalization Cost Coverage for In-patient hospitalization Coverage for Domiciliary hospitalization Coverage for Ambulance cost in-patient coverage under AYUSH
Bajaj Allianz HealthInfinity Policy	Unlimited	6500+	Cost Coverage for Pre- and post-hospitalization Coverage for Daycare procedures Preventive health care check-ups Road ambulance In-patient hospitalization
Edelweiss HealthInsurance Policy	Min – 1 lakhMax – 1 crore	3200+	Cost coverage of Daycare treatment Cost coverage for Pre and post hospitalization Maternity benefit Ambulance cover Hospitalization cost coverage
SBI Arogya PremierPolicy	Min – 10 lakhsMax – 30 lakhs	6000+	Maternity cost coverage Hospitalization expenses Advanced treatment procedures Mental illness cost coverage Air ambulance
Tata AIG MediCareInsurance Policy	Min – 3 lakhsMax – 20 lakhs	7200+	Daycare cost coverage In-patient cost coverage Compassionate travel Ambulance cost coverage In house treatment
Reliance HealthInfinity insurance policy	Min – 3 lakhsMax – 1 crore	7300+	Emergency ambulance cost coverage Transportation benefits In-patient care Daycare procedures AYUSH benefits
Royal SundaramLifeline Supreme	Min – 5 lakhsMax – 50 lakhs	5000+	Emergency domestic evacuation cost coverage Pre- and post-hospitalization cost coverage Second opinion In-patient hospitalization coverage Annual health check-ups
National MediclaimPolicy	Min – 1 lakhMax – 10 lakhs	6000+	In-patient hospitalization Ambulance charges Pre-and post- hospitalization coverage Modern treatments Mental illness coverage
IFFCO TokioIndividual HealthProtector	Min – 50,000Max – 20 lakhs	6400+	Hospitalization coverage AYUSH coverage Organ donor coverage Domiciliary hospitalization
Bharti AXA SmartHealth insurance policy	Min – 50,000Max – 5 lakhs	4500+	Daycare In-patient hospitalization Critical illness Pre- and post-hospitalization Domiciliary hospitalization

Health Insurance Plan: What is covered

The common medical expenses covered under major Health Insurance plans are mentioned below-

1. In-patient Hospitalization Cost Coverage: The policyholders get cost coverage for the treatment of an injury or illness. The only condition is hospitalization should be more than 24 hours.
2. Pre-Diagnosed Disease/Illness: If you have any pre-existing medical condition, after the completion of the waiting period, you can claim the cost coverage for expenses that occurred.
3. Pre and Post Hospitalization Cost Coverage: Medical Tests such as blood tests, Ultrasound, x-ray, and other diagnostic tests are covered by health insurance plans. After your discharge, your insurance provider covers all the medical expenses.
4. Ambulance Charges: The Cost coverage for the Ambulance facility is covered under your insurance policy. The Coverage amount can vary according to your health insurance policy.
5. Maternity Cover: Many Health insurance policies cover the pregnancy/delivery-related cost. Cost coverage for Newborn babies is also offered under major health insurance plans.
6. Preventive Health Care: Major health insurance plans offer routine checkups to the policyholders.
7. Daycare Procedures: Medical procedures where hospitalization is not necessary for more than a day are covered under most of the health plans
8. In-House Treatment Coverage: Some Medical plans also offer in-house treatment cost coverage to the insured.
9. AYUSH Benefit: AYUSH cost coverage is provided by major Health insurance providers.
10. Mental Health Cost Coverage: Coverage for mental illness and other mental health-related issues is being covered by major health insurance providers.

Health Insurance Plan: What is not covered

There are a few limitations on the cost coverage of health insurance plans. Some of the common situations where a health insurance policy does not apply are mentioned ahead-

• You cannot claim cost coverage for the initial 30 days unless a medical emergency is accidental.
• A policyholder who has a pre-diagnosed illness/medical condition have to complete a waiting period
• There are 90 days waiting period for Critical medical conditions
• Injuries caused due to terrorism/war/nuclear activity
• Self-harm/ Suicide attempt
• AIDS, Terminal illness, and other medical conditions of similar characteristics
• Plastic Surgery/Cosmetic surgery/ Hormone replacement Surgery.
• Eye/dental surgery expenses
• Rehabilitation & Hospitalization/ Bed rest and common illness
• Diagnostic Tests, Post-care expenses, Treatment tests
• Injuries occurred due to adventurous activities/sports

Exclusions can differ from insurer to insurer. It is advised to read all the exclusions carefully.

Key factors to note before purchasing a Health Insurance Policy

If you want a perfect health plan for yourself and your family, you should consider a few things beforehand –

• Coverage Scope: The Health plan coverage and the insured amount of Policyholder will decide the scope of cost coverage for different medical conditions. Check all the benefits provided by your health insurance provider.
• Insured amount: How much you can invest in a health plan is a crucial factor in getting the best health insurance plan. It is advisable to go for a minimum insurance amount of INR 10 Lakh. The higher the insured amount, the better the facilities.
• Policy Type: There are many health insurance policies available in India. These policies cater to the needs of different age groups/people. You can choose from Individual health insurance plans, Senior Health Insurance plans, Critical illness plans, etc.
• Waiting Period: Your health plan gets activated after a waiting period. No insurance coverage is provided during this waiting period except for accidental injuries. You can purchase a health plan with a minimum waiting period.
• Copayment Policy: Under the co-payment clause, the insured has to bear a part of medical expenses. This means your insurer will pay for a definite percentage and you have to pay the rest. This decreases the cost of the premium and adds to your pocket expenses.
• Room Charges/Sub-limits: Check for the sub-limits on your room rent while buying a health insurance plan. If your insurance amount is 2 lakh and the sub-limit is 1% then only INR 2000 will be covered for your room rent. You need to pay the rest.
• Hospital Network and Cashless Treatment: Before buying a health plan, make sure your insurance provider offers a large hospital network with a cashless claim facility. This will save you a lot of time during a medical emergency.
• Renewability: If you are looking for a long-term health plan, purchase a health plan with lifetime renewability.
• Premium-Loading Factor: This factor applies to senior citizens where additional charges are applied on premiums. Choose a health plan with no premium loading.

Claim Settlement Ratio of Your insurance Provider- Check the reliability of your insurance provider by checking their claim settlement ratio.

Health Insurance: Eligibility Criteria to buy one

Many factors decide the eligibility of a policyholder for a certain health plan. Some deciding factors are mentioned ahead:

Criteria	Specifications
Age Criteria (adults)	18-65 years
Age Criteria (Dependent Children)	90-25 years
Medical Screening	For the adults of 45/55/60 years
Waiting Period (Pre-existing disease)	2-4 years

Health Insurance Plans: Compare Online

Comparing different insurance plans online is easy. Many expert views are available online for you to select the perfect health insurance policy for yourself. Here are some benefits of online comparison of Health insurance plans:

• Accurate information: You can read accurate information about different health plans. This can save you time and effort.
• Effortless comparison: With the help of expert websites, you can compare numerous health plans at once. You can also know the special features of different health plans.
• Affordable Premium: Save your money by comparing the premium rates for different health plans. You do not have to waste your time consulting an agent.

Health Insurance Plan: Factors that can affect your health plan premium

The premium rate of your health insurance plan is affected by many factors. Some of the major factors are explained ahead.

1. Medical History

The medical history of a policyholder plays a crucial role in deciding his/her premium cost. There is a medical screening for policy buyers that assesses their health conditions.

2. Age and Gender

It is said that the perfect age for buying a health plan is when you are young. It is because of the low premium rates and high health coverage. Old people are more prone to getting ill that is why their premiums are costly.

Some insurance providers offer a lower premium for women as they have a lower risk of heart attack and other heart-related problems.

3. Policy Term

Your policy term decides the cost of your premium rates. a 2 years health insurance plan will have a higher premium rate in comparison to a one-year health plan. Many discount offers are provided by insurance companies to long-term policyholders.

4. Health insurance plan type

There are different types of health insurance plans, for example, individual health plans, family health plans, and senior citizen health plans. You can compare these premiums with the help of a premium calculator.

5. No-Claim benefits

If you have not made any claim under your health insurance plan, you can earn a cumulative bonus on it. The No claim bonus is a deciding factor for your premiums.

6. Lifestyle

Policyholders who drink and smoke excessively are charged with additional premium charges. In some instances, the insurance provider may not accept your application.

Health Insurance Claim

Health insurance policies come with cashless treatment/cost reimbursement benefits. You can file a claim for the expenditure under your health insurance policy. There are two claim processes –

Health Reimbursement Claim

If you get treatment in a hospital that does not come under the hospital network of your insurance provider, you can file a claim for the treatment cost reimbursement. Collect all necessary documents related to your treatment and file a claim with TPA or your insurance provider.

Cashless Claim

In case you receive medical treatment in a network hospital, you can avail the cashless treatment service. In such cases, your insurance provider manages the treatment cost directly with the hospital.

The procedure for a claim is different for planned and emergency hospitalization. The procedure is mentioned below-

Planned Hospitalization

• Inform your insurance company 48 hours before getting a medical treatment
• Get approval from TPA, file for a claim (Reimbursement/cashless)
• Submit documents (Medical Bills, Discharge summary, Reports)
• After the approval, you will get the money from your insurance company
• A cashless claim is settled directly with your hospital by your insurance company.

Emergency Hospitalization

• Inform your insurance provider within 24 hours of hospitalization
• Show your health card to the hospital
• Submit authorization form and get TPA approval
• Claim the money from a network hospital
• In case of TPA disapproval, file a reimbursement claim later
• Submit asked documents
• Claim the treatment amount

Health Insurance Claim Reimbursement: Documents Requirement

You have to submit certain documents to avail the services of your health insurance claim reimbursement-

• Hospital Discharge card
• In-hospitalization Medical Bills Signed by you
• Prescription of Doctor or Medical Store
• Claim form with your signature
• Investigation Report
• Consumables Prescribed by your doctor
• Consultation Bill
• Insurance Policy copies (Previous and present year)
• Copy of TPA ID
• Any Document TPA asks for.

Health Insurance Plans: Types

There are many types of health insurance plans to cater to the needs of diverse policyholders. Here are the different types of Health Insurance Plans-

• Family Health Insurance Plans

Family health insurance is ideal for those policyholders who are looking for a family health insurance policy. Under this health plan, the insured sum is divided equally among the family members.

• Critical Health Insurance Plans

Policyholders who have a family history of Critical illness can go for this insurance policy. Under this health plan, a lump sum amount is insured to provide cost coverage against medical expenses. Some of the critical disease examples are Kidney failure, Cancer, Paralysis, heart attack, etc.

• Senior Citizen Health Insurance

This health plan covers the age group of 60 years and above. Under this health insurance policy, the medical cost coverage is provided against medical treatments such as in-patient treatment/hospitalization.

• Health Insurance for Coronavirus

IRDA launched two health plans seeing the outbreak of Covid-19. These plans are the Corona Rakshak Health Insurance plan and Corona Kavach Health Plan.

• Personal Accident health insurance

Under the Personal accident health insurance plan, the hospitalization cost is covered due to the accident.  It reimburses the medical cost in case of disability and death.

Health Insurance – FAQs

Q1. Are there any health insurance plans that cover COVID-19 Medical costs?
Ans. Yes, two health plans are launched by IRDA to cover the medical expenses that occurred due to COVID-19. These plans are the Corona Rakshak Health Insurance plan and Corona Kavach Health Plan.

Q2. What should I check before buying a health insurance plan?
Ans. Before buying a health insurance plan, check the waiting period, Grace period, Co-payment clause, Restore benefits, Sub-limits, Network hospitals, No claim bonus of your insurance policy.

Q3. I am still young; do I need health insurance?
Ans. Yes, it would be better for you to buy health insurance at a young age. The premium cost is low and you can get additional benefits.

Q4. Is there any special health insurance plan for women in India?
Ans. Major Health Insurance providers have started to offer health plans for women at a lower cost.

Q5. Can I buy health insurance Online?
Ans. Yes, you can buy health insurance online. It is cost-effective and time-saving. The major insurance provider offers online health insurance plans. You can visit their official website for additional information.