Health Insurance: Buy the Best Medical Insurance & Mediclaim Plans Online | RenewBuy

GET HEALTH INSURANCE PLANS

Health Insurance: Buy the Best Medical Insurance & Mediclaim Plans Online

What is health insurance? 

Health insurance is a good wealth besides money. In a simple form, health insurance is a product which gives you a sense of security from the incurring expenses of hospital bills at the time of emergency. It covers the medical and surgical costs of an insured person. It can either be done upfront (cashless treatment) or post-treatment (reimbursement) by the insurer (the insurance company).

Health insurance has now become essential for the individual of all the age group in today’s life of ever-soaring medical expenses. Moreover, following a rise in lifestyle diseases and double-digit medical inflation in India every year, you must have a health insurance plan that fulfils your requirement. Though private and public-sector employers provide group health insurance, such do not offer all benefits to your family. Therefore, you always need separate health insurance that covers you and your family. Going by medical expenditures of individual health insurance is essential as uninsured people receive less medical care. Don’t let your health problems become a financial breakdown for your household. Buy a family health insurance to ensure you and your family and get total peace of mind. This way, you can focus on looking after the hospitalised family member rather than running around gathering funds for the treatment or more disastrously, preceding treatment altogether due to lack of funds.  

Importance of taking a health insurance policy- 

Falling sick or getting hurt is not on anybody’s to-do list. It is always unplanned as well as uncertain. Nobody wants to get hurt or fall ill, but still, we all need medical care like doctor’s visit, prescribed drugs, lab tests, and so on at some point in time. As advanced technology has taken the place of those old ways in the health care segment, the cost of health facilities has also increased. At that point of time, a health insurance solves the purpose by providing us with the financial aids either in the form of cashless or reimbursement. In addition to the hospitalisation, health insurance also gives us the facilities like outpatient care, medication; laboratory tests cost when needed.

So, having health insurance is beneficial for one or other reasons. We all know the importance of health insurance, but the fact is that it is still considered as a tax-saving tool only and taken by people only for the sake of getting exempted from the tax slab. But the fact is that other than a tax exemption, health insurance covers essential health benefits critical to maintaining your health and treating illness, accidents and high medical costs and gives us free preventive care. In India, the medical expenses are surging at the rate of 15% to 20% every year.

Types of Health Insurance Plans

With more companies issuing health insurance products to suit various lifestyles and personal requirements, it can become somewhat confusing to decide which is the best health insurance and what purpose they serve. For selecting the best health insurance plan, it is essential to know about different types of health insurance policies, coverage extent, features, and customization options. Let us take you to various health insurance plans in the Indian market: 

1) Individual Plans – This is the best health insurance policy for a single person or those who only want to take a policy for themselves. It covers hospital and surgical expenses to the extent of the sum insured under the policy.

2) Family Floater Plan or health insurance policy for the family- This type of health insurance covers the entire family under one single plan for the payment of a single premium. The policyholder will specify who all are to be covered, including themselves, spouse, children and parents as required. Such policies cover simultaneous medical events of more than one member of the family as well; subject to the claim limit of the maximum sum assured by the insurance company. Such health insurance plans for family tend to be much more economical than buying individual plans for every member separately.

3) Hospitalization Plans- Also known as basic plans, these policies offer a cashless settlement of claims arising from hospitalization due to disease or illness. Comprehensive plans cover a more extensive range of ailments and medical conditions and offer better protection. A basic health insurance policy for the family will typically cover room rent (which could be subject to a sublimit), surgical, nursing, specialist, anaesthetist, diagnostic expenses and medications. Such policies also usually cover medical costs incurred 30 days before hospitalization and 60 days after discharge**. A policyholder can also opt for various riders to create a more enhanced policy offering more protection. Such as maternity cover, domiciliary hospitalization benefits, daily cash allowance etc. Basic plans usually include daycare procedures – surgical or other interventions that do not need a person to be admitted to the hospital overnight or for extended periods.

4) Top Up and Super Top Up Plans – This is the best health insurance policy for those who already have some amount of health insurance. This type of insurance policy usually has a deductible amount that will be the threshold limit above which the Top-up or Super top-up plan will be activated. However, it can be an excellent way to supplement an existing policy, whether self-purchased or offered by an individual's employer. Such a top-up plan also acts as an insurance policy for the family when employee health insurance is inadequate or where it covers only one member of the family. Also, there is an option of super top-up health booster plans that offers additional coverage of a higher sum against an aggregate deductible. The other benefit is that premiums are more affordable in this case.

5) Group Insurance Plans – Many insurance companies offer group plans to specific groups of people, such as the employees of a company, members of a club or social group, and so on. A policyholder can buy this type of insurance in addition to an existing policy or their employer may provide such insurance. Group insurance can be an economical option since insurance companies would typically be able to offer a bulk discount in respect of such policies.

6) Pre-Existing Disease Plan – For older people or those with specific medical ailments, the best health insurance plan with the highest coverage limit may be inadequate if there is a pre-existing disease exclusion clause. A pre-existing disease is defined as “any condition, ailment, injury or related condition(s) for which you had signs or symptoms, and/or was diagnosed, and/or received medical advice/treatment, within 48 months before taking your first policy”. Which means the insurance company will not pay for claims made about conditions that already exist at the time of policy purchase. It is further necessary to note that even with the best health insurance policy there is typically a waiting period of between 12 and 36 months (Varies from insurer to insurer) from the initiation of the insurance policy before the policyholder can claim a pre-existing illness. The policyholder can prevent this problem by buying a policy that covers pre-existing conditions and has no waiting period for making a claim.

7) Indemnity plans- Indemnity plans seek to bring about zero changes to the financial condition of the policyholder. It is done by reimbursing the actual hospitalization costs borne by him/her. The extent of the amount borne will be equal to or less than the sum insured amount associated with a given policy. Consider the two scenarios for an indemnity health plan of Rs. 1 lakh–Total costs of hospitalization and medicines = Rs. 76,000. Amount disbursed by company = Rs. 76,000

Total costs of hospitalization and medicines = Rs. 2,10,000. Amount disbursed by company = Rs. 1 lakh (maximum SI amount allowed)

Inclusions and Exclusions of health insurance

Inclusions of Health Insurance Policy -

Health insurance plans do offer protection and peace of mind, Still they have several terms and conditions, inclusions and exclusions (a basic policy does not provide critical illness insurance for instance) that determine the circumstances and medical procedures for the insurance company to pay under a policy. 

Let’s look at the inclusions of a health insurance plan:

  • Health insurance covers hospitalization expenses arising from a specified illness or disease up to the maximum limit or value of the policy. It includes room rent, surgical and operation theatre expenses, nursing, anaesthetist charges, prescription medications and relevant diagnostic procedures. Most insurance policies require overnight hospital stays for a successful claim.

  • Health Insurance policies also pay for related expenses that a policyholder incurs 30 days before hospitalization as well as up to 60 days after discharge from hospital (varies from company to company). Under a health insurance policy, the company will pay the expenses incurred by a policyholder, 30 days before hospitalization and up to 90 days (duration varies from company to company) after discharge Tests, consultations with specialists and prescribed medicines may some of the costs covered.

  • Whereas individual plans designed for single people, families can opt for family floater plans. This type of health insurance plan gives coverage to you and your whole family under one policy in a single premium. These types of health insurance plans cover the entire family under one policy, for the payment of a single premium. Even if more than one person in the family needs treatment concurrently, the insurance company will pay for both claims so long as they are valid claims covered by the policy: subject to the maximum amount payable under the policy.

  • Cashless service is one of the attractive features of health insurance. Getting admitted to a network hospital has the advantage of not having to pay cash upfront. The insurance company undertakes to pay the hospital directly for treatment, surgery and other covered medical expenses. Each health insurance company has a network of hospitals and diagnostic centres where covered individuals can receive cashless treatment.

  • Like other types of insurance, health insurance policies also offer no claims bonus. This means that if the policyholder does not claim the previous insurance term, the company may offer discounts or additional features on policy renewal.

  • Health insurance policy portability is another feature that insurance companies are bound to offer. It allows the policyholder to port their policy from one to another company for seamless protection without loss of accrued benefits on the plan. The policyholder is free to switch service providers if he or she feels that another company offers a better deal or additional features at a better price. Insurance companies cannot disallow this.

  • Health insurance policies also offer tax benefits to the policyholder. Under section 80D of the income tax act, policyholders could save Rs 25,000 in taxes and up to Rs 55,000/- if senior citizens are also covered under the policy.

What Is Not Covered/exclusions in Your Health Insurance Policy?

A policyholder needs to understand the exclusions of health insurance that a health insurance policy does not cover. Typically, even a product that claims to be the best health insurance plan may not include the following:

  • Critical illness – A health insurance policy does not pay for critical diseases such as stroke, cancer, heart attacks, coma, organ failure requiring regular dialysis, major organ or bone marrow transplant, permanent paralysis of the limbs, motor neuron disease, Multiple Sclerosis and other conditions. These are listed in the definitions set out in the IRDA circular covering Guidelines on Standardization in Health Insurance. However, a policyholder can buy a separate critical illness policy or opt for a rider that adds protection to a basic plan. It is essential to find out exactly what expenses are covered and whether there are set sub-limits within the overall coverage limit.

  • Daycare procedures – Daycare procedures are those that do not need overnight, or more extended hospital stays, such as keyhole surgeries, endoscopies and minimally invasive procedures. Unless a health insurance policy expressly covers day care procedures, these are excluded as well. Even policies that claim to cover day care procedures usually have a pre-defined list of day care treatments that will be covered. Any other daycare procedures outside of this list won’t be covered. Exclude specified list of such medications. So be careful about the definitions set out in the terms and conditions of the health policy. The best health insurance plan is one that covers all daycare procedures rather than ones on a specified list.

  • Maternity and neonatal care – An individual plan or even health insurance plans for the family will not usually cover expenses incurred for pregnancy, delivery, abortion, miscarriage and obstetric other expenditures.. If there are complications for mother or child after birth such as neonatal ICU or emergency surgery, these are also not covered. However, some group plans such as employee insurance do offer maternity coverage. A policyholder can also opt for a maternity and/or neonatal protection rider to acquire additional protection.

  • Pre-existing conditions – health insurance policy will not cover ailments that already exist before the commencement of an insurance policy. Some types of pre-existing diseases may be covered. Still, typically, there is a waiting period of between 12 and 36 months (duration varies from company to company) before a policyholder can make a claim for pre-existing disease-related expenses. It is essential to make full disclosure of any pre-existing medical conditions to the insurance company at the time of buying a policy, so the insurance company cannot raise a dispute or dishonour a claim later.

  • Dental and eye care – Most of the health insurance policies will not cover dental or eye care procedures, such as dental implants, braces and corrective surgery that is not medically indicated. Though some insurance policies do have dental and eye care provisions, their scope may be limited. Here again, the policyholder must check the terms and conditions; particularly those relating to day-care procedures, since these could be considered day-care or outpatient treatments.

  • Cosmetic surgeries – Even the most expensive and the best health insurance plan will not offer to pay for plastic surgery, beauty treatments or any treatment that has only cosmetic application (not medically necessary). However, if cosmetic surgery is required as a result of an accident, some policies do cover these expenses.

  • Sexually transmitted or lifestyle diseases – STDs such as HIV or AIDS and others or any conditions arising from STDs are not covered by a health insurance policy,even if the insurance policy provides critical illness insurance. The insurance company will also not pay for diseases or disorders that are the result of unhealthy lifestyles or habits such as excessive drinking, drug abuse or prescription medication abuse.

  • Self-harm or suicide attempt – Any hospitalization or treatment that arises from illegal acts, self-harm or an attempt to suicide is outside the purview of a health insurance policy.

The table below can give you a quick picture of inclusions and exclusions of a health insurance policy:

S.No

Inclusions

Exclusions

1

Health Check up

HIV / AIDS and its complications

2

Ambulance charges

Suicide or drug abuse

3

Maternity

Contamination from Nuclear fuel or radiation

4

Organ donor

Foreign invasion or civil war

5

Daily Cash

 Cosmetic Surgeries

6

Restore benefits

 

7

Domiciliary Hospitalization

 

8

In Patient Hospitalization

 

9

Pre- hospitalization

 

10

Post hospitalization

 

11

Day care treatment

 

12

AYUSH cover

 

13

Cumulative bonus

 

 

Add-Ons in Health Insurance:

Opting for an add-on in a health insurance policy enhances the coverages in case of medical emergency:

1. No Claim Bonus – No Claim Bonus is the discount you get from the insurance company, on renewal of the policy, for not claiming throughout a health insurance policy year. It is of two types: Discount on Premium and Cumulative Bonus. 

  • Discount on Premium: gives you a discount on the policy purchased. 

  • Cumulative Bonus: Depending on insurer to insurer, a certain percentage (5%) of the amount is added to the next sum insured on the policy renewal in every claim-free year.

2. Top-Up – Top-up health insurance plans is an add-on plan for your regular health insurance policy. A top-up plan offers you additional coverage when your basic health insurance plan is exhausted. A top-up only covers a single incidence of hospitalisation. Insured gets a Tax Benefit, as per the premiums paid on top-ups. 

3. Convalescence- After hospitalisation, when the patient (insured) is discharged and goes back to live his normal routine, a minimum amount is given to him/her to support him/her for the supplementary cost incurred during his hospitalisation term. For example: if the insured is salaried and in case of prolonged hospitalisation there is a loss of salary that the person has to bear. A lump-sum amount is given to the insured to recover such loss.  

4. Personal Accident, PA Cover – Accidents are unfortunate and uncertain. To provide the financial coverage to the victim in case of an unexpected event, Personal Accident comes handy in a health insurance plan.  

5. Critical illness Add-on- Critical illness add-on helps to cover the critical illness or any other specified severities like first heart attack, open chest CABG, coma, repair of heart valves etc. A critical-illness add-on can be taken along with the health insurance policy as an add-on or can be purchased separately. 

6. Daily cash allowance/Hospicash- Under a health insurance plan, a fixed cash benefit is given to the insured every day during hospitalisation is known as daily-cash allowance or hospicash. The amount is paid to the insured every day to take care of the incidental expenses in case of hospitalization.  

Note: AYUSH Treatment Cover- It is an alternate treatment method one can avail apart from the regular treatment. To get an alternate treatment method in a medical emergency that includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatment, one can opt for an additional AYUSH treatment cover while taking a health insurance plan AYSUH treatment is not necessary to get along with the insurance plan, but yes, it is safe to take beforehand, that it might take a major toll on your pocket.

 

Terminologies to know in a health insurance policy: 

1.Sum Assured - The amount you can expect to receive from the insurer for hospitalisation expenses. If bills are more than the sum assured, then you need to bear the amount above the sum confirmed on your own

2. Co-payment - Co-Payment is a certain percentage of the claim that the insured agrees to pay along with the insurance company. The insurer then pays the remaining claim amount

3. Sub-Limits - Within the policy, you will find some sub-limits i.e. the maximum you can get even if you aren’t exhausting your overall coverage. Room rent is one component that carries its sub-limit, beyond which the insurer won’t reimburse you

4. Comprehensive Cover - A comprehensive plan offers the most extensive coverage against every illness and thus provide your family with optimal protection

5. Critical illness - A severe life-threatening disease or a chronic condition like Cancer or Heart Attack. To cover such illnesses, one can opt for critical illness add-on in the same policy or can purchase a separate critical illness policy. Such critical illness cover provides a lump-sum amount of treatment upon being diagnosed with the illness.

6. No claims bonus (NCB) – NCB or no claim bonus is an incentive for not raising a claim in the previous year. The incentive can be in the form of reduced premium or enhanced coverage

7. Waiting period - The policyholder needs to serve a fixed waiting period for any pre-existing ailments to prevent the policy’s misuse. He cannot apply for claims in this period.

8. Maternity - Maternity plans provide cover for pre- and post-natal care, expenses towards the delivery of baby, and post-delivery baby care.

9. Indemnity Plans- A traditional health insurance policy, also known as - Indemnity health insurance, helps you to protect against unexpected and sudden medical expenses. An indemnity insurance policy reimburses the hospitalisation charges, up to an assured sum. This assured sum is pre-decided between the policyholder and the insurance company. Indemnity plans also include health insurance plans for a family.

10. Cashless hospital network-  Subject to the limits and sub-limits, which are ultimately subject to the sum-assured of the health insurance policy. If a person is hospitalised in the tie-up range of the hospitals, he need not to pay anything from his/her pocket.

11. Premium Loading- The increase in standard premium when the insurance company thinks the buyer is likely to get certain disease after a certain age or smoking or drinking habit. It is strongly recommended to check all the Terms and conditions of the Premium loading. 

12. Health Insurance Portability- Some insurance companies give an advantage of portability. Earlier the policyholder must stick to that particular plan only. But with the health insurance portability, one can switch the insurer without losing the waiting period. The portability of health insurance is free of cost in many companies. But some of them are chargeable.

13. Restore benefit- Restore benefit of a health insurance plan helps you to restore the necessary sum insured in case it is exhausted. Restore benefit helps to replenish the sum insured in case of next hospitalisation that might occur in the same policy year. The individual restore benefit ensures to pay the surplus hospitalisation charges due to extended hospitalisation. 

The restoration benefit extends in case the insured has opted a family floater plan. Restoration Benefit under a family floater plan, the sum insured is shared by all the insured family members. In case one of the family members is seriously ill and hospitalised and the sum insured is exhausted, restoration benefits of other family members can be utilised for the hospitalised family member. 

How one can save on health insurance policy? 

Many insurance companies give coverages to various health ailments. All health insurance companies cover terminal illness or critical illness, depending on the coverages insured has taken. One can always go to a specific insurance company of own choice or can go to an aggregator. While approaching a particular insurance company limits the option, going to an aggregator give options for comparison and get the suitable policy of your needs. 

As already mentioned, different companies offer different types of insurance plans. However, you need to know which insurance plan is the best health insurance plan when it comes to protecting you and your family. Online insurance aggregator offers you various quotes available with insurance companies. With online comparison, you may choose the best coverage for yourself. You can check out multiple parameters like sum insured, add-ons, riders, and premium costs. It will let you make the right purchase decisions. It saves you from the unnecessary travelling cost involved in travelling to various insurance companies, picks their brochure and then make a decision. With online comparison facility, you can compare the health insurance plans and avail one for yourself and your family.

Ill health, diseases and sickness come without announcement. Though no one wants to be hospitalized, this becomes necessary from time to time. It can happen to anyone at any age or stage of life. At such time, the family's resources can become severely stressed and savings may be completely depleted because of surgery, extended and unnecessary hospital stays, specialist’s consultation and prolonged medication protocols. Since health care is costly, buying the right health insurance plans can help mitigate the expenses. Health insurance acts as a safety net for the entire family. 

What are the required documents for Health Insurance Policy?

Any health insurance company can ask for some documents in majorly two scenarios – 

on new policy issuance and on making a claim. If you are going to purchase a new/fresh health insurance policy, you are required to have the following documents- 

  • Identity proof - Voter ID or Pan card or Driving license 

  • Age Proof- PAN Card or Aadhaar Card or any other document that has your age details

  • Address proof – Driving License or Passport or Rent Agreement (if residing on rent) or PAN card

  • Passport size photographs

  • Medical Reports (if the insurance company demands it) 

Documents required for making Claims in Health Insurance Policy-  

  • Claim form

  • Medical Certificate 

  • Hospitalisation Bills  

  • Doctor’s prescriptions (Throughout the medication and hospitalisation)

  • Copy of FIR (in accident case)

Following are the required documents for Health Insurance Policy Claims Reimbursement:  

When you opt for a health insurance claim reimbursement, you need to keep detailed records of all bills. Some documents of the hospitalization that you would be required to furnish include:

  • Discharge card

  • Pre-signed and filled up hospital bills

  • Bills from the pharmacy and from in-hospital disposables

  • Claim form filled up properly with the insured signature

  • Patient reports and charts

  • ID card of TPA (Third-Party Administrator)

  • Insurance policy document copy

  • Cancelled cheque and ECS authorization to allow the insurer to make the deposit in your bank account

  • KYC documents for ID purpose​​

Health insurance FAQ’s 

1)What are different health insurance plans available in India?

These are the health insurance plans available in India-

Individual health insurance plan, Family floater health insurance plan, Group health insurance cover, Critical health insurance, Top-up policy, Super top-up policy

2)What is room rent capping in health insurance plans?

The amount paid as room rent during hospitalisation is called as room rent capping. It depends on the sum insured in your health insurance plan. One can opt for room rent capping as an add-on with the health insurance policy. It is totally up to the buyer if he/she wants to take it or not. 

3) What is day-care health insurance cover?

For any treatment, if the insured is hospitalised for a minimum of 24hours is called as day care. Technological advancement has reduced the extended period of hospitalisation due to a medical emergency. Hence any treatment which is given to the patient during 24 hours hospitalisation is called as day-care health insurance. 

4) What is super-top-up in a health insurance plan?

Super Top-up insurance add-ons help to increase the sum insured in case there is an increase in hospitalisation. If the spent on medical bills exceeds, due to extended hospitalisation, then the top-up plan comes handy. Additional coverage given by a health insurance company above the threshold limit covered under the top-up health insurance plan. 

5) What is the daily hospital cash benefit? 

On average daily cash, the benefit is given to the hospitalised person during his hospitalisation. In most of the cases, a lump sum amount that the insured person gets during hospitalisation is called a daily cash benefit. The benefit and amount vary from company to company. It starts from 1000 and goes upto 10,000 in a day.   

 

6) What is co-payment?

Co-Payment is a certain percentage of the claim that the insured agrees to pay along with the insurance company. The insurer then pays the remaining claim amount.

7) Is there any specific plan for cancer? 

One can always opt for a standalone critical insurance plan to cover diseases like cancer. The buyer is advised to read the coverages of plan before purchasing one. 

Note: Some health insurance plan also covers partial treatment of the critical illness within the policy. 

8) What is Third-party administrator (TPA) in health insurance? 

Third-party administrator (TPA) is an outsourcing company that acts as a mediator between insured and the insurance company. The dedicated person sitting on the TPA desk passes the claim-related information to the insurance company and insurance company’s information to protected if required.   

9) Are pre-existing diseases covered in a health insurance plan?

Depending on the seriousness of health ailment, pre-existing diseases are covered in a health insurance plan with a waiting period*. The waiting period in a health insurance plan, varies from company to company and depends on the age of the policy buyer. Some PEDs or Pre-existing disease comes with certain restrictions with some insurers. 

10) What in case if I am admitted to a non-panel hospital in case of emergency?

In case of a medical emergency, the time is imperative to decide if we have go to the empanel hospital for treatment or save the life. We go and get admitted to the nearby hospital without worrying for the reimbursement. The medical treatment on a non-network hospital, will only be reimbursed when you back it with the medical bills. 

11) Is medical insurance policy valid PAN India?

It is a subjective question that can’t be answered. Medical insurance purchased in India has its geographical boundaries. Some medical insurance companies do not compensate for anything that is happening beyond the set geographical limits. Whereas, some insurance companies offer international covers too. 

*Varies from company to company. Waiting period differs from company to company.

**varies from company to company

Rate this