What is Health Insurance?

Health insurance is a legal agreement with a health insurance company that entitles you to receive payment or reimbursement for your healthcare expenses. It offers financial protection in case of accidents or illnesses by helping to cover costs like doctor’s services, medications, hospital care and special equipment.

Health insurance can also assist with rehabilitation hospital stays, home health care and routine check-ups. Additionally, it often covers preventive services like immunization and cancer screening without any additional cost.

Up to 75% of Indians cover their health expenditures from their own pockets.

Types of Health Insurance

There are 12 different types of health plans available in India to meet your unique healthcare needs.

Individual Health Insurance Plan

Designed to provide coverage for a single person, offering a range of benefits, such as doctor visits, prescription drugs, preventive care and more.

Family Floater Health Insurance Plan

Provides coverage for the entire family, including the spouse, children and parents under a single policy, making it convenient and cost-effective.

Senior Citizen Health Insurance Plan

It is specifically designed to provide health coverage for individuals above the age of 65. It offers various benefits including coverage for pre-existing conditions, hospitalization and medical expenses.

Critical Illness Insurance Plan

This insurance plan provides important financial protection in the event of a serious illness. It provides coverage for expenses such as hospital stays, surgeries and rehabilitation.

Group Health Insurance Plan

These plans provide a way to access healthcare coverage collectively for a group of people, such as a company’s employees. By pooling together, the group can often secure better rates and benefits compared to individuals purchasing insurance plans on their own.

Top-up Health Insurance Plan

These plans are beneficial for individuals seeking a financial safety net for medical expenses beyond their current insurance coverage. These ensure comprehensive protection against unforeseen healthcare costs.

Personal Accident Cover

Covers for personal accidents include protection for individuals who may experience partial or total disability or even death as a result of an accident.

Maternity Health Insurance Plan

This provides coverage for all expenses from the prenatal stage, including pre-natal checkups and tests, to the delivery of the baby and also covers the postnatal stage, including hospitalization and any necessary follow-up care.

Mediclaim Insurance Plan

It typically covers in-patient expenses such as room rent, nursing charges, doctor’s fees and various medical tests and procedures during hospitalization.

Disease-specific

People who are looking for insurance coverage tailored to a particular health condition, such as diabetes or cancer, may be interested in disease-specific insurance plans that cover the specific needs related to their conditions.

Hospital Daily Cash

In this, the insurer provides a daily allowance to cover expenses during hospitalization, helping to ease the financial burden on the insured.

Unit Linked Insurance Plan

It is a type of insurance product that combines the benefits of insurance and investment into a single integrated plan.

List of Health Insurance Companies Available in India

There are 13 health insurance companies in India providing health insurance plans. Each health insurance company offers its own health plan with some unique features and benefits. So, we have compiled a list of all the health insurance companies available in India with their claim settlement ratio, customer rating, and network hospitals.

S.No.	Company Name	Claim Settlement Ratio (Latest Available)	Network Hospitals	Total Plans
1.	Care Health Insurance	10% Claims Settled in the Year 2021-22	10+ Network Hospitals	4
2.	ICICI Lombard Health Insurance	10% Claims Settled in the Year 2021-22	10+ Network Hospitals	5
3.	IFFCO Tokio Health Insurance	10% Claims Settled in the Year 2021-22	10+ Network Hospitals	2
4.	Niva Bupa Health Insurance	10% Claims Settled in the Year 2021-22	10+ Network Hospitals	3
5.	SBI Health Insurance	10% Claims Settled in the Year 2021-22	10+ Network Hospitals	2
6.	TATA AIG Health Insurance	10% Claims Settled in the Year 2021-22	10+ Network Hospitals	2

*Claim Settlement Ratio data may vary depending on the source. It's recommended to check the company's latest annual report for the most accurate data.

Benfit of Health Insurance

Covers Hospitalization Expenses

Covers hospital costs, including room, doctor, surgery, ambulance and pre/post hospital expenses, relieving the burden of expensive bills during emergencies.

Cashless Treatment

Many insurance plans offer cashless hospitalization, eliminating upfront payment at network hospitals.

Tax Benefits

Health insurance premiums can be tax deductible in countries like India which helps in saving you money.

Security and Reduced Stress

It provides peace of mind and financial protection in case of illness or injury, reducing stress and allowing focus on recovery.

Access to Quality Care

Some insurance plans cover network hospitals and doctors for better healthcare services.

Preventive Care

Some plans cover preventive health check-ups, helping to identify potential health problems early for better overall health outcomes.

Coverage for Specific Needs

Offer additional coverage for critical illnesses and maternity care, addressing specific health needs.

Rewarding Healthy Habits

Some plans reward healthy habits with better insurance benefits.

How does Health Insurance Work?

Health insurance offers financial support during medical emergencies by helping policyholders cover their healthcare expenses. In India, there are various types of health insurance plans, but they all work in similar ways.
Here are the steps involved in how health insurance functions:

Evaluate Your Needs and Financial Constraints

Assessing your needs and budgetary restrictions will help you make informed decisions and prioritize your expenditures accordingly. By carefully analyzing your needs and financial limits, you can ensure that you make realistic and responsible choices to meet your requirements within your available resources.

Selecting a Health Insurance Plan

There are several factors to consider when it comes to selecting a health insurance plan. It is important to assess your medical needs and preferences, as well as your financial situation. Research different plans to compare coverage options, costs and network providers. Additionally, take into account any potential life changes or specific health conditions that may require special consideration.

Choose the Insured Amount

Please specify the amount you would like your insurance to cover. This sum insured amount will determine the extent of coverage provided under the policy. It is important to consider your assets and potential liabilities when selecting the sum insured.

Select Your Preferred Add-On Options

You can choose from a wide range of add-on options. Whether you want to include additional features, upgrade your package or enhance your services, there is something for everyone. Select the add-ons that best suit your needs and create a personalized package that meets all your preferences. Take advantage of the flexibility and customization that are offered to make the most out of your chosen plan.

Regularly Pay Your Premiums

Pay your premium amount regularly to ensure that your insurance policy remains active and provides you with the coverage you need. Setting up automatic payments or reminders can help you to stay on track and avoid any lapses in coverage.

Use Health Insurance for Medical Emergencies

In case of a medical emergency, you can rely on your health insurance plan to provide coverage and financial support. It is important to be aware of the details and benefits of your plan so that you can make the most effective use of it during an emergency.

The premium amount is calculated based on several factors including the sum insured, the insured person’s age, coverage benefits, deductibles and add-on riders. These variables help to determine the level of risk and potential cost of providing coverage. It is important to carefully consider these factors when selecting an insurance policy to ensure it aligns with your needs and budget.

Best Health Insurance Plans In India

When it comes to the best health insurance, there is no “one-size-fits-all” policy. It is like choosing a Netflix or OTT plan - different plans offer different benefits and have different costs. However, this age is designed to meet the diverse needs of most users, making it a versatile and comprehensive health insurance comparison page.

It is essential to conduct a thorough comparison to find the policy that best suits your needs. We have created a comprehensive table of how some of the top mediclaim policies in India compare to others in the industry.

Insurance Provider	Plan Name	Coverage Type	Sum Insured Range	Age Limit (Adults)	Important Parameters
Care Health Insurance	Care Advantage Health Insurance Plan	Individual & Family Floater	₹2 Lakh - ₹6 Crore	18-65 years	Extensive network hospitals Customizable coverage options Wellness programs	Check Premium
ICICI Lombard Health Insurance	ICICI Elevate Health Insurance Policy	Individual & Family Floater	₹2 Lakh - ₹6 Crore	18-65 years	Extensive network hospitals Customizable coverage options Wellness programs	Check Premium
IFFCO Tokio Health Insurance	IFFCO Tokio Family Health Protector Policy	Individual & Family Floater	₹2 Lakh - ₹6 Crore	18-65 years	Extensive network hospitals Customizable coverage options Wellness programs	Check Premium
Niva Bupa Health Insurance	Niva Bupa Aspire Policy	Individual & Family Floater	₹2 Lakh - ₹6 Crore	18-65 years	Extensive network hospitals Customizable coverage options Wellness programs	Check Premium
SBI Health Insurance	Arogya Supreme Policy	Individual & Family Floater	₹2 Lakh - ₹6 Crore	18-65 years	Extensive network hospitals Customizable coverage options Wellness programs	Check Premium
TATA AIG Health Insurance	TATA AIG Medicare Lite Policy	Individual & Family Floater	₹2 Lakh - ₹6 Crore	18-65 years	Extensive network hospitals Customizable coverage options Wellness programs	Check Premium

Eligibility Criteria to Buy Health Insurance

Health insurance plays a vital role in providing financial protection during medical emergencies. It is important to have a clear understanding of the eligibility criteria before choosing a health insurance plan in India.

This will help ensure that you find the right coverage that meets your specific needs.

Age
- Minimum Age: In India, the minimum age to buy health insurance is 18 years
- Maximum Age: It is 60 to 65 years and varies by company and plan. Some insurers offer special plans for seniors
- Dependents: Newborn babies can have health insurance from 15 days after being born. The age limit for child dependents varies which usually goes up to 18 or 25 years, depending on the plan
Pre-Existing Medical Conditions
- Disclosure: Disclose pre-existing conditions during the application process to avoid future claim rejections
- Impact on Eligibility: Pre-existing conditions may impact eligibility for health insurance but not necessarily disqualify you. Factors like coverage and costs can be affected.
Medical Tests
- Younger Applicants: People under 45 years old often do not need to take medical tests when they apply for health insurance.
- Older Applicants or Pre-Existing Conditions: Insurance companies may request medical tests for older or pre-existing conditions of applicants to evaluate the risk before issuing a policy.
Other Factors

Claim process of Health Insurance

To ensure a seamless cashless claim experience with your health insurance, follow these steps:

Step 1

Ensure you enrol in a hospital within your insurance network by reaching out to the insurance helpdesk and seeking their guidance.
Step 2

To verify your identity, simply present the health card issued by your insurer in this step.
Step 3

The hospital will give you a pre-authorization form to fill out if you want to avail of their cashless service.
Step 4

After completing the pre-authorization form, it should be submitted to the insurance desk at the hospital.
Step 5

After you have completed the form, the hospital will send it to your health insurance provider for further processing.
Step 6

The insurer carefully reviews the request and accompanying documents. If everything meets the policy requirements, the insurer approves the cashless claim.
Step 7

Settle any out-of-pocket expenses that are not covered by your insurance policy when you are discharged.
Step 8

In the final step, the insurer will complete the payment process and settle the bill with the hospital based on the terms outlined in the policy agreement.

Documents Required

Documents Required for Buy Health Insurance?

Identity Proof : Aadhar Card/Passport/Voter ID Card/Driving License
Age Proof : Aadhar Card/PAN card/Passport/Driving License/Voter ID Card/Birth certificate
Address Proof : Driving License/Ration Card/Aadhar Card/PAN Card/Passport/Rent agreement, if applicable/Utility bills like electricity bill or telephone bill
Other Important Documents: Passport-size photographs (if demanded by the insurer)/Medical reports (if demanded by the insurer)/Proposal form duly filled in and signed

Documents required for Health Insurance Claim Process?

Filled out insurance claim form with an accurate signature
Accepted identity proof (Aadhar, PAN, passport, driver’s license, or voter’s ID)
Original policy documents containing:
- Policy number
- Insured’s name
- Coverage details
Hospital document summarizing:
- Diagnosis
- Treatment
- Stay details
Medical records, including:
- Doctor's notes
- Test reports
- Prescriptions
Original, stamped, and signed hospital bills
Payment receipts for hospitalization payments
Pre-authorization claim form submitted to the insurer before hospitalization
FIR copy (required for accident claims)
MLC (doctor’s document for medico-legal cases)
Settlement certificate (required if multiple health insurance policies are involved)

Frequently asked questions

Health insurance represents a crucial financial agreement between the insured and an insurance company. By paying a regular premium, you secure the insurer’s commitment to covering a portion of your medical expenses in the event of illness or injury. This coverage encompasses various essential medical services such as hospitalization, doctor visits, prescriptions and more.

Medical expenses can be costly, but having health insurance can alleviate this financial burden. With health insurance, you can receive reimbursement or direct payment for your medical bills, ensuring that you can afford necessary healthcare without accumulating debt. This coverage offers financial protection and allows you to access the medical care you need.

Health insurance often excludes certain types of treatments and services. These exclusions vary depending on the policy but may include:

Cosmetic surgery
Dental and vision care
Pre-existing conditions
War injuries
Self-inflicted injuries

An in-network provider is a healthcare facility that has an agreement with your insurance company to offer services at agreed-upon prices. By opting for in-network providers, you can usually benefit from reduced expenses on your part.

Government assistance programmes such as Medicaid and subsidies through the health insurance marketplace can provide support if you are unable to afford health insurance.

Yes, even young and healthy individuals can benefit from health insurance as it protects them from unexpected medical costs. Accidents and illnesses can occur at any time and having insurance ensures that you are financially protected in such situations. It is important to consider health insurance as a means of safeguarding your well-being and finances.

Most health insurance plans do not provide adequate coverage for medical care received outside of your home country. It is important to consider purchasing travel insurance if you are planning to travel internationally, especially for longer durations.

Urgent care: It is designed to address non-life threatening medical issues promptly, without the extended wait times commonly experienced in emergency rooms. However, it is important to note that they may have limited resources for complex diagnostics. If you require immediate attention for a non-life-threatening illness or injury, urgent care could be a more efficient option.
Emergency care: It is necessary for life-threatening situations or serious injuries that need medical attention. Emergency rooms are fully equipped to handle complex medical emergencies. However, it is important to note that emergency room visits can result in high costs. Therefore, understanding the distinction between emergency care and other levels of care can help you receive the appropriate treatment and potentially save money.

Telemedicine allows for remote consultations with healthcare providers using technology like video conferencing. While coverage for telemedicine services is becoming more prevalent, it is important to review your specific plan details to ensure coverage and understand any potential limitations.

It is important to thoroughly review your insurance plan to understand the extent of mental health coverage it provides. This can include therapy sessions, inpatient care and medication. Be sure to investigate any potential limitations or requirements, such as referrals or copays, to avoid unexpected costs. Understanding these details can help you make informed decisions about your mental health care.

The Affordable Care Act (ACA) prevents health insurance companies from denying coverage or imposing higher premiums due to pre-existing conditions. However, there might be waiting periods before pre-existing conditions are covered. It is important to disclose such conditions during enrolment to prevent complications with coverage.

Health Insurance