Health Insurance

What is Health Insurance?

Health Insurance is a contract between the policyholder and the insurer where the health insurance company provides financial coverage to the insured up to the sum insured limit. It offers medical coverage for healthcare expenses incurred during an emergency or planned hospitalization. It also provides tax savings on the premium paid to the insurance company under Section 80D of the Income Tax, 1961.

Health Insurance at a Glance

*Pre-existing diseases are covered after the waiting period is over.
#This is the maximum tax benefit that can be claimed in case both the policyholder and his/her parents are senior citizens.

What is the Ideal Coverage for Health Insurance?

A general rule of thumb says people should buy health insurance plans with a sum insured of at least half of their annual income. Considering medical inflation, experts suggest buying a health insurance policy of at least ₹10 lakh. But it’s not that simple.

Health insurance coverage should be tailored to the medical needs and circumstances of the people. Broadly, the ideal coverage amount for medical insurance depends on three factors:

1. City of residence (i.e. tier-1, tier-2 or tier-3 cities)
2. Age or life stage of the insured
3. Cost of hospitalization expenses in future (while considering medical inflation)

A low sum insured of ₹5 lakh may be sufficient for a young person living in a tier-3 city with no pre-existing disease. However, an older person with pre-existing diseases or someone living in a tier-1 will have to opt for a higher sum insured of at least ₹10-20 lakh to cover their medical expenses adequately.

To know your ideal medical insurance coverage amount, check out the table given below:

Alternatively, people can also opt for a ₹1 crore health insurance policy that has become extremely affordable these days. A ₹1 crore health policy can come in handy for the treatment of a critical illness that goes on for a long duration or for treatments taken abroad. You can easily get a ₹1 crore health cover by paying approximately Rs 1500 more premium.

Additionally, people can also opt for a base health insurance policy with a low sum insured and buy a top-up cover with a high sum insured, which is a more affordable option.

Top Reasons to Buy a Health Insurance Plan

Medical inflation is on the rise making treatments expensive. If you get hospitalized for a critical illness or lifestyle disease, you may end up losing all your savings. The only way to afford quality medical treatment during a health emergency is by buying a health insurance policy. Take a look at some of the top reasons to buy a health insurance plan below:

• Beat Medical Inflation - A health insurance policy can help you pay your medical bills, including pre and post-hospitalization expenses, today as well as in future despite the rising medical costs.
• Afford Quality Medical Treatment - It helps you to afford the best quality medical treatment and care so that you can focus only on getting cured.
• Fight Lifestyle Diseases - It allows you to pay for the long-term treatment of lifestyle diseases like cancer, heart ailments, etc., that have been on the rise with the changing lifestyles.
• Protect Your Savings - It helps you to protect your hard-earned savings by covering your medical expenses so that you can avail the required treatment without any financial worries.
• Avail Cashless Hospitalization Facility - It allows you to obtain a cashless hospitalization facility at any of the network hospitals of your insurance provider by raising a cashless claim.
• Get Tax Benefits - It enables you to save tax on the health insurance premium that you’ve paid under section 80D of the Income Tax Act for better financial planning.
• Ensure Peace of Mind - It allows you to obtain medical treatment with peace of mind as you do not have to worry about paying hefty hospital bills.

Benefits of Buying Health Insurance Plans Online

Buying a health insurance policy online comes with several benefits. Take a look at them below:

• Easier to Compare Plans – It is easier to compare health insurance plans from different insurers online at websites like Policybazaar.com to make an informed decision.
• More Convenient – It is more convenient to buy the policy online as you do not have to visit the branch of the insurance company or take an appointment to meet an insurance agent.
• Online Discounts – It allows you to avail discount on premiums for buying the policy online.
• Lower Premiums – Health plans are available for a lower premium online as insurance companies save a lot on operational costs.
• Minimal Paperwork – The process of buying a health insurance policy online involves minimum to zero paperwork.
• Policy Available 24x7 – A health insurance policy can be purchased online any time of the day, even on public holidays, which is not possible in offline buying.
• Digital Payment Options – It allows you to avoid cash payments and use digital payment methods to pay the premium online safely.
• Time-saving – It saves you a lot of time as the policy is issued within a few minutes of buying.

Key Benefits of Health Insurance Plans in India

Health insurance plans offer a variety of health benefits to the insured, depending on the plan. Following are the key benefits of buying a health insurance plan in India:

1. Hospitalization Expenses

   A health insurance plan covers the medical expenses incurred on getting admitted to a hospital for more than 24 hours. It includes room rent, doctor’s fee, medicine costs, diagnostic test fees, etc.

2. Pre & Post Hospitalization Expenses

   It covers the medical expenses that you may have incurred on an illness before getting hospitalized as well as follow-up treatment expenses incurred after getting discharged. The pre-hospitalization and post-hospitalization expenses are covered up to a fixed number of days as specified in the policy document.

3. ICU Charges

   A health insurance plan also covers the cost of availing treatment in an ICU or Intensive Care Unit during hospitalization.

4. Ambulance Cost

   It covers the cost of ambulance services availed to reach the nearest hospital during a medical emergency.

5. Cashless Treatments

   All health insurance providers in India offer cashless treatment facilities at their network hospitals. You do not have to worry about arranging money to pay the hospital bills if you get admitted to a network hospital, as it will be settled by your insurer under cashless claims.

6. Maternity Benefit

   Several health insurance companies offer maternity benefits, including delivery expenses, pre-natal & post-natal expenses and medical termination of pregnancy. They also cover the cost of treatment and vaccination of the newborn baby. However, all maternity insurance plans have a waiting period ranging from 3 months to 4 years.

7. Day Care Procedures

   It also covers the cost of availing day care treatments that require hospitalization of less than 24 hours.

8. Pre-existing Diseases

   The right health insurance policy also provides coverage for pre-existing diseases after you have completed the waiting period. Usually, pre-existing diseases are covered after a waiting period of 2 to 4 years.

9. AYUSH Treatment

   It covers the cost of availing medical treatment through the AYUSH system of medicines that includes Ayurveda, Unani, Homeopathy, Siddha and Yoga.

10. Medical Check-ups

    Most health insurance companies in India offer free preventive health check-up facilities to the insured at regular intervals depending on the policy terms and conditions.

What is Covered in a Health Insurance Plan?

Most health insurance plans in India cover the following medical expenses:

• In-patient Hospitalization Expenses -The hospitalization expenses incurred during the treatment of an illness or injury are covered, provided the hospitalization is for more than 24 hours.
• Pre-existing Illnesses or Diseases - After the completion of the waiting period, you can file a claim for the expenses incurred on the treatment of any pre-existing illness or condition.
• Pre and Post Hospitalization Expenses - Medical expenses incurred on blood tests, x-rays, and other medical check-ups required before hospitalization are covered by the insurance company. Similarly, the cost of medicines and preventive health check-ups done to ascertain your recovery after discharge from the hospital is also covered under most health insurance plans.
• Ambulance Charges - Although the coverage amount varies from insurer to insurer, most medical insurance plans cover emergency ambulance charges.
• Maternity Cover - Medical expenses incurred during the pregnancy and delivery are covered along with newborn baby expenses.
• Preventive Health Check-ups - Regular health check-up facilities are also made available in most health insurance plans in India.
• Day-Care Procedures - Day care treatments are covered by health plans where hospitalization of more than 24 hours is not required. It includes eye surgery, dialysis, and other common day care surgeries, as mentioned in your policy document..
• Home Treatment Cover - It also covers the expenses incurred on getting medical treatment at home on the advice of a medical practitioner.
• AYUSH Benefit - A health insurance plan also reimburses the hospitalization costs incurred on availing Ayurveda, Unani, Siddha, Yoga or Homeopathy treatment up to the specified limit.
• Mental Healthcare Cover –All health plans in India cover mental illnesses as per the Mental Healthcare Act, 2017. IRDAI had directed all insurers to amend health policies to cover the in-patient treatment of mental illnesses, like acute depression, bipolar affective disorder, schizophrenia, etc., by 31st October 2022.

What is Not Covered in a Health Insurance Plan?

The following medical expenses and situations are usually not covered in a health insurance plan:

• Unless there is an accidental emergency, claims arising during the initial 30 days of buying a health insurance plan are not covered.
• Coverage of pre-existing diseases is subject to a waiting period of 2 to 4 years
• Critical illnesses coverage usually comes with a 90-day waiting period
• Injuries caused by war/terrorism/ nuclear activity
• Self-inflicted injuries or suicide attempts
• Terminal illnesses and other diseases of a similar nature
• Cosmetic/plastic surgery and replacement of hormone surgery
• Non accidental dental treatments
• Bed rest and rehabilitation
• Diagnostic tests
• Claims arising out of adventure sports injuries

Note: It is recommended to check your policy wordings to get a detailed list of exclusions.

Key Factors to Consider Before Buying a Health Insurance Plan

There are a few factors that you should consider to make the right decision while buying a health insurance plan:

• Scope of Coverage -The policy coverage will decide the type of illnesses and surgeries that you can claim during the policy term. Closely look at the benefits offered like hospitalization expenses, daily cash benefit, COVID hospitalization cover, critical illness cover, maternity cover, etc., while choosing a health plan.
• Sum Insured - The sum insured amount is a crucial deciding factor in selecting a medical insurance policy. Looking at the ongoing inflation, it is advisable to buy a health insurance plan with a minimum sum insured of ₹10 lakh. You can also choose to buy ₹1 crore health plan to get wider coverage as they have become affordable nowadays. If it’s a family floater policy or senior citizen insurance, the higher the sum insured, the better the coverage will be.
• Policy Type - There are different types of medical insurance policies available in India. As per your requirement, you can choose to buy individual health insurance, senior citizen health insurance, family floater or critical illness plans. Moreover, you can buy Top Up and Super Top Up health insurance along with your existing health plan to enhance the coverage. This is beneficial in case your base sum insured gets exhausted during the treatment. You can choose this option at the time of policy purchase and renewal.
• Waiting Period Clause - Your health insurance policy only comes into action once the initial waiting period is over. If any claim is filed during the initial waiting period except for accidental hospitalization claims, the insurer will reject it. Moreover, the waiting period clause also applies to pre-existing diseases like thyroid, blood pressure, diabetes, etc.  It is also applicable to specific illnesses, treatments, and maternity cover. Just make sure to choose a plan with a minimal waiting period.
• Co-payment Clause - Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (policyholder). The co-payment option does not have any effect on the sum insured. However, it allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Thus, opt for this clause only if you can afford to pay off a portion of your hospitalization bills, that can be 10% and above, without a financial burden.
• Room Rent Sub-limits - A health insurance plan may have various sub-limits and the most common one is the room rent sub-limit. For instance, if your medical insurance policy comes with a sum insured of ₹3 lakh with a sub-limit of 1% on daily room rent, then your room cost will be covered up to ₹3,000 per day. Any additional amount on room rent will have to be paid from your own pocket. So, choosing a health plan with no or minimal sub-limits is advisable.
• Network of Cashless Hospitals - Check the list of network hospitals for an insurance company where cashless claims can be filed. The higher is the number of network hospitals in your vicinity, the better are the chances of availing cashless hospitalization benefits. 
• Lifelong Renewability Option - Medical insurance policies are usually renewed every year. When the policy term is about to end, the policyholder has to pay the insurance premium at the time of renewal in order to continue the insurance coverage. Thus, when buying a health insurance plan, choosing a plan with a lifetime renewability option is beneficial in the long run.
• Premium Loading Factor - Premium loading is the additional amount that is charged to a risk-prone customer in the premium, especially in senior citizen health insurance plans. Choosing a medical insurance plan with no loading will save you from paying a higher premium. Some insurers also charge a claim loading. This aspect, though ignored in the beginning, usually increases your out-of-pocket expenses at the time of claim.
• Check the Claim Settlement Ratio - Claim Settlement Ratio is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. A claim settlement ratio above 80% can be an ideal choice.

Health Insurance Riders

Riders in health insurance are the additional coverage that you can purchase to avail extra benefits and make your health policy more comprehensive. The cost of the health insurance rider depends on your age, sum insured, type of coverage, etc. Take a look at the five most common riders that you can consider buying with your health insurance policy:

• Maternity Cover Rider- The maternity cover rider can help you to get your maternity expenses covered, including childbirth, pre and post-natal expenses, etc. Some insurers may offer coverage for newborn baby expenses until the end of the policy tenure. However, this rider comes with a waiting period that may range from 9 months to 6 years, depending on the health insurer.
• Consumables Cover Rider - The consumables cover rider pays for non-medical expenses incurred by the insured during hospitalization, such as cotton, bandages, prescriptions, thermometers, syringes, registration charges, gloves, masks, etc. These expenses account for approximately 10-20% of the total hospital bill but are usually not covered by insurers. With consumable cover, policyholders can significantly reduce out-of-pocket expenses while obtaining the best quality treatment.
• Critical Illness Rider- The critical illness rider will ensure that your health insurance policy covers critical illnesses, such as heart diseases, cancer, etc., diagnosed for the first time during the policy tenure. It will provide you with a lump sum benefit amount irrespective of the actual medical expenses incurred during the treatment. It comes with a waiting period of 90 days & a survival period of 30 days. Most plans cover about 10 to 40 critical diseases, depending on the insurer.
• Personal Accident Rider- The personal accident rider can help you get compensation from your insurer in case an accidental injury leads to your disability or death. It will pay you the entire sum insured in case of permanent total disability but only a part of the sum insured, depending on the nature of the injury in case of partial disability. It is also known as the double indemnity rider, as your family will get a death benefit in case of accidental death.
• Hospital Cash Rider- The hospital cash rider enables you to get a fixed daily cash allowance from your insurer to cover incidental expenses that you may incur during hospitalization for an injury or illness. It offers twice the coverage amount for a specific number of days in case you are admitted to the ICU. The daily cash amount may vary as per the policy terms and opted coverage. However, you need to be hospitalized for at least 24 hours to activate this rider.
• Room Rent Waiver- The room rent waiver ensures that your health insurance policy covers the rent for the hospital room of your choice during hospitalization. It ensures that no cap on room rent applies to you and, thus, allows you to opt for a room with higher sub-limits or no sub-limits without paying extra money from your pockets.

Does Your Health Insurance Policy Cover Coronavirus (COVID-19) Treatment?

Yes, your existing health insurance policy covers the cost of COVID-19 treatment. Several health insurers and general insurers have already launched health insurance plans for coronavirus that cover medical expenses incurred on the treatment of coronavirus. After the IRDAI guidelines, two special standard health insurance products, namely the Corona Kavach policy and the Corona Rakshak policy, were launched and purchased by a lot of people. Let’s check out these two COVID insurance products and how they are different from basic health plans.

• Corona Kavach Policy

  It is an indemnity-based health insurance plan that covers COVID hospitalization expenses, home treatment, and AYUSH treatment costs. The cost of masks, gloves, ventilators, oxygen cylinders, and PPE kit is also covered in the Corona Kavach policy.

• Corona Rakshak Policy

  Corona Rakshak policy is a benefit-based product that provides a lump sum payment for hospitalization (minimum 72 hours) expenses upon the diagnosis of coronavirus during the policy term. The minimum policy term is 3.5 months and the maximum is 9.5 months.

Eligibility Criteria to Buy a Health Insurance Plan

The eligibility criteria to buy a health insurance plan depends on a number of factors such as the age of the policyholder, pre-existing diseases, etc. In most health insurance plans, the following eligibility criteria should be met:

Age Criteria- The entry age criteria for adults and children varies and can range from 18-65 years and 90 days to 25 years respectively. The actual age can vary from one medical insurance policy to another.

Pre-medical Screening- Pre-medical examination is required for applicants mostly above the age of 45 years or 55 years. However, most of the senior citizen health plans require pre-medical tests before policy issuance.

Pre-existing Diseases Disclosure- Any pre-existing illness is covered after the completion of the waiting period i.e. 2-4 years. Most health insurers ask the applicant if they are going through any medical conditions like high blood pressure, diabetes, cardiovascular diseases, kidney problems, etc., at the time of buying a health insurance plan. If you are a smoker or an alcoholic, then you need to disclose it to the insurance company.

Do not keep it a secret, as it may cause problems at the time of claim settlement. It can even lead to rejection of your claims.

Based on these criteria, the insurance company decides to offer medical coverage to the applicant.

Why Compare Health Insurance Plans Online?

Comparing health insurance quotes online helps you in choosing the right health plan to suit your healthcare needs. Sometimes, it can also get confusing to select a good health insurance plan as so many insurers offer different health insurance products with impressive features.

Thankfully, Policybazaar.com understands the confusion of the customers and offers a platform where you can compare different health insurance plans’ features, sum insured and quotes online. Here are some of the major advantages of comparing and buying a health insurance plan online:

• Access to Accurate Information: It offers easy access to all medical insurance policies available in the market. It also saves the buyers from dealing with insurance agents who may provide unreliable and biased information to achieve their professional goals.
• Easy Comparison of Different Health Plans: Comparing different health insurance plans online is both time-saving and convenient. You don’t have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing health insurance plans, etc., are also easier online.
• Find a Policy with Suitable Premiums: If a customer is looking to buy a health plan online, he/she will be able to compare the premiums of different plans and opt for the one that fits in the budget. Also, no brokerage or agent fees are levied, and hence, the buyer ends up saving a significant amount of money.
• Availability of Provider/Plan Reviews: You can check an insurance company’s ability to meet your claim requests by comparing the Claim Settlement Ratio and customer reviews online. Doing so will help you get an overall idea of an insurer’s reputation and customer service, enabling you to make an informed decision.

Some Myths about Health Insurance

Before buying a health insurance policy, you must be aware of how it works. Mentioned below are some popular myths that most people believe about health insurance:

How to Calculate Health Insurance Premiums?

In order to keep the policy in force, regular payment of a fixed premium amount is essential. Did you ever think about how this premium is calculated? There are certain factors that affect health insurance premiums, such as your age, the medical background of your family, sum insured, cumulative bonus, your personal medical history and so on.

Naturally, you might want to calculate your premium to figure out how much you would have to pay for a policy. Well! You can do that through a health insurance premium calculator. A premium calculator is an online tool that calculates the premium to be paid as per the information you provide, such as the preferred sum insured, the age of the insured, etc. At Policybazaar.com, you can calculate your health insurance premium online easily and free of cost.

Which Factors Affect Health Insurance Premium?

With the advancement in medical facilities, healthcare costs have also increased. The main benefit of health insurance is that it takes care of your healthcare expenses. It offers financial security to you and your family in the event of an unanticipated serious illness or accidental injury that could drain all your savings. Here is how the cost of your insurance policy is determined:

• Medical History: Your medical history is one of the major determinants of your health insurance premium. Almost all health insurers in India make pre-medical tests mandatory after a certain age for buying a health insurance policy. While some insurance companies don’t make medical screening mandatory, they do consider your current medical conditions, lifestyle-related health risks and the medical background of your family. That is why medical insurance premiums for smokers are higher than other people.
• Gender and Age: Age is another important determinant of medical insurance premiums. The premium increases as the age of the insured increases. That is why it is recommended to buy a policy at a young age because the premiums are lower for younger applicants.
  Elderly people are vulnerable to cardiovascular diseases and other critical illnesses, such as cancer, kidney problems, etc. For this reason, senior citizens medical insurance premiums are usually on the higher side.
  Also, the cost of health insurance for women is lower in comparison to the male candidates due to the lower risk of stroke, heart attack, etc.
• Policy Term : premium for a 2-year health insurance plan will be higher than a 1-year plan. However, almost all insurance companies offer a discount on long-term medical insurance plans.
• Type of Health Insurance Plan: The type of health insurance policy you select also affects your premium. The wider is the coverage, the higher will be the premium. With the help of an online health insurance premium calculator, you can compare the premium for different health insurance plans before buying.
• No Claim Bonus: you have not made any claim during your previous policy term, then you can earn an NCB or No Claim Bonus discount. With NCB, you can save 5% to 50% on your renewal premium, depending on the number of claim-free years. It is also one of the most important factors that is taken into consideration while calculating the policy premium.
• Lifestyle Habits: If you drink or smoke regularly, chances are high that you will be charged a higher premium. In severe cases, the insurer can also reject your medical insurance policy request.

How to File a Health Insurance Claim?

Health insurance plans offer cashless treatment and expense reimbursement by the insurer. Traditionally, cashless claims were only available at network hospitals. However, with the "Cashless Everywhere" feature, you can file a cashless claim at non-network hospitals up to the sum insured limit of your health insurance policy. There are two types of claim processes:

1. Reimbursement Claims

For the treatments availed in non-network hospitals, the policyholder can file a claim for reimbursement of the treatment charges. Once the treatment is completed, the insured needs to settle the bill, collect all the documents, and submit them to file a claim with the insurer or the TPA for reimbursement. 

2. Cashless Claims

If the treatment is availed in a network hospital of the insurer, then the policyholder will be eligible to avail cashless treatment services. Once the treatment is completed the insurance company settles the bill directly with the hospital.

For both cashless and reimbursement claims, the procedure for planned and emergency hospitalization may vary as given below:

In Case of Planned Hospitalization:

• You need to inform the insurer at least 48 hours before the treatment.
• Once you get the approval from the TPA/insurer, you can then file for reimbursement or cashless claims on submission of the claim form.
• Also, submit other related documents like medical bills, reports, discharge summary, etc.
• Once the approval is provided, the claim amount is paid to you by the insurer in case of reimbursement claims.
• In the case of cashless claims, the hospital bill is directly settled by the insurer.

In Case of Emergency Hospitalization:

•  You need to inform the insurer within 24 hours of getting hospitalized.
• Showcase your health card at the hospital.
• Submit the pre-authorization form to get TPA approval for emergency hospitalization for cashless claims
• If approved, the insurer will settle the claim amount directly with the network hospital
• If you fail to get TPA approval, you will need to file for reimbursement later.
• Submit all the required documents like hospital bills, discharge bills, etc., after getting discharged from the hospital.
• After verification of documents, the claim amount will be paid to you.

How to Get a Physical Copy of Your Health Insurance Policy?

All insurance companies share a soft copy of the health insurance policy with their customers, which is digitally verified and legally valid. However, if you need a physical copy of your health policy, you can use the options given below:

1. Download the policy document your insurer shared on your registered email ID and get it printed.
2. Request a physical copy of your health policy from the insurer by contacting their customer support team.
3. Log in to your insurer’s website to access your policy document, download it and get it printed.

If you have purchased your mediclaim policy from Policybazaar.com, you can log in to the website to download your policy document and get it printed.

Documents Required for Health Insurance Claim Reimbursement

In the event of a hospitalization, the policyholder needs to submit certain documents as mentioned below to file a reimbursement claim with the insurer:

• Discharge card issued by the hospital
• In-patient hospitalization bills signed by the insured for authenticity
• Doctors’ prescriptions and medical store bills
• Claim form with insured’s signature on it
• Valid investigation report
• Consumables and disposables prescribed by the doctors with complete details
• Bills of doctors’ consultations
• Copies of the health insurance policy from the previous year and the current year
• Copy of ID Card
• Any other document(s) asked by the TPA

How to Buy Right Health Insurance Plans Online from Policybazaar?

Buying health insurance can be easy if you approach the right channel. Having said this, Policybazaar.com can be a good platform for choosing the right insurance policy. Policybazaar Insurance Broker Private Limited has made the process of comparing & buying a health insurance policy easier in comparison to earlier days. A person has easy access to complete details of almost all health insurance plans available in the Indian insurance market at a competitive price.

Policybazaar.com helps you to compare numerous health insurance plans and zero down on the plan that best fulfils your needs. Moreover, the post-sale services are extended to the customers online as well as at the time of a medical insurance claim.

Steps to Buy a Health Insurance Plan Online from Policybazaar

To get insured from the comforts of your home, you can buy health insurance online from Policybazaar Insurance Broker Private Limited. No medicals are required and payment can be made online. The steps to buy a health insurance plan online from Policybazaar.com are listed below:

Step 1- Select Male/Female and choose the family members to be insured along with their age.

Step 2- Enter your city, full name and phone number.

Step 3- Choose if you or any family members to be covered have an existing illness.

Step 4- Click ‘Yes’ or ‘No’ if your office provides medical insurance. If yes, choose the coverage amount.

Step 5- Select the right health insurance plan from the options that are displayed. Choose ‘Get Free Advice’ if you want suggestions or help.

Step 6- Select and compare different health insurance plans on Policybazaar.com. You can customize your search to choose the right plan for yourself.

Step 7- Once the plan is selected, you can pay the premium or speak to our customer care representative to take you through different options.

Step 8- Once all the steps are completed, the policy will be emailed to your registered email Id.

Documents Required for Health Insurance

Take a look at the list of KYC documents that may be required to buy or renew health insurance in India:

• Aadhaar Card
• Driving License
• Passport
• Voter ID Card
• Letter by the National Population Register with demographic details
• Job Card NREGA signed by a state government officer
• Any other document notified by the central government in consultation with the IRDAI

Common Health Insurance Terms

Take a look at some of the most common health insurance terms that you may come across:

AYUSH Treatment

AYUSH treatment refers to medical treatments taken through Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy system of medicines. Several health insurance plans cover AYUSH treatment costs.

Bariatric Surgery

Bariatric surgery or weight-loss surgery refers to the surgery performed to treat obesity or reduce the weight of a person. A lot of health insurance policies offer coverage for bariatric surgery.

Claim

Claim refers to the request made to the insurance company by the policyholder to pay the medical expenses incurred on an illness or hospitalization under the health insurance policy. In the absence of a claim, you will have to pay for the medical expenses on your own.

Co-payment

Co-payment refers to a fixed percentage of the claim amount that the policyholder has to pay at the time of claim settlement. Opting for a co-payment can help to reduce your premium amount.

Coverage

Coverage refers to the extent of benefits available under a health insurance policy. The wider is the coverage, the more will be the benefits offered under the policy.

Cumulative Bonus

Cumulative bonus refers to an increase in the sum insured amount without a hike in premium as a reward for not raising a claim in the previous policy year.

Day Care Procedures

Day care procedures refer to those medical procedures and surgeries that are performed using advanced medical technology and require hospitalization of less than 24 hours. Almost all basic health insurance plans offer coverage for day care procedures. For example, cataract surgery.

Deductible

Deductible refers to a fixed amount that the policyholder agrees to pay towards the incurred medical expenses before raising a claim with the insurance company. It is a part of the total claim amount. Once the deductible is paid, the insurance company will pay for the remaining medical expenses claimed by the policyholder.

Dependent

Dependent refers to the family members of the policyholder who can also be covered under the same health insurance policy. It usually includes your legally wedded spouse, children, parents and parents-in-law..

Domiciliary Treatment

Domiciliary treatment refers to the medical treatment taken at home under the supervision of a medical professional in case hospital admission is not possible. This treatment is covered by health insurance plans under domiciliary hospitalization.

Entry Age

Entry age refers to the age at which a person can buy a health insurance policy. Most health insurance plans come with an entry age of 91 days to 65 years.

Exclusions

Exclusions refer to the conditions or circumstances that are not covered under a health insurance policy. Any claim arising out of an excluded medical expense or circumstance is not payable by the insurance company.

Family Floater

Family floater refers to the type of coverage where a single sum insured amount is shared by all the insured family members on a floater basis. A family floater policy is more affordable than buying an individual policy for each family member.

Free Look Period

Free look period refers to the first 30 days of buying the policy, where the policyholder can change the insurance company or cancel the policy without paying any cancellation fee. If the policy is cancelled during this period, then the premium amount is refunded to the policyholder.

Grace Period

Grace period refers to a fixed period that begins after the due date of a health policy. During this period, the policyholder can pay the due premium amount without losing the continuity benefits, such as waiting periods. Grace periods are usually of 15 days or 30 days.

Indemnity Plan

An indemnity plan is a type of insurance policy where the claim amount is paid based on actual medical expenses incurred. Under this type of plan, the policyholder has to submit the medical bills to the insurance company so that they pay the claim amount equal to the total bill amount.

Insured

Insured refers to the person who is eligible to receive medical coverage under a health insurance policy.

Insurer

Insurer refers to the insurance company that is responsible to pay for the medical expenses of the insured under a health insurance policy.

Network Hospitals

Network hospitals refer to the empanelled hospitals of the insurance company that offer the cashless hospitalization benefit to the policyholders. All insurance companies in India have a network of cashless hospitals.

No Claim Bonus

No Claim Bonus is a renewal premium discount offered by insurance companies to policyholders for not raising a claim in the previous policy year. This discount can be accumulated up to 50% for five consecutive claim-free years.

Portability

Portability refers to the procedure of changing the existing insurance company or health insurance policy without losing any continuity benefits like the waiting period. This facility is beneficial for people who are unhappy with their current insurer or policy.

Pre-existing Diseases

Pre-existing diseases refer to the diseases or medical conditions that the applicant was diagnosed with up to 4 years before buying the health policy. Most health plans cover pre-existing diseases after 2 to 4 years of waiting period.

Premium

Premium refers to the cost of an insurance policy. It is the amount paid by the policyholder at regular intervals to get insurance coverage and enjoy the benefits available under a health insurance policy.

Preventive Health Check-up

Preventive Health Check-up Preventive Health Check-up refers to a series of medical tests that are undertaken to assess the health of a person and take suitable measures to prevent the occurrence of a disease.

Restoration Benefit

Restoration benefit refers to the facility of refilling your sum insured amount before the policy renewal date in case the original amount gets exhausted on raising one or more claims.

Riders/ Add-on Covers

Riders or add-on covers refer to the additional covers that the policyholder can buy on payment of an extra premium amount to expand the coverage of a basic health insurance policy. For example, PED waiting period reduction, etc.

Room Rent Limit

Room rent limit refers to the limit up to which the insurance company will pay for the hospital room charges incurred by the policyholder. If the hospital room charges are more than the room rent limit, then the additional amount will have to be borne by the policyholder.

Sub-limits

Sub-limits Sub-limits refer to the limit set on the coverage amount of a benefit under a health insurance policy. Eg: room rent limit. In case a coverage benefit comes with a sub-limit, the insurance company will only be liable to pay up to that limit, and any additional amount will have to be paid by the policyholder.

Sum Insured

Sum insured refers to the maximum coverage amount that the insurance company will pay in a policy year. The sum insured is ascertained at the time of buying or renewing the policy.

Top Up Plan

Top up plan refers to a type of health insurance plan that offers a higher sum insured and can be bought to enhance the medical coverage of a person. However, a deductible amount needs to be paid under all top up insurance plans, which makes its premium affordable.

Underwriting

Underwriting refers to the process where an insurance company evaluates the application of a person. The underwriting team evaluates the medical history and personal details of a person to determine whether the policy should be issued and how much premium must be charged.

Waiting Period

Waiting period refers to the time period from the commencement of the policy during which the policyholder is not allowed to make any claims. Any claims raised during this period will be rejected by the insurance company. For example, the PED waiting period, critical illnesses waiting period, etc.