Health Insurance in India

What is Health Insurance?

A health insurance policy is a written agreement between a policyholder and an insurance company where the insurer provides financial coverage to the insured for medical expenses such as hospitalisation, surgical treatments, and other healthcare-related expenses. A typical medical insurance policy in India works in two different ways- Cashless health insurance and Reimbursement health insurance.

Why is Buying/Renewing Health Insurance Important?

A medical insurance policy is an important financial tool for a variety of different reasons. For instance, the best health insurance in India that has access to a wide range of network hospitals can offer the policyholder the quality treatment they need for any medical emergency. Here is a list of some important reasons why health insurance plans are a must:

• Financial Security

Managing medical expenses is the top reason to buy medical insurance. Healthcare costs across the country have risen by a large margin over the past few years. With the best medical insurance, you will be able to financially deal with unforeseen health emergencies and treatments, and rest assured that healthcare costs will not eat away your entire savings.

• Rising Health Issues

While prevention is better than cure, one should always be prepared for emergencies. Hectic work schedules and unhealthy eating habits have led to an increase in diabetes and cardiovascular-related illnesses. The best medical insurance plan will ensure that you can get the best treatment for any health conditions at reputable hospitals.

• Tax Benefits

Buying medical insurance in India also provides tax benefits to the policyholders, as they can claim maximum tax deductions of up to ₹75,000 as premiums paid for health insurance plans under Section 80D of the Income Tax Act, 1961.

• Coverage for Self and Family Members

Health emergencies can arise anytime and anywhere. With family health insurance plans, you can get the best treatment for yourself as well as your loved ones, all under a single policy and save money at the same time.

• Extent of Coverage

Most health insurance companies offer their customers the choice to choose the extent of financial cover they require. The cost of the insurance premiums also depends on the amount of coverage selected. This allows people from all financial backgrounds to get the level of coverage that they are comfortable paying for.

• Add-on Covers

When you buy health insurance, you also have the choice to buy add-on covers on top of your health policy. These add-on covers offer specific coverages such as personal accident cover, room rent waiver, critical illness cover, etc. You can choose and purchase the specific add-on covers that you may need to enhance your health insurance plans. 

Under cashless health insurance, you can directly go to a network hospital affiliated with your insurer and get medical treatment for no cost. The hospital directly settles the treatment bills with your insurer. Under a reimbursement policy, you pay for the treatment out of pocket and then get the medical expenses reimbursed from your insurer. Now that you understand the meaning of health insurance, let’s take a look at the various components of a health policy in detail.

Best Health Insurance Plans in India for 2022 on Bajaj MARKETS

Check out the best health insurance options available on Bajaj MARKETS from different insurance companies like Bajaj Health Insurance, Aditya Birla Health Insurance, and Care Health Insurance: 

Disclaimer: Premiums rates mentioned above for the above health insurance plans are not constant and subject to change over time. 

Types of Health Insurance Plans

Understanding the types of health insurance plans and their features will help you make the right choice when buying a health plan for yourself:

Individual Health Insurance Plans

Medical emergencies may strike and catch you off-guard anytime. This is why it becomes critical for you to secure yourself with an Individual Health Insurance plan. This plan is designed to offer adequate coverage for medical treatment, to deal with such emergencies or unforeseen risks. With benefits like cashless treatments, pre and post hospitalisation expense coverage, cover of day care treatments and more, the individual health insurance plan is a great choice.

Moreover, when it comes to buying medical insurance, it is recommended that you buy the plan when you are young. This is because the premium payable is comparatively less when one is young, and the benefits to be reaped by the policyholder over the long run are very attractive. Hence, millennials should definitely consider buying individual health insurance.

Family Health Insurance Plans

When it is about our loved ones, we always want to go for the best treatment, especially when it comes to securing their health. While you can definitely go for individual health insurance plans for each of the family members, family health insurance seems a better choice.

With this plan, a defined sum insured coverage amount is split among the family members for treatment costs. Being a single plan that offers coverage for the entire family, you need to pay a single premium amount, making it a cost-effective choice.

Senior Citizen Health Insurance Plans

Senior citizen health insurance plans are specifically desired for people above the age of 60 years. You can buy the policy for your parents or in-laws. It usually covers a wide range of critical illnesses, pre- and post-hospitalisation treatment, in-patient costs, daycare procedures, and more. Besides, if you have a senior citizen health insurance plan for your parents, you can claim tax deductions under Section 80D of the Income Tax Act, 1961.

Top-Up Health Insurance Plans

In case you have already purchased a health insurance plan with lower coverage but wish to increase the coverage limit in the future, the most cost-efficient way to do it is by getting a health insurance top up plan. Top-up health insurance is a very valuable add-on that can help you extend your total coverage amount by a large margin while you only pay a small portion of the original cost of the health plan.

Group Health Insurance Plans

Offering group health insurance is one of the perks that employers offer their employees these days. Just like any other health insurance policy, the group health insurance plans offer coverage for medical treatment costs and more.

Buy/Renew Health Insurance Plans Online

A large number of services have moved online over the past few years. Now, you have the option of buying or renewing your medical insurance while sitting in the comfort of your home:

Steps to Buy Health Insurance Online

Step 1: Head on to the health insurance page of the insurance company that you wish to purchase your plan from.

Step 2: Provide the necessary details about whom you wish to insure, along with your personal information.

Step 3: Pick from the list of available health insurance plans. You can also enhance your coverage by selecting the add-on covers.

Step 4: Upload the necessary documents and make your health insurance premium payment online.

Step 5: And that’s it! Your policy will be emailed to you shortly.

Steps for Health Insurance Renewal Online

Health insurance renewal online in India is just as easy as buying a new plan. Check out the simple steps given below:

Step 1: On the main health insurance page of the insurer of your choice, click on the type of health insurance plan you wish to renew, i.e., individual, family, or top-up.

Step 2: Now, click on the ‘Renew Plan’ option that shows up on the screen.

Step 3: Enter your existing policy details on the page along with other necessary details and check the renewal quote.

Step 4: Upload the necessary documents and make your renewal premium payment.

Step 5: Your plan will be renewed shortly and details will be sent to your registered email. 

How to Calculate Health Insurance Premiums Online in India 2022

Calculating the insurance premiums you will have to pay for any plan is really easy with the help of a health insurance premium calculator. All you need to do is enter relevant information like your age, gender, weight, location, amount of coverage needed and other necessary data. The premium calculator uses your data to provide an accurate estimate of the amount you will need to pay in the form of health insurance premiums. 

Inclusions and Exclusions of Health Insurance

Inclusions refer to the variety of diseases and medical conditions for which the treatment/hospitalisation costs are covered by the health insurance policy. On the other hand, exclusions are those medical conditions or situations for which the health insurance policy does not provide any coverage for medical treatments. Let’s take a look at the common inclusions and exclusions under medical insurance in India.

Inclusions

• Pre & Post Hospitalisation

Coverage for treatment costs incurred during pre & post-hospitalisation procedures so you need not worry about your hospital bills.

• Day-Care Procedures

Expenses incurred for day care treatment and procedures that require short-term hospitalisation are also covered.

• Organ Donor Expenses

Expensive organ donation procedure treatments are taken care of by health insurance plans.

• Daily Hospital Cash

The daily hospital cash benefit takes off the burden of the sudden hospitalisation expenses, so you need not face the last minute hassle of arranging additional cash.

• Road Ambulance Cover

Avoid an unexpected ambulance bill while you go to or return from a hospital in times of an emergency with ambulance cover.

Exclusions

• Pre-Existing Illnesses

Pre-existing diseases without the completion of the waiting period (which is typically 2-4 years) are not covered under the policy. However, check with your insurer for the same before raising any claim requests.

• Injuries Due to Exceptional Scenarios

Treatment cost for injuries caused due to war-like scenarios, nuclear activity, suicide attempts, and terrorism is not covered.

• Dental Procedures

Dental procedures unless arising due to an accidental injury are not covered.

• Medical Conditions Caused Due to Drinking or Substance Abuse

Medical emergencies arising due to consumption of intoxicants and/or addictive substances like drugs, alcohol, etc. are not covered.

• Injuries in Dangerous Activities

Injuries when participating in naval, military or air force operations or dangerous sports like racing and driving are not covered.

Tax Benefits of Health Insurance

Health insurance is one of the most powerful tax-planning instruments. With health insurance plans, you can avail several tax benefits under Section 80D of the Income Tax Act, 1961. Here’s a quick walkthrough of the same.

Note: The deduction for parents is over and above the maximum deduction allowed for an individual and his/her family.

Additional Deductions: You can claim an annual deduction of up to ₹5,000 on expenses incurred for health check-ups. This includes the check-up expenses of all members of a family – self, spouse, children and parents.

Health Insurance Claim Process

Understanding the claim settlement process is also important before you buy the best health insurance policy for you. Knowing your plan’s claim details is critical so that you can make the most of your medical coverage. Here’s how to file both cashless health insurance claims and reimbursement claims:

How to File Cashless Claims

Step 1: Visit your provider’s network hospital. Submit policy details and take the pre-authorisation form.

Step 2: The insurer verifies the form and the hospital is notified about the details of the policy.

Step 3: Once discharged, the hospital will send the bill along with discharge papers to the insurer.

Step 4: The claims are then directly settled with the hospital, after reducing the co-payment, if any.

How to Get a Claim Reimbursement

Step 1: Submit all original medical documents and hospital bills and insurance claim form to the insurer.

Step 2: The insurer evaluates the details and may ask for any additional information, if required.

Step 3: On receiving all the documents, your claim decision is made.

Step 4: You will receive the claim amount based on the policy terms and conditions.

Documents Required for Filing Insurance Claim

You will need to submit the following documents to the insurer in order to make a health insurance claim:

• Duly filled the claim form

• Medical Certificate

• Original copy of hospital discharge summary or card

• Prescription and cash invoice from pharmacies and the hospital

• Investigation report by the doctor

• FIR or Medico Legal Certificate (MLC), in case of an accident

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