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Your Step-by-Step Guide to Choosing a Health Insurance Plan

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The health insurance landscape can be tricky to navigate. Here’s a start-to-finish guide to choosing the best plan for you and your family, whether it’s through the federal marketplace or an employer.

IN THIS ARTICLE:

Step 1: Find your marketplace

Most people get health insurance through an employer. If you’re one of them, you won’t need to use the government insurance exchanges, or marketplaces. Essentially, your work is your marketplace.

If your employer offers health insurance and you still wish to search for an alternative plan in the exchanges, you can. But plans in the marketplace are likely to cost a lot more. Most employers that provide insurance pay a portion of workers’ premiums, so they’ll likely offer the least expensive option.

If your job doesn’t provide a health insurance benefit, shop on your state’s Affordable Care Act marketplace, if available, or the federal marketplace to find the lowest premiums. Start by going to HealthCare.gov and entering your ZIP code. You’ll be sent to your state’s exchange if your state is green on the map below. Otherwise, you’ll use the federal marketplace.

You can also purchase health insurance through a private exchange or directly from an insurer. If you choose these options, you won’t be eligible for premium subsidies, which are income-based discounts on your monthly premiums.

Step 2: Compare types of health insurance plans

You’ll encounter some alphabet soup while shopping for plans; the most common types are HMOs, PPOs, EPOs, or POS plans. The kind you choose will help determine your out-of-pocket costs and which doctors you can see.

While comparing plans, look for a summary of benefits. Online marketplaces usually provide a link to the summary and show the cost near the plan’s title. A provider directory, which lists the doctors and clinics that participate in the plan’s network, should also be available. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.

Comparing health insurance plans: HMO vs. PPO vs. EPO vs. POS

When comparing different plans, put your family’s medical needs under the microscope. Look at the amount and type of treatment you’ve received in the past. Though it’s impossible to predict every medical expense, being aware of trends can help you make an informed decision.

If you choose a plan that requires referrals, such as an HMO or POS, you must see a primary care physician before scheduling a procedure or visiting with a specialist. Because of this requirement, many people prefer other plans.

POS and HMO plans may be better if you don’t mind your primary doctor choosing specialists for you; one benefit of this system is that there’s less work on your end, since your doctor’s staff coordinates visits and handles medical records. If you do choose a POS plan and go out of network, make sure to get the referral from your doctor ahead of time to reduce out-of-pocket costs.

If you’d rather choose your doctors, you might be happier with a PPO or EPO. An EPO may also help you lower costs as long as you find providers in network; this is more likely to be the case in a larger metro area. A PPO might be better if you live in a remote or rural area with limited access to doctors and care, as you may be forced to go out of network.

Step 3: Compare health plan networks

Costs are lower when you go to an in-network doctor because insurance companies contract lower rates with in-network providers. When you go out of network, those doctors don’t have contracted rates, which costs your insurance company, and you, more.

If you have preferred doctors and want to keep seeing them, make sure they’re in the provider directories for the plan you’re considering. You can also directly ask your doctors if they take a particular health plan.

If you don’t have a preferred doctor, you’ll probably want a plan with a large network so you have more choices. A larger network is especially important if you live in a rural community, since you’ll be more likely to find a local doctor who takes your plan.

Eliminate any plans that don’t have local in-network doctors and those with very few provider options compared with other plans.

Step 4: Compare out-of-pocket costs

Nearly as important as network size is how costs are shared. Any plan’s summary of benefits should clearly lay out how much you’ll have to pay out of pocket for services. The federal marketplace website offers snapshots of these costs for comparison, as do many state marketplaces.

This is where it’s useful to know a few health insurance vocabulary words. As the consumer, your portion of costs consists of the deductible, copayments, and coinsurance. The total you spend out of pocket in a year is limited, and that maximum is also listed in your plan information. In general, the lower your premium, the higher your out-of-pocket costs.

Cost-sharing options vary, so your goal is to narrow down choices based on out-of-pocket costs. A plan that pays a higher portion of your medical costs, but has higher monthly premiums, is better if:

  • You see a doctor, whether a primary physician or a specialist, frequently.
  • You frequently need emergency care.
  • You take expensive or brand-name medications on a regular basis.
  • You are expecting a baby, plan to have a baby, or have small children.
  • You have a planned surgery coming up.
  • You’ve recently been diagnosed with a chronic condition such as diabetes or cancer.

A plan with higher out-of-pocket costs and lower monthly premiums is the financially smart choice if:

  • You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.
  • You are in good health and rarely see a doctor.

Step 5: Compare benefits

By now, you likely have your options narrowed down to just a few. To further winnow down, go back to that summary of benefits to see which plans cover a wider scope of services. Some may have better coverage for things like physical therapy or mental health care, while others might have better emergency coverage.

If you skip this quick but important step, you could miss out on a plan that’s much better tailored to you and your family.

Once you’re down to a couple of options, it’s time to address any lingering questions. In some cases, only speaking with a person will do, so call the customer service line of the insurers you’re considering. Write your questions down ahead of time, and have a pen or computer handy to record the answers.

Your questions will be based on your current health situation, but here are some examples of what you could ask:

  • I take a certain medication. How is that covered under this plan?
  • Which drugs for this disease are covered under this plan?
  • What maternity services are covered?
  • What happens if I get sick when traveling abroad?
  • How do I get started signing up, and what documents will I need?

A final tip: Don’t forget to discontinue your old plan before the new one starts if you switch.

Checklist: Choosing a health insurance plan

Here’s a quick checklist that summarizes the steps above:

  1. Go to your marketplace and view your plan options side by side.
  2. Decide which type of plan — HMO, PPO, EPO, or POS — is best for you and your family.
  3. Eliminate plans that exclude your doctor or any local doctors in the provider network.
  4. Determine whether you want more health coverage and higher premiums, or lower premiums and higher-out-of-pocket costs.
  5. Make sure any plan you choose will pay for your regular and necessary care, like prescriptions and specialists.

Health Insurance

Health Insurance is an insurance policy that ensures that you get cashless treatment or expense reimbursement, in case you fall ill. A health insurance policy reimburses the insured for medical and surgical expenses arising from an illness or injury that leads to hospitalization.

The insurance company provides the insured with the facility of cashless hospitalization at a network hospital or provides a reimbursement for the incurred expenses. Furthermore, health insurance cost is subsidized to the insured in the form of tax exemption under section 80D of Income Tax Act, 1961.

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Importance of Health Insurance in India

Health insurance in India is one of the fastest growing industries. However, this wide scope for growth indicates the limited penetration of health insurance among the Indian populace. As per the latest report released by National Sample Survey Organization (NSSO) titled “Key Indicators of Social Consumption in India: Health”, only 20 percent of the Indian population had health insurance coverage. Additionally, only 18 percent of the total population residing in urban areas and 14 percent of the total population residing in rural areas had any form of health insurance coverage.

Thus, there is no debating the importance of having insurance in a country like India where medical expenses are sky-rocketing. Everyone must buy a good health insurance policy that includes medical costs, hospitalisation costs, medication and laboratory test costs, including critical illness. Don’t get confused with questions like – Which health policy to buy? Does it cover every eventuality? What illnesses are excluded from this cover? PolicyBazaar is here to resolve all such confusions.

Compare Health Insurance Quotes & Save Big

It is vital that you compare health insurance online before purchasing any plan in order to choose the best plan for your healthcare needs. As it is, it can get mind-boggling to select one as there are so many companies offering health insurance policies with features as varied as the providers.

It is no wonder that sometimes, people end up with a plan that, though costs less, has contradictory clauses, and they practically get nothing when a claim is filed. On the other hand, you end up buying a plan with a higher cost just to find out later that it has features that you did not use or might never need.

Treatment costs are increasing by the day. A Health insurance policy prevents a medical emergency from turning into a financial emergency. It makes sure that one’s healthcare needs are taken care of without depleting his/her savings or compromising on one’s future goals.

Benefits of Comparing Health Insurance Online

Due to tight and hectic schedules these days, it has become quite impossible to visit different offices or branches of different health insurance companies in order to compare various medical insurance policies.

Thankfully, Policybazaar understands the dilemma of the customers and hence, has offered a platform where you can compare health insurance policies online. Which means, no more lines and no more lies. But, there is more.

Enlisted below are few of the major advantages of buying a health insurance plan online:

Access to Accurate Information:

Offers an easy access to every insurance policy available in the market. It also saves the buyers from dealing with agents who are known to provide unreliable and biased information most of the times.

Time Efficient and Convenient:

By comparing health insurance plans online, the users are able to save their time as they don’t have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing the plans, etc., are also easier via online mode.

Pocket-Friendly:

If a customer buys a health plan via an online channel, he/she will be able to compare 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:

Doing so will help you get an overall idea of an insurer’s reputation, enabling you to make an informed decision.

Tips to Compare Medical Insurance in India

With more than 25 insurance companies and more than 200 health insurance products in the Indian health insurance market, comparing health plans and finding the best one is not an easy task. Enlisted below are a few pointers that can help make this process easier and smoother. One must go through these tips to make an informed decision:

Focus on the Sum Assured of Your Choice

The healthcare inflation in the country is skyrocketing and is increasing at the rate of 17% to 20% annually. To cover this inflation, it’s important to look for the maximum available sum assured at the best possible rate.

Provide Complete & Correct Details

Provide accurate information regarding your health in the proposal form, as any sort of inaccurate or mismatched information can make the insurer reject your claim form.

Keep in Mind the Factors That Influence the Premium

A few factors that influence the premium of a health plan include the proposer’s life history, family health history, lifestyle, smoking habits, etc. These are taken in account before the premium amount is determined.

Check the Credibility of the Company

Do go through the history of the insurance company you are planning to buy the plan from. You should select a company based on the following parameters:

  • ICR: Incurred Claim Ratio or ICR, is the most important parameter to check for when comparing health insurance companies. Each year, it is calculated using the following formula:

When taking in account the ICR of a company, look for the average ICR of all companies on PolicyBazaar and go for the one which is closest to this average for a period of few years.

  • Customer Experience: You should always take heed to the mass opinion. Look for customer reviews online. If a large number of customers of an insurance company are unhappy, it may be because their customer support or after-sales service isn’t up to the mark.
  • Find out the Claim Process: Though health insurance claim process is pretty generic over providers, knowing the nitty-gritty of the process can help save a lot of hassle at the eleventh hour.

Best Health Insurance Policies in India By Top Health Insurance Companies

Note: Figures shown in the table above belong to the Financial Year 2017-18.

Types of Health Insurance Policies in India

Everyone needs to secure their own and their family’s health. With the increasing cost of healthcare in India, buying a health insurance policy has become almost mandatory for everyone. In today’s world of options, people have different choices when it comes to purchasing health insurance. There are various plans readily available in India to include every aspect of a medical emergency. Some popular types of policies are explained below:

  • Individual Health Insurance Policy: This type of health insurance provides coverage to an individual against certain illnesses, offering advantages like cashless hospitalisation, reimbursement, coverage of pre-hospitalisation and post-discharge expenses and various add-ons. The entire sum assured is available for only one individual.
  • Family Health Plan: With family health plan, you can include your family members under the umbrella of a single health cover. Family floater mediclaim policies offer a fixed sum assured to the family members, which can be availed either by one or all members of a family for one or more claims during the tenure of the policy. Family health plans come are more expensive than an individual health plan
  • Senior Citizen Health Insurance:Senior Citizen health insurance is designed particularly for anyone aged above 60 years and offers protection from health issues during old age. According to IRDAI, every health insurance firm must include people up to the age of 65 years in its plans.
  • Surgery & Critical Illness Insurance Plans:This plan is usually brought as a standalone policy or as a rider for the treatment of various critical illnesses, such as kidney failure, paralysis, cancer, heart attack etc. As the medication of such illnesses is expensive, the imbursement related to them is also very high. A critical illness is a serious, possibly terminal, disease and is pre-defined by the provider. Most critical illness policies provide a lump-sum benefit if the insured is diagnosed with one or more of the specified terminal conditions.
  • Maternity Health Insurance:Medical insurance companies today cover additional costs, including those incurred in both pre and post-natal care, child delivery (normal or caesarean), and sometimes include vaccination of newborn babies in a maternity plan. This insurance covers the newborn baby up to the validity of this policy. It also covers transportation fee for ferrying the mom-to-be to the nearest network hospital of her choice.
  • Personal Accident Cover:These personal accident plans are frequently offered as riders. They include hospitalisation and bear the medical outlay in the event of an accident. These are issued as fixed benefit policies, where a specified sum is paid on the occurrence of unforeseen events, such as accidents, which can result in death or disability of the person. However, the payout is not related to the sum assured.
  • Pre-Existing Disease Cover: After 2-4 years of policy inception, various policies begin considering pre-existing diseases, e.g. diabetes, hypertension, kidney failure, cancer etc., for claims. Pre-existing disease cover is offered for the policy-specified illness(es) that the insured had before purchasing the policy.
  • Preventive Healthcare: Undoubtedly, healthcare is very expensive and nobody wants to fall ill. So, now we have preventive health care that takes care of you before you fall sick. Preventive care, such as regular health check-ups, concession in X-ray fees, consultation fee etc., is offered by this policy. By offering various healthcare provisions, this plan aims at keeping you healthy. Preventive care is a medical care rendered not for a specific complaint but for prevention and early-detection of ailments.
  • Unit Linked Health Plan: Unit- Linked Health Plan (ULHP) has been introduced recently, which offers a unique combination of health insurance and investment. Apart from giving health protection, ULHPs also contribute in building a corpus that can be used to meet expenditures which are not covered by health insurance policies.

Among the ULHPs available in Indian market, ICICI Pru’s Health Saver, LIC’s Health Protection Plus, Birla Sunlife’s Saral Health and IndiaFirst’s Money Back Health Insurance Plan are a few big names. By opting for this plan, one can save a certain amount which can later be used to pay for the treatment of any pre-existing illnesses that are not covered by a normal health policy during the waiting period.

Which Health Insurance Policy You Should Buy?

Key Advantages & Features of Health Insurance Policies in India

The cost of healthcare in the modern days is increasing at a crazy rate while one’s earnings do not seem to match up that level. A patient looking forward to availing frequent health check-ups may no longer be able to bear the expenses associated. A comprehensive health insurance comes packed with features that can assist a person in managing expenses associated with medical emergencies and also with preventive healthcare. Understanding the following features can make purchasing a medical insurance policy easy:

    • Cashless Treatment: Every medical insurance organization has tie-ups with various nursing homes and hospitals across the country called ’empanelled hospitals’. If you are admitted to one of these, you don’t need to pay anything. You only need to mention your policy number and everything else will be taken care of by the hospital and your insurer. This type of plan is preferred because there is no stress of claim reimbursement and arranging documentation. However, if your expenses go beyond the sub-limits specified by the insurance cover or marked as “not covered” by the provider, then you will have to settle it directly with the hospital. Another important thing to remember is that cashless Mediclaim is not available if one gets treatment at a hospital which is not a part of the hospital network of the insurance provider.
    • Coverage of Pre and Post-Hospitalization expenses: This feature of a health insurance policy takes care of both pre and post-hospitalisation fee. It takes into account the costs incurred during a certain number of days both prior to and post hospitalization for a specified period from the date of discharge as part of the claim, provided the expenditures are related to the disease/sickness.
    • Ambulance Fee: The person is free from burden of transportation fee as it is borne by the insurer. This is an add-on benefit and you should opt for it while purchasing medical insurance.
    • No Claim Bonus: NCB (or No Claim Bonus) is a bonus provided to the insured if the no claim has been filed for any treatment in the previous policy year. The reward can be offered either as an increment in the sum assured or as a discount in the premium cost. You can avail this advantage on policy renewal.
    • Medical Check-Up: A Medical plan entitles the insured to receive regular medical check-ups. A free check-up is provided by few insurers, provided you have a good history of no-claim bonus.
    • Room Rent in Your Health Insurance Sub-limits: A health insurance policy may have various sub-limits associated with it; room rent is one of those sub-limits. General Insurance Companies provide you with a maximum coverage up to the sum assured. However, they can deliberately trim down their liability by introducing the sub-limit clause in the coverage for hospital room rent.

    A sub-limit on room rent in case of hospitalization works on per day basis. For instance, if your medical insurance policy covers your daily room rent up to a maximum of Rs. 3,000 and your room costs you Rs. 5,000 per day, then you will have to pay the remaining Rs. 2,000 out of your own pocket. Besides, room charges are directly associated with the type of room you are availing, i.e. a single room or on a sharing basis. Everything else is calculated proportionately.

    If the total cost incurred for your treatment at the hospital is Rs. 5,00,000, the table shown below illustrates the proportionate expenses that are expected to be borne by your insurer and you, respectively.

In this case, the total cost borne by you is Rs. 1,16,000 out of the total expense incurred, i.e. Rs. 5, 00,000. Thus, make sure you choose wisely if you want any such sub-limits in your health insurance policy.

  • Co-Payment: According to this feature, you can lower the cost of your health insurance. Medical insurance plans offer co-payment option that pre-defines the voluntary deductibles which have to be borne by the insured. So, in the event of a medical exigency, some amount is paid by the customer and the rest, by the provider. Co-payment is a cost-sharing requirement under a health policy, which states that the organization or the person will bear a certain share (in percentage) of the total admissible cost. However, the co-payment option does not have any effect on the sum assured. It allows you to reduce your premium to a certain extent (subject to the insurer and insurance policy).
  • Tax Benefits of Health Insurance: Health insurance policies entitle you to receive tax benefits under section 80D of Income Tax Act, 1961. The premium you pay towards insurance plans for yourself or your family members, get you a tax rebate, irrespective of whether they are dependent on you or not. The tax benefit offered, with respect to the premiums, is subject to the age of the person and there is a cap on the maximum benefit that can be availed. You can save a max up to Rs. 25, 000 in taxes a year unless your age is above 60 years. If your age is above 60 years, then this cap of maximum tax benefit increases to Rs. 30, 000.

If you are paying the insurance premiums for your parents as well as your own, then you are eligible for tax exemption up to Rs. 55, 000 a year under section 80D, provided your parents are senior citizens.
Health Insurance by Employer: More than 80% of employers in today’s age provide health coverage to their employees. The health insurance offered by an employer covers hospitalization expenses of the employee and his/her family including spouse, children or parents. It is a wise decision to opt for the mediclaim offered by your company as you need not pay any premium. This comes under a group health insurance policy and the premium is paid by the employer, based on the group size and the opted benefits.

However, it might be that you feel your employer’s medicliam policy is insufficient to fulfil your medical needs. Also, what if you change your job? You will no longer be a member of this plan once you leave the organisation. Hereby Hence, it is necessary to understand the policy terms thoroughly. You can communicate with the HR department regarding what’s covered and what’s not in your health insurance. Mostly, we have observed that employees are more than satisfied with their company providing health insurance, only to find out later that the plan is not sufficient. So, before it’s too late, make your call!
Third Party Administrators: The TPA concept is the brainchild of Insurance Regulatory and Development Authority of India (IRDA), to assist both the insured and the insurer. While it benefits the insurer by reducing their overheads or administrative costs, fake claims, and claim ratios, the insured, too, enjoy improved and fast insurance services.

TPAs are an important players in the sector of health insurance. They have the capacity to handle all or a portion of the claims related to mediclaim insurance. They have tie-ups with the health insurers or self-insuring companies to manage services such as premium collection, enrollment, claim settlement and other administrative services. Often, hospitals and insurance companies organizations outsource health and insurance-related responsibilities to lower their burden. Similarly, an employer may prefer to provide claim resolution of the group health insurance policy via a TPA to manage various aspects of an employer-funded healthcare policy.

Factors to Consider Before Purchasing Best Medical Insurance Plans in India

There are few factors that you should consider closely to make the right decision.

  • Caps and sub-limits: Caps and sub-limits are the thresholds set on various policy-covered expenses. If a health policy has impositions of co-payments, sub-limits, and other caps, this would mean that there will be a policy-stated coverage offered for various expenses. At times, co-pay clause and caps help in reducing the premium of the plan. These, however, would alter the benefits in the long run. To make the most of your health insurance policy, you must understand these factors before you pay for a plan.
  • Claim settlement record: This is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. Thus, you can ensure that your claims would not be wrongly withheld. Always ask for the company’s claim settlement ratio before purchasing their health plans and save yourself from unnecessary harassment in future.
  • Scope of cover: Don’t buy a plan by just comparing health insurance premium. Less cost does not necessarily mean a good plan. On the contrary, such a plan might not consider your needs properly. Closely look at what the plan includes. Buying a comprehensive plan is a better option comes to your rescue when you need it the most.
  • Renewability: It is important to see how many years the plan proposes to protect you. It makes no sense if you are covered by a plan during your youth only to be left without a safeguard when you need it the most – during your old age. Mediclaim policies are usually annual contracts. Once the policy term ends, in the order to continue the insurance coverage, the insured has to pay a premium. This recurring process is called renewal. The policy should be renewed continuously, because if there is a break, then, the person will lose the benefits of insurance.
  • Cashless Hospital Network: Check if a hospital around you is included by the company you are considering to buy the plan from. You and your family won’t be required to run around collecting documents and filling reimbursements. The provider or its Third Party Administrator should have a tie-up with a range of hospitals. The insured can get admitted in any of these nursing homes without paying anything from the pocket. However, cashless mediclaim resolution is subject to limits and sub-limits, which, in turn, are subject to the sum assured of the policy.
  • Premium Loading: Premium Loading refers to the increase in standard premium applicable when the insurer perceives a person to be more at risk (of claiming the insurance) in comparison to others. It is strongly recommended that you check the terms and conditions pertaining to premium loading. This will save you from paying an incremented premium after making a claim. This aspect, though ignored in the beginning, usually becomes a bone of discontentment later. The best practice would be to verify the cost fluctuation data of the plan for the previous 5 years at the very least.
  • Internal Team: Check for plans from firms who have a dedicated internal team for handling Mediclaim. This expedites the Mediclaim resolution process. Most of the players use a third-party administrator to process the claims and do the paperwork. Even though most of these Administrators provide great services, the fact that they are a third-party slows down the process. There are certain rules and regulations to be followed when an administrator processes a claim before it is handed over to the insurance company. These affect the turnaround time.
  • Floater (family) Size: Everyone has a different family size, so you should always look for the family size allowed under the plan before purchasing it. If you are a person in your late 20s and your parents are in their 40s, 50s or 60s, then purchasing insurance only for yourself does make sense. Alternatively, if you are married with or without kids and have dependent parents, parents-in-law, siblings etc., then a family health plan is best for you. Checking the cost, family size covered, critical illnesses or other benefit will ensure that you are able to purchase the plan you need.
  • Health Insurance Portability: It is wise to choose a health insurance company that offers health insurance portability. Earlier, policyholders had to stick to a policy just to retain the advantage. Now, you are allowed to switch from one insurance company to another without losing the waiting period advantages earned in your current policy. Moreover, with insurance landscape changing so regularly, insurance companies regularly come up with better policies and it may make sense to opt for health insurance policy portability. Although health insurance portability is free, some companies may charge you a certain fee if you are to port out of their plans to those of some other players. Therefore, make sure you do not pay any charges for medical insurance portability. Health insurance portability is a good thing to check when you are finding the best health policy or mediclaim.
  • Restore Benefit: With ‘restore benefit’ facility in your health care plan, you can restore your basic sum assured in case you have already spent the same or the multiplier advantage during your policy tenure. Mostly, the benefit cannot be obtained on the same ailment if you have exhausted the existing sum limit.

Restoration assistance proves to be helpful for a family floater health plan, where if the entire sum assured is used in the treatment of only a single family member, the other members are not left uncovered. In such a case, the other family members can avail policy coverage for the illness other than the one for which the expenses have already been compensated by the insurer.

Well, while finalising your health insurance plan, you should consider other influencing factors such as waiting period, sub-limit, claim settlement procedures etc. You can replace restore benefit with a super top-up plan at an affordable price. Moreover, top-up plans are more comprehensive since they comes with less or no restrictions.
Top up Plans: With the rise of medical inflation, having a large medical cover is prudent. But, not all can afford it due to the high premium. This is where a top-up plan comes into the picture. A top up plan reduces the deductibles cost i.e. the portion of claim you pay willingly for the damages before the insurer compensates the rest or up to the sum assured. With a top up policy, you don’t pay until a hospital breaks its defined limit. A top up plan is considered far cheaper than a standalone medical policy.

For instance, if the medical bill is Rs. 6 lakhs with a deductible of Rs. 2 lakhs, you are required to pay only the latter amount and the remaining 4 lakhs will be paid by the insurer. But, you can utilise your health policy to pay the liable amount. Again, the blending of a top-up plan with a medical cover is helpful as the premium you pay is much more affordable than the single plan. For example, if you pay 6,500 as a premium for Rs. 5 lakh regular cover, a top up coverage of Rs. 15 lakh will entail to an additional premium of 5,000, which is anyhow cheaper than a separate policy of identical cover.

  • Waiting Period: As per the insurance norms, every insured must serve a defined waiting period for any pre-existing illness. It is usually a 30-day period from the day your health insurance policy is initiated. If any claim falls during the waiting period, the insurer has the right to reject the claim for any hospitalisation, except in the case of an emergency. A hospitalisation that arises out of an accident can be registered as a claim and the insurer will compensate the hospitalisation cost. However, the insured is not required to serve the waiting period for subsequent years.
  • Compare Health Insurance Online with Policybazaar

    Policybazaar has made the process of comparing & buying a health insurance policy easier in comparison to earlier days. One has easy access to the complete details of almost all the health plans available in the Indian insurance market at a competitive price.

    You have the option of comparing health insurance policies from top health insurers on our website and buy the best plan. Or, let us know your basic requirements and we will find the best-suited health insurance policies for you. You can, then, compare health insurance quotes side-by-side, based on parameters like health insurance cost, add-on riders etc., and choose the best health insurance plan for yourself and/or your family members.

    Policybazaar helps you sieve through numerous mediclaim and health insurance policies and zero down on the one that measures up to your needs. As Policybazaar is an unbiased portal, the first priority is to ensure customer satisfaction. The first step in this direction is the post-sales services which are extended to the customers at the time of claim as well.

    Also, instead of going to different insurance websites and accessing the plan details one by one, Policybazaar can provide an insurance-seeker with the option of comparing various health insurance policies on a single page, including their quotes. The entire process is smooth and hassle-free.

    Health Insurance Portability Explained

    You do not have to stick to your current insurer any longer if you do not want to since IRDA now allows you to change your current insurer without losing any of the existing benefits. Previously, if you changed your insurer, then you had to compromise on the benefits, viz. coverage for any pre-existing disease offered by your existing medical insurance policy.

    According to the new rules, IRDA allows you to switch from one insurer to another while the new insurer will have to consider the credits you gained from your previous insurer, where credits refer to the waiting period under pre-existing conditions. The same applies if you switch from one plan to another with the same insurance company.

    What you can do

    • Switch from one health insurance company to another
    • Any family floater or individual policy can be switched from/to.
    • Avail insurance cover by your new insurer up to the sum assured by the previous policy.
    • Both the insurers should mutually complete the formalities as per the IRDA timeline.

    Criteria to meet

    • A policy can be switched only at the time of renewal.
    • With the new policy, the terms and conditions, including the premium are at the discretion of the new insurer.
    • Submit a formal shifting request to your current insurer at least 45 days before the due date of the renewal.
    • Make sure you specify the name of the new insurer you are willing to switch to.
    • There should not be any break between policy renewals.

    Health Insurance Inclusions

    The coverage offered by a health insurance policy is subject to the type of policy and the insurance provider. An ideal policy is customizable and suites your requirements in the best way possible. Following are some common health insurance policy inclusions:

    • In-patient hospitalization expenses
      • Donor expenses, in case of organ transplantation
      • During injuries requiring overnight hospitalization
    • Pre-existing illnesses or diseases
    • Pre and post hospitalization
    • Ambulance charges
    • Maternity or newborn
    • Health check-ups
    • Daycare procedures
    • Treatment availed at home or domiciliary hospitalization

    Health Insurance Exclusions

    Coverage offered by health insurance policies varies with the insurer; however, certain points are not covered by health policies, and fall under the category of policy exclusions. Following are common health insurance policy exclusions:

    • Unless an accidental emergency, no coverage or reimbursement offered with the waiting period of the policy, usually initial 30 days.
    • Coverage of critical illnesses and pre-existing diseases is subject to a waiting period of 2 to 4 years.
    • Clear exclusion of expenses incurred for maternity/newborn unless a maternity rider has been added on.
    • Injuries caused by war/terrorism/ nuclear activity/suicide attempt.
    • Terminal illnesses, AIDS, and other diseases of similar nature.
    • Cosmetic/plastic surgery, replacement of hormones, sex change and more.
    • Dental or eye surgery.
    • Non-allopathic diseases’ treatment.
    • Bed rest/hospitalization and rehabilitation, common illnesses etc.
    • Treatment/diagnostic tests, post-care procedures.
    • Treatment in abroad or by an under-qualified medical professional.

    Note: It is recommended to explore each plan to ensure maximum coverage.

    Health Insurance Premium Calculator

    Health insurance policies provides an assurance that you will get the required medical assistance whenever you need it. You pay a fixed amount of money in exchange for that at certain intervals to ensure that the policy remains in force. Did you ever think how this premium is calculated? There are multiple certain factors that affect your health insurance premium, including some provider-specific terms, such as the medical background of your family, your personal medical history and so forth.

    Based on that, you might want to calculate your premium to figure out how much you would have to pay for the policy. At PolicyBazaar, we allow you to choose one of the best medical plans online, by comparing health plans offered by the most reliable medical insurance players in the market. Keeping your affordability in view, we hand you the health insurance premium calculator to calculate your premium and purchase the plan that suits your needs in the best possible way.

    Health Insurance Eligibility Criteria

    Health insurance policy is mandatory for almost everyone, especially for those who have dependents and/or families since they certainly do not want them to have financial strains. Buying a medical insurance policy ensures that one’s health is secured and medical expenses are covered across a wide network of hospitals in India. One can opt for the best health insurance policy with extended coverage on the following two bases:

    The following criteria must be fulfilled without failure:

    • Entry age for Adults: 18 to 65 years (70 and above, based on the plan and insurer)
    • Entry age for Children: 90 days to 18 years.
    • Policy renewability: Lifelong and subject to medical clearance

    Important Points to Remember while buying Health Insurance

    Buying insurance is not child’s play and when it comes to buying a health insurance policy, you need to be pretty sure about certain points. A few of such key points are listed below:

    • What covers are you offered and who offers the covers?
    • Are add-on features available for later use?
    • Are individual and/or family floater options available?
    • What is the Sum Assured?
    • What are Sum-limits applicable?
    • Is/are there any discount(s) offered?
    • Are there any voluntary/co-payment deductible options?
    • Are policy exclusions mentioned in the documents?
    • What is the claim process like? – Reimbursement, cashless benefit, immediate claim settlement?
    • Is there any medical check-up required before proposal acceptance?

    Health Insurance Claim Procedures

    Medical plans come with additional benefits of cashless treatment and expense reimbursement by the insurer. One can file a claim against an event that is covered by the insurance policy. Following are two claim processes:

    Expense Reimbursement:

    Health insurance policies provide the insured with the benefit of getting their medical expenses reimbursed by the insurer, based on the policy terms documented. The cost of various hospital charges such as bed charges, medicines, lab tests, surgeon’s fees etc. are paid back to the insured at the time of claim. The insured pays the (hospital) expenses, but gets reimbursed by the insurance company.

    Cashless Treatment:

    Insurance companies provide policyholders with a wide network of hospitals to get medical treatment without having to make upfront payments. No payment is required to be done by the insured, since the clause involves a mutual agreement between both the parties, i.e. the insurer and hospital. In contrast, availing cashless benefit requires TPA approval.

    The insured can also show the insurer-issued health card at the particular hospital as a proof of medical insurance cover along with a valid government ID. Following cases considered for cashless treatment:

    Planned Hospitalization:

    In case of planned hospitalization, to avail health insurance benefit the policyholder needs to have TPA approval in advance along with other mandatory documents. Fill the pre-authorization form at the hospital signed by the treating doctor(s).

    Emergency Hospitalization:

    Show the health card issued by the insurer at the hospital along with the appropriately-filled pre-authorization form to get TPA approval for emergency hospitalization. If you fail to get TPA approval, get the expenses reimbursed later. The policyholder might have to show itemized bill, proof of medical expenses, discharge bill etc., as the proof of the treatment availed to avail claim reimbursement.

    Documents Required for Health Insurance Claim Reimbursement

    In the event of hospitalization, the policyholder needs to submit certain documents as mentioned below:

    • Discharge card issued by the hospital.
    • In-patient hospitalization bills signed by 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’ consultation.
    • Copies of the Insurance policy from the previous year and the current year/copy of ID Card of TPA.
    • Any other document(s) asked by the TPA.

    Top 10 Best Health Insurance Companies in India

    In order to help you with the best and safest buying experience, we’ve compiled a list of top 10 best health insurance companies in India. This list is prepared based on incurred claim ratio (ICR) and the overall financial standings of these companies. With this list, you can easily compare health insurance companies in India and pick the one that features the best health insurance plans at affordable premium rates. Let’s have a look at the list below:

    • Star Health Insurance
    • HDFC Ergo Health Insurance
    • Cigna TTK Health Insurance
    • Apollo Munich Health Insurance
    • Bajaj Allianz Health Insurance
    • Bharti AXA Health Insurance
    • Cholamandalam MS Health Insurance
    • Future Generali Health Insurance
    • SBI Health Insurance
    • Religare Health Insurance

    Lets discuss about these Health Insurance Providers in detail

    Star Health Insurancee

    India’s first standalone health insurance company, Star Health and Allied Insurance Co Ltd. was founded in the year 2006. The initial business focus was on Overseas Medicliam Policy, Health Insurance, and Personal Accident Plan but the vision has now expanded. Since then, the company has been trying to deliver innovative insurance solutions to its customers. Today, Star Health is counted among the best health insurers in India. It has more than 340 branches around the world and more than 8400 network hospitals across the country to offer cashless facilities to its policyholders. Moreover, the company settled around 3,78,710 claims in the year 2016-17. For its excellent performance, Hindustan MaRs Survey rated Star Health as the company with the best claim settlement.

    Apollo Munich Health Insurance

    A joint venture between Apollo Hospitals Group, India’s premier private hospitals company and Munich Health, the medical insurance arm of Munich Re, the German reinsurance major, Apollo Munich Insurance is a focused insurance services provider in India providing a range of health insurance plans. The health insurance company merges the corporate healthcare competencies of Apollo Hospitals Group with the global healthcare insurance and reinsurance expertise of Munich Health.

    The company has won numerous accolades over the years and has recently been honoured with awards like the Infosec Maestros Awards – 100 Top CISO 2015 for the second time in a row and Health Insurance Provider Award by Money Today (of India Today Group) and Financial Planning Corporation (India) Pvt. Ltd. (FPCIL) in 2015.

    Apollo Munich Insurance focuses on being a trusted leader in the health insurance space with its innovative solutions. Their mission is to regularly introduce pioneering health insurance and wellness solutions that meet customer needs. The company also intends to build an organisation on the principles of transparency, trust and integrity that can constantly deliver on various commitments to all stakeholders.

    Bajaj Allianz Health Insurance

    A joint venture of Bajaj Finserv Limited, a comprehensive financial services company based out of India and Allianz SE, the global financial services major based out of Munich, Germany, Bajaj Allianz General Insurance Company focuses on the general insurance space in the country, including medical insurance. The joint venture seeks to leverage successfully Bajaj Finserv’s in-depth understanding of the local Indian market and its extensive distribution network across the country with the vast global experience of the Allianz Group. Bajaj Finserv Limited holds a 74% stake in the general insurance company while Allianz holds the remainder.

    The company has been one of the outperformers in the space as testified by it receiving the iAAA rating from ICRA for the 10 th year in a row. The rating highlights the company’s highest claims paying ability and its strong position in the general insurance industry. Most recently, the company was conferred the Economic Times; Best Corporate Brand Award as an outcome of the newspaper’s Best Brands Survey for 2016. Bajaj Allianz General Insurance was also acknowledged as the Most Admired Health Insurance Company of 2015 by Pharma Leaders Power Brands Awards. In addition, Indian Market Research Bureau (IMRB) ranked it second among the top health insurance brands in the country on the basis of customer loyalty based on a syndicated survey.

    Bajaj Allianz General Insurance was also recently awarded a Certificate of Appreciation by Rajasthan High Court, and Punjab and Haryana High Court for excellence in the field of claim servicing for motor third party claims. Other awards in 2015 included The Silicon Valley Business Award 2015 under the categories of Best Financial App and Best Overall App for Insurance Wallet product. In addition, it won the Claims Award Asia 2015 for the third year running, under the categories of Insurer Claims Team of the Year for Claim Settlement during the Jammu and Kashmir floods, and Claims Innovation of the Year for launching pioneering claim settlement practices for health insurance claims.

    Bajaj Allianz General Insurance intends to be the first choice in insurance for Indians. It has a mission to be a responsible and customer focused market leader that understands and meets the insurance needs of the market through affordable, value for money products.

    Bharti AXA Health Insurance

    A joint venture of Bharti Enterprises, one of Indian’s leading business groups, and AXA, the France-based international insurance solutions company, Bharti AXA General Insurance is a provider of various general insurance solutions in addition to health insurance. Bharti Enterprises owns the majority 74% stake while AXA holds the remainder in the company. Bharti AXA General Insurance started operations in August 2008 and is headquartered in Bangalore and has 59 branches across India.

    The company has received numerous awards for innovation and performance over the years, among other categories. In 2014, it received the Asia Insurance Industry award for its initiative to reach the under penetrated smaller towns and cities where the physical branch network was limited. In addition, it received the honour of being the best insurance company in the private general insurance sector from the World HRD Congress at the 2014 BFSI Awards.

    Bharti AXA General Insurance focuses on serving all its stakeholders including its customers, business partners, employees, shareholders and the overall society. It uses its fundamental values of professionalism, integrity, team work, innovation and pragmatism to realign industry standards through empathetic service that helps drive customers towards its comprehensive and innovative insurance solutions.

    Cholamandalam MS Health Insurance

    Cholamandalam MS General Insurance Company Limited, established in 2001, was set up by the India-based Murugappa Group, a multi-business conglomerate, and the Japan-based Mitsui Sumitomo Insurance Group as a joint venture to address the general insurance market in India. The company provides both individual and corporate insurance solutions through its 105 branches and 9000 plus agents in the country.

    Also known as Chola MS, the company was awarded the best insurance company across Asia as ‘Health Insurer Claims Team’ at the 2013 Claims Asia Awards. It also received the ‘Innovation Leader Award’ for 2012 from Fintelekt and was adjudged the best insurance company for ‘In time Claims Settlement for the year 2011-12’ in the Rashtriya Swasthya Bima Yojana (RSBY) scheme operated under the aegis of the Ministry of Labour and Employment, Government of India.

    Cholamandalam MS has a singular focus on value creation and hopes to become the most respected general insurance company in India. It uses a T3 strategy of Trust, Transparency and Technology to deliver innovative risk-free medical insurance solutions for all its customers.

    Cigna TTK Health Insurance

    Established as a joint venture between TTK Group, the Indian conglomerate and Cigna Corporation, the US based international medical insurance solutions company, CignaTTK Health Insurance Company Limited focuses on providing health policy solutions to the Indian market. The health insurance company was launched in February 2014 and has ramped up its operations to create a pan India presence across 15 cities within a short while. The company is headquartered in Mumbai.

    The company was recently awarded the Economic Times’ ‘Best Promising Brands 2015’ award. CignaTTK has also shown its focus on good health and wellness and has served as the official health insurance partner for the popular Delhi and Mumbai marathons.

    CignaTTK Health Insurance Company’s mission is to improve the health, well-being and sense of security of the people. Its service philosophy is to make customer experiences easy and reliable so that customers always receive personalised and empathetic services.

    Future Generali Health Insurance

    A joint venture of the Indian conglomerate Future Group, and the Generali Group, one of the world’s largest international insurance companies, Future Generali India Insurance Company has a pan India presence through its 137 branches. The company provides a range of insurance solutions and intends to exploit the expansive network and local experience of the Future Group and the in-depth insurance expertise of Generali Group.

    It’s solutions include both life insurance and general insurance, with the latter providing solutions for motor insurance, travel insurance, home insurance besides a host of health insurance policies. The company has also moved into the rural and commercial insurance space and provides a range of products that take care of the specific needs of these sectors.

    HDFC Ergo Health Insurance

    A 74:26 joint venture between HDFC Limited, India’s premier housing finance institution, and ERGO International AG, the primary insurance entity of global reinsurance and insurance major, Munich Re Group, HDFC ERGO General Insurance Company provides a range of solutions for the general insurance market in India. The company has been expanding its network across the country at a rapid pace and currently has 109 branches across 89 cities. The company has an employee base of over 1900 people.

    HDFC ERGO General Insurance has been awarded the ‘iAAA’ rating by ICRA that indicates its highest claim paying ability. The company has also received the CMS Outstanding Affiliate World-Class Service Award for 2015 from Chubb Multinational Solutions in addition to ICAI Award for Excellence in Financial Reporting in the Annual Report for the financial year 2014-15 under the insurance sector category.

    SBI Health Insurance

    SBI Health Insurance operated as a joint venture between State Bank of India and Insurance Australia Group. The company offers a range of health plans for both individuals and groups. Serving a large share of insurance customers in India, it has gained the trust of its existing as well as prospective customers. Over these years, the company has successfully established its feet in the vast insurance market of India. The health insurance products of SBI allow its customers to manage their financial expenses. Based on the health cover required, its customer can opt for plans with sum assured up to Rs. 50, 000 to Rs. 5, 00,000.

    Religare Health Insurance

    Religare Health Insurance, founded by Religare Enterprise Limited along with Corporation Bank and Union Bank of India, operates as a standalone insurance company. The company, during its service years, has successfully managed to be one amongst the most popular medical insurance companies in India.

    With a wide network of over 4, 100 hospitals across the country, the company is promoted by the founders of India’s leading private hospital chain, Fortis Hospitals. The insurance claims are directly entertained by the company executives and there is no third-party involved in the claim processing. Based on the coverage offered by individual health plans, customers can opt for riders for protection enhancement.

    List of Health Insurance Companies in India

    India has a huge insurance market that comprises of many life and general insurance companies. These companies offer different insurance plans, targeting customers with specific needs in terms of protection. The following is a table that segregates some renowned private and public sector insurers in India.

    IFFCO-Tokio General Insurance
    L&T General Insurance
    Liberty Videocon General Insurance
    Max Bupa Health General Insurance
    Raheja QBE Health Insurance
    Reliance General Insurance
    Religare Health Insurance Company
    Royal Sundaram General Insurance
    SBI General Insurance
    Star Health and Allied Insurance
    Tata AIG Health Insurance
    Apollo Munich Health Insurance
    Cigna TTK Health Insurance
    Bharti AXA General Insurance
    Cholamandalam MS General Insurance
    HDFC ERGO General Insurance
    Future Generali India Insurance
    Bajaj Allianz General Insurance

    United India Health Insurance
    National Insurance
    New India Assurance
    Oriental Insurance

    Universal Sompo General Insurance

    List of Government Health Insurance Schemes in India

    Pradhan Mantri Suraksha Bima Yojana (PMSBY)

    It is a government-of-India-backed health insurance scheme, which offers coverage against personal accident resulting in accidental disabilities, or death on account of an accident. It is offered for a period of one year and requires annual renewals. The policy is available with all public sector insurance companies that deal in the general insurance sub-domain. All private sector insurers are open to selling the scheme on a similar set of terms in collaboration with various banks upon necessary approval. Anyone within the age group of 18 to 70 years, with a savings account in any of the participating banks can benefits from the scheme while the AADHAR would be the prime KYC for the scheme and bank account.

    Rashtriya Swasthya Bima Yojana (RSBY)

    A government-run health insurance scheme for poor people in India, it provides them with the cashless facility at various public and private hospitals across the country. Enrolled in 2008, the scheme already has over 36 million families (as on February 2014) enrolled across 25 Indian states. The operations under this plan started under the Ministry of Labor and Employment and were transferred to the Ministry of Health and Family Welfare on April 1, 2015. As this plan works for BPL (Below Poverty Line) families, they get a smart-card that is biometric-enabled to become eligible for inpatient medical care worth Rs. 30, 000 per year at an empanelled hospital. The coverage for pre-existing diseases is there right from day one for parents and up to three children.

    Universal Health Insurance Scheme (UHIS)

    Aimed at improving the health standards of people at or below the poverty line, four of the public sector general insurers implemented UHIS in India. Under this scheme, the eligible families can get reimbursement for medical expenses up to Rs. 30, 000 and accidental death benefit of Rs. 25, 000 to the breadwinner in the family. The loss of income of the family is also compensated with Rs. 50 per day up to 15 days in a month. The scheme was revised later, thereby increasing the premium subsidy from Rs. 100 to Rs. 200 for an individual and Rs. 300 for a family of 5 members and Rs. 400 for a family of 7 members.

    Aam Aadmi Bima Yojana (AABY)

    A government-of-India-run scheme for people from rural regions of India, who are landless, was launched in October 2007 and covers the prime earner in the family with the benefits. An annual premium of Rs. 200 is payable by the family, which is divided between the Central Government and State Government, while the age of the insured lies between 18 and 59 years. Below are the benefits

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