Indemnity Plan: These are traditional health insurance policies that protect the insured against unexpected and sudden medical expenses by reimbursing the hospitalization charges incurred by the insured up to the limit of the Sum Insured. These plans can be taken on an individual basis or family floater basis. 

In a family floater policy, the entire family is covered on the payment of a single premium. The sum insured called, “floater Sum Insured”, covers the entire family under a single umbrella cover. The floater Sum Insured can be used in case of multiple hospitalizations of all members of the family.

Super Top Up Plan: In a Super Top Up Plan, the insured will pay health insurance deductible before the insurance company picks up the remainder of your bill. The insured is free to choose this threshold value, called “deductible” before any hospitalisation claim up to the limit of Sum Insured shall become payable. As a portion of the risk, as “deductible”, is borne by the insured himself/ herself, these plans are cheaper when compared to regular indemnity health insurance policies.

Benefit Plan: In these plans, a pre-defined fixed benefit becomes payable on a pre-defined health insurance risk viz. 24-hour hospitalisation, diagnosis of critical illness, accidental injuries etc. E.g. Rs. 1,000 becomes payable on 24-hour hospitalisation for each day insured is hospitalised for a maximum of 30 days in a policy year.

Comprehensive health insurance plans come packed with features to assist a person in managing expenses associated with medical emergencies.

Following are the key health insurance benefits that one can consider:

Cashless Medical Treatment: Every medical insurance company has tie-ups with various hospitals across the country called 'empanelled hospitals/network hospitals'. In this network of hospitals, you can avail cashless medical treatment.

Coverage of Pre and Post-Hospitalization Expenses: This feature of a health insurance policy takes care of expenses incurred on both pre and post-hospitalisation. It takes into account the costs incurred during a certain number of days both before and post-hospitalization as part of the claim, provided the expenditures are related to the covered disease/illness.

Ambulance Fee: Transportation fees incurred by the insured is covered by the insurer as per policy.

No Claim Bonus: NCB (or No Claim Bonus) is a bonus provided to the insured if no claim is filed for any treatment in the previous policy year. The reward is offered as an increment in the sum assured.

Medical Check-Up Facility: Medical insurance plans offer the insured to receive regular medical check-ups. A free check-up facility is provided by some insurers, or you can get it as an add-on benefit.

Health Insurance Tax Benefit: You can save up to a maximum of Rs. 25,000 in a financial year for yourself, your family and dependents below the age of 60 years against the premium paid towards health insurance. If any of your age is above 60 years, then this benefit increases to Rs. 50,000.

If you are paying the medical insurance premium for your parents, then you are eligible for tax exemption up to Rs. 50, 000 in a year under section 80D, provided your parents are senior citizens.

*Tax benefit is subject to changes in tax laws

Pre-Existing Disease Cover:  Health insurance plans consider pre-existing diseases, e.g. diabetes, hypertension, etc., for claims after an initial waiting period as per policy guidelines.

Preventive Healthcare: Nowadays, we have preventive health care check-ups that take care of you before you fall sick. Preventive care, such as regular health check-ups, wellness benefits, consultation fees, etc., are offered under some health insurance plans.

The eligibility criteria for health insurance depends on the age of the customer, pre-existing illnesses, current medical conditions, etc. A medical test is conducted by the health insurance companies to ascertain the medical condition of the applicant.

Age Criteria- Entry age for adults and children is based on the plan and insurer.

Pre-medical Screening- A pre-medical screening is conducted by the health insurance companies to ascertain the medical condition of the applicant above a certain age as per the insurer. The criterion for individual and family floater health plans may vary as per the policy terms and conditions.

Pre-existing Diseases- When buying the policy, you need to disclose the health diseases that you have or any pre-existing illness that you or your family members have. Do not keep it a secret as it may cause problems at the time of claim settlement. It can even lead to the rejection of your claims.

Select the Appropriate Sum Assured: You and your family must be adequately covered. The Sum Insured requirement for a family of 4 members in a metropolitan city would be higher than an individual residing in a rural area. 

Provide complete & correct details: Insurance is based on the principle of utmost good faith implying it is the onus of the insured to provide accurate information regarding health status in the proposal form. The insurance company has the right to reject any claim if it finds information/ medical history submitted at the time of proposal is inaccurate.

Keep in mind the factors that influence the premium: A few factors that influence the premium of a health insurance plan include the proposer’s age, medical history, family health history, lifestyle, Sum Insured chosen, add-ons chosen etc. These factors are taken into account before the premium amount is determined.

I am healthy, and I don't need Health Insurance

Despite taking good care of your health, there are numerous unforeseen circumstances like seasonal illnesses, dengue, malaria, or an accident that can hit anyone at any time. Nowadays, hospitalization expenses are not easy to pay off. Even 2-days of hospitalization expenses would cost you somewhere between INR 60,000 to INR 1 lakh and even more (depending on the type of illness) whereas, an insurance premium usually would be a fraction of a cost that one would incur in event of a hospitalisation.  

My Health Insurance will cover all the medical expenses

All health insurance plans come with their own set of exclusions and limitations. It is required that you check all the policy details and the coverage that is mentioned in the plan. The insurer will only compensate for the expenses that are covered in the policy and up to the specified limit.

Declaration of Pre-existing Diseases

It is essential to declare all the pre-existing diseases in the proposal form. One must mention pre-existing diseases clearly before buying an online health insurance policy. Inadequate information can lead to the rejection of the claim and can cost more than the expected amount.

Medical Insurance will only cover Hospitalization Expenses

These days most health insurance plans cover medical expenses for hospitalization as well as medical expenses incurred in Outpatient Treatment care. Most insurers these days’ cover listed day-care procedures as well, where due to advancement in medicine it is not required to be hospitalized for 24-hours

I am covered under a Group or Corporate Health Insurance Plan

Most people rely on the health insurance plan that is provided by their employer. It is important to know that a group health insurance policy comes with a set of limitations. It may not offer coverage to your family members, the sum assured may not be sufficient, it may not cover critical illnesses. Also, getting health insurance coverage after retirement or losing a job can prove to be an expensive affair.