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Health Insurance is a commitment/ indemnity by the Insurance Company in which an Insured person is taken care of Medical expenses up to the Sum Insured opted, against an agreed premium amount. The Insured person can avail cashless treatment at Network Hospitals of the Insurance provider and also at any hospital (Subject to meeting the criteria fixed by Insurer) against reimbursement of the claim. Therefore, opting for a health Insurance cover keeps us worry-free from managing health care cost which at times are huge and becomes difficult to manage. Add on coverages e.g. PA (Personal Accident) may be opted against an additional premium to the base policy.
Health Insurance plans have enhanced offerings to cover a wide spectrum of requirements, like a family health plan offers complete cover to all members of a family under a single umbrella.
Medical Bills : Coverage against medicinal expenses incurred, including pre and post hospitalization
Pre-existing Diseases : Coverage for any pre-existing disease is provided to you after a certain waiting period.
Claim Reimbursement : Coverage for expenses incurred for hospitalization due to a medical
Tax Rebate : Annual premium paid for health coverage are subject to tax exemption u/s 80D of ITA, 1961. Tax exemption ranges from Rs. 25,000 to Rs. 75,000.
Other Benefits : As an innovative feature, OPD expenses are now covered under few Insurer plans and don’t require hospitalization for minimum 24 hours for claim reimbursement. Standalone OPD plans are also available in the market..
The following Health Insurance Plan are majorly opted to meet the specific requirement of any Individual:
Indemnity based health insurance policies generally pay for the actual hospitalisation expenses incurred during the treatment up to the policy sum insured limit. It means that the insurer will pay for the treatment cost within the sum insured limit as offered under the policy. Individuals aged between 18 to 65 years
This policy provides medical expenses incurred during period post hospitalisation. The category of the age bracket considered is 61 to 80 Years. Expenses related to certain Day care procedures are also covered by the policy.
This policy covers life threatening disease like tumour, permanent paralysis etc. It provides comprehensive health insurance including hospitalisation expenses. Hospitalisation. In this policy hospitalisation is required to avail policy benefits, Diagnosis is enough to get the Lump Sum payment.
Disease specific plan caters to a particular disease. People do sometimes prefer a disease specific plan. It eliminates the long waiting time that regular insurance takes to pay for the given health conditions. The insurance covers the particular disease at any stage whether it is at the beginning of the critical stage.
As the Name suggests, the hospital daily cash plan is a health plan which provides a fixed allowance for each day you are hospitalised. The amount paid is fixed at the time of policy issuance. The plan is a defined benefit plan in the sense that it pays a fixed amount irrespective of the actual amount of expense.
The insurance benefits provided under the Super Top-up plans are similar to Top up plans. Both are used to provide higher insurance coverage while keeping the total premium low. The major difference lies in the fact that a super top up plan offers coverages for complete hospitalisation bills above the threshold limit, whereas a top up policy only covers a single hospitalisation claims above the threshold limit (i.e. Deductible).
Two special COVID health insurance policies namely, Corona Rakshak policy and Corona Kavach policy also introduced that provide lump sum payment upon diagnosis and also pay for the cost of consumable items like PPE Kits, Masks, Gloves, etc.
Almost all the health insurance plans include Coronavirus treatment cover. As per the IRDAI guidelines, insurers have also launched COVID-19 specific
Two special COVID health insurance policies namely, Corona Rakshak policy and Corona Kavach policy also introduced that provide lump sum payment upon diagnosis and also pay for the cost of consumable items like PPE Kits, Masks, Gloves, etc.
Under health insurance plans, you can make a claim in two ways, i.e. cashless claim and a reimbursement claim. A cashless claim is when you do not pay anything at the hospital for the treatment availed. Whereas in reimbursement claim, you will be first required to pay for the treatment taken, at the hospital, and the insurance company pays to you later. The claim processes for them are mentioned below:
To make a cashless claim, the following steps need to be followed:
Immediately inform the insurance company/ Broker in the event of hospitalisation at a network hospital of your choice. Generally, you are required to inform the insurance company/broker within 24 hours of hospitalisation in case of emergency, whereas 48 hours prior in case of planned hospitalisation.
You will be required to share health insurance details at the network hospital. Show your Health ID card or your policy number with a valid photo ID proof at the desk of the hospital.
Once the identification has been done, the network hospital will send the pre-authorisation request form to the insurance company.
The insurance company will then verify and analyse the documents and may ask the network hospital for more information if required.
Once the formalities have been completed, the insurance company will pay the medical expenses excluding co-payment if any, directly at the network hospital. You will be informed about the same within the stipulated time. Even if the claim is rejected, you will be informed about the same.
To avail reimbursement treatment, you must follow the steps given below:
Inform the insurance company/ Broker within the stipulated time, in case of hospitalisation. You can also connect directly with the insurance company via email.
Avail the required treatment at the hospital if your policy covers you for the same. Collect all the medical test reports, discharge summary, medical invoices, and other relevant documents from the hospital to share to the insurance provider.
Submit the claim documents along with required medical documents to the insurance provider.
Valid ID proof
Medical practioner’s advising letter for hospitalisation
Original hospital bills and discharge certificate signed by the medical practitioner
Medical practioner’s prescription for consultation, medicine, and medical tests
Original pharmacy bills
Original reports of diagnostic tests, reports, etc.
First Information Report (FIR), in a police case
Post Mortem Report, if applicable.
Premiums paid for a health insurance plan for self, spouse and dependent children is allowed as a tax deduction under Section 80D. The limit is INR 25, 000. If you are a senior citizen, the limit increases to INR 50, 000.
Premiums paid for health insurance plan for dependent parents earns an additional tax deduction under Section 80D. This limit is also INR 25, 000 which increases to INR 50, 000 if the parents are senior citizens.
Sum Insured Amount
Policy premium to be paid to avail the coverage benefits
List of network hospitals and Claim Settlement Ratio
Sub-limits (if any) and Waiting Period (for PEDs)
Room rent capping
Waiting Period
Co-payment Clause
No Claim Bonus
