Health Insurance

What is Health Insurance?

Health Insurance is a product by Insurance Companies to cover the medical and surgical expenses incurred by the insurer. Health is the most unpredictable aspect of one's life. Anybody can encounter a serious health issue at any stage of life.

If not any health issue, it could be hospitalisation due to an accident. Meeting medical expenses which appear out-of-the-blue is not in the reach of everyone. At least not at present times, when the cost of medical treatment is soaring high day by day.

The product that covers the expenses that arise out of such emergencies is Health Insurance. Periodical payment of premium as stipulated by the Insurance Company has to be made. The payment of the premium could be either monthly, quarterly, half-yearly or yearly.

The insurance company either pays the medical expenses incurred directly to the hospital or will reimburse the expenses to the insured individual. Flexible coverage for ailments/disease is provided. Some Health Insurance companies offer a cover for as many as 80 and above surgical procedures and as many as 30 and above critical illness.

Health Insurance can be a saviour when such critical emergencies emerge at the eleventh hour. If you have a huge family responsibility with regard to every member of the family, then going in for Health Insurance for the entire family is recommended.

Features and Advantages of Health Insurance Policy

• With a Health Insurance Policy, you will be able to get medical treatment in the best of hospitals without being worried about the cost of the treatment.
• Any medical emergencies can be handled with great ease even at times when you are in a disastrous financial situation.
• Imagine you come across a situation when you are diagnosed with a health issue which can be treated in specialised hospitals whose cost of medical treatment seems unaffordable. This is at such times that Health Insurance comes handy.
• The cashless facility of the Health Insurance policy is the best feature. All the expenses incurred in the course of your medical treatment will be directly remitted to the hospital and you will not have to worry about paying the hospital first and then claiming reimbursement from the Insurance Company.

The main features of a Health Insurance policy are:

• Cover for expenses incurred prior to hospitalisation and post hospitalisation: The expenses incurred 30 to 60 days prior to hospitalisation and post hospitalisation will be reimbursed upon submission of relevant bills and receipts.
• Treatment without payment - Cashless treatment: Under this feature, treatment will be provided in the hospitals listed in the insurance policy without the payment of cash. The hospital authorities will send a pre-authorisation request with the details of treatment and the cost.
• Various Plans:
  • Plans that cover the medical expenses of an insured individual along with the pre and post hospitalisation expenses.
  • Plans for treatment of critical diseases like the brain tumour, cancer, kidney problems, heart- related issues, etc.
  • Plans that cover pre-existing diseases like diabetes, hypertension, kidney problems, heart- related problems, cancer that might be diagnosed even before obtaining the policy.
  • Plan to cover the medical expenses of all the family members. All the members will be covered under a single policy.
  • Some plans cover the medical expenses of senior citizens up to the age of 65.

Best Health Insurance Policies in India

Some of the best insurance policies by top insurance companies in India are:

• Max Bupa Health Companion: Designed to cover an individual or provide cover for the entire family. Offers a comprehensive cover up to Rs. 1 Crore, cashless treatment in 4,000+ hospitals, lifetime renewal, and tax benefits under Section 80D.
• Royal Sundaram Lifeline Health Insurance: Available in Classic, Supreme, and Elite categories with coverage from ₹2 lakh to ₹1.5 crore, including ambulance, organ donor, and maternity benefits.
• Apollo Munich Optima Restore: Popular for Multiply, Restore, and Stay Active Benefits. Offers coverage before and after hospitalisation and 100% restoration of the sum insured.
• Star Health and Allied Insurance: Offers different plans for individuals, families, and senior citizens with daycare treatments, cash benefits, and lifetime renewal.
• New India Premier Mediclaim Policy: Provides coverage for individuals and families, with sum insured options from ₹15 lakh to ₹1 crore and hospital cash benefits.

Difference Between Mediclaim and Health Insurance

The following are the differences between Mediclaim and Health Insurance:

How to Choose the Best Health Insurance Policy

Here are a few tips to choose the best Health Insurance policy:

• Maximum coverage and maximum amount for treatment should be the prime concern while choosing a health plan.
• For families, a floater policy covering all members is ideal instead of separate individual policies.
• If married, choose a sum insured that sufficiently covers both you and your spouse.
• Check the waiting period for pre-existing diseases—generally 2 to 4 years, sometimes less.
• Consider renewal age — choose plans allowing lifetime renewal or up to at least 80 years.
• Pick an insurer with a high claim settlement ratio for faster, reliable claim processing.
• Review sub-limits like room rent and daily medical expenses, balancing benefits with premium cost.
• Look for a wide hospital network for cashless treatment convenience.
• Compare premiums and benefits before finalising. Choose one with maximum value.
• Read customer reviews to gauge claim experience and service quality.
• Check exclusions and pick policies with the fewest uncovered conditions.
• Add a critical illness rider if you want extended cover for major diseases like cancer or heart failure.
• Ensure maternity benefits and check waiting periods if needed for family planning.
• Some plans include free health check-ups during renewal — prefer those.

Importance of Health Insurance in India

With the soaring prices for medical treatments, it is vital to have Health Insurance plans to cover unexpected medical expenses.

The reasons to have Health Insurance are:

• The insurance will take care of all the medical expenses.
• It keeps you financially prepared for medical emergencies.
• The premiums are nominal compared to the financial protection offered.
• Claims are simple and hassle-free.
• Claim rejections are rare unless there’s a valid reason.

Claim Ratio and Claim Settlement Ratio in India

The claim ratio shows claims settled versus the premium collected. A 95% claim ratio means the company settled claims worth 95% of premiums collected. A higher claim ratio benefits customers but reduces company profits.

The claim settlement ratio shows the number of claims received versus those settled. Always choose companies with high settlement ratios for better reliability.

Claim Ratio of Different Health Insurance Companies:

Which Medical Insurance is Best for Family

The following medical insurances are best for families:

• Star Family Health Optima
• Max Bupa Health Companion
• HDFC Health Suraksha
• Apollo Munich Optima Restore Family Plan
• SBI Life Smart Health Insurance
• Oriental Insurance Happy Family Floater Policy
• Bajaj Allianz Family Health Guard