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Even the healthiest of individuals can fall sick without warning and require expensive medical treatments. In such a scenario, being financially unprepared to tackle the costs of the necessary medical procedures is not an option. This is where comprehensive health insurance plans come into play, to ensure the financial comfort of your family and you. Here is an in-depth look at this handy financial tool that has helped many individuals heave a sigh of relief in their hour of need.

What are health insurance plans?

Health insurance plans reimburse insured customers for their medical expenses, including treatments, surgeries, hospitalisation and the like which arise from injuries/illnesses, or directly pay out a certain pre-determined sum to the customer. A health insurance policy offers coverage for any future medical expenses of the customer.

This is an agreement between the insurance company and the customer where the former agrees to guarantee payment/compensation for medical costs if the latter is injured/ill in the future, leading to hospitalisation. In most cases, insurance companies have tie-ups with a network of hospitals, thereby ensuring cashless treatment for patients there.

Types of Health Insurance Plans

  • Cancer Insurance Plans - A cancer insurance plan is a health policy specifically designed to offer financial protection against the costs of several types and stages of cancer. The plan can offer high lump sum payouts on the diagnosis of cancers
  • Critical Illness Plans - Critical illness plans are a type of health insurance plan which provides money for the treatment of major critical illnesses like kidney ailments, liver disorders, heart attacks, cancer, paralysis, and more. Critical illness plans offer a high sum assured that can be adequate to cover the costs of such illnesses. They also provide lump sum payouts on the first diagnosis of a critical illness without the claimant having to submit any hospital bills
  • Individual Health Insurance Plans - This is a basic health insurance plan that covers an individual. The coverage and sum assured can depend on the age, gender, and health status of the person
  • Family Floater Insurance Plans - These health insurance plans offer umbrella coverage that covers the entire family under a single policy. These plans have a unified premium and sum assured for all the members of the family. They can be used to cover costs like hospitalisation, surgeries, room rent, and more
  • Personal Accident Insurance Plans - A personal accident insurance is a health policy that covers the cost of treatment due to an accident. These plans cover the life assured and offer a payout to cover expenses like ambulance costs, emergency surgery expenses, doctor’s consultation, and more

What is the need for health insurance?

Here is why you need health insurance:

  • Health insurance covers future illnesses/medical treatments without depleting your savings or negatively impacting your family’s financial future
  • Medical costs are increasing rapidly and for those with insufficient savings, affording medical care becomes a problem during emergencies
  • Cashless treatment is possible within network hospitals, while reimbursements are given by insurance companies in other cases
  • Health insurance plans offer coverage against several types of ailments and surgeries, along with other aspects of medical treatment
  • Health insurance keeps you and your family worry free; you only have to pay an affordable premium for the same
  • In many cases, you also get coverage against hospitalisation costs, ambulance costs, consultations, medicines, tests and post-hospitalisation expenditure

Source: Cost of Medical Treatment & Duration https://www.indiahealthcare.org/average_cost_treatment

What are the kinds of health insurance plans available?

There are several kinds of health insurance plans. Here are the main ones:

How to choose the right kind of Health Insurance for yourself?

Key Benefits of Health Insurance Plans

There are several benefits offered by health insurance plans, including the following:

Features of ICICI Pru Heart/Cancer Protect

Fixed benefit health insurance plans like ICICI Pru Heart/Cancer Protect plan pay out a certain amount/sum upon the occurrence of any particular pre-specified event that is covered by the policy. For instance, a critical illness plan will involve the payout of a guaranteed/assured lump sum upon diagnosis of any critical illness covered under the health insurance policy.

Why should you buy Fixed Benefit Health Insurance plans?

  • Lumpsum Payout- Fixed benefit health insurance plans pay out a lump sum# amount upon diagnosis of any disease/ailment covered under the same. This helps you take care of treatment and other costs right from the outset without financial worries. Payouts are made irrespective of the cost of treatment
  • No Worries of Sub Limits- Many health insurance plans come with sublimits in terms of room rent, hospitalisation expenses and so on. With fixed benefit health insurance plans, you receive a lump sum payout upon diagnosis of a particular illness without bothering about sublimits and so on
  • No Hospital Bills Required- Unlike other health insurance plans, fixed benefit health insurance plans pay upon diagnosis of the illness without the hassle of submitting hospital bills
  • Get treated anywhere in the world- Since you get a lump sum payout upon diagnosis, you need not be admitted to a network hospital for cashless treatment. You can opt for treatment anywhere in the world as per your own preferences and convenience
  • Affordable and fixed premiums- You can get higher coverage for premiums that are affordable. Premium amounts also remain fixed for the entire duration of the policy.
  • Tax Benefits- You can avail tax benefits* under Section 80D of the IT Act on the premiums you pay on these policies. Maximum amount of deduction from taxable income is `25,000 for you and your family (children and spouse) if you are less than 60 years old. If you are all more than 60 years old, the maximum deduction can increase to `50,000. The same is applicable for premiums that you pay for your parents, i.e. a maximum deduction of `25,000 if they are below 60 years of age and `50,000 if they are above 60 years of age

Does your Health Insurance cover COVID-19 claims?

With the COVID-19 pandemic being the biggest medical concern of the world right now, the Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory that all health insurance products must cover the treatment and hospitalisation cost of COVID-19 as well. If the insured person has been hospitalised for more than 24 hours after being diagnosed with COVID-19, the insurance policy will cover the hospitalisation costs. There are also several insurance schemes that will cover pre and post-hospitalisation care as well as quarantine related expenses in registered centres. Some policies may also include ICU charges. These are all subject to the terms and conditions of the policy and it is therefore advisable that one contacts the insurance company to gain further clarification on all the expenses covered.

Why should you buy Health Insurance online?

Why are many of the policyholders underinsured?

Many policyholders buy insurance to save taxes. The purpose of insurance is security during unforeseen circumstances- not to save tax, it is just an ancillary benefit. The market is filled with a variety of insurance products. However, different products suit different people and if research is not done properly, people usually end up buying policies with higher premiums and inadequate covers

Why Buy a Health Insurance Plan at an Early Age?

  • One can avail lower premiums as the premium amount is usually determined on the basis of the current age and health status of the policyholder, by insurance providers
  • One can enjoy tax* benefits for a longer duration. One can claim the premium deducted from the income under Section 80D of the Income Tax Act, 1961
  • Insurance providers exclude pre-existing conditions. As you grow older, you are more likely to have such conditions and if you buy a policy then, it won't cover them
  • As a young person, there are lesser health problems at the onset. This reduces the chances of the health insurance policy getting rejected
  • Along with better coverage, buying insurance at a young age helps in better financial planning. If the health aspect is taken care of, one can think of making other financial investments as well
  • We are trapped into sedentary lifestyles from a very young age, which lay the foundation of many critical illnesses. In such times, it becomes more important than ever to have a health insurance policy to keep one covered
If you have any queries regarding the online purchase of our Health Insurance Plan, please give us a call on
1800-300-69777

Optional Add-ons in Health Insurance

  • 1. Maternity cover add-on This optional add-on will cover expenses during childbirth. It is mostly for pre and post-delivery expenses
  • 2. Critical illness add-on This optional add-on covers the cost of selected critical illnesses with the sum assured paid by the insurance company
  • 3. Accidental disability add-on This optional add-on helps the policyholder in case of an accident and the amount paid depends on the sum assured (totally or partially) for the optional add-on. However, the amount that would be paid would depend on the severity of the injury
  • 4. Room rent waiver The room rent waiver helps the policyholder select the room of their own choice without paying the payment of extra money
  • 5. Hospital cash add-on If the policyholder has been hospitalized, this optional add-on provides them with the cash amount for all the days of hospitalisation

Fixed Benefit Health Insurance Plans Online in India by ICICI Prulife that are Worth Checking Out

ICICI Prulife Heart/Cancer Protect
Coverage against heart ailment and Cancer
Claim amount paid out upon first diagnosis of any of the listed minor/ major condition irrespective of actual costs of medical treatment.
High coverage amount for comparatively lower premium, i.e. ₹ 20 lakh coverage at ₹ 387 per month1.
5% discount on first year premium when you buy health cover for yourself and spouse2.
Waiver of premium in case of minor claim or on diagnosis of permanent disability due to accident 4.
A 10% increase in sum assured if it is a no claim policy year5.(Available with Increasing cover benefit (Optional).)
1% of sum assured paid out as additional income for five years after a major condition6. This is over and above the lump sum payable. (Available with Income benefit (Optional))
25% of lump sum payout in case of minor condition7 diagnosis and 100% payout in case of major condition8 diagnosis post deduction of any previous payouts on minor claims if applicable.

As can be seen, health insurance is a basic need that cannot be ignored. Assess your current financial situation and future needs to choose the best policy for yourself and your family now!

Important documents to get your Health Insurance claim amount easily

Points to consider before choosing a Health Insurance Plan

As you can see, there are various types of health insurance plans in the market. Therefore, choosing the most appropriate one can be confusing. When you select a health insurance plan, it is essential to compare different plans and choose the one that offers an affordable premium for comprehensive protection. Here are some factors that can help you choose a good health insurance plan for your needs:

  • A considerable number of network hospitals - It can be beneficial to look for a health insurance plan that covers a wide network of hospitals. Network hospitals simplify and speed up the claim process. They can help you save crucial time during an emergency. So, always check the list of networks hospitals and pick a health policy that covers treatment undertaken in hospitals close to your area of residence
  • Cashless hospitalisation facility - With cashless hospitalisation, you no longer have to worry about clearing bills. The hospital settles the bill with the insurance company internally, so you can solely focus on your health. The cashless hospitalisation feature offers convenience and can help you in your hour of need
  • A good claim settlement ratio - Claim settlement ratio is the percentage of the individual claims that an insurance company settles in a financial year out of the total claims received in the same financial year. A consistently high Claim Settlement Ratio shows that the company is committed to the needs of its customers
  • Range of sum insured - If you have a good range of sum insured amounts to choose from, you have greater flexibility to select the amount you need. This enables you to pick a suitable health policy that can offer you adequate financial protection
  • A home care facility - Treatment is not limited to the hospital alone. Many illnesses can require long-term care at home. Therefore, it can help to look for a plan that covers medical expenses incurred at home, such as pre and post-hospitalisation expenses
  • Good customer rating and reviews - Customers ratings can be an excellent indicator of a health insurance plan. They can help you understand the services of the insurer. They can also offer a glimpse into the claim settlement process and how prompt the insurer is to solve the customer’s queries and issues. You can check online reviews and customer feedback to ensure that you pick the best insurance company

Health Insurance Plans FAQs

How much does health insurance cost for an individual?

Health insurance costs are a function of your age, coverage amount and health status. For instance, if your age is 20 years, the health insurance cost in the form of a premium will be lower than that of somebody who is 50 years of age. For instance, a 20-year-old Male buying ICICI Pru Heart/Cancer Protect Health Insurance will pay a premium of ₹ 119 per month (including taxes) for a ₹ 20 lakh cover3 for 20 years. But a 50-year-old Male for the same cover and duration will shell out ₹ 1652 per month (including taxes). Do note that the premium cost goes up if you are a smoker since they are prone to more health risks. A 20-year-old male who smokes will pay ₹ 132 per month for ₹ 20 lakh cover for 20 years as premium, about 11% more than a non-smoker.

What are the things to look for while choosing a health insurance plan?

The best health insurance policy depends on your specific needs. There are a few important factors that one must look at while choosing a health insurance plan -

  1. Payout mechanism - Whether payout happens on diagnosis, or on actual hospitalisation
  2. Claim Process - Claim process should be simple, fast and efficient involving minimum discomfort to policyholder/family
  3. Waiting Period - The best plans will have minimal waiting period before you can claim for a pre-existing cover
  4. Adequate cover - With health costs on the rise, the best health plans will give maximum cover at an affordable cost
  5. Pre/post hospitalisation benefit - Some health plans have limits related for pre and post hospitalisation expenses and so you must be aware of them before buying.

Does health insurance provide tax benefits?

Yes, paying a health insurance premium every year can lower your annual tax liability. Health insurance premium paid can be used to claim deduction under Section 80D^. An individual can claim a deduction of up to `25,000 for the insurance of self, spouse, and dependent children. An additional deduction for the insurance of parents is available. This is to the extent of `25,000, if the parents are less than 60 years of age. The additional deduction can be up to `50,000 if the parents are aged above 60.

Do health insurance plans cover diagnostic charges like X-ray, MRI or ultrasound?

Yes, the health insurance cover usually pays for them as long as the patient is hospitalized for at least 24 hours and such tests have been prescribed. Such tests done out-patients are not always covered, unless specified in the policy#. Please read your health insurance policy document to find out. In ICICI Pru Heart & Cancer health insurance, you get upfront payment for covered ailments, which means you can use them to pay for X-ray, MRI, Ultrasound, nurse and therapy related charges/tests pre and post hospitalization at your own choice.

What are the documents required for buying a health insurance plan?

Generally, the following documents are required to buy health insurance
  1. Age proof
  2. Identity proof
  3. Address proof
  4. Some plans may require medical check-up reports, usually for people above the age of 45

What is the right age to get health insurance?

The earlier you get health insurance, the lower is your premium amount. If you wait to buy a health insurance policy at later stages of life, you might be deprived of immediate coverage due to the waiting period$. So, it is better to buy health insurance as soon as you meet the minimum entry age requirements for the policy.

Can a person have more than one health policy?

Of course, you can have more than one health policy. Many people have a separate health insurance policy apart from the health cover provided by their employer. You may use the second policy if you exhaust the health cover in the first one.

Is medical test mandatory to purchase a health insurance policy?

Many health insurance plans issue policies without medical tests, depending on the age and medical history of the applicant. However, if your age is above the minimum age limit set by the insurer, then you will have to go through a medical test.

Is there any difference between health insurance and a mediclaim policy?

Mediclaim is a type of health insurance plan that takes care of the policy-holder’s healthcare expenses in case he/she gets hospitalized due to an illness or an accident. These policies cover the policyholder for a defined time period and up to a predetermined limit known as the ‘sum assured’. These policies need to be renewed regularly to continue enjoying the benefits.

How do I estimate the cost of health insurance?

You can calculate the premium for ICICI Pru Heart/Cancer Protect plan using this calculator.

Can I add my family members to a health insurance policy cover?

Yes, you can add different family members to a health insurance plan. Usually, health insurance plans let you add the following family members to the same plan:

  • Spouse
  • Dependent children (biological and legally adopted children)
  • Dependent parents
  • Dependent parents-in-law
  • Brothers and sisters

You can opt for a family floater health insurance plan if you wish to insure your loved ones. All insured members of a family floater plan can avail up to the maximum limit of the sum insured of the policy. Moreover, such plans extend the coverage to the entire family under a single premium. This saves a lot of time and money in the long run.

Do I need to purchase additional health insurance plans to increase the sum assured amount?

There can be two ways to increase the sum assured amount of your health insurance plan. These are:

  • You could buy a new health plan with a higher sum assured
  • You could simply increase the sum assured of your plan at the time of policy renewal

Will my health insurance work in non-network hospitals?

Yes, your health insurance plan will work in both network and non-network hospitals. However, you can claim the cashless facility at a network hospital only. If you were to seek treatment at a non-network hospital, you would not be able to use the cashless facility and might have to submit the bills of hospitalisation/treatment to request a claim. It may be advised to read and understand such details before signing the policy document. And remember that it helps to pick a health insurance policy that offers a vast network of hospitals.

What happens if I am hospitalised and on the same day my health insurance plan has lapsed?

Typically, all insurance companies give customers a grace period of 15 – 30 days after the date of expiry. The customer can use this time to renew the plan and keep the policy running. However, it is important to understand that health insurance is given in return for the premiums paid. In the absence of a premium, the insurer is not obligated to offer you financial protection. Hence, till you renew your plan again, you will not receive any protection or benefits from your health plan. Therefore, it is advised to renew your plan in time and ensure that your plan is always active.

What does cashless hospitalisation mean in a health insurance plan?

Cashless hospitalisation is a health insurance feature that allows you to avail of medical services at a hospital without making any upfront payments. Under this feature, the insurance company directly deals with the hospital and clears all hospital bills. However, this facility can only be availed at a network hospital specified in the health insurance plan.

At what age can you include your children in the health insurance plan?

Family floater health insurance plans can be used to cover children between the ages of 90 days and 25 years. You can include your children in your plan anytime during this period.

Can the nominee be changed in the mid-term of the health insurance policy?

Yes, health insurance plans allow you to change the nominee anytime during the policy term.

Can a person have more than one health insurance policy?

Yes, you can have more than one health insurance policy from several insurers. Multiple health insurance policies can offer several benefits like wider coverage, safety from claim rejection, better features and more peace of mind
COMP/DOC/Feb/2022/172/7442

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Disclaimer

~ On the fulfilment of certain conditions as per the terms and conditions of the product.

1 The premium rate is of ₹ 10 lakh Cancer cover and ₹ 10 Lakh Heart cover for 35 year healthy male for policy term of 20 years and inclusive of tax.

2 A discount of 5% on the first year’s premium will be offered on purchase of ICICI Pru Heart / Cancer Protect when life assured and his/ her spouse is covered under the same policy. The policy benefits of both the Lives Assured shall be independent of each other. The Sums Assured of both the lives could be different. A claim made by one Life Assured under the policy does not affect benefits of other Life Assured. This Family benefit has to be chosen at the inception of the policy only, spouse cannot be added once the policy is issued. This discount is not applicable on Single Pay Policy. With one policy, you can avail either Family Benefit or Loyalty Benefit.

3 ₹ 20 lakh cover mentioned here consist of ₹ 10 Lakh Cancer cover and ₹ 10 Lakh Heart cover of ICICI Pru Heart/Cancer Protect plan.

^ Tax benefits under the policy are subject to conditions under Section 80D and other provisions of the Income Tax Act, 1961. Goods and Services Tax and Cesses, if any, will be charged extra as per prevailing rates. Tax laws are subject to amendments made thereto from time to time. Please consult your tax advisor for details, before acting on above.

# A lump sum is paid out on diagnosis of any of the listed conditions. This payout is based on the level of the condition. In any case, the total payout in the policy cannot exceed 100% of the Sum Assured of the cover selected. Please refer to the sales brochure to know about the payouts at different level of condition.

* Tax benefit of ₹ 7,800 is calculated at highest tax slab rate of 31.2% (including Cess excluding surcharge) on health premium u/s 80D of ₹ 25,000. Tax benefits under the policy are subject to conditions under Section 80D, 10(10D), 115BAC and other provisions of the Income Tax Act, 1961. Goods and Services Tax and Cesses, if any, will be charged extra as per prevailing rates. Tax laws are subject to amendments made thereto from time to time. Please consult your tax advisor for details, before acting on above.

4 The Company shall waive all future premiums on a claim of Minor condition under the chosen cover; or on the diagnosis of Permanent Disability (PD)of the Life Assured due to an Accident. If both Cancer cover and Heart cover are chosen such waiver is allowed on a minor/major condition claim under either Cancer cover or Heart cover; or on the diagnosis of PD. This benefit is available only if the Policy is in force as on the date of diagnosis of the condition/at the time of accident.

5 With Increasing Income Benefit, the Sum Assured chosen at inception increases by 10% simple interest on each policy anniversary, for every claim free year. The maximum Sum Assured under the cover will be capped at 200% of the Sum Assured chosen at inception. This increase in Sum Assured will stop on occurrence of first claim under the cover. Where Cancer cover and Heart cover are chosen together, the Sums Assured for both the covers increase by 10% simple interest on each policy anniversary, for every claim free year. The maximum sum assured will be capped at 200% of the Sum Assured chosen at inception for each type of cover. In case of occurrence of first claim under any one type of cover, the increase in Sum Assured will stop for that cover type and Increasing Cover Benefit will continue for the other type of cover, for which no claim has occurred.

6 Under the Income Benefit, the Sum Assured has to be chosen at inception of the plan. An amount equal to 1% of the Sum Assured chosen at inception will be paid to the policyholder each month, for a period of 5 years upon a valid claim under any of the listed Major conditions. Where the Cancer cover and Heart cover are taken together, pay out under Income Benefit will be triggered for only that cover for which a claim of Major condition is registered and all Benefits through other cover remains unaffected.

7 In case of Minor Conditions, the total payout will be capped at 100% of the Sum Assured.

8 Under the Income Benefit, the Sum Assured has to be chosen at inception of the plan. An amount equal to 1% of the Sum Assured chosen at inception will be paid to the policyholder each month, for a period of 5 years upon a valid claim under any of the listed Major conditions. Where the Cancer cover and Heart cover are taken together, payout under Income Benefit will be triggered for only that cover for which a claim of Major condition is registered and all Benefits through other cover remains unaffected.

$ A waiting period is the amount of time an insured must wait before some or all of their coverage comes into effect. The insured may not receive benefits for claims filed during the waiting period. Source: https://www.investopedia.com/terms/w/waiting-period.asp

# Source - https://www.insuranceinbox.com/health-insurance/health-guide/faq/does-health-insurance-cover-diagnostic-charges-like-x-ray-mri-or-ultrasound

ICICI Pru iProtect Smart UIN - 105N151V06

ICICI Pru Heart/Cancer Protect UIN - 105N154V03

W/II/4413/2021-22