Are you comparing health insurance plans for yourself and your family members in order to get the best one? First up, there is nothing that can be objectively classified as the best plan. The best health insurance plan for you and your family is one that depends on your specific needs and requirements. It is important to remember here that what works best for you may not be suitable for someone else, so it is best to do your research before opting for a specific plan.

Health insurance policies are usually of two kinds, i.e. those that pay for the costs incurred post hospitalization and those which pay out a fixed amount upon diagnosis of any illness without taking hospitalization into account. Fixed benefit health insurance plans offer a guaranteed payout upon the diagnosis of any critical illness covered by the policy. You do not require medical bills for making a payout claim for the same.

In contrast, other types of health insurance allows the insured to avail of cashless treatment at network hospitals upon hospitalization and treatment for an illness. In this case, hospital expenses will be verified by the insurer before the money is directly paid to the hospital. The person insured may also seek treatment at a network hospital although expenses will be reimbursed later on by the insurance company post verification.

What to keep in mind while comparing health insurance plans

While comparing health insurance plans, you should keep a few things in mind. These include the following:

  • Claims Process: You should be able to get your dues with a fast claims process which does not require much paperwork or substantiation with bills and other medical documents/proof.
  • Waiting Period: In case there are any pre-existing illnesses, insurance companies specify various waiting periods for the same. Any claims linked to these illnesses will be processed only after the completion of such waiting periods.
  • Coverage: You should always opt for ample coverage. The emphasis should not be on the cost of premiums alone. For example, treatment for serious illnesses like cancer may necessitate costs between ₹ 4 to 20 lakhs and hence, your insurance plan should offer coverage for the entire amount.
  • Network Hospitals: Health insurance policies which have reimbursement-based frameworks, come with faster claim settlement at network hospitals and this is often cashless as well. However, if you choose a fixed benefit health insurance plan instead, there is no requirement to look for a network hospital since you will be paid out the fixed amount based on the diagnosis report of an illness irrespective of actual proof of hospitalization. There are no limitations in other regard as well like room rent, sub-limits and so on.
  • Post/Pre-Hospitalization Benefits: Reimbursement health insurance policies may have varying regulations regarding pre and post hospitalization coverage. Fixed benefit health insurance plans do not come with any limitations since the settlement of claims is based on the diagnosis of an illness and not on the actual hospitalization.

Salient features of health insurance plans

Fixed benefit health insurance plans come with several features that you should know about. These include the following:

  • Assured Benefits - Lump sum payout of guaranteed benefit upon first diagnosis of illness covered in the policy without medical bills. This makes sure that you get payout instantly without having to worry about treatment costs. You can then focus on the treatment and subsequent recovery from your illness.
  • Affordable Premiums - There is only reasonable premiums for policies with easy renewal options. For instance, a 30-year old male policyholder can get coverage of up to ₹ 20 lakhs for a tenor of 20 years. The premium amount is only ₹ 235 on a monthly basis.1 This ensures that you can easily pay reasonable amounts which do not affect your monthly budget and can get good coverage in return.
  • Flexibility - There are no limitations regarding the type of hospital room and pricing of the same, or regarding any waiting periods, pre-existing diseases, co-payment terms and so on. Since you get the payout instantly, you can focus on your health without having to worry about the costs and all the other factors linked to hospitalization.
  • Payout upon diagnosis - There is assured payout upon diagnosis irrespective of actual cost of treatment and utilization of benefit amount. You do not have to furnish hospital bills to get the amount, which speeds up the treatment process and keeps your family members worry-free2
  • Tax Benefits - Tax benefits are provided under Section 80D for health insurance premiums paid under these policies. You can thus get additional savings with your health insurance plan which ensures that the family budget is not negatively affected or depleted3
  • Additional Coverage - These health insurance plans also help in taking care of non-medical costs like transportation or household necessities in addition to post-treatment costs like regular doctor visits, medicines and so on. This secures you financially and emotionally as you may be unable to work/earn during this period yet have your basic costs taken care of by these plans.

Fixed Benefit Health Insurance Plans That You Can Consider

Making a decision about health insurance can seem daunting at first. However, if you understand the various options available in the market, you will quickly realise what is best for you. Here are a few health insurance plans that are worth knowing about:

Particulars ICICI Pru Heart/Cancer Protect ICICI Prudential Smart Health Cover with ICICI Pru iProtect Smart
Assured Payouts Lump sum payout of guaranteed amount upon diagnosis or detection of major illness without medical bills2. Lump sum payout of guaranteed amount upon diagnosis of any illness included in the list of 34 critical illnesses4 covered under the policy.
Coverage Maximum cover for Heart: 25 Lakh & Cancer: 50 Lakh for 40 years Maximum Critical Illness Benefit of ₹ 25 lakh
Premium Affordable premium lower than ₹ 160 per month. Monthly premiums starting from ₹ 2,400 every month.
Waiver of Premium Premium waiver in case of permanent disability suffered due to accident5. Premium waiver in case of permanent disability caused due to accident.
Payout Plan Up to 25% of the sum assured paid out on diagnosis of minor conditions covered in policy6. Lump sum benefit paid out on occurrence/first diagnosis of critical illness/death.

Some other features of ICICI Pru Heart/Cancer Protect are the following:

  • Attractive Discounts - 5% discount on combined premiums for the first policy year if you buy health coverage for yourself and your spouse7
  • Loyalty Discounts - 5% loyalty discount on the premium for the first policy year for existing ICICI Prudential customers who choose this plan8
  • Scaling up Coverage - An option for increasing coverage by 10% for every no-claim policy year.

Some other features of ICICI Prudential Smart Health Cover with ICICI Pru iProtect Smart include the following:

  • No Hospital Bills Required - Lump sum payout with only medical diagnosis and no mandatory submission of hospital/medical bills.
  • Life Cover & Fixed Premium - It also offers life cover & the premium amount remains fixed for the entire policy term.
  • Multi-Illness Protection - Get protection against 34 critical illnesses under this policy.

 

Health insurance policies will help you plan ahead for a secure financial future for both yourself and your family. Put some thought into it and get the one that is best suited to your financial and healthcare needs.

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1 The above mentioned premium rate is for ₹ 10 Lakh Cancer Cover and ₹ 10 Lakh Heart Cover for a 30 year old healthy male for a policy term of 20 years. If you choose monthly mode, then the premium amount works out to ₹ 235.

2 Only doctor’s certificate confirming diagnosis needs to be submitted. 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

3 Tax benefits will apply to the premiums paid and benefits received as per the prevailing tax laws. Tax benefits under the policy are subject to conditions under Sec. 80C, 80D, 10(10D) and 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 Critical Illness Benefit is optional and available under Life and Health and All in One options. This benefit is payable, on first occurrence of any of the 34 illnesses covered. The CI Benefit, is accelerated and not an additional benefit which means the policy will continue with the Death Benefit reduced by the extent of the CI Benefit paid. The future premiums payable under the policy will reduce proportionately. If CI Benefit paid is equal to the Death Benefit, the policy will terminate on payment of the CI Benefit. To know more in detail about CI Benefit, terms & conditions governing it, kindly refer to sales brochure. Critical Illness benefit is available till age of 75

5 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.

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

7 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.

8 With one policy, you can avail either Family Benefit or Loyalty Benefit.

W/II/0651/2019-20

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