Health Insurance Plans
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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. 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. Here is why you need health insurance:
What are health insurance plans?
Types of Health Insurance Plans
What is the need for health insurance?
How to choose the right kind of Health Insurance for yourself?
Make sure your health plan covers a wide range of medical problems and can help you avail of various pre and post-hospitalisation benefits. If the health insurance you have bought is for your family, it is necessary to make sure that it covers the needs of all the family members
As much as it is important that the health plan meets your needs, it is equally important that it also suits your budget. As your income increases, and the size of your family as well as requirements change over time, the plan can further be reviewed accordingly
According to your status, select an individual or family health plan. If you have a family who needs your support, opt for a family health plan so as to reap maximum benefits at a comparatively low cost
It is important to know the term for which the policy would cover you. After all, one is more likely to require medical facilities at a later stage in life, as we approach old age. Therefore, a plan which offers lifetime renewability would be more beneficial
It is always better to choose an insurance provider that has a wide network of hospitals included in its list. One should also check if the hospitals one prefers are included in the list or not
It is advisable to choose an insurance provider with a higher claim settlement ratio. The claim settlement ratio is the number of claims settled by the insurance provider over the total number of claims received
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?
- Lump sum 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.
What is Covered under Health Insurance Policy?
Below are some common elements covered under health insurance plans:
- Hospitalisation expenses: Health insurance usually covers the cost of hospitalisation, including room charges, nursing expenses and other associated fees
- Surgical expenses: Most policies cover surgical procedures and related costs, including surgeon fees, anaesthesia and operating room charges
- Medicines: Health insurance covers the cost of prescribed medications and drugs
- Consultation fees: Expenses related to consultations with doctors, specialists and healthcare providers are covered under health insurance
- Pre and post-hospitalisation expenses: Many policies cover expenses incurred before and after hospitalisation. This may include diagnostic tests, consultations and medications related to your hospital stay
- Ambulance charges: Health insurance can cover the costs of an ambulance to transport you to the hospital
- Diagnostic tests: The cost of diagnostic tests, such as X-rays, MRI scans, blood tests and other laboratory work, is usually covered under health insurance plans in India
- Emergency care: Health insurance covers emergency medical treatment
What is not Covered under a Health Insurance Policy?
Below is a breakdown of the exclusions under health insurance plans:
- Health insurance policies often have a waiting period for pre-existing medical conditions and expenses related to these conditions may not be covered for a certain period after the policy's effective date
- If you failed to disclose any pre-existing medical conditions when applying for the insurance policy, it could lead to the denial of coverage for related expenses
- Health insurance does not cover expenses related to Sexually Transmitted Diseases (STDs)
- Health insurance typically does not cover medical expenses resulting from self-inflicted injuries or suicide attempts
- Health insurance may exclude coverage for medical issues arising from the use of intoxicating drugs, alcohol, or solvents, except when administered under medical supervision
- Health insurance plans in India may exclude coverage for illnesses resulting from exposure to radioactive contamination, such as those from a nuclear accident
- Congenital disabilities or diseases diagnosed before a certain age may not be covered under health insurance plans
Why should you buy Health Insurance online?
Factors Affecting Your Health Insurance Premium
Below are some factors that can impact the premium for health insurance plans:
- Family Medical History
Your premium can be affected by your family's medical history. If your family has a history of hereditary diseases, you may be considered at higher risk of contracting them. This can result in a higher premium. - Age and Gender
Your age and gender can impact the premium for your health insurance plan. Health insurance premium tends to increase as you get older, as your health is more likely to suffer. Gender may also affect the premium, as healthcare needs differ for men and women. - Policy Term
Longer-term policies may have a higher premium compared to short-term policies. However, long-term policies offer better protection by ensuring financial protection for an extended period. Short-term policies may seem more affordable but can come with additional costs for renewal, which can be more expensive in the long run. - Pre-Existing Diseases People with pre-existing medical conditions typically pay a higher premium. Insurance companies charge more to cover potential medical expenses related to these conditions.
- Lifestyle
Lifestyle habits like smoking, alcohol consumption and others may result in a higher premium as they enhance the chance of falling sick. On the other hand, a healthy lifestyle may lead to a lower premium.
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
How to Calculate Health Insurance Premium?
Health insurance plans offer financial protection against medical expenses. However, in order to keep the plan active, you must pay a premium. The premium for a health insurance policy is calculated based on a number of factors. These include the age and gender of the policyholder, the occupation of the policyholder, lifestyle habits like smoking and drinking alcohol, health history, family history of illnesses and more. In addition to this, factors like sum assured, policy term and benefits can also affect the premium. Companies offering health insurance plans in India take all of these factors into consideration and calculate the premium.
You can use an online health insurance premium calculator to get an estimated quote for medical insurance plans. You can enter your details on this free tool, and the calculator will give you an estimate of the premium within a few minutes.
If you have any queries regarding the online purchase of our Health Insurance Plan, please give us a call on
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 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 accident4. |
| 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 for Health Insurance
Important Document for Buying Health Insurance Plans
Below is a list of documents required to buy a health insurance policy:
- Age proof, such as Passport, Class 10th Mark Sheet, Aadhaar Card and others
- Identity proof, such as Driver’s Licence, Passport, Aadhaar Card and others
- You may be required to submit a medical check-up report
- Passport size photos
Important Document for Claiming Health Insurance
Below is a list of documents required for claiming a health insurance payout:
- Claim intimation form
- Medical records like admission and discharge documents
- Attending doctor’s certificate
- Policy certificate
- Canceled cheque
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
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 -
- i) Payout mechanism - Whether payout happens on diagnosis, or on actual hospitalisation
- ii) Claim Process - Claim process should be simple, fast and efficient involving minimum discomfort to policyholder/family
- iii) Waiting Period - The best plans will have minimal waiting period before you can claim for a pre-existing cover
- iv) Adequate cover - With health costs on the rise, the best health plans will give maximum cover at an affordable cost
- v) 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.
Generally, the following documents are required to buy health insurance
- i) Age proof
- ii) Identity proof
- iii) Address proof
- iv) Some plans may require medical check-up reports, usually for people above the age of 45
- v) Passport size photo
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.
As per the IRDAI, if a policyholder is diagnosed with a disease at least 48 months before buying a health policy, it is termed a pre-existing disease. Usually, health insurance companies provide coverage for these pre-existing diseases after a waiting period.
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.
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.
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.
You can calculate the premium for ICICI Pru Heart/Cancer Protect plan using this calculator.
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:
- i) Spouse
- ii) Dependent children (biological and legally adopted children)
- iii) Dependent parents
- iv) Dependent parents-in-law
- v) Brothers and sisters
There can be two ways to increase the sum assured amount of your health insurance plan. These are:
- 1) You could buy a new health plan with a higher sum assured
- 2) You could simply increase the sum assured of your plan at the time of policy renewal
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.
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.
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.
Almost all insurance companies in India allow you to increase your health insurance sum insured at the time of policy renewal. All you need to do is intimate your medical insurance provider that you want to increase the sum insured on your policy. However, this can result in an increase in your health insurance premium amount. You can also take a top-up plan on your health insurance policy to increase its sum insured.
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.
Yes, health insurance plans allow you to change the nominee anytime during the policy term.
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.
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