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Health Insurance

What is Health Insurance?

Health insurance is a legal agreement between the health insurance company and you. According to this agreement, the health insurance company is responsible to pay all your medical expenses when you are hospitalized or taking home treatment in the critical situations. The insurance company makes sure that the policyholder should get cashless treatment in network hospital or reimbursement facility in the non-network hospital. Apart from health expenses, the policyholder will also get tax benefit u/s 80D of the Income Tax Act- 1961.

To enjoy this facility of the insurance company, the policyholder has to pay the premium every year. The insurance company provides additional benefits if you pay the premium for 2 years in 1 shot. The company also provides claim free year bonus. The bonus can be discount on premium or addition in sum assured.

It is important for the policyholder to know that Health Insurance Company keeps a waiting period for some of the fixed diseases and also keep a waiting period for pre-existing diseases. The company doesn’t ask for the medical test up to a certain age group but, it is the responsibly of the policyholder and its family member to disclose all the existing diseases. Being truthful and disclose all the information is better as it will help in easy claim settlement. In case you hide diseases from the company, the company can suspend the policy and no claim will be given to you.

Health Insurance is a need of every individual and family. But, the sad thing is that the Health Insurance Policy does not cover each and every disease and has a waiting period for some of the diseases. Most health insurance policies do not cover maternity, disabilities and much more cases. Some health insurance companies provide lifetime renewal but limit the entry age. Some plans have room rent capping while some have health checkup limits. There are things that you should compare before buying a health care policy because it is difficult to port your policy i.e. transferring your policy to another company to another after you have taken a claim under the same policy.

Why you need a health insurance policy?

I simple terms, every person has health-related issues and after a certain age the diseases will increase and this will increase your financial expenses. You can take precaution for your health but the atmosphere where we live and the food item are not enough hygienic. Apart from diseases, road accidents can come any time even if you are walking on the road safety. In such cases, you are on hospitalized for some days and in such situation, you need a financial support. Such accidents can happen anytime, anywhere and with anyone. Life is uncertain so you need a life insurance policy also that will support your family when you are not here for them. Life insurance will help your family when you are not there and health insurance will help your family member when somebody is hospitalized. 

For every person, it is difficult to beat the health expenses as they are increasing rapidly. People avoid visiting government hospitals. But still, in a government hospital, you have to pay some amount of other expenses such as medicine and tests. Such expenses are also covered by your health insurance policy.

When you are hospitalized in a private hospital, you have to spend lakhs and this is very common for all the hospitals. But, you don’t have to worry about whatever is the bill, your health insurance policy will cover it.

How to Choose Best Health Insurance in India?

Choosing best health insurance policy is a big decision but you have to look at your budget also. As everyone knows that medical expenses are huge and as compared to the premium. So, the one should not focus on the premium amount but should focus on the benefits that the policyholder and his family will get from the policy. You should inform your health insurance agent about your requirements before opting for a health insurance policy. 

Like if you are planning for a health insurance that will cover maternity expenses also so it is your duty to tell the agent about needs so that the agent can suggest you a policy which covers maternity.

Health Insurance Plans

There are several types of health insurance policy available for different needs.

1.   Family Floater

This is a type of health insurance which covers your whole family like your Spouse and children. The SUM Assured should be huge as there are more members included in this policy.

2.    Individual

This cover medical expenses of a particular person i.e. policyholder.

3.    Senior Citizen

Some policies have an age limit and some policies have no age limit but based on the requirement every company has a policy which is specially designed for a senior citizen. Some policies are made for a particular decrease also.

Types of Health insurance claim settlement processes

There are basically two types of claim settlement processes. First is Cashless and the other one is reimbursement process.

1.    Cashless

Under cashless treatment, the policyholder has to inform the TPA of the health insurance company about the hospitalization under a specific time frame. Normally it is 7 day and in case of emergency, it is 24 hours. After the request is submitted to the TPA the TPA will confirm to the panel hospital to start the cashless procedure. In case you visited a hospital which is not on the panel of the health insurance company, so for that, you can use reimbursement process. 

2.    Reimbursement 

Reimbursement process involves getting the amount back from the health insurance company for the medical expenses. In case you visited a hospital which is not on the panel list of your health insurance company. In such a case the amount you spend in hospital will be given back to you after following the submission procedure. If you got a cashless facility in the hospital still you require requirement facility. Because the pre and post hospitalization expenses are covered under the health insurance policy. The duration of pre-hospitalisation and post hospitalization are according to the policy. For daycare and home treatments, you can also request your reimbursement.

Things to Keep in Mind When Buying Health Insurance

There are certain points which are common to all health policies like pre-hospitalisation, post-hospitalization etc. But there are few things which need to be kept in mind before buying a health insurance policy. Some points are given below:

•    Maternity

•    Ayurveda

•    Cosmetic Surgery

•    Dental  Services

•    The injury caused by protest, tourist attack.

•    Homeopathy

What is co-pay in health insurance?

Co-Pay means that the policyholder and the insurance company, on the mutual written consent agrees for a percentage to pay at the time of claim. The policyholder agrees that his health insurance company will pay a certain percentage of the amount at the time of claim and remaining expenses will be given by the policyholder.

What is Life Long Renewal in health insurance?

This simply means you can have a health insurance policy for a lifetime, especially in your old age.

No Claim Bonus?

It is an important factor to check while purchasing a health insurance policy. No claim bonus means that your health insurance company will give you some discount on the renewal or increase the Sum Assured for every claim free year.

Example some policies can offer 10% discount on premium while some policies offer 50% increase in sum assured.


As the medical expenses are rising a person while choosing a sum assured free a common risk that if the sum assumed is exhausted then it will be difficult for him to pay medical expenses. So he thinks for higher sum assured, but as the sum assured will increase the premium will also rise.

So, as a solution now Health Insurance Company provide restoration option. Restoring the sum assured when it is partially or fully exhausted. The company will not charge any additional premium for this. The facility will depend on policy.

3 Reason Why not to buy Health Insurance Online    

1.    You can buy health insurance policy and company will help you but, in reality, an employee of the company will help you. He will not be liable for any information provided by him at the time of purchase as his major focus is on target. On the other side, if you buy your health insurance policy, your agent is with you, even if you need him to collect documents of visit hospital etc. You have to deal with one person only, not with different representative whenever you gave a call to the company.

2.    5 – 10 minutes process to buy online. But 5 seconds process to buy a policy offline because your agent will fill the form for you.

3.    Your agent has an experience in filling the form, but if you fill the form and you made a mistake or select a thing that you have to leave blank. It will be harmful to you at the time of claim.

Health Insurance vs Mediclaim Policy

People often get confused between health insurance policy and Mediclaim. Basically, a Mediclaim policy provides coverage for hospitalization expenses for a definite pre-specified illness till a certain time as per the sum insured. Under the mediclaim policy, the maximum limit for all claims is fixed at a definite amount. Health insurance is a wider term than mediclaim.


What is health insurance?

Health insurance is insurance of your health. The health insurance company will bear all the medical expenses during hospitalization. This is will also cover pre and post hospitalization with lots of additional benefits. To avail this benefit for himself (individual) or group of individuals (Family), the policyholder has to pay premium annually. 

Why is medical insurance important for every citizen?

Every person and his family member should take health insurance because future is uncertain but the atmosphere where we will, health issues and hospital expenses are rising rapidly. So the one should not think that health insurance is not for him because he/she is fit. Accidental and diseases can come anytime. But, spending 20 – 30k for 3L-5L policy is not a big deal. Even if you are spending 30,000 for 10 years i.e. 3L and you are hospitalized 1 -2 times, your bill would be more than 3 lacks. This cover is for the whole family not just for an individual.

What are tax benefits of health insurance?

Under section 80D of income tax department, the proposer (policyholder) can get income tax rebate up to 25,000 which includes a policy for spouse and children. The deduction for the senior citizen is 30,000.

How is health insurance premium affected?

Health insurance premium is basically calculated on the age of the senior person (proposer). As the age would increase the premium would also increase. You are lucky if you are totally fit. Your premium will be calculated on nominal rates. It is difficult for a person to get policy who is already under a treatment and his premium can also rise.

What is waiting period?

Waiting period means a person cannot get a claim during that period. 

What is Pre Exiting Decease?

Pre Exiting Decease means if you are suffering from a disease and after that, you apply for a health insurance policy. In such case, your health insurance company can reject your case, or can put your case on 2yr or 3yr waiting period or can increase your premium. This depends on your health condition and health insurance company policies.

Is there any limit of claims Limits in a year?

The answer is no. There is no limit of claim in a year. The only condition is, you should have a balance left in your Sum Assured amount.

What is health checkup option offers by health insurance policy?

Health checkup means you can get routine body checkup from any lab. The facility differs from policy to policy. Some policies allow health checkup every year, some allow after two years. Some policies have health checkup expense limit. 

Can a person take more than 1 health insurance?

 Yes, Person can take more than 1 health policy.