Medical emergencies can strike anyone anytime, anywhere. No matter how hard you try, you can neither prevent nor predict them. The only thing you can do is stay prepared for them. This is where health insurance plans or medical insurance plans come to the rescue.
What is health insurance or mediclaim?
Health insurance protects you from expenses that may arise out of sickness or surgery. Health insurance policies can be taken in an individual’s name or for the family as a whole.
Health insurance plans in India offer two options: cashless and reimbursement. In cashless, the insurance company has a list of network hospitals. If a patient goes to any hospital that is on this list, he can avail of hospitalisation without having to pay cash. Under a reimbursement plan, the patient informs the company of a planned or emergency hospitalization. On submission of all relevant documents, the patient is reimbursed the actual expenses.
For all kinds of Medical insurance plans, you get tax exemption for the premium amount as defined under section 80D of Income Tax Act.
Why are health insurance plans necessary for everyone?
The growing number of lifestyle diseases and the rising cost of healthcare has made it necessary to have health insurance plans. A majority of the salaried class in India does have a health cover provided by the company that they work for. However, more often than not, this turns out to be insufficient. Therefore, it is important to buy a personal health insurance policy based on your requirements.
Benefits of buying a mediclaim policy
You must know by now that buying a mediclaim policy provides tremendous financial assistance to a family in case of medical emergencies. In simple words, Mediclaim policies cover all the hospitalization charges of individuals to provide relief to a family at unfortunate events. Considering the current situation of pandemic and rising prices, investing in an insurance policy seems quite fair.
Below is a list of benefits that you can get on buying a mediclaim policy. Take a look:
- Brilliant Cashless Facilities: This is available in each of the networked hospitals of the insurance company. It cuts down all the unpredictable expenses in terms of unfortunate events.
- Dual Cover: Herein, both policies including family floater and individual cover are available.
- Highly Affordable: Investing in a mediclaim policy is a cost-effective approach to avail of extensive healthcare services without shattering your savings.
- Lifelong Renewal Facility: Insured individuals obtain a comprehensive and lifelong renewability option on buying a mediclaim policy as per the chosen policy.
- Cover Hospitalization Expenses: Individuals that opt for mediclaim policy receive hospital expense (in-patient) coverage like doctor’s fee, OT charges, medicine cost, nursing charge, etc.
- Eliminates Financial Contingencies: Purchasing a mediclaim policy reduces the financial burden of a family during unforeseen medical emergencies.
- Tax Exemption Benefits: Under Section 80D, policyholders receive tax benefits on the policy premium each year.
- Other Benefits: Mediclaim policy tags a pool of additional benefits with it like room rent, ICU charges, etc.
Mediclaim vs. Health Insurance
Although often spoken about in the same breath, there are major differences between health insurance plans and Mediclaim insurance plans.
| Mediclaim | |
|---|---|
| An indemnity product that compensates the policy holder for the actual costs incurred for treatment limited by the sum assured | A benefit product which provides a lump sum amount to the insured as laid down in the policy |
| It covers only the costs of hospitalisation | Along with hospitalisation costs, it also covers pre and post hospitalisation expenses, ambulance charges, reimbursement for lost income, etc. |
| Hospitalisation is mandatory | Hospitalisation is not required, especially in critical illness cases |
| The upper limit of the cover usually does not exceed Rs 5 lakh | The upper limit can be close to Rs 60 lakh |
| More than one claim can be made till the sum assured amount is reached | Limited to a single claim. A lump sum is paid only once. |
Compare and buy the best mediclaim and save upto 60,000/-
What are the different kinds of health insurance plans?
There are different types of health insurance plans in India, and also add-ons that can be bought on top of a basic health plan.
Based on the number of people covered under the plan, medical insurance plans can be divided into two categories.
- Individual Plans – These plans cater to only one individual.
- Family Plans – Health insurance plans for family cover an entire family under a single policy.
Buy the best family health insurance plans for you and your loved ones with Turtlemint
Based on the type of coverage, health insurance plans can be divided into the following categories.
- Mediclaim or Regular Health Plans – In this plan, the insurance company reimburses the cost of hospitalization and other hospital stay expenses, as per the sum insured.
- Top-up plan – This is an add-on cover on top of an existing policy. It supports expenses incurred beyond the sum insured of the basic policy. There are many types of top-up plans in the market.
- Critical illness plans – Critical illness plans can be bought separately or as a rider for certain ailments like cancer, kidney failure, heart diseases, etc.
- Senior Citizen Health Plan – With an increase in the average life expectancy of human beings, most health insurance companies are now offering plans specific to the needs of senior citizens.
Why buy health insurance?
Reasons you should buy Health Insurance
- Offers protection in times of need.
- Provides tax benefits, daily cash allowance, etc.
- Gives the policyholder the benefit of cashless hospitalisation.
- Enables one to avail of the best possible treatment.
Points to consider before buying Mediclaim or Health Insurance.
- Opt for health insurance at an early age – The premiums are lower if you start off early.
- Check the premium amount that needs to be paid. However, remember that higher premium does not necessarily mean that the policy is better.
- Read the fine print carefully. This will help you understand what is covered in the policy and what is not. It will also explain the process of claims and reimbursements, waiting period, tax deductions, etc.
- Assess your lifestyle and requirements before buying a policy.
- Last but not the least, clarify every single doubt, no matter how silly and insignificant it might seem.
What is covered in a mediclaim policy?
Mediclaim policy offers comprehensive coverage for a list of hospital expenses. Below is a list of services that the mediclaim policy offers.
- Hospitalization Costs: This covers a range of expenses and charges that occurred during patient hospitalization. To name a few, mediclaim policy covers expenses incurred on:
- OT charges
- Blood
- Diagnostic processes
- Oxygen
- Chemotherapy
- X-ray
- Medicine
- Donor expenses
- Radiotherapy
- Pacemakers
- Sickness
- Accidental hospitalization
- Medical Room Costs: All charges incurred in intensive care units (ICU) and regular wards are compensated under the policy. However, note that this cashless hospitalization takes place at network hospitals only.
- Medical Professional’s Fee: This involves fees charged by all medical professionals. The insurance policy provides compensation for doctors, anesthetists, surgeons, nurses, etc.
What is not covered in a mediclaim policy?
Like every policy, the mediclaim policy has a set of exclusions too. Below is a list of limitations or circumstances wherein you can expect your claim to be considered null.
- Addiction to drugs and alcohol
- Pre-existing ailment until the completion of the waiting period
- Critical illness or medical conditions that are treated within 30 days of the commencing date of the policy
- Certain ailments like joint replacement surgeries are excluded for 2-4 years under the terms of the policy
- Suicide cases
- HIV AIDS
- Hormonal treatment
- Birth control
- Congenital anomaly
- Expenses occurring on dental surgeries (unless the surgery calls for hospitalization)
- Complications during ectopic pregnancy
- Childbirth
Note: To get complete knowledge on the list of exclusions, ensure reading the policy documents carefully.
Why should you read health insurance plans thoroughly?
The policy document will give you details on everything that is covered in the health insurance plan. Here’s an overview of what your medical insurance plans may cover:
Day-care treatment: Hospitalisation for less than 24 hours. Chemotherapy, cataract surgery, angiography, dialysis, radiotherapy, appendectomy, etc., are covered under this form of treatment.
Inpatient hospitalisation: When a patient is admitted to the hospital for more than 24 hours.
Pre-hospitalisation expenses: Medical expenses before being hospitalised. E.g., pathology tests, sonography, X-Ray, etc.
Post hospitalisation expenses: Medical expenses after release from the hospital.
Accident cover: This covers additional expenses in case of accidents and is active from the day of issuance.
Hospital cash/Surgical plans: Many insurance companies offer daily allowance to the insured to handle miscellaneous expenses.
Ambulance charges: Certain health insurance companies cover ambulance charges as well.
Domiciliary hospitalisation: This is when the patient opts for getting treated from their home.
Factors to consider while buying a mediclaim policy
Before buying a mediclaim policy, there are certain factors that need utmost attention. Don’t skip on considering these factors to purchase the best policy available in the market. Have a look!
- Plan Availability: There are two types of plans: Individual and Family Floater. Under individual plans, each individual gets insured for a certain amount. On the other hand, in a family floater plan, the entire family gets insured under a fixed sum. Furthermore in the case of a family floater plan, note that when the insured individual reaches an exit age or dies, the policy gets closed. Hereafter, other members of the family cannot renew the plan. However, in the case of an individual plan, the individual stays insured under the sum assured even if the policyholder reaches the exit age or dies during the policy term.
- Exclusions: Under a mediclaim policy, there are certain expenses that are covered by the insurance provider and that are not covered by the insurance provider. For example, drugs, HIV, alcohol addiction, etc. are excluded from the policy. However, certain surgeries including gall bladder and kidney stones are covered under the plan. Ensure checking the exclusions of policies before buying.
- Pre-existing Illness: Typically, every insurance company covers pre-existing diseases after a certain waiting period. Hence, while making a policy purchase, make sure to check on the pre-existing waiting period of the plan.
- Coverage Amount: This factor needs utmost attention. While selecting a coverage amount, we recommend you to consider a range of factors including surging healthcare cost, rate of inflation, etc. In addition, if you reside in an urban city, know that the hospitalization costs will be 3x times more than rural areas. Hence, if you wish to cover your precious people in the policy, consider going for a higher sum assured.
- Flexibility In Policy Renewal: Some plans are available with a lifetime renewability option. In other terms, such policies denote that you can renew your insurance policy at any age. As many policies have an age limit, these facilities help older people to renew insurance at any age.
- Co-payment Facility: Several mediclaim policies tag a co-payment clause with it. Ideally, co-payment is a percentage of the sum insured that the insured individual needs to bear while raising a claim. However, this takes place before the insurance company settles the surplus amount. Note that this co payment can range anywhere from 10-30% as per the insurance provider. Make sure to check the co-payment option under the chosen policy.
- Network Hospitals: The ideal objective of mediclaim policy is to ease unforeseen financial expenses incurred at unusual events and hospitalizations. Bear in mind that every insurance company has a list of network hospitals wherein policyholders can avail cashless hospitalization expenses. Hence, check the list of network hospitals that the insurance company is associated with.
Health insurance eligibility criteria
Ideal time to buy health cover: The entry age for purchasing health insurance plans in India is 18 – 65 years. Children aged between three months and 18 years are eligible to avail of health insurance.
Existing medical conditions, if any: You need to provide a self-declaration of good health before buying a health insurance plan. Sometimes, the insurer might insist on medical tests to evaluate the health risk.
Health insurance plans in India
Companies offering Mediclaim and Health Insurance Plans in India.
More and more companies are offering either stand-alone Mediclaim insurance plans or a range of health insurance plans in India. Here is a comparative list of the top health insurance plans offered by these companies today.
| Health Insurance Plans | Coverage | Waiting Period (in years) | Sum Insured Range (in lakhs) | Maximum Entry Age (in years) |
|---|---|---|---|---|
| Cigna TTK ProHealth Protect Plan | Up to 4 family members | 4 | 2.5 – 10 | None |
| HDFC ERGO Health Suraksha Insurance | Up to 4 family members | 4 | 2 – 10 | 55 |
| IFFCO Tokio Individual Medishield Policy | Up to 5 family members | 3 | 1 – 5 | 80 |
| Niva Bupa Health Companion | Up to 4 family members | 3 | 2 – 100 | None |
| Reliance Health Gain Insurance | Up to 6 family members | 3 | 3 – 9 | 65 |
| Care Health Insurance Plan | Up to 6 family members | 4 | 3 – 60 | None |
| SBI Health Insurance | Up to 4 family members | 4 | 0.5 – 5 | 65 |
| Star Health and Allied Insurance Family Health Optima Plan | Up to 4 family members | 4 | 2 -25 | 65 |
Mediclaim policy claim procedure
Generally, there are two types of claims that policyholders can raise under a mediclaim policy. Take a look at both of these claim procedures below:
- Cashless Claim Procedure
These claims make sure that a patient gets free (cashless) treatment in a network hospital. This is because the insurance company compensates for the hospital bills on behalf of the insured individual. Typically, the insurer settles bills with the network hospital directly. To raise a cashless claim, follow the steps noted below.- Visit the registered/network hospital of your insurance firm to receive treatment
- Get a pre-authorization application from the insurance desk available in the hospital
- Fill the form with accurate information
- Get a stamp on the form from the hospital (At this stage, the hospital sends your form to the insurer/TPA (third party administrator))
- After approval, the insurance company verifies the treatment
- Next, the company sends a fax to the hospital briefing the total amount/expenses born by them
- After treatment, sign each of the necessary documents during hospital discharge
- Sit back, and your insurer settle your hospital expenses
- Reimbursement Claim Procedure
Under reimbursement claims, make sure you inform your insurance firm that hospitalization is likely to take place or has taken place. To do this, you can either mail your insurance provider or call customer service.
Once you are done with the treatment, ensure collecting all the medical bills/documents from the hospital. To claim a reimbursement, you will have to submit each of the payment receipts, hospital bills, medical bills, etc. incurred during the treatment. Alongside, you need to attach the claim form and the original discharge card. Subsequently, the insurance provider starts reviewing and studying your claim. Upon approval, the insurance company pays the reimbursement amount.
Documents required while buying a mediclaim policy
While purchasing a mediclaim policy, you will need to submit the following documents:
- Address proof: This can be anything like an Aadhar card, Driving license, passport, etc.
- Age proof: This includes passport/voter ID card, Aadhar card, etc.
- Duly filled application/ proposal form
- Identity proof: Driving license, Aadhar card, passport
- Pre-policy medical test reports
- 2 Passport-size photographs
Why choose Turtlemint?
Turtlemint is a one-stop destination for all your health insurance needs, making the entire process smooth, quick and convenient.
- Compare all health insurance policies with one click and find the best health insurance plans in India.
- Calculate the premium using our free premium calculator to understand the cost.
- Contact our experts to resolve any queries through online chat or telephonic discussions.
- Download all brochures and policy documents from one place.
- Once you know the most appropriate policy for you and have gone through all its details, you can buy the best policy online at Turtlemint.
- Do health insurance online renewal easily.
Health insurance renewal
How to renew health insurance plans at Turtlemint?
Health insurance policies can be taken for a maximum of two to three years at a stretch. To ensure continuous coverage, you need to renew your policy before it expires. Most companies offer a grace period of 15 days for renewal. After this grace period expires, the policy lapses.
Renewing your health insurance at Turtlemint is easy. With convenient payment options and ease of porting from one insurer to another, it takes just a few minutes.
- Fill in the basic policy details.
- Select the payment option and make the payment.
- Once the payment is authorised, a digitally signed copy of the renewed policy is issued.
During the health insurance renewal process, you are given a username and password. You can use these credentials to check your policy details online on the health insurance provider’s website.
Know how to renew your health insurance policy online
Tax exemptions on health insurance
Section 80D of Income Tax Act pertains to deductions for premium paid for medical insurance plans. The following rules apply to the deductions.
- If you are under 60 years of age, you can claim deduction up to a maximum of Rs. 25,000/-.
- If you are over 60 years of age, the deduction upper limit is Rs 30,000.
- If you have health insurance for parents (any or both), an additional deduction can be claimed. The limit is up to Rs. 25,000/– if parents are less than 60 years old and Rs 30,000 if they are older than 60 years.
- Hence, the maximum deduction available under section 80D for medical insurance plans is Rs. 55,000/-.
- This limit includes an amount of Rs 5,000 for preventive health check-ups
FAQ’s
Health insurance plans in India can be bought either online or offline. For offline purchases, you can go to a bank or an insurance company’s branch office near you. For online, you can either directly go to an insurance company’s website or go to an insurance aggregator’s website (like Turtlemint), compare the different available products and make the best choice.
The entry age for buying a health insurance policy is 90 days – 18 years for children and 18–65 years for adults.
A Mediclaim plan covers only hospitalization costs. Purely diagnostic treatment and day-care treatment like dental treatments are not covered. Pregnancy and associated complications, congenital disorders, alternative treatments and critical illnesses are also excluded from Mediclaim policies.
You can buy a family floater health insurance policy to cover self, spouse, up to two children, parents and parents-in-law. The sum assured will be shared by all the family members in this case.
If the primary person expires, the policy can be renewed for the other family members, but only if the premium has been paid. The family needs to fill up a change of request form to change the primary insured. The premium would then be recalculated based on the age of the new primary person.
You can increase the sum insured only at the time of renewal of the policy. However, the waiting period will be applicable once again on the extra sum. The insurer may also insist on fresh medical tests.
The policy can be cancelled within the freelook period (usually 15 days). If it is cancelled within this period, a refund will be provided. This refund amount will be calculated after deduction of applicable taxes, proportionate risk premium amount and the expenses incurred for the medical check-up. The policy termination clauses can give a clearer idea about the actual refund.
