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About India health insurance

As humans, we are vulnerable to falling sick or getting a disease due to our hectic and stressful lifestyle. Sometimes even a minor change in weather can cause sickness. Health care of late is very expensive and more than the disease itself, it is often the cost of treatment that takes its toll on our peace of mind. The solution to these health related expense worries lies in having a good Health Insurance Policy which covers medical expenses incurred during pre and post hospitalization stages.
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eindiainsurance is the best platform for you to compare various policies and the benefits offered by leading Insurance Companies in India and to buy the best suitable mediclaim policy online for your family and you.

So why wait? Compare and Buy a plan today and leave your health care worries to your Health Insurance policy..!!

Best Health Insurance in India

Star Health
  • Available for age 3 months - 75 yrs
  • Life long renewal.
  • Suitable plan for middle class
  • Floater basis and individual basis
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Max Bupa
  • Available for age 0 - 99 yrs
  • Life long renewal.
  • Free health check up on renewal
  • Maternity up to Rs. 1Lac and new born baby coverage from day one
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Religare
  • Choose sum-insured 2-60 lacs
  • Automatic policy free recharge
  • Direct claim settlement
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Apollo Munich
  • Covers maternity after 4/6 years of waiting period
  • Pre-existing benefits are covered after 4 years of continuous renewal
  • Renewal for life
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Reliance
  • Pre-existing dieseases covered after 2/4 years of continuous renewal.
  • No Copayment, No room rent or ICU restrictions
  • No loading on renewal premium
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Bajaj Allianz
  • Coverage for the entire family
  • Gives comphrehensive coverages
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TATA AIG
  • Available for age 3 months - 65 yrs
  • Life long renewal.
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Future Generali
  • Available for age 90days - 70 yrs
  • Life long renewal.
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IFFCO Tokio
An medical ailment or an injury can arrive at any time when you are totally unprepared. Health Insurance helps you pay for this high quality healthcare.
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HDFC Health
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Cholamandalam
  • Available for age 18 years - 65 years.
  • Pre and post hospitalization expenses covered for 60 days and 90 days respectively.
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Cigna TTK
  • Min Entry Age: Child - 91 days, Adult - 18 years
  • Max Entry Age: No limit
  • Cover Type: Individual and Family Floater
  • Policy Period: 1, 2 and 3 years
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Health is a human right. It’s accessibility and affordability has to be ensured by the Government but the escalating cost of medical treatment is beyond the reach of common man especially in Tier II and Tier III cities (Rural areas). Health care has always been a problem area for India, a nation with a large population and larger percentage of this population living in urban slums and in rural area, below the poverty line. Under this situation, one of the ways for the government to reduce funding and augment the resources in the health sector was to encourage the development of health insurance. Currently (according to the Health Vertical Specialist team at Cognizant Technology) some of the challenges being faced in the Health Sector are :
  • Increase in health care costs due to better quality treatment, more qualified doctors and other facility maintenance Costs in Urban Areas
  • The poor are finding the escalating medical costs a huge financial burden
  • Need for long term and nursing care for senior citizens because of increasing nuclear family system
  • Increasing burden of new diseases and health risks - There have been disrup¬tive lifestyle changes in the country over the past two decades mainly due to the rapidly evolving urban economy and the Indian middle class. It is estimated that around 130 million people may suffer from lifestyle diseases such as diabetes and obesity in the next few years, leaving a $160 billion hole in the national econ¬omy during the next few years
  • Preventive and primary care and public health functions in Rural India have been neglected. Affordable care (government hos¬pitals or community-based care) suffers from quality issues and is unable to cater to the basic healthcare needs of the growing population. While some private care delivery centers and profes¬sionals are accessible to the needy, they are not affordable for a majority of the population.
  • Medical health insurance penetration is very low. Health insurance is a minor contributor in the health¬care ecosystem. Insurance payment struc¬tures are based on an almost indemnity-based payments. Indian insurance has been limited to critical illness coverage for inpatient surgical proce¬dures.
The India Healthcare Industry is estimated to row to $280 billion by 2020 from the $79 billion that was the size in 2012. This is despite the per capita spending on Healthcare in India (according to WHO Report 2012) amongst the lowest in the world.
health graph
In India the Per capita spending is just $109 per person against the world average of $863, this highest being in the USA who have this number pegged at $7,285. The focus of the India Healthcare Industry thus has to focus on Access, Cost and Quality to ensure we correct this alarming situation.
According to a detailed study by the Global Conference of Actuaries a few years ago, almost 78% of the Healthcare spend is borne Out of the Pocket of the individuals... this presents perhaps the biggest gaps that the Health Insurance players must fill aggressively over the next decade or so as well as being the biggest opportunity for Health Insurers and Distributors to capitalise upon…this is significantly higher than most developed nations across the world.
health graph
You will note in the tables below (in the same study by the Global Actuaries), that India and China lag behind the other developed nations in terms of their Government’s allocation to Healthcare overall. In India this stand at currently around 2.9%, which China is slightly higher at 10.10%. But very importantly as a % of the overall GDP, the Health spends in India is around 5%, a marginal step ahead of China. But even then when we compare this to the largest economy like USA, the Government spend is a whopping 15.4% of their massive GDP. So there is a long way to go for India in the Healthcare space.
health graph
health graph
What are the Illness plaguing India today?
Almost 38 million deaths occurred due to non-communicable diseases ( NCDs) each year. In that 16 million deaths occur before the age of 70 & 82% of these premature deaths occurred in low- and middle-income countries including India. The World Health Organisation (WHO) indicates that India ranks very high among the nations affected by the rising wave of premature deaths caused by non-communicable diseases, which account for 60% of all deaths in India.

Non-communicable diseases, also known as chronic diseases, which are impacting India today. They are long duration illnesses and have slow progression like cardiovascular diseases, cancers, chronic respiratory diseases and diabetes which are not passed from person to person. In India, roughly 5.8 million Indians die because of diabetes, cancer, stroke, heart and lung diseases each year. In other words, out of 4 Indians 1 has risks dying from an NCD before the age of 70.
  • About 1.7 million Indian's deaths caused by heart diseases every year, according to the World Health Organisation.
  • Roughly 16 lakh people suffer from stroke throughout the India and health has found that 55 to 60 per cent men are prone to stroke as compared to women.
  • In 2014, the incidence of cancer in India was 70-90 per 100,000 populations and this has been growing steadily year on year. And cancer prevalence is established to be around 2,500,000 (2.5 million) with over 800,000 new cases and 5,50,000 deaths occurring each year.
  • Latest statistics provides that diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic. And it is predicted that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India. According to International Diabetes Federation (IDF) 1 in every 10 adults will have diabetes in 2030. Study to find prevalence of diabetes & hypertension discovers 80% people had abdominal obesity.
According to the World Health Organisation (WHO) Statistical Profile for India in 2012, the Top 10 causes of death amongst Indians are presented in a chart below.
health graph
Price-Waterhouse-Coopers predicts that in 2025, an estimated 18.9 crore people in the country (more than 60 years of age), will be needing higher healthcare spends. By the end of 2025, India will need as many as 17.5 crore additional beds according to a combined study by an industry body and Ernst & Young. In India, 3.2 crore people go below the national poverty line because of their spending on healthcare out of their own pockets for themselves and their family members. Out of total expenditure on healthcare, more than 78% goes out of the patient's pocket and the rest is paid by the Government and insurance companies.

Another challenge is the underinsurance percentage of people between 61-65 years which is currently hovering around 75%. This means that the persons in this age category, while having an insurance policy, have a very low SI which will not completely cover their medical expenses and again they will need to cough up from their pocket all their hard earned savings. One of the main reasons for this alarming underinsurance statistics is that people must understand that health insurance is not just a tax saving tool, and therefore be mindful while choosing an appropriate sum insured based on their lifestyle for themselves and their family. At 52% men are more underinsured than women at 46%. Also, underinsurance is more prevalent in higher age brackets as 62% of policyholders above 45 years of age.

The positive news for the India market is that between the Stand Alone Health Insurance players and the General Insurance companies offering Health Insurance, almost all policies cover such Lifestyle Illnesses and some of them have products specifically for Cancer, Diabetes etc. The Sum insureds offered by the Health insurers have also significantly increased and with options like “Sum Insured Restore” the customer really is spoilt for choice today. This means that individuals can insure themselves against financial stress in case they are effected by any of these NCD’s.
Some data around the Health Insurance Market (as put together by IBEF in June 2018) :
  • Only 18% of people in urban areas and 14.1% in rural areas are covered under any kind of health insurance scheme and this is primarily driven by Government Sponsored and Corporate Health schemes.
  • Gross direct premium from health insurance reached Rs 37,897 crores (US$ 5.88 billion) in FY17-18 and contributed 25.2% per cent to the gross direct premiums of non-life insurance companies in India.
  • Absence of a government-funded health insurance makes the market attractive for private players
  • Introduction of health insurance portability was expected to boost the orderly growth of the health insurance sector ut has not created the desired impact in the India market (much like the Telecom sector)
  • In July 2016, IRDA issued Health Insurance Regulations, 2016. These regulations replace the Health Insurance Regulations, 2013. As per these new norms, companies will provide better data disclosure, pilot products, coverage in younger years, etc.
  • Government-sponsored programmes expected to provide coverage to nearly 380 million people by 2020, driven by initiatives such as RSBY and ESIC
  • RSBY is a centrally sponsored scheme to provide health insurance to Below Poverty Line (BPL) families and eleven other defined categories of unorganised workers, namely building and other construction workers, licensed railway porters, street vendors, MGNREGA workers, etc.
So what Health Insurance?
Health Insurance is a policy which covers the insured for Medical Expenses post hospitalisation, whether it be a Sickness or Accident. This treatment could have major financial impact on the insured and their family and hence it is prudent for every individual to have sufficient Health Insurance in place. Some of the main coverages under the Health Insurance policy include:
  • In-patient treatment (Cashless) including room rent, ICU, nursing, medicines drugs & consumables covered without as per the policy terms and conditions upto the Sum insured mentioned on the policy. Covered expenses include:
    • Room, Boarding expenses
    • Nursing expenses
    • Fees of surgeon, anesthetist, physician, consultants, specialists
    • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
  • Pre and Post Hospitalization medical expenses: Medical expenses incurred normally upto 30 days immediately before hospitalization and normally upto 60 days immediately post hospitalization remain covered. The coverage period can be extended by submitting relevant documents to the insurer at least 5 days before the Hospitalisation.
  • Day Care Procedures: Most policies covers medical expenses for 120-150 different day care treatments which do not require 24 hours hospitalization
  • Domiciliary Treatment: The policy also covers for the medical expenses incurred for availing medical treatment at home on the advice of the attending Medical Practitioner which would otherwise have required Hospitalisation.
  • Organ Donor: The policy covers Medical Expenses on harvesting the organ from the donor for organ transplantation.
  • Dental Treatment (in case of Accident): The insurance company will reimburse Medical Expenses of any necessary dental treatment from a Dentist provided that the Dental treatment is required as a result of an Accident. Maximum liability shall be limited to the amount specified in the Schedule of Benefits.
  • Ambulance Charges - In most cases the ambulance charges are paid by the policy and the policy holder usually doesn't have to bear the same
  • Cover for Pre-existing Diseases - Health insurance policies have the option of covering pre-existing diseases after 3 or 4 years of continuously renewing the policy without any break in period, i.e. if someone has hypertension, then after completion of 3 or 4 years of continuous renewal with the same insurer (depending on the plan offered and his age), any hospitalisation due to hypertension will also be covered)
  • Other Terms to be aware of:
    • Sum Insured : The Sum Insured offered may be on an individual basis or on floater basis for the family as a whole.
    • Cumulative Bonus (CB) : Health Insurance policies may offer Cumulative Bonus wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal subject to a maximum percentage (generally 50%). In case of a claim, CB will be reduced by 10% at the next renewal.
    • Cost of Health Check-up : Health policies may also contain a provision for reimbursement of cost of health check up. Read your policy carefully to understand what is allowed.
    • Minimum period of stay in Hospital : In order to become eligible to make a claim under the policy, minimum stay in the Hospital is necessary for a certain number of hours. Usually this is 24 hours. This time limit may not apply for treatment of accidental injuries and for certain specified treatments. Read the policy provision to understand the details.
    • Pre and post hospitalization expenses : Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness. Go through the specific provision in this regard.
    • Cashless Facility : Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
    • Additional Benefits and other stand alone policies : Insurance companies offer various other benefits as "Add-ons" or riders. There are also stand alone policies that are designed to give benefits like "Hospital Cash", "Critical Illness Benefits", "Surgical Expense Benefits" etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
    • Key Points to Remember when Choosing your Health Insurance Plan
      • Sum Insured by the policy
      • Co Pays / Deductibles / Sub Limits
      • Waiting Period for Pre Existing Diseases
      • Insurer’s List of network hospitals across India and Claim Settlement Ratio
      • Reputation and Claims paying capacity of the insurer
      • Premium to be paid for the coverage

Frequently Asked Questions

Please find below some relevant FAQ’s for Individual Health Insurance.

The health insurance policy is a type of insurance policy that covers your medical expenses in case of sickness or accident. A health insurance policy is a contract between an insurer and an individual /group in which the insurer agrees to provide specified health insurance cover at a particular “premium”.

Every individual should buy health insurance and for themselves and members of their family, based on their requirements. Buying health insurance protects individuals from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent into household savings. Each person is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advancements, new procedures and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.

Today the Health insurance industry is flooded with various options to choose from. Under a vanilla Indemnity Plan Sum insureds ranging from Rs 5000 in micro-insurance policies to even a sum insured of Rs 50 lakhs or more in certain critical illness plans are being offered to individuals. Most insurers offer policies between 1 lakh to 5 lakh sum insured. Also, while most non-life insurance companies offer health insurance policies for a duration of one year, there are policies that are issued for two, three, four and five years duration also. Another product, which is the Hospital Daily Cash Benefit policy, provides a fixed daily sum insured for each day of hospitalization. A Critical Illness benefit policy provides a fixed lumpsum amount to the insured in case of diagnosis of a specified illness covered under the policy or on undergoing a specified surgery. There are also other types of products, which offer lumpsum payment on undergoing a specified surgery (Surgical Cash Benefit), and others catering to the needs of specified target audience like senior citizens.

The individual must read the prospectus/policy wordings (terms and conditions) to understand what is covered and not covered under the plan opted for. Generally, pre-existing diseases are excluded under a Health Insurance policy for the first 3-4 years. There would generally be certain standard exclusions such as cost of spectacles, contact lenses and hearing aids, dental treatment/surgery, congenital defects, intentional self-injury / suicide, use of intoxicating drugs/alcohol, AIDS, treatment relating to pregnancy or child birth. Please read the policy terms and conditions.

Age is the most important factor that determines the premium, the older the person is, the premium cost will be higher because older persons are more prone to illnesses. Previous medical history is another major factor that influences the premium. If no prior adverse medical history exists, premium will automatically be lower. Claim free years also come with certain percentage of discount on premium.

Family Floater is one single policy that takes care of the hospitalization expenses of your entire family. The policy has one single sum insured, which can be utilised by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured.

It is a medical condition/disease that existed before the person obtained health insurance policy, for which the insured is availing treatment or has undergone a surgery in the recent past. Normally pre-existing conditions, are excluded for the first 48 months. It means, pre-existing conditions can be considered for payment after completion of 48 months of continuous coverage.

After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement unless the plan has a “Restore Option” For Example: In January you start a policy with a coverage of Rs 5 Lakh for the year. In April, you make a claim of Rs 2 lakh. The coverage available to you for the May to December will be the balance of Rs.3 lakh. This is provided the insured has not opted for the plan with Restore cover. This reinstates the SI to Rs.5 lacs.

Some health insurance policies pay for specified expenses towards general health check up once in a few years. Normally this is available once in four years and is mainly offered as a value add to their corporate customers.

Insurance companies, through Third Party Administrators (TPA’s) have arrangements with several hospitals all over the country as their network to offer cashless treatment for individuals. This means that the insured can get treatment without having to pay the hospital bills as the payment is made to the hospital directly by the Third Party Administrator, on behalf of the insurance company. However, expenses beyond the limits or sub-limits as per terms and conditions of the policy and expenses not covered under the policy have to be settled by the insured directly with the hospital. Cashless facility, however, is not generally available if you take treatment in a non network hospital.

Yes. When the insured buys a new policy, generally, there will be a 30 days waiting period starting from the policy inception date, during which period any hospitalization charges will not be payable by the insurer. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable for subsequent policies under renewal.

Yes. The Insurance Regulatory and Development Authority (IRDA) has issued a circular in October, 2011, which allows the insurance companies to allow Portability from one insurance company to another and from one plan to another, without making the insured to lose the renewal benefits for pre-existing conditions, enjoyed in the previous policy.

Any number of claims are allowed during the policy period unless there is a specific cap prescribed in any policy. However the sum insured is the maximum limit under the policy.

The policy will be renewed provided the insured pays the premium within 15 days (called as Grace Period) from the date of renewal. However, coverage would not be available for the period for which no premium is received by the insurance company. The policy will lapse if the premium is not paid within the grace period.

Health insurance comes with attractive tax benefits as an added incentive. There is an exclusive section of the Income Tax Act which provides tax benefits for health insurance, which is Section 80D, and which is unlike the section 80C applicable to Life Insurance wherein other form of investments/ expenditure also qualify for the deduction. Currently, purchasers of health insurance who have purchased the policy by any payment mode other than cash can avail of an annual deduction of Rs. 15,000 from their taxable income for payment of Health Insurance premium for self, spouse and dependent children. For senior citizens, this deduction is higher, and is Rs. 20,000.

Below are some of the exclusions under a Health Insurance policy, please refer to the respective insurance company’s policy wordings for the entire list of exclusions.
  • Medical Exclusions:
    • "AIDS" / HIV
    • Abuse of intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction
    • Treatment of Obesity and any weight control program subject to cover under benefit
    • Psychiatric, mental disorders (including mental health treatments)
    • Parkinsons and Alzheimer’s disease
    • Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services
    • Plastic surgery or cosmetic surgery
    • Dental treatment or surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization & any dental treatment
  • Non Medical Exclusions +-+
    • Adventure Sport like diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
    • Intentional self-injury or attempted suicide while sane or insane.
    • Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy
    • Any treatment and associated expenses for alopecia, baldness, wigs, or toupees
    • Any claim incurred after date of proposal and before issuance of policy where there is change in health status of the member and the same is not communicated to the insurer

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