India health insurance coverage, factors and premium calculator

Some key things you should consider before buying a health insurance plan are:

• Cashless Hospital Network of the Insurer – Number of hospitals
• Room Rent Limits
• % Co Payment for claims
• Waiting periods across all coverages
• Exclusions under the policy
• No Claim Bonus for claim free years
• Claims Settlement Ratio and Reputation of the Insurance company

Typical coverages under the Health Insurance policy will be

• 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.
• 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).