Types of Health Insurance Policies Available in India

In today's lifestyle, health problems are difficult to avoid. Increasing stress, poor nutrition, and intake of fast foods have deteriorated our health leading to investment in skyrocketing health care costs. Even a regular checkup nowadays costs a few thousand bucks. In such a case, health insurance acts as an umbrella for financial security. Investment in a good health insurance plan helps us to save our finances and get the best health care services in a time of need.

There are various health insurance available in India nowadays and therefore your choice of plan decides whether it is the perfect one for you or not. The perfect plan can be chosen based on numerous factors such as premium, sum assured, coverage, family or individual plan, critical illness, personal accidents, and additional benefits. Today, InsuranceDekho is going to discuss all the major health insurance plans available in the market, their benefits, and exclusions which will surely help you to choose the best one for you in the future.

Some of the popular types of health insurance policies in India are Individual health insurance, Family floater health insurance, Senior citizen health insurance, Critical illness health insurance, Maternity health insurance, Group health insurance plans, Preventive healthcare, and Personal accident insurance.

Types of Health Insurance Policies In India

Let us get a detailed picture of all the healthcare policies:

1. Individual Health Insurance Plans

Individual health insurance plan protects only an insured individual from all the medical expenses covered in his/her respective health plan. It is an agreement between a health insurance company and a policyholder wherein the insurer guarantees to take care of medical costs based on the investment made or the premium amount paid by the insured.

Benefits of Individual Health Insurance Plans

The benefits of having individual health insurance are immense which includes the best healthcare possible at an affordable premium; one gets the cashless facility which saves you from the hassle of initiating a claim. Here are the other benefits:

• Insured gets all the benefits that are available in the plan taken by him/her.
• The sum assured amount can be completely used by the policyholder without distributing it to any other person.
• The policyholder, if wishes to, can add their immediate family members to the policy in the future.
• Under this plan, any number of claims can be made by an individual in a year as there are no restrictions like the family floater plans.
• The plan covers lifetime renewal as there is no restriction on the maximum age for the members for the renewal of the policy.
• Individual plans generally include hospitalization expenses, pre and post-hospitalization charges, medical examinations cost, surgery cost, laboratory charges, maternity care expenses, and consultation fees.
• The plan provides coverage for critical illness.
• The insured get tax benefits on premiums paid towards medical insurance under Section 80D of the Income Tax Act, 1961.

Exclusions of Individual Health Insurance Plans:

• In most cases, pre-existing diseases are not covered, even if covered, then only after the completion of the waiting period.
• Non-allopathic treatments are not covered in individual health insurance plans but some insurers have started offering insurance for AYUSH treatment, that is, for Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatments.
• Alcohol and drug-related issues are not covered.
• Cosmetic surgeries are also not covered under individual healthcare plans.

2. Family Floater Health Insurance Plans

As the name suggests, a family floater health insurance plan is designed to offer insurance coverage to an entire family, unlike an individual health insurance policy. These plans act as an umbrella medical protection for all the family members in case of unforeseen events. The plan saves you a lot of money (as it is cost-effective), and time (as only a single plan is capable of fulfilling the medical costs of the entire family), and is hassle-free (as you are safe from the trouble & tension of buying and looking after multiple individual health plans).

Most of the family floater insurance plans in India cover the policyholder, spouse, and dependent children and a few insurers include dependent siblings, parents, and in-laws. Most insurance plans cover up to 13-15 members of a family.

To decide on the right family floater health insurance policy, take the below-mentioned factors into consideration:

Lifelong Renewability: Most of the insurance companies offer the option of policy renewability till the age of 60 to 65 and there are some that offer lifelong renewability. Choose health insurance that provides financial aid when it is needed the most.
Sum Insured Amount:  Insurance companies give you the option to increase the sum insured to cover the medical costs as the expenses are increasing day after day.
NCB (No Bonus Claims): If you haven’t made any claims in the previous year, you will receive NCB in the form of an increase in the sum insured.
Cashless Facility: If you choose cashless treatment, you are surely safe from the hassle of initiating a claim for reimbursement. In cases of emergency hospitalization, accidents, and non-network hospital admissions, insurers need to pay for treatment first, then claim for reimbursement.
Pre-existing Conditions (including critical illness)- Choose a policy that covers pre-existing conditions or a policy that has a shorter waiting period as compared to other plans.
New members’ addition: If you plan on having a baby, you have the option to go for maternity and newborn baby cover as new members can be added anytime in the family floater plan.

3. Senior Citizen Health Insurance Plans

The older we get, the more our chances are to get targeted by unexpected medical expenditures and lack of income adds to the problem; therefore, the plan which suits the most in such a case is, the Senior Citizen health insurance plan. These plans are designed specifically for people who are 60-65 years or above. Senior citizens must invest in a good medical insurance plan that provides them with adequate health coverage caused due to an ailment, disability, or an accident and offers various special features like cashless hospitalization, critical illness coverage, and specific coverage for diseases like Stroke, Cancer, and so on. The premium amount depends on the age of the policyholder and the sum insured.

Factors to Consider while choosing a Senior Citizen Health Insurance Plan in India

Co-payment: It is the fixed amount that the insured has to pay for covered healthcare service and the remaining is paid by the insurer to the hospital. Co-pay depends on the hospital and the specified ailments.
Sub-limit: It is the percentage of the sum insured that the insurance company pays such as room rent, doctor’s fee, cataract treatment, and cardiovascular treatment.
Waiting period: The waiting period for a senior citizen health insurance plan is higher, for critical illness, it is between 1 to 4 years.
Pre-existing Medical case:  Some plans offer coverage for pre-existing medical conditions after the completion of a waiting period (which is around 2-3 years) and only up to 50% of the claim is payable in case of pre-existing conditions.
Medical Certificates: Senior citizens have to provide medical certificates while buying a health insurance policy.

Advantages of senior citizen policies:

1. A good plan can lead to a peaceful and stress-free retired life knowing that their medical expenses will be covered in case of emergency.
2. In most of the cases, a higher sum assured benefit is given in senior citizen policy.
3. Senior citizens, in their chosen plan, can make use of the cashless hospitalization facility available.
4. Hospitalization covers including room charges, daycare expenses, and ambulance charges are included.

4. Critical Illness Insurance Plans

A critical illness health insurance plan provides health coverage against a severe illness that can be very expensive to treat and usually takes a long time to recover. Under this health plan, if within the term of the policy, the policyholder is diagnosed with any of the critical illnesses mentioned in the policy document (after a time frame of 90 days), then the sum assured amount and the related benefits are paid to the insured.

Diseases like cancer, heart attack, aplastic anemia, permanent paralysis of limbs, muscular dystrophy, and kidney failure are some of the critical illnesses covered. Buy a critical illness rider with a Low waiting period, Affordable premium, plan with a good number of illnesses covered, Maximum renewability age of 60 to 65 years or with lifelong renewability, and Sum insured of 4 to 5 times the annual income.

Benefits of critical illness plans

• This plan gives you a lump sum amount if diagnosed with a serious illness covered by your policy.
• It also covers recuperation (healing) aid and other expenses that your basic insurance plans do not cover.
• Insured can avail of tax benefits.
• Apart from covering your medical expenses, the policyholder is also eligible for regular free health check-ups.
• Many insurers also take into consideration the fact that policyholders with a critical illness cannot work and therefore offer them daily allowance benefits.

Exclusions of a Critical Illness Rider

The critical illness rider will not insure you in case of the following diseases:

• Diagnosis of the illness within the first 90 days from the date of policy inception.
• Demise of the member insured in a time period of 30 days from the date of diagnosis or surgery.
• Illnesses caused due to substance abuse, smoking, pregnancy or childbirth.
• Illness caused due to HIV/AIDS.
• War, terrorism, navy or military operations
• Infertility treatment
• Dental or cosmetic surgery.
• Treatment done outside India
• Hormone replacement treatment

Note: Critical illness insurance plan is different than the other health insurance plans and is taken separately as its benefits are mostly not provided in any of the health insurance plans, that is, getting a health insurance plan does not provide medical expenses against any of the critical/fatal diseases.

5. Maternity Health Insurance Plans

Maternity is a life-altering journey for a woman. With rising medical expenses and overall expenditure, childbirth costs has become expensive. Lack of proper planning before your pregnancy may result in burning a hole in your pocket and therefore one has to be financially prepared to welcome a child. During maternity, a plethora of consultations, follow-ups, and medical tests are required. To sort out all the financial matters in such a case, a maternity health insurance plan acts as a savior, as a comprehensive maternity health insurance plan keeps your savings in place as the insurance company settles the bill directly with the hospital and gives you a sigh of relief.

A maternity insurance rider can be attached to your base health insurance policy to provide coverage for pregnancy and childbirth expenses. Its benefits can help reduce the cost of hospitalization, delivery (Caesarean or normal), tests, and medication.

Facilities Offered under Maternity Health Insurance Plans:

Pre and Post Hospitalization expenses: Pre-hospitalization expenses of up to 30 days before the date of admission are covered by the insurer along with the post-hospitalization expenses of up to INR 5,000 for 60 days from the date of discharge.
Hospitalization expenses: It covers ambulance fees for emergency transportation, room rent, delivery expenses, nursing expenses along with surgeon, and consultation fees.
Inclusion of Pre and post-natal care: It comprises delivery (both normal and cesarean), and in case any complication arises, post-delivery for the mother, then it also covers that.
Coverage for newly born: It provides medical coverage for the newborn child diagnosed with a critical illness or congenital disorder. Some plans also cover vaccination expenses for the infant for the first year.

Exclusions of Maternity Health Insurance Plan

• Doctor's fee for regular health check-ups
• Diagnostic tests, follow-ups, and consultation fees during the pregnancy period, that is, nine months of pregnancy, are not covered.
• Vitamins and tonics, unless part of treatment or mentioned in the plan, are not covered.
• In-vitro fertilization and infertility-related expenses
• Non-allopathic treatment costs

Note: In a maternity health plan, there is a waiting period of 3 to 4 years before the benefits are activated.

6. Group/Employee Health Insurance Plans

Group health insurance provides insurance coverage to employees of the company. This is provided by the employer to its employees as an incentive to boost their morale and for personnel retention. In this group health insurance plan, the employees can also opt for additional coverage to cover their family members including self, spouse, children, and parents.

Benefits of Employee/Group Health Insurance Policy:

One of the important benefits of group health insurance policy in India is that it helps any organization retain its employees as they feel safe when their employer offers sufficient insurance coverage for them. Other benefits include:

1. Insured members do not have to undergo tests or provide medical certificates to obtain group health insurance. Employees are eligible for the group insurance policy automatically.
2. Any employee can avail of cashless treatment at the network hospitals of the insurer.
3. The plan may also provide reimbursement of specialists' fees for follow-up health check-ups.
4. The policyholders, employers, and employees get tax deductions on the premiums paid.
5. The cost of this health insurance is lower as compared to individual health insurance.
6. Maternity benefits (covered by some policies) are a part of group/employee health insurance policy which most individual health policies do not cover.
7. The claim period is less as claims can be made within the first 30 days of getting the group insurance policy.
8. Even a relationship manager is assigned to the company to take care of the employees’ policy-related queries.
9. Co-payment is not required for the company’s employees above 60 years of age.
10. Ambulance cost is covered under the group health insurance plans.
11. Some group insurance policies may cover boarding expenses excluding the surgeon, anesthetist, and consultant fees, costs for anesthesia, oxygen and diagnostic materials, X-rays, and dialysis costs among others.
12. Some plans also provide coverage for pre-existing diseases after payment of an extra premium.

7. Preventive Healthcare Plans

Preventive health care plans include the identification and minimization of disease-causing factors at an early stage by detecting the disease through screening. This has become very important since it allows an individual to know about their health issues within time. For example, a diagnosis of a fatal disease such as cancer in the last stage can lead to death, whereas, with prior warning, you can get the best treatment and save yourself.

Neglecting a disease may lead to fatal or irreversible conditions and the preventive care plans do not let this thing happen. Preventive healthcare plans include various tests such as HIV tests, cancer screenings, cholesterol tests, sugar tests, PAP smears, and genetic testing.

Facilities Offered by Preventive Healthcare Plans:

Preventive healthcare packages in India cover the following expenses:

1. Regular Checkups: Regular health check-ups at network hospitals of the insurer.
2. Employee Health Checkup: An employee can go for regular health check-ups under group insurance plans for various organizations.
3. Family Healthcare: Family preventive healthcare to cover the self, spouse, children, and dependent parents.
4. Child Healthcare: Child preventive healthcare package for children aged zero to thirteen (0-13) years.
5. Diabetes Plans: Diabetes may affect the vital organs of the body- brain, kidney, heart, and liver; therefore, regular check-ups of the patients are of extreme importance.

8. Personal Accident Insurance Plans

As we all know accidents are increasing day by day, therefore safeguarding yourself from unforeseen situations can help you immensely. An accident insurance plan provides for the accidental death benefits, disabilities, and also for the expenses of hospitalisation, transportation of patient & family, and repair of vehicle or residence. Other miscellaneous expenditures can also be covered in this plan.

Apart from covering a policyholder’s medical expenses, personal accident plans offer a sum assured amount to the family in case of the demise of the insured. You can attach personal accident insurance as a rider to your base policy.

There are two types of personal accident plans:

Individual accident insurance

This plan covers an individual in the event of disability, dismemberment, or demise due to an accident.

Group accident insurance

Employers provide group accident insurance to their eligible employees. This type of plan usually offers basic coverage unlike individual accident insurance, which provides many benefits. Some of the other features that can be included in a personal accident cover are ambulance fees, burns, daily cash allowance during hospitalization, etc.

Advantages of Personal Accident Cover

Have you ever wondered how would you manage your financial commitments in case the breadwinner of your family is permanently disabled or, in the worst case, is not there anymore? Here is when a personal accident plan comes to your rescue.

Some of the benefits of personal accident plans are as follows

1. Cover ensures the family’s security.
2. No medical tests or documentation is required.
3. Personal accident cover is available for families as well as individuals.
4. In India, most of the personal accident covers include legal and funeral expenses.
5. Easy and certified claim process
6. Worldwide coverage
7. 24*7 support system/staff
8. Highly customized plan
9. In case of accidents, some plans also offer bonuses for kids who are dependent, in case the treatment period is stretched or there is demise of the insured.

Exclusions of a personal accident cover

• Suicide and self-injuries
• Pregnancy or childbirth
• Pre-existing disability or injury
• Disability due to abuse of substances such as drugs and alcohol
• Death or injuries due to an unlawful act
• Suffering from a mental disorder
• Participation in the navy, military, and air force
• Participation in extreme sports

It can be concluded by saying that health insurance plans are very important in a person’s life, from kids to adults everybody requires security. Health insurance plans offer security against unexpected medical contingencies and keep your family's finances intact in time of need. If we keep in mind the rising medical inflation and spurt of diseases, buying the best health insurance plan is mandatory for every individual. A medical emergency can affect you financially as well as mentally. Therefore, choose the best out of the above-mentioned health insurance plans, in accordance with your needs and budget, without even giving it a second thought.

Also Read:

Senior Citizen Health Insurance Plans - Benefits, Types and Exclusions

Types of Health Insurance Plans Offered by Religare Health Insurance