You And Your Healthcare Policy

Sayanika GhoshFeb 4 . 8 min read

You And Your Healthcare Policy

Before buying a health insurance policy, at the very first you must understand what health insurance is. 

Health Insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses.

In the next part, let's know more about health insurance and discuss the best plans and companies. 

Health Insurance FAQs India 

1. What is a pre-existing condition in health insurance?

Most people might be suffering from one or another disease before a policy is bought. These diseases or conditions which existed before the health insurance policy was bought are known as pre-existing conditions in health insurance. It stands as a very important topic in health insurance since many of the health insurance policies might not cover pre-existing conditions, for 4 years after the purchase of the first policy.

2 . Is there any waiting period for claims under a policy?

Yes, there will be a 30days waiting period starting from the policy inception date, during which the insurance companies will not pay any hospitalization charges. However, this does not apply to any emergency hospitalization occurring due to an accident

3 . What is meant by a cashless facility?


All the insurance companies have tied up arrangements with the best hospitals all over the country. Therefore the policyholder can take treatment only in any of the network hospitals without having to pay a single penny to the hospital as the payment is made directly by the third-party administrator on behalf of the insurance company. This is known as the cashless facility in health insurance.

4 . What is the maximum number of claims allowed over a year?

There is no limit of claims over a year during the policy period until and unless there is a specific cap prescribed in any policy. However, the sum insured is the maximum limit under the policy.

5 . Can the policy expire if it is not renewed on time?

Most insurance companies offer a grace period of fifteen days to pay a premium from the date of expiry of the policy. However, the coverage would be unavailable for the period for which no premium is received by the Insurance company and the policy will lose its existence if the premium is not paid within the specified grace period.

Health Insurance in India 

One of the growing segments of India's economy is Health Insurance. The Indian Healthcare system is one of the largest in the world with the number of people it concerns; nearly 1.3 billion potential beneficiaries. 

There are 4 types of Health Insurance, they are as follows:

1. Health maintenance organizations (HMOs): Health maintenance organizations offer you a local network of participating doctors, hospitals, and other facilities that you're required to choose from. 

2. Exclusive provider organizations (EPOs): Exclusive provider organizations offer you a network of participating providers. However, EPO plans might not always cover out-of-network care except in the case of an emergency.

3. Point-of-service (POS): Point of Service plans provide both the features of HMO and PPO plans.

4. Preferred provider organizations (PPOs): Preferred Provider Organizations offer you a large network of participating providers, so you'll have a long list of doctors, hospitals, healthcare professionals, and facilities to choose from.

Different Types of Health Insurance Plans

1. Individual health insurance policy

2. Family floater insurance policies

3. Senior citizen health insurance policies

4. Critical illness plans 

5. Maternity health insurance schemes 

6. Group or employe health insurance 

7. Preventive health care 

8. Personal accident covers

IFFCO Tokio General Insurance Company, which has 1416 networked hospitals, ranks 1st in India with a Health Claim Settlement Ratio of 96.33%, followed by Care Health Insurance Company, which has 2500 networked hospitals, ranking 2nd with a Health Claim Settlement Ratio of 95.47%, and Magma HDI Health Insurance company, which has 5016 networked hospitals, ranking 3rd with a Health Claim Settlement Ratio of 95.17%. 

Key points to remember while purchasing a health insurance plan 

1. A typical health insurance policy doesn't cover OPD expenses.

2. Choosing an IPD policy with an OPD component in it as an add-on is more cost-effective.

3. Indemnity health plans with in-built or optional OPD cover or OPD-specific plan.

Guidelines in health insurance 

IRDA issued guidelines standardizing 46 most commonly used terms/definitions/conditions in health insurance policies. The IRDA guidelines for claim settlement is that the claim should be settled within 30-45 days from the date of communicating, the last required document to the policyholder. The time duration will depend upon the nature of the claim and investigation is required. The guidelines also include definitions of 11 common critical illnesses covered under various health insurance policies in India.

For more information, visit here.

Best Health Insurance Plans in India

Although there are many mediclaim policies offered by different insurance companies here I've listed some of the best medical policies in India that you can consider buying.

1. Aditya Birla Mediclaim Policy, Some insured-10-30 lakhs, Network Hospitals 8700+, Renewability- lifelong.

2. Bajaj Allianz Mediclaim Policy, Sum insured- 1.5-50 lakhs, Network Hospitals- 6500+, Renewability- lifelong.

3. Bharti AXA Mediclaim Policy, Sum insured- 3,4,5 lakhs, Network Hospitals- 4500+, Renewability- lifelong.

4. Care Health insurance Mediclaim Policy, Some insured- 3-60 lakhs, Network Hospitals 16500+, Renewability- life long.

5. Cholamandalam Mediclaim Policy, Sum insured- 2-15 lakhs, Network Hospitals 6500+, Renewability- lifelong.

6. Digit mediclaim policy Mediclaim Policy, Some insured-2-25 lakhs, Network Hospitals 6400+, Renewability- lifelong.

7. Edelweiss Mediclaim Policy, Sum insured-5 lakhs 1 crore, Network Hospitals 3200+, Renewability- lifelong.

8. Future Generali Mediclaim Policy; Sum insured: vital- 3,5,10 lakhs, superior- 15,20,25 lakhs, premiere- 50 lakh to 1 crore; Network Hospitals- 6000+, Renewability- lifelong.

9. IFFCO TOKIO Individual Medishield Mediclaim Policy, Sum insured-50 thousand -5 lakhs, Network Hospitals- 6400+, Renewability- lifelong.

10. Kotak Mahindra Mediclaim Policy, Sum insured- 2 lakh -1 crore, Network Hospitals- 5000+, Renewability- lifelong.

How to claim health insurance in India

1. If there is a medical issue and you need to get admitted, check the list of network hospitals in your vicinity and select one of the hospitals of your choice.

2. Every hospital has an insurance desk where they address insurance and cashless claim-related worries. Ask them for a pre-authorization form or you can download and get a printout of the document from the third-party administrator's website.

3. Fill up the form carefully and submit it at the insurance desk.

4. The third-party administrator will process your form and send you a confirmation email along with a letter sanctioning the maximum treatment amount.

It is to be assured that the information provided in this article is well-researched and trustworthy.

More from Vedifly