Health Insurance

Best Health Insurance Plans in India

by SMCIB on Wed, Feb 08 2023

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Imagine a carpenter with a toolbox. Just like he has many types of tools to carry out different jobs, a good health insurance plan should also have multiple benefits and features to meet your healthcare needs. And similar to a carpenter choosing the right tool for the right job, you must choose the right health insurance plan with the right benefits that fit your needs and requirements.

In this article, we discuss what health insurance is and also some of the best health insurance plans in India. So, let’s get started!

What is Health Insurance?

You never know when a medical expense will come knocking at your door. A health insurance plan makes sure that when there is a medical need, you don’t pay expensive bills for treatments from your pockets. Instead, you pay regular premiums to the insurance company and they cover both planned and unplanned healthcare expenses.

What is Covered under a Health Insurance Plan?

A health insurance policy covers a majority of your hospitalisation expenses. This includes –

  1. Inpatient Care Expenses: - These expenses are covered when you have been hospitalised consecutively for more than 24 hours. They include treatment expenses, room rent, surgery costs, consultation fees, oxygen supply, medicinal costs, etc.

  2. Pre-Hospitalisation Expenses: – These are the healthcare expenses incurred before getting hospitalised. Pre-hospitalisation expenses include consultation and test costs like blood tests, X-rays, ECG, EEG, OPD consultation fees, etc. They are generally covered for a period of 30-90 days depending on the health insurance provider.

  3. Post-Hospitalisation Expenses: - These are the expenses that are incurred after getting discharged from the hospital. Post-hospitalisation expenses include the costs of follow-up consultations, diagnostic tests like colonoscopy, physiotherapy sessions, etc. They are generally covered for a period of 60-180 days depending on the health insurance provider.

  4. Daycare Treatment Costs: – These are the medical costs incurred on treatments that are completed in less than 24 hours. The treatment can take place either at a hospital or daycare centre under local or general anaesthesia. Some of the daycare treatments are chemotherapy, cataract surgeries, hernia treatments, dialysis, gallbladder removal, etc.

  5. Domiciliary Treatment Costs: – These are the costs that are incurred for treatments received at home. The reason may be because there are no available beds at the hospital at the time or because your condition is so serious that you cannot be transferred to a hospital.

  6. AYUSH Treatments: – These treatments include Ayurveda, Yoga Unani, Siddha, Homeopathy, etc. If you undergo any such treatments, then the policy might offer coverage for them.

    You must check the scope of coverage a plan offers to pick and customise the best one that fits your and your family’s medical needs.

What is Not Covered/Excluded Under Your Health Insurance Plan?

Your health insurance plan might not cover certain expenses that are classified as Permanent and Temporary exclusions.

  1. Permanent exclusions are those that will never be covered under your health insurance plan. They are further classified into Standard and Additional permanent exclusions.

    Standard exclusions include the costs of diagnosis or observation, obesity or weight control expenses, treatments for use of drugs or narcotics, gender change treatments, cosmetic or plastic surgeries, unproven treatments, treatments for injuries caused due to risky profession or adventure sports, other costs like registration fees, administrative fees, etc.

    Apart from these exclusions, the insurance provider may not cover additional exclusions for the costs of treating specific diseases and conditions. If such treatments or diseases are excluded from your policy, then the insurer will not pay for any such expenses when incurred. But you should be aware of the fact that insurers are allowed to restrict only a specified set of illnesses. This means that they cannot apply permanent exclusions to medical conditions and diseases beyond this list.

  2. Temporary exclusions (waiting periods) are those that the insurer does not cover for a specific duration. You will have to serve certain “waiting periods” to get coverage from the insurer.

    Initial waiting period - This is a waiting period of 30 days from the date of the policy issue. You cannot claim any medical expenses during this period except for accidents.

    Pre-existing disease waiting period - A pre-existing disease is a condition, injury, ailment, or disease that your family is diagnosed or treated for 48 months prior to the date of your policy issue. All health insurance plans come with a waiting period of 2 to 4 years for pre-existing diseases.

    Specified disease/treatment waiting period - Your insurer will impose a waiting period of 2 to 4 years for a specified list of conditions like hernia, haemorrhoids, spinal disorders, chronic kidney diseases, etc. Your policy document will list all such diseases, and you must go through them carefully before buying health insurance.

  3. Your health insurance plan might have certain financial limits, like -

    Room Rent Limit - Room rent is the per day room charges that are incurred when you get hospitalised. And, a room rent limit is a limit set on such charges. If you choose a room that is beyond the limit you are eligible for, insurers will not just deduct the difference in room charges but will also proportionately deduct associated medical expenses.

    Copay - The copay clause is an agreement between you and the insurer that the claim amount will be shared by the insurance company and you. It means that a percentage of the approved claim will be paid from your pockets and the rest by the insurer.

    Sub-limits on Treatments/Surgeries - These are limits set on specific treatments and surgeries that you might undergo in the future. So, you will not be able to make a claim beyond the specified amount - even if the treatment costs fall within your sum insured. The limit imposed can either be a percentage of the cost incurred or a predefined amount specified at the time of buying the policy. Common treatments that have such sub-limits are knee surgeries, cataract treatments, etc.

When choosing the best health insurance plan for yourself or your family, you must make sure that it has the least restrictions and minimal limitations. This will ensure that you make the best use of the health insurance purchased.

Best Health Insurance Plans in India

Imagine you ask your friends what the best car in India is. One person might say that a Maruti is the best because of its mileage, while someone might say that a Tata is the best because of its safety rating. Everyone will give you a different answer, simply because the “best” is wholly personal. It depends on the needs and requirements of the individual.

Similarly, when it comes to health insurance, there is no single “best” policy. It entirely depends on your unique needs. The best policy for you is the one that suits your healthcare requirements the most. For instance, a person who envisions having kids in the near future will want a maternity cover with their health insurance plan. A person who prefers Ayurvedic treatments will require AYUSH treatments to be covered by their health insurance plan.

So, when it comes to choosing the “best” health insurance for yourself, you need to figure out what you need from it.

To help ease your hunt for the best plan here’s a quick comparison of the Top Health Insurance plans available in the market today.

Care Insurance - Care (Supreme) Manipal Cigna - ProHealth Prime (Protect) Tata AIG - Medicare (Premier)
Room Rent Limit There is no limit There is no limit Single Private AC Room
Pre-Existing Diseases Waiting Period A duration of 48 months A duration of 24 months A duration of 24 months
Specific disease Waiting Period A duration of 24 months A duration of 24 months A duration of 24 months
Pre-hospitalization Expenses Covered for 60 days up to the Sum Insured Covered for 60 days up to the Sum Insured Covered for 60 days up to the Sum Insured
Post-hospitalization Expenses Covered for 180 days up to the Sum Insured Covered for 180 days up to the Sum Insured Covered for 90 days up to the Sum Insured
Day Care Treatment Expenses All treatments are covered All treatments are covered 541 treatments are covered
Modern Treatment Expenses Up to the Sum Insured Up to the Sum Insured Up to the Sum Insured
Domiciliary Treatment Expenses Up to the Sum Insured Up to 10% of the Sum Insured Up to the Sum Insured
Organ Donor Expenses Harvesting expenses covered up to the Sum Insured Inpatient expenses are covered up to the Sum Insured Harvesting expenses covered up to the Sum Insured
Refill/ reload of sum insured Available Available Available
No Claim Bonus

Available

(50% increase, for every claim-free year, up to a maximum of 100% of the Sum Insured)

Available

(25% increase, for every claim-free year, up to a maximum of 200% of the Sum Insured)

Available

(50% increase, for every claim-free year, up to a maximum of 100% of the Sum Insured)

Super No Claim Bonus

Available

(100% increase every year, maximum up to 500%)

Available

(50% of increase every year, maximum up to 100%)

Available

Annual premium ₹18,213 ₹21,340 ₹24,029

Please Note: Premiums are taken on 10.01.2023 for a family of 3. The family comprises a 30-year-old male, a 30-year-old female, and a 1-year-old son. The sum insured is 10 Lakhs and the premium is inclusive of taxes.

Conclusion

As we have come to the end of the article, we hope you have gained enough insights on choosing the best health insurance plan. We highly recommend that to pick the right plan, you must first analyse your and your family’s medical needs. This will ensure that you buy a plan that is best for you.