Which is the No 1 Health Insurance in India?

by SMCIB on Monday, 06 March 2023

Which is the No 1 Health Insurance in India?

With good health comes happiness. However, life is not a bed of roses and uncertainties are an inseparable part of it. So, it is crucial to be prepared for any situation that comes your way.

A report by Indus Health Plus states that 5.8 million Indians die every year as a result of diseases like diabetes, cancer, stroke, etc. In other words, 1 out of 4 Indians faces death because of non-communicable diseases each year - which is quite frankly, a shocking statistic. Not to mention the fact that the costs of treating such diseases can be pretty high.

To protect yourself from the financial repercussions of medical treatments and hospitalisation, you should invest in a good health insurance plan. But, how do you ensure that the plan you choose is the best, the number 1 health insurance? Let’s see - in this article!

Which is the No 1 Health Insurance in India?

To find the no 1 health insurance in India, you should pick a plan -

That Gives You Ample Coverage & Fits Your Budget

Buying a health insurance policy is a way to secure your future against all medical costs. With increasing medical inflation, it is crucial to opt for a sum insured that will be enough for both the present and the future. You should factor in an inflation rate of 8-10% to ensure that your health insurance cover will suffice your medical needs down the road, because upgrading your cover later will be a huge task. Your health insurance eligibility goes down as you grow older because of your increased susceptibility to diseases and health issues.

While choosing the coverage, keep in mind that the premiums are directly proportional to the sum insured. The larger the sum insured, the higher the premiums. So, remember to pick a sum insured that’s both enough for your healthcare requirements and gives you pocket-friendly premiums.

That Provides Comprehensive Coverage

Before buying a policy, you should be aware of the coverage that it offers you. You should confirm that the policy offers comprehensive coverage and covers several expenses including -

Inpatient care The care that you receive when you are admitted to a hospital for treatment purposes due to an illness, accident, surgery, etc. These treatments are covered by the insurance company if you undergo a continuous hospitalisation of 24 hours or more.
Daycare treatments This is an exception to inpatient care coverage. Daycare treatments are performed under general or local anaesthesia and usually take less than 24 hours to complete. For example, cataract surgery, angiography, hernia, gallbladder removal, etc.
Pre and post-hospitalization expenses

All the expenses incurred before and after your hospitalisation are covered under the pre and post-hospitalization expenses.

  • Pre-hospitalization expenses include blood tests, X-Rays, OPD, doctor consultation, etc.

  • Post-hospitalization expenses include follow-up visits to your doctor, diagnostic tests, rehabilitation, etc.

Domiciliary treatments These are medical treatments carried out at home under the supervision of a doctor and the observation of nurses/paramedics.Domiciliary treatments are opted for when there is a lack of hospital beds or when the injury/illness is so severe that you can’t be moved to the hospital.

That Offers Numerous Features and Benefits

Health insurance provides numerous benefits which enhance your coverage. The greater the scope of coverage, the better the plan.

Some benefits are in-built while some can be chosen voluntarily. Some benefits you should keep an eye out for are the Restoration Benefit, which restores or reinstates your sum insured if it gets used up in a policy year, and the No-Claim Bonus, under which the insurer rewards you with a higher sum insured or lower premiums if you have a claim-free policy year.

Note: All such benefits come with associated terms and conditions. Peruse them carefully.


That Has The Least Limitations

Your health policy might come with certain financial limitations. You should go through the policy wording and have a chat with your agent/advisor to know about the same - so you don’t run into any unpleasant surprises when you make a claim.

Here are a few financial limitations you must be aware of -

  1. Room-Rent Limit

    It is the limit up to which your health insurance plan will cover the per-day hospital room expenses. If you choose a room whose rent is more than what you are eligible for, your insurer will not only deduct the difference in room charges but will also deduct all associated medical expenses.

  2. Copay

    Copay is a portion of the approved claim amount that you will have to pay from your pocket before the insurer pays the remaining amount. So, before buying a health policy, look for options without the copay clause, or with a limited copay. This will limit your out-of-pocket expenses.

  3. Limits on Treatment

    Some health policies may have restrictions on the amount to be spent on certain treatments or surgeries, like cataract surgery, knee surgery, etc.

  4. Limits on Benefits

    Certain benefits in a health insurance plan such as domiciliary hospitalisation cover, organ donor cover, etc. may have financial limits. A cap may be imposed by the insurance companies on the coverage that these benefits provide. If your expenses surpass the limit specified by the insurer, you will have to pay the same from your pocket.

That Comes With The Lowest Exclusions

Situations that are not covered under a health plan are referred to as exclusions. Types of exclusions -

  1. Permanent Exclusions

    There are certain exclusions set by IRDAI, which are standard and must be followed by every insurance company. Besides these, various exclusions may be applied by insurance companies - which they mention in their policy wording. These additional exclusions need to adhere to the diseases listed by the IRDAI.

  2. Temporary Exclusions (Also known as ‘waiting periods’)

    Health insurance plans come with waiting periods. A waiting period is a time span during which the insurer will not cover your healthcare expenses.

    Types of waiting periods -

    • Initial waiting period

      Your insurer will impose a 30-day initial waiting period for all treatments after you purchase a policy, except those related to accidents.

    • Pre-existing disease waiting period

      Any medical condition that is diagnosed or treated within 48 months before the purchase of the policy is referred to as a pre-existing disease. PEDs have a waiting period of 2-4 years.

    • Specified disease/ procedure waiting period

      A waiting period of 2-4 years is imposed on specific conditions and treatments like hernias, haemorrhoids, chronic kidney disease, etc.

    So, to ensure that you receive the maximum coverage as early as possible, pick a plan that comes with the lowest exclusions.

Where The Insurer Has Tie-Ups With Many Network Hospitals

A hospital that has an agreement for cashless treatment with your insurance provider is referred to as a network hospital. In a cashless treatment, all medical bills and paperwork are settled between the hospital and the insurer. So, you don’t have to run around to arrange documents and the money required for the treatment.

Before buying a health policy from an insurance company, always check the list of network hospitals. Make sure the insurer has tie-ups with the maximum number of hospitals and that there are multiple network hospitals in your vicinity. This will ensure that you avail of quality treatment on a cashless basis in both unplanned and planned situations.

Where The Insurer Has An Impeccable Record

You should research and have a look at the track record of the insurer. Check their claim settlement ratio, the time they take to settle a claim, and any complaints they have received. You can also talk to previous and present customers, read online reviews, and have a look at their social media and community handles to get a better sense of how their customer service is.

Finding The No 1 Health Insurance At SMC

You can follow these simple steps to pick the best health insurance plan -

  • Visit www.smcinsurance.com and select Health Insurance.

  • Select the members you want to cover and fill in their ages.

  • Enter details like your pin code and mobile number.

  • After this, you will be redirected to a page with the top Health Insurance plans.

  • You can select the sum insured, features, and add-ons you need.

  • Then, you can proceed with the application process.

Wrapping Up

Once you understand all the features, benefits, exclusions, etc., of the various health insurance plans in the market, you can buy a plan that suits your needs. Compare the plans and choose a policy that fits your budget and aligns with your needs and requirements seamlessly. That is the number 1 health insurance for you!

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