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Benefits of Health Insurance

Comprehensive health insurance policies are full of benefits for their policyholders that most people may not be aware of.

  • 1

    Cashless Treatment

    A policyholder can avail of required treatment in any network hospital (registered with his insurance provider) without paying the treatment expenses (up to the sum insured limit). How? The company pays on his behalf and allows him to focus on his treatment.

  • 2

    Pre & Post Hospitalization Expenses

    The expenses before hospitalization and after discharge from the hospital (up to a specific period) are covered by health insurance, provided the treatment agrees with the terms and conditions of the chosen policy

  • 3

    Covers pre-existing diseases

    A health plan covers you for a pre-existing disease once you have completed the waiting period mentioned in the policy certificate.

  • 4

    Claim tax benefit

    You can claim a tax benefit on health insurance premium under section 80D of the Income Tax Act, 1961.

  • 5

    Covers ambulance expenses

    Comprehensive health insurance also pays for your ambulance expenses during a medical emergency.

  • 6

    Portability

    Health insurance portability allows the policyholders to switch from their existing health insurance company to another, in case they are not satisfied with their existing health insurance plan, or find a more suitable plan. Portability feature saves the policyholders from being taken for granted and offers them flexibility to switch in case of dissatisfaction.

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As per the insurance guideline, you are allowed to cancel the policy within 15 days from the date of issuance of the policy. For more details, please read the Plan Brochure carefully or talk to our advisor at the time of purchase.

  • Know more About Health Insurance

    What Is Health Insurance?

    Health insurance is a specific type of insurance policy that offers medical coverage to the insured against unforeseen medical bills in case of sudden hospitalization. Medical insurance ensures protection against diseases and injuries by directly paying the medical care provider on your behalf.

    A comprehensive health insurance policy covers the cost of hospitalisation including pre and post-hospitalisation expenses, medical care at home (otherwise known as Domiciliary Hospitalisation), daycare procedures, ambulance charges, amongst others.

    • Cashless Treatment: Cash is something that may not be available to everyone all the time and that is the reason why cashless health insurance has taken a massive ground. In the event of hospitalization, if you are covered under a health insurance plan that provide cashless treatment, you no longer have to worry about your medical bills payment because your insurance company will take care of the payment through cashless scheme on your behalf let you focus on the medical treatment only.

      Cashless treatment may be your savior when you don’t have arranged funds in the form of cash at the time of any medical emergency. All you have to do is choose a health insurance provider that offers cashless treatment facility to avail this benefit.

    • Covers Pre & Post Hospitalization Costs

      Health insurance policy covers all the expenses before the patient is admitted to a hospital and after discharge from the hospital up to a specific period given that such expenses are associated with the illness depending on the terms and conditions of the insurance company.

    • No Claim Bonus (NCB): No Claim Bonus (NCB) for health insurance stands for a specific amount of discount that you will receive for not filing any claim during a policy term. This discount is applicable on your premium at the time of your health insurance renewal. NCB triggers the health insurance policyholder to not file a claim during a policy period.
    • Co-payment: When you buy a mediclaim policy, you will come across the term stated as co-pay. Co-pay stands for a pre-specified amount that you have to pay before your health insurance company comes forward to settle down the rest of the medical bills when you file a claim. Your overall Sum Insured amount is not affected by co-payment.
    • Family Discounts: This discount is offered by various health insurance companies in India for enrolling any family member or any person under a health insurance policy. This is a form of reward offered by health insurers to their existing policyholders for referring them to people.
    • Lifelong Renewability: Since it’s important to pick the best health insurance plan that comes with the option of lifetime renewability, especially in the old age, health insurance companies in India has started offering health plans that can be renewed throughout the lifetime of an insured person. However, lifelong renewability is only applicable if there’s no break in your health policy.
    • Free Health Check-Ups: Health insurance companies provide free health check-up to encourage all its policyholder lead a healthy life. The free health check-up facility is provided only once in a while but that totally depends upon the type of plan you choose to buy.
    • Get Tax Benefits

      If you purchase a health insurance policy, you will be eligible to get tax benefits for the premiums paid under Section 80D of the Income Tax Act, 1961. Depending upon the age of the policyholder and his/her parents (if any), one can enjoy tax benefits up to a certain limit.

    • Restoration Benefit

      Restoration benefit under health insurance basically restore your Sum Insured amount automatically once the you have completely used your Sum Insured in a policy year. The insurance company will offer you this benefit you do not have to pay any additional cost for the same. However, the medical insurance plans with restoration benefits are expensive when compared to basic health insurance plans and are applicable on the word of the clauses of the policy.

    • Covers Organ Transplant Expenses

      Your health insurance company will bear the costs of organ transplantation since health insurance policy covers surgery expenses related to organ donation. However, keep in mind that costs for complications post surgery, medical tests and organ donor expenses are not covered under the same.


    Health Insurance Claim Settlement Procedure

    Although most people are concerned about how TPAs work, still many don’t know how health insurance claims are settled. A good health insurance company will settle your health claims as soon as possible. However, the time it may to settle a health claim may vary. For the claim on your mediclaim policy, the insured must approach the TPA for all formalities and verification process. It takes generally two days to settle claims for TPAs. Here’s how to file a health insurance with your insurance provider.

    Although most people are concerned about how TPAs work, still many don’t know how health insurance claims are settled. A good health insurance company will settle your health claims as soon as possible. However, the time it may to settle a health claim may vary.

    For the claim on your mediclaim policy, the insured must approach the TPA for all formalities and verification process. It takes generally two days to settle claims for TPAs. Here’s how to file a health insurance with your insurance provider.


    • Cashless Health Insurance Claim Process

    • Cashless treatment can be availed only through the network hospital of your best health insurance company in India.
    • You must intimate the TPA prior to pre-planned hospitalization, or within a specific time duration in case of an emergency.
    • The hospital's insurance desk will assist you with all the paperwork.
    • The TPA needs to approve the mediclaim amount and thereafter the insurance company will settle the bills with the hospital except some excluded costs that have to be settled from the pocket of the patient party directly.
    • Reimbursement Health Insurance Claim Process

    • Reimbursement facility can be availed both at networked and non-networked hospitals by the patients.
    • With this facility, you will have to settle your mediclaim bills directly with the hospital after treatment.
    • Thereafter you can file health insurance claim reimbursement of the expenditures from the TPA by providing the relevant receipts and bills.

    10 Things to Check before Buying Health Insurance Plans Online

    There are a number of factors that you must consider while buying health insurance policy online. However, including every one of the factors would be both confusing and hard, so here are the 10 most important things that you must check while buying health insurance plans online in India.

    • Sublimits on the Health Insurance Plan: While buying health insurance online, for most of the time we are inclined to ignore the sublimits on certain benefits and then regret afterwards. Therefore, it is important to ensure the limits on room rent, ambulance charges and other expenses so that these charges don’t end up devouring your lifelong savings later.
    • Level of Coverage: Before buying health insurance online, firstly, you must check the coverage level of that particular health insurance plan. Even though the fundamental coverage remains the same, some absolute limits may vary in from one medical policy to another. Moreover, it’s always shrewd to go with a health plan that includes features that you may require and not overload yourself with needless features.
    • Cashless Claim Feature: Cashless claim facility is one of the best benefits where a direct settlement of medical expenses takes place between the insurer and hospitals. This facility is basically offered under most health insurance plans when the patient undergoes any treatment in one of the hospitals that is listed in the network of hospitals with the insurance company.
    • Entry Age: Checking the entry age is an important factor that you must consider if you wish to buy a family floater health insurance plan. You must check for the maximum age of parents/parents-in-law and dependent children if applicable.
    • Waiting Period: Waiting period is basically a limited time period where exclusions of specific ailments/sickness are applicable. You will have to wait for this waiting period before your insurer starts covering pre-existing diseases (if any). It’s always wise to check the waiting period earlier since different health insurance plans impose different waiting periods under different plans.
    • Exclusions: It would be awfully disappointing if your medical condition or ailment is not covered under your health insurance plan at the time of a medical emergency. Thus, it is always wise that you read the policy documents carefully and be cautious of all the medical conditions which are excluded from your health insurance plan.
    • Network of Hospitals: At the time of choosing a health insurance plan, the wisest move is to learn about the network of hospitals that are associated with the insurance company and offer cashless claim services. This facility gives you mental relief at times of medical emergencies.
    • Premium: The premium that you are paying for a health insurance policy should always be kept in mind before buying the policy. The amount payable for your health insurance policy should be reasonable and suitable when compared to other medical insurance plans.
    • Exclusions: It would be awfully disappointing if your medical condition or ailment is not covered under your health insurance plan at the time of a medical emergency. Thus, it is always wise that you read the policy documents carefully and be cautious of all the medical conditions which are excluded from your health insurance plan.
    • Additional Benefits: When you check for the best health insurance plan online, it makes sense to seek for add-on riders attached with your health plan in order to increase the coverage, scope and benefits of the comprehensive mediclaim policy.
    • Renewability: Nowadays, a perfect health insurance policy generally offers a lifelong renewal option on most health insurance plans. For this reason, renewability is a vital factor while choosing the right health insurance plan for your loved ones or yourself.

    Steps to Choose the Best Health Insurance Policy for Family

    There are quite a few parameters that you must consider before you buying a health insurance plan for family. Some of them are stated below:

    • Co-payment: This is one of the factors that one must consider. You must find out whether or not the health insurance plan you are purchasing for family provides a co-payment option. The co-payment option is basically a standard feature. It is defined as a fixed percentage of money that is to be paid by the insured when a claim is filed.
    • Your Budget: You must consider the financial budget of your family, on the basis of how much coverage would be enough for the protection of all your family members.
    • Compare Health Insurance Plans Online: It is a must that before you invest a single penny in a health insurance plan, you compare the health plans from the top insurers and choose the one that suits best for your needs.
    • Number of Family Members: When buying a health insurance plan, you must consider the number of family members. Most health insurance providers in India generally cover up to 4 to 6 family members under their family floater health insurance policy plan.
    • Addition of New Family Member: : The addition a new member to the family is a moment of joy. Therefore, when purchasing health insurance online, you must also consider the circumstances in the policy if you wish to get the new family member added under the health insurance policy.
    • Claim Settlement Procedure: Claim settlement process of any insurance company used to be a bulky process which generally forbids a person from purchasing a health insurance plan online. But today, all the health insurance companies provide an easy and hassle-free claim settlement procedure that makes it convenient for the insurance buyers.


    Why Health Insurance Policyholders Go for Portability?

    Portability is a relatively new facet introduced for mediclaim policies in India. Now, you don’t necessarily have to get your policy renewal done with the same insurer year after year. New insurers are coming with lucrative deals. So, you can compare medical insurance companies in India and select the provider of best policies on your medical policy renewal. The portability feature of health insurance in India essentially allows mediclaim policyholders switch from one insurer to another. You can retail all your accrued benefits even if you decide to change your policy provider.

    There are many reasons why policyholders choose to port their mediclaim policy. Mediclaim policyholders change insurers if they find an insurer with better deals. Sometimes, inefficient services by existing providers force policyholders look for a new medical insurance company in India. Ever since its introduction, portability has proved to be beneficial for policyholders. Here are the advantages of porting of health insurance in India.

    • You can port your mediclaim policy in India to another insurer for free.
    • Both individual mediclaim policy and family floater policies are eligible for mediclaim policy portability.
    • All benefits earned by medical insurance policyholder regarding waiting period and NCB are retained when they port the mediclaim policy to new insurance provider.


    Conditions regarding medical policy portability

    IRDAI imposes some terms and conditions and deadline for all policyholders willing to port their mediclaim policy have to maintain. Policyholders in India also have to go by guidelines set by IRDAI. Here are some vital guidelines about portability of medical cover in India.

    • Medical insurance portability can be done only at the time of health insurance renewal
    • Mediclaim policyholders need to make application a minimum of 45 days before their health insurance renewal
    • Both the existing health insurer and the new insurer where mediclaim insurance policy will be ported must be aware of this decision of policyholders.
    • New medical company can rightfully work out the terms and conditions of the best health insurance policy in India
    • New health insurance company has to retain the benefits accumulated by the mediclaim policyholders from their previous providers.
    • Mediclaim policyholders can select between individual and family floater policies for their new medical insurance policy.
    • The new health insurance company can turn down the request of portability if mediclaim policyholders don’t pay their premium in time.
    • Policyholders get 30 additional days if their porting is under process.

    Health Insurance Schemes by Our Government of India

    • Rashtriya Swasthya Bima Yojana (RSBY): This scheme of Government of India is especially launched to offer the health insurance benefits to the families that are below property line. This plan offers financial protection for the unorganized workers. Ministry of Labor and Employment under the Central Government has launched this scheme.
    • Pradhan Matri Suraksha Bima Yojana: This Government scheme is beneficial for those families that belong to economically underprivileged sections of the Indian society. This scheme financially securing those families with a sum insured of up to Rs. 2 lakhs. It is specially designed to financially protect families and individuals against death, and partial and total disability.
    • Aam Aadmi Bima Yojana: The scheme was launched in 2013. This government scheme has been tailor-made for addressing the 48 occupational groups or rural areas with landless households. The amalgamation of Aam Aadmi Bima Yojana (AABY) and Janashree Bima Yojana (JBY) has resulted in the newly formed scheme, named Aam Aadmi Bima Yojana. It offers medical insurance benefits to any one earning member of a family or the head of a family.
    • Ayushman Bharat: This scheme is specially launched by Government of India with the aim of offering benefits of up to Rs. 5 lakhs to 50 crore to the people who belong to underprivileged families throughout India. Ayushman Bharat is an ambitious scheme covering even pre-existing disease. This health insurance scheme can be availed at government as well as private hospitals. In other words, this plan offers comprehensive medical benefits to the deprived families.
    • Universal Health Insurance Scheme (UHIS): It is an effective initiative of Indian Government and was launched in 2003. This scheme provides quality healthcare to Indian families that are below as well as above the poverty line, especially BPL families. Under this scheme compensation of Rs.30, 000/- is given to the insured and his or her family against medical expenses due to hospitalization. Even death of the earning member of the family due to any mishap is covered in this scheme.


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Product Comprehensive Plan Family Health Optima Care Care Freedom Kotak General Isurance Edelweisses ICICI Lombard
Product Type Reimbursement Hospitalization And Cashless Reimbursement Hospitalization And Cashless Reimbursement Hospitalization And Cashless Reimbursement Hospitalization And Cashless Reimbursement Hospitalization And Cashless Reimbursement Hospitalization And Cashless Reimbursement Hospitalization And Cashless
Key Features ( Key features of the plan ) Automatic Restoration – 100% Available, No Claim Bonus, Hospital Cash Benefit, Cover Against Accidental Death And Permanent Total Disablement, Health Checkup For Every Claim-free Year, Wellness Program – Earn Wellness Reward, Option Available To Buy Back Pre-existing Disease Automatic Restroration Of SI, Instant Recharge UPTO 30% Of SI, New Born Baby Cover From 16th Day 15 Days Free-look Period, Lifelong Renewability,Auto Recharge If SA Exhausts Upto 100%, 541 Day Care Treatment, No Claim Based Loading, 5420+ Network Hospital Covered 15 Days Free-look Period, Lifelong Renewability, 170 Day Care Treatment, 5420+ Network Hospital Covered, 100% Increase Of Sum Insured With No Claim Bonanza Low Premium , No Limit on everything ,Can take mimimum 3 lacs SI , No co-pay till 65 age 241 Benift , Can take 3 Lacs SI , Not limit     on minimum SI & no zone wise co pay USP : Donor Expenses, Emergency Assistance, World Wide Coverage, Unlimited Reset, Air Ambulance, Super No Claim Bonus, ASI Protector, Sum Insured Protector,Claim protector
OPD Details ( In some policies, OPD (Out patient department) expenses are also covered. ) Available Once Every 3 Years, Rs 5000 Not Applicable Not Applicable (Optional) Not Applicable Not Applicable Not Applicable Not Applicable, (optional) 
Pre-acceptance Medical Check Up ( Whether a pre-acceptance check up is required or not to buy the policy ) Not Applicable Not Required Not Applicable Not Applicable Not Applicable Applicable Post  60 age Applicable after 55
IN-PATIENT CARE






Room Rent ( A limit of room rent cover during hospitalization if any ) Private Single Standard A/C Single Standard AC Room, Actual Single Private Room, Upgradable  Twin Sharing Single Private Room Single Private Room, Upgradable  Any category 
Domiciliary Hospitalization ( It is the expenses incurred on treatment of the patient at home ) Covered For A Period Exceeding Three Days. Yes Up To SI Up To SI Up To SI Up To SI Up To SI
Pre-hospitalization ( Expenses before the insured is hospitalized ) 60 Days 60 Days 30 Days 30 Days 60 Days 30 Days 30 Days
Post-hospitalization ( Expenses after discharge from the hospital ) 90 Days 90 Days 60 Days 60 Days 90 Days 60 Days 60 Days
Non-allopathic ( Expenses incurred on non-allopathic treatment ) Yes Yes Yes No Yes Yes Yes
Day Care Treatment Covered ( Day care treatments refers to the treatments that do not necessarily require 24hrs of hospitalization like MRI. ) All Daycare Treatments Are Covered ALL DAY CARE PROCEDURES COVERED 541 Procedures 171 Procedures All Daycare Treatments Are Covered All Daycare Treatments Are Covered All Daycare Treatments Are Covered
COVERAGE TERMS






Organ Donor Expenses ( Expenses incurred on organ donor in case of organ transplants ) Applicable Upto Rs 0.5L Upto Rs 1L No Applicable Applicable Applicable
Hospital Daily Allowance ( Some plans offer daily allowance to take care of expenses like food, etc ) Yes Not Applicable Not Covered Upto Rs 1000 Per Day Yes (Optional) Yes (Optional) Yes(As per plan)
Pre-existing Coverage ( If the insured is having some existing diseases, that would be covered after particular time period ) After 3 Years, Can Get Reduced To 1 Year On Additional Premium Payment After 4 Years After 4 Years After 2 Years After 4 Years After 4 Years After 2 Years
Cumulative Bonus ( The amount by which your sum assured gets increased, if there is no claim. ) 50 % Every Year First 25 % then 10 % if Unclaimed 10 % if Unclaimed 10 % if Unclaimed 10 % Garunteed No Claim Bonus 10 % if Unclaimed 10 % if Unclaimed
Restoration Benefit ( Increase of Sum Insured for non-related illness if the original sum insured is exhausted ) Yes Yes Yes Yes Yes Yes Yes
Restoration Details ( Increase of Sum Insured for non-related illness if the original sum insured is exhausted ) Upto Rs SI Once During Policy Period Upto Rs SI Once During Policy Period Upto Rs SI Once During Policy Period Upto Rs SI Once During Policy Period Upto Rs SI Once During Policy Period Upto Rs SI Once During Policy Period Upto Rs SI Once During Policy Period
EMERGENCY COVERAGE






Ambulance Charges ( Expenses incurred on ambulance charges ) Yes Upto Rs 750/- Per Hospitalization And Overall Limit Of Rs 1500/- Per Period Upto Rs 2000/- Upto Rs 1000 Per Hospitalisation Yes Yes Yes
Worldwide Emergency ( The emergency medical assistance and cover against medical expenses while the customer is abroad ) Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Applicable
WELLNESS BENEFITS






Health Checkup ( An added benefit of one time full health checkup of policy holder. ) Yes Upto Rs 1500/- Available To All Members Available To All Members Yes Yes Yes
Non-allopathic Details ( Expenses incurred on non-allopathic treatment ) Upto SI Upto SI Upto Rs 20000/- Not Applicable AYUSH Up To 15000 Upto SI Upto SI
Animal Bite ( Cover againts any medical expenses occurred due to any Animal Bite ) Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
LIMITATIONS






Sub Limit ( Sub-limit is a monetary capping that applies on specific diseases like cataract ) Not Applicable Not Applicable Not Applicable Applicable (Check Broucher) Not Applicable Not Applicable Not Applicable
Co-pay ( Mentioned %, if any is to be borne by Insured and rest will be borne by insurer ) You Pay 0% Of Claim You Pay 0% Of Claim You Pay 0% Of Claim You Pay 20% Of Claim You Pay 0% Of Claim You Pay 0% Of Claim You Pay 0% Of Claim
MATERNITY COVERS






Maternity Benefits ( All Hospitalization cost covered at the time of pregnancy. ) After 2 Years - Upto Rs 20K Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered

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