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Types Of Health Insurance In India

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Types Of Health Insurance In India

With healthcare costs continuously rising, health insurance has become a crucial and unavoidable part of financial planning. It is available for both individuals as well as families and ensures access to quality healthcare services in times of need without putting any financial burden. Nowadays there is a wide array of health insurance products available in the market. It is important to understand these products so that you can get the right health insurance plan that suits your needs. These health insurance products are broadly classified into categories: Indemnity and Fixed benefit health insurance plans.

Let us explore different types of health insurance in India, their features and their uses for different scenarios.

Indemnity and Fixed Benefit Health Insurance Plans

Before we go into the details of various types of health insurance plans, let’s first look at the basic difference between indemnity and fixed-benefit health insurance plans.

Indemnity health insurance plans – Also known as comprehensive health insurance plans, these plans reimburse the expenses actually incurred on a medical treatment up to the sum insured. These plans offer wider coverage such as hospitalisation expenses, pre and post-hospitalisation expenses, daycare procedures and much more.

Fixed benefit health insurance plans – These plans pay a fixed amount on the diagnosis of covered critical illnesses or specific medical conditions. These plans pay a lump sum amount as a part of the sum insured on the diagnosis. Such plans do not reimburse medical expenses like an indemnity plan.

Types of Health Insurance Policies in India

Indemnity and fixed benefit health insurance plans are further divided into different types of health insurance plans as explained below:

1. Indemnity:
Indemnity health insurance plans are categorised into various types of plans depending on their coverage.

○ Individual Health Plans
These plans provide coverage for an individual under a single sum insured. They are suitable for people seeking personalised coverage for their specific needs and hence such plans are available on an individual basis only.

○ Family Floater Plans
These plans offer coverage to the entire family under a single policy with a single sum insured. The members covered under such a plan include self, spouse, dependent children and parents. The sum insured can be utilised by any member of the family.

○ Senior Citizen Health Plans
These plans are designed to provide coverage to senior citizens or individuals above 60 years. These plans provide specialised coverage to fulfil the special healthcare needs of senior citizens such as they provide coverage for pre-existing diseases with reduced waiting periods.

○ Top-up and Super Top-up Plans
These plans provide additional coverage after the sum insured by the base policy is exhausted. These plans supplement your existing health insurance plan at an affordable cost.

○ Disease-Specific Health Insurance Plans
These plans cover specific diseases or illnesses and offer comprehensive coverage for that particular disease only. These plans include,
● COVID-19 health insurance plans
● Cancer care health plans
● Diabetic health plans
● Dengue care health plans, etc.

2. Fixed Benefit:
These plans can be purchased along with an indemnity plan to cover expenses not covered under an indemnity plan including non-medical expenses, loss of income, ancillary expenses etc. Following are some common fixed benefit plans.

 
These plans pay a lump sum amount up to the sum insured on the diagnosis of critical illnesses listed in the policy. The lump sum payout can be used to cover medical expenses as well as other financial needs.

○ Personal Accident
These plans cover injuries, disablement or death due to an accident. These plans provide much-needed financial support in an unforeseen emergency situation.

○ Hospital Cash
These plans pay a fixed daily benefit in case the insured is hospitalised for more than 24 hours irrespective of the medical expenses incurred. Such a plan provides financial support to cover additional expenses during a hospital stay.

3. Standard Health Insurance Plans
These plans offer basic mandatory covers as per IRDAI guidelines. These plans aim to make basic healthcare accessible to all. One such plan is Arogya Sanjeevani, which all insurers have to offer if they are offering indemnity health plans.

4. Group Health Insurance Plans
These plans are specially designed for a group of people and are generally offered by an employer to his employees. There has to be a minimum of 20 employees.

5. Government Health Insurance Plans
These are health insurance plans sponsored by the government to make healthcare accessible to the people in the remotest parts of the country. These plans offer medical coverage of a significant sum insured at a very low premium.

6. Unit Linked Health Insurance Plans
These plans offer the dual benefit of health insurance and investment by providing health coverage along with building a corpus. These plans are offered only by life insurance companies providing life+health insurance benefits and help in covering expenses not covered under health insurance.

Types of Health Insurance Plans Focusing on Specific Benefits

Maternity Benefit
Maternity Benefit

These plans cover expenses related to childbirth and maternity care. There are no standalone maternity-only health insurance plans in India. Indemnity Health Insurance Plans offer maternity benefits either as an in-built or an add-on benefit in the plan.

Dental Insurance
Dental Insurance

These are plans available as a base health insurance benefit or as an add-on benefit with a health insurance plan providing coverage for dental treatments, procedures and consultations.

OPD Insurance
OPD Insurance

It is health insurance with OPD coverage that pays for medical consultations, diagnostic tests and treatments taken in the outpatient department up to the limit specified in the policy.

Women-Specific Health Insurance Plans
Women-Specific Health Insurance Plans

These plans are specially designed for women and provide coverage for women-specific diseases and common health issues in women. These may include infertility and maternity cover, critical illness cover, etc.

Why is Health Insurance Important?

Health insurance is a very important investment not just for the financial aspect of it but also for getting access to quality medical service during an emergency. With rising lifestyle diseases and expensive medical treatments, health insurance has become an absolute necessity for everyone. There are many reasons why health insurance is important.

1. Protection against medical inflation
Lifestyle diseases are so common nowadays, that it has become impossible to avoid medical expenses altogether. A single visit to the hospital can severely affect your finances due to the high costs of medical treatments. A health insurance plan saves you from spending your savings on medical expenses and protects your finances against rising medical inflation.

2. Coverage at an affordable cost
Health insurance premiums are affordable and can be paid in instalments. With so many types of health insurance plans available in the market, there is a plan available to suit everyone’s pocket.

3. Extensive range of coverage
Health insurance plans have coverage for almost all kinds of medical expenses from comprehensive coverage to specific benefits. You can even customise your health insurance plan to add benefits to suit your requirements.

4. Access to quality healthcare
With a health insurance plan, you can afford to get treatments at top-notch hospitals that are included in the insurance company’s network without worrying about finances and ensuring good diagnosis and genuine treatments.

5. Tax benefits
The premiums paid for health insurance plans qualify for tax deductions up to ₹ 1 lakh under section 80D of the Income Tax Act, reducing your tax liability.

Which type of Health Insurance is for whom?

Everyone is aware of the importance and necessity of health insurance but which type of health insurance is best for you depends on various factors such as age, family composition, and healthcare needs.

1. Youth
A young professional in the age group of 25 to 30 years might think that he does not need health insurance but does not realise that having health insurance can save a lot of money during a medical emergency or an accident in a metro city. For such individuals, an individual health insurance plan can help cover medical costs and also offer rewards for maintaining good health and lifestyle.

2. Young married couple
For a young married couple, a family floater plan with maternity benefits is suitable and affordable. Since most plans offering maternity benefits have a waiting period of 2 to 4 years, it is best to invest in such a plan before you start planning your baby so that you are not denied coverage because of a pre-existing pregnancy.

3. Older couples
For a couple with children, it is best to have a family floater plan even if you have insurance from your employer because group insurance has a lot of restrictions and a family floater plan lets you choose coverage according to your family’s healthcare needs. Select a plan that offers free annual health check-ups, it will help you monitor your health and maintain a healthy lifestyle.

If a family floater doesn’t suit your budget, you can opt for a top-up plan. Top-up plans are cheaper compared to a family floater plan and can be purchased as a supplement to your group insurance to enhance coverage.

4. Senior Citizens
For senior citizens, plans specially designed for senior citizens are suitable. These plans cover pre-existing diseases, domiciliary expenses, OPD consultations, and much more considering the needs of senior citizens. There are plans that provide coverage for both self and spouse at affordable premiums.

For dependent senior citizen parents, it is best to purchase separate individual plans instead of including them in a family floater plan because they will need comprehensive coverage for age-related health issues and including them will increase the premium of a family floater plan as the premium depends on the age of the oldest family member.

5. Individuals who travel a lot
For individuals who travel a lot, travel health insurance with international coverage is the ideal health insurance plan. Such a plan will not only cover the medical expenses but will also make it easier to avail medical services abroad and help in emergency evacuation if required. Such a plan may also cover passport or baggage loss and provide full medical assistance on your trip.

Things to Consider While Buying Health Insurance

To get the maximum benefit out of your health insurance coverage, it is important to choose the right product. Here are some important factors you should consider while buying a health insurance plan.

1. Selecting the right insurance company
Your insurance company decides whether to accept or reject your claim, the quality of service available to you and the customer support you get during a medical emergency. Hence it is important to carefully select an insurer. Check the customer reviews, claim settlement process, claim approval timelines, customer service, and network of hospitals before you make a decision.

2. Inclusions and Exclusions
Understand the inclusions and exclusions, sublimits, co-pay etc., of your plan thoroughly to avoid any claim rejection in future. Get as much clarity about the coverage as possible. Select a plan that covers all your healthcare needs.

3. Waiting Periods
It is the period during which you cannot file a claim. Waiting periods are applicable for pre-existing diseases, specific ailments and maternity benefits. Check what are the waiting periods in your plan before purchasing.

4. Sum insured and Premium
The premium of a policy depends on the sum insured value and the coverage offered. If you are selecting a comprehensive plan ensure that the premium is justified as per the coverage offered. Go for plans that offer a flexible sum insured where you can increase the sum insured when needed and also compare similar policies to make an informed decision.

5. Add-on Covers
These are add-on benefits available that can be added to enhance the scope of coverage at an additional premium. Check the add-on covers available with a plan so that you can customise your health insurance coverage when needed.

Buying health insurance at a young age can give you numerous benefits.

1. Low Premiums
Insurance companies consider your age before calculating premiums. Hence, when you buy health insurance at a young age, you pay a much lower premium and you can lock it for a longer term.

2. Waiting period for pre-existing diseases
When you are young, you can serve the waiting period for a pre-existing disease without any claims as you are healthy. By the time you need coverage for a pre-existing disease, you have already served the waiting period, so you file a claim without any waiting period.

3. Preventive and wellness benefits
Most health insurers reward you for maintaining good health. You can take advantage of these benefits when you are young. Also, health insurance plans cover health screenings and vaccinations as part of preventive care so that you are protected against the development of future ailments.

4. Protects your savings
A health insurance plan protects your savings and investments during a medical emergency and lets you get the best medical service without worrying about the cost of medical care.

To Sum Up!

Understanding different types of health insurance plans can help you make the right choice. Select a plan that suits your budget as well as fulfils all your healthcare needs. Investing early in health insurance can benefit you in getting comprehensive coverage at a very low rate of premium. Hence, do not delay buying a health insurance plan to your 40s. Invest in a good health insurance plan today.

Frequently Asked Questions

An individual of age 18 years and above is eligible to buy health insurance. For children, the eligibility age is 90 days to 18 years.

A pre-existing disease or condition is a disease or condition that exists before buying the health insurance plan. Such diseases or conditions are covered only after a waiting period.

Co-payment is a certain percentage of the claim amount that has to be paid by the policyholder.

Yes, mental health services are covered under the women-specific health insurance plan. However, the coverage depends on the insurer. It may include counselling and therapy.

Yes, you can increase the sum insured by your plan. It will increase the premium. In case your insurer doesn’t allow you to increase the sum insured, you can get a top-up cover for additional coverage.

Yes, you can have multiple health insurance plans such as group insurance from your employer, a family floater health insurance plan and an individual senior citizen plan for your parents.

Your age, lifestyle, occupation, location, type of plan, policy term, and medical history are the factors that determine health insurance premiums.

The coverage you need depends on your lifestyle and income. According to personal finance experts, your health insurance coverage should be a minimum of 50% of your annual income. To choose the right coverage amount, consider your age, health and family members.

There is no limit to the number of claims you can file in a year provided it does not exceed your sum insured limit.

ULIP is a combination of health insurance and investment. Part of the premium you pay goes towards your health insurance and the rest is invested to build a corpus.

Leading Health Insurance Companies

Manipal cigna health insurance
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