A Comprehensive Guide to Buy a Health Insurance Policy in India

Health insurance sales have increased sharply with the rising cost of healthcare. Obviously, you and many others are aware of why it is important to have health insurance that protects both you and your family.

What is the best plan for you?

Are you familiar with health insurance policies, including waiting periods, exclusions, no-claim bonuses, top-up insurance and critical illness coverage.?

This article discusses the basics and nuanced aspects of health insurance plans. A thorough knowledge of health insurance will help you avoid any claim rejections. To choose the most appropriate health insurance coverage for you and your family, you should first determine your healthcare needs.

How does health insurance work?

As the name suggests, health insurance provides coverage for medical emergencies caused by accidents, illnesses, or injuries. Among the medical expenses covered by health insurance are hospital bills, medicines, and consultation costs, etc.

A You can pay a monthly or yearly premium for a health insurance policy that is for a specific period. Health insurance premiums are determined primarily by three factors – the age of the insured, the sum insured, and the habits of the insured.


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How should you know the important terms used in Health Insurance?

  1. The waiting period:
    It is a general rule that most health insurance policies have a 30-day waiting period attached to them. Hospitalizations due to certain illnesses and diseases are subject to the waiting period. Your health insurance covers hospitalization resulting from an accident from the very beginning of your policy.
  2. Diseases pre-existing: If you have pre-existing conditions, you and/or your family have diseases or illnesses that existed before you purchased the health insurance policy. Pre-existing conditions are not covered by health insurance companies unless a minimum waiting period of two to four years is imposed.
  1. Survival Period:
    If the insured lives at least 30 days after the diagnosis of a critical illness, the claim benefit is offered.
  2. Network hospitals:
    A few hospitals offer cashless claims because they have ties with your insurer. The insurance company settles hospital expenses directly with a network hospital listed with it when you visit.
  3. Add-ons and Riders:
    Add-ons and riders are benefits provided by your base plan that aren’t included in regular plans. For a small premium increase, insurance companies offer these riders and add-ons. Riders and add-ons are optional and can be purchased depending on the policyholder’s needs. These are just a few examples of add-ons and riders, such as personal accident coverage, critical illness coverage, room rent waivers, maternity coverage, top-up coverage, daily hospital cash, etc.
  4. Inclusions:
    There is a list of inclusions included in every health insurance policy. An inclusion is a condition or illness that is covered. For that reason, you need to check if a specific condition is included in the list of inclusions, if you are looking for coverage against it.
  5. Exclusions :
    The policy excludes disease and circumstances that are not covered.
  6. No Claim Bonus:
    The No Claim Bonus, or NCB, is a reward you receive for every year in which you do not file a claim. The insurer rewards you with the additional sum insured if you do not make any claims during a policy year.
  7. Co-Pay:
    The amount a policyholder pays out of pocket as part of a claim. You will need to pay that part of the claim yourself as and when you make a claim; the percentage of co-pay is specified in your policy documents. Some renowned insurance companies do not demand co-pays because arranging for the money during a medical emergency can be stressful.

In what ways does having a health insurance policy benefit you?

  • The policy pays and/or reimburses the insured members’ medical expenses and hospital bills, as specified in the policy.
  • Through a cashless claim, you will not be charged for treatment in a network hospital of your insurance company anything from your poIf you make a cashless claim, your insurance company will not charge you anything for treatment in a network hospitalcard to the hospital.
  • You can claim the amount later with the original hospital and medical bills if you choose to go to a hospital that is not on your insurer’s network.
  • A majority of health insurance companies cover AYUSH treatments (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy).
  • As a general rule, health insurance plans cover pre-hospitalization expenses for up to 30 days, as well as post-hospitalization expenses for up to 60 days, including treatments done under AYUSH.
  • Basic health insurance policies cover some critical illnesses.
  • Insurers typically require a minimum of 24 hours of hospitalisation for medical coverage, but nowadays many include day-care services that do not require hospitalization.

How do health insurance plans differ?

  1. Health insurance plans tailored for individuals:
    Individual health insurance plans are designed to provide coverage to a single person according to their individual requirements. As a result, you must purchase a separate policy for each member of your family if you want to cover them all. This plan is best suited for singles and single parents. not eligible for the family floater health insurance.
    If Mr. Mehta, 55, has two grandchildren as well as his son and daughter-in-law, then he has a total of five members in his family. His health insurance policy includes a sum insured of Rs 5 lakhs. Medical benefits can only be claimed by Mr Mehta since it is an individual plan. No family members are covered under that policy.
  2. Family Floater Health Insurance:
    A family floater plan is a health insurance plan that covers an entire family under one policy. A single premium provides coverage for multiple members as it is a single policy. Consequently, all members of the policy are covered. In a policy year, it can be used by one or more people. A family floater plan benefits families consisting of two adults and up to three children. Let’s look at the example of Mr. Mehta’s son; Mr. Mehta’s son has purchased a family floater insurance policy for his wife, two children, and himself with a sum assured of Rs 5 lakhs. As a family floater policy, this benefit can be claimed by anyone covered by the policy. All four are covered by the same amount. When one of his children uses four lakhs of the insured amount, only one lakh remains to be used by other family members.
  3. Group Health Insurance:
    Most companies provide their employees with medical insurance coverage through Group Health Insurance policies. Insurance companies provide these health plans at a reasonable cost. which Employers pay the employees. Providing the employee is employed by the same company and the company has not discontinued the coverage, the employee can benefit from the policy.
  4. Critical Illness Insurance:
    Almost all health insurance plans have a list of exclusions which corresponds to situations and illness types which will be excluded from the coverage. Cancer and kidney failure, among other critical illnesses, are not covered by basic health plans. Nevertheless, treatment for these conditions can be extremely costly. In a nutshell, critical illness insurance offers coverage for all critical illnesses at a low premium. Add-on coverage for critical illness is available from some insurers. It is essential to check the list of critical illnesses covered by the insurer before making a purchase decision, since each one differs.
  5. Senior Citizen Health Insurance:
    As we age, our health risks also increase. Despite the fact that seniors can purchase individual health policies, such policies do not include coverage for certain diseases or ailments to which senior citizens are more prone. More than 60 year olds are now offered special policies for the health insurance needs of senior citizens.
  6. Maternity Insurance:
    This type of policy covers both normal and induced pregnancies The plan includes coverage for C-section deliveries, pregnancy termination due to complications, pre- and postnatal expenses, and newborn expenses. Several years of waiting are required for this insurance plan.
  7. Top-up Coverage

  As you go through new milestones in your life, your existing sum insured may seem insufficient. In such cases, instead of buying separate health insurance with a higher sum insured, you can buy a top-up cover that can increase your sum insured in your existing policy.

While purchasing a health insurance policy, what points should you keep in mind?

  1. Benefits offered:
    A health insurance policy does not come with the same benefits from every company. Be sure you find a policy that fits your needs. Consider comparing the different benefits that are offered, such as ambulance charges, the room rent cap, day care treatment, critical illness coverage, and a complete list of inclusions.
  2. Premium:
    Make sure to compare and check the premium you pay with the benefits offered and the sum insured. You can easily check the On the official websites of the insurers, you can find premium calculators that can calculate the premiums for different health insurance policies.
  3. Network hospitals:
    Check with your insurer to see if your preferred hospitals are included in the network. You will then be able to use the cashless claim facility. In a stressful situation, neither you nor your family members will have to worry about paying for medical expenses.
  4. Claim settlement process:
    Claims should be settled quickly and easily. Customers should receive prompt service from the insurer.
  5. Claim settlement ratio:
    This ratio determines the number of successfully resolved claims compared to the number of claims filed in a year. You have a greater chance of settling your claim if your claim settlement ratio is high.
  6. Company reputation:
    Aside from its claim settlement ratio, you also need to consider the company’s goodwill, its years of experience, its solvency ratio, which outlines its ability to pay its short- or long-term liabilities, and how many policies are issued each year.
  7. Convenience:
    When purchasing and renewing your health insurance policy, ensure that the process can be done smoothly Many insurers enable you to buy and renew the policy online, which will save you time and money. Another feature that can be extremely useful is the ability to modify existing policies at any time.
  8. Exemptions, exclusions, and terms and conditions:
    Carefully read the health insurance policy’s exclusions, policy exemptions, and terms and conditions before buying. You will avoid future disputes by reading the policy documents beforehand.


Before purchasing a health insurance policy, you should know everything mentioned in this article. You will be better able to understand the differences between the plans if you have an understanding of the terminologies explained at the beginning. Consider the following factors when selecting a health insurance plan that suits your needs before you make your decision.

Read the policy documents carefully, compare the benefits and premiums, and understand the plans. By doing so, you will be able to make an informed decision.

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