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Medical Insurance


Typically speaking, changing lifestyle, changing food habits, increased pollution and other things related are making people more prone to more medical disorders. Health disorder and hefty medical bills are now becoming part of our regular household budget, which was not the scenario few years ago. So in a scenario like this if you want to plan things in advance and don't want to burn your hands in paying all those heavy bills when a medical emergency arise , get the right Medical insurance policy from the right insurer with features and coverage best suited to your needs.
While deciding upon the coverage you want from your policy and the other auxiliary features that you are looking from your insurance provider to offer would decide the premium that you would pay per year. Keeping this into perspective keep a clear understanding of needs before deciding upon any policy .You shouldn't judge a policy only by the premium that you pay because nothing comes free and if you are looking something specific you should ready to pay for it otherwise your policy might not be of any help when you actually need it.

Benefits A Medical Insurance Policy Offers:

a) Cash less benefits: All insurance companies do have their respective tie ups with individual hospitals and hospital chains across India to give their customers cash less claim facility. In a case when you are faced with a medical emergency and you need an instant financial support you can visit any of these hospitals and just spell out your policy number then your hospital and insurance company can care of the rest and you can be rest assured of the treatment that is necessary for you.

b) Cover for critical diseases: Critical medical ailments like cancer, kidney failure , heart attack ,paralysis etc are generally part of the regular cover offered by a regular policy so if you have specific needs your medical insurance policy can cover that but may come as a extra or augmented feature.

c) Pre-existing medical disorders: Before you even decide upon your medical insurance policy you might be already affected by some medical disorder. Generally a regular policy would not cover anything that happens to you because of them as there is higher probability of you getting affecting by them well before you have passed a sustainable period of your policy term. Your Medical insurance policies offer cover for meeting medical cost for treating ailments arising out of pre-existing diseases but generally when you have passed 2 or 3 years.

d) Pre and Post Hospitalization cover : Your medical policy can also come with an extended cover for a period of 30 to 60 days of hospitalization cost before or after the treatment of the ailment

e) Ambulance charges and other charges: There are many charges which generally treated as an extra cost that you might have to pay which is other than the cost of treatment. Medical policies do come with features can help you to cover this extended cost so that you are not forced to pay an extra

f) Tax benefits: The money that you pay for premium is liable to get you tax benefits under section 80 D of the Income tax act. The maximum value of tax benefits which you can enjoy if you fall under the age group of 18 to 50 years is Rs.25000 whereas for people above this age group are entitled to get a maximum benefit of Rs.30,000

Types Of Medical Insurance Policies Offered By Insurance Companies:

Your Medical condition as a state is quite different from others and depends a lot on your age group, the profession you are into and various other factors. From the broader perspective Medical insurance policies are broadly classified as per the application. The various policies on offer are:

1) Individual medical insurance policy: Meant strictly for Individual Medical Insurance to cover for cost involved in medical treatment which involves hospitalization cost, special cost in case of critical illness and surgery with add on features to meet custom requirement.

2) Family Medical Insurance policy: A Family Medical Insurance policy in terms of features is quite similar to an individual policy but the best part of policy is that it is floater in nature. The benefit of being floater is that any member of the family can use the total cover and available under the policy as per individual. A family policy is bit cheaper in terms of premium that you would pay if we compare it consolidated value of premium that you might pay if you brought individual polices for every body .

3) Senior Citizen Medical Insurance policy: In a regular policy people generally get covered are in the age group between 18 to 60 years but in case senior citizen policies the age categories are much higher may be in the age group 60 to 75.People at this age group have very specific needs so if you are looking at buying a medical insurance policy for your old parents then it is possibly a senior citizen policy that might of your help.

Buying A Right Medical Insurance Policy Online:

As insurance companies come different variants of medical insurance plans so it become very tough for deciding the right product that actually suits. It is not always the cost that you pay to buy a policy that decides a right or wrong policy but the overall coverage and the features offered should be right factor.
Doing an online comparison can be of great help for deciding upon the right feature and right coverage. Factors to be considered for comparing online:

Cash less option: Please look at possible tie up of your insurance provider specially close to your city of stay which can help you access the cashless option is a better way

Co-pay: While availing for cashless claims you policy may ask you pay a part of the hospital cost by yourself and the rest to be taken care by your insurance provider so it better look for zero co-pay options

Renewability: This refers to the maximum numbers of years your policy would give you cover .This is an important factor because it might happen that you policy become inefficient when you actually need it.

Scope of coverage: Look at the amount of coverage your insurance company offers against the amount of premium that you pay plus what all sections are covered under it. The policy which provides a wider coverage and is comprehensive in nature can be helpful in all possible medical emergencies

Claim settlement ratio and process: Claim settlement ratio defines the effectiveness of your insurance provider in settling numbers and amount of claims out of the total claims made by other policyholders and plus you need to understand the effectiveness by the time period under which claims are settled by insurance provider . A better score on these parameters in also a defining factor in deciding the right insurance provider and policy.

Coverage of the pre-existing ailment: Generally all insurance policies don't cover pre-existing ailment from the day one of the policy term . The insurance company may start giving you a cover in this case only after you have passed 2 to 3 years of your policy term. Compare the policy based upon less time the insurance provider takes to cover preexisting diseases .

Related Articles

We all understand the benefits of having a health insurance plan with the right amount of cover.Plans offered today by insurers come with various kind of value added services which we need to understand before we opt for it.We should remember than nothing comes free so we should always make a conscious decision.


Let’s try understanding the various value added services which are in offer today and evaluate the merits and demerits around it.


Wellness Program:

A Wellness program is more off like a reward program for the policyholders and they get incentivized with additional benefits for maintaining good and healthy habits. The whole idea behind a program like this is that it a saves a lot of future costs for the insurer. The underlying idea of cost savings comes from the fact that people staying healthy would raise lesser claims. Some of the common examples of Wellness program is insurers offering loyalty points for quitting cigarettes. Like some insurers provides a set off of loyalty points for following certain healthy practices like going to gym, doing yoga on a regular basis etc.


Under most these wellness programs which are part of a base policy , the policyholder can avail an option to cash out the loyalty points and use the same as reimbursement against medical expenses which are not covered under the base policy.


Ayush Benefits:

If you go by the structure of health insurance plans and compare plans offering ayush benefits and those which are not , plans without benefits are preferably more comprehensive whereas the plans offering ayush benefits are more cheaper. Ayush benefits are more related to covering medical costs if the treatment availed by the policyholder through a ayurvedic , unani or any other forms of alternative medicine and which are not covered by any base policy.


We should remember in case of Ayush benefit, one need to go through a 24 hour hospitalization under any medical facility offering ayush services and the services should be recognized by a government hospital and should be accredited by Quality Council of India or National Accreditation Board on Health. We should also keep in mind that outpatient services under Ayush medication methodology are not covered under ayush benefits.


Second opinion:

As the name suggests, it is related to cost involved in taking a second opinion from a different medical expert. In terms of ailment management this can act a real boon. People who have a  hereditary history or a predisposition to certain illness the option can be quite helpful. Plans offering this particular value added service offer it as an embedded service and generally charges no extra cost.


Medical repatriation /evacuation

Most of the existing plans become ineffective outside India and that is why travel insurance plans are recommended. But there are lot of health insurance plans which have started offering this benefit as an additional value. We all know that medical cost outside India is always costly and if in case of an emergency situation the policyholder is forced to depot to the home country in a state of medical emergency , this particular value added service can be quite helpful.


But one thing that we need to keep in mind the claims under this special benefit are only settled if and only if the base policy also addresses the claim.


Sum insured restoration:

This is a common value add service which provided by most insurers. In case of claim years we all know that the sum assured get reduced by the amount of the claim but for the policy to run efficiently the sum assured need to maintain. This particular value added service comes with an extra cost and while opting for the same one should effective compare with the benefits of a top up plan. It is better to do a cost benefit analysis.


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Why One Should Buy A Separate Health Policy For Their Parents?


You may get enticed by offers made your existing health insurer that you can make your parents a part of the existing family floater plan at a discounted price or you can always buy family floater plan with your parents being included into it so that you don’t have to buy a separate plan. Though this offer might look very attractive but don’t make a mistake by doing that.


We all understand that health is actual wealth and a buying the right health insurance policy is the first step towards protecting it. Things have to be planned in a proper manner to get right benefits underlying a policy and it is helpful when you actually need it. Hasty decision while buying a health plan can be sometime be very dangerous.


One of the foremost reason why including your parents in your family plan is a big mistake is  because health needs are different at different stages of life and your health insurance company calculates the premium based upon the risk associated with insuring a family and the age of the eldest member defines everything. So in case if you have including your elderly parents as a part of the family floater plan the cost of insuring the family drastically increases and if there is a pre-existing health conditions with your parents, it puts an extra load on the premium even though of the members of your family are healthy.


Another important factor is the effect the same will have on NCB benefits of your policy. In any case if you have claim free years you can accumulate the benefits as NCB or non claim bonus and which you can utilize at the time of policy renewal by availing the same as discount. But once you get your parents includes the NCB value depletes because at an older age there are higher chances of raising a claim. You should always prefer to have separate policy for your parents because that ensures NCB protection on your family plan under which you, your spouse and your kids are included.


Third most important factor that need to be considered is that since in any floater plan the total cover can be used for the benefit of any member of the family, your parents making regular claims because of their health condition can eat up the total sum assured during any Health insurance policy term and the same becomes ineffective for the rest of the members.


Since your parents always need an extra support for their health care and they might be making a constant claim, you should always have a separate policy for them. Though a separate plan and extra sum assured might look like an extra cost it always helps because it gives an extra protection to them. Other than you can always claim for extra tax benefits under it under Section 80D and you can increase your tax benefit limit from Rs.25000 to Rs.50000 which is a huge jump. 

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Why Health Insurance Is Important For The Women In The House?

In today’s Indian society contribution of women to the overall societal and economic development has changed. Women are no more just stay home mothers anymore , their role in running the affairs of an Indian family have changed dramatically. They now go hand in hand with male members of the family in terms of generating wealth for the family. We also need to understand the stay home mothers or women in our family also have a large economic value for the family even if they are not working.


Women have always been a great contributor to the overall well-being of the family. She has always been the inner link who binds the various members of the family and in this endeavor they generally miss out to take care of their own health. It is the responsibility of the other members of the family to take this issue very seriously. Single women, stay home mothers, married women and working women all require the right amount of health insurance cover and ignoring can be quite disastrous.


At present, some health insurance providers have started offering the specific health insurance plans for the women in the house. To look at few

  1. Health insurance for women-specific diseases like breast cancer, uterine cancer, fallopian tube cancer, cervical cancer, vaginal cancer, and ovarian cancer.
  2. Health insurance plans covering maternity cost.
  3. Personal accident cover for women
  4. Pre- and post hospitalization cost coverage for critical illness
  5. Support of livelihood benefit in case of accidental death.


Let’s try and understand why health insurance is important for women and what benefits they should look into:

  1. As women, an important role in the family either she is a home woman or office lady and she also has an economic value attached to her. From this very perspective adequate health insurance cover for women is very much important.
  2. Women should also look at starting their health insurance plan at an early age. Like any other policyholder starting early has its own benefits in terms of low-cost premium.
  3. In a country where the health cost inflation is one of the highest in the world women should always look at buying an adequate health insurance cover.
  4. Likewise, male taxpayers, if the women in the house contribute to the family’s income she can also tax benefits under section 80D.The limit of Rs.25000 is also applicable for women taxpayers also.
  5. Looking at the health condition it is always seen that women always have a higher life expectancy compared to their male counterparts so having a health insurance plan well suited to their needs is very much important. This helps them and their family in handling medical emergencies in a much better and efficient way. 
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Why It Is Important To Invest In Health Insurance plans In 2017?

In a country which has the second highest health care inflation of 12% among all Asian countries, health care is actually becoming a pain for a lot of Indians. The pain is further aggravated by the fact that we still don’t efficient public health care services which should have been providing services at a discounted rate which has lead to more dependence on private facilities and which is quite unbearable for lot of households and makes it tough for them to manage financial turmoil in a state of health emergency. The most effective way the to take this  problem can be by building effective financial reserve for handle the emergency .The cost effective option to build that reserve is to buy a health insurance plan. In fact if you don’t have a health insurance plan in place then it should be the most important commitment that you should make for 2017...This supposedly should be the most effective investment which you should plan for the year 2017.

So if you are planning to fulfill your health insurance this year, below is the list of thing that you should look into in your health insurer’s plans so that you make the most effective decision:

Hospitalization benefits: In the earlier days the only way you can raise a claim with your health insurer is when you have gone through a 24 hour hospitalization. Though the concept has changed drastically but still a lot of policies do have certain limitations which defines what would be covered and what is the amount that would be covered so while buying a health insurance do look at the various clauses governing which this part of the  benefit.

Day to Day care related benefits:  With recent advancements in medical science today a lot medical treatment doesn’t even require somebody to get a hospital admission. All a lot of ailments can be handled by OPD services provided by various hospital. While planning for your health insurance in 2017 you should look at guidelines regarding day care health procedure and check is there any limitation governing the same.

Cashless facility: Today all health insurance plans offer cashless facility but the challenge lies in understanding are there any hospitals under your insurer's network present in current city of residence. Though cashless is an efficient way  to settling claims and you don’t have panic for financial aid when you are faced with a medical emergency but the factor regarding presence of hospitals through which you can access this facility is also very important.

Room rent: This is actually bit tricky benefits. A lot of health insurer limits the type of services that you can opt under a specific plan and hospital room facilities in one of them. A  better of this very important because it's misinterpretation can put you in a state where your others claims can also be denied.

Ancillary benefits : You should understand the during the state of a medical emergency other than the major cost like hospitalization , doctor advise and medicine cost there are a lots of ancillary cost involved which we often ignore. One of the most common of them is Ambulance services which can be at times can become very costly. While investing in a health insurance plan do check at things relating how claims would be settled by your insurer against all these costs.

Other than these important things which are defining factors to identify which policy to buy and which not , you can always take tax benefits on Sec 80D on the premium that you would pay this year and in the future years subject to the conditions the regulation don’t change. Another thing is that important is that you always do an online comparison of all health insurance plans before investing so that the decision that you take this year should have long term benefits.

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Understanding Top-Up Health Insurance plans in India

Combating health cost today is one of the toughest challenge people are facing . In a situation when uneven lifestyle ,bad eating habits etc are becoming a common phenomenon leading to regular medical requirements and which is further supplemented by a higher health care inflation compared to regular inflation the need for effective amount of health insurance cover is becoming very important. Few years back an amount Rs.3 lac of health cover was enough for a family of four but considering current situation you would be called underinsured. But this additional health insurance cover requirement comes with an extra cost and can always be a burden for lot of people and that is where top up health cover becomes an effective solution.

What is a top up health insurance?

When you already have an existing cover and the same is inadequate looking at the current context so to get  an extra cover you can look for below given options:

a)Buying a new policy from scratch may be from a new insurer

b)Buying just a top up plan from the existing insurer.

But let us now understand how the two options are different so that you can get a better clarity about top up plans. When you buy a top up plan there is always a concept of deductible. A deductible can be defined as the amount of claim until which your top Health insurance plan would not give you a settlement but if the claim amount of exceeds that particular amount then your top up plan become liable to cover that cost. Take for example, your base health cover is Rs.3 lacs and you have opted for an additional top up Rs.4 lac. In case you raise a claim of Rs.5 lac then first you base policy would cover the initial Rs.3 lac and the remaining of the Rs.2 lac would be covered by the top up plan. Because of the concept of deductible the premium cost of any top up plan is always lower than the buying a new health policy.

Things you should look in a top up health insurance plan:

Though top up is a much cheaper option and reduces premium burden from you but you should have a clear understanding of the amount of deductible. Claims under deductible also come with various limitations which should be kept in mind. It is always recommended to have a top up cover equivalent of the cover of your base policy. Other than this you should have a clear understanding that in case multiple hospitalizations top cover are not very effective.

So in terms of having a proper planned approach right amount of health insurance cover and also keeping cost of premium low one should always have the right mix of base and top plans.

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Why Heart Disease Related Health Insurance Is Becoming More Important?

Some of the astonishing facts released by WHO in it’s report shows an higher propensity of Indians getting their first heart attack at a very early age. Compared to Europeans an average Indian generally gets his/her first attack during the age of 50 and the survey even shows at least 25% of Indians get their first heart attack at the age of 40. The rise of heart related problems in rise during due to uneven lifestyle, bad work hours and improper eating habits.and this calls for higher demand for health insurance solutions to handle any financial emergency arising out it.


Any heart disease which is at a curable stage calls for higher spends on hospitalization ,medicine and doctoral advisees and when we see the same from the point of view of covering the same with your already existing comprehensive health plan may be an impossible thing in most of the cases.In recent few health insurance companies have started offering health insurance plans specific to heart diseases.All these plans come with twin cover benefits , they not only cover health related cost in case of occurrence of an emergency  but they also provide an added term cover which in case of death the benefits are given to the dependents.


With rising occurrence of heart related disorders and rising cost of heart related treatment has lead to a rising demand for heart related health insurance . All heart related health insurance plans are actually long term plans with policy term of 10/15/20 years with a maximum of 75 lacs of sum assured under a single plan. Some insurance players have also launched dual benefits plans which covers both heart related and cancer related ailments under a single plan. Cancer related ailments is also on rise.Going by the WHO data most of the cancer related ailments are repercussions of diabetes ,which is again one of the most popular lifestyle disorders among Indians.Compared to 2000 data the number of Indians suffering from diabetes have actually doubled by 2013 taking the number to 63 millions.This added benefit of the heart related health plans makes it most have to products for most Indians.

All heart related health insurance plans are generally reimbursement plans which means they don’t offer any cash less facility .Compared other comprehensive plans which have lot of sub-limits on various type expenses , heart plan don’t have them making it is a very useful plan for the policyholders.Though all these heart related plans are gaining a lot of popularity and people are a getting a lot of benefit from them but it is always that one should look at the terms & conditions of any policy before they buy one. Online health insurance comparison plans can be looked as one of the smart ways to do it and get the highest benefit.

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