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Health Insurance in India

Health Insurance Plans 2022

Last Updated 28th May 2022

A health insurance policy, popularly known as medical insurance policy is a plan in which the insurance company reimburses the medical expenses of the insured for a pre-agreed list of diseases against an annual premium paid by insured.

Health Insurance Plan Who is eligible?
Individual Health Insurance Individual
Family Health Cover Whole Family - Self, Spouse, Children & Parents
Group Health Insurance Employees of Corporate Houses for self as well as close dependents

What is a Health Insurance Policy?

A health insurance policy is a mutual agreement between the insured and insurance company to provide the financial coverage of medical expenses of the insured. It contains health insurance plans with several benefits such as reimbursement of the medical costs, cashless hospitalization and daycare facilities. A health insurance policy also provides tax benefits under Sec 80D of the Income Tax Act.

What are the benefits of Medical Insurance?

The best medical insurance protects against the high medical costs without any strain on the pockets.

Here are some benefits of health insurance plans:

  • Cashless medical treatment: If you have taken medical insurance, then you can prevent yourself from paying the medical expenses at the hospital as it is taken care of by the insurance company. However, the insurance providers tie-up with various nursing homes and hospitals across the country and you can get Mediclaim, only if you get admitted in these specific health centers.
  • Covers wide range of pre and post hospitalisation expenses: The best health insurance also covers the pre and post hospitalisation medical expenses for 60 days. The health insurance plans also cover the transportation costs of an ambulance in case you are hospitalised. Most of the health insurance plans also provide claims against room rent of the hospitals are also covered under the health insurance plans.
  • Tax benefits: Under Sec 80D of the Income Tax Act, you can claim tax deductions on the premiums paid on the health insurance plans.
  • No claim bonus: No claim bonus is a reward offered as an increment in the sum assured or some discount on the premium costs if no claim has been filed for treatment of a health insurance plan.

What are the types of Health Insurance Plans Available in India?

While every insurance plans suit the different medical needs of the insured, given below are some of the standard health insurance plans available to you in India:

Individual Health Insurance Plan

This health insurance plan covers the medical expenses of individual policyholders. The premiums for the individual health insurance plan are generally low and dependent on the medical history of the insured. These insurance plans are most suitable for individuals who have higher health risks as can claim for the insurance amount more than once in a year. The insurance companies provide insurance for covering critical illness including any surgery costs or expenses for laboratory tests. The insured can claim tax benefits for the sum insured under an individual health insurance plan under Sec 80 D of the Income Tax Act.

Family Health Insurance Plan

The family health insurance plan provides health insurance plans for the family against a single premium annually. The number of members covered under the family health insurance plan varies on the health insurance companies. Most of the health insurance plan covers the insured, his spouse, along with up to 4 children; however, in some cases, the insurance plan may also include the parents of insured. Broadly, the family insurance plan covers hospitalization expenses for daycare treatments and critical illness such as any surgery, kidney failure, heart attack etc.

Group Health Insurance Plan

The medical insurance plans offered by the employers for its employees is known as a group health insurance plan. It covers the hospitalisation expenses of the employee and family members, including parents, children or spouse for any pre-existing disease from the first day of the employee. It also provides health insurance coverage for maternity expenses, including normal delivery or C-section. Most of the companies offer health insurance benefits to the employees to retain them in the organization.

Senior Citizen Health Insurance Plan

Senior Citizen Health insurance is available for the individuals between the age group of 60-75 years. The premiums for these health insurance plans are high as the senior citizens are more prone to illness and diseases. Most of the health insurance plans cover pre-hospitalization and post-hospitalization expenses for the pre-existing diseases. Also, the senior citizens can make claims for day care costs for chemotherapy, dialysis etc.

Maternity Health Insurance Plan

The maternity health insurance plans cover the expenses incurred in the prenatal stage, delivery, and post-natal stage when the mother delivers the baby. The health insurance plan also covers the expenses for newborn care if the child suffers from any critical illness. Also, you can get cover up to Rs. 50,000 in case of any emergency during the pregnancy.

Critical Illness Health Insurance Plan

Life-threatening diseases such as cancer, heart attack, organ transplant, kidney failure, etc. are covered by health insurance plans. The insurance companies provide lump-sum payment for the expenses of critical illness. The number of diseases covered by the insurance providers can range from 8-36 depending on the insurance plan.

Other Health Insurance Plan

Some of the other health insurance plans are personal accident insurance, unit-linked health insurance etc. The health insurance companies provides cover for uncertainties such as any temporary or permanent disabilities.

What is the eligibility for Medical Insurance?

Your eligibility to get a Medical Insurance and amount of premium you pay on it is a function of your age, health condition, pre-existing diseases, any occupational hazards as well as your family history of certain genetic diseases. The best health insurance companies examine the pre-existing health conditions of the insured for diseases such as hypertension, diabetes etc. The health insurance companies also ask for medical examinations which usually comprise mainly of physical, urine, and blood tests and a certification that you suffer from none of the diseases at the time of buying the insurance. Along with the health conditions, your age is also an essential factor for getting health insurance.

Age eligibility criteria for medical insurance plans

Health insurance eligible age for adults is 18 to 65 years old. Adults above 70 years of age have limited health insurance options for which they will need to discuss their requirements with the insurer. Children within the age group of 90 days to 18 years can also be covered under health insurance plan. The policy can typically be renewed annually. However, a medical clearance will be required to re-calculate your eligibility and premium for a policy renewal.

What are the documents required for getting health insurance?

You require the following documents to purchase health insurance in India:

  • Age proof: Birth certificate, Passport, 10th mark sheet, Voter’s ID, PAN card, Aadhaar card and Driving license can be submitted as age proof.
  • Identity proof: Aadhaar card, PAN card, Voter’s ID, Passport and Driving licenses can be submitted as ID proof while buying a health insurance plan.
  • Proof of residence: A permanent address proof document such as utility bills, driving license, ration card or a passport also need to be submitted when you are applying for health insurance.
  • Medical Certificate: A medical certificate is required by the doctor which states the current health state of the insured from a registered medical practitioner.
  • Passport-size photographs

How to choose the best health insurance plan?

While choosing the best insurance plans, you may compare different health insurance plans based on parameters such as inclusions and exclusions of the plan, premiums and other advantages. These are some of the factors that you must consider while choosing the appropriate plan for you and your family.

  • Understanding the needs: The first and foremost step that you need to keep in mind while choosing a health insurance plan is to understand the medical history of you and your family. To determine the best plan, you must analyse the health conditions of the family members as it will give you a clear idea to decide about the health coverage plan.
  • Health insurance amount: While every health insurance policy has different coverage for the number of diseases covered, the amount of coverage, age of renewal etc., you must choose the range of health insurance plan by analysing the medical conditions of the insured. If there is more probability of illness in the family, it is prudent to get high coverage for your medical insurance.
  • Choosing the right health insurance policy: To determine the best health insurance policy, you must compare the inclusions and exclusions of the health plans. As the medical cost for any critical illness is skyrocketing, you must choose the health plan accordingly. Also, it would be best if you choose the health policy that has a higher age limit for renewal.
  • Claim settlement ratio: It is wise to choose the insurance companies, which has a high claim settlement ratio as it will increase chances of getting the high coverage for your medical expenses.
  • The network of health coverage: It is essential to look at the interface of health coverage of the insurance companies. The best health insurance companies have the most comprehensive network of hospitals. If you choose the insurance company with a vast network, you can easily claim for cash reimbursement in the health centers across the states.

What are the Health Insurance Schemes offered by Government of India?

Government of India has launched several national level health insurance policies to provide insurance cover for poor and the masses of India. Some of the popular health insurance schemes by Government of India are as follows:

  • Rashtriya Swasthya Bima Yojana: The health insurance plan is available for individuals below the poverty line. Individuals can receive medical insurance for hospitalisation of up to Rs. 30,000. The registration fees for getting the health insurance plan for the family is merely Rs. 30. You can get the health insurance of you, your spouse and three other additional members of the family.
  • Universal Health Insurance Scheme: The universal health scheme is a government scheme available for families at or below the poverty line. The insurance covers individuals, groups and families. The individual can get up to Rs. 30,000 for reimbursement under the health insurance policy. Also, in cases when the primary member of the family deceased, the family members will receive a death benefit of Rs. 25,000.
  • Central Government Health Scheme: This health insurance plan is available for the employees and pensioners of the central government of India. The insured can get reimbursement and cashless facilities under this scheme. CGHS provides facilities like OPD treatment, indoor treatment, special consultation, maternity, family welfare and child health services.
  • Ayushman Bharat Scheme: Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana provides health cover up to Rs. 5 Lakhs per family. The government aims to provide the benefits of this scheme to 10 crore low-income families of rural and urban India.

What is Mediclaim?

A mediclaim is a type of health insurance which covers medical costs incurred on the hospitalisation in an accident or illness. The insurance companies include the medical cover of Rs. 5 Lakhs in case of a mediclaim.

What is the difference between Health Insurance and Mediclaim?

The term health insurance and mediclaim are used interchangeably; however, the difference between the health insurance and mediclaim is that a mediclaim is a type of health insurance which covers medical costs incurred on the hospitalisation in an accident or illness. Health insurance, on the other hand, covers all the pre-hospitalisation and post hospitalisation costs, OPD and daycare facilities. Also, unlike a mediclaim, the insurance company covers higher medical expenses than health insurance.

What is the procedure for claiming Health Insurance?

To claim the medical coverage under the chosen health insurance policy, you need to submit the request to the insurance company to provide the medical coverage during an accident or illness.

There are two types of process of claiming health insurance:

  • Cashless Claims: If your policy is cashless and you request for a cashless claim, it would mean that insured company will directly pay the medical expenses to the hospital. However, cashless claims are available only if the hospitalisation is in networked and approved hospitals list of the insurance company. To get cashless claims, you need to provide details of the health insurance policy to the hospitals who will directly contact the insurance companies. The insurance company will settle the health insurance amount after analysing the claim details, health conditions and matching it with their policy guidelines.
  • Reimbursement Claims: In the case of reimbursement claims, the medical bills are paid by the insured, which are later reimbursed by the insurance company. Such requests are available for all the hospitals which are not included in the network hospitals and is still the more prevalent form of claiming insurance payments.

Tax Benefits on Health Insurance

Indian Income Tax Act allows to claim tax benefits on medical insurance premium under section 80D. The tax deduction is higher for senior citizens above 60 years of age.

  • Tax Deduction for family members below 60 years: If the Mediclaim for family member including self, spouse and children is below 60 years, then a tax deduction of upto Rs. 25,000 is allowed. Income tax also allows for tax deduction on mediclaim paid for parents which is upto Rs. 25,000 if the parent is below 60 years of age. This means that the deduction of total Rs. 50,000 can be claimed.
  • One Parent over 60 years: If any one of the parents is over 60 years, then you can enjoy an additional tax benefit on Rs. 50,000 on medical insurance premium. The premium paid for self, spouse and children is eligible for a tax benefit of Rs. 25,000. This means that you can claim a total deduction of Rs. 75,000 from your taxable income for the premium paid on a health insurance plan.
  • Eldest Member over 60 years: If any of the self, spouse or children is above 60 years, one can claim a tax deduction of Rs. 50,000 on medical insurance. Also, for parents above 60 years, a deduction of Rs. 50,000 is allowed. This means that one can enjoy a total deduction of Rs. 1 Lakh on medical insurance.


Can you buy health insurance directly from an insurance company?

You can buy health insurance plans from banks, third-party or directly from an insurance company by talking to their customer representative, visiting their website and purchasing an online policy

Does health insurance provide tax benefits?

Under the Section 80D of the Income Tax Act, you can claim tax deductions on the premiums paid on health insurance. You can claim tax deductions up to Rs. 25,000 which can be further extended up to Rs. 50,000. Thus, overall, you can claim tax benefits up to Rs. 75,000. The limit for tax deductions for senior citizens is up to Rs. 1 Lakh.

What is the right age to get health insurance?

While there is no specific age of purchasing health insurance, there are different health insurance plans for every age group between 18 years to 65 years, however, if you purchase the health insurance policy at a young age it can help you to enjoy low premiums rates on the health insurance plans.

Can a person have more than one health policy?

You can buy multiple health policies from multiple insurance companies depending on your health conditions and illness. There are different types of health insurance plans such as individual health insurance plans, family insurance plans, health insurance plans for critical illness and group insurance plans etc. Multiple insurance policies can also act as a hedge against claim rejection if one insurer rejects the claim and the other accepts the claim.

Do you need hospitalization to claim health insurance?

No, it is not compulsory to be hospitalised to be able to claim health insurance as most popular plans provide coverage for daycare procedures such as chemotherapy, cataract surgery and kidney stone removal. Further, best health insurance plans cover the pre and post hospitalization expenses and hence, it becomes extremely important to check the coverage of the policy you plan to buy.

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