When a medical emergency strikes, you not only need emotional support but also financial support. While you have your loved ones to lift up your spirits, you need someone to take care of the medical bills as well. This is where health insurance comes to your rescue. Thus, it is wise to know the different types of health insurance plans available in India.

Different Types of Health Insurance in India

• 1. Individual insurance plans:

  This is the most common type of health insurance plan in India. Such a policy only covers an individual. It takes care of your medical costs in case you get admitted into a hospital. The premium in such cases will depend on personal factors such as your age, medical history, etc.

• 2. Family floater insurance plans:

  As the name suggests, this type of health insurance plan covers the entire family. It is similar to an individual policy except that the sum insured in this case is usually higher and is shared between the family members. One of the main advantages of such an insurance plan is that you need not manage different policies. Moreover, such policies are also more cost-effective than buying an individual policy for each member.

• 3. Senior citizen insurance plans:

  These health insurance policies are specially designed for senior citizens who are usually above the age of 60. Since old people are more likely to make a claim, the premium to be paid is higher in such cases. Also, many insurers don’t stress on a pre-medical screening or exclude pre-existing diseases before granting senior citizen insurance because old age often comes with health issues.

• 4. Critical illness insurance plans:

  A critical illness insurance plan insures you for fatal diseases such as kidney ailments, heart attacks, cancer, paralysis, etc. In such cases, the policyholder receives a lumpsum amount on the diagnosis of the covered illness. Unlike individual policies, no hospitalization is needed for claiming the money. Such a plan is advisable for those who have a history of such illnesses in their family.

• 5. Personal accident insurance plans:

  Accidents are common and the expenses they bring along can drain all your savings. A personal accident insurance covers the cost of medical treatment needed after an accident. Usually, such a policy offers benefits against 3 events – partial disability, total disability, and death due to accident.

• 6. Maternity insurance plans:

  These are women-specific health insurance plans. Such plans provide coverage for pre-natal and post-natal expenses along with the delivery and ambulance cost. A baby cover is also provided wherein the expenses related to the new-born baby are covered up to a certain duration. Most maternity plans have a waiting period before they get active. Thus, it is prudent to buy such cover as soon as a woman gets married. These can also be taken as an add on to a basic policy.

• 7. Unit Linked Insurance plans:

  Unit Linked Insurance Plans or ULIPs are insurance plans that double up as investments. When you pay the premium, a part of it is utilized for providing cover to you, as usual. The remaining amount of the premium is invested in a mix of equity and debt. With ULIPs, you not only secure your health but also build wealth for the future with the returns.

• 8. Mediclaim:

  The Mediclaim insurance plan is a fundamental option for individuals seeking coverage for in-patient expenses related to accidents or illnesses. This type of health insurance policy provides compensation for hospitalisation expenses incurred due to medical emergencies to offer financial security during challenging times. The plan ensures peace of mind by covering the costs associated with hospital stays, surgeries and other medical treatments and help you pay for hefty medical bills.

• 9. Group Health Insurance:

  Group health insurance is a unique type of health insurance that offers comprehensive coverage for a group of individuals. This is typically provided by employers for their employees and can sometimes be extended to their dependents also. The plan provides medical coverage for hospitalisation, including maternity, daycare treatment and outpatient services.

  Group health insurance is advantageous due to its affordability, as premiums are often subsidised by employers. These plans are also known for their inclusivity, as they allow coverage for a wide range of individuals within a group. Additionally, the administrative ease of managing a single policy for a group simplifies the insurance process for both employers and employees.

• 10. Hospital Daily Cash:

  Hospital daily cash insurance provides a fixed cash benefit for each day of hospitalisation due to illness or injury. Unlike conventional health insurance policies that reimburse actual medical expenses incurred, hospital daily cash insurance offers a predetermined daily allowance directly to the patient.

  One of the primary benefits of hospital daily cash insurance is its versatility in addressing various expenses associated with hospitalisation. While traditional health insurance policies cover medical treatments and procedures, they often do not account for non-medical expenses such as room rent, transportation, food and others. Hospital daily cash insurance provides financial assistance to manage all of your daily needs while hospitalised. You can use the cash benefit to cover out-of-pocket expenses or supplement lost income due to hospitalisation.

• 11. Top Up Health Insurance:

  Top-up health insurance does not exactly feature in the types of health insurance plans. Instead, it is a special provision that offers additional coverage beyond the basic health insurance plan. It can be activated once the maximum claim amount of a policy has been exhausted.

  This plan provides flexibility to increase your coverage limit as and when needed. It ensures you have sufficient financial protection against high medical expenses and serves as a cost-effective solution for enhancing insurance coverage without significantly increasing the premiums. It is also a much more convenient process than opting to purchase an entirely new policy.

• 12. Disease-Specific Health Insurance Plans (e.g., Corona Kavach):

  Disease-specific health insurance plans have gained significant relevance in the context of current health challenges, particularly amid the COVID-19 pandemic. These plans address the unique healthcare needs of individuals and provide financial coverage for treatments and other related expenses associated with particular diseases. An example of such a policy is the Corona Kavach, which offers targeted financial protection against COVID-19.

  These plans offer peace of mind and financial security, ensuring you and your family are adequately protected during times of health crises.

Why Should You Buy Health Insurance?

Health insurance provides financial protection, ensures access to quality healthcare and can reduce the financial burden of expensive treatments.

With increasing lifestyle-related health issues and high treatment costs, having health insurance offers peace of mind and essential coverage for you and your family.

• 1. Financial Assistance

Health insurance offers crucial financial support during medical emergencies. It helps cover unexpected expenses, prevents the need to deplete your savings and eases the financial burden associated with urgent and unplanned medical care.

• 2. Annual health checkups

Many health insurance plans cover annual health checkups, encouraging policyholders to get regular medical evaluations. This proactive approach helps you detect potential health issues early and promotes a healthier lifestyle with timely medical intervention.

• 3. Medical Inflation

Medical inflation significantly drives up the cost of healthcare treatments and services. Health insurance helps counter the impact of rising medical expenses and ensures you receive necessary care without being overwhelmed by inflation.

Consider These Factors When Purchasing Health Insurance

Below are some factors to consider when purchasing a health insurance plan:

• 1. Coverage Options

There are many types of health insurance in India, each offering different levels of coverage. Choosing a plan with comprehensive coverage is crucial to meet your unique health and financial needs. This ensures optimal protection and prevents any gaps in coverage.

• 2. Network Hospitals

Health insurance policies typically include a network of hospitals where you can benefit from cashless hospitalisation. This means that if you are admitted to or treated at one of these network hospitals, you do not need to pay the bill upfront and then seek reimbursement from the insurance company. Instead, the insurance company directly clears the bill with the hospital. Opting for a plan with this feature provides you with quick service and eliminates the need for paperwork and hassles.

• 3. Premiums

The premium for a health insurance plan is generally decided on the basis of factors such as the age, health, gender, occupation, lifestyle habits and other factors of the policyholder. The sum assured and coverage of the plan also affect the premium. When selecting health insurance, looking for an affordable premium is essential. However, you must also balance the premium with the features offered by the plan.

• 4. Sum Assured

The sum assured represents the maximum amount you can claim under your health insurance plan. A higher sum assured provides better coverage for most health issues and ensures financial security but may increase the premium. Conversely, a lower sum assured might leave you underprepared in emergencies. Therefore, when selecting the sum assured, you must carefully consider your health needs, income capacity and medical inflation.

• 5. Deductibles

A deductible is the amount you must pay before your insurance policy starts covering your medical expenses. A higher deductible typically results in a lower premium and vice versa.

When selecting a deductible, it is important to analyse your health history and future needs. If you anticipate needing medical care, a lower deductible might be beneficial despite a higher premium, as it could save you money in the long run. If not, you can select a higher deductible and save money with a lower premium.

• 6. Co-payments and Co-insurance

Co-payment refers to a fixed amount you pay for a covered health service, while co-insurance is a percentage of the cost of the service.

For example, if you avail a health service costing ₹ 50,000 and the co-payment is ₹ 10,000, you pay ₹ 10,000 and the insurer covers ₹ 40,000. With co-insurance, if the rate is 15%, you pay 15% of ₹ 50,000, which is ₹ 7,500, and the insurer covers the rest of the ₹ 42,500.

Co-payments are straightforward and predictable, while co-insurance can vary based on the service cost. You must evaluate these costs before choosing a plan.

• 7. Out-of-Pocket Maximum

The out-of-pocket maximum is the limit up to which you pay for covered health services in a policy year. Once this limit is reached, you do not have to pay any more, and the insurance company will cover the remaining expenses for the year.

A policy with a high out-of-pocket maximum might require you to pay more out-of-pocket, so choose carefully.

• 8. Prescription Drug Coverage

Prescription drug coverage helps cover the cost of prescription medications given by a licensed doctor. It is important to select a policy that includes coverage for both generic and branded medicines to ensure comprehensive and affordable treatment.

• 9. Coverage for Pre-existing Conditions

Health insurance policies may have a waiting period for pre-existing conditions, which can range from a few months to a few years from the time of purchase. During this period, you cannot make claims related to a pre-existing condition. It is important to review the list of pre-existing conditions and the waiting period of a policy before making a selection.

• 10. Annual health checkups

Annual health checkups are crucial for maintaining good health. Health insurance policies that offer free annual checkups ensure regular testing and timely detection of health issues. This ensures you get access to preventive care, reducing the risk of more serious and costly conditions later.

• 11. Waiting Period

A longer waiting period can make it difficult to raise a claim and results in higher out-of-pocket expenses. Health insurance plans typically have an initial waiting period that starts immediately after purchase, as well as waiting periods for specific illnesses and pre-existing conditions. Make sure to choose a plan with a manageable waiting period to avoid potential issues.

• 12. Renewability Options

Ensuring your health and financial security over the long term is crucial. A health insurance policy that offers lifetime renewability makes it easier to maintain continuous coverage, save money and stay protected as you get older. This is essential for your ongoing security and peace of mind.

• 13. Additional Benefits and Wellness Programs

Some types of health insurance policies offer additional benefits such as wellness programs, fitness incentives, mental health support and other initiatives that enhance your overall well-being. While these features might seem supplementary, they can significantly contribute to your overall health.

COMP/DOC/Oct/2024/810/7280

With so many types of health insurance in India, navigating the insurance landscape can be a bit overwhelming. From traditional Mediclaim plans to innovative solutions like group health insurance, hospital daily cash, top-up health insurance and disease-specific health insurance plans, you have several options to choose from. Remember to compare all the different types of health insurance and see how they fit into your requirements. This way, you can secure your well-being and financial stability with the most suitable health insurance plan for your needs.