Health Insurance Plans

Buying the right medical insurance policy can be a bit complicated. This is because there are different types of Health Insurance plans available in India. Have a look below and choose accordingly.

• 

  Individual health insurance policy

  Only the individual/insured person under the individual health insurance plan can avail of the benefits and can claim the sum assured under the policy.

• 

  Family floater health insurance policy

  You can cover all your family members with a family health insurance policy under a single plan. The sum insured under the chosen plan applies to all the insured family members in the policy. One member or multiple people in the active policy year can use this policy.

• 

  Group/employee medical insurance

  Employee or Group Health Insurance policies cover your employees' expenses against unforeseen medical emergencies. The premium of group mediclaim policy is generally lower than average and offers comprehensive coverage for medical expenses.

• 

  Senior citizen health insurance policy

  Individuals 60 years and above can avail a medical insurance for senior citizens plan designed to cover medical care expenses. Such or as a rider to an already existing policy.

• 

  Maternity health insurance

  Maternity Insurance provides complete health and maternity care coverage to expecting mothers and their newborn babies. From hospitalisation of the pregnant lady to normal or C-section delivery fees and newborn vaccination, this plan covers all medical expenses.



Cancer insurance plan

Cancer insurance plans cover the medical expenses for cancer treatment. It covers chemotherapy, diagnosis costs, and other related expenses. These plans come at a higher premium because of the risk coverage. Some health insurance policy also come with cancer add-on cover at slightly higher premium.



Health insurance for parents

Parents health insurance is essential for securing medical coverage, safeguarding against high healthcare costs, and ensuring timely access to treatments, which ultimately promotes peace of mind and family well-being.

Key inclusions and exclusions

Here’s a quick look at the inclusions and exclusions of Health Insurance policies:

Key inclusions

• In-patient hospitalisation expenses: Get coverage for hospitalisation expenses incurred due to illness or accidental injuries sustained during the policy period

• Pre- and post-hospitalisation expenses: Covers medical costs incurred due to an illness or injury from 60 days before hospitalisation

• Critical illnesses: Get coverage for critical illnesses such as asthma, cholesterol, diabetes, and high blood pressure

• Road ambulance charges: Get coverage for road ambulance charges up to the amount mentioned in the policy details. The ambulance coverage is applicable for transporting the policyholder to the hospital

• Domiciliary hospitalisation: Get coverage for availing of hospital-like treatment at home

• Daycare procedures: Get coverage for daycare procedures that require less than 24 hours of hospitalisation

Key exclusions

Losses arising due to an act of war/terrorism/invasion

• Breach of law: Criminal intent, intentional self-injury, or attempted suicide while sane or insane

• Substance abuse: Abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol

• Cosmetic surgery: Cosmetic, aesthetic, and re-shaping treatments and surgeries

Things to consider before you buy health insurance plans

You need to consider certain crucial factors before buying a medical health insurance policy. Here's the list:

• Policy coverage
  One of the essential factors to consider when purchasing a medical insurance is the financial coverage offered by the insurer. The top insurance providers extend a range of coverage. They include pre-and post-hospitalisation expenses, daycare facilities, ambulance charges, doctor consultation, and more.

• Type of policy
  Before considering medical insurance plans, one must go through the types of policies offered by the lender. Reputed insurers offer a range of policies. They range from senior citizen, family floater plans, to critical illness cover. Additionally, there are group health plans, top-up health plans, and more.

• Sum insured
  The sum insured can be a deciding factor in choosing a health insurance plan. Considering the rising cost of medical treatment across the country, choosing a policy with a maximum sum insured value is wise. A higher sum insured will ensure comprehensive coverage.

• Network hospitals
  It is essential to check the availability of network hospitals before buying a health insurance policy. This will save you from the hassle of arranging the money during medical emergencies.

• Claim settlement ratio: The claim settlement ratio is the ratio of claims settled to claims made in a financial year. It further helps in gauging the capability of an insurance provider to handle customers'

Eligibility criteria for buying a health insurance plan

The eligibility criteria for every health insurance policy depend on the insurer's terms and conditions. Medical insurance eligibility depends on age, pre-existing conditions, and pre-medical screening. Here are some of the common eligibility criteria that you must know.

Eligibility criteria

Eligibility criteria for Health Insurance	Specifications
Age (adults)	18 – 65 years
Age (children)	90 days – 25 years
Pre-medical screenings	Depends on the insurer
Pre-existing diseases	Waiting period of at least 2 years, depends on the insurer

Health insurance premiums are calculated based on several factors. These include the age of the insured, type of plan, sum insured, habits and lifestyle, and medical history. The older you are, the higher your premium is likely to be, as the risk of mortality, hospitalisation, and medical expenses increases with age. The type of plan you choose, such as an individual  health policy or a family floater plan, also affects your premium. Here are some of the factors that affect the health insurance premium.

• 

  Medical history

  Every insurance provider considers the applicant's and sometimes family's medical history. Before getting health insurance, you must report any pre-existing conditions. This determines the insurer's coverage and premium.
  To receive coverage for pre-existing diseases without a waiting period, you can pay more or buy an add-on.

• 

  Age

  Age affects premiums for health insurance policies. Younger applicants have to pay less, and premiums increase as their age increases. For instance, someone over 50 years old may need significant coverage due to heart, blood pressure, or serious sickness. In such cases, the premium will also get higher.

• 

  Lifestyle

  Your lifestyle choices could significantly affect how much you pay for your health insurance. This is because you become more susceptible to lifestyle disorders like obesity, diabetes, high blood pressure, and heart disease.

• 

  Type of health insurance chosen

  The coverages of various types of health insurance plans, such as individual and family health insurance policies, vary. Hence, the range of coverages you select will determine your premium.

• 

  No claim bonus

  Check your health insurance plan's No Claim Bonus (NCB) before renewing. You can receive a no-claim bonus of up to 50% for each year you do not make a claim. This amount reduces your coverage or premium.

Here are some tips to choose the best health insurance plans for you and your family.

• 

  Analyse the plan type

  Understand your requirement, whether you need an individual health insurance or a health insurance for family.
  

• 

  Affordable premium with maximum coverage

  Consider your budget and coverage required on the policy, and for how many people if buying a family health insurance.
  

• 

  Coverage details

  Check the coverages offered like pre-and post-hospitalisations expenses, hospitalisation expenses, daycare procedures, and more.
  

• 

  Easy claim process

  You must also consider the claim settlement ratio of the health insurance company. This will help you know the insurance company’s efficiency to resolve the claims.

Based on these requirements, choose a health insurance that fits your requirements.

Health insurance coverage should align with your personal medical needs and financial situation. Ideally, your sum insured should be at least 50% of your annual income to ensure adequate protection. With rising healthcare costs, experts recommend opting for a health insurance cover of ₹10 lakh or more to comfortably manage medical expenses without financial strain.

• 

  City of residence

  Coverage requirements can vary significantly between tier-1, tier-2, and tier-3 cities due to different medical costs.
  

• 

  Age or life stage

  Younger individuals typically need less coverage compared to older individuals who may have more health issues.
  

• 

  Future hospitalisation costs

  Consider the potential increase in medical expenses due to inflation.
  

Below is a table to help determine the ideal health insurance coverage based on different types of plans and city tiers:

Types of Health Insurance plans	Tier-1 City	Tier-2 City	Tier-3 City
Individual Health Insurance Plan	Rs. 15 lakh & above	Rs. 8-15 lakh	Rs. 7 lakh
Family Floater Health Insurance Plan	Rs. 40 lakh & above	Rs. 25 lakh & above	Rs. 12 lakh & above
Senior Citizen Health Insurance Plan	Rs. 25 lakh & above	Rs. 18 lakh & above	Rs. 12 lakh & above


People can consider purchasing a Rs. 1 crore health insurance policy, which has become more affordable. This is particularly useful for long-term critical illness treatments or treatments abroad.

Disclaimer: The above sum insured is suggestive and may vary according to the age and medical needs of individuals.

Here are things you need to calculate health insurance premium online.

• 

  Step 1

  Enter the value of number of people you want to cover under the policy.
  

• 

  Step 2

  Provide your mobile number and date of birth.
  

• 

  Step 3

  Enter information like the sum insured, plan tenure, and add-on covers if any.
  

• 

  Step 4

  You need to also enter your health conditions and lifestyle habits.
  

Once you fill in all the above information, you will receive the health insurance policy quotes on your registered number or email address.

Health insurance riders are additional benefits that policyholders can add to their base health insurance plans for enhanced coverage tailored to specific needs. Here are some common health insurance riders explained in a descriptive and pointers format:

• 

  Critical illness rider

  Provides a lump-sum benefit upon diagnosis of specified critical illnesses such as cancer, heart attack, or stroke, supplementing treatment costs.
  

• 

  Hospital cash rider

  Offers a daily cash benefit during hospitalisation to cover incidental expenses like transportation or caregiver costs.
  

• 

  Maternity and newborn rider

  Covers maternity expenses including prenatal care, delivery, and postnatal care. Some plans extend coverage to newborn care.
  

• 

  Personal accident rider

  Pays a lump sum or ongoing benefits in case of disability or death due to accidents, complementing health insurance coverage.

• 

  Waiver of premium rider

  Waives future premiums if the policyholder becomes permanently disabled or critically ill, ensuring continuous coverage without financial burden.



Top-up and super top-up riders

Super Top Up Health insurance Provides additional coverage beyond the base sum insured once the threshold limit is reached, offering cost-effective enhancement of coverage.

Choosing the right riders depends on individual needs and health risks, offering flexibility and comprehensive protection against unforeseen medical expenses.

Here are tips to reduce the health insurance premium.

• 

  Compare premiums

  Compare health insurance premiums online. Look for different health insurance policies online from different insurance companies.
  

• 

  Reasonable

  Compare the coverages offered and premiums. Go for the health insurance policy that provides maximum coverages at reasonable premiums.
  

• 

  Age

  Buying a health insurance policy at an early age can help you save on premiums, as you are less likely to have health issues when you're young. Pre-existing conditions or health issues can lead to higher premiums because the coverage amount would increase.

• 

  Top-up benefits

  You can look for top-up health insurance policies that come at an affordable premium. You can choose a basic health insurance plan and enhance the policy with a top-up health plan that gives extra coverage.
  

• 

  Avoid claims for smaller expenses

  Do not make claims for small medical expenses. Health insurance companies offer a cumulative bonus for every claim-free year. You can use this bonus to increase your sum insured without increasing the premium on health insurance renewal.
  



Co-pay feature

You can opt for co-pay as well. Co-pay in health insurance means the insured and the insurance company both share the medical expenses. For instance, if you opt for 20% co-pay on your sum insured of Rs. 10 lakh, then you may have to pay Rs. 2 lakh. The insurance company will pay Rs. 8 lakh. The higher the co-pay you choose, the lesser premium you will pay.

Check: How to choose senior citizen health insurance?

Comparing health insurance policies online offers several significant advantages:

• 

  Comprehensive comparison

  Easily compare multiple health insurance policies side-by-side to identify the best coverage options.
  

• 

  Cost efficiency

  Find the most affordable premiums and comprehensive coverage, helping you save money in the long run.
  

• 

  Feature evaluation

  Evaluate additional benefits, such as wellness programs, cashless hospital networks, and preventive care services included in each health insurance policy.
  

• 

  User reviews

  Access real customer feedback and ratings, providing valuable insights into the performance and reliability of different insurers.
  

• 

  Convenience

  Save time and effort by comparing policies from the comfort of your home, without the need to visit multiple insurance offices or agents.

By comparing health insurance policies online, you can make an informed decision that best suits your healthcare needs and budget.

• 

  Convenient online process

  To make purchasing and renewing policies online simpler, Bajaj Finance offers a quick, basic process, with minimal documentation.

• 

  Online account management

  Policyholders can manage their medical insurance using Bajaj Finance's improved customer experience. Users can search nearby doctors, book appointments, lab testing, and teleconsultations, and buy Bajaj health insurance.

• 

  Additional sum insured

  You can choose from senior citizen, group, and family floater plans, as well as low-cost supplemental coverage. These policies also pay for pre- and post-hospitalisation expenditures, consultation fees, the price of medical tests, etc.

• 

  COVID-19 coverage

  You can opt for health insurance plans that pay for the costs of treating COVID-19. This can assist policyholders in obtaining coverage for costs related to hospitalisation and quarantine.

• 

  Wide network of affiliated hospitals

  Partnering with top health insurance providers in India, Bajaj Finance is enabling policyholders to access cashless care at more than 10,000+ network hospitals.


Comprehensive coverage
These insurance plans include pre- and post-hospitalisation costs, reimbursement for prescribed testing, costs associated with organ donation, childcare services, etc. Additionally, it provides a selection of Bajaj health insurance plans at reasonable premiums.

Health insurance premiums are available with tax benefits. Section 80D of the Income Tax of India, 1961 allows health insurance deductions. Given below are the details for tax exemption:

• 

  For self and family

  Everyone below 60 years: Rs. 25,000

• 

  For self, family, and parents

  Everyone below 60 years: Rs. 25,000 + Rs. 25,000

• 

  For self and family

  Everyone below 60 years and senior citizen parents: Rs. 25,000 + Rs. 50,000

• 

  For self and family

  Eldest member above 60 years and senior citizen parents: Rs. 50,000 + Rs. 50,000

Health Insurance covers medical expenses and reduces taxes, get deduction up to Rs. 75,000* under section 80D of Income Tax Act, 1961.

*Note: The tax benefit amount can vary based on the premium of different policies.

Raising a claim for medical insurance policies in India might seem complicated, but it is a simple process if you follow the right steps. Here's a quick guide on how to raise a claim for your medical insurance plans:

• 

  Inform the insurer

  As soon as you or your family member is admitted to the hospital, inform the insurance provider to start the claim process.

• 

  Fill out the claim form

  Submit the duly filled claim form along with other documents such as hospitalisation bills, discharge summary, doctor's prescription, and diagnostic reports.

• 

  Pre-authorisation

  In case of a planned hospitalisation, pre-authorisation from the insurance provider is necessary. Submit all the relevant documents to get pre-authorisation.

• 

  Cashless treatment

  If your policy provides cashless treatment, then after pre-authorisation, the insurer will directly settle the medical bills with the hospital.

• 

  Reimbursement

  If cashless treatment is not available, then you can opt for medical reimbursement where you pay the hospital bills first, then file a claim with the insurer, and get reimbursement for the medical expenses.

  Raising a claim for your health insurance policy is a simple process. Make sure you submit all the relevant documents to avoid delays and ensure a smooth claim process. Knowing the process will make it easier for you at the time of medical emergencies.

Buying medical insurance plans at an early age has numerous benefits. Here are a few reasons to consider buying health insurance plans when you are young:

• 

  Low premiums

  Health insurance premiums are determined based on your age. So, the younger you are, the lower the premiums.

• 

  Lesser health issues

  Typically, you experience fewer health issues compared to those in their thirties, which increases your likelihood of obtaining comprehensive coverage. With minimal or no pre-existing conditions, securing a strong medical policy becomes easier, giving you an early advantage in insurance planning.

• 

  Avoiding the waiting period

  Most health insurance policies have a waiting period of 2-3 years for pre-existing illnesses. Buying a health insurance plan at an early age ensures you have coverage when you need it.

• 

  Comprehensive coverage

  Buying a health insurance plans earlier ensures you get comprehensive coverage. So, you stay protected against unforeseen medical emergencies.

• 

  Tax benefits

  You can claim deductions under section 80D of the Income Tax Act for the premium paid towards your health insurance policy.


Financial security
A health insurance policy offers financial security and protects you against high medical bills that can cause a significant financial burden. Check health insurance tax benefit.

• 

  Health insurance is only for older people

  Many believe that health insurance is only necessary for the elderly. However, medical emergencies can occur at any age. Buying insurance early offers lower premiums and comprehensive coverage when needed most.

• 

  Only hospitalisation expenses are covered

  A common myth is that health insurance only covers hospitalisation costs. In reality, most policies also cover pre- and post-hospitalisation, diagnostic tests, day-care treatments, and sometimes even preventive care, like health check-ups.

• 

  Pre-existing conditions are never covered

  While many think pre-existing conditions are excluded, most health insurance policies cover them after a waiting period. It's crucial to choose a policy with a manageable waiting period to ensure comprehensive protection.

• 

  Claiming insurance is a hassle

  Many believe that claiming health insurance is a complicated process. However, with cashless claims at network hospitals and digital claim processes, insurers have made it more convenient than ever to get timely reimbursements.