The Ultimate Guide to
Health Insurance

Health insurance curated for every specific need.

Articles & Guides

Explore over 130 detailed guides and articles to help you understand every nuance of health insurance.

How to Find the Right Health Insurance Plans?

If you're on the quest for the best health insurance plan in India, you're in good hands! We're here to guide you through the entire process.

Step 1: Begin your journey with MyInsureBuddy Match

Visit the MyInsureBuddy website, go to ‘Health Insurance’ and click on ‘Find Best Health Plans’ i.e., MyInsureBuddy Match - an intuitive tool designed to simplify your health insurance search. Fill in the details asked.

Step 2: Get your personalised Match report

You’ll receive a personalised Match report that provides tailored recommendations for the most suitable health insurance plans along with their features, benefits, and premiums.

Step 3: Talk to our expert

Connect with a seasoned insurance advisor who will guide you through the intricacies of the recommended plans. Our expert advisors will explain the fine print, answer your questions, and ensure you make an informed decision.

Step 4: Make your choice and secure your future

Once you are completely satisfied and clear on all aspects of the policy, you can proceed to make the payment and secure your health insurance plan.

Documents Required to Buy Health Insurance

The exact documentation requirement can vary depending on the insurance provider, but here are some commonly requested ones -

• Age Proof: Aadhaar card, PAN card, driving licence, birth certificate, passport, etc.
• Identity Proof: Aadhaar card, passport, voter ID card, driving licence, etc.
• Address Proof: Ration card, Aadhaar card, PAN card, driving licence, electricity bill, etc.
• Other: In addition to the previously mentioned documents, insurance companies might request further documentation to support your application. This can include medical test reports if required by the insurer.

What is Health Insurance?

Health insurance is a comprehensive plan that covers expenses related to hospitalization resulting from illnesses, accidents, or injuries. It provides protection against unforeseen medical expenditures, which could otherwise impose significant financial stress on you and your family.

How Does Health Insurance Work?

Health insurance works by providing financial coverage for medical expenses. You need to pay regular premiums to the insurance company, and in return, the insurer helps cover the costs of eligible healthcare services. When you need medical treatment covered by your policy, the insurance company covers you for the incurred expenses, up to the sum insured - this is the maximum amount available for your hospitalisation expenses.

For example, Raghu has a health insurance policy with a sum insured of Rs 5 lakhs. A few years after paying the premiums, he gets hospitalised for surgery that costs around Rs 3 lakhs. In this case, the insurer will pay for his actual expenses incurred i.e. Rs 3 lakhs from the sum insured. Now, his remaining sum insured i.e Rs 2 lakhs can be used if he requires another medical treatment in the same year.

One important thing to note is that the coverage opens up gradually. For the initial 30 days, health insurance does not cover treatments related to any medical condition except for accidents. This is known as the initial waiting period. Additionally, for pre-existing diseases - any condition diagnosed or treated by a doctor 48 months prior to the policy's issuance, there is a waiting period of 2-4 years. This means you can only claim for these pre-existing conditions after the completion of the waiting period. Furthermore, there are waiting periods of 2-4 years for specific medical conditions and treatments. During these waiting periods, coverage is not available for these specific conditions. But once the waiting period is over, you can claim for them.

Health insurance offers the flexibility to make multiple claims within a policy year, up to the sum insured. This means that throughout the policy term, you can seek coverage for various medical treatments and expenses covered by your policy, up to the limits specified in your policy. And, insurers offer you with two options to claim for your medical expenses - cashless and reimbursement claim.

• Cashless claim option allows you to receive treatment at network hospitals listed with your insurer without the need for any upfront payments.
• Reimbursement claim involves paying bills upfront and later claiming reimbursement from the insurer.

Ultimately, the availability of both cashless and reimbursement claim options empowers you to choose the approach that best aligns with your healthcare needs and preferences.

How Much Health Insurance Cover Should You Buy?

Here’s a tool that can help! MyInsureBuddy Health TruMatch is a one-of-a-kind tool that scientifically calculates the right cover right you should opt for, within 5 minutes. And that too, absolutely free of cost!

What Is The Difference Between Health Insurance And Medical Insurance?

In the realm of insurance, the distinction between health insurance and medical insurance has been a subject of debate and confusion. It's time to set the record straight: Health Insurance and Medical Insurance policies are not distinct.

Before delving into why these policies are essentially the same, let's step back to the year 1986. During this era, the concept of 'Mediclaim' or ‘Medical Insurance’ was first introduced by government and PSU (Public Sector Undertaking) insurers in India. The term 'Mediclaim' essentially referred to claiming insurance for medical expenses.

However, there was a catch to early-day mediclaim policies. They came with certain limitations, such as restrictions on room rents, specific disease-wise coverage limits, and co-payment clauses. These limitations didn't create the most favourable image of health insurance or mediclaim in the eyes of consumers. To address this, the Insurance Regulatory and Development Authority of India (IRDAI) and insurance companies made a strategic shift. They abandoned the name 'Mediclaim' and embraced the more comprehensive term 'Health Insurance' for all future policies and regulations.

As this transition occurred, many of the earlier constraints of mediclaim policies were removed. Insurers gradually phased out their old mediclaim products and introduced modern health insurance policies, offering more extensive coverage and greater flexibility for individuals' healthcare needs. This is what you get today from all insurers - these new-age health insurance policies.

What Is Covered Under A Mediclaim Or A Health Insurance Policy?

Decode Insurance Plans like a Pro

Heard about a popular plan? Understand the fine print in plain English. Discover the good, the bad, and the ugly before you buy. Heard about a popular plan? Discover the good, the bad, and the ugly before you buy.

There is a common misconception that a mediclaim policy is a basic hospitalization policy that doesn't extend to cover pre and post-hospitalization expenses, while a health insurance plan is believed to encompass all health-related costs. However, this is not entirely accurate. Whether you hold a Mediclaim or a health insurance policy, they both provide coverage for specific expenses. To gain a better understanding of what these policies offer, let's explore these expenses in detail.

1️⃣ Pre-Hospitalization Costs

Pre-hospitalization expenses encompass the costs of diagnostic tests, doctor fees, etc., that occur before hospital admission or any treatment, such as blood tests, x-rays, urine tests, etc. Typically, most health insurance plans provide coverage for pre-hospitalization expenses for a period ranging from 30 to 90 days. Pre-hospitalization expenses are covered only if they are related to the medical condition for which you are later hospitalized, and your claim for them is approved as part of hospitalization coverage.

2️⃣ Hospitalisation Costs

During your hospital stay, your mediclaim or health insurance policy covers various expenses, including room rent, ICU charges, the cost of surgery or treatment, fees for doctors and specialists, oxygen, blood, consultancy fees, the cost of medicines, and more. Generally, the policy requires a minimum hospital stay of 24 hours to qualify for coverage.

3️⃣ Post-Hospitalisation Costs

After being discharged from the hospital, your health insurance policy continues to provide coverage for expenses such as follow-up visits to your doctor or the hospital, diagnostic tests, rehabilitation, physiotherapy sessions, and more. These expenses, however, are covered only if they are related to the medical condition for which you were hospitalized, and your claim for them is approved as part of hospitalization coverage. Typically, most health insurance plans offer post-hospitalization coverage for a period of 60 to 180 days. This ensures that your medical needs beyond your hospital stay are also taken care of.

4️⃣ Costs of Hospitalisation At Home

Domiciliary hospitalization, a crucial aspect of health insurance, comes into play when hospitalization isn't possible due to the unavailability of beds in a hospital or when a patient's condition is too severe to be moved to a hospital. In such cases, all expenses incurred for home-based treatment are covered under most health insurance policies. This ensures that even when hospitalization isn't feasible, you can still receive the necessary medical care at home with the financial support of your health insurance.

5️⃣Cost of Daycare Procedures

Health insurance policies often include a daycare procedure clause, covering specific treatments and surgical procedures that don't necessitate an overnight hospital stay (typically less than 24 hours). These may include procedures like cataract surgery, hernia repair, chemotherapy, dialysis, and more. By including coverage for daycare procedures, health insurance ensures that you receive financial support for a wide range of medical treatments and surgeries, even if they are brief and don't require an extended hospital stay. This can significantly ease the financial burden associated with these medical interventions.

6️⃣ Costs of the Organ Donor

In certain health insurance or mediclaim policies, coverage is provided for the expenses incurred by the organ donor during their hospitalization and surgery when an organ transplant is conducted for the insured individual. This coverage is valuable because it helps alleviate the financial burden on both the insured organ recipient and the organ donor. However, it's important to note that not all policies offer this coverage, and in its absence, the expenses incurred by the organ donor during their hospital stay become the responsibility of the insured organ recipient.

7️⃣ Optional Covers & Extra Benefits

Health insurance and mediclaim policies offer several valuable add-ons as well as extra benefits to enhance your coverage. These can include benefits like a No Claim Bonus, Restoration Benefit, and add-ons or optional covers like waiving the exclusion of non-medical expenses (like consumables), eliminating copay requirements (if any), and more.

What Is Not Covered Under Health Insurance?

Prefer watching a video instead? Here you go!

Health insurance will not cover certain medical conditions or circumstances at any cost. These are known as exclusions. Here are some of the types of exclusions -

1️⃣ Permanent Exclusions Of Health Insurance
A permanent exclusion is a situation or medical condition that will not be covered by your health insurance at any cost. Meaning, you will be liable to pay for any costs associated with a permanent exclusion.

Types Of Permanent Exclusions

👉  Standard Permanent Exclusions
The IRDAI has mandated a set of 'standard permanent exclusions' that must be implemented by all insurance companies. Here are some of the standard permanent exclusions -

• Investigation and evaluation: Hospital admission solely for observation or monitoring purposes.
• Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, where no active treatment is provided.
• Obesity/weight control: Treatment or surgery for weight control or obesity.
• Change of gender treatment: Treatment aimed at altering the body's characteristics to those of the opposite sex.
• Plastic/cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
• Profession in hazardous or adventure sports: Treatment expenses incurred while participating as a professional in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc.
• Breach of law: Expenses related to the treatment of a person who has committed or attempted to commit a breach of law with criminal intent.
• Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
• Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
• Treatments in establishments arranged for domestic purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
• Dietary supplements, substances purchased without prescription: Vitamins, minerals, etc. not prescribed by a medical practitioner.
• Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters for improved eyesight.
• Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
• Expenses related to birth control, sterility infertility: Contraception, sterilization, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
• Maternity expenses: Pre/post-natal costs, childbirth-related hospitalization expenses, etc.

👉 Additional Permanent Exclusions Of Health Insurance
Apart from the standard permanent exclusions mentioned above, there may be additional exclusions for specific medical conditions or situations. If insurers deem certain diseases or severe medical conditions as too risky to cover, they can permanently exclude them from the policy. It's important to note that insurers are only allowed to permanently exclude illnesses that are explicitly listed by the IRDAI. Diseases not included in the list cannot be subject to a permanent exclusion.

👉 Temporary Exclusions Of Health Insurance
Temporary exclusions are also known as waiting periods. A waiting period is a timeframe during which certain illnesses or treatments will not be covered right after buying a policy.

👉 Types of Waiting Period

1️⃣ Initial Waiting Period
Health insurance policies typically cover accidents from day one of policy purchase. However, all other medical treatments and conditions are subject to a 30-day waiting period after which the coverage becomes effective.

2️⃣ Pre-existing Diseases Waiting Period
A pre-existing disease refers to any condition, ailment, injury, or disease diagnosed or treated by a doctor in the 48 months prior to issuing your health insurance policy. These conditions typically have a waiting period of 2 to 4 years. During this period, the policy will not cover any expenses related to your pre-existing condition.

With the introduction of new features and benefits, the waiting period for Pre-Existing Diseases (PED) may vary across health insurance products. Certain plans offer the flexibility to reduce the PED waiting period by opting for an add-on and paying an additional premium. Some plans feature a shorter waiting period for specific PEDs such as asthma, hypertension, etc. Further details on this can be found in our article dedicated to Shorter Waiting Periods for PEDs.

3️⃣ Specified Disease/ Procedure Waiting Period
The insurance companies have a predetermined list of medical conditions like hernias, haemorrhoids, chronic kidney disease, spinal disorders, etc., apart from your pre-existing diseases which will have a waiting period irrespective of whether you have had those diseases in the past or not. The duration of this waiting period is decided by the insurance company and it is not influenced by your present health condition. Such specific diseases may entail a waiting period of 2 to 4 years. You can find the list of such conditions in the product brochure or policy document.

Note: Keep in mind that a health insurance policy may not cover situations beyond the aforementioned ones. Hence, read the documents thoroughly before signing up for the policy.

Types Of Health Insurance Plans

Here are some of the types of health insurance plans offered in the Indian market -

👉 Individual Health Insurance

Individual health insurance is crafted to address an individual's distinct healthcare needs, offering coverage for various medical expenses such as surgical costs, pre- and post-medical care, and more. It empowers individuals with the freedom to customize their health insurance to align perfectly with their unique requirements.

👉 Family Floater Health Insurance

A family floater health insurance policy offers the advantage of covering multiple family members under a single plan, allowing them to collectively share the sum insured. Since it consolidates all family members' coverage under one premium, you can avoid the need to manage multiple individual policies.

👉 Senior Citizen Health Insurance

Senior citizen health insurance is particularly designed to cater to older citizens aged 60 and above. They have increased susceptibility to illnesses due to age-related factors, weakened immune systems, etc. This policy provides coverage for a wide range of medical needs, including pre- and post-hospitalization, injuries resulting from accidents, domiciliary hospitalization, among other essential healthcare services. However, please bear in mind that these plans usually come with a lot of restrictions and limitations like mandatory copay, room rent limit, sub-limits on specific treatments/diseases, etc.

👉 Group Health Insurance

Large organisations or companies often offer group health insurance plans to their employees to safeguard their health and ensure their financial security. It entails lower or no premiums for the employee since the risk is distributed among a sizable group, making them cost-effective but it may also come with a lot of restrictions. It's essential to note, though, that once you leave the group or organisation, your coverage ceases to exist. Therefore, in our view, you should consider acquiring a group health plan as a final option, especially if obtaining an individual policy is challenging due to age or health-related concerns.

👉 Maternity Health Insurance
Maternity health insurance is a financial safety net designed for parents preparing for the arrival of a new baby. It allows families to fully embrace the joys of parenthood without the burden of hefty medical bills. Maternity health insurance covers a wide range of expenses, including childbirth, prenatal and postnatal care, etc. In some cases, the coverage extends to the newborn for up to the initial 90 days from the date of birth. It's important to note it has a waiting period, which can vary from 9 months to 4 years or more, depending on the insurer.

👉 Top-Up & Super Top-Up Health Insurance
Top-Up and Super Top-Up health insurance plans are additional layers of coverage that complement your existing health insurance policy. These plans entail a 'deductible' feature, which is an amount you are liable for paying before the health insurance provider steps in to cover your medical expenses. You usually match this deductible to the payout offered by your base health insurance policy, so as soon as the deductible limit is taken care of by your health plan, these top-up extensions will come into force.

The deductible for a Top-Up plan is calculated based on every single hospitalization. In other words, the Top-Up plan becomes active and starts paying only if the expenditure on one, single hospitalization crosses the deductible limit. Conversely, a Super Top-Up plan's deductible is calculated based on the sum total of all hospitalization expenses incurred during the entire plan-year. Once the cumulative costs paid across admissions surpass the deductible, your Super Top-Up starts paying for subsequent expenses.

How Much Does Health Insurance Cost?
Health insurance costs can differ significantly, influenced by various factors. Typically, younger and healthier individuals enjoy lower premiums, while older individuals or those with health concerns may encounter higher costs. Moreover, the extent of coverage, your location, and the type of plan you choose all contribute to determining your premium.

As an example, the annual premium for a 30-year-old seeking a health insurance plan with a sum insured of Rs. 10 lakhs may range from approximately Rs. 10,000 to Rs. 15,000. For a family of three, consisting of two 30-year-old adults and a one-year-old child, the annual cost could be estimated at about Rs. 18,000 to Rs. 25,000.

Please keep in mind that these figures are approximate, and actual premiums may vary depending on individual circumstances and unique factors.

Benefits Of Health Insurance

Here are some of the reasons why health insurance is a must-have -

1️⃣ Offers Financial Protection
Unexpected hospital stays and prolonged medical treatments result in overwhelming bills. Health insurance steps in like a dependable friend, wrapping you in a comforting financial embrace. It covers a substantial part of these expenses during challenging medical times (subject to the policy’s terms and conditions), granting you peace of mind.

2️⃣ Safeguards Against The Increased Cost Of Healthcare
The sharp rise in healthcare costs is evident in the substantial increase in average claims for infectious diseases, soaring from Rs 24,569 in 2018 to Rs 64,135 in 2022 - a staggering 160% surge. This upward trend underscores the financial strain caused by the growing prevalence of diseases, emphasising the critical need for robust health insurance coverage to mitigate the impact of escalating medical expenses on you and your family.

3️⃣ Access to State-Of-The-Art Facilities
When a family member faces illness, the natural inclination is to provide them with the best possible healthcare. Health insurance acts as a reliable financial safety net, ensuring that, no matter the circumstances, you have the necessary financial support to access top-notch healthcare. In times of medical uncertainty, having health insurance provides the peace of mind that you can prioritise the health and well-being of your loved ones without being unduly burdened by the associated costs.

4️⃣ Provides Preventive Care Services
Besides offering financial security, health insurance also extends its caring hand towards your well-being. It offers a wide array of preventive services like routine vaccinations, screenings, regular check-ups, etc. These acts of vigilance not only keep you healthier but also prevent more serious and costly health problems down the road.

5️⃣ Savings on Medications and Outpatient Care
For individuals managing chronic conditions, health insurance is like a beacon of hope. It covers the costs of prescription drugs, lightening the load of medication expenses. Moreover, it extends its coverage to outpatient care, ensuring that routine medical visits, consultations, diagnostic tests outside of hospital stays, etc., are taken care of. This is a boon for those in need of frequent check-ups or consultations.

6️⃣ Peace of Mind and Financial Security
The benefit of health insurance goes beyond just financial coverage; it provides a sense of peace and security. Knowing that you have a dependable support system in place to manage unforeseen medical expenses offers reassurance, allowing you to focus on your health and recovery, rather than worrying about the financial burden.

7️⃣ Cashless Treatments
If you apply for a cashless claim under health insurance, your insurance provider takes care of settling bills directly with the network hospital, saving you from the hassles of billing and the need to arrange funds during emotionally draining situations. You only need to pay for expenses not covered by your policy. This seamless process not only ensures timely medical attention but also eases the financial burden, allowing you to focus on your health.

8️⃣ Supplementary Benefits
Health insurance isn't just one-size-fits-all; it's customizable to your unique needs and preferences. It offers an array of supplementary benefits, such as critical illness coverage, maternity expenses, wellness programs, access to second medical opinions, alternative treatments, ambulance services, etc. These additional perks give you the freedom to tailor your health insurance plan according to your specific requirements, making it truly personal.

9️⃣ Tax Advantages
According to Section 80D of the Income Tax Act, you can claim deductions on the annual premiums you pay for your health insurance policy. So, with health insurance, you can lower your overall tax liability as well as make sure that you have a proper safety net in place.

Let’s learn about these tax benefits in detail.

Tax Benefits Of Health Insurance

As discussed above, health insurance policies offer more than just financial protection for hospitalisation, they also provide tax advantages. Under Section 80D of the Income Tax Act of 1961, you can qualify for tax deductions on your yearly health insurance premiums you pay for covering yourself, your spouse, dependent children, and parents as well.

Tax Deduction Limits Under Section 80D

In accordance with Section 80D, the maximum deductions you can claim under your policy depend on your age and the age of your family members. Here are the deduction limits applicable to different categories:

Important Things To Keep To Mind!
👉 The entire health insurance premiums, inclusive of taxes, are eligible for deductions under Section 80D.

👉 To qualify for tax deductions, payments for premiums must be made through bank transfer, credit card, check, or demand draft. Cash payments for premiums are not eligible, except for preventive health check-ups.

👉 Tax deductions stipulated in Section 80D does not apply if you are covered by your employer's health insurance plan. However, if you pay a portion or the entire premium, you can still claim the deduction.

👉 Health insurance policies must be obtained from government-approved or IRDAI-authorised entities to qualify for tax deductions.

👉 You have the opportunity to claim tax deductions of up to Rs. 5000 for preventive health checkups. Even if you had paid for the preventive health checkup in cash, you can still claim this deduction.

Difference Between Mediclaim Plan And A Critical Illness Insurance Plan

In our modern world, where healthcare costs continue to soar, having a health insurance policy is a lifeline to protect both you and your loved ones from the crushing weight of medical bills. When it comes to health insurance, there are two essential types: Health Insurance/Mediclaim plans and Critical Illness Insurance plans. While both offer financial help in times of medical need, they have distinct roles.

Mediclaim, also known as health insurance, is like a safety net that covers a wide array of medical expenses, providing comprehensive coverage. On the other hand, critical illness insurance is your safeguard against listed specific illnesses, ensuring financial support precisely when you receive a critical illness diagnosis. Such illnesses can strike anyone and have the potential to shake your financial foundation.

A critical illness not only impacts your income but also leads to a surge in expenses. This includes doctor visits, treatments, tests, checkups, and even lifestyle changes like requiring wheelchairs, ramps, or specialised beds, along with full-time nursing care. Unfortunately, basic health insurance often falls short in covering these costs. This is where critical illness insurance steps in, lightening the financial burden when you're unable to work due to a severe medical condition. Moreover, it offers flexibility, as the payout can be used to address a wide range of potential needs, providing peace of mind during challenging times.

Let’s take a look at the key differences between both these plans!

How To Buy Health Insurance?

Understanding health insurance can be like navigating a complex maze, with numerous options, benefits, and fine print to decipher. It's a crucial puzzle to solve, considering the uncertainties of healthcare needs. Fortunately, the process of buying health insurance has become more accessible and convenient today, offering options to suit various preferences.

Enter MyInsureBuddy, a platform that simplifies this journey. With our user-friendly interface and comprehensive information, we streamline your search for the right health insurance. We go beyond simplifying complexities by connecting you with some of India's top financial advisors – your trustworthy companions on this insurance journey.

Think of these experts as your insurance GPS, guiding you through the maze to find a plan tailored to your unique needs and friendly to your budget. Their expertise demystifies the insurance world, providing personalized recommendations for individuals, families, or businesses. With MyInsureBuddy, you can confidently navigate the health insurance landscape, knowing you have the right coverage for your well-being.

Remember, just as assembling a puzzle becomes clearer with each piece, MyInsureBuddy ensures that every aspect of your health insurance falls into place with clarity and confidence.

Why Does Having a professional Health Insurance Advisor Make Sense?

Health insurance advisors play a crucial role in simplifying the intricate landscape of insurance plans, utilizing their extensive product knowledge to offer valuable services. These professionals provide personalized guidance tailored to individual needs and addressing concerns.

One of their key strengths lies in decoding the fine print and terminology, demystifying policy details that might be confusing for the average consumer. Importantly, a good health insurance advisor offers unbiased advice, steering clear of marketing tactics. Beyond this, they streamline the often overwhelming purchase process, efficiently handling paperwork.

At the time of claims, these advisors become indispensable, guiding you through the process and ensuring all necessary documentation is in place for a seamless experience. Navigating the realms of insurance can be daunting, especially when expert guidance is sought. This is where MyInsureBuddy steps in, providing a comprehensive solution to simplify the entire process.

MyInsureBuddy serves as a platform where you can connect with India's top financial advisors, carefully selected from across the country, to guide you through every aspect of your health insurance journey - from initial purchase to renewals and claims. Each advisor is accountable not only to the individual but also to MyInsureBuddy, ensuring a high level of responsibility.

These advisors come with verified profiles, boasting a minimum of 5 years of industry experience. Transparent information about their work profile, including licenses and specializations, along with real customer reviews, adds an extra layer of reliability. MyInsureBuddy facilitates hassle-free appointments, offers free calls with no hidden charges, and allows the convenience of scheduling calls according to individual availability, eliminating the nuisance of spam calls. In essence, MyInsureBuddy stands as the one-stop solution for expert financial advice, making the health insurance journey a smoother and more informed experience for you.

How To Book an Appointment with Advisors in the MyInsureBuddy Community?

Here's a step-by-step guide on how MyInsureBuddy can assist you in finding your right insurance plan -

Step 1: Begin by visiting the MyInsureBuddy website and navigate to the "Talk-to-Experts" section.

Step 2: Depending on your needs, choose either health insurance or term insurance. Rest assured, we have advisors specialising in both, ensuring you're in capable hands.

Step 3: Explore the advisors' portfolios at your own pace. Consider their experience, qualifications, areas of expertise, and track record of assisting others through MyInsureBuddy.

Step 4: Once you've identified an insurance expert who resonates with your needs, schedule your first free one-on-one call. Simply select a convenient time slot, and our advisors will be ready to address all your questions. An email confirmation with the meeting link will be sent to you.

Eligibility Criteria To Buy Health Insurance?

Here are some of the factors insurance companies consider to decide whether they can offer you a health insurance policy -

👉 Age
Age plays a crucial role in determining one's eligibility for health insurance coverage. Health insurance policies typically cater to individuals within specific age brackets, spanning from infancy to a particular upper limit. These age-related criteria can vary significantly across different insurers and policies.

For adults, the entry age requirements can differ. Some policies may accept individuals as young as 18 and continue coverage until the age of 65, while others might extend eligibility up to 99 years of age. Similarly, for children, the age at which they can be covered varies, with some policies allowing coverage as early as 90 days after birth and others providing coverage up to the ages of 18 or 25.

Moreover, there are specialised health insurance plans tailored for senior citizens. These plans are designed to meet the healthcare needs of individuals aged 65 and older, and they offer specific coverage options suitable for this demographic.

It's important to note that both the minimum and maximum age limits can fluctuate between different insurance providers and their respective policies. As a result, it is imperative to directly consult with your chosen insurer to obtain precise information regarding age-related eligibility requirements.

👉 Medical History and PEDs
Your eligibility for health insurance is influenced by both your medical history and pre-existing medical conditions, often referred to as PEDs. Insurance providers examine these factors to assess the level of risk you represent.

Insurance companies consider your medical history, as well as your family's medical history, in their evaluation. They also take into account any pre-existing medical conditions you may have. While having a medical history or pre-existing conditions doesn't necessarily disqualify you from obtaining coverage, it can impact the amount of premium you're required to pay. Additionally, it may result in certain medical conditions being excluded from your insurance policy.

Insurers assess your medical history in various ways. Some plans require pre-acceptance medical exams for all age groups, while others mandate them for those above a specific age, often 50 or 65. Medical exams may be requested after an underwriter reviews your proposal and documents. Further, factors like sum insured and location can influence the need for medical tests. High sum insured amounts may waive tests. For example, in some instances, medical tests may be waived if the sum insured exceeds a certain threshold, such as 10 lakhs.

Understanding your and the insurer’s responsibilities is crucial to prevent claim rejections.

• Insurer's Responsibility: The insurer's primary duty is to thoroughly assess the risk before issuing a policy. They must ask relevant questions and gather necessary information for an informed decision. Courts have held insurers accountable for failing to conduct medical tests and subsequently rejecting claims. The burden of proving willful misrepresentation or information suppression rests with the insurer.
• Your Responsibility: You must understand the questions asked and provide accurate and complete answers. This involves disclosing your medical history and that of your family as well as all other details truthfully, to the “best of your knowledge”.

When filling out application forms or speaking with insurance representatives, it's crucial to provide complete and accurate information. You should ensure that all relevant details are included, and you can even send separate emails to the insurer for additional information. Keep a record of all your declarations in the same folder as your policy documents and inform your family members about this documentation.

If you have uncertainties about symptoms or the health of family members, especially seniors, and you're concerned about the accuracy of your disclosures, consider these steps:

1. Examine medication boxes to identify regularly taken medications.
2. Consult with the family doctor or any healthcare professional your family member visits.
3. Review medical files and records thoroughly.

These actions help guarantee that you've given the insurer accurate and comprehensive information, reducing the likelihood of disputes in the future and ensuring your claims are accepted.

Documents Required to Buy Health Insurance
The exact documentation requirement can vary depending on the insurance provider, but here are some commonly requested ones -

• Age Proof: Aadhaar card, PAN card, driving licence, birth certificate, passport, etc.
• Identity Proof: Aadhaar card, passport, voter ID card, driving licence, etc.
• Address Proof: Ration card, Aadhaar card, PAN card, driving licence, electricity bill, etc.
• Other: In addition to the previously mentioned documents, insurance companies might request further documentation to support your application. This can include medical test reports if required by the insurer. It's important to be prepared for such requests and cooperate with the insurer to ensure a smooth application process.

What Are The Factors That Affect Health Insurance Premium?

Here are some of the factors that influence the premium of your health insurance policy -

👉 Sum Insured
The premium of your health insurance premium is greatly influenced by the sum insured you select. It represents the maximum amount you can claim from your insurance provider for your medical costs. If the chosen sum insured is inadequate, you may be responsible for covering excess expenses, emphasizing the need for a mindful choice to avoid substantial out-of-pocket costs.

👉 Policy Type
There are many various types of health insurance plans available in the market today. Your health insurance premium can vary depending on the specific health insurance plan you select.

👉 Pre-Existing Diseases
A pre-existing disease refers to any condition, ailment, injury, or disease diagnosed or treated by a doctor within 48 months prior to the date of issue of your health insurance policy. Individuals with pre-existing medical conditions like diabetes, high blood pressure, asthma, etc. often have significant and ongoing medical expenses, leading to more hospitalisation claims. Consequently, their insurance premiums tend to be higher than healthier people in the same age group.

👉 Medical History
Your personal and family medical history can affect the amount you pay for insurance premiums. If you or your immediate family members, such as your parents, grandparents, etc. have a history of conditions like cancer, heart disease, diabetes, etc. then insurers consider you a higher risk. Consequently, they may charge a higher premium.

👉 Co-payment
A copayment, often referred to as a co-pay, is a portion of the approved claim amount that you are liable to pay from your end before the insurer steps in to take care of the rest. For instance, say your policy includes a 10% copayment clause. When you file a claim, you'll need to pay 10% of the approved claim amount, and the insurer will cover the remaining 90%.

While some health insurance policies may include mandatory co-payment clauses, others may give you the option to pick your co-payment percentage. Opting for a higher co-payment can reduce your overall premium costs. But, remember, you'll end up with higher out-of-pocket expenses during claims. So, ensure you buy a policy with no or low co-pay to avoid higher out-of-pocket costs.

👉 Occupation
Your insurance company may also consider the type of work you do when assessing your insurance premium. If your work entails high risk, you may be charged a higher premium. For example, an IT employee is likely to pay a lower premium compared to an employee in a chemical factory where the risk of injury is higher.

👉 Add-Ons
Add-ons, also known as riders, are optional benefits that you can incorporate into your base health insurance policy to broaden your coverage. They can provide extra protection for yourself and your family in case of specific circumstances. Some of the riders available with health insurance include maternity cover, critical illness coverage, room rent waiver, and more. It's important to note that these additional benefits come at an extra premium.

Compare Health Insurance Plans Online

New India Yuva Bharat (Base) + Key Add-ons

280 treatments covered

Consumables coverage

HDFC Ergo Optima Secure+ + Key Add-ons

No room rent limit

All day care procedures

2X cover from Day 1

ICICI Lombard Elevate + Key Add-ons

No room rent limit

All day care procedures

Reduced PED waiting period

How To Choose The Right Health Insurance Provider?

Choosing the right health insurance provider in India is undoubtedly a significant decision, but it doesn't have to be overwhelming. Here's a guide to help you make an informed choice -

• Ensure that the insurance company is approved by the Insurance Regulatory and Development Authority of India (IRDAI) to ensure legitimacy.
• Evaluate their product portfolio and check whether they have a wide range of plans to suit your various needs and budgets.
• Check the network of hospitals they offer, as having access to preferred hospitals can be crucial during emergencies.
• Pay close attention to the fine print of the plans they provide to uncover any hidden terms and conditions that may impact your coverage.
• Lastly, review claims and customer support quality to gauge the insurer's reputation.

Now equipped with these important considerations, you can embark on your health insurance search in India with confidence.

How to Find the Right Health Insurance Plans?

If you're on the quest for the best health insurance plan in India, you're in good hands! We're here to guide you through the entire process.

Step 1: Begin your journey with MyInsureBuddy TruMatch

Visit the MyInsureBuddy website, go to ‘Health Insurance’ and click on ‘Find Best Health Plans’ i.e., MyInsureBuddy TruMatch - an intuitive tool designed to simplify your health insurance search. Here, you will have to complete a basic questionnaire related to your specific needs, preferences, and medical history.

Our exclusive algorithm then swings into action, comparing your requirements against a vast database of 150+ health insurance plans that we've thoroughly researched, analyzed, and rated. The result? A personalized recommendation, ready in minutes! This comprehensive report is all you need for confident decision-making.

But, Why MyInsureBuddy TruMatch?

• We've conducted in-depth research on over 150 plans, ensuring you have the most comprehensive options.
• We're fiercely independent, with no affiliations or bias towards any insurance company or platform.
• Our research covers more than 100 parameters, and it's conducted meticulously by industry experts you can rely on.
• We're 100% committed to your privacy, with bank-level data security. Your data is never shared with third parties without your explicit permission.

So, when you choose MyInsureBuddy TruMatch, you're not just getting a recommendation – you're getting peace of mind and trust in your insurance decisions.

Step 2: Compare policies & access detailed information with Health Insurance Decoder.

Step 3: Next, schedule a free one-on-one call with an experienced advisor.

Step 4: Receive unbiased, personalised guidance on health insurance plans tailored to your goals, needs, and budget.

Step 5: Engage in a discussion with your desired advisor, review the report, and purchase a plan with no additional charges or fees.

Plus, you can always drop your health insurance queries on the MyInsureBuddy Insurance Forum for prompt and valuable advice!

How To File A Health Insurance Claim?

Health insurance policy operates in two ways when it comes to covering medical costs: cashless and reimbursement.

• Cashless Method
  Under this option, you can get treatment at a hospital that's part of your insurance company's network. These network hospitals have a partnership with your insurance company. If you decide to go to a hospital from the list of approved cashless facilities provided by your insurer, they will handle the payment of your medical bills directly with the hospital on your behalf. This means you don't have to worry about paying the hospital upfront; your insurance takes care of it for you.

Cashless Claim Proces

Here are the steps to follow when filing a cashless claim with your health insurance:

1.  Make sure you are eligible to file a claim under your insurance policy.  This is particularly important for medical conditions that are covered after a 2 to 4-year waiting period.

2.  Confirm if the hospital you plan to visit for treatment is part of your insurer's network and accepts cashless payments.

3.  Review your insurance policy for any limitations or conditions - whether it has any financial restrictions such as a cap on room rent, ICU charges, or sub-limits on specific diseases and treatments (in case of planned procedures). Verify whether it’ll pay for non-consumable items. If so, don’t forget to check if there is any specific list of items that the insurer will not provide coverage for. These could result in out-of-pocket expenses

4.  Keep the following documents handy,

• Policy copy or cashless card.
• Your PAN card, Aadhar card, and passport-size photo, as the proposer.
• The patient's ID proof.
• Past medical records related to the hospitalisation, such as first consultation papers, follow-ups for any medical condition(related or unrelated to your current ailment), etc.
• Police FIR (in case of accidents)

5.  Make sure to submit your claim request ahead of time. For planned hospitalisation, you should file a claim at least 3-4 days prior to admission. And,  for emergency hospitalization, the claim should be submitted within 24 hours of admission.

6.Provide all required details and documents to the hospital for pre-authorisation with your insurer. Here are the documents that you need to submit -

• Your health card
• KYC documents of the proposer - PAN card, Aadhar card, and a passport-size photo
• ID proof
• KYC documents of the insured
• Your policy number
• Your name and address
• Type of illness or injury and the treatment or surgery required
• Name and address of the medical practitioner that’s attending
• Proposed date of admission to the hospital
• Past medical history, including any conditions related or unrelated to the present ailment.

7.  Be prepared to make an advance deposit if the pre-authorisation process takes longer than expected. Ensure you make a claim for any medical expenses incurred before hospitalisation separately from your insurer. So make sure you secure all original prescriptions, bills, receipts, and reports (including films) related to your hospitalization.

8. Ensure the hospital's insurance desk submits all necessary paperwork to your insurer once the discharge date is confirmed.

9. Stay vigilant for communications from your insurer and promptly respond to any queries or requests for additional documents.

10.  Keep track of the status of your claim to prevent delays.

11.Carefully review the final bill and approval letter to understand which expenses are approved and which are not.

12.If you have questions or need clarification at any point, contact your insurance advisor or insurer directly.

13. Be prepared to cover any expenses that your insurer does not approve before leaving the hospital.

• Reimbursement Claims: 
  When you receive medical treatment at a hospital that is not part of your insurance provider’s network, you are typically required to pay the hospital bill and all associated medical expenses upfront. Afterward, you can file a reimbursement claim directly with your insurance company, and they will reimburse you based on the terms and conditions outlined in your policy.

Reimbursement claim process

Here are the steps to follow when filing a reimbursement claim with your health insurance provider -

1.  Confirm that the hospital you've chosen is not excluded from your insurance provider's network.

2.  Notify your insurance company within 24 hours of your hospital admission.

3.  Before leaving the hospital, ensure you collect all original documents, including,

• Receipts/invoices,
• Discharge summary,
• Medical reports (including MRI/X-ray films),
• Doctor prescriptions, and
• The claim form (part to be filled out by the hospital).

4.  Request a detailed bill from the hospital that breaks down all expenses and obtain a copy of the patient's case sheet or indoor case papers.

5.  Verify that all documents correctly state the patient's name, gender, and age, and if any errors are found, get it corrected.

6.  Gather other necessary documents such as,

• Health card or policy copy
• KYC of the proposer 
  PAN card
  Aadhar card
  Passport size photo
  Bank statement with the bank name, account number, IFSC code printed on it or a bank passbook copy with the latest transaction page or an original canceled cheque with your name printed on it.
• PAN card
• Aadhar card
• Passport size photo
• Bank statement with the bank name, account number, IFSC code printed on it or a bank passbook copy with the latest transaction page or an original canceled cheque with your name printed on it.
• ID proof of the patient
• Claim form - filled and signed
• All documents, test reports, films, receipts, and medical prescriptions associated with the treatment
• Original copy of discharge summary from the hospital
• IOL sticker and invoice from the hospital for claims related to implantation, i.e., knee replacement, cataract claims, etc.

7.  Keep these documents organised in a file and make copies for your records.

8.  Complete the claim form and submit it to your insurer along with the required documents.

9.  Obtain an acknowledgment from your insurer for all the original documents you've submitted.

10. Stay in touch with your insurer to track the progress of your claim.

11. If your insurer requests additional documents, promptly provide them.

12. Carefully review the claim settlement summary, paying close attention to any deductions made.

13.If you have questions or need clarification, contact your health insurance advisor or the insurer for assistance.

Things To Avoid While Buying A Health Insurance Plan

Before you purchase health insurance for yourself and your family, ensure you -

• Don’t Ignore The Waiting Periods
  Health insurance plans make you wait a certain period of time before they cover some medical conditions or treatments. This timeframe is called a waiting period. It's crucial to understand the applicable waiting periods and pick a plan with shorter ones, especially if you have pre-existing conditions. This way you can ensure you can get your hands on coverage sooner when it matters most.
• Don’t Conceal Information
  It's important to provide accurate and comprehensive information to your insurer. Failing to do so can jeopardise your insurance claims in the future. Ensure you disclose all the relevant details about yourself openly and honestly. This way, you can ensure that your insurance coverage will be there to support you when you need it most.
• Don’t Concentrate Only On The Premium
  Never base your health insurance decision solely on the premium cost. You need to prioritise sufficient coverage over a low premium to ensure your health insurance serves you effectively. Look at what the plan actually covers, the benefits it offers, and the reputation of the insurance provider. This broader perspective will help you find a policy that truly aligns with your healthcare needs.
• Don’t Procrastinate Your Buying Decision
  It's a smart move to consider getting health insurance when you're young. When you obtain health insurance early, you can finish off serving waiting periods while you're still in good health. This means that you can access the coverage at times of need without facing any delay due to waiting periods. Illnesses and accidents can happen at any age. With health insurance in place, you can protect yourself from unforeseen medical expenses. This ensures that your hard-earned savings aren’t depleted due to medical bills.
• Don’t Buy The Plan Without Any Research
  Before you dive into buying a health insurance plan, make sure you've got a solid grip on what it's all about – its coverage, limitations, exclusions, etc. Having a plan that doesn't really cover what you need is like having no plan at all. That's why it's crucial to get some help from the experts. They can break things down for you, answer your questions, and guide you toward a plan that actually fits your healthcare needs.
• Don’t Settle With A Basic Cover
  If you are buying health insurance solely for tax reasons or without looking at its benefits, you might be making a huge mistake. Remember, the whole point of buying health insurance is to ensure you have the financial security you need when life gets tough. So, take your time and choose a comprehensive plan that offers an all-round protection.
• Don’t Settle For A Plan Solely Because Your Dear Ones Bought It
  When you're looking for a health insurance plan, getting advice from friends and family can be a good start. But remember, everyone's health needs are unique. So, ensure you don’t rely solely on their recommendations. You need to analyse your healthcare needs and choose a policy that best suits them.

Decode Insurance Plans like a Pro

Heard about a popular plan? Understand the fine print in plain English. Discover the good, the bad, and the ugly before you buy. Heard about a popular plan? Discover the good, the bad, and the ugly before you buy.

Factors To Consider Before Buying A Health Insurance Policy

Here are some of the aspects to look into before taking a plunge -

1️⃣ Sufficient Coverage For Later Years
Let's face it - healthcare costs are skyrocketing. The medical inflation rate in India stands at 5.88%.

Now, say you're 30 and are buying an individual policy with a sum insured of Rs 5 lakh for yourself. Though this amount seems sufficient now, it may not be sufficient in the future. Moreover, as you age, upgrading your coverage gets trickier - if you're dealing with health issues. That means you might not be able to buy a more substantial policy when you actually need it most. So, here's the bottom line: don't procrastinate. Get the most coverage you can afford right now. Then, over the next few years, slowly increase it up. It's the only way to ensure that your health as well as financial well-being are always protected.

2️⃣ No Room-rent Limit
Room rent limit is the maximum amount your health insurance will pay for the room you stay in during your hospitalisation. It may either be a percentage of the sum insured (eg: 1% of sum insured per day) or as a category of rooms (twin sharing room allowed).

Room-rent limits can put constraints on how you use your sum insured because of proportionate deductions. Let's break it down - Say you have a sum insured of Rs 5 lakhs, and your policy has a room rent limit set at 1% of the sum insured. That means you'd need to choose a room that costs less than Rs 5000 per day to have full coverage. If you opt for an elite room that exceeds your allowed limit, your insurer won't just deduct the extra room charges, they'll also proportionately deduct other hospitalisation costs tied to that room. The best solution is to go for a plan that doesn't have a room-rent limit. With that kind of plan, you can make use of your sum insured without worrying about room rent.

3️⃣ Covers All Day Care Procedures
Medical procedures such as dialysis, treating piles/fistulas, appendectomies, chemotherapy, etc. once required days in a hospital. But, now they can be completed within just 24 hours. These are called daycare procedures. With faster, effective treatments, people can access the care they need faster and head back to their usual routine sooner.

But here's the catch - your health insurance policy might have limitations on which day-care procedures it covers. Some insurers break them down into specific treatments to increase the count. For instance, one insurer might cover "ear surgery," while another might break it down into things like "repairing a hole in the eardrum" and "rectification of ear bone" just to inflate the number of treatments covered.

So, the smart move here is to opt for a policy that gives you comprehensive coverage for all day-care procedures. This means you're not just covered for the treatments available today but also for any new ones that may emerge in the future. It's like ensuring your health coverage is future-proof, ready to adapt to evolving medical advancements.

4️⃣ Covers Organ Donor Costs Without Any Cap

As medical advancements make organ transplantations more viable for those facing chronic organ failure, the critical question shifts to the affordability of these life-saving procedures. While your insurance plan may cover the costs of your own surgery in case of organ failure, it's essential to consider the financial implications for the donor who will be undergoing surgery to save your life.

The expenses for the donor can include organ screening, pre-hospitalisation tests, consultations, surgery costs, post-hospitalisation recovery, and any complications post-surgery. These costs will automatically become your responsibility. Without proper financial planning, you might find yourself unable to proceed with a life-saving transplant, despite having a willing donor match and insurance coverage, or worse, deplete your savings to meet these unexpected expenses.

This is where organ donor cover comes in. Several health insurance companies in India now offer comprehensive plans with an in-built cover for the hospitalisation of organ donors. This addition ensures that the expenses related to the donor's medical procedures are adequately covered. Without such coverage, you could face significant financial strain, even with your health insurance policy in place.

5️⃣ No Co-payment

Many health insurance plans, particularly those tailored for senior citizens, often include a co-payment clause. This means you'll be required to cover a portion of the hospital bill before the insurer contributes the remaining amount. With the escalating costs of treatments, managing these co-payment expenses might become increasingly challenging over time. It could necessitate creating a dedicated healthcare fund specifically to handle these costs, or else risk eroding your savings. If finding a policy without a co-payment clause seems difficult, especially with pre-existing conditions or for senior citizens, opt for one with the lowest co-pay.

6️⃣ Cover Specific Conditions Without Any Cap

Some insurance policies come with limitations on how much coverage they provide for specific diseases or treatments. For instance, there might be a cap, like a maximum cover of Rs 1 lakh for cataract surgery. Now, imagine you require an extended hospital stay due to some complications. In such a case, despite having a significant sum insured, you end up paying the additional costs out of your own pocket.

These restrictions can be tucked away in the fine print, and you might not notice them before signing the policy. The revelation often happens when you make a claim, and you realise only a portion of it gets paid.

So, what's the solution? Get back to the basics. Stay informed. Dive into the policy document, read the terms and conditions thoroughly, and understand the fine print before sealing the deal. Compare these details across different plans to figure out which one suits your needs the best.

7️⃣ Restoration Benefit Applicable For Both Related Or Unrelated Conditions

While you may have an ample sum insured to meet your family's expected medical needs, an unforeseen incident resulting in a substantial bill could deplete your entire coverage. This can leave you without protection for subsequent hospitalisations in the same year. This concern is exacerbated if you've opted for a family floater policy, where one member exhausting a major portion of the floater amount could leave the rest of the family without coverage.

Enter the Restoration Benefit – a valuable feature in many health insurance plans. This benefit restores your sum insured within the same year after it gets exhausted, ensuring continued coverage. Restoration benefits are available in both individual policies and family floaters. In individual plans, if you utilise part or the entire sum insured for one hospitalisation, the amount is restored, allowing for subsequent hospitalisations within the same year. In family floaters, if one family member exhausts a significant portion of the sum insured for treatment, the restoration benefit ensures that the remaining family members aren't left without sufficient coverage. Therefore, considering a policy with a restoration benefit can safeguard you from unexpected healthcare expenses and ensure continuous coverage.

When considering a restoration benefit, here are some crucial points to keep in mind:

• Opt for a plan where the restoration benefit is an in-built feature in the base policy, not an add-on. This ensures you won't incur an additional premium.
• When selecting a plan with this benefit, prioritise those offering unlimited restoration. This means your sum insured can be replenished any number of times within a year. Also, confirm that the restoration benefit is an integral part of the base cover, not an add-on.
• Be aware that some plans only allow restoration for unrelated conditions. This condition may limit coverage for repeated hospitalisations related to the same condition. To ensure comprehensive protection, seek a plan that allows restoration for both related and unrelated conditions.
• Look for a plan that replenishes the sum insured even after partial utilisation. This ensures you receive full coverage for every hospitalisation, offering maximum financial protection.
• When choosing a plan with  a restoration benefit, ensure that the restoration is up to the sum insured (and not just the claimed amount). This provides a more extensive coverage for each hospitalisation, offering enhanced financial protection.

8️⃣ Coverage Of Non-medical Costs

Non-medical expenses, encompassing consumables like gloves and oxygen masks, typically fall outside the coverage of most health insurance policies. Despite their seemingly minor nature, these expenses can constitute a substantial portion of your overall hospital bill. Opting for a non-medical expenses add-on cover with your health insurance ensures that these costs are included in your coverage, offering a more comprehensive financial safeguard.

Health Insurance Terminologies

1. Sum Insured
   Sum insured is the maximum amount available to cover your hospitalisation expenses during a policy year. It works on an indemnity basis. Meaning, it pays for the actual expenses incurred rather than paying a fixed amount. It's important to keep in mind that if your hospitalisation expenses go beyond the sum insured specified in your policy, you will be responsible for covering the remaining costs.
2. Exclusions
   Exclusions refer to any conditions, illnesses, diseases, etc. that are not covered by a health insurance policy. Before selecting a plan, it's crucial to review the list of exclusions specified in it.
3. Network Hospital
   A network hospital is a hospital that has been approved and listed by an insurer, Third-Party Administrator (TPA), or both, to deliver medical services to you through a cashless facility.
4. Loading
   Loading is an extra charge added by an insurer to your premium. It is applied when you are at higher risk for certain health issues or illnesses. This extra fee helps them compensate for this risk. Several factors can influence how much loading is applied to your health insurance premium. These factors include your health conditions, which encompasses your medical history, surgeries, and any ongoing illnesses, your lifestyle habits, such as drinking, smoking, etc. your occupation, and more. It's important to keep in mind that loading can vary from one insurer to another. So, it's essential to check with your insurer to understand how loading might affect your health insurance premium.
5. Porting
   Porting is the process of transferring your health insurance from one insurance company to another insurance company. There are several reasons why you might want to switch your current health insurance policy - you may be dissatisfied with the features of your current policy, another policy with better benefits may interest you, etc.
6. No Claim Bonus
   The No Claim Bonus (NCB) is a benefit or discount extended by an insurance company if you haven't filed any claims during a policy period. This bonus is typically provided in the form of an increased sum insured for the same premium amount or as a discount on the premium amount.
7. PED (Pre-Existing Diseases)
   A pre-existing disease is any condition, ailment, injury, or disease that has been diagnosed or for which medical advice or treatment was advised by, or taken from, a medical professional within 48 months before the effective date of the insurance policy issued by the insurer or its reinstatement.
8. Waiting Period
   When you enrol in a health insurance policy, you cannot immediately make claims for all diseases or conditions. Certain ailments are temporarily excluded from coverage for a specific period of time after the policy is issued to  you. This timeframe is known as the waiting period. Once this waiting period concludes, these temporary exclusions are lifted, and you can make claims for these conditions as well.
9. Reasonable and Customary Charges
   Reasonable and Customary Charges in health insurance refer to the acceptable and customary costs associated with medical services or procedures within a specific geographical area. Insurance companies use this clause to establish a limit on the amount they are willing to cover for various healthcare services.
10. Free-Look Period
    The free-look period is a designated time frame during which you can review the terms and conditions of your health insurance policy. This period begins upon receiving the policy document, distinct from the policy issuance or effective date, and lasts for 15 days. If no claims are made during this period, you are entitled to a premium refund. However, some charges, such as stamp duty, administration fees, etc. may be deducted from the refund amount.

Summing up!

Health insurance is crucial for both individuals and families, offering a crucial layer of financial security in the face of unforeseen medical expenses. It encompasses coverage for medical treatments, hospitalization, and various other healthcare-related costs. A well-suited health insurance plan not only protects your savings but also ensures access to high-quality healthcare when needed.

MyInsureBuddy simplifies the intricacies of insurance and financial planning by seamlessly connecting you with some of India's top financial advisors. These advisors are meticulously selected, with verified profiles, a minimum of 5 years of industry expertise, and transparent information about their qualifications. The added convenience of 1-to-1 consultation and flexible scheduling, all at zero cost to you, makes MyInsureBuddy your ultimate solution for expert financial advice.

Plan Reviews

In-depth, unbiased reviews of the top health insurance plans in India.

Compare Plans Head-to-Head

Unsure which plan is better? Browse our massive library of direct comparisons to make the right choice.

What Is Covered Under A Health Insurance Policy?

There is a common misconception that a mediclaim policy is a basic hospitalization policy that doesn't extend to cover pre and post-hospitalization expenses, while a health insurance plan is believed to encompass all health-related costs. However, this is not entirely accurate. Here is what they both provide coverage for:

1️⃣ Pre-Hospitalization Costs

Pre-hospitalization expenses encompass the costs of diagnostic tests, doctor fees, etc., that occur before hospital admission or any treatment, such as blood tests, x-rays, urine tests, etc. Typically, most health insurance plans provide coverage for pre-hospitalization expenses for a period ranging from 30 to 90 days. Pre-hospitalization expenses are covered only if they are related to the medical condition for which you are later hospitalized, and your claim for them is approved as part of hospitalization coverage.

2️⃣ Hospitalisation Costs

During your hospital stay, your mediclaim or health insurance policy covers various expenses, including room rent, ICU charges, the cost of surgery or treatment, fees for doctors and specialists, oxygen, blood, consultancy fees, the cost of medicines, and more. Generally, the policy requires a minimum hospital stay of 24 hours to qualify for coverage.

3️⃣ Post-Hospitalisation Costs

After being discharged from the hospital, your health insurance policy continues to provide coverage for expenses such as follow-up visits to your doctor or the hospital, diagnostic tests, rehabilitation, physiotherapy sessions, and more. Typically, most health insurance plans offer post-hospitalization coverage for a period of 60 to 180 days. This ensures that your medical needs beyond your hospital stay are also taken care of.

4️⃣ Costs of Hospitalisation At Home

Domiciliary hospitalization comes into play when hospitalization isn't possible due to the unavailability of beds in a hospital or when a patient's condition is too severe to be moved to a hospital. In such cases, all expenses incurred for home-based treatment are covered under most health insurance policies.

5️⃣ Cost of Daycare Procedures

Health insurance policies often include a daycare procedure clause, covering specific treatments and surgical procedures that don't necessitate an overnight hospital stay (typically less than 24 hours). These may include procedures like cataract surgery, hernia repair, chemotherapy, dialysis, and more.

6️⃣ Costs of the Organ Donor

In certain health insurance policies, coverage is provided for the expenses incurred by the organ donor during their hospitalization and surgery when an organ transplant is conducted for the insured individual. This helps alleviate the financial burden on both the insured organ recipient and the organ donor.

7️⃣ Optional Covers & Extra Benefits

Health insurance policies offer several valuable add-ons as well as extra benefits to enhance your coverage. These can include benefits like a No Claim Bonus, Restoration Benefit, and add-ons or optional covers like waiving the exclusion of non-medical expenses (like consumables), eliminating copay requirements, and more.

What Is Not Covered Under Health Insurance?

Health insurance will not cover certain medical conditions or circumstances at any cost. These are known as exclusions.

1️⃣ Permanent Exclusions

A permanent exclusion is a situation or medical condition that will not be covered by your health insurance at any cost. You will be liable to pay for any costs associated with a permanent exclusion.

• Investigation and evaluation: Hospital admission solely for observation or monitoring purposes.
• Obesity/weight control: Treatment or surgery for weight control or obesity.
• Plastic/cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
• Profession in hazardous or adventure sports: Treatment expenses incurred while participating as a professional in adventure activities like river rafting, scuba diving, etc.
• Breach of law: Expenses related to the treatment of a person who has committed or attempted to commit a breach of law with criminal intent.
• Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
• Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters for improved eyesight.
• Maternity expenses: Pre/post-natal costs, childbirth-related hospitalization expenses, etc.

2️⃣ Temporary Exclusions (Waiting Periods)

A waiting period is a timeframe during which certain illnesses or treatments will not be covered right after buying a policy.

• Initial Waiting Period: All medical treatments and conditions (except accidents) are subject to a 30-day waiting period after which the coverage becomes effective.
• Pre-existing Diseases Waiting Period: Conditions diagnosed or treated 48 months prior to issuing the policy typically have a waiting period of 2 to 4 years.
• Specified Disease/Procedure Waiting Period: A predetermined list of medical conditions like hernias, chronic kidney disease, etc. entail a waiting period of 2 to 4 years.

Frequently Asked Questions