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A Simple Guide to get into

Health Insurance

A Simple Guide to get into Health Insurance

Page | 2

Index

Introduction to Health Insurance…………………………………………………………………………… Page 3

Flowchart – Getting into Health Insurance.……………………………………………………………. Page 4

Flowchart –Claim Process………………………………………………………………………………………. Page 5

Health Insurance Providers in India………………………………………………………………………… Page 6

Health Insurance for person aged under 18 years…………………………………………………… Page 7

Health Insurance for person between 18 & 45 years…….………………………………………… Page 8

Health Insurance for person between 45 & 60 years…….………………………………………… Page 9

Health Insurance for person aged above 60 years…………………………………………………… Page 10

Common terms in Health Insurance..………………………………………………………………………. Page 11

Conclusion ………………………………………………………………………………………………………………. Page 11

A Simple Guide to get into Health Insurance

Page | 3

Introduction to Health Insurance:

Health insurance is insurance against the risk of incurring medical expenses among individuals.

By estimating the overall risk of health care and health system expenses, among a targeted group, an

insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure

that money is available to pay for the health care benefits specified in the insurance agreement.

The commonest form of health insurance policies in India cover the expenses incurred on

Hospitalization, though a variety of products are now available which offer a range of health covers,

depending on the need and choice of the insured. The health insurer usually provides either direct

payment to hospital (cashless facility) or reimburses the expenses associated with illnesses and injuries

or disburses a fixed benefit on occurrence of an illness. The type and amount of health care costs that

will be covered by the health plan are specified in advance.

All of us should buy health insurance and for all members of our family, according to our needs.

Buying health insurance protects us from the sudden, unexpected costs of hospitalization (or other

covered health events, like critical illnesses) which would otherwise make a major dent into household

savings or even lead to indebtedness. Each of us is exposed to various health hazards and a medical

emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with

technological advances, new procedures and more effective medicines that have also driven up the

costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the

security of health insurance is much more affordable.

Many people mistake life insurance to health insurance. Sometimes people see life insurance

and health insurance lumped together because of the fact that they both insure the person (rather than

the car, the house, etc). The difference is that if you insure your health, with health insurance, then if

you become ill then the insurance company pays for your medical treatment, whereas with life

insurance, if you die then the insurance company pays your nearest and dearest and those who depend

on you. They can't replace you, but they can provide financial help to cover the losses incurred because

of your absence. If you have a job that pays a salary then in the case of a life insurance claim the

insurance company pays so your family aren't left in troubles.

To draw a vehicular analogy, life insurance is like the type of car insurance where you're covered

in case the car is written-off, for example by going off a cliff, where the insurance company pays out the

value of the car. In contrast, health insurance is more like the type of car insurance known as car

breakdown recovery where various motor ailments are covered.

As per the current scenario, not even 1% of the Indian population is covered under health

insurance, compared to developed nations where larger part of the population is covered under health

insurance. It is high time for the Indians to realize the need of health insurance, as the hospitalization

charges are on the rise these days.

A Simple Guide to get into Health Insurance

Page | 4

Flowchart – Getting into Health Insurance

A Simple Guide to get into Health Insurance

Page | 5

Flowchart –Claim Process

A Simple Guide to get into Health Insurance

Page | 6

Health Insurance Providers in India:

The following are the Companies Offering Health Insurance in India :

STANDALONE HEALTH INSURANCE PROVIDERS - PRIVATE FIRMS : APOLLO MUNICH MAX BUPA STAR HEALTH

PRIVATE FIRMS

BAJAJ ALLIANZ BHARTI AXA CHOLAMANDALAM MS FUTURE GENERALI HDFC ERGO ICICI LOMBARD IFFCO TOKIO L&T GENERAL RELIANCE ROYAL SUNDARAM SBI GENERAL

PUBLIC FIRMS

NATIONAL NEW INDIA ORIENTAL UNITED INDIA

The Health Insurance falls under the General Insurance category (Non-life) and it comes under

the supervision of Insurance Regulatory and Development Authority (IRDA).

A Simple Guide to get into Health Insurance

Page | 7

Health Insurance for person aged under 18 years :

Things to look for:

Minimum entry age.

Coverage Amount –

Since the age is lesser, risk of illness will be lesser and hence can go in for lesser

coverage amounts.

Premium Amount –

Lesser premium amount should be preferred as age is lesser so is the risk, and many

companies provide competitive premiums.

No Claim Discounts/Bonus.

Co-payments on treatments especially daycare treatments.

Simple Comparison:

Company Name

Star Health Apollo

Munich Bajaj

Allianz TATA AIG New India

United India

Product Name

MediClassic Individual

Easy Health Standard

Individual Health Guard

MediPrime Individual

Individual Mediclaim

Health Platinum Individual

Minimum Entry Age

5 months 91 days 91 days 91 days 3 Months 3 Months

Coverage Amount

1.5 Lakh - 15 Lakh

1 Lakh - 5 Lakh 1.5 Lakh - 10 Lakh

2 Lakh - 10 Lakh

50k - 5 Lakh

1 Lakh - 10 Lakh

Co-Payment

30% of the claim

No copayment

10% copayment

if in non network hospitals

No Copayment

0 -25% 0 -25%

Discounts/ Bonus

5% discount on No Claims

Discount of 7.5% if you choose a 2 year policy

5% cumulative

bonus benefit for each claim free year, maximum up to 50%.

No

Loyalty and Claim free discounts provided

5% cumulative

bonus benefit for each claim free year, maximum up to 25%

Cashless facility

Hospitals 5400 4500 2300 3000

Depends on the TPA

Depends on the TPA

Premium (2Lakh

Coverage)

Rs.3236/- Rs.2843/- Rs.2626/- Rs.2872/- Rs.2775/- Rs.2472/-

Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.

Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

A Simple Guide to get into Health Insurance

Page | 8

Health Insurance for person between 18 & 45 years:

Things to look for:

Maximum Renewable age-

Continuous renewals will benefit in the future years.

Wider range of Coverage Amount.

Options for good family floater policies.

No Claim Discounts/Bonus.

Lesser loading on premium amount.

Co-payments on treatments especially daycare treatments.

Simple Comparison:

Company Name

Star Health Apollo

Munich Bajaj

Allianz TATA AIG New India

United India

Product Name

MediClassic Individual

Easy Health Standard

Individual Health Guard

MediPrime Individual

Individual Mediclaim

Health Platinum Individual

Maximum Exit Age

70 years No limit 80 years No limit No limit No limit

Coverage Amount

1.5 Lakh - 15 Lakh

1 Lakh - 5 Lakh

1.5 Lakh - 10 Lakh

2 Lakh - 10 Lakh

50k - 5 Lakh

1 Lakh - 10 Lakh

Co-Payment

30% of the claim

No copayment

10% copayment

if in non network hospitals

No Copayment

0 -25% 0 -25%

Discounts/ Bonus

5% discount on No Claims

Discount of 7.5% if you choose a 2 year policy

5% cumulative

bonus benefit for each claim free year, maximum up to 50%.

No

Loyalty and Claim free discounts provided

5% cumulative

bonus benefit for each claim free year, maximum up to 25%

Loading 20 - 50% No loading upto 50% No loading 0 - 200%

depending on claims

0 - 200% depending on claims

Cashless facility

Hospitals

5400 4500 2300 3000 Depends

on the TPA Depends

on the TPA

Premium (5Lakh

Coverage)

Rs. 6596/- Rs.6017/- Rs.9576/- Rs.6992/- Rs. 8174/- Rs.7800/-

Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.

Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

A Simple Guide to get into Health Insurance

Page | 9

Health Insurance for person between 45 & 60 years:

Things to look for:

Early Pre-existing diseases coverage and the sub-limits for them.

Maximum Renewable age.

Sub-limits on Hospitalization.

Coverage of diabetes and other special diseases, if required.

Individual policies can be preferred as family floater policies become costlier after age of 50.

Amount Restoration and Top-up options are additional features that can be looked upon, but

they are offered by limited companies.

Simple Comparison:

Company Name

Star Health Apollo

Munich Bajaj

Allianz TATA AIG New India

United India

Product Name

MediClassic Individual

Optima Restore

Individual Health Guard

MediPrime Individual

Individual Mediclaim

Health Platinum Individual

Maximum Exit Age

70 years No limit 80 years No limit No limit No limit

Pre-existing Covered

after

4 years 3 years 4 years 4 years 4 Claimless

years 4 years

Coverage Amount

Restoration

No Available No Available No No

Top-up Option(i.e.

with deductable

amount)

No Available No No No Available

Cashless facility

Hospitals

5400 4500 2300 3000 Depends

on the TPA Depends on

the TPA

Premium (5Lakh

Coverage)

Rs. 15,230 Rs.14445/- Rs.15236/- Rs.15039/- Rs.

14134.88/- Rs.9873/-

Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.

Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

A Simple Guide to get into Health Insurance

Page | 10

Health Insurance for person aged above 60 years:

Things to look for:

Early Pre-existing diseases coverage and the sub-limits for them.

Maximum Renewable age.

Co-payments and Sub-limits on Hospitalization.

Loading on premiums.

Domiciliary hospitalization coverage.

Simple Comparison:

Company Name

Star Health

Apollo Munich Bajaj Allianz TATA AIG New India

United India

Product Name

Senior Citizen

Red Carpet

Optima Senior Silver

Health

Senior Citizens

Mediclaim Policy

Senior Citizens Health

Insurance Policy

Varishta Mediclaim for Senior

Citizen

Maximum Exit Age

No limit No limit 75 years 90 years No limit 90 years

Pre-existing Covered

after

1 year 3 years 1 year but only 50 % covered

18 months 3 years (Claim free)

1 year (Claim free)

Co-Payment

30% for all claims and

50 % for pre-existing

diseases

15-30 % on claims

20% copayment if treatment is

taken in other

hospitals

No details 20% on major illness

10% on admissible

claims

Loading 20 - 50% No loading available 10 - 20%

30% loading

for including diseases

like diabetes,

etc.

10 - 20%

Cashless facility

Hospitals

5400 4500 2300 3000 Depends

on the TPA

Depends on the TPA

Premium (2Lakh

Coverage)

Rs.9500/- Rs.11,932/- Rs.11203/- Rs.5720/-

(for 1.5 Lakh)

Rs.7600/- Rs.6187/-

Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.

Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

A Simple Guide to get into Health Insurance

Page | 11

Common terms in Health Insurance:

Insurance Agent:

Licensed salesperson, who represents one or more health insurance companies and presents

their products to consumers.

Insurance Broker:

Licensed insurance salesperson, who obtains quotes and plan from multiple sources information

for clients.

Co-payment:

Copayment is a predetermined (flat) fee that an individual pays for health care services, in

addition to what the insurance covers.

Cumulative Bonus:

Each claim free year ensures that you get a benefit known as “cumulative” bonus - it is similar to

“no claim discount” in concept. The only difference being that instead of giving an upfront discount, the

health insurance company adds more benefits for the same premium paid. However, the overall amount

of these benefits will not exceed a certain percentage as specified in the policy

Deductible:

The deductible is the amount an individual must pay for health care expenses before insurance

covers the costs. Often, insurance plans are based on yearly deductible amounts.

Dependent:

A dependent is a person or persons relying on the policy holder for support may include the

spouse and/or unmarried children (whether natural, adopted or step) of an insured.

Domiciliary Hospitalization:

Domiciliary Hospitalization is the treatment of the patient is carried out at home. This needs to

be as per the doctor's recommendation. Most health insurance companies do cover domiciliary

hospitalization subject to a certain limit depending on the sum insured.

In-Network:

In-network refers to providers or health care facilities that are part of a health plan’s network of

providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-

network provider, because those networks provide services at lower cost to the insurance companies

with which they have contracts.

Loading:

An amount an insurance company adds to the basic premium to cover the expense of securing

and maintaining the business.

Conclusion:

As already said, it is high time for the Indians to realize the need of health insurance, as

the hospitalization charges are on the rise these days. As premiums are higher when a person enters

into health insurance after an age of 46 years, it is better to get into health insurance earlier and insure

the whole family, and ensure a risk free happy life.

A Simple Guide to get into Health Insurance

Page | 12

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