Save tax up to ₹75,000~ u/s 80D
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Save tax up to ₹75,000~ u/s 80D
Health insurance coverage helps you stay covered in medical emergencies that might require hospitalisation, doctor consultations, diagnostic tests, etc. This guide explains everything you need to know about health insurance policies.
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Health insurance is a type of agreement between a policyholder and an insurance provider where the insurer agrees to cover medical expenses in exchange for a premium. It protects individuals from medical bills and ensures access to essential treatments. Plans vary in coverage and services, like wellness programs.
There are several types of health insurance coverage based on the type of coverage they offer. Here's a breakdown of the most common types of medical insurance policies available in India
This health plan covers and reimburses hospitalisation expenses up to the SI. It's a medical plan ideal for individuals seeking budget-friendly medical coverage.
This policy offers healthcare coverage for the entire family under a single health insurance premium. All family members share the coverage pool, making it a cost-effective option for small and large families. However, the number of family members covered under a family floater depends on the insurer and the specific policy terms.
The senior citizen insurance plan is curated for individuals aged 60+, which includes higher coverage for age-related illnesses along with annual health checkups, tax benefits, and fewer exclusions.
A Maternity insurance plan covers medical expenses during pregnancy, including prenatal, postnatal care, delivery, and often newborn care.
This indemnity-based insurance coverage offers financial aid for medical expenses incurred to treat a list of pre-defined critical illnesses. It’s critical for managing high-cost treatment and income loss during long-term care.
It is an insurance policy that offers additional coverage to your existing health coverage and works on the principle of a deductible. A super top-up activates once a deductible threshold is exhausted and is useful for high medical inflation scenarios.
Health insurance supports you and your family in managing health challenges. It supports your overall financial health and gives access to quality treatment in your challenging moments. Here are the key benefits
Medical insurance coverage significantly reduces medical costs for surgery, hospitalisation, and emergencies, preventing financial strain from unexpected bills.
An individual with health insurance coverage can get treatment at network hospitals with cashless facilities, reducing delays and ensuring immediate care during unexpected medical crises or planned treatment.
Provides reassurance knowing you're covered in medical crises, reducing financial stress and allowing focus on recovery.
Insurance providers offer access to a large list of empannelled hospitals across India. This list includes multi-speciality centers and private clinics that enhance convenience and treatment options.
Many plans include free annual health checkups, vaccination and wellness programs which encourage early detection and a healthier lifestyle.
Family members are usually covered in a health insurance policy that ensures they can receive the same protection. This enables them to preserve the family's wellness and health without worrying about financial obligations.
You can claim deductions up to ₹1,00,000 based on the members included in your plan, making a medical insurance policy a smart tax-saving tool in India.
Health insurance is an essential tool for accessing quality healthcare in India without financial burden. It enables proactive health management, early diagnosis and long-term financial protection.
A health insurance plan enables policyholders to alleviate the risk of unforeseen and increased healthcare expenses, delivering security from economic lapses.
It assists in managing lifestyle-related illnesses like hypertension or diabetes and gives access to expert consultations.
Buying medical insurance can promote regular health monitoring and preventive care.
A good health plan reduces out-of-pocket spending and supports financial well-being
It ensures access to immediate care during medical emergencies, preventing treatment delays.
Good health insurance provides medical coverage against increasing treatment costs. It helps you with out-of-pocket expenses by providing coverage for surgery, hospitalisation, and other medical needs.
Health Insurance in India functions by reimbursing or directly settling your medical bills up to the sum insured, in exchange for a fixed premium.
Insurance premiums may vary based on age, medical history, coverage amount, policy type and plan tenure. High claim settlement ratios and cashless hospitalisation are essential features in any healthcare plan
With healthcare costs on the rise, purchasing a health insurance policy is critical for financial security and timely treatment. Here are some reasons you need health insurance:
Medical inflation is growing faster than overall inflation, and quality medical care is now more expensive than expected. Investing in health insurance now protects you from potentially exorbitant medical costs in the future.
Illnesses affect people of all ages. Today's fast-paced lifestyle and environmental factors increase health risks. Insurance provides a safety net, ensuring access to quality medical care and support.
Cashless hospitalisation gives you access to immediate treatment at a network hospital. You can choose any network hospital empanelled with us, according to your locality and convenience. Network hospitals are equipped with good infrastructure and qualified doctors to ensure quality treatment.
A health insurance scheme often includes medical coverage for pre- and post-hospitalisation expenses. This implies expenses incurred 30 days prior to hospitalisation and up to 60 days after discharge can be reimbursed subject to the sum insured. This benefit ensures that your treatment journey from diagnosis to recovery is financially covered.
Chronic illnesses like kidney failure, cancer, and cardiac conditions often require ongoing treatment, therapies, and medications. A comprehensive health plan tailored for critical illness offers exclusive coverage for long-term care, supporting high-cost treatment without any financial strain.
Most health policies offer preventive healthcare services, for example annual health check-ups. These benefits help in early diagnosis and proactive health management. Also they are offered on a cashless basis helping policyholders and families maintain long-term wellness at no additional cost.
Under Section 80D of the Income Tax Act, you can also avail tax benefits. For the premium you pay towards a health insurance policy for yourself, dependent senior citizen parents, children, and spouse, you can get a tax deduction up to Rs. 75,000. However, the taxable amount is subject to your income and age. This benefit not only lowers tour tax liability but also encourages smarter financial planning by investing in long-term medical insurance plans for you and your loved ones.
Here's a checklist to help you compare and select the affordable medical insurance plan.
An all-inclusive health Insurance helps you stay financially secure during a medical crisis. Still, choosing the right plan can be confusing. There are several questions like what's covered, what's not and which one is the best health insurance plan for a family are common and finding the right answers is key.
Pre-existing diseases refers to any medical condition, illness or injury that a policyholder had before buying medical insurance such as hypertension, diabetes, or asthma.
Will it be covered? Yes, however, expenses related to treating pre-existing diseases and any related complications shall be excluded until the expiry of 24 to 36 months (depending on the health plan) of uninterrupted coverage after the date of inception of the first policy with the insurer.
Therefore always choose a policy with a shorter waiting period and make sure to fully disclose your medical history to eliminate the possibilities of claim rejections.
A standard health policy in India offers the following medical coverage:
To understand this, you must read about the exclusions mentioned in your policy document. Exclusions refer to scenarios and expenses for which a policyholder is not eligible to get a claim under the health policy. However, there may be conditions that may not be covered temporarily. That is, they would be covered after a certain waiting period.
Examples of some expenses and medical conditions that are permanently excluded from policy coverage include:
To process your cashless claim under the medical insurance coverage, you must present your health card and identity proof at the network hospital and submit the duly filled pre-authorisation form at the hospital insurance/TPA desk as part of the claim settlement procedures. To ensure hassle-free claim settlement, keep the following details ready:
Please inform your insurer or TPA (Third-party administrator) at least 2 days before planned hospitalisation. In emergency hospitalisation, ensure intimation is given within 24 hours of admission to avail cashless claim benefits.
Yes, your health insurance claim can be rejected and often for unavoidable reasons. Therefore, it is essential to understand your health policy, including its medical coverage, terms, and exclusions which can help you avoid claim denials.Moreover, it is also essential to renew health plans on a timely basis to avoid health insurance claim rejection.
Common Reasons Why Health Insurance Claims Get Rejected:
Being familiar with the following terminologies can help you make smarter choices and handle claims smoothly.
The sum insured refers to the maximum payout an insurer is liable to pay an insured in case of an unforeseen medical emergency or planned medical treatment. It is based on the principle of indemnity; the health insurance policy will cover the expenses an insured incurs up to the sum insured.
The amount you pay an insurer in exchange for coverage. This is often paid annually. The premium amount is dependent on factors like the type of insurance, coverage amount, age, health and risk level. Therefore, timely premium payments are essential to keep the policy active.
The facility where your insurer directly settles the medical bills with the hospital. The policyholder doesn’t have to pay out of pocket, except for non-covered services or deductibles. This service is available only at network hospitals tied up with the insurance provider. It ensures hassle-free treatment during an unexpected medical emergency or a planned treatment.
Any medical condition, illness or injury that was diagnosed or treated by a medical practitioner, for which medical treatment was sought, before the start of the health insurance plan. These conditions are typically subject to a waiting period before the medical coverage begins.
Exclusions refer to specific conditions or treatments that are not covered under a health insurance plan. This implies the insurer will not pay for medical expenses related to the excluded items. Some of the common exclusions include self-inflicted pain, Cosmetic or plastic surgeries, unless medically required, Dental or vision treatment, unless related to any accident. Therefore, it is advisable to check the policy documents to understand what’s excluded.
The waiting period refers to policyholders waiting before claiming certain medical expenses or treatments. In health insurance plans, there are three types of waiting periods, namely:
Network hospitals or healthcare providers empanelled with an insurance company provide cashless medical treatment facilities to the
Policies: Key Factors to Consider
A No-Claim Bonus is a reward that many health insurance plans provide if the insured spends a claim-free year. It refers to a bonus amount, in the form of an increased sum insured by a specified percentage, that a policyholder is entitled to receive under a health insurance plan for not claiming during the policy tenure.How to Compare Health Insurance Policies: Key Factors to Consider
| Factors | Why it Matters | What to Look For |
|---|---|---|
| Sum Insured | This is the maximum amount the insurer pays for claims in a particular policy year. | Choose a policy that matches the medical expenses you’re likely to bear in your city and family size. |
| Premium Amount | This is the amount the policyholder pays annually to keep the policy active. | Compare what different insurers charge for the same type of coverage to get the best value for your money. |
| Network Hospitals | Enables cashless hospitalisation. | Make sure there are enough well-rated network hospitals in your area so you can easily access the benefit of cashless treatment when required. |
| Waiting Periods | It is the period after buying the health plan when specific illnesses or treatments are not eligible for claim. | Pick healthcare plans with shorter waiting periods, especially for pre-existing diseases or maternity. |
| Co-Payment Claus | It’s the share of the medical expenses that the policyholder is responsible for, while the insurer covers the rest. | Lower co-payment is ideal, especially for seniors. |
| No-Claim Bonus | Rewards for not filing claims during the policy year. | Certain plans increase your sum insured up to 100% or more without extra premium. |
| OPD Coverage | Covers for small treatments or consultations that don’t require 24-hour admission. | Useful especially if you need regular medical consultations. |
| Claim-Settlement Ratio (CSR) | It indicates the insurer’s efficiency in how quickly an insurer settles claims. | Aims for a health plan with a high claim-settlement rate, ideally 95% or more. |
My appreciation for your prompt service
Rahul Sangwan
Health Insurance
We will continue to avail of your scheme
Samanway Barik
Health Insurance
Everything went very smooth
Soubhagya K Kulkarni
Health Insurance
Really helpful explaining the process in advance
Vaibhav Rai
Health Insurance
Health insurance safeguards against rising medical costs and reduces the financial burden of emergencies. It ensures access to quality treatment and acts as a safety net, especially with rising health risks and limited public coverage.
A health insurance policy usually covers hospitalisation, pre- and post-hospitalisation expenses, surgeries, ambulance cover, domiciliary hospitalisation, and modern-day care treatments.
In cashless hospitalisation, you get treatment at a network hospital without paying upfront. The insurer directly settles the bill with the hospital, excluding deductibles or non-covered expenses. You need to flash your health card and get pre-authorisation for planned treatments.
Health insurance in India typically covers medical expenses in exchange for a regular insurance premium. It safeguards individuals and families from rising healthcare costs during illness or medical emergencies.
No, health insurance is not legally mandated in India. However, it is highly recommended to safeguard against unexpected medical expenses and increasing healthcare costs.
Health insurance premiums are primarily calculated based on factors like sum insured, medical history, policy type, lifestyle habits, and add-on covers. Riskier health profiles lead to expensive insurance premiums.
Yes, you can claim tax benefits under section 80D of the Income Tax Act for the premium paid. You can lower your tax liability by claiming up to ₹25000 for individual health insurance and an extra ₹50,000 for senior citizen parents.
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Disclaimer: Plan features, benefits, coverage, and underwriting of claims are subject to policy terms and conditions. Please refer to the brochure, sales prospectus, and policy documents carefully.
~Tax benefit is subject to changes in tax laws. Standard T&C Apply
**Number of Claims Settled as of Dec'24
^10% discount is applicable for a 3-year policy
^^Number of Cashless Healthcare Providers as of Feb 2025
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