Best health insurance plans in india

Changing lifestyles, increasing age, rising medical inflation, and intensifying health concerns are some of the factors that may compel you to look for the best health insurance plan. Although some people already have health insurance plans, they may not have enough coverage to withstand the present healthcare expenses. There are numerous health insurance providers today that offer different types of health insurance with all sorts of benefits included in a package. It is only a matter of investing time in research to find the perfect match for your needs. Some of the best health insurance are enlisted here.

People often think about investing in health insurance and securing their family’s future but don’t know where to start. This page can serve as a guide for you to find the best health insurance policy for you and your family.

What is health insurance?

Health insurance is a financial contract between two parties—insurance providers (insurer) and consumer (insured). This is a legal document that signifies the insurer’s agreement to pay for predetermined medical expenses of the insured in exchange for small fees (policy premium) every month. Depending on the insurance policy, you may be required to pay additional deductibles or charges. Generally, the contract is a one-year agreement, which can be renewed again with mutual consent.

Best health insurance plans aim to provide comprehensive coverage for your medical expenses in a medical crisis or for routine check-ups. Many people also use health insurance as a financial tool to maximise their savings and avail tax benefits.

Types of health insurance plans

Following are some of the most common types of medical insurance policies based on the consumers’ needs:

1. Individual insurance plan

This is one of the most common insurance policies, which is ideal for you if you do not have to take responsibility for anyone’ medical expenses other than yourself. People sometimes buy an individual insurance in addition to a family pack. You can choose additional coverage options by paying extra.

2. Family/float insurance plan

As the name suggests, this plan covers an entire family—your spouse, your children, and (sometimes) your dependent parents—under one policy. You have to pay a single policy premium, and the coverage is shared by everyone in your family. Compared with an individual health insurance, family medical insurance is generally less expensive. Families who don’t have significant medical problems should opt for this plan.

3. Mediclaim insurance plan

This type of insurance plan offers coverage for hospitalisation and in-patient department (IPD) expenses for treatment of accidental injuries and other diseases. Many companies invest in mediclaim insurance for their employees (group mediclaim).

4. Disease-specific insurance plan

It is a broad category that includes different insurance plans, which provide coverage against particular ailments. Usually, they offer a fixed amount as compensation (predetermined) for diseases such as cancer, paralysis, stroke, and multiple sclerosis. Some plans are also designed for chronic diseases, including diabetes, that cover out-patient department (OPD), day care, and IPD medical expenses along with diagnostic tests and drugs.

5. Personal accidental insurance plan

This type of insurance provides a lump sum amount to the insured or their family in case of an accidental injury that causes total or partial impairment or demise.

How to pick the best health insurance policy for you?

Here’s a simple guide to help you buy the best medical insurance according to your needs:

• For young or single people

An individual health insurance plan might be the most suitable choice for you in case you don’t have to take anyone else’s responsibility but yourself. You are likely to get a low policy premium if you purchase health insurance at a young age. Depending on any major life events, including marriage or expecting a child, you can choose a different plan or add additional coverage.

• For people who have a spouse and/or a family

When considering the health and well-being of your entire family, it is best to go for one comprehensive coverage plan. You can choose a family floater medical insurance plan for you and your spouse, add up to 3 children, and even include your parents in the policy. In case that you are planning to have a child, opting for a maternity cover can also prove to be beneficial.

• For your parents or senior citizens

Old age accompanies multiple (minor and major) health problems with it; with the rising medical costs, these health issues can be financially burdensome. However, some insurance companies have dedicated plans for the elderly, which may come at slightly high premium prices but ensure your peace of mind.

• For additional coverage boost only

It is possible that a previously ideal health insurance plan may not be working for you today. In such scenarios, it may be beneficial to consider additional coverage to your existing plan, as buying a new insurance plan will be a tedious process.

Please note that before finalising any plan, you should invest some time in research and consider all encompassing factors—required sum insured, your age, number of family members, and their ages—to select the best health insurance plan for you.

Importance of health insurance

Looking for the best health insurance plan has become a necessity these days. Following are some of the reasons you should invest in a medical insurance:

1. Financial security

You can safeguard your savings and be prepared for a medical crisis by investing in a health insurance policy. Looking for funds in dire times is not ideal; you may end up drowning yourself in debt trying to provide optimum care for yourself and your family. With a health insurance policy, your finances will be in check, and you can then pay attention to your recovery or providing support to a loved one during hospitalisation. If someone in your family is diagnosed with a critical illness (such as cancer, and renal failure), you can have more financial support in times of need with an additional cover for critical illness.

2. Peace of mind

Having a financial cushion—health insurance—to fall back on can ensure your peace of mind. Most experiences related to a hospital visit are stressful for people; investing in a medical insurance can ease the anxiety and enable you to focus on the medical care.

3. Optimum care

People may shy away from a better procedure available for their health condition due to lack of funds. This won’t be the case if you have a health insurance plan, and you will be able to avail optimum treatment. Since most health insurers have numerous network hospitals across the country, you have the choice of going to any of these hospitals anywhere in India for medical treatments.

4. Beat medical inflation

Simply saving for a rainy-day fund might not be enough in the upcoming future due to the rising medical costs. Healthcare treatments are getting expensive and as per the current trends, if a procedure costs INR 3 lakhs today, it may cost INR 6 lakhs in the next 7 to 8 years. You can overcome this problem by investing in the best medical insurance for you.

5. Tax benefits

You can avail of tax deductions on the health insurance premiums paid under the Section 80D of the Income Tax Act, 1961. While filing for income tax return, you can club all policy premiums, including premium paid for yourself and/or dependent members of your family.

6. Additional benefits

Since medical insurance companies wish to avoid paying for claims, to maximise their earnings, some of them offer additional services to their customers to ensure good health. Your insurer may encourage you to participate in fitness activities and a healthy diet by giving rewards for joining a club or for doing physical exercise such as yoga through a subject-expert consultation online. Many insurance providers also offer no-claim bonuses to the customers for every claim-free year and send the customers for free regular health check-ups at one of the network hospitals.

 

Some of the best health insurance plans

Finding the right plan for you can feel like a daunting task when you have to go through the plethora of insurance policies online. Following are some of the best health insurance plans available today with key features, categorised by different policy types.

Individual/Family floater insurance plans

This is the most common type of health insurance people seek either for themselves of their entire family.

1. HDFC Ergo Optima Restore

Some of the features of this plan are as follows:

• Sum insured ranges from INR 3 lakhs to INR 1 crore
• Three policy tenure options of 1, 2, or 3 years
• More than 13,000 network hospitals PAN India
• Optional benefit for 100% unlimited restorations of the basic sum insured in a policy year after exhaustion
• 50% increase in your coverage for every claim free year (subject to a maximum 100% increment)
• Preventive health check-ups at the time of policy renewal after continuous coverage
• Up to 8% discounts on renewal if you actively live a healthy lifestyle
• No capping on room rent or type
• All day care procedures are covered

2. Care Advantage

Some features of this plan are presented here:

• Three options for sum insured of INR 25 lakhs, INR 50 lakhs, and INR 1 crore
• Lifelong renewability
• Availability of over 9,800 network hospitals
• Automatic recharge of the basic sum insured once in a policy year upon exhaustion
• 10% increase in the sum insured for every claim-free year up to a maximum of 50%
• Minimum age of 5 years for getting insured (proposer must be 18+) and no maximum age
• No sub-limit on room rent or ICU charges
• Air ambulance cover of up to INR 5 lakhs
• Free annual health check-up
• Optional covers for reducing the waiting period and waiving co-payment clauses at additional costs

3. Star Mediclassic Base/Gold

Some features of this plan provided here:

• Sum insured ranges from INR 1.5 to 25 lakhs
• Policy term can last up to 3 years
• Cashless facility available at 13,000+ network hospitals
• All day care procedures are covered
• Minimum entry age is 5 months and maximum entry age is 65 years for getting insured
• Coverage for AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) treatment
• Coverage for cataract treatment with specified sub-limits
• Limited coverage for treatment of an infant 16 days after the baby’s birth
• Optional covers at additional charges for hospital cash, rehabilitation, weight management, change of gender treatment, cosmetic procedures, etc.

Disease specific health insurance plans

These plans are more of a necessity for people with chronic diseases who wish to invest in their secure future.

4. Care Freedom

Some features of this plan are provided here:

• Treatment expenses for diabetes, high blood pressure, and high BMI are covered
• Annual sum insured ranges from INR 3 to 10 lakhs
• Availability of 9,800+ network hospitals across India
• Policy tenure of 1, 2, or 3 years
• Coverage for medical expenses, including treatment for cataract, total knee replacement, hernia, hysterectomy, renal complications, cardiovascular and cerebrovascular disorders, and cancer, with specified limitations
• Lifelong renewability
• Annual health check-ups for each adult
• Available for individuals and families (up to 6 members)
• Allowance for consumables or non-medical essential items required for treatment during hospitalisation
• Complete recharge of sum insured upon exhaustion
• Optional coverage for home care and extensive health check-ups for diabetes and cardiac ailments

5. Activ Health Platinum Enhance by Aditya Birla Health Insurance

Some features of this plan are as follows:

• Chronic management program that covers treatments for diseases such as asthma, high blood pressure, diabetes, and high cholesterol when these are detected after policy purchase
• Sum insured ranges from INR 2 lakhs to INR 2 crores
• Access to health coach for expert guidance on nutrition, fitness, mental health, etc.
• 50% increment in base sum insured for every claim-free year (up to a maximum of 100%)
• Coverage for advanced treatments including oral chemotherapy and robotic surgery
• Complete recharge of the sum insured in a policy year for unrelated disease
• Obesity and AYUSH treatment expenses are covered
• Rewards for leading a healthy life equivalent to (up to 100%) the sum insured
• Expenses for obesity, AYUSH, day care, and domiciliary treatment covered up to the sum insured
• No maximum entry age and lifelong renewability

Insurance plans for women

These plans are designed keeping in the mind the medical requirements of a woman.

6. TAGIC MediCare Primier

A few features of this plan are given here:

• Coverage for the maternity expenses of up to INR 50,000 (and additional INR 10,000 for a girl child), subject to a waiting period of 4 years of continuous coverage
• Treatment cover of up to INR 10,000 for a new-born for essential medical treatments at the same hospital where the infant was born
• Coverage for first year vaccination expenses for the baby of up to INR 10,000 and an additional INR 5,000 for a girl child
• Sum insured ranges from INR 5 to 50 lakhs
• Policy tenure of 1, 2, or 3 years
• Minimum entry age of 5 years and maximum entry age of 65 years
• Family floater coverage offered for up to 7 members
• Global coverage for the medical expenses incurred outside India if the diagnosis was made in the country

7. ManipalCigna ProHealth Preferred/Premier

Few features of this plan are provided here:

• Coverage up to a specified limit for maternity expenses for 2 child births for the mother aged between 18 and 45 
• Coverage for medical expenses for the treatment of a new-born and first year vaccinations 
• Options for the sum insured (Preferred plan)—INR 15/30/50 lakhs
• Sum insured for the premier plan is INR 1 crore
• 100% restoration for the basic sum insured in a policy year
• Optional cover for reducing maternity waiting period
• Coverage for organ donation, AYUSH, and domiciliary treatment expenses
• Annual free medical health check-ups with a specified list of included tests

Insurance plan for senior citizens

Medical expenses gradually increase with the increasing age; here is a plan made especially for the elderly.

8. HDFC Ergo my:health Suraksha Silver Smart Plan

Some of features of this plan are given here:

• Home healthcare and nursing coverage
• Sum insured ranges from INR 3 lakhs to INR 50 lakhs
• Policy tenures of 1, 2, or 3 years
• Lifelong renewability and no maximum age restrictions on entry
• No capping on the room rent
• AYUSH coverage
• Health coach access for weight and disease management, nutrition, and fitness guidance

Critical illness insurance plan

Some insurance policies have the option for choosing additional coverage for critical ailments when they occur with a waiting period for raising claims.

9. ICICI Health Shield

Some of the features of this plan are presented here:

• Optional critical illness cover at additional charges
• Coverage for critical illnesses or medical procedures, including cancer, open chest coronary artery bypass grafting, kidney failure treatment, major organ/bone marrow transplant, stroke, permanent paralysis, open heart replacement, with limitation
• Sum insured ranges from INR 3 lakhs to INR 50 lakhs
• Policy tenure options of 1, 2, or 3 years

Insurance plan for frequent flyers or high-net-worth individuals (HNIs)

‘Frequent flyers’ is a term used for individuals who are hospitalised four or more times in a single year. This plan is appropriate for people who require a high coverage amount.

10. ManipalCigna ProHealth plan

With coverage up to INR 1 crore for a single policy year, this plan is ideal for frequent flyers and HNIs. Sub-limit clauses decrease with an increase in policy coverage (and premium rates), and the insured can enjoy benefits in addition to the features mentioned in the 7th policy option. 

Things to know before purchasing health insurance online

If you invest some time in research, you can make an informed decision about the medical insurance policy maybe save some money. Here’s a list of things you should know about before investing in a plan:

• Claim settlement ratio (CSR)

CSR for a health insurance company is calculated by dividing the number of claims they successfully settled by the total number of claim requests the company received, and the ratio is then multiplied by 100 to obtain a percentage. A high CSR means that your chances of getting your claim approved from that insurance providers are high and vice versa. When comparing similar policy options, you should always make your final decision based on CSR.

• Sum insured

When deciding the right amount of coverage for yourself (or your family), consider your medical expenses for the past few years and any major expenses that may potentially arise in the future (about 3 years or so). As a general criterion, you can also consider a health insurance plan that provides 50% of your annual income. For example, if you earn INR 10 lakhs in a year, the right amount of sum insured for you will be INR 5 lakhs.

• Online policy premium calculator

With the advent of technology, you can now look for different policies online and compare different options against premium rates. You can easily find multiple premium calculators on the internet that show a preview of benefits and key features of different plans. Make sure to put some time in researching the best health insurance online so that you don’t end up paying more for a plan that covers less benefits.

• Indemnity based vs fixed benefit medical insurance plan

Apart from the ones mentioned above, health insurance plans can also be classified into two types based on the type of coverage they offer. Fixed-benefit plans offer coverage up to a specified limit, whereas indemnity-based plans cover the actual expenses for treatment (except for policy exclusions) in exchange for small deductibles and/or co-payment clauses along with the policy premium.

If you are not sure about the scope of medical expenses in the near future, you can go for an indemnity-based coverage while choosing the insurance plan. However, if you feel that your medical expenses will likely not be more than the sum insured then you can avoid paying the extra deductible cost.

• Optional covers or riders

In addition to an all-inclusive coverage policy, your treatment costs, and related miscellaneous expenses, it is generally a good idea to look for optional add-on covers/riders provided by the insurance provider. Generally, the following types of policy riders or optional covers are offered with a medical insurance at additional cost:

1. Maternity rider
2. Hospital cash rider
3. Critical illness benefit rider
4. Waiting period waiver
5. Accidental death benefit rider

Riders are extremely beneficial as they provide extra coverage for the time period you choose, and you can add them anytime during your policy tenure. You can also opt out in case they are no longer required.

• Sub-limit clauses

Many insurance providers offer a low policy premium for a health insurance plan with same/similar sum insured with a catch—sub-limits. They might not affect the total sum insured, but they limit your coverage considerably. For example, a policy might offer treatment expenses for cataract surgery but may limit the claim amount for this treatment up to INR 18,000 in a policy year. When you are tight on a budget, you can consider investing in a policy with sub-limits, otherwise it is better to buy a comprehensive plan without any limitations.

• Waiting period for pre-existing

Usually, insurance policies have a 2–4 year waiting period after which you can claim medical expenses for a pre-existing condition. Some insurance providers will require pre-acceptance medical check-ups before signing you on for their insurance policy, but most companies hold this procedure for people over 50 years.

For the purpose of building good faith with the insurance provider, which also impacts your claims later on, it is always better to disclose a pre-existing condition. In case you withhold this information at the time of purchase, insurance provider can partially/completely reject your claim request.

• Renewability

Look for a health insurance plan that has lifelong renewability as health problems and medical expenses only increase with time. Purchasing a new health insurance policy after the age of 60 will be more expensive than renewing an existing one (even if your old policy’s premium increases with inflation).

• Eligibility criteria

Apart from pre-existing diseases, a person’s age is the most important factor while buying health insurance. Your age affects the policy premium and whether you get a policy or not. It is better to buy a medical insurance early on because there are very few policies that offer coverage for people who are above 50 (as they are considered high-risk individuals or people who are likely to raise more claims).

• Common inclusions and exclusions

Although medical insurance offers similar coverage to the policyholders, different policies have different coverage that may also vary depending upon your eligibility criteria. Hence, it is recommended that you read through the policy documents to confirm the actual inclusions and exclusions.

Here’s a list of common expenses covered in a health insurance:

1. Pre- and post-hospitalisation treatment
2. IPD treatment
3. Diagnostic and investigative tests including X-rays
4. Room rent
5. Doctor consultation
6. Medical equipment used in surgery
7. No-claim bonus
8. Rewards for maintaining good health (such as free annual health check-ups)
9. Treatment for mental health problems
10. Organ donor expenses

Here’s a list of common exclusions in a health insurance:

1. Treatment for injuries due to self-harm or unlawful activities
2. Treatment for congenital (from birth) diseases
3. Cosmetic and dental procedures
4. Treatment for weight management such as nutritionist’s fee
5. HIV treatment
6. Treatment for injuries due to natural forces or war

Please note that these inclusions and exclusions may differ from policy to policy.

Claim settlement process

Although the claim settlement process is similar for most insurance companies, make sure to read the policy documents to avoid making mistakes in your claim request.

• Cashless claim

You can avail treatment at any of the network hospitals, mentioned in the policy documents, without paying for all of the expenses. If you are going for a planned treatment, you can give an intimation to the insurance provider 5–7 days in advance or notify them within 24 hours in case of an emergency hospitalisation.

The procedure for raising cashless claim is easier than that for raising a conventional reimbursement claim. After intimation, you only have to fill a form at the reception or third-party administrator’s (TPA’s) desk and share few basic details; the rest will be taken care by the insurance provider and the hospital. The TPA will also ask you for your customer ID or policy number for verification. Some of the best health insurance companies, such as Star Health Insurance, pride themselves on processing claim requests at the network hospitals within 2 hours.

• Reimbursement claim

This is a more traditional approach that you may have heard about from your parents, which involves collecting all treatment related documents and sharing them with the insurer (insurance company). Similar to the cashless claim process, you can send an intimation to the insurance provider and share all other documents later (usually within 15–30 days of getting discharged).

Following documents are required for the reimbursement claim:

1. Duly filled claim form
2. Investigative and diagnostic reports
3. Consultation forms
4. Pharmacy bills
5. Discharge summary and/or fitness certificate
6. Receipts of any equipment used in the treatment
7. Final hospital bills
8. Cancelled cheque or NEFT details
9. FIR or mediocre-legal certificate (MLC) in case of an accidental injury treatment

Please note that any mistake in your claim process may end up in total or partial rejection of the claim. You should also make 2 to 3 extra copies of all the documents after compiling your claim application, in case the original (sent to the insurer for processing) gets misplaced.

Final word—which health insurance should you buy?

After investing some time, you will likely know the requirements and a rough idea about the ideal premium amount. This information will form the basis for your decision. You should go through a few brochures of the best health insurance policies according to you and figure out which one suits you the most. Make sure to consider all the factors mentioned in the ‘Things to know’ section so that you can make an informed decision.

If you haven’t found the appropriate policy, wait for a while or talk to the insurance provider to see if they can accommodate your requirements at a reasonable price. Since, buying health insurance is a long-term commitment, it is better to wait for some time instead of getting caught up in the wrong insurance plan. In case you have some qualms about the policy, most insurance providers share contact information on their website. Book an appointment to clear doubts or visit the nearest branch office to enquire about the policy.