All Need To Know Insurance: You About Health

All You Need To
Know About
Health Insurance
All You Need To Know About Health Insurance 1
Content
CHAPTER 1: HEALTH INSURANCE OVERVIEW
1.1 HEALTH INSURANCE CHAPTER 5: IMPORTANT ASPECTS OF HEALTH INSURANCE
1.2 Health Risks 5.1 Policy Inclusions
1.3 Importance of Health Insurance 5.2 Policy Exclusions
1.4 Health Insurance Policies in India 5.3 What factors impact Health Insurance Premium?
1.5 Different Forms of Health Insurance Policies in India 5.4 Cashless Hospitalization
1.6 Mediclaim Policy (group / family floater and individual) 5.5 Day Care Treatment
5.6 Pre & Post Hospitalization
CHAPTER 2: THIRD PARTY ADMINISTRATOR (TPA) 5.7 Grace Period
2.1 Definition 5.8 Claim Settlement
2.2 Benefits of TPA to policyholders 5.9 Free Look Period
2.3 Benefits of TPA to the insurance companies 5.10 Waiting Period
2.4 How do the TPAs function 5.11 Tax Benefits of Health Insurance

CHAPTER 3: BUYING & MAINTAINING HEALTH INSURANCE
3.1 Various ways / platforms to buy health insurance
3.2 Factors to consider while buying health insurance policy
3.3 Online Policy Renewal
3.4 Health Insurance Portability
3.5 Benefits of Health Insurance Portability

CHAPTER 4: DIFFERENT TYPES OF HEALTH INSURANCE
4.1 Individual Health Insurance
4.2 Family Floater Insurance
4.3 Critical Illness Insurance
4.4 Maternity Insurance
4.5 Senior Citizen Insurance

1
Chapter 1:
HEALTH INSURANCE OVERVIEW

1.1 Health Insurance
Every day, we come across instances of people dying due to their inability to
get timely treatment. Not that there is a paucity of hospitals or treatment
facilities in India, but because the hospitalisation expenses and costs of
medical treatment have risen to a level that very few can afford. Inflation has
had an overbearing effect on medical costs, which explains the increasing
need to buy health insurance.

What is health
insurance?
Simply said, it is a kind of risk cover against increasing medical and surgical expens-
es. A health insurance policy is an agreement between the insurance company and
the policyholder in which the former is liable to pay for the hospitalisation and
treatment expenses of the latter in lieu of regular payment of premiums during the
policy term. With a health insurance policy in place, the policyholder can seek the
benefits of either cashless treatment or reimbursement of the amount spent on
treatment, if and when required. However, the insurer is liable to pay off the med-
ical bills subject to the condition that the total billing amount does not exceed the
amount of sum assured and premiums are paid on time.

Let’s understand the concept of health insurance with the following example.
Jogesh Kumar, aged 34, is a married man with two children. In addition, his aged parents are also living with him. The entire family
runs on Jogesh’s income. This means that Jogesh is not only responsible for their financial security but has to also take care of
their hospitalisation and treatment expenses irrespective of whether the medical treatment is planned or sudden.
Suppose Jogesh’s wife has been suddenly hospitalised and needs to be treated for some medical disorder. The total hospital bill
amounts to Rs. 3,69,000. Jogesh who already had bought a health insurance plan with a sum assured totalling Rs. 4,00,000. Since
Jogesh had opted for the cashless treatment option, he simply submits the health insurance card at the insurance desk of the
hospital. The insurance company is now liable to pay off the medical bills, thus, relieving Jogesh from the liability of having to pay
such a huge medical bill from his accumulated savings.
Important points about health insurance

It is important to note that your health insurance policy will cover only those medical expenses that are not incurred on treatment
of illnesses not covered or excluded under the policy. Almost every health insurance plan sold in India covers hospitalisation
expenses, day care treatment, the amount expended on domiciliary care, organ transplantation, ambulance expenses, etc.
Additionally, health insurance policies take care of pre and post-hospitalisation expenses too.
Though many health insurance policies in India cover both pre and post-hospitalisation expenses, it is important to keep in mind
the following points before opting for a health insurance plan. These include:
• The insurance companies do not cover pre and post-hospitalisation expenses for an infinite period. Most insurance companies
cover the expenses incurred for 30 days or 60 days before hospitalisation. Similarly, they cover post-hospitalisation expenses for
60 days or 90 days after getting discharged from the hospital;
• The actual number of days for which pre-hospitalisation and post-hospitalisation expenses would be covered differs from
one insurance company to the other, thus, making it important for the policyholder to read the details of the policy before buying
it;

• The insurance company is liable to pay for the pre-hospitalisation expenses subject to the condition that the expenses
were incurred for the illness or disease for which the insured was hospitalised. Similarly, the insurer would pay off the post-
hospitalisation expenses only if they are incurred on the ailment for which the insured had been admitted to the hospital.
1.2 Health Risks

Uncertainty is the only certain element in one’s life. This explains why some people are always in a hurry to achieve, succeed
and ensure complete financial security for their loved ones. Sadly, health gets ignored in the daily grind of life. While we all have
been taught the importance of the age-old adage “Health is Wealth”, people always tend to ignore and undermine the need for
maintaining good health in the pursuit of wealth.
Common health problems affecting Indians

The Indian society is fraught with lifestyle problems stemming from smoking habits, drinking culture, sleeping late at nights,
eating junk food, dependence on vehicles even for travelling short distances, etc. Those with smoking and drinking habits have to
pay greater amounts of premiums on non-smokers and non-drinkers. This explains why some insurance companies require their
customers to go through certain essential medical tests before deciding on their health insurance proposal.
For example, Anmol Jha, a resident of Bihar, is a chain smoker. Little does he realise that his smoking habits will make him prone
to serious health problems. Anmol Jha opts for a health insurance plan sold by a private insurance company after going through
all the policies being sold in the market and comparing their features and benefits. The insurance company he has chosen agrees
to sell health cover to customers with smoking habits too subject to the condition that the customers have to undergo a complete
medical checkup as prescribed in the terms and conditions of the policy. Anmol will have to bear the expenses of the medical
checkup before buying the policy.
Now, Anmol has two options. Either he assents to the idea of getting through a thorough health checkup as prescribed by the
insurance company or opts for a different insurer that does not seek any medical test before selling the policy. However, in either
case, Anmol being a smoker will have to pay higher premiums if he wishes to avail the benefits of having a health insurance plan
to ensure health cover for himself and his loved ones.
Pollution is another reason that makes an increasing number of people susceptible to health hazards. Sedentary lifestyle adds to
the existing list of disorders affecting Indians of all age groups unbiased of their economic conditions. Some common illnesses
that most Indians are afflicted with include:
Respiratory Problems;
Gastrointestinal Diseases;
Obesity;
Cancer;
Cardiovascular Disorders;
Hormonal Imbalance;
Food Allergies;
Mental Illnesses.
1.3 Importance of Health Insurance

The penetration of the health insurance concept is relatively low in India, which explains why many people are bereft of timely
medical aid. The rising cost of treatment in the country has led to inequitable access to health care services. According to details
published in the National Health Profile 2018 unveiled in June 2018, only 27 per cent of the country’s total population has
health coverage. This means that there is still an ardent need to improve and expand the insurance coverage that covers only
a percentage of the country’s vast population. Out of the total number of Indians who have bought health insurance till date,
roughly 79 per cent were covered by the public insurance companies whereas the rest had accessed the necessary cover from
private insurance companies.
While the National Health Programmes have played a prominent role in tackling the grievous health disorders in India, the share
of public expenditure on health by the Centre is gradually decreasing. Many people in their younger years do not realise the
need for having an adequate medical cover to tackle the burden of sudden medical emergencies. Since the young are less likely
to fall ill or be diagnosed with any serious disorder, they fail to realise how paying a nominal premium for health insurance will
ensure them the freedom to seek the best possible treatment in the long run. Moreover, the insured can get themselves treated
at their choice of hospital, provided that it is listed in the network of hospitals of the insurance company they have chosen to be
associated with.
Why do you need
health insurance?
Lifestyle habits, increasing pollution levels, aggravating stress from their savings account. Hefty bills may also cause them
levels and augmenting pervasiveness of diseases have enhanced to postpone investing in important financial instruments that
the risk of suffering from unforeseen health problems. A sudden provide security in the long run. Health insurance plans not
need for treatment may leave the patient’s family financially only defray rising costs of medical expenses but ensure added
distressed as they have to dig deep into their savings to pay for tax benefits too as the insured can claim a deduction on the
the costs of treatment. Some families also have had to liquidate premiums under Section 80C of the Income Tax Act.
their investments to ensure that the loved ones get the best
possible treatment. Health plans, on the other hand, keep ➢ A shift in lifestyle has may have many medical
the policyholders and their loved ones protected by paying complications. As opposed to earlier days when people used
off the medical bills and, thus, relieving the families from an to walk for long hours or indulged in manual labour, most of
unwarranted financial crisis. them live a sedentary lifestyle, thus, resulting in continued
health problems. Having a health insurance policy in place
Listed following are some factors that shed light on why buying ensures that the policyholder avails medical checkups regularly,
health insurance is important, but must be included as an gets the much-needed treatment at the best available medical
essential financial instrument. These may include: treatment facilities.
➢ Financial security is the ultimate aim of every individual

or family belonging to any income group. However, the extent
of financial security not only depends on how much you
invest but to the extent you can save on your income levels.
Ignoring the need to invest in a health insurance plan results in
many people having to pay their medical bills by withdrawing

1.4 Health Insurance Policies in India National Health Insurance;
Reliance Health Insurance;
Health insurance plans are an essential element of one’s financial Bharti AXA Health Insurance;
planning. A few thousands of premiums paid regularly in advance Bajaj Allianz Health Insurance;
can help offset the expenditure worth lakhs of rupees on medical Aditya Birla General Insurance;
treatment. Buying health insurance is equivalent to paying for one’s SBI Health Insurance;
security that must be done after a lot of consideration. Some of the HDFC ERGO Health Insurance;
top health insurance policies sold by insurance companies in India Max Bupa Health Insurance;
include: IFFCO Tokio General Insurance;
Future Generali Health Insurance;
Star Health Health Insurance;
Apollo Munich Health Insurance;
ACKO General Insurance;
Royal Sundaram Health Insurance;
Tata AIG Health Insurance.

1.5 Different Forms of Health Insurance Policies in India
Not all health insurance policies sold by the insurance Whether you are opting for cashless settlement or
companies in India are the same. More than ever before, reimbursement of the claims made, you will always find
the health insurance sector in India is undergoing a sea a health insurance plan suited to your needs. While many
change as insurance companies are constantly innovating people buy health insurance policies to cover medical
and re-inventing their products in a bid to grab a larger expenses stemming from planned treatment in future,
market share. Customization of health insurance plans is policies that meet medical emergencies are also available.
the buzzword as insurers modify their products to suit their Some of the popular health insurance policies include:
customers’ needs.
Individual Health Insurance Policy: Planning a health cover for yourself? Fret not as a number of insurance
companies sell health insurance plans that ensure a health cover to individuals against illnesses while covering the risk of
hospitalisation and medical treatment. These policies offer benefits like cashless hospitalisation, reimbursement of medical
expenses, pre and post-hospitalisation charges in addition to add-on cover benefits. However, as the name suggests, this cover is
available for an individual only, and hence, the sum assured must be chosen accordingly.
Family floater health insurance: Nothing matters more than family. This is precisely what family health plans or
family floater insurance plans are all about. The idea to ensure that your family avails the necessary treatment at their choice of
a hospital without worrying about the resulting hospital charges. This kind of cover brings the entire family under one umbrella.
These plans offer a fixed amount of sum assured, which means that the insurance company will pay for treatment of the family
members (one or more than one) subject to the condition that the hospital bill does not exceed the amount of sum assured
predetermined while buying the policy.
Senior citizen health cover: Seeking cover for aged parents used to be difficult once. This is because old people
are more likely to fall ill or seek treatment for major health disorders. Since the risk associated with their health is high, most
companies refrained from providing them with any kind of health cover. However, the insurance scenario has drastically changed
in the last few years with new players entering the market.
Maternity cover health insurance: Family planning has its own place in financial planning too. That is why many
insurance companies sell health insurance policies that cover the expenses on pre and post-natal care, child delivery and vaccination
of the newborns in the family. However, the expenses on treatment of the newborn child are supported by the insurance company
only until the policy is active. There are other policies too that cover additional expenses including covering the amount expended
on transporting the mother-to-be to the hospital of your choice.
Top-up plans: As the name suggests, these plans have the advantage of top-up or the benefits of an added coverage
amount, i.e., over and above the amount of cover you had opted for while buying the plan. These plans are bought as supplementary
plans, i.e., a plan in addition to the basic health cover that you had bought in the first place. The top-up plans operate on the
concept of “deductible limit”. This means that the plan will not come into force until the hospital expenses exceed a particular
limit also called the deductible limit. If the claim made by the policyholder exceeds the deductible limit, then the insurance
company is liable to pay the excess amount.
Super top-up plans: These plans are way better than the top-up plans and must be bought by those whose loved
ones are prone to serious disorders due to a family history of illnesses. Since the treatment of these illnesses incurs a very high
expenditure, it makes sense to pay for these plans so as to offset the rising medical expenses in the long run. As opposed to top-
up plans where each claim over and above the deductible limit is said the trigger the plan, in super top-up plans the aggregate
claims incurred during any particular year are considered.
This can be explained with the help of an example. Take, for instance, Shyam Sundar has bought a super top-up plan with a
threshold limit of Rs 100,000. Suppose Shyam has made two health insurance claims of Rs 80,000 and Rs 70,000 respectively.
Since the total claim made on the two plans amounts to Rs 1,50,000 which is in excess of the threshold limit of the super top-up
policy, then the insurance company is liable to compensate to the tune of Rs 50,000 (aggregate of the two claims – threshold
amount limit).
Fixed benefit plans: These are also called defined benefit plans. Instead of compensating for the claim made by the
policyholders, these plans promise a fixed benefit predetermined while buying the plan. The plan benefits are irrespective of the
claims made on them and may exceed or be less than the claim amounts.

There are different kinds of fixed
benefit plans. These include:
✔ Critical Illness Plans: These are also a kind of health insurance plans that operate differently and provide a specific amount
of coverage only during hospitalisation or treatment of specific critical disorders only. Every critical illness plan is different in the
sense that each plan covers a list of specific critical illnesses only and is activated only if the policyholder receives treatment for
that particular grievous disorder only. Instead of paying the claims made on the hospitalisation costs, the insurance company is
liable to pay in a lump sum the predetermined coverage amount to the policyholder. A majority of the insurance companies selling
critical insurance plans cover the following disorders under the policy:
- Major organ transplantation;

- Cancer;
- Pulmonary arterial hypertension;
- Cardiovascular disorders;
- Aorta graft surgery;
- Coronary artery bypass surgery;
- Multiple sclerosis;
- Kidney failure;
- Paralysis.
✔ Hospital Daily Cash Plans: These plans are also called hospital cash benefit plans and promise a fixed amount for each day
of hospitalisation in the event of any, irrespective of the nature of the treatment of the insured. The amount of money given out
by the insurance company is unbiased of the amount spent on hospitalisation and treatment.
✔ Personal Accident Cover: These are not individual health insurance plans but offered as riders to the health cover bought.
Opting for this rider by paying an additional amount of premium benefits the policyholder as the insurance company is liable
to pay for hospitalisation and treatment in case of an accident. The payout by the insurer is in the form of a fixed benefit and is
independent of the amount spent on treatment.
1.6 MEDICLAIM POLICY (Group / Family
Floater And Individual)
Good health is a necessity. The challenge of being fit and remaining fit is, at
times, marred by genetic disorders, congenital problems or illnesses stemming
from pollution and unhealthy lifestyle habits. Advancements in medical
science and innovation in treatment methods have ensured that people are
able to seek necessary treatment without delay. However, inflation has had
its effect on medical expenses too, thus, resulting in many people remaining
untreated and suffering from their disorders. Health insurance fulfils the
need by availing the necessary medical cover in lieu of regular payment of
nominal premiums.
Currently, health insurance plans are sold under two categories:
• Individual health insurance;

• Family floater health plans.
In addition, companies today are availing the benefits of health insurance

coverage to their employees under various Group Health Insurance schemes.
Individual health plans are taken by policyholders to insure themselves.

The Family health plans are actually extended versions of individual health
insurance policies that customers buy to ensure that their loved one(s) or
dependent(s) are secure against unforeseen medical disorders and are,
thus, able to seek treatment at their choice of hospital. Under family health
insurance, one can seek cover for spouse, children and aged parents beside
themselves.

A corporate or group health insurance policy is like a benefit that is
passed on by a company to its eligible employees. This is one of the
perks that most companies are currently giving to their employees
to ensure their loyalty and prolonged service. Some group health ● Star Health and Allied Insurance Policy;
insurance policies are structured to include the family members ● HDFC ERGO Group Health Insurance;
of the employees under the ambit of the policies. The top group ● Future Generali Group Health Insurance;
health plans sold by insurance companies that sell health insurance ● ICICI Lombard Group Health Insurance.
policies include:
Let us understand the kinds of health insurance plans with the help of some examples:
Example of An Individual Health Insurance Plan

Shikha Dhawan, aged 28, works with the private sector and understands the need to buy health insurance. Shikha’s parents are
retired Government employees. This means that any expenses incurred on their treatment are reimbursed by the government.
Since Shikha is not covered under any health insurance policy, she decides to buy a health insurance plan that would secure her
against any future hospitalisation and medical costs, if any. Since Shikha chooses to get only herself insured, she chooses to buy an
Individual Health Insurance Plan.
Example of Family Floater Insurance Plan

Niladri Shekhar Dutta, aged 34, is a married man with two children and lives with his parents in the same house. Being the only
earning member in his family, each member of the family is dependent on Niladri’s income. This also implies that Niladri has to bear
every expense including the medical costs of his family members.

Niladri realises that hospitalisation expenses and treatment costs are gradually rising. He seeks a health insurance plan that would
cover his entire family in lieu of nominal premiums. He logs on to the internet to read about various family floater plans and chooses
one that promises an adequate amount of coverage at reasonable premium rates. Since the family floater health policy covers each
member of his family, he is secure from the burden of bearing exorbitant medical costs incurred during the treatment of his family
members at the hospital of his choice. Moreover, the insurance company he chooses promises him additional benefits like claim
settlement of daycare treatment expenses in addition to the amount expended as pre and post-hospitalisation expenses.
Example of a Group Health Insurance Plan

Sakshi Mehra, aged 32, is employed with a company that promises perks and benefits as an effective employee retention method.
The company has tied up with Kotak Insurance that covers all its employees under its Group Insurance Cover Plan. In lieu of the
premiums paid by the company, each employee including Sakshi is guaranteed a cover, not exceeding Rs 4 lakhs, to secure against
treatment costs in case of any sudden medical emergency stemming from illness or accident. Sakshi, who is currently not covered
under any health insurance policy, finds it an effective financial instrument to manage future medical expenses, if and when arise.
However, Sakshi also realises that this cover is guaranteed only until she remains employed with the company. She will be bereft of
this important cover once she resigns or is officially relieved from her services.

2
Chapter 2:
THIRD PARTY ADMINISTRATOR (TPA)
2.1 Definition
The innovative idea of introducing the concept of Third-Party Administrators
(TPA) was first introduced by the Insurance Regulatory Development
Authority of India (IRDAI) in 2001. One can find the list of TPAs on the IRDAI
site. As evident from the name, these TPAs are third-party entities licensed
by the IRDAI to ensure a seamless and hassle-free claim settlement process.
They do this by acting as the intermediary between the policyholder, the
health insurance company and the healthcare service provider. For example,

Narayanan Krishnamoorthy, aged 35, needs urgent medical treatment as advised by his doctor. He gets in touch with the TPA
and informs about the need to seek medical treatment. The TPA advises the policyholder about the nearest hospital listed in the
insurer’s network and aids him in the claim process post-discharge from the hospital. The TPA is liable to help the policyholder
irrespective of whether he had opted for cashless claims or reimbursement of the amount expended on hospitalisation and
subsequent treatment.
The IRDAI has listed certain guidelines governing the working of the TPAs engaged in providing necessary management solutions
to the health insurance companies. The myriad responsibilities of TPAs include timely premium collection, seeking details of the
treatment from the policyholder and intimating about the same to the concerned health insurance company, finding details of
the network hospital nearest to the policyholder, approving the claims raised by the hospital or treatment facility, approving the
cashless claims raised by the policyholders and disbursement of the billing amount to the hospital.
The concept of TPAs came into effect after the government allowed private insurance companies to sell health insurance policies.
The inception of TPAs since 2001 has greatly increased the efficiency of the claim settlement process, thus, enhancing the
effectiveness of buying health insurance in India.
2.2 Benefits of TPA to policyholders

An essential benefit is that the policyholder gets an opportunity to get treated at any of the hospitals in the TPA’s empanelled
network and make use of the services as per need and choice. Moreover, for every recurring hospitalisation, the policyholder will
have the advantage of knowing whether the treatment he or she wishes to undergo is covered under the health insurance policy
bought. Similarly, during emergency hospitalisation, all the policyholder or the dependant has to do is to show the health insurance
card and get admitted at any of the network hospitals for treatment. No amount would be charged from the policyholder or any
of the insured under the policy at the time of discharge from the hospital. Some TPAs provide added services like an ambulance
referral or advising about any surgeon or specialist who can help.
Statistics highlight how a lot of Indians continue to be ignorant. Since most of the customers are unable to understand the
technical terms and jargons included in the insurance proposal, they face the risk of claim rejection. TPAs enable an efficient
delivery network that ensures that the policyholders do not feel cheated and are the ultimate beneficiaries of the insurance they
had paid for.
Before the TPAs came into the picture, lots of policyholders complained about how they found it difficult to get their medical
expenses reimbursed from the concerned insurance company. However, as now reimbursements are routed through the TPAs, it
is the TPAs who meet the hospital expenses by paying the healthcare provider from their fund and then get reimbursed from the
concerned insurance company.
2.3 Benefits of TPA to the Insurance Companies

The TPAs, since they were first introduced, have gone a long way in curtailing the costs of the insurance companies. This is because
the insurance companies did not have to spend on increasing or spreading their network throughout the country, especially,
to the remote areas. TPAs act as the most vital link between the three elements of the health insurance sector including the
policyholders, the health service providers and the insurance companies. As treatment facilities scramble to make more money
to run their operations and earn profits, insurance companies look at all means to control their costs. As an increasing number of
people prefer to opt for the cashless option, it is the role of the TPAs to identify the actual expenses that may have been incurred
and the credibility of the amount to be paid by the insurance company.
2.4 How Do the TPAs Function?

The TPAs function as the intermediary between the insurance company and the policyholders by facilitating the claim and
settlement processes. To customers opting for cashless hospitalisation services, the TPAs issue the ID Cards to the policyholders.
These policyholders can show these cards while gaining admission to the hospital for treatment during an emergency. Also, the
TPAs assist the policyholders by giving them details about the nearest hospital in the insurer’s network so that they may avail
the benefits of cashless settlement. However, if the customer opts for some other hospital outside the insurer’s network, then
the TPA enables reimbursement of the claim payment. For easy and quick claim settlements, the TPA collects all the necessary
documents including bills and the copy of the claim to the insurance company.

3
Chapter 3:
BUYING & MAINTAINING HEALTH

INSURANCE
3.1 Various Ways / Platforms to Buy Health
Insurance
Buying patterns have largely changed in the past few years. From the brick-and-mortar
showrooms, people have moved on to virtual platforms that allow them to shop from
the comfort of their homes. Payment methods have also changed, which means that
the strain of having to carry cash and fear of losing it has been replaced with online
banking methods and payment gateways that ensure immediate payment with just
the click of a button.
In addition to buying insurance plans offline, interested customers can now log on to
the sites of the insurance companies from which they wish to buy or search for the
various insurance plans listed on the websites of multiple insurance web aggregators
including Policy Bazaar, Bank Bazaar, Cover Fox, Policy X, etc. With so many platforms
offering multiple benefits to people looking to buy insurance products, one could not
have asked for more.
3.2 Factors to Consider While Buying
Health Insurance Policy
The uncertainties of life have always prompted people to
rely on technological innovations and medical advancements
for better living. Along with expectations, expenses have
also gone up as is evident from rising healthcare costs, thus,
explaining the relevance and importance of including health
insurance as an essential financial tool. An increasing number
of insurance companies have now come up with innovative
health insurance products that promise multiple benefits in
lieu of nominal premiums. Those looking for added benefits
over and above what they are already getting can easily apply
for the same by agreeing to pay over and above the basic
premium rates.
“Insurance” is not a new concept, especially, in the Indian

context. However, most customers continue to be ignorant
about the various terms used in insurance and their significance
in today’s living. With a multitude of health insurance plans to
choose from, customers are sometimes confused and unable
to choose the health insurance policy that would serve their
needs and defray their medical costs in the long run. However,
a careful look at certain essential factors can help to make
choice of the right health insurance policy. These include:

Price of the product: Most customers flood to insurance companies selling cheap health insurance plans. What they
fail to realise that the price of any health insurance plan is subjective and has a lot to do with the quality of the product that is
being sold. The relationship between price and quality is fine and intricate and must be looked into entirety instead of considering
each separately. For any insurance company selling health insurance cover, the price of the product has a lot to do with the
underwriting efficiency of the insurer in addition to its operational efficacy. Similarly, the price of an individual plan will always
be different from that of a family floater. This is because the price of the latter depends on the number of members covered and
the quantum of cover selected.
Incurred Claims Ratio: Now that one is aware of the various product prices, it’s time to look at the Incurred Claims
Ratio (ICR) of each insurance company. The ICR is nothing but the ratio of the total amount paid in claims to the total amount
collected as premiums by the insurance company. Ideally, the value of ICR must be between 50 per cent and 80 per cent. While
having an ICR on the higher end does highlight the company’s efficiency in settling the claims made by their customers, an
extremely high ICR value also implies that the company is giving away more than it has earned. This may mean that the company
may introduce new rules to clamp down on the claim settlement to restrain its capital outflow. Ignore companies with an ICR
below 50 percent as this means greater chances of your claims getting rejected when needed.
➢ Co-payment Clause: The co-payment clause means that policyholders would be required to foot a portion of the
medical expenses themselves. Most insurance companies have introduced this clause to refrain their customers from opting for
unnecessary surgical procedures or fancy treatments even if they may not be required. Policyholders may be required to opt for co-
payment that may vary from zero to 10 per cent. While this may seem that accepting the co-payment clause allows policyholders
to pay low premium rates, it is equivalent to bearing a part of the medical costs in the long run. Refrain from accepting policies
with a co-payment clause.
➢ Policy Exclusions: While choosing a health insurance plan, most customers look at the policy inclusions only. However,
a careful look at the policy exclusions is similarly important. This is because most health insurance plans are embedded with a
waiting period, thus, relieving them from paying for claims towards the treatment of pre-existing disorders. This waiting period
may vary from 30 days to four years depending on the seriousness of the disorder and the amount of money expended in their
treatment. In addition to the exclusions for the pre-existing illnesses, some insurers may exclude paying for certain hospitalisation
expenses within the first few months of their customers buying the policies. Basic health insurance plans include sublimits for
specific treatments that must not be ignored.
Customers opting for family floater plans that would cover their aged parents too must find out if their choice of policy pays for
OPD charges and ambulance expenses too.
Waiting Period: No health insurance plan comes without a waiting period for diseases that the customers had been
diagnosed with before buying the policy. The idea is to opt for a plan with a lesser waiting period or that plan which has fewer
exclusions corresponding to the waiting period clause.
Cashless Hospital Network: Statistics by the IRDAI in the past have revealed how the average claim payout in
the case of reimbursement settlement is only half the amount settled by cashless claim settlement. Prefer to opt for a cashless
settlement claim. Scan through the insurer’s network of hospitals that offer the cashless settlement. One can find the list of
network hospitals on the insurance company’s network. Find out if your choice of hospital falls within the insurance company’s
cashless network.
Though there is no harm in choosing the reimbursement option, cashless settlement fares better as the policyholders simply have
to show the health card issued by the insurer and seek necessary treatment. Also, in the reimbursement option, policyholders
would be required to pay for the treatment first and seek claim later. This may put undue strain on their finances, thus, affecting
the quality of treatment. Also, opting for the cashless route saves the policyholders the trouble of collecting and collating the
medical bills and documents for submission to the insurance company before making the claim.
Insurer’s Track Record: Never opt for an insurance company that has just entered into business. Experience matters,
especially, a company that enjoys the reputation of a sound financial strength and has a good business track record. Apart from
the claim settlement ratio of each insurance company, study its solvency ratio as the latter highlights the company’s ability to pay
out the claims. Find out if the company has earned enough in premium amounts during the past financial year. High premium
growth registered by the insurance companies depicts the growing faith of the people in this company. Expertise comes with
experience, which means that longer the company has been into the insurance business, greater is its credibility. This apart, any
insurance company with a wider range of insurance products catering to every section of the society is always preferable.

3.3 Online Policy Renewal
The internet has influenced every aspect of our living. This is true of insurance policies that can be renewed
online, thereby, saving policyholders the hassle of having to submit physical documents and queuing
outside insurance companies to submit their renewal proposals. Policyholders have to simply log
on to their choice of insurance companies or register their details on insurance aggregator
sites, type out their policy number, read through the benefits, terms and conditions by their
insurers and apply for renewal accordingly.
Irrespective of the kind of policy including life or general insurance policies,

application for online insurance renewal and subsequent payment towards
the same is now possible.
3.4 Health Insurance Portability

Before understanding the concept of health
insurance portability, it is important to realise
what the concept of “Portability” means in
the context of health insurance and its
significance to policyholders in the
long run.

Every health insurance plan that you buy from any insurance company must involve a level of satisfaction regarding the benefits
promised by the insurer in addition to the terms and conditions laid down by it. In the event of dissatisfaction, the insured looks
for ways to buy a similar policy from another insurance company that promises greater benefits in lieu of low premium charges.
Portability is actually the right allowed by the current insurance company to their policyholders to move to another insurance
company while retaining the existing credit and benefits regarding pre-existing disorders, waiting period and other exclusions that
are time-bound pursuant to the original policy bought. The benefit of portability can be availed by health insurance policyholders
irrespective of whether they had bought an individual health insurance plan or paid for a family cover health policy.
Also, the policyholders can choose to move from one insurance company to the other or from one plan to another plan sold by
the same insurer. However, policyholders can seek the advantage of health insurance portability subject to the condition that they
had towards premiums of the previous policy regularly and had maintained the policy sans any break.
The concept of “Health Insurance Portability” was first introduced by the IRDAI in 2011, thus, allowing policyholders to switch
from one insurer to the other while retaining benefits including no-claim bonus (NCB) and free medical checkups promised by the
previous health insurance policy.
Caveat:
“Nothing Good in Life Comes for Free”, which means that the policyholders can avail the benefits of health insurance portability
subject to certain conditions. To secure the interests of the insurance companies, the IRDAI allows them the right to reject any
port-in requests. Also, all the requests made by customers for portability would be treated as new. This means that the health
details and past insurance claim details would be scrutinised by the underwriter of the new insurer. Only after a detailed evaluation
of the risk exposure, the new insurance company would determine the premium charges that would be applicable to the health
insurance cover sought by their customers. The health insurance proposal may be rejected or accepted post the risk assessment
by the new insurer. In the event of rejection, the policyholder would be required to continue with the existing insurance service
provider.

Important Considerations Regarding Health Insurance Portability
Many people do not realise that age matters when it comes to insurance. This is because the risk associated with health
conditions go up with increasing age. As a result, most insurance companies are reluctant to approve health insurance portability
applications proposed by senior citizens. Some insurers may accept subject to payment of high premium charges in addition to a
co-payment clause.
High premium charges is one of the reasons that most policyholders apply for portability of their health insurance portability.
Your new insurer may agree to charge you less. However, there is a possibility that the coverage amount is reduced. While this may
seem beneficial initially, you may have to spend more for your treatment in the long run owing to the low amount of insurance
cover that you had opted for. This means that looking at premium rates is not enough. It is important to check the premium vis-
a-vis health insurance coverage.
Every insurance application including the new one opted post health insurance portability is based on the “Principle of
Good Faith”. This means that filling in wrong information, incorrect details about existing health disorders or inability to submit
the previous policy documents mandated during portability may result in rejection of the portability application.
Increasing age and health disorders have a determining effect on the portability requests made. The new insurance company
may seek details of your pre-existing disorders or the claims that you had made on your previous policy in the past. Some insurers
also ask their prospective customers, aged above 45 years, to undergo some necessary medical tests. The insurance companies
have to the right to reject the portability application if the policyholder is diagnosed with medical problems including high blood
pressure, diabetes, etc.
Understand the important waiting period clause during health insurance portability. Any and every kind of health insurance
agreement contains the waiting period clause that falls into three categories. Fresh policies come with a waiting period of 30 days.
For minor disorders like kidney stones or appendicitis, the waiting period does not exceed two years. However, policyholders
afflicted with pre-existing disorders like cardiovascular disorders, cancer or Type 2 diabetes can seek a claim for treatment of
the diseases only after completion of the waiting period equal to four years. A policyholder who applies for portability to a new
insurer after continuing to pay for their insurance with the existing insurer for three years do not have to again go through the
waiting period of 30 days and two years respectively. However, the four-year waiting period clause will continue to be applicable
and the insured will have to wait for another one year before filing claims for pre-existing illnesses.

3.5 Benefits of Health Insurance
Portability
It is evident that if you are dissatisfied with the services of the
current insurer, you will seek a change to another insurance
company that offers you the kinds of benefits you are looking for.
Dissatisfaction with your current health insurance plan may be
due to myriad reasons. To ensure that policyholders feel secure
under the cover they wish to avail, the IRDAI had introduced the
concept of “Health Insurance Portability” similar on the lines of
“Mobile Number Portability”. The policyholders have to submit
the portability proposal form 45 days prior to the date of existing
policy renewal. The insurer would assess the proposal details
and the risk factor associated with the policyholder post which it
will accept or reject the proposal within 15 days of receiving the
application for portability.
Policyholders who have paid the premiums towards their existing

policies without any break will continue to avail the benefits
and credits earned during the earlier policy despite switching
to another insurer as per the guidelines published by the IRDAI
regarding health insurance portability.

4
Chapter 4:
DIFFERENT TYPES OF HEALTH

INSURANCE
4.1 Individual Health Insurance
Nothing in life matters more than good health. Simply said, good health is the
basis of all our future endeavours and lays down the groundwork for all the major
accomplishments we make. However, lifestyle habits, the pervasiveness of pollution,
stress during work and ignorance regarding certain aspects of health planning have
resulted in many people suffering from unforeseen health disorders. As medical costs
increased owing to the impact of inflation and other factors, buying an adequate
health insurance policy became important.

Key Features of Buying Individual
Health Insurance
Many people are now buying individual health insurance plans to ensure that they are able to avail the necessary treatment at
their choice of hospital, if and when required. The essential features of any individual health insurance policy include:
This kind of health insurance affords cover to a single individual only. This means that only the insured individual covered
under the policy gets all the benefits of the sum assured and other added advantages pursuant to the policy in lieu of nominal
premiums;
The insurance company covers all the costs of hospitalisation and subsequent medical treatment subject to the condition
that the medical bills do not exceed the sum assured;
There is scope for lifetime renewability in most individual health insurance policies. This means that the policyholder can
start early and continue to be covered under the same policy till the end depending on choice and requirements;
Tax benefits as premiums paid towards individual health insurance plans are eligible for tax deduction under Section 80C of
the Income Tax Act;
Pre and post-hospitalisation costs are also covered under individual health insurance plans;
Depending on the kind of insurance company one has opted for and the age at which one buys the plan, policyholders may
have to agree to the co-payment clause. Agreeing to the co-payment clause proves beneficial as policyholders are guarded against
agreeing to unnecessary treatment proposals, thereby, refraining from the tendency to raise exorbitant medical bills;
Critical Illness Cover is also available.

Benefits of Buying Individual Health Exclusions Under Individual Health
Insurance Policies Insurance
Though individual health insurance policies are more
Many people prefer to buy health insurance that ensures preferred than the family health cover plans, there are some
an umbrella cover over the entire family; there are others exceptions to the policy that one must not ignore. These
who prefer to buy a health policy only for themselves. This include:
is because paying for an individual health insurance plan has
its own set of benefits. These may include: - Most individual health insurance policies cover pre-existing
disorders subject to a waiting period ranging from two to four
n The individual alone enjoys all the benefits that the years. This can be a cause of discomfort for those not willing
plan has to offer; to wait so long before availing the benefits of the policy;
n This kind of plan is best suited for customers running
high risks of health disorders; - Expenses on prescription glasses, lens and hearing aids
n Individuals whose family members are already cannot be covered under this policy;
insured can buy this plan;
n Greater protection than that offered under family - Policyholders cannot claim cover for expenses met on dental
floater health insurance; treatment or procedures;
n Dependents can be later added to the plan, if and
when required; - Naturopathy treatment is treated as an exclusion in most
n Cashless claim settlement can be availed while buying individual health insurance policies;
this plan;
n No age restriction during policy renewal. - Customers prone to diseases including cataract, hernia,
sinusitis, etc. must beware as they cannot claim cover for
the treatment of these disorders during the first year of the
policy.

Example Of How Individual Health Insurance Vs Family Floater Health Cover
Udit Desai, aged 34, had bought an individual health plan for Rs 2 lakhs. He suddenly meets with an accident and the hospital
bills amount to Rs 1,75,000. Since Udit is covered under the plan, he opts for the cashless settlement claim benefit. The insurance
company, in this case, is liable to pay the hospital bill amounting to Rs 1,75,000.
Naman Singh, aged 34, had bought a family cover for Rs 2,50,000. Apart from Naman, this plan covers his wife, children and
aged parents. Naman meets with an accident and had to be hospitalised. The hospital expenses add to a total of Rs 180,000.
Unfortunately, Naman’s family had already made a claim on the policy during the same year to pay for a surgery amounting to Rs
190,000. This means while paying for his medical treatment, Naman has to pay Rs 120,000 from his own pocket as he could make
a claim only the remaining Rs 60,000 from the family health cover that he had bought.
4.2 Family Floater Insurance

The rising costs of hospitalisation, surgery and other treatment processes can cost a huge amount of money. The impact of
treatment expenses is felt most by those people who are the only earning members in their family. This is where buying family
floater becomes imperative and proves to be beneficial in the long run.
Family floater insurance, also called the family health insurance plan, is a kind of health insurance that covers all the members of
the family against any expenditure on treatment of unforeseen illnesses, disorders or emergency situation. It is the most reliable
method to cover your family by paying nominal premium rates depending on the age of those insured.

Key Features of Buying Family Benefits of Buying Family Floater
Floater Insurance Insurance Policies
Why should you buy a family health insurance plan? Under Everyone prefers to keep their loved ones protected. This
what circumstances would a family floater prove beneficial. A explains the increasing preference of customers to buy family
keen look at the following features will help understand how floater insurance policies. Let us walk through certain benefits
family health insurance can keep you and your loved ones of family health insurance policies before proceeding to pay
secure in today’s times. Some of the important features are: for one. These include:
The entire family including spouse, children and First, it helps to save money. Instead of buying individual
dependent parents can be covered under the same health health insurance for each member for your family, you can
insurance policy. Some insurance companies will also allow always choose to buy a family health cover with a higher sum
you to cover your parents-in-law; assured in lieu of nominal premiums. Buying a single family
floater is indeed a cheaper option than paying for an individual
Many insurance companies offer rebates on premium health plan for each member;
rates when customers opt for a higher sum assured;
You can avail tax benefits on premiums towards family
Customers can avail the benefit of No Claim Bonus floater insurance plans. The premiums paid towards insurance
(NCB). This means that if the customers do not claim for a are eligible for deduction under Section 80C of the Income Tax
particular year, they can avail the benefits of an increased Act;
sum assured in the subsequent year;
Restoration benefit is available in many family floater
Customers can avail the benefit of cashless claim plans. This means that the insurance company will restore you
settlement at a choice of their hospital; with the full coverage amount if your claim gets exhausted
during any policy term;
There are varying policy terms customers can opt from.
Customers can opt for policy terms ranging from one to three You can choose to add a new family member easily in
years depending on their needs. the family floater plan.

Exclusions Under
Family Health
Insurance plan
While the benefits are known, there are certain
exclusions to family floater policies that one must be aware
of. These include:
n Claims raised within 30 days of buying the policy

unless the claim arises because of an accident;
n Claims raised against treatment of sexually
transmitted disease(s);
n Claims raised against treatment of fertility problems;
n Expenses incurred during routine medical checkups;
n Expenditure on gender reassignment surgery;
n Expenditure on plastic surgery, aesthetic treatment
or cosmetic surgery;
n Claims raised against treatment of any psychological
health problem(s);
n Claims against expenses on OPD treatment;
n Expenses on treatment or surgery on foreign soil;
n Expenditure on treatment stemming from addiction
problems;
n Claims against treatment of injury sustained during
suicidal attempt;
n Maternity expenses.
4.3 Critical Illness Insurance
Anil Sharma was suddenly diagnosed with a serious disease called muscular dystrophy. The doctors told him that his treatment
would last many years, thus, resulting in heavy medical expenditure. Anil had bought a health insurance policy of Rs 10 lakhs.
However, the insurance company informed him that it would take care only of its hospitalisation expenses, and therefore, he
himself would have to bear the cost of treatment. With such a heavy financial burden to bear, Anil was unable to seek the
necessary treatment, thus, resulting in permanent disability.
Should Anil have bought a critical illness plan in addition to paying for a health insurance policy?
Critical disorders are different from common health problems. As opposed to the latter, the former have a damaging impact on
health resulting in death or disability, thus, resulting in heavy expenses on the patient’s medical treatment. Elevating healthcare
costs and the pervasiveness of critical illnesses prompted many insurance companies to sell critical illness health insurance plans
that are different from health insurance policies.
Why Is Critical Illness Policy Important?

More people are now suffering from critical disorders than before owing to shifts in lifestyle habits, rising pollution levels,
stress due to work pressure and many other reasons. Common examples of critical illnesses include heart attack, massive stroke,
major organ transplantation, kidney failure, dialysis, paralysis, multiple sclerosis, bacterial meningitis, viral hepatitis, muscular
dystrophy, etc. This explains why people must consider buying a critical illness insurance plan that secures them against heavy
medical costs in the long run. Critical illness insurance is useful for people
- Who do not have enough savings to pay towards the treatment of serious health problems;
- Who is not covered under any group health insurance scheme or do not receive employees benefit packages to look after
them in the event of sudden illness.

Apart from the fact that critical illnesses policies defray the treatment costs of serious health problems, some of them also
include benefits of free health checkups. Those buying health insurance policies can either opt for cashless benefits or choose
to get the hospitalisation expenses reimbursed by submitting the hospital bills. Policyholders paying towards critical illness plans
do not have to be necessarily hospitalised to seek the coverage benefits. It is enough that the patient has been diagnosed with a
particular critical disorder listed in the plan to seek the critical illness benefits in a lump sum.
In addition, all these plans offer tax benefits as the premiums paid towards these policies are subject to deduction from under
Section 80C of the Income Tax Act 1961.
Insurance companies may cover different kinds of critical illnesses in the critical illness insurance plans that they sell. Before
buying a critical illness plan, it is important to go through the policy details carefully and read about all the illnesses that are
covered under the policy.
Important Considerations While Buying Critical Illness Insurance

Every critical illness plan has its own set of features and benefits, which means that not all plans would cater to your specific
needs in future. Apart from reading the list of critical illnesses included in the policy, there are certain necessary factors that must
be considered before paying for your choice of the plan. These include:
= The extent of the survival period;

= Waiting period clause;
= Number and kinds of illnesses covered;
= Inbuilt coverage benefits;
= Clause against pre-existing disorders;
= Amount of Sum Assured;
= Claim Settlement Ratio of the insurance companies.

Top Critical Illness Plans Sold By =

Problems stemming from complications during childbirth
or caesarian infections;
Insurance Companies = Sexually transmitted diseases including HIV or AIDS;
= War or terrorist activities;
Not all insurance companies sell critical illness plans. Also, = Cosmetic surgery;
each critical illness insurance policy differs from the other = Treatment of infertility problems;
in feature, benefits and premium prices. Some of the best = Gender reassignment surgery;
critical illness plans include: = Treatment carried out in any foreign country.
= Bharti AXA Smart Health Critical illness Policy;

= Religare Care Insurance Policy;
= Apollo Optima Vital Health Insurance Policy;
= Max Bupa CRITICARE Policy;
= HDFC ERGO Critical Illness Policy. 4.4 Maternity Insurance
Critical Policy Exclusions Most Indians are unaware of the concept of Maternity Insurance.
Not because it is a novel concept, but because people in the
country deem insurance as a cover that secures against death,
Though having a critical illness policy helps, there are certain
disability and disease. Maternity insurance is just like any other
disorders that no critical illness insurance plan covers. Also
insurance product and covers the expenses on childbirth up to a
called policy exclusions, these are:
certain limit. Customers interested to buy it can either pay for it
as a standalone policy or choose the same as an add-on cover to
= Any critical illness detected within the first three
the existing health insurance plan by agreeing to pay an added
months of buying the policy;
premium amount.
= If the patient dies within a month of being diagnosed
with the critical illness;
= Any disorder stemming from addiction problems
including dependence on cigarettes, alcohol or drugs;
= Any disease resulting from congenital problems;

To understand how Maternity Insurance works, let us look at the following example:
Vivek Singhal and his wife Ishita had been married for the past two years. They are now planning for a family and are looking
at possible expenses that would have to be met during delivery and childbirth.
Vivek’s father Subodh recently shared the good news of becoming a father and how his wife had to undergo a caesarian to
deliver the baby. The total hospital expenses had amounted to Rs 1,60,000. Vivek was concerned about the high maternity
costs and subsequent medical care. It is then that Subodh informed Vivek about maternity insurance plans and how they serve
to downplay the impact of inflation on medical costs. Subodh informed about how and he and his wife had made plans for the
child’s delivery by choosing a maternity plan beforehand that also includes health insurance benefits for infants too.
Vivek and his wife, however, continued to be unsure about the concept of maternity insurance and decided to look for details
on the web.
How Maternity Insurance Works?

Medical expenses are increasing each year. This includes consultation fees, hospitalisation expenses, costs of medicines and
expenses on various surgeries. Complicated surgeries cost more than others. This holds true for hospitalisation expenses during
childbirth, especially, if there are complications involved during child deliveries. Most hospitals charge between Rs 50,000 to Rs
2,00,000 depending on the facilities and the nature of treatment during the childbirth process. Buying a maternity insurance
plan in advance helps pay for the childbirth expenses in addition to the amount expended on the baby’s healthcare subject to
the condition that hospital charges do not exceed the sum assured amount. This helps alleviate the financial burden that many
families face while making payments towards the hospital bills.

When Should You Opt For Maternity
Insurance?
No insurance company will grant you maternity cover once you are
pregnant. Ideally, the best time to seek maternity cover is before you
conceive. While buying any maternity insurance policy, it is important
that you read the policy details carefully, especially, those that relate
to the waiting period before pregnancy. Many insurance companies
mandate a waiting period of three to four years before the insured can
claim the benefits of the policy.
It is rightly said that the principle underlying the maternity insurance

concept is proper family planning as opposed to sudden and unexpected
pregnancies.
What Does Maternity Insurance Cover?

Most maternity plans sold by insurance companies in India cover:
= One month’s pre-hospitalisation expenses and two months’ post-

hospitalisation costs;
= Delivery expenses irrespective of normal childbirth or delivery
through C-section;
= Expenses on hospitalisation including doctors’ fees, nursing
expenses, room rent, surgery costs and anaesthetist’s fees;
= Charges of daycare treatment;
= Vaccination charges of the newborn infant;
= Ambulance charges for carrying the mother to the hospital for
delivery;
= Cashless facility in network hospitals.
Maternity Insurance Does Not Cover ...
Though maternity plans cover pre-hospitalisation expenses, it does not pay for treatment of disorders existing prior to the pregnancy
of the insured. Treatment of infants born with congenital defects is not covered under any maternity plan. Any expenses made
on medicines or procedures outside the purview of treatment will not be considered a valid claim. Routine visits to the doctor for
checkups and consultation fees after two months of the child’s delivery will not be considered as a part of the maternity insurance
claim.
Which Maternity Plans Can You Choose From?

If you are looking to buy maternity insurance, you may choose from the following plans.
• Religare Health Insurance Maternity Plan – JOY;

• Star Wedding Gift Insurance;
• i Health plan;
• Easy Health Plan;
• Heartbeat Plan.
4.5 Senior Citizen Insurance

Insurance is bought to secure against the risk of death, disability and disease. While old age is synonymous with memories and
life long experiences, increasing vulnerability to diseases cannot be ruled out. This explains the need for having a senior citizen
health insurance policy that ensures financial security to all those aged 60 years and above.
Following are the names of the senior citizen health insurance plans corresponding to the insurance companies that sell them.

S. No. Senior Citizen Health Insurance Plans Insurance Companies Senior Citizen Health Insurance
1 Senior Citizen Red Carpet Star Health Policy Exclusions
2 Varistha Mediclaim National Insurance
3 HOPE – Health of Privileged Elder Oriental Insurance = Policyholders cannot seek a claim for diseases
4 Silver Health Bajaj Allianz diagnosed within a month of buying the policy;
5 Senior Citizen Mediclaim Policy New India Assurance = Any kind of treatment that is non-allopathic in
Co.Ltd. nature;
= Injuries sustained during a suicidal attempt;
= Pre-existing disorders before buying the policy.
Some may argue about how ensuring enough savings can defer the However, these exclusions are subject to the
need for buying a Senior Citizen Health Insurance Plan. However, the terms and conditions of the policy bought;
essential features and benefits of these plans help to understand why = Claims on the treatment of addiction problems;
buying them can be beneficial in the long run. Some of them include: = Treatment of sexually transmitted diseases;
= Treatment of old-age problems like joint
= The benefit of a greater amount of sum insured; replacement can be availed after two years of
= Premiums paid towards these plans are eligible for tax buying the policy;
deduction under Section 80C of the Income Tax Act 1961; = Amount spent on dental treatment;
= Daycare costs on the use of special equipment during treatment = Cosmetic surgery procedures;
of critical illnesses like kidney disorders or cancer are covered; = Treatment of injuries sustained during war or
= Expenses on yearly health checkups covered; terrorist attacks.
= Cashless treatment facility in hospital network;
= Policy renewability option available; Note that lifestyle habits are major determinants of
= Ambulance expenses to carry the insured also covered under premium rates, which means that policyholders who
the policy; do not smoke cigarettes or drink alcohol would be
= Treatment of pre-existing disorders subject to the terms and charged lower than those who drink or smoke. Since
conditions of the policy are also covered; these plans are best suited for retired individuals or
= Claim settlement is quick and seamless, unlike most other plans. aged customers, they can be bought by either the
senior citizens themselves or young people for their
aged parents.

5
Chapter 5:
IMPORTANT ASPECTS OF HEALTH

INSURANCE
5.1 Policy Inclusions
Not all insurance policies promise you everything. Knowing which policy allows you
certain benefits is equally important as understanding the exclusions of each policy.
For example, policyholders can seek claims on 30 days pre-hospitalisation and 60 days
post-hospitalisation while treatment of sexually transmitted diseases does not fall
under the purview of any health insurance plan.
Other policy inclusions are prolonged coverage for as long as two years from the date
of policy inception, wide coverage, claims on expenses towards in-hospitalisation
treatment, the amount spent on daycare procedures, costs of domiciliary treatment,
restoration benefits and a separate cover for critical illnesses in lieu of added premium
payments on health add-on covers.

5.2 Policy Exclusions claimed under any health policy scheme sold by any insurance
company.
Despite the growing importance of health insurance in today’s
times, customers prefer to compare only the premium rates and = Injuries sustained during war or terrorism: Injuries or
their coverage amount promised by each insurance company. disorders resulting from any kind of war or terrorist activities
While it is an understood fact that one buys health insurance will not be covered under any health plan, thus, implying
to pay for medical costs in the long run and, thus, ease possible that policyholders are required to pay for such treatments
financial burden stemming from elevated healthcare costs, there themselves.
are certain claims that no insurance company would entertain.
Such claims made on various treatments for various reasons = Treatment of addiction problems: Treatment of drug-
are excluded from the purview of most health insurance plans, induced diseases or any illnesses caused by dependence on
though the same is subject to the terms and conditions of each cigarettes, alcohol or any kind of narcotic substance are not
insurance company. covered under any health insurance policy. This is an exclusion
common to all health insurance plans sold in India.
Common policy exclusions are:
= Dental care treatment expenses: The treatment of
= Waiting period exclusions: Waiting period is particular to dental care is not covered under any health plan.
each insurance company. However, one exclusion concerning the
waiting period common to every insurer is that no company pays = Cosmetic surgeries: Health plans are bought to tackle
towards claims made on treatment expenses carried out within sudden emergencies and not for defraying costs on surgeries
the first 30 days of policy inception. carried out to enhance beauty. While there are many health
plans that cover expenses on plastic surgeries, none of them
= Pre-existing disorder treatment: The waiting period for covers the costs of cosmetic surgeries.
pre-existing disorders ranges from 30 days to four years. However,
there are certain diseases included in the list of pre-existing = Investigative treatment: Some people tend to
disorders of each insurer. The claims raised on the treatment of participate in medical surveys or give themselves up for medical
these are covered only after three years of paying the first policy experiments carried out by various research centres and
premium. pharmaceutical companies. Sudden investigative procedures
may result in the policyholders afflicted with disorders of the
= Sexually transmitted diseases treatment: Any expenses body or mind. Treatment of such diseases is not covered under
incurred on the treatment of diseases like HIV or AIDS cannot be any health insurance plan sold by any insurer in the country.

5.3 What factors impact Health Insurance
Premium?
Nihar Pandya logged on to the sites of various insurance companies and
insurance web aggregator portals to find out the details of various health plans
and their corresponding premium rates. Nihar is currently looking for a health
plan that charges nominal premiums in lieu of a handsome coverage amount.
He finds that all the insurance companies charge premiums differently.
Nihar seeks to find answers to the following questions:
1. Are premiums charged randomly by insurance companies?

2. What are the factors affecting health insurance premium rates?
Most people, like Nihar, compare the premium rates of every health insurance plan before choosing the one that suits their
budget. However, not many are aware of factors that insurance companies take into consideration while determining the premium
amounts they would charge from their customers. While there may be multiple reasons particular to each insurance company, the
common factors affecting health insurance premiums include:

= Pre-existing disorders: Before agreeing to health insurance
proposals, many companies require their customers to go through
some mandatory medical tests. These health records help companies
determine if their customers are already suffering from pre-existing
disorders and the propensity to seek treatment within the waiting
period. Depending on the seriousness of the disease and the quantum
of risk associated with their health conditions, insurers may decide to
reject the proposal or cover the customer at increased premium rates.
= Medical history: Customers with a history of ailments running

in their families will be charged higher than those hailing from a
healthy background. This is because such people are more likely to
seek treatment for their genetic disorders, thus, posing a high risk of
financial burden for insurance companies involved in claim settlement.
= Body Mass Index (BMI): When was the last time you had
exercised? While this may seem like a rhetoric question, the answer
to it determines your premium payment throughout the policy period.
This is because insurance companies charge more premiums from
customers with a high BMI as the latter are more vulnerable to serious
health problems like heart diseases, joint problems, diabetes and
others. Also, female policyholders with a higher BMI are more likely to
seek claims on expenses incurred on treatments including pregnancy
too.
= Addictive habits: Dependence on cigarettes, alcohol or snuff

can result in serious health disorders. Insurance companies realise
that addicts are more likely to be hospitalised and seek treatment.
This explains why insurance companies charge more premiums from
customers who smoke, drink or consume tobacco in some form or the
other.

= Age: Age is not just a number, especially, for insurance companies
that charge premiums from their customers accordingly. Young people
are required to pay much lower premiums than their aged counterparts.
This is because young people are less likely to suffer from health problems
or seek treatment for critical illnesses, thus, reducing the quantum of
risk faced by insurance companies.
= Marital status: Insurance companies in India, till date, have been

unable to submit any well-validated reason for charging low premiums
from married people. This implies that being married gives Indian men
the benefit of paying less than their unmarried peers.
= Residential status: Insurance companies are interested to know

where their customers stay or live. This is because their residential locality
or region has a determining effect on the health of the policyholders
that, in turn, affects premium charges. The place of residence has a
direct bearing on the quality of food and water consumption. Climatic
conditions and cultural aversion to exercise are other factors that decide
the quality of health of the policyholders. This explains why insurance
companies are keen to know about the place where their customers
come from before deciding the premium rates.
= First-time policyholders: Insurance companies seek details about

their existing insurance status and the policies their customers have
bought till date. Insurance companies charge higher premiums from
people who are buying health insurance for the first time in their lives.
This is because such people are at a greater likelihood to be hospitalised
and get the necessary treatment and claim, from the insurance
companies, the expenses incurred on their medical treatment.

5.4 Cashless Hospitalization
Prateek Agarwal’s son needed emergency treatment and had to be hospitalised suddenly. Since Prateek did not have enough cash
with him, he went to the nearest ATM to withdraw cash. The expenses on his son’s hospitalisation and subsequent treatment
were more than he had expected. Left with no other option, Prateek went to his friend seeking financial help.
If Prateek had bought a health insurance plan that included a cashless benefit plan, he would have been in a better position to
face this medical emergency. However, unaware of cashless mediclaim policies, many people like Prateek fall in a debt trap while
paying for necessary medical expenses.
Cashless hospitalisation is just one of the benefits that health insurance policyholders enjoy. This feature helps policyholders to
seek necessary medical attention and emergency treatment at their choice of hospital. The insurance companies issue a health
insurance card to their customers that they have to show to the insurance desk at the hospital during admission. The insurance
company then settles the claim made by the hospital subject to the condition that the amount raised does not exceed the
insurance coverage amount.
In India, there are two types of cashless health insurance claims available that policyholders may choose from. These include:
= Cashless Family Health Insurance;

= Cashless Health Insurance for Senior Citizen.
Policyholders can avail the benefits of cashless hospitalisation unbiased of whether they are opting for planned treatment or have
to hospitalised to meet medical emergencies.

Cashless Hospitalisation Exclusions
While cashless mediclaim plans help to defray the rising medical costs of hospitalisation and subsequent treatment, not all kinds
of expenses are covered under this kind of treatment. Cashless mediclaim plan benefits exclude expenses like:
- Expenditure on attendants hired;

- Ambulance charges;
- Charges on toiletries used;
- Additional service charges;
- Additional expenditure on the oxygen mask, diapers, nebulizers, etc.;
- Documentation charges.
Your Mediclaim Policy May Be Rejected. Know Why ...

However, some policyholders find the claims made on their mediclaim policies getting rejected for certain reasons. These include:
= Claim on expenses made on hospitalisation and treatment of an illness not covered under the policy;
= Claim exceeding the amount of sum assured;
= Incorrect details regarding pre-existing disorders or incomplete personal details filled in the policy form;
= Delay in intimating about the hospitalisation to the TPA.
5.5 Daycare Treatment

Vineet Chandihok’s mother was advised a cataract operation by the ophthalmologist. However, the doctor also suggested that
the treatment would be minor and, hence, Vineet’s mother would be discharged a few hours after the surgery. Though Vineet did
have a health insurance plan in place, he was not sure if the plan covered expenses on daycare procedures.

Vineet decided to talk to the insurance company and seek necessary advice. He was advised that his plan includes scope for claim
settlement of the treatment costs as the surgery falls under the category of daycare procedures. Vineet, though initially unaware
of the concept of daycare procedures and its inclusions in most health insurance plans, feels greatly relieved.
The pervasiveness of various disorders and increasing medical costs have changed the structure and scope of health insurance
policies in India. Today, a majority of the health insurance plans in India pay for daycare procedures as an additional benefit other
than promising the usual cashless mediclaim and reimbursement of claims on treatment expenses.
Understanding Daycare Treatments

Simply said, Daycare treatments are those treatment procedures carried out under the supervision of a local or general anaesthetist
in a hospital or day care treatment centre. These treatments do not last more than 24 hours and are included under the scope of
many health plans sold in India. Some of the health insurance policies that pay for daycare procedures too are:
= Apollo Munich’s Easy Health;

= Religare’s Care;
= Star Health’s Family Health Optima;
= Max Bupa’s Heartbeat Plan;
= New India’s Family Floater Mediclaim Policy;
= National Parivar Mediclaim Plus.
How To File Daycare Claims In Health Insurance?

The daycare coverage is an in-built feature in many health insurance plans, thus, implying that the process of filing daycare claims
is the same as that of seeking claims on treatment expenses under a regular health cover. Since most daycare procedures are
treatments planned in advance, policyholders can avail the benefit of cashless claim provided that the insurer is intimated in
advance about the same.
However, some insurers ask their customers to submit the documents necessary for making the claims and reimburse the treatment
expenses accordingly.

5.6 Pre & Post Hospitalization
We all talk about health insurance plans and how they help to tackle rising medical expenses. However, few realise how the
various health policies cover pre and post-hospitalisation expenses too.
Before getting admitted to your choice of hospital for treatment, there are certain medical costs incurred by the policyholder.
These are classified as pre-hospitalisation expenses. These may include the amount spent on various tests that are needed to
diagnose the kind of disorder the incurred is suffering from before prescribing the correct nature of treatment. Such tests may
include urine tests, blood tests, MRI scans, CT scans and X-rays to diagnose the exact medical condition of the insured.
Post discharge from the hospital, the incurred has to bear certain necessary medical costs. These are categorised as post-
hospitalisation expenses. These expenses may include the amount spent on tests prescribed the doctor or healthcare provider
to ascertain the health status and recovery progress of the insured. These may include the costs of medicines, consultation
fees and charges on diagnostic tests. However, insurance companies do not cover therapies like naturopathy, acupuncture,
homoeopathy, etc.
Most insurance companies pay for the pre and post-hospitalisation expenses subject to certain conditions. The number of days of
pre and post-hospitalisation cover differs from one health insurance company to the other. However, most insurance companies
cover 30 days of pre-hospitalisation and 60 days of post-hospitalisation expenses.
Important Considerations
= Policyholders can seek a claim for pre and post-hospitalisation claims provided that the claim for expenses towards
hospitalisation is accepted by the insurance company;
= Expenses on pre-hospitalisation must be for the same condition for the patient had been hospitalised and availed
necessary treatment;
= Costs of pre and post-hospitalisation will be allowed only for the number of days mentioned in the policy. Any expenses
incurred before or beyond the time limit will not be considered by the insurance company.

To understand the concept of pre and post-hospitalisation expenses better, let us understand the same with the help of the
following example ...
Ajay Mehrotra had been hospitalised for treatment of malaria on March 01, 2019. Before being admitted to the hospital, Ajay
had been consulting various doctors and underwent diagnostic tests from February 12, 2019 to February 28, 2019 subsequent
to which he got hospitalised for necessary treatment. Ajay was treated for a week after he was discharged on March 08, 2019.
Post discharge, Ajay had to undergo certain tests so that doctors could monitor his health progress and prescribe medicines
accordingly. The post-hospitalisation tests and medicine purchases continued for nearly 35 days.
In this case, Ajay had claimed pre-hospitalisation expenses for 17 days and post-hospitalisation expenses for 35 days. He was
hospitalised and treated for 8 days. Assuming that the hospital is within the network of the insurer or the insurer accepts to pay
claims for expenses raised by this hospital, Ajay would be reimbursed the entire expenses incurred including the pre-hospitalisation
expenses, in-treatment costs and the amount spent during the post-hospitalisation period.
5.7 Grace Period

Shekhar Ahluwalia had bought a health insurance plan from Kotak General Insurance. However, he had forgotten to make the
payment towards the premium by the due date and fears that the insurance company will cancel his policy. Will Shekhar lose his
health cover or do companies allow their customers to pay the premiums past the due date?
Insurance companies allow their customers to pay for their insurance plan even after the due date has passed. However, there is a
time limit for late payment of premiums too also called the grace period. “Grace Period” is the additional time that the insurance
company grants to its customers who had defaulted in making timely payment of their premiums. As per the guidelines shared
by the IRDAI, every insurance company is required to offer a grace period of 15 days for payment of health insurance premiums.
However, some insurers extend the grace period to 30 days also. The grace period starts from the date on which the last payment
was due. If the insurance premium is paid after the grace period, then the insurance company reserves the right to refuse the
policy renewal even though the policyholder may be willing to make the payment.

5.8 Claim Settlement
The ultimate aim of buying any kind of insurance, including
health insurance policy, is timely settlement of the policy.
While there may be many factors based on which you
determine the worth of any insurance company, one must
not ignore to look into the claim settlement ratio (CSR) of
each company over the past few years before zeroing on any
particular policy. The CSR is the ratio of the number of claims
settled by the company to the number of claims raised by its
customers during any particular year.
One must opt for an insurance company reputed for its easy,
claim settlement process. This is because the purpose of
buying health insurance is to ensure that the medical expenses
incurred on the treatment of the insured are ultimately paid
off by the insurance company. Rejection of the claim owing to
certain unforeseen condition or some hidden clause written in
fine print will not only result in the insured having to pay the
bills on their own but also the loss on the amount having paid
as premiums to the insured company till the date of making
the claim.
Before opting for any insurance company to buy health

insurance, it is important to study the company’s CSR that
reflects the ability of the company to settle the claims raised
by its customers. A higher value of the CSR means that the
number of claims fulfilled by the company is on the higher
side, which implies that there are greater chances of your
claims being paid by the insurer, if and when required.

5.9 Free Look Period
Understand the following scenario ...
Subhash Sharma, a resident of Madhya Pradesh, was advised to buy a health insurance policy that would secure him and his loved
ones against possible medical expenses in the long run. However, Subhash realised that the policy he had opted for provides a
limited sum assured amount than he might require as he was the only earning member in the family. Apart, the premiums were
higher than he had anticipated, which means that he got limited benefits even after paying a higher price. Subhash looks through
the portals of various insurance web aggregators and the insurance companies too and stumbles upon a better option. He finds
another policy that not only promises a greater sum assured in lieu of nominal premiums but also assures additional benefits
than what he had originally opted for. Subhash is determined to get his present policy cancelled but is unsure about how he must
proceed.
This is not the first instance of a new insurance policyholder looking to cancel the policy nor would it be the last. To ensure that
the new insurance policy owner can get the policy terminated without having to pay the penalty amount, the Insurance Regulatory
Development Authority of India (IRDAI) has included a provision that allows policyholders to surrender their policies and seek a
refund for the same. The policyholders are allowed a free look period, limited to 15 days, during which they must go through the
terms and conditions published in the policy proposal and assess the utility of the policy accordingly.
Important details regarding the free look period include:

= The free look period starts from the day on which the policyholder receives the policy document. The free look period, in
most cases, is limited to 15 days. During this period, the policyholder may request for policy modifications or move to get the
policy altogether.
= Policyholders who wish to avail the free look period must be able to prove the date of receipt of the policy document. For
this, they must write a request to the policyholder informing them of their intent to return the policy. To save time, insurance
companies have a policy cancellation form on their websites that customers can download from to fill in the details.

= Request for a free look option for the health insurance plan
involves submitting necessary details including the date of policy
receipt, details of the agent who helped them buy the policy and
the reason for policy cancellation. In addition, the policyholders
must submit bank details including the account number and the
IFSC code to which they would like the premium to be refunded.
Policyholders need to affix a revenue stamp of the mentioned
denomination on the policy cancellation form before submitting
the same.
= It is important that policyholders must submit the original

policy document issued to them by the insurance company along
with the receipt of the first premium payment they had made
and a cancelled cheque drawn from the bank account to which
the premium money must be refunded. Policyholders who have
misplaced the original policy document and are unable to replace
it must submit an indemnity bond.
= The insurance company liable to refund the premium amount

will pay back after deducting the proportion of the premium
amount towards the coverage period, stamp duty charges and the
expenses borne by the insurer towards the medical examination of
the policyholder if any.
The procedure of policy cancellation during the policy period is

the same for all insurance policies. However, policyholders who
have paid for health insurance can apply for cancellation subject
to the condition that they have bought the same for a minimum
policy of three years.

5.10 Waiting Period
Ayub Khan, aged 34, has recently bought a health insurance policy that promises health cover to the entire family. Before
buying the policy, Ayub had been diagnosed with certain ailments for which he had undergone treatment in the past. Ayub
discloses details about his health disorders while submitting the insurance proposal which the company accepts. Three months
after buying the policy, Ayub is suddenly hospitalised and requires treatment for his pre-existing illnesses. Can Ayub seek
claim from the health insurance company? Does the insurance company have the right to reject the claim made despite Ayub
having paid all the premiums regularly? How do the insurance companies cover their customers already suffering from certain
diseases before applying for the policy?
The most important thing to note is that one cannot make a claim soon after buying the policy. Every insurance company selling
health cover has in place a waiting period that may range from 30 days to four years that differs from one company to the other.
Waiting period is the gap or period during which a policyholder cannot claim for certain expenses made on treatment. It is the
period that the policyholder has to wait before seeking health cover from the insurance company.
The waiting period clauses for individual health insurance and a family floater insurance policy are different. These include:
= Initial waiting period is 30 days – 90 days: Most health insurance companies including a waiting period of one month during
which they would not enter any claims barring treatment of injuries resulting from accidents. This waiting period may extend up
to 90 days for some insurers. This has been done to protect the interests of the insurance companies against customers who buy
health insurance plans immediately after being detected with some serious disorder and attempt to seek claim just after paying
the first premium.
= Waiting period for pre-existing diseases: Many insurance companies ask their customers to undergo certain medical tests
to check if they are suffering from any ailment(s) including blood pressure problems, diabetes, thyroid disorders, etc. Depending
on the medical reports, the insurer may decide to accept or reject a policy proposal. Some insurance companies agree to cover
the customers subject to the condition that the health cover is either limited or excluded for any pre-existing disease. Some
insurers agree after prescribing a waiting period that may be limited a year or extend up to four years. Patients can seek a claim
for the medical expenses incurred for the treatment of the pre-existing disorders only after the passage of the waiting period as
mentioned in the policy proposal form.
However, if the customer had been suffering from any disorder before buying the policy but has been diagnosed with the disease
only after having bought the policy, then the insurance company is liable to pay the expenses on its treatment. Also, in group
health plans offered by companies to their employees, the insurance companies do not insist on including the waiting period
clause for health insurance.
= Maternity waiting period: Some insurance companies also extend their benefits to maternity expenses too. However, many
of them necessitate a waiting period extending from nine months to four years. This means that one must consider buying health
insurance early so that the maternity expenses can be claimed after conception past the maternity waiting period.
5.11 Tax Benefits of Health Insurance

Buying health insurance can help you save on taxes on health insurance premiums too. Buying a health insurance plan, on one
hand, ensures a health cover to the insured in case of any medical treatment, planned or sudden, if any while on the other it
avails you taxation benefits. Investing in health insurance as an essential measure of tax planning not only ensures that you and
your loved ones can access necessary medical treatment at your choice of hospital without spending too much on hospital bills
but also avail income tax exemption under Section 80D of the Income Tax Act.
Health insurance policies are bought to offset the rising medical costs each year. The expenses of hospitalisation and subsequent
treatment may be more in the case of senior citizens who are more prone to old-age problems or recurring disorders. This explains
why most people prefer the family floater health insurance that covers all in the family and takes care of their medical expenses
in lieu of nominal premium charges. There are others who buy individual plans for themselves and separate senior citizen health
insurance policies depending on their needs and budget. The current norms state:
= A policyholder, be it an individual or belonging to a Hindu Undivided Family (HUF), can avail a deduction not exceeding Rs
25,000 on premiums paid on behalf of self, spouse, dependent parents and children under Section 80D of the Income Tax Act.

= Policyholders who have bought additional health insurance policies for their parents aged above 60 years can claim an
additional amount of deduction limited to Rs 50,000 for each parent. However, the additional amount of deduction can be claimed
subject to the condition that the parents covered under the policy are senior citizens. This means that the maximum amount of
deduction policyholders can claim for health insurance plans bought for parents is equal to Rs 100,000 (Rs 50,000 for father + Rs
50,000 for mother).
= Many health insurance companies are reluctant to sell health insurance plans to senior citizens owing to the increased
quantum of health risk that they suffer from. This refrains senior citizens to buy health insurance plans for themselves. However,
policyholders whose senior citizen parents are not eligible to secure a health cover for themselves can claim deduction up to Rs
50,000 towards payment of their medical bills during the year;
It is important to note that policyholders can claim tax deductions on health insurance premiums provided that the premiums
have been paid in any mode other than cash. This means policyholders who pay their health insurance premiums in cash cannot
claim tax benefits allowed under the Income Tax Act.

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both in India and abroad.
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All Need To Know Insurance: You About Health

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All You Need To

All You Need To Know About Health Insurance 2

HEALTH INSURANCE OVERVIEW

All You Need To Know About Health Insurance 3

All You Need To Know About Health Insurance 4

Important points about health insurance

All You Need To Know About Health Insurance 5

1.2 Health Risks

Common health problems affecting Indians

1.3 Importance of Health Insurance

➢ Financial security is the ultimate aim of every individual

All You Need To Know About Health Insurance 8

All You Need To Know About Health Insurance 9

All You Need To Know About Health Insurance 11

- Major organ transplantation;

Currently, health insurance plans are sold under two categories:

• Individual health insurance;

In addition, companies today are availing the benefits of health insurance

Individual health plans are taken by policyholders to insure themselves.

All You Need To Know About Health Insurance 13

Example of An Individual Health Insurance Plan

Example of Family Floater Insurance Plan

All You Need To Know About Health Insurance 14

Example of a Group Health Insurance Plan

All You Need To Know About Health Insurance 15

THIRD PARTY ADMINISTRATOR (TPA)

All You Need To Know About Health Insurance 16

2.2 Benefits of TPA to policyholders

2.3 Benefits of TPA to the Insurance Companies

2.4 How Do the TPAs Function?

All You Need To Know About Health Insurance 18

BUYING & MAINTAINING HEALTH

“Insurance” is not a new concept, especially, in the Indian

All You Need To Know About Health Insurance 20

All You Need To Know About Health Insurance 22

Irrespective of the kind of policy including life or general insurance policies,

3.4 Health Insurance Portability

All You Need To Know About Health Insurance 23

All You Need To Know About Health Insurance 24

All You Need To Know About Health Insurance 25

Policyholders who have paid the premiums towards their existing

All You Need To Know About Health Insurance 26

DIFFERENT TYPES OF HEALTH

All You Need To Know About Health Insurance 27

Critical Illness Cover is also available.

All You Need To Know About Health Insurance 28

All You Need To Know About Health Insurance 29

4.2 Family Floater Insurance

All You Need To Know About Health Insurance 30

All You Need To Know About Health Insurance 31

n Claims raised within 30 days of buying the policy

Why Is Critical Illness Policy Important?

All You Need To Know About Health Insurance 33

Important Considerations While Buying Critical Illness Insurance

= The extent of the survival period;

All You Need To Know About Health Insurance 34

= Bharti AXA Smart Health Critical illness Policy;

All You Need To Know About Health Insurance 35

How Maternity Insurance Works?

All You Need To Know About Health Insurance 36

It is rightly said that the principle underlying the maternity insurance

What Does Maternity Insurance Cover?

= One month’s pre-hospitalisation expenses and two months’ post-