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What Is Health Insurance?

Health insurance policy provides financial strength when we need any kind of medical or healthcare service. The expenses are reimbursed by the health insurance provider. Ailment & physical injuries are covered under the health insurance policies. Accidental claim under health insurance policy covers entire costs of medical services. Some are exclusions which are not covered under the policy like adopting the room rent higher then your policy limit, Co-pay if adopted under the policy etc.

So, how does it work? The premium charged by the health insurance companies in India differs from company to company and depend upon the insurance plan selected, the premium also depends on a some other factors, age, no of person like inclusion of spouse children’s, parents etc. The amount of coverage you select also has an effect on the premium amount. The coverage amount is directly proportional to premium.

Health Insurance

Besides choosing a coverage amount or sum insured, you also need to choose your policy period. Presently the health insurance plans are available for one and two years.

In the case of cashless hospitalization, you don’t have to pay anything at the hospital. Your insurance provider will pay the claim amount directly to the hospital, subject to approval & submission of all relevant documents through hospital.

Why Should You Buy Health Insurance!

Buying a health insurance policy will take care of your health expenses during the hospitalization within the permissible limitations of the policy. You wouldn’t worry about the rising health care bills because it can deteriorate your health further. The second reason to buy effective health insurance is to provide on-time quality treatment.

Importance of Health Insurance!

Nowadays the medical expenses are very high. In case of any medical emergency, it is quite difficult to spend a huge sum of money. Not all people have a financially stable background to handle huge medical expenses, so it is necessary to well prepare. Health insurance policy will safeguard you from this unforeseen situation. Health insurance also provides a cover for critical illness too.

How to Select the Right Insurance Policy

It’s difficult to select the best insurance policies because all insurance company provides a similar type of health insurance plan. Hence some of the important points that any Person should look before purchasing any health plan are:

  • Sum Assured
  • Minimum Entry Age and renewability clause
  • Room/ICU rent Capping
  • Inclusion and Exclusion
  • No Claim Bonus
  • Disease wise sublimit
  • Ambulance charges
  • Automatic reinstallation
  • Pre-post expenses
  • Cashless facility & network hospital etc
  • Past claim settlement records & credential of insurance company
  • Premium outgo

Types of Health Insurance Plans!

Individual Health Insurance

This policy covers the health expenses and hospitalization expenses of an individual who has taken the policy. Premium of this policy depends upon the age of insured and sum insured.

Family Health Insurance Plan

Under this policy, an individual can include all the family members under a single sum insured. Family health plan offers a fixed sum assured for the family members, which can be availed by all of the family members or by any one individual in the family this plan is popular as floater health insurance.

Senior Citizen Health insurance Plan

This policy is designed for individuals over 60 years of age offering protection from health issues during old age. However up to this plan provide restricted coverage with co-payment.

Surgery and Critical Illness Insurance Plan

This plan is suitable for the insured person that requires treatment against critical illness, for example kidney failure, paralysis, cancer, heart attack etc. As the medical expenses of these treatments are very high, the premium of these types of policies is also high.

Personal Accident Plan

This policy covers hospitalization expenses in the event of an accident. Premium amount depends upon the amount of cover taken.

Top–up Plan

If you have a health insurance plan and need more sum insured then you can take a top-up plan to increase the sum insured. Under this plan you must have a basic health insurance policy up to the limited sum insured and this policy provide the use over & above this plan.

Diabetic plan

If you are a diabetic patient then you can avail this plan. This plan is only for the diabetic patient.

Cancer Plan

This plan is only for the cancer patient. If someone has cancer and it is on the 1st stage then they can avail this cancer plan.

Dengue Plan

Some more plans are also available like exclusive for dengue etc.

Choose Plan Wisely

If the choice for more than one plan is available, then compare each plan on the following grounds:

  • Coverage’s
  • Co-payment
  • Room Rent / ICU Capping
  • Pre-existing diseases
  • Exclusions
  • Disease wise sublimit

Eligibility Criteria For Health Insurance Plan!

In India, people under 45 years of age are not required to undergo a mandatory health checkup while purchasing a health insurance policy. However, there are companies who are not seeking any medical test up to 60 also but required to disclose any pre-existing conditions such as diabetes or hypertension. It is, therefore usually advised that one should get health insurance when younger before contacting any disease.

Documents Required when buying a Health Insurance Policy

There are a few documents that you need to provide such as:


Age proof

Any one of Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter ID, etc.


Identity proof

Driving License, Passport, Voter ID, PAN Card, Aadhaar Card, which proves one’s citizenship.


Address proof

Aadhaar card, Electricity Bill, Driving License, Passport, should clearly mention the permanent address.


Medical check-up

Medical check-up required above the age of 45 years depends on insurance company.

How to buy a health insurance

There are two ways to buy a health insurance:

  • Offline : You can directly contact the company from which you want to buy Health Insurance or you can contact the insurance brokers. The procedure will take 4-5 working days after providing all of the documents needed. You can pay by the cheque.
  • Online : It is very easy to buy a insurance online go to a website which provide insurance online, select your plan and complete the payment procedure. There are various modes of payments available like credit card, debit card, net banking. Here you can compare the various products of the various insurance companies.

Expenses covered for inpatient treatment include

  • Accommodation
  • Boarding expenses inclusive of patient’s diet
  • Nursing care
  • Expenses of medically qualified staff
  • Covers cost of procedures that are medically required during treatment
  • Medical consumables
  • Pre-hospitalization Expenses e.g. examination, tests, medication etc. incurred by you before your hospitalization.
  • Post-hospitalization Expenses incurred on follow-up visits, consultations, therapy, medication etc. after your hospitalization.

Key Benefits and Features!

The hospital bill can be settled in a cashless manner without spending any amount out of pocket depending on your policy terms and conditions.

Cost for transferring the patient from residence to Hospital or between Hospitals to hospital.

You have a period of 15 days from the date of receipt of the first policy document to review the terms and conditions of this Policy. If you have any objections to any of the terms and conditions, you have the option to cancel the Policy stating the reasons for cancellation.

Note:The first slab of Number of days “within 15 days” in above table is applicable only in case of new business. Free lock period is not applicable for renewal policies.CIN

A deduction of the expenses incurred by insurance company on your medical examination, stamp duty charges, & proportionate risk premium.

24 hours hospitalization is compulsory to take benefits of health insurance policy. However, there are some ailments which are covered under day care procedure. Treatments took in the out-patient department (OPD) are not considered under Day Care Treatments. So a dental clean up would be considered as an OPD procedure while a dental surgery would be reimbursed as a day care procedure.

Cumulative Bonus means any increase or addition in the Sum Insured for continued renewal with no claims granted by the insurer without an associated increase in premium.

At the end of every continuous claim free periods of 1 year/2 year/3 year/4 year, one can claim for a free medical check-up for the amount specified in the Health Policy.

A medical treatment for an illness/disease/injury which require care and treatment at a hospital but actually taken at home under any of the following circumstances

  • The condition of the patient is such that he/she is not in a condition to be shift to a hospital.
  • The patient takes treatment at home due to non-availability of room in a hospital.

The medical expenses incurred during the 30 days immediately before were hospitalization. Provided that such medical expenses were incurred for the same illness/injury for which subsequent hospitalization was required, and have accepted an inpatient hospitalization claim treatment Cover. Pre hospitalization days vary from company to company.

The Medical Expenses incurred during the 60 days immediately after the discharged. Post hospitalization provided that such costs are incurred in respect of the same illness/injury for which the earlier hospitalization was made, and insurance company has accepted an inpatient hospitalization claim. Post hospitalization days vary from company to company.

This is a provision under section 80D of the income tax to get the rebate of income tax on the payment of health insurance premium. The detail are as under

Deductions under section 80D
Situations based on age Eligible deduction limits (up to Rs.) Total eligible deduction limit under section 80D (up to Rs.) (including Rs. 5,000 on preventive health checkup)
Medical Insurance Premium paid in respect of
Medical Insurance Premium paid in respect of Parents (whether dependent or not)
No one has attained age of 60 Years 25,000 25,000 50,000
You and your family is less than 60 years & Parents are above 60 years of age 25,000 30,000 55,000
You and your parents have attained the age of 60 years and above 30,000 30,000 60,000

The major benefits of cashless health insurance are:

You do not have to arrange for immediate funds in case of emergencies, to pay hospital bills. Just focus on the treatment.

You do not have to worry about the paperwork to be submitted to file the claims. TPA appointed by the insurance company will take care of everything by coordinating directly with the network hospital.

If you are not able to get the treatment at a network hospital, you can claim for reimbursements after submitting relevant documents.

Factors That Affect Health Insurance Premium!

Two people of the same age, opting for the same health insurance plan may have to pay different premium amounts. Many factors affect your premium cost Here are the reasons:

You pay a higher premium if your family members have had high blood pressure, heart attacks or succumbed to cancer in the past. This is because you are more likely to be at health risk as compared to those with a relatively unblemished family medical history.

Since studies show that tobacco users are at a higher risk of cancer or other illnesses, insurers charge a higher premium for them. If you have quit using tobacco, you are still liable to pay a higher premium. This is because the effects of tobacco take time to go away and the risk of cancer persists.

Firstly, you’ll need to check if the insurer will provide you with a health cover. If they do, it is likely to charge you a higher premium amount.

People with a high BMI are at more risk of suffering from heart problems, diabetes, arthritis and so on. A high BMI can also lead to pregnancy complications. Therefore, the premium amount is likely to be higher for them those who have a normal BMI.

The younger you are, the lower your premium is. This is generally because you may not be as susceptible to diseases when you are younger.

Although the reasons for this are unknown, married couples usually have a longer lifespan and are generally healthier. So, if you are married, you pay a lower premium than those who are unmarried.

Why Should You Compare Health Insurance?

Let us take a look at the top three reasons why you must compare health insurance and then buy the best health insurance policy:

You cannot ignore the cost factor when it comes to buying health insurance, and even while you want the largest possible health insurance umbrella, it is very important for you to be practical about the costs too. The different health insurance plans have different features and you must choose the one that suits you the best.

You can compare the various policies to find what each plan offers. Then, evaluate them against your own requirements and identify a good match. If the plan is too expensive you have to pay a high premium for it. If the burden becomes too much, you may find it difficult to pay the premiums every time and may even end up with discontinue of insurance.

Some health insurance plans are only available for you while others are available for the whole family. Some health insurance plans are specifically available for diabetes patients while others cater to cancer care. Some health insurance plans are targeted towards older people and some are specially designed for the younger generation. Health insurance is a very vast sector and you simply cannot buy the first health plan that you come across.

Therefore, need to compare the various plans to understand what each plan offers. After that, you can see whether or not you fall under that category. It is a laborious task to individually go through all the available options and see which plan is the best match for you. Luckily, the process can be completed online and you don't have to spend those long hours physically going through the different policy documents.

Just buying a health insurance plan at the lowest cost is never the best thing to do. It is highly advisable for you to check the insurance provider’s credentials as well. Insist on buying a health insurance plan from an insurer who has a high claim settlement ratio. Do this even if the costs are slightly higher because later on you will reap higher benefits and avoid any issues related to rejected claims.

When you compare the various plans, the reputation, average customer ratings and claim settlement ratios of each insurer will also be flashed on the screen. It will then become easier for you to choose the best health insurance plan from the best possible health insurance provider. This is, therefore, another very important reason why you must compare all the available health plans before you make a final purchase.

Health Insurance Claim Process

A health Insurance policy equips you to get the best healthcare treatment without worrying about the huge costs payable at the time of discharge. Therefore knowing about the claim process is essential.

There are two types of health insurance claim which an individual can choose i) cashless claim ii) Reimbursement Claim

Only be made when the insured gets his treatment at a network hospital. Every insurance company has a list of cashless hospitals where they can undergo treatment. When you are admitted in one of your insurer’s network hospitals, you need to submit a copy of mediclaim card / policy copy to the TPA cell at the hospital. They will give you the pre-authorization form, which needs to filled and submitted to them. The hospital will then send the request to the insurer.

Note: If your hospitalization is planned, inform the insurance company 48 hours prior to admission. If your hospitalization is an emergency, you need to inform the insurance company within 24 hours of your admission.

This is an easier to understand process. With this option, you pay for your medical bill and get it reimbursed later from the insurance company on discharge. However, there is a lot of processing time required with this method of claim settlement. Additionally, it also puts a financial burden on you in case of emergency or cash crunch. Sometimes, the insurance company might even refute your claim for reimbursement. So make sure you read the insurance literature carefully and submit all necessary documents on time. On approval of the insurance company, the claim will be made to the policyholder. In case the claim has been rejected the insured person will be will notify.

What is Health Insurance Portability?

If you are not happy with the policy or the current company, you can choose a better one. No need to start health insurance all over again. You port i.e. transfer your health insurance from one company to another. It is like switching your phone number to another company.

In order to avail this facility, the policyholder has to apply to the insurance company, where he wishes to port his/her policy, at least 45 days before the premium renewal date of the existing policy.

Portability of Health Insurance

When you change your health insurance policy from one insurance company to another, you don’t have to lose the benefits you have accumulated. In the past in health insurance policies, such a move resulted in your losing benefits like the waiting period for covering "Pre-existing Diseases". Now IRDA protects you by giving you the right to port your policy to any other insurer of your choice. It has laid down that your new insurer “shall allow for credit gained by the insured for pre-existing condition(s) in terms of waiting period”.

This applies not only when you move from one insurer to another but also from one plan to another with the same insurer.


You can port your policy from and to any general insurance company or specialized health insurance company

You can port any individual/ family policies

Your new insurer has to give you the credit relating to waiting period for pre-existing conditions that you have gained with the old insurer

Your new insurer has to insure you at least up to the sum insured under the old policy

The two insurers should complete the porting as per the timelines prescribed in the IRDA (Protection of Policyholders’ Interests) Regulations and guidelines


You can port the policy only at the juncture of renewal. That is, the new insurance period will be with the new insurance company

A part from the waiting period credit, all other terms of the new policy including the premium are at the discretion of the new insurance company

At least 45 days before your renewal is due you have to

Write to your old insurance company requesting a shift

Specify company to which you want to shift the policy

Renew your policy without a break (there is a 30 day grace period if porting is under process)

What are the benefits of Medical Insurance Portability?

Are you not happy with your health insurer. Do you wish to have your health insurance from any other company? IRDA has made your wish come true. IRDA has introduced a great concept in the health insurance domain in which a person can transfer his health insurance policy from the current company to another without losing its benefits.

This concept is called Health Insurance Portability. It is just like Mobile Number Portability. Submit a form to the new insurer before 45 days of your policy renewal date stating the portability. That’s it. Within 15 days, the new insurer will decide the acceptance of your policy. What could be simpler than this?

Health Insurance Portability is a very beneficial concept for those who are not happy with their health insurance. The new policy you will choose with a new company can be individual or family floater as per your choice. The benefits of the previous policy will continue to exist after portability. Moreover, the sum insured of your new policy will be at least up to the sum insured of your previous policy.

Along with the benefits, there are also some conditions:

  • You can opt for portability only at the time of policy renewal
  • You need to submit the application before 45 days of the policy renewal date
  • The new insurer you will choose can set a high premium
  • The policy must be in continuation otherwise the new insurer may reject the portability in case premiums are not paid
  • In case the previous policy has been maintained without any break, all insurers will allow for gained credits by the insured when he switches to another insurer or plan as per the circular introduced by IRDA. The credit gained by the policyholder can be for pre-existing conditions or critical illness in terms of the waiting period.
  • However, this credit will remain limited to the previous policy’s sum insured. To know about the history of health insurance of the policyholder, a common database will be available accessible by all the insurers. That database will be carrying the entire data about the policy including claims also. This will help the insurers to decide whether to accept the portability or not.

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