Health Insurance — Protect Your Health & Savings

What is Health Insurance?

Types of Health Insurance

Benefits of Health Insurance

• Cashless hospitalization at network hospitals — no need to pay upfront, the insurer settles bills directly with the hospital
• Coverage for hospitalization expenses including room rent, surgeon fees, anesthesia, medicines, diagnostic tests, and ICU charges
• Pre and post-hospitalization expenses — typically 30 days before and 60 days after hospitalization
• Daycare procedures coverage — over 500+ daycare treatments (cataract, chemotherapy, dialysis) that don't require 24-hour hospitalization
• Tax benefits under Section 80D — premiums up to Rs. 25,000 (Rs. 50,000 for senior citizens) are deductible from taxable income
• No-claim bonus — sum insured increases by 5-50% for every claim-free year, rewarding healthy policyholders
• AYUSH treatment coverage — Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatments are covered under most policies
• Free annual health check-up — most insurers provide complimentary health check-ups after a claim-free year
• Restoration benefit — some policies restore the entire sum insured if it gets exhausted during the policy year
• Portability — IRDAI allows you to switch insurers without losing credit for waiting periods served

Key Factors to Consider Before Buying

1. Sum insured — choose adequate coverage based on your city's healthcare costs. Metro cities need minimum Rs. 10-15 lakh, non-metros Rs. 5-10 lakh
2. Network hospital list — check if your preferred hospitals are in the insurer's cashless network
3. Waiting period for pre-existing diseases — ranges from 2-4 years across insurers. Lower waiting period is better
4. Room rent capping — many policies cap room rent (e.g., 1% of sum insured per day). Choose policies with no room rent limit
5. Co-payment clause — some policies (especially for senior citizens) require you to pay 10-20% of the claim amount. Lower co-pay is better
6. Sub-limits on specific treatments — some policies cap expenses for cataract, knee replacement, etc. Choose policies with no sub-limits
7. Claim settlement ratio — check the insurer's claim settlement ratio (higher is better) and average claim settlement time
8. Exclusions — read what is NOT covered — cosmetic surgery, dental treatment, self-inflicted injuries, war, and specific diseases may be excluded
9. Renewal — health insurance must be renewed annually. IRDAI mandates lifetime renewability — the insurer cannot refuse renewal
10. Restoration and no-claim bonus — these features significantly enhance the effective coverage over time

Health Insurance Claim Process

1. For cashless claims — inform the insurer or TPA (Third Party Administrator) at least 48 hours before planned hospitalization or within 24 hours for emergency hospitalization
2. The hospital's insurance desk will submit the pre-authorization form to the insurer/TPA on your behalf
3. Carry your health card, policy document, and photo ID to the hospital
4. The insurer approves or queries the request — on approval, the hospital treats the patient and bills the insurer directly
5. For reimbursement claims — pay the hospital bills yourself and submit the original bills, discharge summary, and claim form to the insurer within 15-30 days of discharge
6. Submit all original documents — hospital bills with itemized breakup, diagnostic test reports, doctor's prescription, pharmacy bills, and discharge summary
7. The insurer processes the claim within 30 days of receiving all documents (as per IRDAI guidelines)
8. If the claim is partially or fully rejected, you can file a grievance with the insurer, escalate to IRDAI (igms.irda.gov.in), or approach the Insurance Ombudsman

Documents Required for Claim

• Duly filled and signed claim form
• Original hospital bills with itemized breakup of all charges
• Discharge summary from the hospital
• Doctor's prescription and treatment notes
• Diagnostic test reports (blood tests, X-rays, MRI, CT scan, etc.)
• Pharmacy bills with corresponding prescriptions
• Photo ID proof (Aadhaar, PAN, Passport)
• Health insurance card and policy copy
• Bank account details and cancelled cheque for reimbursement claims
• FIR copy (for accident-related claims)