Health Insurance

Top-up in health insurance is the extra coverage offered to policyholders if they reach the maximum limit on their health insurance plans. The benefit of a top-up plan is that it significantly increases your sum insured at a very nominal increase in cost.

Example: Pingoo has health insurance of INR 4 lacs with a premium of INR 8k. But he feels that with the rising medical costs and incidences of illnesses in India, it won't be enough to cover him in case of a medical emergency. If he buys an additional policy of the same amount or increases the coverage of the existing amount to 8lac, it will cost an additional premium of INR 8k. Instead, a top-up plan at the rate of 1k per lac acts as an excellent incentive for him to increase his cover at a lower amount. So, he only has to pay INR 6k additionally instead of INR 8k.

Most health insurance plans have a waiting period of at least 3 months to a maximum of 4 years, during which certain illnesses, pre-existing diseases, and medical emergencies are not covered. Suppose you have already crossed this waiting period but now wish to switch to a different insurance provider. In that case, porting your existing health insurance to the new insurer can be very useful. In this way, you can avoid the second waiting period under your new insurer.

For most health insurance policies, you will be able to claim medical insurance as many times as you want. However, after you have exhausted your total sum insured amount, you will no longer be able to make a claim. You can only begin to do so again after your policy has been renewed.

Most policies DO NOT require you to take a medical test under 45.

Yes, you may have any number of policies as you like. But you cannot claim the same expenses from multiple insurance policies. However, if one cover isn't enough, you may use another cover to help you pay for the costs.

Every insurer has a network of hospitals, clinics, and medical professionals that charge their policyholders a lower fee than other medical care facilities/professionals. This medical network also makes provisions for "cashless" treatment wherein the expenses borne by the patient can be directly settled between the insurer and the hospital.

According to the IRDAI (Insurance Regulatory Development Authority of India), any person up to 65 can buy insurance. Specific senior citizen policies are available for persons aged between 65 and 80. The lower age limit to purchase health insurance in India is 18 years – that is when you are legally an adult

The initial period of 15 days (usually) during which you can terminate your health insurance policy or ask for changes in the features of the policy without having to pay any penalties is known as the 'Free Look Period. Typically, policies that grant the free look period option to their holders have a minimum term of 3 years or more.

A pre-existing illness denotes any health issues that the policyholder is already facing before he/she purchases the policy. Common pre-existing diseases in India include diabetes, asthma, hypertension, etc. Insurers are wary of pre-existing diseases as it means that the chances of the holder claiming the sum insured are much higher. Hence some policies don't cover these at all. However, most insurers cover pre-existing diseases with a waiting period of a minimum of 2-4 years, depending on the severity and nature of the disease. This means that the cost of any treatment- medication, doctor consultation, or hospitalization- related to the pre-existing illness will not be covered by the policy's issuer until the waiting period as specified by the policy terms has elapsed.
Some insurers offer a co-payment option on pre-existing diseases. This means that if you, that is, the policyholder, have to undergo any pre-existing disease expenses, part of the expenses will be borne by you and the remaining by your health insurer.

Certain medical conditions, known as "Exclusions" in health insurance parlance, are typically not covered by your health insurer, either during the "Waiting Period" or the entire course of the policy. These usually include the following 7:

1. Pre-existing diseases, which, as discussed above, have a waiting period of 2-4 years even if covered by the policy.
2. Except for those occurring due to accidents and deaths, all other medical expenses are covered in a health insurance policy only after 2-4 months have elapsed since the purchase of the policy.
3. Pregnancy and expenses related to the same are usually included only after a waiting period of 2 years.
4. Elective surgery such as cosmetic surgery, gender transfer, dental or joint replacement is also excluded.
5. Alternative treatment methods such as Homeopathy and Ayurveda
6. HIV/AIDS
7. Congenial disease, i.e., a medical condition present from or even before birth.

If you've opted for a family floater, your children can be covered in the plan right from their birth to a period of 90 days. The policy includes benefits such as hospital stays and vaccinations. After 90 days, you can add the child to the policy by paying an additional premium. In the case of an individual health policy, a newborn baby can be covered right from the day they're born as long as either of the parents is included in the health plan.

A standalone health insurance plan is one that you have in your name only. It does not provide any benefits to your family members. It is also known as an individual health insurance plan and is one of India's most common health insurance policies.

IRDAI stands for The Insurance Regulatory Development Authority of India. It is an autonomous regulatory body under the Ministry of Finance (the Government of India) that monitors and awards licenses to India's insurance and reinsurance industries. The body comprises a 10-member team including the chairman, 5 full-time and 4 part-time members appointed by the Indian Government.

Policyholders can air their grievances against their insurer in the following ways:
1. Reach out to the insurance company's government redressal officer (GRO). You can find the contact details of all GROs in India here. You have to give your complaint in writing along with supporting documents. You should also make a written acknowledgment of your complaint with the date.
2. If within 15 days, your issue remains unresolved or you're unhappy with the resolution, you can reach the
Grievance Redressal Cell of the Consumer Affairs Department of IRDAI in any of the following ways:
1. Call the toll-free number 155255 or 1800 4254 732
2. Send an email to complaints@irdai@gov.in
3. Use IRDAI's online portal- Integrated Grievances Management System, to register and monitor your complaint here.
4. Send a letter to IRDAI with your complaint by filling the complaint registration form addressed to the IRDAI GRO at the address provided here.

There is no "perfect" health insurance sum insured. It varies based on several factors. There are 3 handy and broadly accepted rules that you can apply to arrive at an amount that is prudent and practical for you:
1. Your health cover should be at least 50% of your total annual income.
2. The sum insured should at least cover the cost of a coronary artery bypass graft in a hospital of your choice.
3. Most personal finance experts recommend a minimum cover of at least INR 5 lakhs.

A Minimum Premium Plan is a type of corporate health insurance plan in which the employer agrees to pay healthcare expenses up to an aggregate amount. This results in the least (a minimum) amount of premium that the employer is liable to pay. The insurer has only to bear the expenses that accrue over and above this aggregate predetermined amount.

Earlier, policy owners had to pay their health insurance premiums annually or once unless renewed. However, recently the IRDAI, to make health insurance more accessible and affordable to the masses in India, has allowed the option of monthly payment of health insurance premiums. This has come as a boon to Indians since a large, single payment is difficult for many prospective policyholders.

Yes, your health insurer will provide you with free health check-up (s) based on your plan and the insurance company. While some health insurers in India specify the monetary value of the tests you can avail of as a percentage of the sum insured, others detail the type and number of lab/blood tests you can avail for free. Most routine tests are covered under this complimentary health check-up.

Yes, you can easily claim your medical bills in health insurance, provided you have not exhausted your annual sum insured amount. You will have to produce the original copies of all medical receipts to your insurance provider to claim your medical bills.

You can easily add your family members to your existing policy by contacting your insurance provider and complying with the process for the same. It typically involves furnishing the following documents:
1. Request Letter
2. Proposal Form
3. Marriage Certificate (in case you're adding your spouse)
4. Adoption papers (In case you're adding your adopted child)
5. Birth Certificate Papers (In case you're adding your child)
6. Cheque with premium (New and increased amount in light of the member addition)
However, there is an important caveat you should bear in mind before adding family members to an existing policy:
It's usually wiser to buy a separate policy for your parents (especially senior citizens) rather than add them to your cover. This works out more cost-effectively in the long run as the premium you pay on a family floater is calculated based on the eldest policyholder. So you end up paying extra, overall.

If you are admitted into a non-network hospital, you must bear the cost of treatment and settle the bill with the hospital. However, you can claim reimbursement from your health insurance provider by submitting the medical bills to them.

Most health insurance policies in India do not cover overseas medical treatment.

A basic health insurance policy in India covers your cost of hospitalization, which includes room and board, surgical procedures, nursing, etc. However, the medical costs during a health emergency typically extend beyond hospitalization, as you may have to incur expenses for counseling, rehabilitation, physiotherapy, dietary supplements, and more.

These expenses can add up to a considerable amount- one that you may ill-afford.
This is where "riders" in health insurance can come to your rescue. 3 Common riders include:
1. Critical Illness: This provides you a monetary lump sum if you or your nominee gets diagnosed with a critical illness covered by the plan.

2. Hospital Cash: This rider pays you a fixed amount in case of hospitalization. And in case you're admitted to the ICU, the rider amount doubles. This cash comes in handy for the miscellaneous expenses you have to undergo while in the hospital.

3. Maternity: This rider pays for your expenses related to delivery, be it C-Section or vaginal. It also covers your pre-natal and post-natal expenditure, newborn expenses, or medical termination of pregnancy.


Other riders that insurance providers cover include accidental death, out-patient dental (deemed medically necessary) costs, convalescence costs, etc.