HEALTH INSURANCE

What is Health Insurance?

Think of health insurance as your financial safety net during medical emergencies or planned treatments. When you buy a health policy, you're securing coverage for a wide range of healthcare expenses — from hospitalisation (emergency or planned) and surgeries to day-care treatments, ambulance charges, and even pre- and post-hospitalisation care.

In short, it ensures that a health event doesn't turn into a financial crisis.

At Probitas, we always tell our clients — a good health insurance plan isn’t just protection for the body, it’s peace of mind for the family and stability for your finances. And yes, it also gives you the added benefit of tax savings under Section 80D of the Income Tax Act, 1961.

Health Insurance at a Glance

*Pre-existing diseases are covered after the waiting period is over.
#This is the maximum tax benefit that can be claimed in case both the policyholder and his/her parents are senior citizens.

What is the Ideal Coverage for Health Insurance?

There’s no one-size-fits-all. The right health insurance coverage depends on your age, city, lifestyle, and future health needs.

Let’s break it down.

But here’s a practical thumb rule we often recommend:

Your health cover should ideally be at least 50% of your annual income, or a minimum of ₹10 lakhs in today’s times — just to stay ahead of soaring medical inflation.

Here are the top 3 factors you should consider:

1. Your City of Residence (Tier-1, Tier-2, or Tier-3)
2. Your Age or Life Stage
3. Expected Future Healthcare Needs (including pre-existing conditions or risk of critical illnesses)

A few examples to put it in context:

• If you're in a Tier-3 city with lower medical costs and no pre-existing ailments, a ₹5 lakh cover may suffice.
• But if you're in a Tier-1 city like Mumbai or Delhi, or have a history of critical illness, a cover of ₹10 to ₹20 lakhs is a more realistic safeguard.

Ideal Health Insurance Sum Insured

*Disclaimer: The above sum insured is suggestive and may vary as per the age and medical needs of the people.

Alternatively, you can also opt for a ₹1 crore health insurance policy that has become extremely affordable these days. A ₹1 crore health policy can come in handy for treating a disease that requires long-term care or for medical procedures taken abroad. You can easily get a ₹1 crore health cover by paying an extra premium of approximately ₹1500.

You also have a more affordable option of purchasing a base health insurance policy with a low sum insured and buying a top-up cover with a high sum insured.

Top Reasons to Buy a Health Insurance Plan

Let’s face it — medical inflation is real. Hospitalisation for a critical illness or even a lifestyle-related condition can wipe out years of savings in just a few days. The smartest way to protect your health and your finances is by investing in the right health insurance policy. Here’s why:

Benefits of Buying Health Insurance Plans Online

In today’s fast-paced world, buying health insurance online just makes more sense — and here's why thousands of smart buyers are choosing takemyinsurance.com for it:

• 🧮 Easy Plan Comparisons - Online platforms like ours let you compare multiple plans, benefits, premiums, exclusions — all side by side. So you can make decisions backed by facts, not sales pressure.
• 🖥️ Unmatched Convenience - No branch visits. No waiting for appointments. Buy your policy from wherever you are — home, office, or even while travelling.
• 💰 Exclusive Online Discounts - Insurers often pass on operational cost savings to you in the form of lower premiums or instant discounts — just for buying online.
• 📉 Lower Premiums - Plans sold online tend to be lighter on your wallet. Why? Because there are fewer intermediaries and lower administrative costs.
• 📝 Minimal Paperwork - Forget the hassle of forms and photocopies. Most online policies are issued with near-zero paperwork and instant confirmations.
• ⏰ Available 24x7 - Whether it's a weekend, holiday, or 3 a.m., you can buy a policy anytime. Health emergencies don’t work 9 to 5 — neither do we.
• 💳 Secure Digital Payments - Pay safely and instantly using UPI, credit/debit cards, net banking, or wallets. No cash. No delays. Just peace of mind.
• ⏱️ Time-Saving - The entire process — from comparison to purchase — can be wrapped up in a few minutes. No queues, no follow-ups.

Key Benefits of Health Insurance Plans in India

A good health insurance plan isn’t just about hospital bills — it’s about ensuring uninterrupted access to quality care when you need it most. Here are the core benefits you can expect:

What Is Covered in a Health Insurance Plan?

A well-chosen health insurance plan should work for you — not surprise you later. Most comprehensive health insurance policies in India cover the following:

• 🏥 In-patient Hospitalisation - Covers hospital expenses if you’re admitted for more than 24 hours due to an illness or injury. This includes room rent, doctor consultations, nursing charges, medicines, and diagnostics.
• 💉 Pre-existing Illnesses - After serving the specified waiting period (usually 2 to 4 years), your policy will cover treatment costs for any pre-existing conditions like diabetes, hypertension, etc.
• 📅 Pre & Post-Hospitalisation Expenses - Expenses like blood tests, scans, or consultations done before admission — and follow-up care or medicines required after discharge — are typically covered for 30 to 60 days.
• 🚑 Ambulance Charges - Most plans cover emergency ambulance costs, subject to a cap depending on the insurer.
• 🤰 Maternity & Newborn Cover - Certain plans offer maternity benefits, covering costs related to pregnancy, delivery, and even newborn care. These usually come with a waiting period — so plan early.
• 🩺 Preventive Health Check-ups - Many insurers offer free annual or periodic health check-ups, depending on the policy terms — a great way to stay ahead of health issues.
• 🔧 Day-care Procedures - If you’re advised by a doctor to undergo treatment at home (due to mobility issues or hospital unavailability), many plans will reimburse you for it — up to specified limits.
• 🏠 Home Treatment - It also covers the expenses incurred on getting medical treatment at home on the advice of a medical practitioner.
• 🌿 AYUSH Benefits - Prefer alternative medicine? Many insurers cover hospitalisation costs under Ayurveda, Unani, Siddha, Homeopathy, and Yoga treatments, as per policy terms.
• 🧠 Mental Healthcare Cover - As per IRDAI guidelines and the Mental Healthcare Act, 2017, all health plans now cover in-patient mental health treatment — including conditions like depression, schizophrenia, and bipolar disorder.

What is Not Covered in a Health Insurance Plan?

No matter how comprehensive the plan, some exclusions always apply. It’s critical to know what isn’t covered:

• ❌ Claims made during the first 30 days of policy purchase (unless due to an accident)
• ❌ Treatment of pre-existing diseases during the waiting period (typically 2–4 years)
• ❌ Critical illness claims made within the first 90 days
• ❌ Injuries from war, terrorism, or nuclear activity
• ❌ Self-inflicted injuries or suicide attempts
• ❌ Terminal illnesses and certain end-stage conditions
• ❌ Cosmetic or plastic surgery (unless medically necessary)
• ❌ Hormonal therapy or non-accidental dental treatments
• ❌ Charges for bed rest, rehab, or unproven therapies
• ❌ Diagnostic tests not linked to hospitalisation
• ❌ Injuries during adventure or high-risk sports

📝 Pro Tip: Always read the policy wording and brochure in detail. Or better yet, ask us. We’ll help decode the fine print for you — no jargon, no surprises.

Types of Health Insurance Plans

Health insurance isn’t one-size-fits-all. Your needs change depending on your age, lifestyle, family responsibilities, and medical history. That’s why we help you choose a plan that aligns with your life stage — not just your budget.

Here’s a smart way to look at it:

• 

  🧑‍💼 Health Insurance for Young Adults (Ages 18–30)

  If you’re just starting your career or studying, this is the best time to buy health insurance. You’re healthy, premiums are low, and you can lock in long-term benefits early.

  Why it matters:

  • Low premiums
  • Minimal waiting periods
  • Early protection against lifestyle diseases
  • Tax savings right from the start
  • Great entry point into cumulative bonuses

  Ideal Plan: Individual health cover of ₹5–10 lakhs, with day-care and mental health coverage.

• 

  💍 Health Insurance for Newly Married Couples

  Marriage is not just about shared dreams — it’s also about shared responsibilities. A comprehensive family floater plan covers both of you under one umbrella, making it simpler and more economical.

  Why it matters:

  • Single premium for both partners
  • Option to add maternity and newborn cover
  • Easy to upgrade as your family grows
  • Simplifies paperwork and claims

  Ideal Plan: Family floater with ₹10–20 lakh cover, maternity add-on (with waiting period awareness).

• 

  👶 Health Insurance for Families with Children

  With kids in the picture, medical needs increase — from paediatric care and vaccinations to emergency treatments. A family floater policy ensures everyone is covered, and you can manage rising healthcare costs with ease.

  Why it matters:

  • Covers all family members under one policy
  • Cashless network access for quick hospitalisation
  • Free preventive check-ups and vaccination cover
  • Can be upgraded as children grow

  Ideal Plan: Family floater plan of ₹15–25 lakhs with OPD/maternity cover if needed.

• 

  👵 Health Insurance for Senior Citizens (Ages 60+)

  Older adults face higher health risks and medical costs. Special senior citizen health plans are designed to cover age-related ailments and offer access to broader benefits despite pre-existing conditions.

  Why it matters:

  • Tailored to chronic conditions and age-related issues
  • Some plans don’t require pre-medical tests
  • Includes home care, AYUSH, and post-hospitalisation cover
  • Lifetime renewability is critical

  Ideal Plan: Senior citizen health plan with ₹5–15 lakh cover, minimal co-pay, and large hospital network.

• 

  🏥 Top-Up & Super Top-Up Health Plans

  If you already have an employer-provided policy or a basic health plan, a top-up plan increases your coverage without increasing your premium significantly.

  Why it matters:

  • High coverage at low cost
  • Kicks in once your base plan’s threshold is crossed
  • Ideal for those relying on corporate health insurance

  Ideal Plan: Super top-up with ₹10–25 lakh additional cover over ₹3–5 lakh base policy.

Key Factors to Consider Before Purchasing a Health Insurance Plan

Before purchasing a health insurance plan, it is essential to consider several key factors to make an informed decision

• Scope of Coverage - The policy coverage determines the types of illnesses and surgeries that can be claimed during the policy term. When selecting a health plan, carefully evaluate the benefits offered, including hospitalisation expenses, daily cash benefits, COVID-19 hospitalisation coverage, critical illness coverage, maternity coverage, and others.
• Sum Insured - The sum insured amount is a crucial factor in selecting a medical insurance policy. Given the ongoing inflation, it is advisable to purchase a health insurance plan with a minimum sum insured of ₹10 lakh. Alternatively, you can opt for a ₹1 crore health plan to obtain wider coverage, as they have become more affordable in recent times. For family floater policies or senior citizen insurance, a higher sum insured generally provides better coverage.
• Policy Type - India offers various types of medical insurance policies. Depending on your requirements, you can choose to purchase individual health insurance, senior citizen health insurance, family floater policies, or critical illness plans. Additionally, you can consider purchasing top-up or super-top-up health insurance to enhance your coverage, particularly if your base sum insured becomes exhausted during treatment. This option can be selected at the time of policy purchase and renewal.
• Waiting Period Clause - Your health insurance policy becomes effective only after the initial waiting period has expired. Claims filed during the initial waiting period, except for accidental hospitalisation claims, will be rejected by the insurer. The waiting period clause also applies to pre-existing diseases such as thyroid, blood pressure, diabetes, and specific illnesses, treatments, and maternity cover. Therefore, it is advisable to choose a plan with a minimal waiting period.
• Co-payment Clause - Your medical insurance policy may contain a co-payment clause, which stipulates that a predetermined percentage of the claim amount must be borne by you, the policyholder. This co-payment option does not impact the sum insured. However, it enables you to reduce your premium to a certain extent, albeit at the expense of increasing your out-of-pocket expenses. Therefore, it is advisable to select this clause only if you can afford to cover a portion of your hospitalisation bills, ideally 10% and above, without incurring a significant financial burden.
• Room Rent Sub-limits - Health insurance plans may have various sub-limits, with the most prevalent being the room rent sub-limit. For instance, if your medical insurance policy has a sum insured of ₹3 lakh with a sub-limit of 1% on daily room rent, your room costs will be covered up to ₹3,000 per day. Any additional amount incurred for room rent will be borne by you. Consequently, it is prudent to choose a health plan with no or minimal sub-limits.
• Network of Cashless Hospitals - Verify the list of network hospitals for the insurance company you are considering. The number of network hospitals in your vicinity significantly enhances the likelihood of receiving cashless hospitalisation benefits.
• Lifelong Renewability Option - Medical insurance policies are typically renewed annually. When the policy term approaches its expiration, the policyholder must pay the insurance premium at the time of renewal to maintain coverage. Consequently, selecting a health insurance plan with a lifelong renewability option offers long-term benefits.
• Premium Loading Factor - Premium loading is the additional charge incurred by risk-prone customers in premium health insurance plans, particularly for senior citizens. Opting for a medical insurance plan without loading can result in cost savings. Additionally, some insurers impose claim loading, which, although initially disregarded, can significantly increase out-of-pocket expenses during claim processing.
• Claim Settlement Ratio - The claim settlement ratio is a crucial metric to evaluate the reliability of an insurer. Prioritising a company with a strong claim settlement record is advisable. A ratio exceeding 80% is generally considered an optimal choice.

Health Insurance Riders

Health insurance riders are additional coverage options that enhance your health policy, providing extra benefits. The cost of a rider varies based on factors such as age, sum insured, and coverage type. Here are five common riders you may consider:

• Maternity Cover Rider - The maternity cover rider can help you get your maternity expenses covered, including childbirth, pre and post-natal expenses. Some insurers may offer coverage for newborn baby expenses until the end of the policy tenure. However, this rider comes with a waiting period that may range from 9 months to 6 years, depending on the health insurer.
• Consumables Cover Rider - This rider covers non-medical expenses incurred during hospitalisation such as cotton, bandages, prescriptions, thermometers, syringes, registration charges, gloves, and masks. These often account for 10-20% of the hospital bill and are typically excluded by default. With this rider, policyholders can significantly reduce out-of-pocket expenses while receiving quality treatment.
• Critical Illness Rider - This rider provides a lump sum payout upon diagnosis of listed critical illnesses like heart disease or cancer during the policy term. The payout is made regardless of actual treatment costs. It generally has a waiting period of 90 days and a survival period of 30 days. Coverage typically includes 10 to 40 critical illnesses, depending on the insurer.
• Personal Accident Rider - This rider offers financial support in the event of accidental injury, disability, or death. It pays the full sum insured for permanent total disability and a partial amount for partial disability. In case of accidental death, the rider provides a death benefit to the insured's family. It is also known as the double indemnity rider.
• Hospital Cash Rider - This rider provides a fixed daily cash allowance during hospitalisation to cover incidental expenses. The benefit is doubled for ICU admissions for a specific number of days. It is activated only if the hospital stay exceeds 24 hours, and the cash amount varies by policy.
• Room Rent Waiver - This rider removes any sub-limit on hospital room rent, allowing the insured to choose a higher-category room without bearing extra expenses. It ensures that policyholders can access better facilities without financial strain.

DOES YOUR HEALTH INSURANCE POLICY COVER CORONAVIRUS (COVID-19) TREATMENT?

Yes, your existing health insurance policy covers the cost of COVID-19 treatment. Several health insurers and general insurers have already launched health insurance plans for coronavirus that cover medical expenses incurred on the treatment of coronavirus. After the IRDAI guidelines, two special standard health insurance products, namely the Corona Kavach policy and the Corona Rakshak policy, were launched and purchased by a lot of people. Let’s check out these two COVID insurance products and how they are different from basic health plans.

Eligibility Criteria for Health Insurance Plans

The eligibility criteria for purchasing a health insurance plan are contingent upon various factors, including the age of the policyholder, pre-existing medical conditions, and other relevant circumstances. Generally, the following eligibility criteria must be met for most health insurance plans:

Criteria - The entry age criteria for adults and children varies and can range from 18-65 years and 90 days to 25 years respectively. The actual age can vary from one medical insurance policy to another.

Pre-medical Screening -Required for applicants above the age of 45, 55, or 60 years, depending on the plan.
Most senior citizen health plans mandate pre-medical tests prior to policy issuance.

Pre-existing Diseases Disclosure - Any pre-existing medical conditions, such as high blood pressure, diabetes, cardiovascular diseases, kidney problems, etc., must be disclosed to the insurance company at the time of policy application.
Smokers and alcoholics are required to disclose these conditions to the insurance company.

Disclosure of Pre-existing Diseases -It is crucial to disclose all pre-existing medical conditions to the insurance company to avoid potential issues during claim settlement and potential rejection of claims.
Based on these eligibility criteria, the insurance company determines whether to offer medical coverage to the applicant.

Why Compare Health Insurance Plans Online?

Health insurance quotes online assist individuals in selecting the most suitable health plan for their healthcare requirements. However, the proliferation of insurers offering diverse health insurance products with impressive features can lead to confusion in the selection process.
Fortunately, takemyinsurance.com addresses this concern by providing a platform that enables users to compare the features, sum insured, and quotes of various health insurance plans. Here are some key advantages of comparing and purchasing a health insurance plan online:

Some Common Myths About Health Insurance

Prior to purchasing a health insurance policy, it is crucial to understand its intricacies. Below are some prevalent misconceptions that the general public holds about health insurance:

Factors Influencing Health Insurance Premiums

Advancements in medical facilities have led to a rise in healthcare costs. Health insurance provides financial security for individuals and their families, safeguarding against unexpected serious illnesses or accidental injuries that could deplete savings.

The determination of health insurance premiums involves several key factors:

• Medical History – Medical history significantly impacts premiums. Most health insurers in India mandate pre-medical tests for policyholders above a certain age. While some insurers do not require screening, they consider current medical conditions, lifestyle-related health risks, and family medical history. Consequently, premiums for smokers tend to be higher compared to non-smokers.
• Gender and Age – Age is another crucial factor influencing premiums. Premiums generally increase as the insured’s age advances. Therefore, it is advisable to purchase a policy at a young age, as premiums are lower for younger applicants. Elderly individuals are more susceptible to cardiovascular diseases and other critical illnesses, such as cancer and kidney problems. Consequently, senior citizens’ medical insurance premiums are typically higher. Additionally, the cost of health insurance for women is generally lower compared to men due to their lower risk of stroke, heart attack, and other health conditions.
• Policy Term – Premiums for a two-year health insurance plan are generally higher than those for a one-year plan. However, most insurance companies offer discounts for long-term medical insurance plans.
• Type of Health Insurance Plan – • The type of health insurance policy you select significantly impacts your premium. Comprehensive coverage typically leads to higher premiums. Utilising an online health insurance premium calculator enables you to compare premiums across various plans before making a decision.
• No Claim Bonus (NCB) discounts are available to policyholders who maintain a claim-free record during their previous policy term. The discount percentage ranges from 5% to 50%, contingent upon the number of claim-free years. NCB is a crucial factor in determining the premium for a policy.
• Lifestyle habits, such as smoking or excessive alcohol consumption, can also influence premiums. In severe cases, these habits may result in the denial of a medical insurance policy request.

How to File a Health Insurance Claim

Health insurance plans provide cashless treatment and expense reimbursement by the insurer. Traditionally, cashless claims were only available at network hospitals. However, with the “Cashless Everywhere” feature, policyholders can file a cashless claim at non-network hospitals up to the sum insured limit of their health insurance policy.

There are two types of claim processes:

• Reimbursement Claims –
  

  For treatments availed at non-network hospitals, policyholders can file a claim for reimbursement of the treatment charges. Upon completion of the treatment, the insured must settle the bill, collect all necessary documents, and submit them to the insurer or the TPA to file a reimbursement claim.

• Cashless Claims –
  

  If the treatment is availed at a network hospital of the insurer, policyholders are eligible to avail cashless treatment services. After the treatment, the insurance company will directly settle the bill with the hospital.

In Case of Planned Hospitalization:

• Inform the insurer at least 48 hours before the treatment.
• Obtain approval from the TPA/insurer before admission.
• Submit the claim form along with required documents such as medical bills, reports, discharge summaries, etc.
• For reimbursement claims, the insurer will pay the policyholder after document verification.
• For cashless claims, the insurer will directly settle the hospital bill.

In Case of Emergency Hospitalization:

• Inform the insurer within 24 hours of hospitalization.
• Present your health insurance card at the hospital desk.
• Submit the pre-authorisation form to obtain TPA approval for a cashless claim.
• If approved, the insurer will directly pay the network hospital.
• If TPA approval is not obtained, pay the bills and subsequently apply for reimbursement.
• Submit required documents (hospital bills, discharge summaries, etc.) for reimbursement.
• After verification, the insurer will release the claim amount.

Obtaining a Physical Copy of Your Health Insurance Policy

All insurance companies provide a digital copy of their health insurance policy to their customers, which is digitally verified and legally binding. However, if you require a physical copy of your health policy, you can utilise the following options:

• Download the policy document from your registered email address or by contacting your insurer's customer support team.
• Request a physical copy of your health policy directly from your insurer.
• Log in to your insurer’s website to access, download, and print the policy document at your convenience.

If you have purchased your mediclaim policy through takemyinsurance.com, you can access your policy document and print it directly from the website.

Documents Required for Health Insurance Claim Reimbursement

In the event of hospitalisation, the policyholder must submit the following documents to file a reimbursement claim with the insurer:

• Discharge card issued by the hospital
• In-patient hospitalisation bills signed by the insured for authenticity
• Doctors’ prescriptions and medical store bills
• Claim form with the insured’s signature
• Valid investigation report
• Consumables and disposables prescribed by the doctors with complete details
• Bills of doctors’ consultations
• Copies of the health insurance policy from the previous and current years
• Copy of the identity card
• Any other documents requested by the TPA

How to Purchase Health Insurance Plans Online from takemyinsurance.com

Obtaining health insurance can be a straightforward process when utilising the appropriate platform. In this regard, takemyinsurance.com emerges as an advantageous resource for selecting the most suitable insurance policy. takemyinsurance.com has streamlined the comparison and purchase of health insurance policies, significantly enhancing the efficiency compared to previous methods. Individuals now have seamless access to comprehensive details of virtually all health insurance plans available in the Indian insurance market at competitive premiums.

takemyinsurance.com facilitates the comparison of numerous health insurance plans, enabling users to pinpoint the plan that best aligns with their specific requirements. Furthermore, the company extends post-sale services to both online and in-person customers, ensuring comprehensive support throughout the insurance journey, including the processing of medical insurance claims.

Steps to Purchase a Health Insurance Plan Online from takemyinsurance.com

For convenience, individuals can purchase health insurance online through takemyinsurance.com Insurance Broker Private Limited. No medical documentation is required, and payments can be made conveniently online. The following outline outlines the steps to purchase a health insurance plan online from takemyinsurance.com:

• Step 1: Select Gender and Family Members
  Select the gender and indicate the family members you wish to insure, along with their respective ages.
• Step 2: Provide Personal Information
  Enter your city, full name, and phone number.
• Step 3: Indicate Existing Illnesses
  Determine whether you or any family members have an existing illness.
• Step 4: Verify Medical Insurance Coverage
  If your office offers medical insurance, select the coverage amount.
• Step 5: Selecting the Appropriate Health Insurance Plan
  From the presented options, select the most suitable health insurance plan. If you require assistance or guidance, choose ‘Get Free Advice’.
• Step 6: Comparative Analysis of Health Insurance Plans
  Visit takemyinsurance.com to compare various health insurance plans. Customise your search to identify the plan that best aligns with your requirements.
• Step 7: Finalising the Plan
  Once you have selected the desired plan, proceed to pay the premium or contact our customer care representative to explore different options.
• Step 8: Policy Submission and Notification
  Upon successful completion of all the aforementioned steps, the policy will be emailed to your registered email address.

Documents Required for Health Insurance in India

Please review the following list of KYC documents that may be required for the purchase or renewal of health insurance in India:

• Aadhaar Card
• Driving License
• Passport
• Voter ID Card
• Letter by the National Population Register with demographic details
• Any other document notified by the central government in consultation with the Insurance Regulatory and Development Authority of India (IRDAI)

Common Health Insurance Terms

Here are some of the most common health insurance terms you may encounter: