Health insurance plan is an insurance coverage or package offered by medical and general insurance companies which covers both the medical and surgical expenses of the insured. In other words Health Insurance reimburses the insured for every expenses made in relation to an illness, injury or any health related issue. An Insurance package can be bought for an individual, an entire family, employees of an organization, domestic household staffs etc.

The term of the plan is ideally for a period of one year and in some cases one can buy the plan for a term of two to three years as well, which is renewable upon its expiration. With a health insurance plan , one is entitled to adequate health care and medical facilities in cases of an emergency or in a pre-planned medical expense, without worrying about the financial costs.

• IN-PATIENT HOSPITALIZATION: In cases of a hospital admission, treatment carried out in a network or a non-network hospital for more than 24 hours are usually covered.
• PRE & POST HOSPITALIZATION : The Medical expenses covered includes diagnostic reports, medicines etc. and the medical treatments during the duration of the hospital admission .
• DAY CARE PROCEDURES : In normal circumstances, OPD treatments are not included, but certain procedures such as cataract, dialysis and kidney stone removal are covered (even if they don’t need 24-hours hospitalization).
• DOMICILIARY TREATMENT – Covers the expenses for treatment carried out at home which would have necessitated a hospital admission.
• ACCIDENT COVER : For medical and other related costs (eg. Ambulance charges) incurred in cases of an accident . In fact, this cover is active from the very first day of policy issuance.
• AYUSH BENEFIT – Treatments under Ayurveda, Unani, Sidha and Homeopathy.

The Insured is an Individual who buys a Health Insurance Plan or on whose behalf an Insurance Plan is being bought.
The Health Insurer is the Insurance company that sells health insurance.
Therefore when a health Insurance package has been bought by an individual, a contract has been entered between the insured and the health insurer, which requires the health insurer to pay some or all of the medical expenses in exchange for a premium.

A premium, is the amount or price, an individual or organization pays in exchange for the health Insurance policy. It also serves as a liability for the health insurance company as the insurer must provide coverage for any health related claim of the insured under the Insurance policy.

Medical emergencies can hit one at anytime regardless of age, gender or lifestyle. Since they are unpredictable, It is necessary that, one should be prepared for it, hence the need for an Insurance plan. Health Insurance protects every member of the family against huge financial losses and debts that can be incurred from unexpected medical emergencies. For an annual premium, the insurer pays for your hospitalization and other medical expenses as mentioned in your policy.

• It Secures One’s Health and Finances: Most of the expenditure related to treatments and other health-related expenditures incurred by people in India are borne out-of-their pocket. A majority of them mostly rely on their savings, and sometimes even borrow money, to fund medical treatments. A good Health Insurance Plan ensures that one’s savings does not dwindle since the insurer will bear the cost. A Health insurance cover provides cashless treatment, medical expenses reimbursement, Pre and post hospitalization expenses, Surgical costs and cost of various investigations and procedures.
• Cashless Treatment: Most health insurance plans offered by insurance companies offer cashless claim facility. Under such an arrangement, the insured individual does not have to make any out-of-pocket expenses when hospitalized. The medical bills will be settled by the insurance company. It is necessary that the individual gets admitted at one of the insurer’s network hospitals.
• Tax Benefits: The premium paid towards a health insurance policy qualifies for tax deduction under Section 80D of the Income Tax Act, 1961. A taxpayer (less than 60 years of age), who has an ongoing health insurance policy for himself or herself and parents (senior citizens) can claim a tax deduction of up to Rs. 75,000. Policyholders (above 60 years) who are paying health insurance premium for self and parents can claim up to Rs. 1,00,000 under Section 80D of the Income Tax Act, 1961.
• Additional Benefits : Other benefits available with a health insurance plan includes ambulance coverage, coverage for day-care surgeries, coverage for health check-up, Ayush treatments and vaccination expenses under health insurance. The customer can also opt for additional premium for various add on covers like Dental, Optical, Top Up, Critical Illness, lump sum benefit, Hospital Cash benefit etc

a) Individual
b) Family Floater
c) Parent / Senior Citizen Health Insurance
d) Super Top Up Cover

a) Individual: A policy is taken in an individual capacity. The premium will be determined based on the age, sum insured and the coverage chosen by the individual.
b) Family : A Family health insurance can be bought for the entire family. There are two ways you can cover your family members:
I) Individual policies for each family member : In this case, each family member is insured individually under different insurance packages.
II) One policy with combined sum assured for the whole family(Family Floater) : Family floater health insurance, is a type of insurance package, wherein every member of the family are covered in a single policy on a group shared basis. The family floater plan protects the entire family – spouse, children and parents in a single policy plan. UP to 6 family members can be added in this insurance plan depending on the policy of the insurance company. Some of the benefits of this type of insurance includes:
a. The sum insured in such a plan can be used by any member, in any proportion, up to its limit.
b. In comparison to buying multiple individual plans, the premiums for Family Floater plans are quite lower.
c. These plans are suitable for families with older children

Insurance Companies are now offering exclusive medical insurance plans to cover parents and senior citizens of age 60 years and above. These plans are designed for the needs of senior citizens and cover a variety of medical expenses usually incurred by senior citizens. Buying health insurance covers for ones aged parents and senior citizens in the family is the best way to secure and cater for their health needs.

This type of health insurance plan is Similar to top-ups in mobile network services, it adds supplementary coverage to your existing health plan. The aim is to increase the overall sum insured with its corresponding coverage by paying a relatively lower premium.

• Compare medical plans of all leading medical insurance companies in India.
• Expert advice.
• Policy servicing
• Claims Support.

The list of expenses and treatments which are generally not covered in a health insurance policy can be quite exhaustive. It all depends on the plan one opts for; but there are some provisions that cannot be covered by any health insurance plan. But generally the following are not covered.
1. Attempted suicide
2. Usage of alcohol or drugs not prescribed by a medical practitioner.
3. Pregnancy, child-birth or related complications
4. Hospitalization primarily and specifically for health checks, diagnostics, Xray or laboratory examinations , investigations and procedures
5. AIDS (Acquired Immune Deficiency Syndrome) or any Syndrome or condition of a a similar kind.
6. The cost of spectacles, frames, contact lenses, hearing aids, artificial limbs, wheel chairs, crutches, dentures, dental prostheses and all other external medical equipments or devices used at home as post-hospitalization care.
7. Cosmetic or aesthetic treatments, Plastic surgery (unless required for the treatment of Illness or accidental Bodily Injury)
8. Therapies such as acupuncture, naturopathy, magnetic therapies and alternative forms of therapies.
9. Hospitalization resulting from war, riot, strike and nuclear weapons etc.

Note : It is very important to go through the detailed list of what the policy covers and does not cover in the Health Insurance Policy.

Domiciliary Hospitalization means any medical treatment carried out on a patient at home for a period exceeding three days for an illness, disease or injury which under normal circumstance would require care and treatment at a Hospital/Nursing Home. Domiciliary hospitalization usually occurs in the following circumstance:

i) Where the condition of the patient is such that he/she cannot be moved to the Hospital/Nursing Home or
ii) Where the patient cannot be moved to Hospital/Nursing Home for lack of accommodation therein.
To ensure a smooth claiming process, ensure that all your documents are in place. It is important to have a report from your family doctor, stating that the patient cannot move to nursing home/hospital due to the following peculiar reasons listed. By providing proof, it makes the claiming process easy. Note that every company does not offer this facility, except it is expressly stated in the insurance Policy