Different people have different needs for health insurance depending on their family size and age. So keeping their needs in mind, I have categories different mediclaim policy or health insurance plans into 4 Categories
- Best Family Floater Health Insurance Plans in India
- Best Health Insurance in India for Individual
- Top Up/Super Top Up Health Insurance Policy
- Best Health Insurance Plan for Parents (Senior Citizen)
Before moving to the list let’s look at the important factors that you should consider before buying the best health insurance policy in India
5 factors you should consider while buying the best health insurance plan in India
#1. Claim Settlement Ratio (CSR):
It is the ratio of the total number of claims settled by the insurance company to the total number of claims received in the same duration of time.
Expert tip: A high CSR indicates that the company is more likely to settle a claim without any hassles. #2. Incurred Claim Ratio (ICR):
It is the ratio of the total amount of all claims received by a company to the total premiums collected in the same duration of time. A high ICR indicates that an insurance company is more likely to accept new customers, more likely to have the less waiting period for pre-existing illnesses, and more likely to issue policies to people with pre-existing illnesses.
#3. Network Hospitals:
An insurer should have a good number of hospitals in its network in each city, which cater to various classes of people. The network hospitals should include nursing homes, day-care centre, and multi-speciality hospitals.
#4. Waiting Period for pre-existing illnesses:
This is one of the most important factors as a longer waiting period for pre-existing illnesses can mean that you cannot make a claim for hospitalization, even though you are paying the premium.
Expert Finding: 2 years is the waiting period for pre-existing illness to be covered. However, there are some insurers who specify the waiting period to be 4 years also. #5. Cost of Premiums:
The premiums no doubt varies across insurers but what matters is what we are going to get for the premium we pay. The premium should cover a fairly acceptable room rent in any city, medical and surgical costs and also cover common treatment costs such as cataract, knee surgery, dialysis etc.
The insurer should have different types of plan available that is suitable for different sections of people such as individual health plans, family floater plans, senior citizen health plans, top-up plans and plans suitable for people with certain health conditions such as cancer and heart disease.
Top 5 Best Health Insurance Companies in India 2020
Let’s see what fits into our requirements from the list of best health insurance companies in India.
#1. Religare Health Insurance
Religare health insurance is one of the best health insurance in India which offers coverage for health insurance, critical illness, personal accident, top-up coverage, international travel insurance, and maternity along with group health insurance.
The claim settlement ratio of Religare is 93% and a high ICR of 51.97%. Religare has over 5420 hospitals in its network.
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#2. Tata AIG
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Tata AIG Insurance is a trusted 20-year-old joint venture between Tata & AIG Group that carries an iAAA rating by ICRA for the highest claims-paying ability. The individual death claim ratio for 2018-19 was 96.12%.
The company has access to 4000+ network hospitals.
#3. Max Bupa
Max bupa insurance offers coverage for a number of illnesses, access to hospital networks and cashless claims.
Claim settlement ratio of Max Bupa is 91.2% and a high ICR of 51.96%. Max has over 3000 hospitals in its network.
#4. ICICI Lombard
ICICI Lombard has a network of 4500+ hospitals to avail cashless facilities.
According to IRDA, it is supposed to have settled 98.32% of the claims received. It has a very high ICR of 80.38% which indicates that people are renewing the policy and also making claims.
#5. Star Health Insurance
Star Health Insurance company provides a wide range of health insurance policies for individuals, families, senior citizens and for those who need specialized care like heart patients and cancer patients.
Star has a high claims settlement percentage of 98.72% and ICR of 60.51% with a whopping 8200+ hospitals are on its network.
Best Family Floater Health Insurance Plans in India
#1. Religare (CARE) Comprehensive Health Insurance Plan
Religare (CARE) comprehensive health insurance is one of the best family floater plan in India that offers a wide range of sum insured starting from Rs. 3 Lakhs to Rs. 6 crores.
So you will have the flexibility to choose the sum insured on the basis of your actual needs.
The various floater CARE plans for different sum insured are
- Super Saver – for sum insured of Rs. 4 Lakhs
- Elite – for sum insured of Rs. 5, 7 and 10 Lakhs
- Elite Pus – for sum insured of Rs. 15, 20, 25, 30 and 40 Lakhs
- Global – for sum insured of Rs. 50, 60 and 75 Lakhs
- Global Plus – for sum insured of Rs. 1, 2, 3 and 6 Crores.
The super save is a basic plan.
The elite plans have a higher limit for ambulance cover, organ donor cover, alternative treatments. Elite Plus covers maternity cover up to Rs. 1 Lakh.
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Features & Benefits
|Minimum Age for cover
|Maximum Age for Renewal
|Waiting Period to cover pre-existing illness
||Four years of continuous coverage
||For every year of no-claims, the plan increases the Sum Insured by 10%, up to a maximum of 50% in consecutive 5 years.
||Medical expenses incurred up to 30 days before hospitalization is covered.
||Covers expenses like doctor consultations, Diagnostic tests, medications up to 60 days post your hospitalization
||Add on cover for unlimited automatic recharge of sum insured.
|Day Care Procedures
||Over 540+ day care procedures are covered
||The plan covers for medical expenses incurred during treatment at home for a period exceeding 3 consecutive days.
|Alternative Treatments – AYUSH
||Ayurveda, Unani, Sidha or Homeopathy, with cover up to Rs. 50,000 under different plans.
||Self-inflicted injuries (suicide), injuries caused by alcohol or drug use, AIDS, pregnancy, abortion, congenital disease, Infertility and IVF treatment, war, riots, strike and nuclear weapon induces hospitalization.
- Annual Health Check-up for you and all members covered.
- Second opinion at no extra cost by Religare Health Insurance
- Add-on Cover for – Automatic Recharge of Sum insured.
- Organ Donor cover up to Rs. 5 Lakhs
- 20% Co-payment if the age of the eldest member insured at the time of the first policy is 61 years or above
- 4 years of continuous coverage required to cover pre-existing illness
- Vaccination and Maternity benefits only in higher plans.
Avoid Medical Emergencies with Religare Health Insurance
#2. Tata AIG Insurance
Tata AIG carries an iAAA rating by ICRA for the highest claims-paying ability and offers one of the best health insurance plans. The individual death claim ratio for 2018-19 was 96.12%.
Tata AIG Medicare is a comprehensive “Health Insurance” plan initially offered for 1,2 or 3 years. One can avail a long term premium discount of 5% and 10% for the policy with tenure of 2 and 3 years respectively.
The best part is that the policy covers medical expenses incurred outside India. However, the initial diagnosis should have been made in India.
Tata AIG Medicare health plans come in three variants – Medicare, Medicare Protect and Medicare Premier.
- Medicare Protect – the sum insured under Medicare protect plan ranges from Rs. 2 Lacs to Rs. 5 Lacs
- Medicare – The sum insured ranges from Rs. 3 Lacs to Rs. 20 Lacs.
- Medicare Premier– The sum insured ranges from Rs. 5 Lacs to Rs. 50 Lacs.
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Features & Benefits
|Minimum Age for cover
||5 years onwards
Dependent children between 91 days and 5 years can be insured only when both parents are getting insured
|Maximum Entry Age
|Initial Policy issued for the period
||1/2/3 years with life long renewal option
||Individual or on a family floater basis.Maximum 7 members
The waiting period to cover pre-existing illness
||24 months from the commencement date24 months
||50% increase in cumulative bonus for every claim-free year
||Medical expenses incurred up to 60 days immediately before hospitalization is covered.
||Medical Expenses incurred in the 90 days immediately after the discharge
||An additional amount equivalent to the base Sum Insured will be restored once during the policy period
|Preventive Health Checkup expenses
||Up to 1% of the policy sum insured subject to a maximum of Rs. 10,000/- per policy
|Day Care Procedures
||541 daycare procedures are covered
||The plan covers medical expenses incurred during treatment at home
|Alternative Treatments – AYUSH
||Medical Expenses incurred for In-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy.
||AIDS, injuries caused by alcohol or drug use, mental disorders, Parkinson’s, congenital disease, laser treatment for correction of eye, pregnancy, abortion,Self-inflicted injuries (suicide), an act of war, riots, strike and nuclear weapon induces hospitalization.
One can have a family floater discount on premium as under:
- 2 members – 20%
- 3 members – 28%
- >3 members – 32%
The unique coverage under the policy includes:
- Bariatric Surgery cover,
- Medical and surgical expenses for organ donor
- In-patient dental treatment
- Health Check-up (max Rs. 10,000)
- Vaccination cover
What I Like
- Global medical cover
- 4000+ Network hospital
- Option to migrate to a similar health insurance policy with Tata AIG
- Health insurance cover without any sub-limit (unless specified)
- Up to 32% family floater discount on premium
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What I didn't like
- Cover for individuals aged 5 years onwards
- Loading up to 16% on premium rates under the monthly installment option
#3.Max Bupa Heartbeat Family Floater Health Insurance Plan
It is a comprehensive health insurance best-suited to a family’s needs.
There are 3 variants in this plan – Silver, Gold, and Platinum.
– It is a basic health insurance plan which covers inpatient care, pre and post hospitalization expenses and day care procedures. It also offers maternity benefits for 2 kids and covers the newborn baby also.
– This has all features of Silver plan and an additional feature of cover for AYUSH treatments.
– This variant offers all features of Gold plan and has many additional features as below:
- No limit on hospital room category.
- Covers international treatment for specified illnesses like cancer.
- Charges for OPD treatment and diagnostic services if required.
- Option to carry forward the sub-limit for consultation and diagnostic services to the next policy year.
- Vaccination expenses for children up to the age of 12 years.
5 Type of Health Insurance Policies in India
#1. Individual health plans
If you have an individual health insurance policy, you alone will be eligible to claim the benefit of the entire sum assured and also, all the benefits covered in the plan and it cannot be transferred to anyone.
The greatest advantages of individual health plans
- Offers higher protection for each person rather than as a family.
- The policy can be renewed without any age restrictions.
- Suitable for people with health risks.
- No risk for other family members even if the cover gets exhausted in a single year.
#2. Family floater health insurance policies
Family floater health policies are umbrella health cover tailored for the entire family. A single premium is paid to obtain a cumulative health cover for the entire family and the amount of health coverage can be utilized for hospitalization expenses of any member of the family.
The advantage of family floater insurance
policy is that
- You can get your entire family covered by health insurance at a lesser cost.
- You can cover 4 children for each policy along with 2 adults.
The biggest disadvantage of family floater health policy
- There is a high possibility of the entire cover getting exhausted due to the hospitalization of one family member.
If your family members have frequent illness then opt for individual plans.
#3. Senior citizen health insurance policies
Buying health insurance at an old age is difficult or unaffordable. I suggest you buying the health insurance policy for your parents before they get too old.
The Senior citizen policies are similar to individual health policies but come with stringent medical checkups, high premiums
, the higher waiting period for pre-existing illnesses
and a greater number of exclusion clauses.
These policies are usually bought by people who have already crossed 60 years of age but did not have any health insurance until then.
#4. Top-up and super top-up insurance policies
Top-up and super top-up policies are health policies which come with a ‘deductible’ clause. These policies come into effect after the amount specified as the deductible is incurred as hospitalization expenses.
For example, assume that you have bought a top-up/super top-up policy of Rs.20 lakhs with a deductible of Rs.5 lakhs. If you get hospitalized, you are eligible to claim from the top-up/super top-up policy for all your hospitalization expenses over Rs. 5 lakhs.
The biggest advantage of these policies is that you can get a large cover for a low premium. Even though there is a deductible clause applicable, you can take a basic health policy whose sum assured will be equal to the deductible.
#5. Policies covering specific illnesses such as cancer or heart disease
The biggest advantage is that these policies cover illnesses like heart disease or cancer, which are usually avoided by many insurers. The premiums for such policies are high as the risk is high for the insurer.
These policies are designed for people who are already diagnosed with certain diseases or are at high risk of getting certain diseases.
Don’t rely on employer-provided health insurance
One of the main reasons why people avoid taking health covers is because of employer-provided group health coverage. But no matter how much health cover your employer provides, it has its own drawbacks.
Let’s understand why having your own health coverage is important.
- Employer-provided insurance benefits will end the moment you leave or change the job.
- You can not carry forward the benefits of employer health insurance.
- Having your own health cover early in life will always help in the case, you are diagnosed with any illness. This is because the waiting period clause will not apply and any illnesses you catch at a later stage gets covered.
- Employer-provided insurance clauses can change any time.
- Employer-provided health coverage can exhaust in a single hospitalisation. You must have a backup policy.
- Would you buy an expensive health cover post-retirement?
13 Practical tips to choose the best health insurance policy
Always buy an individual policy at a young age. Otherwise, insurance becomes expensive as you grow old.
Choose the right amount of sum insured as per your family size. Smokers, obese individuals and people with inactive lifestyles have higher health risks and need higher cover.
If you are buying health coverage for a family of 4 (2 adults and 2 kids), you can either
- Buy individual covers for each family members and buy an additional family floater to increase the cover.
- The second option is to buy a family floater and then buy a top-up/super top-up policy whose deductible is equal to the sum insured of the family floater policy.
Choose a policy with minimal exclusions. Buy a plan which covers 100% of the costs of hospitalization, common day care procedures and a part of pre and post-hospitalization costs. Do not opt for plans which have co-pay option
Choose a policy which offers lifetime renewability.
Do not buy a policy which has sub-limits on per day expenses or room rent
Your health plan should cover hospitalization expenses for critical illnesses also. There should be no “claim loading” in case you or your family are diagnosed with critical illness. Claim loading is a feature in which the insurance company can keep increasing your premiums year on year if you are diagnosed with critical illness.
Check the waiting period for pre-existing illnesses
. Most insurance policies have 2 years as the waiting period but some have up to 4 years.
Check the clauses for getting treated at network and non-network hospitals. Many insurers reimburse only 70-80% of the costs if you get treated at a non-network hospital.
If you are buying health cover for aged parents, check the list of illnesses and medical procedures that are not covered
. Your policy should provide cover for common surgeries required by aged people such as cataract and knee surgery.
Buy the policy before you get any critical disease (health, lungs, cancer). Many policies have clear-cut clauses that the policies are to be bought before the onset of any such illness.
Buy a top-up/super top-up policy at a very less premium to get a large cover if you want to increase your health cover.
Buy separate individual policies for yourself and your spouse as you grow old. This is an important step because family floater policies are issued against the name of the oldest person listed in the group. If the oldest person passes away, the policy ceases and the remaining family members have to buy a new policy at higher premium rates.
Before we look at the best health insurance policies, let us understand some of the common terms used to describe the features, benefits and advantages of health policies.
Things you should know about health insurance
- It is always better to buy from a reputed insurance broker. Verify the credentials of the insurance agent before you buy a health policy. If any claims get rejected, your agent may not be able to help you.
- You can also buy health policies online at lesser price than Offline. You have to make sure that you declare all the requested data correctly and honestly.
- You can actually bargain for less premium rates if you have healthy living habits such as maintaining good BMI, exercising regularly, avoiding smoking etc.
- No insurer will provide cover for a person aged above 90 years. Any existing policies also cease to be effective once the insured crosses 90 years of age. This applies to employer-provided health insurance for retirees also.
- The family floater policies are issued with the eldest member as the policyholder. If the eldest in the family deceases, a fresh policy has to be taken by the surviving family members at prevailing premium rates.
- Always declare every detail of your illness, if any, even if it seems insignificant. Insurers have experts to determine if you have not declared any pre-existing illness and may deny your claims.
- If you are not satisfied with your existing health insurance policy, you can always ‘port-out’ to another policy. However, you have to pay the applicable premium of the new policy. But the greatest advantage is that the waiting period for the pre-existing illness will not apply.
As you can gauge by now, yours and your family’s health insurance needs will be unique. You have to choose a policy based on various factors such as sum insured, co-pay and sub-limit clauses, network hospitals, etc., and not just about quoting low premiums.
Always buy a health policy early in life as it works out cheaper and also, you will be on safer side if you get any illness later in life.