Myth : All Health Insurance Policies Are the Same

Posted on: Jun 5, 2025 | 3 mins | Written by: HDFC ERGO Team

Myth : All Health Insurance Policies Are the Same

When you are considering health insurance, it's easy to believe that all plans are alike. Well, this is something that many people think, like health insurance policies offer the same benefits, coverage, and terms. But remember that the health insurance sector is more diverse. From individual plans to critical illness and family floater policies, each of these serves different purposes. You might overpay or get underinsured if you do not understand their differences. Read further to know why it is essential to compare insurance plans before you buy health insurance to select a plan that best meets your medical needs.

What are the Key Features in Health Insurance Policies

When you are looking to buy health insurance, here are a few things you should be aware of:

• Sum Insured:

The maximum amount the insurer will pay you in a policy year.

• Coverage Scope:

It includes hospitalisation, daycare procedures, pre-and-post-hospitalisation expenses, medication expenses, etc.

• Co-payments Clauses:

This clause explains the percentage of medical expenses a policyholder has to pay out of their own pocket and the remaining cost that will be covered by the insurer.

• Waiting Period:

This is the period you have to serve after certain plan benefits become active, especially for pre-existing conditions.

• Sub-limits:

See if it includes restrictions on particular costs, such as room rent or certain medical procedures.

• Network Hospitals:

Check the list of hospitals where cashless treatments are available.

Types of Health Insurance Policies

Here are the types of health insurance available in India:

1. Individual Health Insurance:

• It's designed to cover one person.

• The coverage amount applies only to the person insured under the policy and does not extend to anyone else.

• You are covered against medical procedures, doctor appointments, hospital care, medication, and room expenses.

2. Family Floater Plan

• This plan offers a single sum insured shared by all family members, typically spouses, children and parents.

• Selecting a family floater plan is relatively more economical than buying an individual coverage plan for each family member.

• This plan covers nursing charges, hospitalisation, medicines, surgery, etc.

3. Senior Citizen Health Insurance

• The premium of this plan is comparatively much higher due to an increase in health risk.

• People who are above the age of 65 can benefit from this plan.

• It covers hospitalisation expenses for illness or accidents, home treatment, and mental health care, depending on the policy’s terms and conditions.

4. Critical Illness Insurance

• The policy provides a lump sum if you are diagnosed with a critical disease like cancer, stroke, kidney failure, etc.

5. Personal Accident Insurance

• It covers partial or total disability/death due to an accident.

• This plan includes compensation for temporary disability or a lump sum for permanent disability/death.

6. Top-up and Super Top-up Plans

• These add to your base policy once the original sum insured is exhausted.

7. Maternity Insurance

• This health insurance cover caters to medical bills incurred before and after delivery.

• Health plans focused on maternity care are available as a separate cover or an add-on to existing health schemes.

• Most policies have a waiting period, which implies that you must wait a certain period before gaining coverage benefits.

• Some plans may cover infant expenses, such as health checks and vaccinations.

8. Mediclaim Insurance

• This insurance strictly covers hospitalisation expenses like doctor's fee, surgery cost, nursing charges and anaesthesia.

• It does not include pre-and-post-hospitalisation costs.

9. Hospital Daily Cash or Hospital Cash Allowance

• Offers a fixed daily allowance while you are admitted to the hospital.

• This add-on is meant to cover expenses you put out of your pocket, like meals, transportation and lodging.

10. Group Health Insurance

• Group health insurance is offered by employers for employees.

• This policy includes maternity, OPD treatment, diagnostics, etc.

• It can be extended to family members with additional premiums.

• This insurance has no waiting period and offers limited options for customisation.

Conclusion

Believing that all health insurance policies are the same is not true. Every health insurance is structured differently, focusing on family, individual, or specific illnesses. The right policy depends on your age, medical history, financial goals, and lifestyle. So, before you buy health insurance, evaluate your medical needs and other factors to choose a policy that best suits you.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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