Health Insurance: Benefits, Renewal and Claims

Here are the top five benefits of having medical insurance in India:

• Medical Inflation:

In India, the medical inflation is growing at approximately 14% annually, making good healthcare expensive every day.

• Cashless Hospitalisation:

Cashless mediclaim lets you receive treatment at network hospitals without paying upfront, as the insurer settles the bill directly (subject to policy terms and approvals).

• Comprehensive Coverage:

A health insurance plan covers a wide range of medical expenses; planned surgeries, emergency treatments, day-care procedures, and more, offering financial protection when you need it most.

• Regular Checkups:

Many plans include preventive health check-ups, helping you track your health regularly. These benefits usually come with limits, such as annual eligibility or capped amounts.

• Tax Savings:

Under Section 80D, you can claim tax deductions on health insurance premiums; up to ₹25,000 for self and family, and additional deductions for parents (higher if they are senior citizens).

Anyone aged 18 or above can buy a health insurance policy as the proposer. Children can also be covered under most plans, with many insurers offering coverage from as early as 90 days old (sometimes even at birth) up to 25 years. Eligibility rules may vary across insurers, so checking the age limits and specific terms of the policy is important before buying.

When it comes to choosing the best health insurance, here are the steps to follow:

• Choose the right insurance type:

Select an individual plan if you need coverage for yourself, or opt for a family floater if you want to insure your entire family under one policy.

• Check for comprehensive coverage:

Review whether the plan includes key expenses such as pre- and post-hospitalisation, day-care procedures, medications, and therapies.

• Choose an adequate sum insured:

Pick a sum insured that matches your healthcare needs and city of residence. Choosing more than necessary increases premiums without adding real value.

• Look for lower PED waiting periods:

Pre-existing disease (PED) waiting periods can extend up to three years. A plan with shorter waiting periods allows faster access to full coverage.

• Check the Claim Settlement Ratio:

A higher CSR indicates reliability, but also look at claim processing timelines and grievance redressal for a complete picture.

• Read exclusions and cost-sharing clauses:

Review policy exclusions carefully. Avoid high co-payments and be mindful of sub-limits on room rent or specific treatments, as these increase out-of-pocket expenses.

Along with these steps, make sure that you read the policy exclusions in detail. Avoid policies with high co-payment clauses (your share of the bill) and be careful of sub-limits (caps on room rent, procedures, etc.) as both increase out-of-pocket costs.

Timely renewal is essential to keep your health insurance active. Since most policies offer coverage for a fixed term, typically one year and sometimes shorter durations, you must renew before the expiry date to avoid losing benefits or continuity. Renewal is straightforward: simply pay the premium through your insurer’s website, app, or helpline, and your coverage continues without interruption.

In order to understand whether you should buy mediclaim insurance or critical illness insurance, you should know how these two differ. In simple words:

• A mediclaim policy covers your hospitalisation expenses caused by an illness or accident. It pays for both emergency and planned treatments up to the sum insured, but hospitalisation proof is mandatory.

• A critical illness policy covers specific severe conditions such as heart attack, cancer, or stroke. It does not require hospitalisation to pay out. Instead, it provides a lump sum amount on diagnosis, which can be used for treatment costs, regular medical visits, or to cover loss of income due to the illness.