Health Insurance

• Online Discounts – It allows you to avail discount on premiums for buying the policy online.
• Lower Premiums – Health plans are available for a lower premium online as insurance companies save a lot on operational costs.
• Minimal Paperwork – The process of buying a health insurance policy online involves minimum to zero paperwork.
• Policy Available 24x7 – A health insurance policy can be purchased online any time of the day, even on public holidays, which is not possible in offline buying.
• Digital Payment Options – It allows you to avoid cash payments and use digital payment methods to pay the premium online safely.
• Time-saving – It saves you a lot of time as the policy is issued within a few minutes of buying.

• Fight Lifestyle Diseases - It allows you to pay for the long-term treatment of lifestyle diseases like cancer, heart ailments, etc., that have been on the rise with the changing lifestyles.
• Protect Your Savings - It helps you to protect your hard-earned savings by covering your medical expenses so that you can avail the required treatment without any financial worries.
• Avail Cashless Hospitalization Facility - It allows you to obtain a cashless hospitalization facility at any of the network hospitals of your insurance provider by raising a cashless claim.
• Get Tax Benefits - It enables you to save tax on the health insurance premium that you’ve paid under section 80D of the Income Tax Act for better financial planning.
• Ensure Peace of Mind - It allows you to obtain medical treatment with peace of mind as you do not have to worry about paying hefty hospital bills.

• ICU Charges - A health insurance plan also covers the cost of availing treatment in an ICU or Intensive Care Unit during hospitalization.
• Ambulance Cost - It covers the cost of ambulance services availed to reach the nearest hospital during a medical emergency.
• Cashless Treatments - All health insurance providers in India offer cashless treatment facilities at their network hospitals. You do not have to worry about arranging money to pay the hospital bills if you get admitted to a network hospital, as it will be settled by your insurer under cashless claims.
• Day Care Procedures - It also covers the cost of availing day care treatments that require hospitalization of less than 24 hours.
• Pre-existing Diseases - The best health insurance policy also provides coverage for pre-existing diseases after you have completed the waiting period. Usually, pre-existing diseases are covered after a waiting period of 2 to 4 years.
• AYUSH Treatment - It covers the cost of availing medical treatment through the AYUSH system of medicines that includes Ayurveda, Unani, Homeopathy, Siddha and Yoga.
• Medical Check-ups - Most health insurance companies in India offer free preventive health check-up facilities to the insured at regular intervals depending on the policy terms and conditions.

• Pre and Post Hospitalization Expenses - Medical expenses incurred on blood tests, x-rays, and other medical check-ups required before hospitalization are covered by the insurance company. Similarly, the cost of medicines and preventive health check-ups done to ascertain your recovery after discharge from the hospital is also covered under most health insurance plans.
• Ambulance Charges - Although the coverage amount varies from insurer to insurer, most medical insurance plans cover emergency ambulance charges.
• Maternity Cover - Medical expenses incurred during the pregnancy and delivery are covered along with newborn baby expenses.
• Preventive Health Check-ups - Regular health check-up facilities are also made available in most health insurance plans in India.
• Day-Care Procedures - Day care treatments are covered by health plans where hospitalization of more than 24 hours is not required. It includes eye surgery, dialysis, and other common day care surgeries, as mentioned in your policy document..
• Home Treatment Cover - It also covers the expenses incurred on getting medical treatment at home on the advice of a medical practitioner.
• AYUSH Benefit - A health insurance plan also reimburses the hospitalization costs incurred on availing Ayurveda, Unani, Siddha, Yoga or Homeopathy treatment up to the specified limit.
• Mental Healthcare Cover –All health plans in India cover mental illnesses as per the Mental Healthcare Act, 2017. IRDAI had directed all insurers to amend health policies to cover the in-patient treatment of mental illnesses, like acute depression, bipolar affective disorder, schizophrenia, etc., by 31st October 2022.

• Critical illnesses coverage usually comes with a 90-day waiting period
• Injuries caused by war/terrorism/ nuclear activity
• Self-inflicted injuries or suicide attempts
• Terminal illnesses and other diseases of a similar nature
• Cosmetic/plastic surgery and replacement of hormone surgery
• Non accidental dental treatments
• Bed rest and rehabilitation
• Diagnostic tests
• Claims arising out of adventure sports injuries

• Sum Insured - The sum insured amount is a crucial deciding factor in selecting a medical insurance policy. Looking at the ongoing inflation, it is advisable to buy a health insurance plan with a minimum sum insured of ₹10 lakh. You can also choose to buy ₹1 crore health plan to get wider coverage as they have become affordable nowadays. If it’s a family floater policy or senior citizen insurance, the higher the sum insured, the better the coverage will be.
• Policy Type - There are different types of medical insurance policies available in India. As per your requirement, you can choose to buy individual health insurance, senior citizen health insurance, family floater or critical illness plans. Moreover, you can buy Top Up and Super Top Up health insurance along with your existing health plan to enhance the coverage. This is beneficial in case your base sum insured gets exhausted during the treatment. You can choose this option at the time of policy purchase and renewal.
• Waiting Period Clause - Your health insurance policy only comes into action once the initial waiting period is over. If any claim is filed during the initial waiting period except for accidental hospitalization claims, the insurer will reject it. Moreover, the waiting period clause also applies to pre-existing diseases like thyroid, blood pressure, diabetes, etc.  It is also applicable to specific illnesses, treatments, and maternity cover. Just make sure to choose a plan with a minimal waiting period.
• Co-payment Clause - Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (policyholder). The co-payment option does not have any effect on the sum insured. However, it allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Thus, opt for this clause only if you can afford to pay off a portion of your hospitalization bills, that can be 10% and above, without a financial burden.
• Room Rent Sub-limits - A health insurance plan may have various sub-limits and the most common one is the room rent sub-limit. For instance, if your medical insurance policy comes with a sum insured of ₹3 lakh with a sub-limit of 1% on daily room rent, then your room cost will be covered up to ₹3,000 per day. Any additional amount on room rent will have to be paid from your own pocket. So, choosing a health plan with no or minimal sub-limits is advisable.
• Network of Cashless Hospitals - Check the list of network hospitals for an insurance company where cashless claims can be filed. The higher is the number of network hospitals in your vicinity, the better are the chances of availing cashless hospitalization benefits. 
• Lifelong Renewability Option - Medical insurance policies are usually renewed every year. When the policy term is about to end, the policyholder has to pay the insurance premium at the time of renewal in order to continue the insurance coverage. Thus, when buying a health insurance plan, choosing a plan with a lifetime renewability option is beneficial in the long run.
• Premium Loading Factor - Premium loading is the additional amount that is charged to a risk-prone customer in the premium, especially in senior citizen health insurance plans. Choosing a medical insurance plan with no loading will save you from paying a higher premium. Some insurers also charge a claim loading. This aspect, though ignored in the beginning, usually increases your out-of-pocket expenses at the time of claim.
• Check the Claim Settlement Ratio - Claim Settlement Ratio is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. A claim settlement ratio above 80% can be an ideal choice.

• Critical Illness Rider- The critical illness rider will ensure that your health insurance policy covers critical illnesses, such as heart diseases, cancer, etc., diagnosed for the first time during the policy tenure. It will provide you with a lump sum benefit amount irrespective of the actual medical expenses incurred during the treatment. It comes with a waiting period of 90 days & a survival period of 30 days. Most plans cover about 10 to 40 critical diseases, depending on the insurer.
• Personal Accident Rider- The personal accident rider can help you get compensation from your insurer in case an accidental injury leads to your disability or death. It will pay you the entire sum insured in case of permanent total disability but only a part of the sum insured, depending on the nature of the injury in case of partial disability. It is also known as the double indemnity rider, as your family will get a death benefit in case of accidental death.
• Hospital Cash Rider- The hospital cash rider enables you to get a fixed daily cash allowance from your insurer to cover incidental expenses that you may incur during hospitalization for an injury or illness. It offers twice the coverage amount for a specific number of days in case you are admitted to the ICU. The daily cash amount may vary as per the policy terms and opted coverage. However, you need to be hospitalized for at least 24 hours to activate this rider.
• Room Rent Waiver- The room rent waiver ensures that your health insurance policy covers the rent for the hospital room of your choice during hospitalization. It ensures that no cap on room rent applies to you and, thus, allows you to opt for a room with higher sub-limits or no sub-limits without paying extra money from your pockets.

Pre-medical Screening- Pre-medical examination is required for applicants mostly above the age of 45 years or 55 years. However, most of the senior citizen health plans require pre-medical tests before policy issuance.

Pre-existing Diseases Disclosure- Any pre-existing illness is covered after the completion of the waiting period i.e. 2-4 years. Most health insurers ask the applicant if they are going through any medical conditions like high blood pressure, diabetes, cardiovascular diseases, kidney problems, etc., at the time of buying a health insurance plan. If you are a smoker or an alcoholic, then you need to disclose it to the insurance company.

Do not keep it a secret, as it may cause problems at the time of claim settlement. It can even lead to rejection of your claims.

Based on these criteria, the insurance company decides to offer medical coverage to the applicant.

• Find a Policy with Suitable Premiums: If a customer is looking to buy a health plan online, he/she will be able to compare the premiums of different plans and opt for the one that fits in the budget. Also, no brokerage or agent fees are levied, and hence, the buyer ends up saving a significant amount of money.

• Availability of Provider/Plan Reviews: You can check an insurance company’s ability to meet your claim requests by comparing the Claim Settlement Ratio and customer reviews online. Doing so will help you get an overall idea of an insurer’s reputation and customer service, enabling you to make an informed decision.

• Gender and Age: Age is another important determinant of medical insurance premiums. The premium increases as the age of the insured increases. That is why it is recommended to buy a policy at a young age because the premiums are lower for younger applicants.
  Elderly people are vulnerable to cardiovascular diseases and other critical illnesses, such as cancer, kidney problems, etc. For this reason, senior citizens medical insurance premiums are usually on the higher side.
  Also, the cost of health insurance for women is lower in comparison to the male candidates due to the lower risk of stroke, heart attack, etc.

• Policy Term : premium for a 2-year health insurance plan will be higher than a 1-year plan. However, almost all insurance companies offer a discount on long-term medical insurance plans.

• Type of Health Insurance Plan: The type of health insurance policy you select also affects your premium. The wider is the coverage, the higher will be the premium. With the help of an online health insurance premium calculator, you can compare the premium for different health insurance plans before buying.

• No Claim Bonus: you have not made any claim during your previous policy term, then you can earn an NCB or No Claim Bonus discount. With NCB, you can save 5% to 50% on your renewal premium, depending on the number of claim-free years. It is also one of the most important factors that is taken into consideration while calculating the policy premium.

• Lifestyle Habits: If you drink or smoke regularly, chances are high that you will be charged a higher premium. In severe cases, the insurer can also reject your medical insurance policy request.

2. Cashless Claims

If the treatment is availed in a network hospital of the insurer, then the policyholder will be eligible to avail cashless treatment services. Once the treatment is completed the insurance company settles the bill directly with the hospital.

For both cashless and reimbursement claims, the procedure for planned and emergency hospitalization may vary as given below:

In Case of Planned Hospitalization:

• You need to inform the insurer at least 48 hours before the treatment.
• Once you get the approval from the TPA/insurer, you can then file for reimbursement or cashless claims on submission of the claim form.
• Also, submit other related documents like medical bills, reports, discharge summary, etc.
• Once the approval is provided, the claim amount is paid to you by the insurer in case of reimbursement claims.
• In the case of cashless claims, the hospital bill is directly settled by the insurer.

In Case of Emergency Hospitalization:

•  You need to inform the insurer within 24 hours of getting hospitalized.
• Showcase your health card at the hospital.
• Submit the pre-authorization form to get TPA approval for emergency hospitalization for cashless claims
• If approved, the insurer will settle the claim amount directly with the network hospital
• If you fail to get TPA approval, you will need to file for reimbursement later.
• Submit all the required documents like hospital bills, discharge bills, etc., after getting discharged from the hospital.
• After verification of documents, the claim amount will be paid to you.

Steps to Buy a Health Insurance Plan Online from Policybazaar

To get insured from the comforts of your home, you can buy health insurance online from Policybazaar Insurance Broker Private Limited. No medicals are required and payment can be made online. The steps to buy a health insurance plan online from Policybazaar.com are listed below:

Step 1- Select Male/Female and choose the family members to be insured along with their age.

Step 2- Enter your city, full name and phone number.

Step 3- Choose if you or any family members to be covered have an existing illness.

Step 4- Click ‘Yes’ or ‘No’ if your office provides medical insurance. If yes, choose the coverage amount.

Step 5- Select the best health insurance plan from the options that are displayed. Choose ‘Get Free Advice’ if you want suggestions or help.

Step 6- Select and compare different health insurance plans on Policybazaar.com. You can customize your search to choose the right plan for yourself.

Step 7- Once the plan is selected, you can pay the premium or speak to our customer care representative to take you through different options.

Step 8- Once all the steps are completed, the policy will be emailed to your registered email Id.

Claim

Claim refers to the request made to the insurance company by the policyholder to pay the medical expenses incurred on an illness or hospitalization under the health insurance policy. In the absence of a claim, you will have to pay for the medical expenses on your own.

Co-payment

Co-payment refers to a fixed percentage of the claim amount that the policyholder has to pay at the time of claim settlement. Opting for a co-payment can help to reduce your premium amount.

Coverage

Coverage refers to the extent of benefits available under a health insurance policy. The wider is the coverage, the more will be the benefits offered under the policy.

Cumulative Bonus

Cumulative bonus refers to an increase in the sum insured amount without a hike in premium as a reward for not raising a claim in the previous policy year.

Day Care Procedures

Day care procedures refer to those medical procedures and surgeries that are performed using advanced medical technology and require hospitalization of less than 24 hours. Almost all basic health insurance plans offer coverage for day care procedures. For example, cataract surgery.

Deductible

Deductible refers to a fixed amount that the policyholder agrees to pay towards the incurred medical expenses before raising a claim with the insurance company. It is a part of the total claim amount. Once the deductible is paid, the insurance company will pay for the remaining medical expenses claimed by the policyholder.

Dependent

Dependent refers to the family members of the policyholder who can also be covered under the same health insurance policy. It usually includes your legally wedded spouse, children, parents and parents-in-law..

Domiciliary Treatment

Domiciliary treatment refers to the medical treatment taken at home under the supervision of a medical professional in case hospital admission is not possible. This treatment is covered by health insurance plans under domiciliary hospitalization.

Entry Age

Entry age refers to the age at which a person can buy a health insurance policy. Most health insurance plans come with an entry age of 91 days to 65 years.

Exclusions

Exclusions refer to the conditions or circumstances that are not covered under a health insurance policy. Any claim arising out of an excluded medical expense or circumstance is not payable by the insurance company.

Family Floater

Family floater refers to the type of coverage where a single sum insured amount is shared by all the insured family members on a floater basis. A family floater policy is more affordable than buying an individual policy for each family member.

Free Look Period

Free look period refers to the first 15 days of buying the policy, where the policyholder can change the insurance company or cancel the policy without paying any cancellation fee. If the policy is cancelled during this period, then the premium amount is refunded to the policyholder.

Grace Period

Grace period refers to a fixed period that begins after the due date of a health policy. During this period, the policyholder can pay the due premium amount without losing the continuity benefits, such as waiting periods. Grace periods are usually of 15 days or 30 days.

Indemnity Plan

An indemnity plan is a type of insurance policy where the claim amount is paid based on actual medical expenses incurred. Under this type of plan, the policyholder has to submit the medical bills to the insurance company so that they pay the claim amount equal to the total bill amount.

Insured

Insured refers to the person who is eligible to receive medical coverage under a health insurance policy.

Insurer

Insurer refers to the insurance company that is responsible to pay for the medical expenses of the insured under a health insurance policy.

Network Hospitals

Network hospitals refer to the empanelled hospitals of the insurance company that offer the cashless hospitalization benefit to the policyholders. All insurance companies in India have a network of cashless hospitals.

No Claim Bonus

No Claim Bonus is a renewal premium discount offered by insurance companies to policyholders for not raising a claim in the previous policy year. This discount can be accumulated up to 50% for five consecutive claim-free years.

Portability

Portability refers to the procedure of changing the existing insurance company or health insurance policy without losing any continuity benefits like the waiting period. This facility is beneficial for people who are unhappy with their current insurer or policy.

Pre-existing Diseases

Pre-existing diseases refer to the diseases or medical conditions that the applicant was diagnosed with up to 4 years before buying the health policy. Most health plans cover pre-existing diseases after 2 to 4 years of waiting period.

Premium

Premium refers to the cost of an insurance policy. It is the amount paid by the policyholder at regular intervals to get insurance coverage and enjoy the benefits available under a health insurance policy.

Preventive Health Check-up

Preventive Health Check-up Preventive Health Check-up refers to a series of medical tests that are undertaken to assess the health of a person and take suitable measures to prevent the occurrence of a disease.

Restoration Benefit

Restoration benefit refers to the facility of refilling your sum insured amount before the policy renewal date in case the original amount gets exhausted on raising one or more claims.

Riders/ Add-on Covers

Riders or add-on covers refer to the additional covers that the policyholder can buy on payment of an extra premium amount to expand the coverage of a basic health insurance policy. For example, PED waiting period reduction, etc.

Room Rent Limit

Room rent limit refers to the limit up to which the insurance company will pay for the hospital room charges incurred by the policyholder. If the hospital room charges are more than the room rent limit, then the additional amount will have to be borne by the policyholder.

Sub-limits

Sub-limits Sub-limits refer to the limit set on the coverage amount of a benefit under a health insurance policy. Eg: room rent limit. In case a coverage benefit comes with a sub-limit, the insurance company will only be liable to pay up to that limit, and any additional amount will have to be paid by the policyholder.

Sum Insured

Sum insured refers to the maximum coverage amount that the insurance company will pay in a policy year. The sum insured is ascertained at the time of buying or renewing the policy.

Top Up Plan

Top up plan refers to a type of health insurance plan that offers a higher sum insured and can be bought to enhance the medical coverage of a person. However, a deductible amount needs to be paid under all top up insurance plans, which makes its premium affordable.

Underwriting

Underwriting refers to the process where an insurance company evaluates the application of a person. The underwriting team evaluates the medical history and personal details of a person to determine whether the policy should be issued and how much premium must be charged.

Waiting Period

Waiting period refers to the time period from the commencement of the policy during which the policyholder is not allowed to make any claims. Any claims raised during this period will be rejected by the insurance company. For example, the PED waiting period, critical illnesses waiting period, etc.