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    Why do you need Health Insurance?


    Rich People have enough money,
    Poor have Social security schemes like ESI and

    The Middle Class has only Health Insurance.





    Insurance Meme Black & White 3 Vector Men - Group Health Insurance
    Insurance Meme Black & White 3 Vector Men - Group Health Insurance

    Why should I buy Health Insurance now?

    Health Insurance is only for Healthy people.

    It is unfortunate but true.
    Most Insurers will not cover you if they find that you already have any
    health conditions. From the Insurers perspective, you are not what
    they call a 'good risk'.

    Therefore, it is best to buy the policy when you are healthy



    How much health insurance coverage should I choose?


    We are just a Hospital bill away from Poverty

    Look for a policy which covers you for at least ₹50,00,000.


    If there is one thing the Covid-19 pandemic has taught us, it is the fact that Sum Insured, sometimes even to the tune of ₹ 30 Lacs, got exhausted in a matter of days in case of hospitalization. Consider below reasons


    Consider this



    Heart Life Vector Icon - Group Health Insurance Medical Inflation

    There is a double-digit gap between our salary increase and medical inflation.

    That means,In the coming years,it will be more and more difficult to afford healthcare.

    Heart Life Vector Icon - Group Health Insurance New Diseases

    As a result of threats like climate change,the occurrence of new diseases has increased exponentially. We can't guarantee we'llgetthe right vaccine everytime,but we can atleast be sure we'll get the right healthcare.

    Heart Life Vector Icon - Group Health Insurance New Medical
    Technologies

    Advancements in medical technologies like robotics and stem cell research are blessings for mankind. If only these blessings could be as cheap as the ones our forefathers shower us with,we would be sorted.Alas, that is not the case.

    We might not be affected by a hospital bill of 2-3 lacs, but a bill of 50 lacs can wipe out our entire savings.

    Hence we recommend a Health cover of anything above ₹50,00,000.


    What is the best way to reduce the cost of
    my health insurance?


    Health has no price, the Doctor has.

    Supertop Up Health Insurance is the Super way to Insure yourself.
    For the price of a cup of coffee, you get cover for 50,00,000.



    Insurance Meme Black & White 3 Vector Men - Group Health Insurance



    How Supertopup Health Insurance Works?

    • What is Super Top Up Health Insurance ?

      The Super Top-up policy has been one of the finest products designed in mediclaim history.
      Super Top-up policies are policies where the Insurer is not bothered about how you pay for a claim that is below a threshold. The Super Top-up policy is triggered only when your claim amount crosses the Threshold. This Threshold amount is called Deductible.
      Super top-up policies can therefore be used to cover expensive claims and at a fraction of the premium that you would have paid for an individual health policy.
      Smaller claims (i.e. claims below the Threshold) can be insured out of pocket or from your employer’s group policy.

    • How does a Super Top Up Health Insurance policy Work?

      Mr. Raju had a major surgery for which the medical expenses were Rs 9 lakh. The insurance policy provided by his company had a threshold limit of Rs 3 lakh. When his boss asked how he would manage the rest of the expenses, Mr. Raju said that he had a Super top-up policy.
      A regular health insurance policy has a sum insured limit, beyond which it does not cover any expenses. This is when a Super top-up policy is useful. It becomes effective as soon as the sum insured from the base health plan is exhausted. Therefore, Mr.Raju can claim the balance amount of Rs 6 lakh from his super top-up health cover. So essentially, he has a super top up plan with a deductible of Rs 3 lakh.

    • Example for Super Top up Claim

      Let’s say you have taken two policies
      Policy 1:
      A Normal Health policy of 3 lakh(it could be your corporate policy or you may choose to cover up to 3 lakh from your pocket) and

      Policy 2:
      Super top up policy of 10 lakh with 3 lakh deductible.

      Now if the claim is for 9 lakh,
      Policy 1 will pay 3 lakh which is equal to its sum insured. If you don’t have a base policy or corporate policy, then this amount will be paid from your pocket.
      Policy 2 will pay above 3 lakh (which is the deductible). That means 6 lakh (9-3=6) will be paid from this policy.
      You will still have a balance sum insured of 4 lakh (10 lakh – 6 lakh = 4 lakh) in the super top up policy which can be utilized in any future claims.

    • Don't Get Confused between "Top up" and "Super Top up" Health plans

      The top-up plan considers the deductible for each claim in a given year. Thus, if Mr.Raju submitted three different claims of Rs 3 lakh, Rs 3 lakh and Rs.3 lakh respectively, the top up plan would be useless since none of them exceed Rs 3 lakh individually.
      A super top-up comes to the rescue in such a situation. The Super top-up policy considers the aggregate amount of all claims within the year. So, once the deductible of Rs. 3,00,000 is exceeded, the remaining amount for all subsequent claims will be payable under the super top-up policy, subject to the maximum sum insured of the policy. In this case, the first claim of Rs. 3,00,000 will be considered as a deductible but the remaining claims amounting to Rs. 6,00,000 will be paid by the insurer. Thus one should always choose Super Top Up instead of a Top Up policy.


    Comparison chart for Possible Combinations of Deductible and
    Sum Insured under Various insurance Companies


    You might find this chart helpful. In the first column on the left, you can select the deductible (in lacs). The right side of the screen shows you the various sums insured (in lacs) offered by the respective insurance company for that deductible.




    Benefits Comparison chart of
    Various Supertop Up Health Insurance Plans.


    Supertop Up Health Insurance is the Super way to Insure yourself.
    For the price of a cup of coffee, you get cover for 50,00,000.


    Insurer
    Plan Name
    Brochure
    Policy Wording
    • Super Surplus

      Max Entry Age65
      Pre Policy Health Check upNot Applicable
      Home TreatmentNot Covered
      Organ DonorFully Covered
      Modern Treatments Partially Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsNot Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months12/36
      Specific Diseases Waiting Period in Months30D 12M & 24
      Maternity Waiting Period in months12
      No Claim BonusNot Covered
      Pre & Post Hospitalisation60/90
      Other Benefits
      Air Ambulance
      Restore
    • Qube Super TopUp

      Max Entry Age65
      Pre Policy Health Check up55
      Home Treatment₹50,000
      Organ Donor₹2,00,000
      Modern Treatments Fully Covered
      Psychometric TreatmentsNot Covered
      Ayush Treatments₹50,000
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months36
      Specific Diseases Waiting Period in Months12 Months
      36 Months
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus10%, Max50%
      Pre & Post Hospitalisation60/90
      Other Benefits Restore
    • Health Super TopUp

      Max Entry Age65
      Pre Policy Health Check upNot Applicable
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern TreatmentsFully Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsDelux
      Pre Existing Diseases Waiting Period in Months36/24
      Specific Diseases Waiting Period in Months30D & 24M
      Maternity Waiting Period in months12
      No Claim Bonus10%, Max50%
      Pre & Post Hospitalisation90/180
      Other Benefits
      Air Ambulance
      Worldwide Emergency Cover.
      Waiver of Deductible for Accidental Claims
      Health Check Up
      Deductible- Buy Back (Optional Benefit)
    • Medicare Plus

      Max Entry Age65
      Pre Policy Health Check up55
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern Treatments Fully Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months36
      Specific Diseases Waiting Period in Months24
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus50%, Max100%
      Pre & Post Hospitalisation60/90
      Other Benefits
      Health Check Up
      Restore
      Second Opinion
      Consumable Benefits
    • Health Hooster

      Max Entry AgeNot Applicable
      Pre Policy Health Check upNot Applicable
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern Treatments Fully Covered
      Psychometric TreatmentsFully Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months24
      Specific Diseases Waiting Period in Months24
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus10% , Max 50%
      Pre & Post Hospitalisation60/90
      Other Benefits
      Health Check Up
      Restore
    • Niva Bupa

      Health Recharge

      Max Entry Age65
      Pre Policy Health Check upNot Applicable
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern Treatments Partially Covered
      Psychometric Treatments Not Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus5% , Max 50%
      Pre & Post Hospitalisation60/90
      Other Benefits
      Health Check Up
      Restore
      HIV / AIDS
    • Extra Care Plus

      Max Entry Age80
      Pre Policy Health Check up55
      Home Treatment Not Covered
      Organ DonorFully Covered
      Modern Treatments Partially Covered
      Psychometric Treatments Not Covered
      Ayush TreatmentsNot Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 12
      Specific Diseases Waiting Period in Months 12
      Maternity Waiting Period in months12
      No Claim BonusNot Covered
      Pre & Post Hospitalisation60/90
      Other Benefits
      Air Ambulance Optional
      Health Check Up
    • Mediclaim Top Up

      Max Entry Age65
      Pre Policy Health Check up50
      Home Treatment Not Covered
      Organ DonorFully Covered
      Modern Treatments Partially Covered
      Psychometric Treatments Not Covered
      Ayush TreatmentsFully Covered
      Room Rent Limits₹5K / ₹8K Link to SI
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in monthsNot Covered
      No Claim BonusNot Covered
      Pre & Post Hospitalisation30/60
      Other Benefits
      Hospital cash covered
      Get Well Benefit
      Other Restrictions
    • Medicare Super Top Up

      Max Entry Age65
      Pre Policy Health Check up45
      Home Treatment Not Covered
      Organ DonorFully Covered
      Modern Treatments Partially Covered
      Psychometric Treatments Not Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in monthsNot Covered
      No Claim BonusNot Covered
      Pre & Post Hospitalisation30/60
      Other BenefitsPremium does not increase after age 60
    • Medicare Super Top Up

      Max Entry Age80
      Pre Policy Health Check up55
      Home Treatment Not Covered
      Organ DonorFully Covered
      Modern Treatments Partially Covered
      Psychometric Treatments Fully Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months 90 days, 12 M, 24 M
      Maternity Waiting Period in months36
      No Claim Bonus5% , Max 50%
      Pre & Post Hospitalisation30/60
      Other Benefits
      Hospital Cash (in excess of initial 3 days)
      Hazardous or adventure sports
      AIDS Treatment Covered ( Any Stage )
    • Super Health Top Up

      Max Entry Age65
      Pre Policy Health Check up55
      Home Treatment Partially Covered
      Organ DonorFully Covered after 24M
      Modern Treatments Partially Covered
      Psychometric Treatments Not Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months 12,24,48
      Maternity Waiting Period in months 12
      No Claim BonusNot Covered
      Pre & Post Hospitalisation30/60
      Other Benefits
    • Super Top Up

      Max Entry Age65
      Pre Policy Health Check up45
      Home Treatment Fully Covered
      Organ DonorFully Covered
      Modern Treatments Fully Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months24
      Maternity Waiting Period in months Not Covered
      No Claim Bonus 5% , Max 50%
      Pre & Post Hospitalisation60/90
      Other Benefits
      HIV / AIDS
      Critical Illness
      Consumables Up to sum insured
    • Supra Super Top up

      Pre Policy Health Check upNot Applicable
      Home Treatment Not Covered
      Organ DonorNot Covered
      Modern Treatments Fully Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsNot Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months24
      Maternity Waiting Period in months Not Covered
      No Claim Bonus 10% , Max 100%
      Pre & Post Hospitalisation30/60
      Other Benefits
      Optional Restoration Benefit
      Optional Worldwide Coverage under reimbursement mode.
      Optional Ayurveda Coverage
      Optional Wellness Program
    • Future Advantage Top Up

      Max Entry AgeNot Applicable
      Pre Policy Health Check upNot Applicable
      Home Treatment Not Covered
      Organ DonorFully Covered
      Modern Treatments Fully Covered
      Psychometric TreatmentsFully Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 24
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in months Not Covered
      No Claim Bonus 10% , Max 50%
      Pre & Post Hospitalisation60/90
      Other Benefits
    • Super Healthcare Gold

      Max Entry Age80
      Pre Policy Health Check up65
      Home Treatment Fully Covered
      Organ DonorNot Covered
      Modern Treatments Not Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsNot Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in months Not Covered
      No Claim Bonus 20% , Max 100%
      Pre & Post Hospitalisation60/90
      Other BenefitsHealth Check up
    • Super Healthcare Diamond

      Max Entry Age80
      Pre Policy Health Check up65
      Home Treatment Fully Covered
      Organ DonorFully Covered
      Modern Treatments Not Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 24
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in months 9
      No Claim Bonus 20% , Max 100%
      Pre & Post Hospitalisation90/120
      Other BenefitsRestore
    • Super Healthcare Platinum

      Max Entry Age80
      Pre Policy Health Check up65
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern Treatments Not Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 12
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in months 9
      No Claim Bonus 20% , Max 100%
      Pre & Post Hospitalisation120/150
      Other BenefitsBariatric Surgery Covered
    • Health Protector plus

      Max Entry Age65
      Pre Policy Health Check upNot Applicable
      Home Treatment 20% of SI
      Organ DonorNot Covered
      Modern Treatments Partially Covered
      Psychometric TreatmentsNot Covered
      Ayush TreatmentsFully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in months Not Covered
      No Claim Bonus Not Covered
      Pre & Post Hospitalisation30/90
      Other Benefits
    • Super Health Plus Top Up

      Max Entry Age65
      Pre Policy Health Check upNot Applicable
      Home Treatment Fully Covered
      Organ DonorFully Covered
      Modern Treatments
      Psychometric Treatments
      Ayush Treatments Fully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 48/36
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in months
      No Claim Bonus
      Pre & Post Hospitalisation30/60
      Other Benefits
    • Advanced Top Up

      Max Entry Age65
      Pre Policy Health Check upNot Applicable
      Home Treatment Fully Covered
      Organ DonorFully Covered
      Modern TreatmentsFully Covered
      Psychometric TreatmentsNot Covered
      Ayush Treatments Fully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus
      Pre & Post Hospitalisation60/90
      Other Benefits
      Second Opinion
      Life Protect Benefit
      Home Care treatment
    • Support plus

      Max Entry AgeNot Applicable
      Pre Policy Health Check up50
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern TreatmentsFully Covered
      Psychometric Treatments ₹50000
      Ayush Treatments 50% of SI
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months 24 Months
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus 10% , Max 100%
      Pre & Post Hospitalisation30/60
      Other Benefits Health check up
    • Shield

      Max Entry AgeNot Applicable
      Pre Policy Health Check up50
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern TreatmentsFully Covered
      Psychometric Treatments ₹50000
      Ayush Treatments Fully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months 24 Months
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus 20% , Max 100%
      Pre & Post Hospitalisation60/90
      Other Benefits Restore
    • Premium

      Max Entry AgeNot Applicable
      Pre Policy Health Check up50
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern TreatmentsFully Covered
      Psychometric Treatments ₹50000
      Ayush Treatments Fully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 24
      Specific Diseases Waiting Period in Months 24 Months
      Maternity Waiting Period in monthsPartially Covered
      No Claim Bonus33.3% , Max 100%
      Pre & Post Hospitalisation60/90
      Other Benefits Hospital Cash
    • Support

      Max Entry AgeNot Applicable
      Pre Policy Health Check up50
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern TreatmentsFully Covered
      Psychometric Treatments ₹50000
      Ayush Treatments 10% of SI
      Room Rent Limits1% of SI
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months 24 Months
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus10% , Max 100%
      Pre & Post Hospitalisation
      Other Benefits Worldwide treatment
    • Secure

      Max Entry AgeNot Applicable
      Pre Policy Health Check up50
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern TreatmentsFully Covered
      Psychometric Treatments ₹50000
      Ayush Treatments 10% of SI
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months 24 Months
      Maternity Waiting Period in monthsNot Covered
      No Claim Bonus10% , Max 100%
      Pre & Post Hospitalisation 30/60
      Other Benefits PTD Cover
    • Health Top Up

      Max Entry Age65
      Pre Policy Health Check upNot Applicable
      Home TreatmentFully Covered
      Organ DonorFully Covered
      Modern TreatmentsNot Covered
      Psychometric Treatments Not Covered
      Ayush Treatments Fully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 24
      Specific Diseases Waiting Period in Months 24
      Maternity Waiting Period in months12
      No Claim Bonus5% , Max 50%
      Pre & Post Hospitalisation 60/90
      Other Benefits
      Covered
      Optional coverages list
      Worldwide Coverage Optional
    • Super To Up Premiere

      Max Entry Age70
      Pre Policy Health Check up55
      Home TreatmentFully Covered
      Organ DonorNot Covered
      Modern TreatmentsNot Covered
      Psychometric Treatments Not Covered
      Ayush Treatments Fully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 48
      Specific Diseases Waiting Period in Months 12
      Maternity Waiting Period in monthsNot Covered
      No Claim BonusNot Covered
      Pre & Post HospitalisationNot Covered
      Other Benefits
    • Super To Up Supreme

      Max Entry Age70
      Pre Policy Health Check up55
      Home TreatmentFully Covered
      Organ DonorNot Covered
      Modern TreatmentsNot Covered
      Psychometric Treatments Not Covered
      Ayush Treatments Fully Covered
      Room Rent LimitsPrivate
      Pre Existing Diseases Waiting Period in Months 36
      Specific Diseases Waiting Period in Months 12
      Maternity Waiting Period in monthsNot Covered
      No Claim BonusNot Covered
      Pre & Post Hospitalisation60/90
      Other Benefits

    Want to Insure your parents?

    For less than ₹ 10500, cover them for ₹ 3 lacs.
    For just ₹ 7500, add ₹ 7 lacs more.

    No Co-payment.| No disease wise limit. | No room rent limit. | No increase in premiums in the future due to an increase in age or claims | Life Long Renewal Assurance irrespective of claims | Pre / Post Hospitalisation – 60/90 days respectively | Unlimited consultations with doctors, nutritionists on phone. | Unlimited counselling sessions with psychologists.| Waiting Periods applicable.
    The indicative premium is for a couple less than 65 years of age. Readmore..




    Parents Protection Shield Vector Image - Personal Health Insurance

    How to choose the best Health Insurance policy for your Parents.

    Metabolism can be called the housekeeper of your immune system. It is incharge of keeping your immune system up to the mark, so that the immune system can do its job i.e., keep you healthy.

    However, somewhere around the age of 45, human metabolism starts to slow down, and this in turn leads to deposit of unwanted fats in the body, which in turn makes human organs work harder to keep replenishing their energy needs.

    While not every disease could be attributed to a slowing metabolism, majority of them can be. If Insurers could, they would avoid offering Health Insurance Policies to people who’ve crossed 45 years of age, when the metabolism rate of a person slows down). Even when they do underwrite such policies, they do it with lots of ifs and buts, applying conditions and sub-limits, and the premiums are expensive.

    Yet another reason for Insurer’s skepticism in covering people over 45 years of age is the morbidity rate. Morbidity rate is the likelihood of 1 person falling sick out of every 100 people. As per the statistics, the morbidity rate for people under 45 yrs of age is usually 3-5%. Whereas the morbidity rate for people more than 45 yrs of age can be as high as 10-15%.

    Most of us cover our parents under our organizations group policies , hence we usually don’t consider taking a separate personal (retail) Health insurance policy for parents.
    However, organizations have started restricting the coverage for parents. This is true even in cases where the premium is being collected from the employees. And the reason for this is the high claims ratio that the organization ends up with, on account of the parent policy. A high claim ratio in turn results in a higher premium for the organization.
    Some organizations therefore have gone to the extent of discontinuing coverage for employees' parents.

    Even if your current employer covers your parents in the policy, if and when you switch jobs and your new employer does not, you would land in a soup, primarily because of the loss of continuity and advance age for your parents.
    Unfortunately, the employers who cover parents usually do so to the extent of ₹ 2-5 Lacs sum-insured. In the inflationary times we live in, this amount is barely enough, especially considering advance age. It is as a matter of fact, barely enough to cover minor illnesses like flu, dengue etc. Hospitalization like cancer, heart ailments, joint replacements etc., we don't think so.
    But do not despair, we can help you get the best policy and coverage for your parents, our team of experts can help you.


    Shall I move my parents from a group policy to retail policy?

    Yes, here’s why
    In a retail health insurance policy, even if you claim, the policy premium does not increase during the renewal.
    The insurance company cannot refuse your renewal even if you prefer claims, every year.
    The policy can be renewed for life, irrespective of the current age of the parent.
    After a certain waiting period, the pre-existing diseases also get covered under the policy.

    But do not despair, we can help you get the best policy and coverage for your parents, our team of experts can help you.

    View less..


    Most important clauses in Health Insurance policy

    • Minimum 24 Hours inpatient Hospitalization Clause

      Most Health Insurance policies will consider a claim only when the hospitalization is more than 24 hours. Advancement in technology and medical sciences has however brought down the amount of time one needs to spend in a hospital considerably. This in turn was leading patients into getting hospital stays extended or their bills forged, all of which was neither in the interest of the insured or the insurer.
      Insurers have therefore, on IRDA's behest, curated a list of Day Care Procedures which allow for medical coverage even if the duration of hospitalization is less than 24 hours. There are more than 580 Day Care procedures and the extent of coverage differs from insurer to insurer. The best approach when planning a day care procedure is to get it vetted from your insurer beforehand.

    • Proportionate Deductions clause

      Apart from room rent, all the other items listed under hospitalization expenses are a function of the room rent i.e., every subsequent charge after you have chosen the hospital room will differ based on the room that you have chosen. This feature has a great impact on the overall claim amount payable under health insurance. Insurance companies put a sub-limit on the room rent payable under a health insurance policy in case of hospitalization. If you opt for a room rent crossing the limit mentioned in the policy, along with excess rent, the insurance company will deduct the cost of other services like doctor’s fees, surgery charges, etc., in a proportionate amount.
      This is because, in any hospital, the cost of exactly the same set of services is charged differently for different room types. Hospitals charge low cost for rooms with lower rent and high cost for rooms with higher rent. Charges which are based on MRP (like medicines) are charged the same for all types of rooms. Hence, these charges will have no impact on room rent capping.
      Let’s understand this better with an example:
      If room rent capping in your health insurance policy is ₹ 2000/- per day, and the actual room rent you opt for is ₹ 4000/- per day the claim amount would be calculated as follows


      FactorsActual Room RentClaim amount payable after deduction
      Room Rent (x)40002000
      Surgery (2.5 * x) 10000 5000
      Doctors fees (0.1 * x) 400200
      Medicines (actuals)460 460
      Total 14860 7660

      Hence, it’s always advisable to select your health insurance policy wisely by verifying the terms of room rent under your policy. It is good to have no cap on room rent to feel free to select the room as per availability and rent charges in the hospital.

    • Life long renewal

      Once the insurer has accepted your health risk and issued you a policy, the policy must be renewed regardless of your health condition now or at subsequent renewals, regardless of claims status, regardless of age, and regardless of medical inflation. That means you do not worry about the coverage in old age as long as you pay the premium on time and renew the policy on time. The most that an insurer can do is stop sending you the renewal notice for your policy renewal, but then keeping track of your renewal shouldn’t be a problem in today's day and age, should it now!

    • Grace Period

      Grace period is the number of days you get to make premium payment for renewal of your policy, after its expiry date. Failure to pay within the grace period could result in the termination of your policy.
      ​​​​​A grace period comes in handy when


      • You have inadvertently missed the deadline for renewal of your policy
      • You are short on funds precisely during the period that your policy is set to expire.

      IRDA allows a grace period of 30 days when the premium payment for policies is made on an annual basis, and 15 days for all other modes. These are the minimum standard guidelines as set by IRDA. Your insurer could therefore also grant a 30 day grace period even if the premium payment is on a quarterly basis. The important point to note however is that one should try and get the renewal payment done before one gets to any other financial commitment. This is because there is n​o coverage available during the grace period.


    • Out patient expense

      Out patient expense are often confused with Day care procedures, because neither of them requires a 24 hour hospitalization.
      It is however extremely important to note the distinction, because no insurance company pays for the stand alone outpatient treatments like POP because of bone fracture, stitches with local anesthesia, doctor consultations, health tests etc.
      Another complexity to note is the fact that a 24 hour hospitalization need not necessarily lead to admissibility of a claim. The hospitalization should warrant an active line of treatment.
      Here’s an example to help you understand active line of treatment - Let's say I experience chest pain at night and I go to emergency hospitalization thinking it may be a heart attack. After being admitted and undergoing tests, the doctor determines that my chest pain is due to a gastric problem and that no treatment is required. While I am happy that my condition wasn’t serious,I will be disappointed when my insurer rejects my claim on the grounds that there was no active line of treatment.
      In certain cases where the patient’s condition is serious and they cannot get admitted to a hospital, insurers agree to consider the claim and reimburse the expenses under the domiciliary hospitalization cover. This cover, however, needs to be approved by the insurer beforehand.

    • Reasonable and customary charges

      Reasonable and customary charges is one of the most dreaded clauses in Health Insurance.
      The term refers to the average claim paid by your Insurance Company for a particular ailment. A charge is considered reasonable, usual and customary if it matches the general prevailing cost of that service within a particular geography. The insurer keeps gathering information on charges that are being levied on services and then uses this information to determine the average price for a particular service that would be paid under the policy. If your hospital charges above the reasonable and customary charge, you may have to bear that extra cost. This clause, disreputed as it is, gives the insurer a lot of room to cut down on the settlement amount.

    • Moratorium Clause

      We can call this clause "Fine print of Fine prints” Once you have paid premiums for eight consecutive years, your insurer is required to pay all claims as per the policy limits as of April 1, 2021.The Insurance Regulatory and Development Authority of India (IRDAI) states in its guidelines on standardization of terms and clauses in health insurance that no health insurance claim should be challenged after an eight-year moratorium period has expired. An exception to this rule is fraud that has been proven beyond a reasonable doubt and permanent exclusions outlined in the contract.Thus, policyholders do not need to wait in anticipation for health insurance companies to approve claims after eight years. The claim will have to be settled within the limits of the medical insurance policy.

    • Free Look period

      The "Free look" period applies to all types of health insurance. The period of time varies between 15 and 30 days, depending on the insurance company. It begins on the day you receive the policy document. In the event that you feel the purchased policy does not meet what was promised, or if you feel a different plan could serve your needs better, you can cancel the policy within the look up period. A minimal cancellation fee applies, and the remainder of the amount is refunded to you. There are some key takeaways of this clause in health insurance.

      Let’s check them out in detail:

      Time Limit

      In the free-look period, a cancellation must be made within 15 to 30 days of receiving the policy documents; your policy document will mention this period. Considering the relatively small time margin (look up period), your insurer would insist on proving the date of receipt of the policy document. You should be able to substantiate this date.

      Credentials and Details

      In order to initiate the cancellation process during this period, you will need to provide certain details that the company will require. You can usually find the list of required details on the company's official website. For this process, you will need to provide proof of start date (date when you received the documents), information about the insurance agent (if involved), and a reason for cancellation, among other details. Your bank details are also required for the refund process.

      Documents

      To initiate the cancellation process, some documents are required. These include original documents, receipt of first premium payment, canceled cheque, etc. An indemnity bond is required in the absence of the original documents. Your insurer may require other documents as well. The list of required documents can be found on the company's official website or by contacting customer service.

      Partial Refund

      The cancellation refund even during the free-look period is not 100%. The insurer will most likely cut a minimal fee for charges incurred on stamp duty, medical test, the proportionate risk premium for the coverage period, etc.
      Whether you buy health insurance online or from an agent, always make sure you read all the scheme related documents carefully and make an informed decision. Thereafter, if you feel the need to change your decision, go ahead and avail the benefits of the free-look period and cancel your insurance anytime within the specified duration!

    Most Important benefits in Health Insurance
    Check if these benefits are covered before buying any policy.



    The cost related to organ donor’s treatment is covered only from the time the donor is admitted to hospital for transplantation surgery, the organ is harvested (removed) and till the time the donor is discharged upon recovery. Such transplantation should be medically advised and approved by law.

    The policy however will not cover:

    1. Cost of the Organ.
    2. Payments for tests or screening for donors to ensure his organ matches.
    3. Tests carried out to assess insured's fitness for transplantation.
    4. Any payments to a government body for getting approval for transplantation.
    5. Any pre or post hospitalization costs related to donors.
    6. Any complications arising out of transplantation to the donor.
    7. Also, if the donor has undergone the transplant voluntarily then he/she will not be covered by their medical policy.

    A comparative analysis of policies that cover organ transplant shows that neither are the coverages across plans similar, nor does any one plan provide complete cover. In some plans it’s an inbuilt cover whereas sometimes it has to be selected as a special benefit upon payment of additional premium.
    The irony is, the donor is neither covered fully in the recipient’s (Insured’s) policy nor in his personal medical insurance.

    Insurance companies now cover not only our health coverage but also the costs associated with mental illness. Depending on the policy, some companies provide coverage up to the policy's sum assured while others only offer coverage up to a certain amount.
    There are differences between companies in terms and conditions as well as waiting periods for Psychometric coverage.

    The Insurer pays only when :

    1. Illness is covered under the definition of mental illness.
    2. Hospitalization is in a Mental Health Establishment.
    3. Hospitalization is as advised by a Mental Health Professional.
    4. Mental conditions associated with the abuse of alcohol and drugs are excluded.
    5. Mental Retardation and associated complications arising therein are excluded.
    6. Any kind of Psychological counseling, cognitive/ family/ group/ behavior/ palliative therapy or other kinds of psychotherapy for which hospitalization is not necessary is not covered.

    None of the sciences have had a steeper trajectory of improvements as compared to medical sciences.

    The regulator now allows coverage of

    1. Uterine Artery Embolization and HIFU
    2. Balloon Sinuplasty
    3. Deep Brain stimulation
    4. Oral chemotherapy
    5. Immunotherapy- Monoclonal Antibody to be given as an injection
    6. Intravitreal injections
    7. Robotic surgery
    8. Stereotactic radiosurgery
    9. Bronchial Thermoplasty
    10. Vaporization of the prostate (Green laser treatment or holmium laser treatment)
    11. IONM – (Intra Operative Neuro Monitoring)
    12. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions are covered.

    While this indeed is good news on the medical front and for patients, the fact that such treatments can cost you an arm and a leg isn't good news.
    Many insurers who do cover Modern treatments under the regulators behest do so by applying sub-limits to the coverage. This dilutes the entire purpose of opting for such a cover.
    Hence we need to ensure that our Health Insurance is covering these treatments without any sublimits.

    Initially only allopathic treatments were covered under health insurance policies. In 2012, as per a circular from IRDA, Ayush treatments were allowed to be included in health insurance coverage. Currently there are more than 15 insurers providing health insurance cover for Ayush treatment either as an additional rider or as inbuilt cover.
    As per IRDA, “AYUSH Treatment refers to the medical and/ or hospitalization treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems. The IRDA Definition is simple enough to understand. Let's know its impact.
    Impact: Although IRDA has granted permission to cover non-allopathic treatments, there are certain limitations as follows.
    The treatment has to be done at a Govt. Hospital, or in any Institute recognized by Govt. And/or accredited by Quality Council of India or National Accreditation Board on Health. There are more than 3600 such hospitals all over India.
    Cashless facilities are not available under such treatments.
    Most insurers apply a capping or sub-limit for such treatments

    Generally speaking, PED form the most number of contentious cases that are heard by the Insurance Ombudsman. IRDAI defines PED as a condition/ ailment/ injury/ disease which was either diagnosed or treated not before 48 months from issuance of a policy. General insurance practice is to cap PED’s at 3 to 4 years.
    IRDAI also allows for carrying forward of this benefit when you decide to port the policy - the number of years of PED waiting period gets reduced from your incoming insurers policy by the number of continuous years you have spent with your outgoing insurer.

    The 30 day waiting period clause. This clause is meant to protect the Insurer from Customers with ill-natured intent - Customers buying insurance policies after they know they are going to need hospitalization in the near future doesn’t sit well with the principles of insurance.

    That said two exceptions to the rule are

    1. Claims arising out of an accident - the Insurer is liable for a claim if you have made the premium payment at the thier office and have an accident on your way home.
    2. Policies that are being ported in - this is a benefit that accrues to the policy holder by virtue of having already borne the 30 day waiting period with an earlier insurer, when she had bought the policy for the first time.

    Most Health Insurance policies will consider a claim only when the hospitalization is more than 24 hours. Advancement in technology and medical sciences has however brought down the amount of time one needs to spend in a hospital considerably. This in turn was leading patients into getting hospital stays extended or their bills forged, all of which was neither in the interest of the insured or the insurer.
    Insurers have therefore, on IRDAI's behest, curated a list of Day Care Procedures which allow for medical coverage even if the duration of hospitalization is less than 24 hours. There are more than 580 Day Care procedures and the extent of coverage differs from insurer to insurer.
    The best approach when planning a day care procedure is to get it vetted from your insurer beforehand.

    This clause, like the earlier one, gives an Insurer a sense of surety that a Customer isn’t buying a policy to make a claim, in the immediate future.
    One of the principles of Insurance from a Customers perspective is to have a policy but to act like she doesn’t have one i.e. an individual is expected to take care of her asset (in this case her health) like she doesn’t own a policy.
    IRDAI doesn’t mandate the number of years that an Insurer can prescribe as a waiting period, but does cap it at 4 i.e. none of the waiting periods in a policy can exceed 4 years.
    The general industry practice is to club all non life-threatening hospitalizations like Cataract, Kidney Stone, Hernia into one bucket and cap the waiting period for such hospitalizations at 1 or 2 years, and life-threatening hospitalizations into another bucket and cap these at 2 or 4 years.
    Your policy will specify the hospitalizations (broadly if not specifically) and the bucket that these would go under.
    In case the specific disease mentioned under the waiting period is pre-existing, then it will be covered after the completion of the waiting period specified for pre-existing conditions.

    There is a waiting period of 90 days to cover the newborn. However, many insurers cover a new born baby from day 1 within the maternity limit or overall sum insured limit.

    The waiting period for maternity claims varies from 2 to 6 years in various plans available in the market. There are a couple of plans which provide a 9-month waiting period for maternity but the premium is so high that it is as good as creating a reserve from our own funds.

    Having this coverage has come as a blessing in the case of Covid-19. During the Covid-19 pandemic, almost half of the population of India has faced a shortage of beds in hospitals, and the onset of domiciliary care has been a "Blessing in Disguise". This is because an insured with a domiciliary cover can take treatment at home if the condition that needs treatment would otherwise have required hospitalization, provided that either:

    1. The attending Medical Practitioner confirms that the Insured cannot be transferred to a Hospital or
    2. The Insured is able to substantiate the unavailability of hospital beds.

    Any outpatient costs like Doctor Consultations, medicines, health tests, taken before or after the Inpatient Hospitalization, can be covered under Pre-Post Hospitalization cover.
    However, these expenses should be pertaining to the same treatment for which the main medical claim is accepted.
    Insurance companies put a cap on these expenses, usually expenses incurred within 30/60 days respectively for pre and post hospitalization.
    For some treatments like domiciliary, maternity and organ donor cases, the pre and post hospitalization cover is not applicable. Some insurance companies put additional caps like 1% of Sum insured on these expenses. Some disallow physiotherapy expenses under pre and post hospitalization.
    It is advisable to check the policy for such finer details before purchasing.

    Any outpatient costs like Doctor Consultations, medicines, health tests, taken before or after the Inpatient Hospitalization, can be covered under Pre-Post Hospitalization cover.
    However, these expenses should be pertaining to the same treatment for which the main medical claim is accepted.
    Insurance companies put a cap on these expenses, usually expenses incurred within 30/60 days respectively for pre and post hospitalization.
    For some treatments like domiciliary, maternity and organ donor cases, the pre and post hospitalization cover is not applicable. Some insurance companies put additional caps like 1% of Sum insured on these expenses. Some disallow physiotherapy expenses under pre and post hospitalization.
    It is advisable to check the policy for such finer details before purchasing.

    In simple terms, if your policy has a co-payment of 20%, then 20% of the admissible claim is supposed to be paid by you and the rest 80% is paid by the insurance company.
    Deductible is a little different, in the sense that it specifies the amount that the insurer will deduct before it makes payment to the Insured. For example,
    If Co-payment is 20%, then the claim amount payable by the insured is 20% and the rest 80% will be paid by the insurer. If the deductible is Rs.25000 rupees, and the claim is around Rs.100000, then the amount paid by the insurer is 75000 only. If the Claim amount is less than the deductible, then no claim is payable by the insurer.
    Both copayment and deductible are applied to the final claim (admissible claim) amount and not to the reported claim amount.
    The option of co-pay is useful if you are already covered by some other insurance like the one provided by your company.
    In case of any claim, the copayment or deductible amount can be claimed under your group policy and the rest of the amount can be claimed under your individual policy.
    If you are in the process of buying a new policy, you can choose the appropriate copayment or deductible to bring down your overall premium amount.

    Copayment is generally linked to the geographical areas of treatment, age of the member, usage in some non preferred hospitals or some specific diseases.

    Benefits that seem good on paper but do not have a significant impact on claims. Opting for a higher sum insured instead of these add-ons can be more beneficial

    • Restore Benefit

      Definition - If the sum insured is exhausted during a policy year, then the sum insured is restored to the full amount which can be used for future claims within the same policy year.
      A lot of Insurers however put in a condition that future claims within the policy year should not be related to the same ailment for which the first claim was made.

      There are 2 drawbacks to this feature.

      • If the sum insured is not sufficient to pay the first claim itself, the restored sum insured is not useful.
      • Most of the insurers do not restore the entire sum insured, as long as the Sum Insured utilization doesn't fall below 95% of the total amount. In this case the insured is again without adequate coverage even if any further claim occurs.

      A Super top-up cover can help overcome such limitations.

    • No Claim Bonus

      As the name suggests, the No Claim bonus is the benefit which an insured receives upon making no claims in the previous policy year. Now the question is how this benefit is provided to the insured in health insurance.
      Until certain limits are reached, the total Sum Insured will increase every Claim-free year without any additional premium.
      It helps us to tackle medical inflation.
      Most insurers offer this benefit, but the rate at which it is increased varies from policy to policy.
      Some insurers provide 10% and some provide 20% for every claim-free year.
      When a claim is made, some insurers decrease the Sum Insured by a similar percentage (or all at once) to the earned cumulative Sum Insured till date.
      Nowadays some insurers are providing optional cover for No Claim Bonus.
      It has been named differently by different insurers like Super NCB, Multiplier benefit etc.
      If you have planned for a Super Top Up policy as well, then you need not bother about what percentage of Sum Insured is being offered as NCB.
      However, 10% of NCB is for sure provided for every claim free year. And interestingly NCB is also a part of some Super top up policy plans.
      Hence instead of paying for an optional cumulative bonus rider it’s advisable to take a super top policy rather than trying to enhance this tentative coverage which would vanish upon a single claim.


    • Emergency Worldwide cover

      This benefit under the policy covers the medical expenses of the insured person incurred outside India.
      It is important to understand that global coverage guidelines vary from company to company such as In case of emergency hospitalization outside India. Which means members’ lives is at threat, treatment cannot be avoided or moved to India for treatment. In such cases it will be paid.
      Hospitalization outside India will be covered provided the disease was diagnosed in India and the insured travels abroad for the treatment.
      This benefit is available for 45 days of continuous travel in a single trip or 90 days on a cumulative basis in a whole trip. Global coverage limit will be restricted to sum insured including the cumulative bonus. It will not be extended to recharge or restore benefits.
      Worldwide coverage will be available on a reimbursement basis. Few companies also provide coverage on a cashless basis.
      The insured also needs to check whether the coverage includes or excludes the United States and Canada.
      Copayment is also applicable sometimes varies from 10 to 20%.
      The waiting periods for pre existing disease, 2 years waiting period will be applicable as usual as per the policy terms.
      A health policy with worldwide coverage or a travel policy which one is better?
      Travel policy comes with additional benefits like emergency hospitalization, public liability, loss of baggage, passport etc. But pre-existing diseases will have a waiting period.
      Whereas the worldwide coverage in Health policy, you can get the benefit of coverage of preexisting diseases or 2 years excluded conditions after completion of the waiting periods. You can also afford to travel to the best countries where advanced treatments are available in case of uncertain conditions. Insurance gives you the privilege of better treatment at a very nominal price.
      We can suggest some health insurance products inbuilt with travel insurance coverage which will be helpful to frequent travelers. It will help the insured to get the benefit of completion of waiting periods.

    • Outpatient Benefit

      Physician consultations, Health Check-ups, pharmacy and laboratory fees, which are not linked to hospitalisation, are covered under the outpatient benefit.
      These are normally excluded from health insurance unless they fall under Pre and Post Hospitalization.
      Some companies that provide outpatient benefits with a cap. Others offer it as an option which can be added to your policy at additional cost.
      Outpatient benefits are different from pre post hospitalization benefits in the sense that hospitalization/ active line of treatment is not mandatory to avail outpatient benefits.
      Outpatient benefits however do not bring a lot of value and buying this benefit by paying additional premium is up to one’s family health conditions and usage per year.
      Opt for Out patient benefit only if you want to take full advantage of section 80D benefits under income tax.
      We are allowed to claim deduction of upto Rs.25,000 from our taxable salary for Mediclaim Insurance premium. However the premiums for most of us does not cross Rs. 15,000. You can utilize the balance benefit by purchasing Outpatient Benefit Insurance as an add on cover.
      For example, let’s say your Mediclaim premium is Rs.9000. (This is the normal premium you pay for Rs. 5 lacs cover for self+spouse+2 kids). You can now buy an additional Outpatient expenses insurance policy for Rs.16,000. Apart from your income tax exemption limit, this also gives you two additional benefits
      1.Outpatient expenses benefit of upto Rs.25,000
      2.Tax saving on Rs.16,000 that you bear as the additional premium.

    • Ambulance Charges

      In case of emergency hospitalization, the ambulance charges are covered up to a certain limit in every health insurance plan.
      Some policies even cover the air ambulance.
      This is not a parameter on which you decide the health insurance plan as it has the least impact on any claim.

    • Health Check-up

      Some policies offer a complimentary health check up every year or in the span of 1,2 or 3 claim free years. The cost of a health check up is usually linked to the Sum Insured. Moreover the health check up is treated as a claim under the policy i.e. any no claim bonus that you would have otherwise accrued is forgone.

    • Wellness Benefit

      Wellness Benefits are the list of activities that are aimed at improving the health of the customers taking the health insurance policy. There are certain wellness benefits such as wellness coach, medical checkups, fitness apps, step counter, calorie counter, exercising apps etc. Insurance companies are rewarding the customers with discounts in premium for maintaining their health and it could be done through the use of the above wellness benefits offered by the insurance company. IRDA in its recent guidelines has asked the insurance companies to incentivize the customers eligible for the reward points and comes within the fitness criteria terms and conditions.

    • Daily Hospital Cash

      Daily hospital cash is the amount that is paid to the insured in case of hospitalization due to an illness or disease for a certain period of time. Insurance companies pay the daily hospital cash for a certain number of days if the hospitalization exceeds a prescribed number of days. The cash benefit would be calculated for the number of days and would be paid in lump sum. The daily hospital cash amount can be utilized to meet certain additional expenses that are not covered under the basic health insurance plan.

    • Critical illness rider

      Critical Illness Rider is the add-on or rider which can be purchased with the base policy on payment of additional premium. The rider compensates the insured in case of diagnosis with any of the mentioned critical illnesses. Critical illness is any disease or illness that is life threatening and requires treatment without which the customer will be in a grave situation. Some of the commonly known critical illnesses are Cancer, heart attack, Kidney failure, Severe Burns, Corona artery surgery, Heart attack, Stroke, Coma, Paralysis etc. The policy would pay the claim as lump sum in case of diagnosis with any of the mentioned critical illnesses.

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    Buying insurance from a broker
    is like having Double Assurance.


    Insurance brokers, unlike agents, are legally obligated to protect your interests


    Know more

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    How to Migrate or port to a better Personal Health Insurance plan?


    (Portability of Health Insurance)

    Remember the time when you used to feel helpless stuck with your mobile telecom operator, especially with the call drops, network congestion and the lackadaisical Customer Support? And then the telecom regulator brought in Mobile Number Portability and the entire landscape changed, as if overnight.
    It was with this intent that the insurance regulator brought in portability in health insurance.
    Readmore..

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    Health insurance policies
    which cover Maternity Benefit

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    Health insurance policies
    which cover out-patient Benefit

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    Health insurance policies
    which cover Diabetes

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    Health insurance policies
    which cover Cancer

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    Health insurance policies
    which cover Obesity

    Know more


    Standard Exclusions in a claim


    The biggest pain point, atleast from a Customer’s perspective, in the health insurance value chain is the claim processing vertical. More often than not the decision as to whether the
    Customer would continue patronizing an Insurer boils down to the qualitative and quantitative aspect of claim settlement.
    While the qualitative aspects are subjective and Insurer dependent, IRDAI brings in some objectivity to the quantitative aspect in terms of what claims would not be settled by the insurers.
    These are generally referred to as standard exclusions and are the same across the board for all Insurers

    Representing of Exclusions Chart Vector Image - Personal Health Insurance

    Exclusions can broadly be classified into



    • Time dependent exclusions

      Ones that would be covered after you have been a continuous policy holder for a certain period of time. Such exclusions are

      1. The 30 day waiting period clause.
        This clause is meant to protect the Insurer from Customers with ill-natured intent - Customers buying insurance policies after they know they are going to need hospitalization in the near future doesn’t sit well with the principles of insurance.
        That said two exceptions to the rule are

        • Claims arising out of an accident - the Insurer is liable for a claim if you have made the premium payment at the thier office and have an accident on your way home.

        • Policies that are being ported in - this is a benefit that accrues to the policy holder by virtue of having already borne the 30 day waiting period with an earlier insurer, when she had bought the policy for the first time.

      2. Specific disease/ procedure waiting period
        This clause, like the earlier one, gives an Insurer a sense of surety that a Customer isn’t buying a policy to make a claim, in the immediate future.
        One of the principles of Insurance for a Customer is to have a policy but to act like she doesn’t have one i.e. an individual is expected to take care of her asset (in this case her health) like she doesn’t own a policy.
        IRDAI doesn’t mandate the number of years that an Insurer can prescribe as a waiting period, but does cap it at 4 - none of the waiting periods in a policy can exceed 4 years.
        The general industry practice is to club all non life-threatening hospitalizations like Cataract, Kidney Stone, Hernia into one bucket and cap the waiting period for such hospitalizations at 1 or 2 years, and life-threatening hospitalizations into another bucket and cap these at 2 or 4 years. Your policy will generally specify the hospitalizations (broadly if not specifically) and the bucket that these would go under.

      3. Pre Existing Disease (PED) waiting period
        Generally speaking, PED form the most number of contentious cases that are heard by the Insurance Ombudsman.
        IRDAI defines PED as a condition/ ailment/ injury/ disease which was either diagnosed or treated not before 48 months from issuance of a policy. General insurance practice is to cap PED’s at 3 to 4 years.
        IRDAI also allows for carrying forward of this benefit when you decide to port the policy - the number of years of PED waiting period gets reduced from your incoming insurers policy by the number of continuous years you have spent with your outgoing insurer.

    • Permanent exclusions

      While insurance has been an evolving industry, we have sadly not reached a point where private Insurers could bear the cost of diseases that are draining in terms of cost (Birth Control/ Infertility); certain treatments are also aesthetic and personal (Cosmetic/ Plastic surgery) in nature and the number of people subscribing for such treatments is simply too small for the insurers to break even let alone make profits on them; finally some treatments are in conflict with the law of the land and can therefore not be covered under any insurance policy.
      IRDAI allows for insurers to exclude such diseases as permanent exclusions. These can broadly be classified into

      • Investigation & Evaluation expenses. IRDAI allows for exemption of charges incurred on diagnostic expenses that do not lead to a hospitalization. Even before/ during/ after hospitalization any diagnostic expense not directly related to the active line of treatment is exempted.

      • Maternity & other miscellaneous expenses. Most individual health policies exclude the maternity cover. Lawful termination of pregnancy is also a standard exclusion, as is treatment for birth control, sterility and infertility.

      • Here’s a list of some other standard exclusions

        1. Rehabilitation & rest cure expenses. Expense incurred on rehabilitative treatment i.e. treatment to restore an individual's health to normal after an addiction or illness is a standard exclusion. In the same vein, any treatment to address a spiritual/ emotional need remains an exclusion.

        2. Any Obesity related surgery that is not prescribed by a doctor and/ or is life threatening in conjunction with comorbidities.

        3. Cosmetic surgery, unless certified by a medical practitioner towards reconstruction of a body part, following an accident, burn or cancer.

        4. Expense on treatment of hazardous or adventure sports.

        5. Expense on treatment arising out of a breach of law with criminal intent.

        6. Treatment for addictions including but not limited to alcoholism.

        7. Treatment received in spas, nature cure clinics.

        8. Treatment by dietary supplements unless prescribed by a medical practitioner as a part of hospitalization.

        9. Correction of eye sight due to refractive error less than 7.5 dioptres.

        10. Unproven treatments that lack significant medical documentation to support their effectiveness.

        11. Any treatment specifically excluded by an Insurer in black and white.

      • IRDAI permits insurers to list certain diseases as permanent exclusions if they do not fit into the underwriting philosophy of the Insurer, albeit after appropriate disclosures to the Insured at the time of underwriting. Some of these illnesses are unfortunately ones where medical science hasn’t been able to achieve any significant breakthrough towards their ultimate cure like HIV, AIDS, Alzheimers, Parkinson's disease; others like Cerebrovascular disease, Inflammatory bowel disease, Chronic liver disease are lifestyle related.

    FAQ's

    • What are the two types of health insurance

      Indemnity based health insurance

      This policy covers expenses to the extent of ones actually incurred. You can either avail a cashless facility at the treating hospital, if it is empanelled with the insurer or pay upfront and claim for a reimbursement.Empanelment is the process whereby an insurance company ties up with a hospital to provide cashless treatment to the insured. The cost of such treatment is settled by the Insurer at a later point in time, mostly in lieu of a credit note. Hospitals where the insured can avail cashless facility are called network hospitals.

      One must always opt for cashless treatment if available, because

      1. It is convenient.
      2. Insurers have negotiated tariffs (in lieu of volumes for the hospital) and the cost of hospitalization for the insured are reduced substantially. That said, the insurer must be informed 48 hours before the planned treatment or within 24 hours after an unplanned hospitalization about the claim.

      That said, the insurer must be informed 48 hours before the planned treatment or within 24 hours after an unplanned hospitalization about the claim.
      Almost all the hospitalization expenses like room rent, doctors fees, intensive care unit, nursing expenses, surgical fees, operating theater, anesthesia, oxygen and their administration, physical therapy expenses, medicines consumed on the premises, miscellaneous expenses like ones on laboratory, x-ray, diagnostic tests, cost of dressing, ordinary splints and plaster casts, costs of prosthetic devices if implanted during a surgical procedure, organ transplantation including the treatment costs of the donor but excluding the costs of the organ, are covered under most policies.
      Non medical expenses like expenses on TV, food, fruits, transport charges, gloves, needles, cotton, disposable items, tissues, consumables are not covered in any Health Insurance policy. A sample list of these non medical expenses can be found here.
      Some insurers restrict expenses on doctor fees, room rent or other medical expenses by a sub-limit clause. Such policies are better left avoided.


      Benefit based health insurance

      There are policies that pay based on the number of days of hospitalization, on a per day basis and there are also policies that pay a fixed lump sum, mostly on detection of a disease. The later category policies are also known as critical illness policies.


      Our Recommendation

      People tend to misunderstand the two policy types and end up buying the benefit-based policy to cover their indemnity based hospitalization needs, for e.g., A Critical Illness policy triggers only when the policyholder contracts a critical illness that is mentioned in the policy, buying it for other hospitalization needs does not serve any purpose. The fact that benefit based policies are cheap is an attraction that misleads price sensitive Customers into buying the policy without having read the terms.
      Benefit-based policies are offered by life insurance companies and that is the biggest distinction that a policyholder can use to her advantage when buying the policy. As a matter of fact, IRDA in its latest circular dated 12th May 2020 has categorically asked life insurers to withdraw indemnity based policies for health insurance. That essentially means, going forward, only general or standalone health insurance companies can offer indemnity-based Health Insurance plans.

    • Can the insurer decline to renew my policy?

      No, an Insurer cannot decline to renew your policy.
      IRDA vide its circular 52/15/IRDA/Health/SN/08-09 has advised Insurers to not deny renewal of policy on any grounds other than fraud, moral hazard and misrepresentation.
      An Insurer can, however, deny renewal of a policy when the Insurer has decided to close that particular product. Closure of a product could be dictated by business considerations i.e. aspects like profitability, serviceability. But even when an Insurer does decide to close a product, they have to make provisions for a replacement product and accord a suitable time for the Insured to make alternate arrangements.

    • When I claim, will my renewal premium increase?

      No, premium increases in personal health policies are not linked to claims. That said, premiums can be increased :

      • with respect to age for e.g., if you turn 46 before your policy renewal date and the policy mentions it has a different premium above the age of 45, you will need to pay extra, irrespective of whether you have made a claim in the current policy or not.
      • when IRDA permits; Insurers need to get an approval from IRDA before they can effect any changes in the policy terms. If your Insurer thinks that the product portfolio is not performing upto their expectations, they might apply to IRDA, who in turn would assess the situation and take a call on the increase.
      • health inflation; this also needs to be approved by IRDA.
      • if explicitly mentioned in your policy; your policy could have different premiums for different age groups, if you cross into a different age group at renewal, the Insurer will increase your premium.
      • addition of covers; if you decide to opt for an add-on on at renewal, it will cost you more.
    • What is normally covered in the Health Insurance policy?

      Health Insurance is an instrument designed to protect you from the monetary shock of your hospitalization needs.
      Here's a broad list of covers that your health insurance policy will generally cover

      • Inpatient treatment that requires an active line of treatment and at least a twenty four hour hospital stay, which will include everything except for consumables and other inflationary charges that your Insurer thinks aren't Reasonable or Customary.
      • Day care procedures like cataract, dialysis and the like, that no longer require you to stay in the hospital.
      • Pre hospitalization charges that include reimbursement for tests that lead to the hospitalization and post hospitalization charges that are incurred on tests/ follow up consultations/ medication. Pre hospitalization expenses are generally covered from about thirty days prior to hospitalization while post hospitalization charges are covered till about sixty days post hospitalization.
      • Post-hospitalization physiotherapy/ counseling charges if advised (in written) by the treating doctor.
    • What is not covered in the Health Insurance policy?

      While there's a whole gamut of things that your health insurance covers, there's some things that your policy will not cover.

      • Consumables
      • Outpatient Expenses
      • Hospitalization for investigative purposes
      • Treatment Taken Voluntarily like cosmetics, weight loss etc.,
      • Anything else exclusively excluded in your policy.

      However some of the exclusions/ add-ons can be covered by paying an additional premium. This might vary from Insurer to Insurer.

    • Death due to Suicide.


      Not covered.


    • What is a Family Floater Policy ?

      A family floater policy is an umbrella cover for the entire family i.e. if you have opted for a family floater cover of ₹ 5 Lac, this cover is available for all the members in the family who have been covered under the policy. This coverage is different from the coverage under an Individual Health policy, wherein, each member of the family will be covered for a sum of ₹ 5 Lac individually.
      Isn’t that wonderful? Well, it would be if not for the cost implications and the fact that you can opt for a family floater cover and stay appropriately insured at the same time. Moreover, both of the products are aimed at serving different policy holders.

      Lets examine when to opt for a family floater cover as opposed to an individual one.
      Somewhere around the age of 45, human metabolism starts to slow down, and this in turn leads to deposit of unwanted fats in the body, which in turn makes human organs work harder to keep replenishing their energy needs.
      While not every disease could be attributed to a slowing metabolism, majority of them can be.

      What does any of this have to do with a Family Floater policy?
      Well, quite a lot actually. Lets try and understand how. Lets look at a couple of scenarios

      Scenario I - If you are a young family of four, that includes your spouse and young kids, with maximum age in the family capped at around 45, your risk profile is low. The probability of your young children needing a hospitalization cover are on the lower side, thanks to all of your metabolisms. A floater cover of ₹ 5 Lac should therefore take care of your emergency hospitalization needs.

      Scenario II - Now, if you are a young couple, around 35 years of age, who also want to insure one set of your aging parents, the same floater cover of ₹ 5 Lac might be a risky proposition. This is primarily because of the added risk of elder parents. The chances that elders in your family use up the entire cover by mid term of the policy cannot be denied. You do not want to run into a scenario where your minor claim of ₹ 50,000 is rejected because of exhaustion of Sum Insured and you end up bearing it out of your pocket.
      The solution to this problem is to always insure elder folks under a separate policy. These days we have policies that have been tailor made to cater to the elderly.

    • Are Bancassurance Health policies any good?

      Here’s a list of some of the benefits of the policies offered through Banks

      • Low premium - Health policies offered via banks are offered cheap in anticipation of capturing large footfalls in the mid to long term future - whether that happens or not, depends on the way the product is marketed, sold and managed; but the important point is these are some of the cheapest policies you could find in the market.
      • You are the Bank’s Customer and therefore have them by your side. In case you need to escalate issues, escalating these to the right people in the Bank can see faster resolution.
      • Discounted capping on waiting periods - a lot of these policies discount the waiting periods for pre-existing disease, other diseases by a year or two.
      • Since these are issued as group policies, many of them do not require you to take up any medical checks. While it is advisable to get a medical check done before you buy a policy nonetheless, not having one as a check mechanism reduces your chances of being rejected.
      • The Bank shares the responsibility for product closure - if a product is being closed, the Bank will see to it that a replacement product is made available to its Customers because after all you are the Bank’s Customer.

      Here’s some of the disadvantages

      • Adverse selection - since the group under a banks group insurance is all of the account holders of the bank, you might end up at risk with a group of people who might not have a healthy risk profile. This could be disadvantageous for you in the long run, from a premium perspective, because the premium for the policy will be revised based on the group as a whole.
      • A lot of the times the bank personnel at ground zero who are in charge of the underwriting do not have any technical or for that matter administrative knowledge about the policy. More often than not they are just about aware of the price.
      • Depending on the nature of operations of your bank, you might have to depend on the bank for premium payments. This could be a hassle if the bank does not have an evolved technology infrastructure and you need to visit the bank branch physically for premium payment.
      • A lot of the times such policies are centralized at particular Insurers offices. For eg. Bank of Maharashtra’s policy with United India used to be centralized at United Pune office. This could create problems for people needing operational support from, say a Delhi or Chennai. Taking into the footsteps of the Insurer, the TPA also had centralized its office at Pune - this could mean a logistics nightmare for an Insured who has preferred a claim from Chennai.
      • Your renewal is your own responsibility. Renewal notices are a business courtesy and therefore not anyone (but your own) responsibility. You are the one who has to keep track as also ensure the payment is credited to the insurer.
    • Is there a tax savings I can achieve by purchasing health insurance?

      Yes. Purchasing health insurance not only saves medical expenses but also provides tax benefits.
      Under section 80D of the Income Tax Act, you can claim tax exemption for the total health insurance premium paid by you during the assessment year. This benefit is over and above the one that you claim under section 80C and depending on the age of the members in the policy, the tax exemption amount can range from ₹ 25,000 to ₹ 1,00,000.

      Limits of exemption

      Age of insuredTax exempted under 80D (₹)
      Self, spouse & children < 60 years25,000
      (Self, spouse & children < 60 years) + (Parents < 60 years)25,000 + 25,000
      (Self, spouse & children <60 years) + (Parents > 60 years)25,000 + 50,000
      (Self, spouse & children with age of eldest member > 60 years) + (Parents > 60 years)50,000 + 50,000

      Health check-up benefit
      Section 80D benefit also includes expenses incurred for preventive health check-ups; this benefit can be availed up to a maximum amount of ₹ 5,000 per year.
      Here’s a couple of scenarios
      Scenario I - Say you’ve bought health insurance for yourself, your spouse and children, and also for your parents who are above 60 years of age. You paid a premium of ₹ 30,000 for your family and ₹ 35,000 for your parents. In this case, the maximum tax exemption that you can claim for yourself is ₹ 25,000, while for your parents, the entire amount of ₹ 35,000 will be exempted.
      Scenario 2 - Now, let's suppose you paid an annual premium of ₹ 23,000 for a health policy that covers you and your spouse. You also got a health check-up done for the both of you for ₹ 3,000. In this case, although the maximum amount that can be exempted under health check-ups is ₹ 5000, since your total expense exceeds your exemption limit, you will be able to claim only ₹ 25,000 as tax deduction under section 80D.
      Few important points to remember

      • The benefit under 80D can be claimed by individuals alone and not by employers.
      • Premium paid in cash is not considered for tax deduction, except in the case of preventive health check-ups.
      • Premium paid on behalf of independent children, siblings or any other extended family will not be considered for tax deduction.
      • Medical expenses incurred by senior citizens above the age of 80 are also exempted under 80D subject to the prescribed limit of ₹ 50,000.

    • How to choose the right Sum Insured in a Health Insurance policy?

      Not less than ₹ 50 Lacs!
      If there is one thing the Covid-19 pandemic has taught us, it is the fact that Sum Insured, sometimes even to the tune of ₹ 20 Lacs, got exhausted in a matter of days in case of hospitalization. Moreover the higher you go in the Sum Insured ladder, the lesser it will cost you per Lac.
      Here’s what you need to keep in mind while choosing your sum-insured.

      • The rate of increase in the Healthcare cost, every year. This rate has traditionally been higher than the rate of inflation.
      • Occurrence of new diseases like Covid-19, Dengue, Swine flu, Ebola, Chikungunya has multiplied manifold over the last few years. The cost of treatment of Cancer, which has become increasingly common, has been growing exponentially too.
      • The new technological advancements in healthcare such as Stem-cell, Robotics are very effective but unfortunately come at a very high cost.

      Hence the ideal Sum Insured in the given scenario is ₹ 50 Lacs.
      However we do understand budget constraints, especially in the current economic scenario, and therefore advise you to explore the option of a Super Top-up policy.
      Super Top-up policies are policies where the Insurer is not bothered about how you pay for a claim that is below a threshold. The Super Top-up policy is triggered only when your claim amount crosses the Threshold.
      Super top-up policies can therefore be used to cover expensive claims and at a fraction of the premium that you would have paid for an individual health policy.
      Smaller claims (i.e. claims below the Threshold) can be insured out of pocket or from your employer’s group policy.

    • What is Deductible and Why should I opt for it?

      A deductible on a health policy is the amount that is borne by the insured. The insurance company becomes liable to pay any claim for such a policy only after the deductible amount has been paid by the insured. The way the insured covers her deductible is irrelevant - she could cover the expense on the deductible from her pocket or via a separate policy.
      In other words, deductible is the amount beyond which the health insurer will pay claims. If the claimed amount is lesser than the predetermined deductible limit, the insurer will not be liable to pay anything. Choosing the deductible intelligently, therefore, can save you money.
      Lets look at an example to understand this better

      Scenario - You are already covered under a basic health policy, possibly by your employer, and you wish to go for a higher cover. In this case, you may buy an additional policy with a deductible that is equal to the sum insured on your base policy.
      Let’s understand the benefit of such an arrangement with an example.

      Suppose you have two policies:
      Policy 1 : A normal health policy with a sum insured of ₹3,00,000.
      Policy 2 : A super top-up policy with a sum insured of ₹ 10,00,000 and a deductible (threshold) of ₹ 3,00,000.
      If your claim amount is ₹ 9,00,000, then Policy 1 will pay ₹ 3,00,000. Since the sum insured of Policy 1 is now exhausted, policy 2 will kick in. The deductible of ₹ 3,00,000 will not be payable under Policy 2. Policy 2 will pay the remaining claim amount of ₹ 6,00,000 (₹ 9,00,000 - ₹3,00,000). The balance sum insured on policy 2 can be utilized for any future claims.

      Whenever the claim amounts are smaller, you should compare them to the total discount you can avail at renewal via the no claims bonus (NCB) feature. Say, you are towards the fag end of your policy renewal and need to make a claim of ₹ 2000, but the NCB at renewal is ₹ 3000, you should then pay the claim out of pocket and save yourself the ₹ 1000 (NCB renewal discount - claim amount).
      Policies with deductibles are cheaper, so you get a higher cover at a lesser cost. If the members to be covered under the policy don’t have a major illness requiring frequent hospitalisations, then going for a policy with a suitable deductible can prove more economical over a period of time. This is also the broad concept behind Super Top-up policies.