Health Insurance: All You Need to Know
Uncovering the Important Aspects of Health Insurance Policies
The world is changing faster parallelly health issues are also changing from their regular form. But there is always a need for the best treatment for any health issue. In this speedy world, getting treatment for health problems has become costly in many cases. The cost increase of the medical treatments may lead to an unexpected financial burden for many people. The health issues or medical emergencies that are not expected may put an individual to sudden stress. Here is why health insurance is needed: it protects an individual from the financial burden of medical emergencies. 30 Lakh Health Insurance serves as one of the comprehensive coverages that offer many benefits.
Health insurance is an essential safety net through which the insured can protect their health and finances by paying premiums on an individual or a family floater basis. Individuals can get higher coverage at an affordable price with the help of health insurance plans in India from Star Health.
In this article, let’s discuss: what is the meaning of health insurance? Its types, benefits, inclusions, exclusions, and more.
What is Health Insurance?
Health insurance is a monetary contract between an individual and an insurance company, meant to cover medical expenses in case of sickness, accidents, or preventive treatment. In return for a steady premium, the insurer will cover all or a portion of the insured's medical expenses, subject to the policy terms. Further, health insurance includes coverage that extends to hospitalisation, surgeries, visits to the doctor, diagnostic procedures, and even post-hospital recovery, depending on the selected plan.
The main function of health insurance is to safeguard individuals and families against the financial stress of unforeseen medical exigencies. As healthcare expenses continue to grow, even basic treatments can put personal finances under pressure. Health insurance guarantees you appropriate time and quality treatment without looking at the cost. Policies usually include advantages such as cashless hospitalisation, where the insurance company itself pays the network hospitals, and reimbursement for treatments availed outside the network. Therefore, having health insurance knowledge is significant to select a personalised plan as per the individual’s requirements.
There are numerous types of health insurance policies, such as individual policies, family floater plans, senior citizen plans, critical illness covers, and top-up plans. Each caters to different requirements and phases of life. Some also provide wellness benefits, health check-ups every year, and tax deductions under Section 80D of the Income Tax Act.
Health insurance plans is a safety net through which the insured can safeguard their health and finances by paying premiums on an individual or a family floater basis. One can get higher coverage at an affordable cost if they have detailed health insurance information. It could include waiting periods for pre-existing ailments, sub-limits on room charges or on a particular treatment, and co-payment provisions. Thus, it's really important to go through the policy document thoroughly and select a plan that best suits your health requirements and financial objectives.
In essence, when people want to know 'what is health insurance?', it's not merely a safety net-it's an actively forward-thinking measure toward financial security and well-being. Whether you're a career professional, parent, or retiree, the right health insurance plan ensures peace of mind and helps you receive quality care.
Why is a Health Insurance Policy Important for an Individual?
All individuals seek to acquire health insurance because it serves to provide security and financial support towards treatment when sickness strikes unexpectedly. The importance of health insurance can be analysed by different aspects, which include:
- Impairment of high medical expenses: Medical services may be very expensive, especially when it comes to cases of chronic diseases or even when one has to undergo surgery or is hospitalised. In the absence of health coverage, individuals may have to self-finance these expenses, which may lead to financial constraints or even bankruptcy. Health insurance assists in the settling of medical expenses and offers burden relief to families and individuals.
- Access to medical care in a timely manner: Health insurance covers the cost of medical services, including outpatient and inpatient care, diagnostic services and therapies, and also preventive and promotive services that consist of routine health check-ups and assessments. This enables individuals to seek health care even when the problems are not advanced and helps to address the potential for more complex and expensive health care.
- Encouragement of preventive measures: In most cases, the insurance company provides members with services that enable them to carry out vaccinations, immunisations, physical examinations, and wellness check-ups. Precautionary measures are very effective since they can help in identifying any health issues before they get complicated. It increases the chances of improving the health status and cuts down on future health costs.
- Protection from health-related risks: Health problems and accidents are unpredictable; however, health insurance serves to lower the risk of being financially disrupted due to unprepared circumstances. Be it losing control of a vehicle, suffering from a long-term condition, or falling ill unexpectedly, health insurance assures that treatment will be provided.
- Increased access to a network of healthcare providers: Almost all health insurance policies come with a network of healthcare centres and hospital providers. Hence, it saves you paperwork hassles as your insurer will settle the medical bills with the hospital.
Advantages Of Health Insurance Plans
There are several advantages of health insurance plans that make them apt for your health insurance needs. Here are some of the benefits of health insurance.
- Your Convenience : You have many choices from the comfort of your home, so that you can save a large effort and time.
- Cashless Hospitalisation : One can benefit from cashless hospitalisation. The cashless hospitalisation feature allows insurance companies to settle medical expenses and bills directly with network hospitals.
- Cost savings : You can find out the best values for your health requirements and choose the medical insurance plan that suits your financial estimate(budget), depending on your health insurance premium.
- Easy Access to Network Hospitals : During a medical emergency, there may be difficulty in finding a hospital. A health insurance plan may help to break this difficulty.
- Cumulative Bonus Advantages : In some plans, you can get a cumulative bonus of between a few percent on the sum insured, based on the plan that you choose. However, this feature is available only for some plans.
- Flexible Plan Options : You can choose a health insurance policy based on your needs. You may choose individual, floater, or family plans depending on your needs.
- Tax Deduction : Under Section 80D of the Income Tax Act, the premiums that you pay to maintain most health insurance policies are exempt from taxes. With some of the health insurance policies, you can claim an additional deduction per year.
However, note that these tax benefits are subject to changes in income tax laws. - Online Options : Instead of standing in long queues to buy or renew health insurance, you could opt for the online process. You could buy or renew policies online.
- Reduction of Financial Burden : Whenever you are stuck with a medical emergency where you need to pay a huge amount, it may stress you financially. At that time, health insurance may serve as a financial stress reducer for you.
- Pre & Post-Hospitalisation Coverage : Health insurance benefits for hospitalisation cover costs incurred during the hospital stay, such as room rent, doctor fees, medical procedures, surgery fees, and nursing care. It also includes pre- and post-hospitalisation expenses such as diagnostic tests and follow-up consultations.
- Coverage for Critical Illnesses : Some policies provide coverage for life-threatening health complications such as cancer, stroke, heart disease, etc. The plan offers lump sum coverage that takes care of the expensive treatment bills of the critical illnesses covered under the policy.
Some basic health insurance information needs to be known before you buy health insurance.
Types of Health Insurance Plans
Our Star Health Insurance provides different types of health insurance policies.
Here is the list of types of health insurance plans available :
| S.No | Health Insurance Plan Type | Suitable For |
| 1 | Individual Health Insurance | Single or Individual persons |
| 2 | Family Health Insurance | Self/Spouse/Children/Parents |
| 3 | Senior Citizen Health Insurance | People aged > 60 years |
| 4 | Critical Illness Insurance Plan | Expensive treatments against critical illness. |
| 5 | Top-Up Health Insurance | People who need extra medical coverage up to a specific amount when the existing sum insured gets exhausted. |
| 6 | Group Health Insurance | A group of people or Company employees |
| 7 | Maternity Health Insurance | Covering medical expenses incurred in the prenatal and postnatal stages. |
| 8 | Personal Accident Cover | Covering partial/total disabilities and death because of accidents. |
| 9 | Hospital Daily Cash | Managing daily cash till the insured is hospitalised. |
| 10 | Disease-Specific | The people who suffer from a particular health condition. |
Know the health insurance policy age limit and other criteria before choosing the right one.
What must be included in your Health Insurance Plans?
Choose health insurance plans wisely by seeing what they include as per their terms and conditions. Besides, knowing health insurance’s rules and regulations is significant to avoid misunderstanding of the concerned policy. Many medical insurance plans include some necessary things. Here are the main inclusions in many health insurance policies.
- Many medical insurance plans offer coverage for the hospitalisation expenses like room rents, ICU charges, surgery expenses, doctor consultations,, incurred on illness, injury, or accidents.
- Many health insurance policies provide coverage for the pre- and post-hospitalisation expenses related to inpatient hospitalisation.
- It is wise to buy health insurance that covers daycare treatments and procedures. Day Care Treatment costs are included based on the plan.
- A few health insurance policies offer coverage for the domiciliary treatments taken at home on the advice of the medical practitioner.
- Some health insurance policies include coverage for the organ harvesting and transplantation expenses if the insured person is the recipient.
- Many mediclaim plans offer coverage for inpatient hospitalisationsdue to road traffic accidents.
- Many plans are available with the AYUSH Coverages, like coverage for the alternative systems of medicine like Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy.
- The expenses incurred for Health check-ups are covered by many health insurance policies.
- Automatic Restoration options are when your medical expenses exceed your Sum Insured. This option is available only in some medical insurance plans.
Hence, Medical insurance is crucial to cover your medical expenses during a healthy emergency.
What are the exclusions in the Health Insurance Plans?
There are a few health insurance rules that most health insurance plans exclude. They are:
- The coverage for any form of self-inflicted injuries will not be will not be covered under medical insurance policies.
- Many health insurance plans will not offer coverage for the expenses of the treatment of obesity or weight control.
- Most medical insurance policies will not provide coverage for expenses incurred in treatment for cosmetic or plastic surgeries.
- Expenses incurred because of health risks for indulging in hazardous or adventure sports will not be covered by the Health Insurance policies.
- Dental treatment or surgery, unless necessitated because of accidental injuries and requiring hospitalisation, will not be covered by the Health Insurance Plans.
- Medical aid costs, like the cost of spectacles, hearing aids, wheelchairs, walkers, and crutches, and other similar aids, will not be covered by the health insurance plans.
Steps to Renew Health Insurance Online
Renewing your Health Insurance Online requires only a few steps. Here are the steps to renew Health Insurance Online.
- First, click on the Renew tab on the official website.
- Next, type your policy number and your date of birth.
- Now, select your plan type and the preferred Sum Insured. Then choose the option Calculate & Proceed.
- Finally, select your preferred payment method and complete the transaction process.
How to claim Health Insurance?
How one can claim of their health insurance has explained here. Below are the steps to claim health insurance :
- Choose a network hospital from the insurance provider's network list.
- Notify your insurance company about your hospitalization as soon as possible.
- Get a pre-authorization form from the hospital's TPA desk or your health insurance company.
- Fill out the form by providing any required documentation and then submitting it to the hospital's TPA desk.
- Receive treatment at the hospital and pay any hospital bills at discharge.
- Gather all necessary documents, bills, prescriptions, and discharge summaries.
- Submit the claim form and supporting documents to your health insurance company as soon as possible.
- Wait for a decision from your insurance company to review your claim request and either approve or deny it.
Advantages of Buying a Health Insurance Plan
Health insurance plans provide many benefits, depending on the plan you buy. Here are the benefits of health insurance plans in India :
1) Pre & Post Hospitalization Expenses
The pre-hospitalization and post-hospitalization expenses are covered up to a certain days as specified in the health insurance policy document. Health insurance plans cover the medical expenses that a policyholder may have incurred on an illness before getting hospitalized, even the follow-up treatment expenses incurred after being discharged.
2) Hospitalization Expenses
A health insurance plan offers coverage for the medical expenses incurred on getting admitted to a hospital for above 24 hours. This coverage includes doctor’s fee, room rent, diagnostic test fees, medicine costs, etc.
3) ICU Charges
A health insurance policy also provides coverage for the cost of availing treatment in an ICU or Intensive Care Unit at the time of hospitalization.
4) Cashless Treatments
Cashless Treatment is a feature of many health insurance plans. Most of the best health insurance providers in India offer this facility at their network hospitals. As per this benefit, if you get admitted to a network hospital, the hospital bills will be settled by your insurance provider under cashless claims.
5) Ambulance Charges
It offers coverage for the cost of ambulance services used to reach the nearest hospital at the time of a medical emergency.
6) Maternity Advantage
Many health insurance companies provide maternity advantages, like prenatal & post-natal expenses, delivery expenses, medical termination of pregnancy, etc. They provide coverage for the cost of treatment and vaccination of the newborn baby. But note that all the maternity insurance policies have a waiting period ranging from 3 months to 4 years.
7) Day Care Procedures
It covers the cost of availing day care treatments that require hospitalization of less than 24 hours.
8) Pre-existing Diseases
A correct health insurance policy offers coverage for pre-existing diseases after you complete the waiting period. In general, the pre-existing diseases are covered after a waiting period of 2 to 4 years.
9) AYUSH Treatment
It provides coverage for the cost of availing medical treatment via the AYUSH system of medicines that includes Homeopathy, Ayurveda, Unani, Siddha, and Yoga.
10) Medical Check-ups
Free preventive health check-up facilities are provided by the health insurance companies as per different health insurance companies. This checkup is offered to the insured at regular intervals only based on the policy terms and conditions.
Eligibility to Avail a Health Insurance Plan
The eligibility criteria needed to buy a health insurance plan depend on several factors, like the policyholder's age, pre-existing diseases, etc. In addition, eligibility for health insurance in India is also based on residency, employment status, and lifestyle factors. Applicants must be Indian residents, and all pre-existing medical conditions must be disclosed truthfully, which may require a medical check-up and could result in a higher premium. In many mediclaim plans, the following eligibility criteria must be met:
| Basis | Description |
| Minimum Age for Dependent Children | 91 days to 25 years |
| Minimum Age for Adults | 18 to 65 years |
| Pre-medical Screening | Needed above the age of 45/55/60 years |
Age Criteria - The minimum age criteria for adults and children differ, and they can range from 18-65 years and 91 days to 25 years, respectively. The actual age can differ from one medical insurance policy to another.
Pre-medical Screening - Pre-medical examination is needed for applicants mostly above the age of 45 years or 55 years. But many senior citizen health plans need pre-medical tests prior to policy issuance.
Pre-existing Diseases Disclosure - Any pre-existing illness is covered following the completion of the waiting period i.e. 2-4 years. Many health insurers enquire the applicant if they are facing any medical conditions, such as cardiovascular diseases, kidney problems, high blood pressure, diabetes, etc., at the time of buying a health insurance policy. If you are an alcoholic, then you need to tell it to the insurance company. Do tell, or it may create problems at the time of claim settlement or might even result in the rejection of your claims. As per these criteria, the insurance company provides medical coverage to the applicant.
How to compare Health Insurances?
Comparing health insurance policies is not simple by looking at the features. You have to see at the insurers, their antecedents, the price at which they market their policy and the use case. Only after you seeing these factors, you can compare the policy for adequate coverage of health insurance. Here are those factors:
- Coverage: Compare the inclusions and exclusions in different plans.
- Sum insured: See for the maximum amount, the insurer will pay for hospitalization.
- Waiting period: The time period you must wait prior to you can file a claim.
- Co-pay clause: Check if you have to contribute towards the claim settlement.
- Sub-limits: See if there are any limits on some coverages.
- Network hospitals: See if the insurer has a big list of hospitals that come under their network.
- Room rent limit: See for the maximum amount you can claim for a hospital room.
- Extra Advantages: Check if the policy provides free health check-ups, wellness programs, or telemedicine services.
- No claim bonus: See if the policy provides a bonus, if you don't make a claim.
- Discounts: Check if the health insurance policy provides discounts on the first few premiums.
How does health insurance differ from medical insurance?
Both the health insurance and medical insurance have similarities as well as differences. Here is the comparison between health insurance and medical insurance.
| Category | Health Insurance | Medical Insurance |
| Inclusions | Offers coverage for the regular checkups, vaccinations, screening tests, hospitalisation expenses, medical procedures, etc. | Expenses related to illnesses or accidents, like diagnostic tests, hospitalisation, surgeries, medications, etc. |
| Claims | It has limit on the number of claims per year. | It may have number of claims per year or on the number of days of hospitalisation. |
| Premiums | Premiums depends on the health condition, age, and coverage needed. | Premiums are based on the policy coverage and the type of policy. |
| Add On Covers | It is available in health insurance. | It is available in medical insurance. |
| Sum Insured | It depends on the health insurance policy coverage chosen. | It also depends on the health insurance policy coverage chosen. |
Need For Comparing Health Insurance Plans Online
There are many benefits of comparing health insurance plans online. It provides sufficient information on all about health insurance in India.
The following are some of the major advantages of comparing and buying a health insurance plan online :
- Convenience in buying health insurance: While you compare different health insurance plans online, that will be both time-saving and convenient. You don't need to meet the agents for comparison and select the best plans.
- Easier tasks: Many tasks, like health insurance plan renewals, premium payments, etc., are also easier online.
- Get access to correct information: Health insurance provides easier access to all medical insurance plans available in the market. Through this, it protects the buyers from dealing with insurance agents who might offer unreliable and biased details to attain their goals.
- Identify a Policy having Suitable Premiums: If a person chooses to buy a health plan online, he/she will compare the premiums of various policies and then buy the one that suits their budget.
- No Brokerage fees: No brokerage fees are levied when a person compares and buys a policy online. Hence, the buyer ends up saving a certain amount of money.
- Availability of Provider/Plan Reviews: You can compare the Claim Settlement Ratio and customer reviews online, and then you can check an insurance company’s capability that meet your claim requests.
Why Should You Buy a Health Insurance Plan?
At Star Health, our health information page provide health insurance basic knowledge regarding common policy types, why one need to purchase mediclaim policy at the earliest and many more. There are many reasons why health insurance plans have to be bought. Here are the reasons to buy a health insurance plan:
- Provide Good Quality Medical Treatment - Health Insurance Plan helps afford the best quality medical treatment, so that you can concentrate on getting the treatment and speedy recovery.
- Meets Sudden Medical Inflation -A health insurance policy can help you pay your medical bills, like pre- and post-hospitalization expenses, in the present and also in the future despite the rising medical costs.
- Helps in fighting against varying lifestyle Diseases -Health insurance permits you to pay for the long-term treatment of lifestyle diseases such as heart ailments, cancer, etc., those that are arising have been on the rise with the changing lifestyles.
- Protect Your Savings - The health insurance helps save your hard-earned savings by covering your medical expenses so that you can get the needed treatment without having to worry about any financial worries.
- Get Cashless Hospitalization Facility - The health insurance permits you to get a cashless hospitalization facility at any of the network hospitals listed by your insurance provider. You can get a cashless Hospitalization Facility by raising a cashless claim.
- Get Tax Benefits -It enables you to save tax on the health insurance premium that you pay under Section 80D of the Income Tax Act. This helps with better financial planning.
- Provides Peace of Mind -It permits you to get medical treatment with peace, as you do not have to get stressed about paying huge hospital bills.
Myths about Health Insurance
There are many myths that has spread about the health insurance. So, it is necessary to be aware of it before you buy a health insurance policy. Here are some of the myths about health insurance :
1) Health Insurance I bought Will Cover All My Medical Expenses
All the health insurance plans will have a set of exclusions/limitations, according to the IRDAI regulations. So, it is necessary to check all the policy information and the coverage offered by your insurer. You will get only the expenses that are covered as per policy terms and conditions and only up to the sum insured limit.
2) No Need for Medical Insurance as I Am Healthy
There may be many unexpected circumstances, such as seasonal illnesses, like dengue, malaria, or an accident, that can hit anyone anytime, in spite of being healthy. Using the medical insurance, you can avail of financial help to pay for the expensive hospitalization costs.
3) There is No Need to Declare My Pre-existing Diseases
Insufficient information or non-disclosure of pre-existing diseases can result in the rejection of the claim and can result in the cancellation of the policy. So, it is a must to declare all your pre-existing diseases in the proposal form when you buy a health insurance policy.
4) Smokers Cannot Buy a Health Insurance Policy
Many people think that smokers cannot buy a health insurance policy. However, there are some health insurance companies that provide medical insurance coverage for smokers as well. As smokers and alcohol consumers face risks, they must have to undergo a pre-medical examination and pay a higher premium to avail the health insurance coverage.
5) I Am Already Covered Under a Group or Corporate Health Insurance Plan
Many people depend on the health insurance policies offered by their employers. But, it is needed to know that a group health insurance policy has several limitations. In many cases, the sum insured will not be sufficient, or it will not cover health insurance for all your family members, or in some cases, it will not cover critical illnesses. The health insurance coverage tends to stop as soon as you quit your job. So, availing a health insurance coverage after retirement or quitting the job can be hard, and it is expensive.
6) Medical Insurance Will Only Offer Coverage for the Hospitalization Expenses
There are health insurance plans that do not have a cap on the period of hospitalization, although many health insurance policies offer coverage for medical expenses for hospitalization of above 24 hours. Most of the insurers cover day care procedures, in which hospitalization of at least 24 hours is not needed. This includes varicose veins surgery, cataract surgery, and similar other medical procedures. Also, many health insurance plans now cover OPD treatments that do not need any hospitalization at all.
Here, we are proud to announce that our Star Health Insurance has 14,000+ hospitals across India, and it has one of the highest claim settlement ratios.
Star Health offers wide-ranging health insurance policies that provide coverage for cashless hospitalisation, pre-existing diseases, critical illness, etc., with a comprehensive network of hospitals.
This guide on 'what is health insurance' aims to provide key insights and relevant details that policyholder require to choose the right medical insurance plan for their needs. Our health insurance information page serves as a tool to empower you with this essential knowledge for making informed decisions about your healthcare coverage.
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DISCLAIMER :
The information provided on this page is for general informational purposes only. Coverage and benefits are subject to change based on individual policy details. For specific advice, please consult a licensed insurance agent or professional. For further detailed information or inquiries, feel free to reach out via email at marketing.d2c@starhealth.in