Health Insurance

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A Simple Guide to get into
Health Insurance

2. A Simple Guide to get into Health Insurance
Page | 2
Index
Introduction to Health Insurance…………………………………………………………………………… Page 3
Flowchart – Getting into Health Insurance.……………………………………………………………. Page 4
Flowchart –Claim Process………………………………………………………………………………………. Page 5
Health Insurance Providers in India………………………………………………………………………… Page 6
Health Insurance for person aged under 18 years…………………………………………………… Page 7
Health Insurance for person between 18 & 45 years…….………………………………………… Page 8
Health Insurance for person between 45 & 60 years…….………………………………………… Page 9
Health Insurance for person aged above 60 years…………………………………………………… Page 10
Common terms in Health Insurance..………………………………………………………………………. Page 11
Conclusion ………………………………………………………………………………………………………………. Page 11

3. A Simple Guide to get into Health Insurance
Introduction to Health Insurance:
Health insurance is insurance against the risk of incurring medical expenses among individuals.
By estimating the overall risk of health care and health system expenses, among a targeted group, an
insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure
that money is available to pay for the health care benefits specified in the insurance agreement.
The commonest form of health insurance policies in India cover the expenses incurred on
Hospitalization, though a variety of products are now available which offer a range of health covers,
depending on the need and choice of the insured. The health insurer usually provides either direct
payment to hospital (cashless facility) or reimburses the expenses associated with illnesses and injuries
or disburses a fixed benefit on occurrence of an illness. The type and amount of health care costs that
will be covered by the health plan are specified in advance.
All of us should buy health insurance and for all members of our family, according to our needs.
Buying health insurance protects us from the sudden, unexpected costs of hospitalization (or other
covered health events, like critical illnesses) which would otherwise make a major dent into household
savings or even lead to indebtedness. Each of us is exposed to various health hazards and a medical
emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with
technological advances, new procedures and more effective medicines that have also driven up the
costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the
security of health insurance is much more affordable.
Many people mistake life insurance to health insurance. Sometimes people see life insurance
and health insurance lumped together because of the fact that they both insure the person (rather than
the car, the house, etc). The difference is that if you insure your health, with health insurance, then if
you become ill then the insurance company pays for your medical treatment, whereas with life
insurance, if you die then the insurance company pays your nearest and dearest and those who depend
on you. They can't replace you, but they can provide financial help to cover the losses incurred because
of your absence. If you have a job that pays a salary then in the case of a life insurance claim the
insurance company pays so your family aren't left in troubles.
To draw a vehicular analogy, life insurance is like the type of car insurance where you're covered
in case the car is written-off, for example by going off a cliff, where the insurance company pays out the
value of the car. In contrast, health insurance is more like the type of car insurance known as car
breakdown recovery where various motor ailments are covered.
As per the current scenario, not even 1% of the Indian population is covered under health
insurance, compared to developed nations where larger part of the population is covered under health
insurance. It is high time for the Indians to realize the need of health insurance, as the hospitalization
charges are on the rise these days.
Page | 3

4. A Simple Guide to get into Health Insurance
Page | 4
Flowchart – Getting into Health Insurance

5. A Simple Guide to get into Health Insurance
Page | 5
Flowchart –Claim Process

6. A Simple Guide to get into Health Insurance
Health Insurance Providers in India:
The following are the Companies Offering Health Insurance in India :
STANDALONE HEALTH INSURANCE PROVIDERS - PRIVATE FIRMS :
Page | 6
 APOLLO MUNICH
 MAX BUPA
 STAR HEALTH
PRIVATE FIRMS
 BAJAJ ALLIANZ
 BHARTI AXA
 CHOLAMANDALAM MS
 FUTURE GENERALI
 HDFC ERGO
 ICICI LOMBARD
 IFFCO TOKIO
 L&T GENERAL
 RELIANCE
 ROYAL SUNDARAM
 SBI GENERAL
PUBLIC FIRMS
 NATIONAL
 NEW INDIA
 ORIENTAL
 UNITED INDIA
The Health Insurance falls under the General Insurance category (Non-life) and it comes under
the supervision of Insurance Regulatory and Development Authority (IRDA).

7. A Simple Guide to get into Health Insurance
Health Insurance for person aged under 18 years :
Things to look for:
 Minimum entry age.
 Coverage Amount –
Page | 7
Since the age is lesser, risk of illness will be lesser and hence can go in for lesser
coverage amounts.
 Premium Amount –
Lesser premium amount should be preferred as age is lesser so is the risk, and many
companies provide competitive premiums.
 No Claim Discounts/Bonus.
 Co-payments on treatments especially daycare treatments.
Simple Comparison:
Company
Name
Star Health
Apollo
Munich
Bajaj
Allianz
TATA AIG New India
United
India
Product
Name
MediClassic
Individual
Easy Health
Standard
Individual
Health
Guard
MediPrime
Individual
Individual
Mediclaim
Health
Platinum
Individual
Minimum
Entry Age
5 months 91 days 91 days 91 days 3 Months 3 Months
Coverage
Amount
1.5 Lakh - 15
Lakh
1 Lakh - 5 Lakh
1.5 Lakh -
10 Lakh
2 Lakh - 10
Lakh
50k - 5
Lakh
1 Lakh - 10
Lakh
Co-
Payment
30% of the
claim
No copayment
10%
copayment
if in non
network
hospitals
No
Copayment
0 -25% 0 -25%
Discounts/
Bonus
5% discount
on No
Claims
Discount of
7.5% if you
choose a 2
year policy
5%
cumulative
bonus
benefit for
each claim
free year,
maximum
up to 50%.
No
Loyalty and
Claim free
discounts
provided
5%
cumulative
bonus
benefit for
each claim
free year,
maximum
up to 25%
Cashless
facility
Hospitals
5400 4500 2300 3000
Depends
on the TPA
Depends on
the TPA
Premium
(2Lakh
Coverage)
Rs.3236/- Rs.2843/- Rs.2626/- Rs.2872/- Rs.2775/- Rs.2472/-
Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.
Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

8. A Simple Guide to get into Health Insurance
Health Insurance for person between 18 & 45 years:
Things to look for:
 Maximum Renewable age-
Page | 8
Continuous renewals will benefit in the future years.
 Wider range of Coverage Amount.
 Options for good family floater policies.
 No Claim Discounts/Bonus.
 Lesser loading on premium amount.
 Co-payments on treatments especially daycare treatments.
Simple Comparison:
Company
Name
Star Health
Apollo
Munich
Bajaj
Allianz
TATA AIG New India
United
India
Product
Name
MediClassic
Individual
Easy Health
Standard
Individual
Health
Guard
MediPrime
Individual
Individual
Mediclaim
Health
Platinum
Individual
Maximum
Exit Age
70 years No limit 80 years No limit No limit No limit
Coverage
Amount
1.5 Lakh - 15
Lakh
1 Lakh - 5
Lakh
1.5 Lakh -
10 Lakh
2 Lakh - 10
Lakh
50k - 5
Lakh
1 Lakh - 10
Lakh
Co-
Payment
30% of the
claim
No
copayment
10%
copayment
if in non
network
hospitals
No
Copayment
0 -25% 0 -25%
Discounts/
Bonus
5% discount
on No
Claims
Discount of
7.5% if you
choose a 2
year policy
5%
cumulative
bonus
benefit for
each claim
free year,
maximum
up to 50%.
No
Loyalty and
Claim free
discounts
provided
5%
cumulative
bonus
benefit for
each claim
free year,
maximum
up to 25%
Loading 20 - 50% No loading upto 50% No loading
0 - 200%
depending
on claims
0 - 200%
depending
on claims
Cashless
facility
Hospitals
5400 4500 2300 3000
Depends
on the TPA
Depends
on the TPA
Premium
(5Lakh
Coverage)
Rs. 6596/- Rs.6017/- Rs.9576/- Rs.6992/- Rs. 8174/- Rs.7800/-
Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.
Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

9. A Simple Guide to get into Health Insurance
Health Insurance for person between 45 & 60 years:
Things to look for:
 Early Pre-existing diseases coverage and the sub-limits for them.
 Maximum Renewable age.
 Sub-limits on Hospitalization.
 Coverage of diabetes and other special diseases, if required.
 Individual policies can be preferred as family floater policies become costlier after age of 50.
 Amount Restoration and Top-up options are additional features that can be looked upon, but
they are offered by limited companies.
Simple Comparison:
Company
Name
Page | 9
Star Health
Apollo
Munich
Bajaj
Allianz
TATA AIG New India
United
India
Product
Name
MediClassic
Individual
Optima
Restore
Individual
Health
Guard
MediPrime
Individual
Individual
Mediclaim
Health
Platinum
Individual
Maximum
Exit Age
70 years No limit 80 years No limit No limit No limit
Pre-existing
Covered
after
4 years 3 years 4 years 4 years
4 Claimless
years
4 years
Coverage
Amount
Restoration
No Available No Available No No
Top-up
Option(i.e.
with
deductable
amount)
No Available No No No Available
Cashless
facility
Hospitals
5400 4500 2300 3000
Depends
on the TPA
Depends on
the TPA
Premium
(5Lakh
Coverage)
Rs. 15,230 Rs.14445/- Rs.15236/- Rs.15039/-
Rs.
14134.88/-
Rs.9873/-
Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.
Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

10. A Simple Guide to get into Health Insurance
Health Insurance for person aged above 60 years:
Things to look for:
 Early Pre-existing diseases coverage and the sub-limits for them.
 Maximum Renewable age.
 Co-payments and Sub-limits on Hospitalization.
 Loading on premiums.
 Domiciliary hospitalization coverage.
Simple Comparison:
Company
Name
Page | 10
Star
Health
Apollo Munich Bajaj Allianz TATA AIG
New
India
United
India
Product
Name
Senior
Citizen
Red
Carpet
Optima Senior
Silver
Health
Senior
Citizens
Mediclaim
Policy
Senior
Citizens
Health
Insurance
Policy
Varishta
Mediclaim
for Senior
Citizen
Maximum
Exit Age
No limit No limit 75 years 90 years No limit 90 years
Pre-existing
Covered
after
1 year 3 years
1 year but
only 50 %
covered
18 months
3 years
(Claim
free)
1 year (Claim
free)
Co-Payment
30% for all
claims and
50 % for
pre-existing
diseases
15-30 % on
claims
20%
copayment if
treatment is
taken in
other
hospitals
No details
20% on
major
illness
10% on
admissible
claims
Loading 20 - 50% No loading available 10 - 20%
30%
loading
for
including
diseases
like
diabetes,
etc.
10 - 20%
Cashless
facility
Hospitals
5400 4500 2300 3000
Depends
on the
TPA
Depends on
the TPA
Premium
(2Lakh
Coverage)
Rs.9500/- Rs.11,932/- Rs.11203/-
Rs.5720/-
(for 1.5
Lakh)
Rs.7600/- Rs.6187/-
Note: Companies for comparison were chosen on the basis of 2 stand alone, 2 private and 2 public firms.
Details were taken from the companies’ website, for exact premiums and other details kindly contact the company directly.

11. A Simple Guide to get into Health Insurance
Common terms in Health Insurance:
Insurance Agent:
Licensed salesperson, who represents one or more health insurance companies and presents
their products to consumers.
Insurance Broker:
Licensed insurance salesperson, who obtains quotes and plan from multiple sources information
for clients.
Co-payment:
Copayment is a predetermined (flat) fee that an individual pays for health care services, in
addition to what the insurance covers.
Cumulative Bonus:
Each claim free year ensures that you get a benefit known as “cumulative” bonus - it is similar to
“no claim discount” in concept. The only difference being that instead of giving an upfront discount, the
health insurance company adds more benefits for the same premium paid. However, the overall amount
of these benefits will not exceed a certain percentage as specified in the policy
Deductible:
The deductible is the amount an individual must pay for health care expenses before insurance
covers the costs. Often, insurance plans are based on yearly deductible amounts.
Dependent:
A dependent is a person or persons relying on the policy holder for support may include the
spouse and/or unmarried children (whether natural, adopted or step) of an insured.
Domiciliary Hospitalization:
Domiciliary Hospitalization is the treatment of the patient is carried out at home. This needs to
be as per the doctor's recommendation. Most health insurance companies do cover domiciliary
hospitalization subject to a certain limit depending on the sum insured.
In-Network:
In-network refers to providers or health care facilities that are part of a health plan’s network of
providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network
provider, because those networks provide services at lower cost to the insurance companies
with which they have contracts.
Loading:
An amount an insurance company adds to the basic premium to cover the expense of securing
and maintaining the business.
Conclusion:
Page | 11
As already said, it is high time for the Indians to realize the need of health insurance, as
the hospitalization charges are on the rise these days. As premiums are higher when a person enters
into health insurance after an age of 46 years, it is better to get into health insurance earlier and insure
the whole family, and ensure a risk free happy life.

12. A Simple Guide to get into Health Insurance
Page | 12
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