10 Best Health Insurance Policies In India:  Benefits, Coverage, Exclusion And How To Choose A Policy

With the rising costs of medical treatments, bearing hospitalisation and other medical expenses can be challenging during an emergency. It can also affect your savings plan for the future. An ideal solution is to get a suitable health insurance plan. If you are not sure which plan to go for, here’s a list of the 10 best health insurance in India. 

Compare the features and benefits before you purchase health insurance for yourself and your family. Read on!

Best Health Insurance Policy In India: Top 10 (2022)

Plans	Features
** Navi Health Insurance	Cashless network hospitals: 10,000+ Claim settlement ratio: 97% Processing time: 20 minutes
Aditya Birla Activ Assure Diamond Plan	Cashless network hospitals: 9000+ Claim settlement ratio: 94% Processing time: 2 hours
Bajaj Allianz Health Guard	Cashless network hospitals: 6500+ Claim settlement ratio: 98% Processing time: 1 hour
Care Health Care Plan	Cashless network hospitals: 16,500+ Claim settlement ratio: 95.2% Processing time: 2 hours
Bharti AXA Smart Super Health Plan	Cashless network hospitals: 4500+ Claim settlement ratio: 92.37% Processing time: NA
Digit Health Plan	Cashless network hospitals: 6400+ Claim settlement ratio: 63.56% Processing time: NA
ManipalCigna ProHealth Insurance	Cashless network hospitals: 6500+ Claim settlement ratio: 91% Processing time: 1 hour 30 minutes
Kotak Mahindra Health Premier	Cashless network hospitals: 5000+ Claim settlement ratio: 98% Processing time: NA
Edelweiss Health Plan	Cashless network hospitals: 3200+ Claim settlement ratio: 85.57% Processing time: NA
Niva Bupa Health Companion Individual Plan	Cashless network hospitals: 7600+ Claim settlement ratio: 90% Processing time: 30 minutes

** Terms & Conditions Apply

Benefits Of Buying A Health Insurance Policy

Helps Avoid Medical Inflation

Due to medical inflation, treatments are becoming increasingly expensive. Nevertheless, a well-rounded health insurance plan covers such expenses and lets you beat inflation. 

Provides Quality and Affordable Medical Treatment

Health insurance policyholders can get affordable and quality treatments from authorised network hospitals. 

Cashless Hospitalisation

While availing of treatment from network hospitals, individuals can opt for a cashless facility which saves them from having to pay a considerable sum out-of-pocket.

Save for the Future

Financial liabilities arising from medical expenses can affect your savings plan for the future. Hence, you might want to cover such liabilities by opting for the best health insurance policy.

Tax Benefits

Members are eligible for tax benefits under Section 80D of the Income Tax Act. The benefits include tax savings on health insurance policy premiums. 

How To Buy The Best Health Insurance Policy In India

Before you buy a health insurance plan, here are the things to consider:

Coverage Scope

You might want to consider checking the coverage benefits under a health insurance plan before choosing one. Consequently, you can raise a claim accordingly. 

Sum Insured

If you are looking for better coverage under medical insurance, you might want to settle for a plan that comes with a high sum insured. 

Policy Type

There are several options available under a typical health insurance plan. One can choose from individual, family floater, senior citizen, critical illnesses policy types, etc.

Waiting Period

Health insurance policies come with a certain waiting period after which the coverage plan kicks in. Ideally, you might want to consider a plan that has a minimum waiting period.

Cashless Hospitals

One might want to choose the best health insurance plan from the top insurers who entail a wide network of cashless hospitals. 

Exclusions Under Health Insurance Policy in India

1. Injuries arising from war, acts of terrorism, etc. 
2. Suicide attempts or self-inflicted injuries.
3. AIDS, terminal diseases and other diseases of the same category.
4. Costs of cosmetic or plastic surgery and hormone replacement surgery.
5. Expenses arising from dental or eye surgeries.
6. Rehabilitation or bed rest costs, common illnesses, etc. 
7. Costs of post-care procedures and diagnostic tests.
8. Expenses for the treatment of adventure sports injuries.

Factors That Affect the Premium of Best Health Insurance Policy in India

While applying for a health insurance plan, one should keep in mind the following factors which will affect the premiums of the plan:

• Past medical records: If the policyholder or his/her family has a record of some chronic illnesses, there are chances of the premiums rates being higher than someone with no pre-existing medical conditions or history.
• Age: The older a person, the higher the risk of getting sick more often. So, younger people usually get the benefit of lower premiums as they are at low risk than the older ones. Hence, it is advisable to get health insurance when you are young to make the most of the benefits at lower costs.
• Location: Insurance companies base their insurance premiums on the location of the insured. It is believed based on data provided that people living in certain locations live healthier lives due to the culture and climate compared to some others. The premiums in those areas with unhealthy habits are generally higher than the healthier ones.
• Body Mass Index (BMI): People with higher BMI have to pay higher premiums than the ones with normal BMI. Higher BMI means more risk of medical conditions such as heart-related diseases and diabetes and needs to be kept under regular medical supervision.
• Insurance features: Insurance features differ from company to company. However, if you choose an individual or group insurance plan then your premiums will be lower than a family insurance plan. If you have add-ons then the premiums will also be higher. While applying for insurance, you should check if the company has the option for co-insurance. This will reduce the premiums significantly.
• Other habits: The habits of the insured will have an impact on the premiums of the insurance. People with habits of injurious substances have to pay higher premiums as they are prone to getting life-threatening diseases like cancer.

Documents Required to Buy Best Health Insurance Policy in India

You will need the following documents mandatorily while applying for insurance plans in India:

• Age proof, such as birth certificate, Voter ID, Aadhaar card, passport, driving licence, 10^th or 12^th mark sheet
• ID proof such as PAN card, voter ID, Aadhaar card, driving licence
• Proof of address such as electricity bill, rent agreement , driving licence, Aadhaar card
• Medical reports for pre-existing medical conditions if any
•  Passport size photographs

How to Calculate Premium of Best Health Insurance Policy in India

The calculation of the premiums for your health insurance plan manually can get hectic. There are online calculators which you can take advantage of for calculation. You will need the following inputs for calculation:

• Age
• Members to be insured in case of family health insurance plan
• Sum insured
• Policy tenure

Eligibility Criteria for Best Health Insurance Policy in India

The eligibility criteria for health insurance policies depend on their terms and conditions and the particular insurance provider. The following are some standard eligibility criteria for medical insurance policies:

Age

18 to 65 years for adults and 90 days to 25 years for dependent children.

Pre-Medical Screening

Required for individuals above 45, 55 and 60 years.

Pre-Existing Disease Waiting Period

2 to 4 years.

Optional Add-On Covers under Best Health Insurance Policies in India

Add-ons are facilities provided by the health insurance companies but are not generally included in the standard plan. The policyholder can add them to their plan by adding a little extra on premiums which covers certain expenses and also increases the sum insured. Following are few of the best optional add-ons one should include in their plan for better medical coverage and emergencies:

• Room charge waiver: With this add-on, one can enhance the limit of the room charge or can opt for no sub-limit on room charges
• Maternity and newborn cover: Pregnancy is not predictable and so is not the medical expenses related to the surgery and childbirth. These large expenses can be managed by including this add-on to your health insurance. The following months will require regular medical supervision and doctor visits as well. So, adding this to your health insurance will be helpful for such foreseen circumstances.
• Hospitalisation cash cover: This add-on will take care of the diagnostic and medical expenses during the hospitalisation of a person. With this coverage, one can get up to Rs.10,000 daily coverage for 30 days.
• Emergency ambulance services: With this add-on, one can avail of benefits of up to Rs. 30,000 on emergency ambulance services.
• Critical illness cover: This add-on is the most beneficial and important when it comes to health insurance. With this add-on, one can get up to Rs. 10 lakh of coverage on treatments of critical illnesses such as cancer. 

How to File a Claim for the Best Health Insurance Policy in India

You can raise claims for health insurance policies through any of the two modes- reimbursement and cashless. Given below are the procedures for raising claims in case of emergency and planned hospitalisation:

Emergency Hospitalisation

• Inform the insurer within 24 hours of hospitalisation. 
• Furnish your health card and obtain a pre-authorisation form. 
• Submit this form to get Third-Party Administrator (TPA) approval for cashless claims. 
• On approval, the insurer will directly settle the amount with the hospital. 
• In case of disapproval, you can file for reimbursement later. 
• For reimbursement, you need to submit documents such as hospital bills, discharge bills, etc. 

Planned Hospitalisation

• Inform the insurer at least 48 hours before your treatment. 
• On getting TPA approval, you can file for reimbursement or a cashless process by submitting the claim form. 
• Attach other essential documents such as bills, reports, etc. 
• After successful approval, you can get the reimbursed money from the insurer. However, in the case of cashless mode, the insurer will directly settle the payment with the hospital. 

Navi Health Insurance policy comes with a range of benefits like a simple claims process and an affordable premium. Download the Navi App on Android or iOS and get comprehensive coverage for you and your family. 

Claim Settlement Process in Health Insurance Plans

There are two types of claim settlement processes in Health Insurance:

1. Cashless
   The insurer will settle the claim with the hospital. However, this facility can only be availed if hospitalisation is done at a Network Hospital.
   

• 2. Reimbursement
  The insurer settles the claim later by reimbursing the amount paid by the policyholder. You can claim reimbursement at a network or a non-network hospital.

How to File for a Cashless Claim?

Cashless claims can be made in either of the two situations- planned and emergency or unplanned.

For planned treatment:

Step 1: Submit the cashless claim to your insurer five days before the treatment

Step 2: The insurer will contact the hospital for a cashless claim form

Step 3: You will get a confirmation message or email which will be valid for 7 days from the date it was issued

Step 4: Submit the health card and confirmation letter during admission and your expenses will be paid by the insurer

For an emergency or unplanned treatment:

Step 1: Notify the insurer within 24 hours of hospitalisation and you will get a reference/intimation number

Step 2: The hospital will submit a cashless form to your insurer and they will send an authorisation letter to confirm the same

Step 3:  Your medical expenses will be paid by the insurer afterwards

How to File a Reimbursement Claim under Health Insurance?

Reimbursement claims are made when the policyholder doesn’t go to one of the enrolled hospitals and has to pay the medical expenses on their own. The following process in followed to claim a reimbursement:

Step 1: Submit the documents regarding the treatment expenses to your insurer

Step 2: The insurer will verify the details on your medical bill

Step 3: After successful verification, your insurer will process the reimbursement which can take up to 21 days

Significance of Health Insurance in Covid-19 Pandemic

The unpredictable attack of Covid-19 worldwide has taught everyone how important it is to have medical insurance and everyone is at risk. If you still don’t have health insurance, you should consider the following factors to know why.

• High requirement for ICU
• Costly protection gears
• Emergency coverage
• AYUSH treatments

Benefits of Navi Health Insurance Plan

1. Zero paperwork
2. Insure you and your family within 5 minutes
3. One-time subscription-based model
4. 10,000+ network hospitals across 400+ locations in India
5. Cashless claims under 20 minutes
6. Claim settlement ratio of 97%

Navi Health Insurance policy comes with a range of benefits like a simple claims process and an affordable premium. Download the Navi App and get comprehensive coverage for you and your family.

Final Word

With the ongoing medical inflation, you might want to consider an insurance cover that curtails your financial burden during times of emergencies. In this regard, you may want to look for the best health insurance policies due to their attractive features and benefits. 

FAQs on Best Health Insurance Policy in India

Before you go…

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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.