Types of Health Insurance Plans in India

India’s health-care prices are sky-rocketing. But this is not what we need to tell you. When you’ve just toured a doctor, you’ll realize how the expense of just a basic operation will expense you a rocket. Therefore a health insurance policy becomes no less than a necessity to take advantage of the best medical treatment without making a hole in your pocket.  Although the variety of multiple forms of insurance coverage – from adult insurance benefits, family floater schemes and senior citizens’ health plans, etc. can render finding the correct one difficult.

The most significant and cost-effective way to secure wealth is by health benefits. This is an important decision that needs you to be cautious when purchasing. By suggesting that you can’t expect the best price without understanding the types of health insurance policies that are accessible in India!

The growing growth in overall healthcare costs has rendered it mandatory for all to provide health insurance benefits. Medical care mitigates the inevitable financial risk that results from an unintended hospitalization or disease. It’s quick to purchase health insurance in India, just when you follow the correct way. In this respect, you should be fully informed of the forms of health insurance plans that ensure adequate coverage.

So to make you understand more, here’s a brief rundown of the different forms of medical insurance schemes in India and their benefits:

Various Health Insurance Plan types in India

There are two different kinds of health insurance policies-

  • Indemnity Plans
  • Defined-benefit Plan

Indemnity Health Insurance

Indemnity benefits are the standard health policy paying up to the paid amount of the hospitalization costs. Such methods include:

  • Mediclaim Insurance.
  • Individual Coverage.
  • Family Floater Coverage.
  • Senior Citizen Coverage.
  • Unit Linked Health Plans.
  • Group Mediclaim.

Mediclaim Insurance

Mediclaim plan gives you coverage for the hospitalization expenses
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Mediclaim plan gives you coverage for the hospitalization expenses suffered owing to sickness or unintended stay. This covers in-patient costs such as hospital services, administrative expenditures, consultant visits, food, medication, etc.

Such insurance is defined as the Mediclaim scheme and is offered in the market as a corporate mediclaim, private medical care abroad, etc.

Individual Health Insurance

Individual Health Insurance offers individual coverage
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As the name suggests, a single health plan offers individual coverage. Yet by charging an additional fee, one may add other participants, including partners, teenagers, parents, etc. Furthermore, the premium is charged according to the age, medical history, and respective insured sum of each individual. It doesn’t impact the insured amount of the other insured party in specific plans lawsuit made by one participant.

Therefore, whether you are single or have no children, you can obtain an individual insurance package for yourself and your partner and receive the separately covered portion of the number. Regardless of the broad coverage, the price is marginally greater than a family floater package, despite the amount guaranteed that is being sold.

Benefits of Individual Health Insurance Plans

There are tremendous advantages to getting individual health insurance
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There are tremendous advantages to getting private health insurance, which provides the finest quality coverage at a reasonable premium; one gets the cashless facility that protects you from the difficulty of filing a lawsuit. Here are the advantages:

  • Insured enjoys all the incentives included in the program he/she has taken aboard.
  • The sum guaranteed will be used in full by the policyholder without any other individual sharing it.
  • If desired, the policyholder may in the future add his immediate family members to the policy.
  • In this scheme, a person may submit any amount of claims in a year, because there are no limitations for the floater policies for the family.
  • The package includes lifelong extension because there is no cap on the participants’ average duration for program renewal.
  • Also, patient benefits cover hospitalization costs, pre- and post-hospitalization expenditures, cost of medical exams, cost of operation, testing services, maternity treatment expenses, and payments for appointments.
  • The Program includes serious condition compensation.
  • According to Section 80D of the Income Tax Act, 1961, the beneficiaries get tax incentives on premiums charged on medical insurance.

Family Floater Plan

This approach comes with a surprise, which is planned for the whole family. For a Family Floater health care package you will protect the whole family in a common program. The sum insured is divided equally among the members. One good point is that the fee you payout on these contracts is relatively lower than the schemes for people or drugs.

For a Family Floater health care package you will protect the whole family in a common program.
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For order to agree about the best family floater health insurance package, address the considerations listed out below:

  • Lifelong Renewability: Most insurance providers provide premium renewability plans by the age of 60 to 65 and others give lifetime renewability. Pick health insurance that offers financial support when it’s most important.
  • Sum Insured Amount:  Insurance providers owe you the option of through the deductible amounts to meet the medical costs as the expenditures through day after day.
  • NCB (No Bonus Claims): You can earn NCB in the context of a rise in the insured amounts if you have not filed any claims in the past year.
  • Cashless Facility: If you choose the cashless treatment you are surely safe from the trouble of initiating a reimbursement claim. For emergency hospitalization, incidents, non-network hospital referrals, hospitals must first compensate for care and sue for compensation.
  • Pre-existing Conditions (including critical illness): Consider a package that covers pre-existing conditions or a proposal that requires a shortened transition time than certain policies.
  • New members’ addition: When you’re going to have a pregnancy, you have the option to go for maternity and newborn baby cover, because new entrants may be introduced to the floater package at any point.

Senior Citizen Health Insurance Plans

These arrangements are tailored for individuals over 60 years of age. Elderly people are more vulnerable to severe illnesses, and treatment costs for such illnesses are also high. Therefore, it is safer for the elderly parents to purchase a senior citizen package to guarantee sufficient insurance care in their post-retirement years.

These arrangements are tailored for individuals over 60 years of age.
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Following considerations should be taken into consideration when considering a health insurance scheme for senior citizens in India:

  • Co-payment: This is the maximum fee to be billed by the patient for the provided healthcare facility, while the balance is charged to the provider by the employer. Co-payment is contingent on the doctor and the conditions reported.
  • Sub-limit: This is the amount of the covered amounts that the insurance provider charges such as room rent, doctor’s visit, cataract care, and medical services.
  • Waiting period: The delay time on a health care program on older citizens is longer, which ranges from 1 and 4 years for serious disease.
  • Pre-existing Medical case:  Many programs provide compensation for pre-existing medical problems until a transition period (which lasts around 2-3 years) has been reached and then up to 50 percent of the premium lasts available on pre-existing conditions.
  • Medical Certificates: Senior citizens may receive medical certificates before buying a health care policy.

Unit Linked Health Plans

Under this scheme, the financial exchange takes a percentage of charged rates.
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Unit Linked Investments, generally referred to as ULIPs are investment and insurance policies that come with combined investment and protection incentives.

Under this scheme, the financial exchange takes a percentage of charged rates, and the insured is given policy protection. The returns are based upon the performance of the market.

Group/Employee Health Insurance Plans

Group health benefits offer medical protection for the company’s workers. The company gives this to its staff as an opportunity to raise their productivity and to attract workers. Employees may also apply for extra benefits through this community health care package to include their family members which involve self, partner, babies, and parents.

Group health benefits offer medical protection for the company's workers.
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Benefits of Employee/Group Health Insurance Policy

One of the significant benefits of community health insurance schemes in India is that it makes every company keep its workers because they feel secure as their employer provides them with adequate medical cover. Certain benefits include:

  • Insured participants will not have to undergo examinations or issue medical credentials to receive community health benefits. Employees are generally liable for a Team benefits scheme.
  • Any employee will receive cashless care at the insurer’s network hospitals.
  • The program will also include coverage of the costs for follow-up insurance check-ups and professionals.
  • The policyholders, employers, and employees receive tax deductions on the bonuses paid.
  • Compared with individual health insurance the cost of this health insurance is lower.
  • Maternity coverage (provided by certain plans) is part of the group/employee health care program and is not protected under other private health programs.
  • The claim period is lower, as claims can be made within the first 30 days of the group insurance policy being received.
  • The organization is also appointed as a contract consultant to take care of the policy-related questions of the staff.
  • To workers above the age of 60, the organization may not allow co-payment.
  • Under community health care policies the emergency expenses are compensated.
  • Most community medical plans can cover boarding expenditures include, though not limited to, nurse, anesthetist and specialist services, medication, oxygen and testing supplies, X-rays, and dialysis costs.
  • Many contracts often offer compensation upon payment of additional fees for pre-existing diseases.

Definite-Benefit Plans

On the other side, the insured is paid with a lump sum balance of disease diagnosis under a defined-benefit package. Such methods include:

  • Critical Illness Plan
  • Personal Accident Plan
  • Hospitalization cash benefit plan

Critical Illness Plan

Each program is structured primarily to manage critical illnesses.
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Each program is structured primarily to manage common illnesses. Since lifestyle disorder on the rise, it has been imperative to seal yourself up from such illnesses. As for handling, this can be a costly affair, particularly for a middle-class family, you can reduce those costs to some degree by purchasing vital insurance. It pays a pre-decided amount for treatment on the detection of disease, regardless of pre- or post-hospitalization expenses. The major illnesses covered by most critical disease plans include:

  • Major organ transplant
  • Cancer
  • Stroke
  • Aorta graft surgery
  • Multiple sclerosis
  • Kidney failure
  • Paralysis
  • Coronary artery bypass surgery
  • First heart attack
  • Primary pulmonary arterial hypertension

Benefits of critical illness plans

  • If you are diagnosed with a serious illness covered by your policy, this plan gives you a lump sum amount.
  • It also covers recovery aid (healing) and other expenses that are not covered by your basic insurance plans.
  • Insured individuals may benefit from tax advantages.
  • In addition to covering your medical expenses, the policyholder is also eligible for free regular health checkups.
  • Most policies often take into consideration the reality that policyholders with a serious disability are unable to function and instead give them regular pay rewards.

Exclusions of a Critical Illness Rider

In case of the following diseases the vital disease driver won’t protect you:

  • Diagnosis of the disease within the first 90 days of policy start date.
  • The covered member’s death during 30 days from the date of diagnosis or operation.
  • Illnesses induced by substance misuse, alcohol, abortion, or childbirth.
  • Illnesses induced by HIV / AIDS.
  • Fighting, crime, naval, or navy activities.
  • Infertility treatment.
  • Activity in the dental or cosmetic area.
  • The treatment takes place beyond India.
  • Treatment to remove hormones

Personal Accident Insurance Plans

Because we all realize that the injuries are rising day by day, shielding yourself from the unexpected circumstance will be of great benefit to you. The injury compensation program pays for the unexpected death gain, injuries, and even for hospitalization, patient & family care, and car or home maintenance expenses. This can also include other miscellaneous costs in this package.

In addition to paying the insurance costs of a policyholder, personal injury benefits provide an amount guaranteed to the survivor in the event of the insured’s death. As a provision, you can add specific liability protection to the policy on board.

Personal injury benefits provide an amount guaranteed to the survivor in the event of the insured's death.
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There are two types of personal accident plans:

  • Individual accident insurance: This program works with a person in the case of an incident causing injury, dismemberment, or death.
  • Group accident insurance: Employers provide their eligible employees with group casualty insurance. Unlike individual accident insurance, this form of program usually offers limited coverage and provides several benefits. Some of the other features that a personal accident cover can include are ambulance fees, burns, daily cash allowance during hospitalization, etc.

Hospital Daily Cash Benefit Plans

During each day of your hospitalization, the form of an insurance package gives a lump sum number. In the beginning, the guaranteed sum is specified and will stay constant irrespective of the costs incurred. So if the insurance provides Rs. 5000 a day of hospitalization, you’ll get the sum for any day of the hospitalization even though the average hospital cost is Rs.1000 or Rs.1500.

The insured can use this balance to fund extra costs not covered by their regular health insurance coverage. As a passenger, or as a stand-alone cover, you will buy a regular hospital cash package.


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