What is Health Insurance

‘Health Insurance’ is a type of insurance policy that essentially covers the medical expenses of the policy holder. A health insurance policy like other policies is a contract between an insurer and an individual / group in which the insurer agrees to provide specified health insurance cover at a particular “premium” subject to terms and conditions specified in the policy.

What a Health Insurance policy would normally cover?

A Health Insurance Policy would normally cover expenses reasonably and necessarily incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured (for all claims during one policy period).

  • Room, Boarding expenses
  • Nursing expenses
  • Fees of surgeon, anesthetist, physician, consultants, specialists
  • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X- ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses

Why is Health Insurance Important?

Each of us is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is getting increasingly expensive, with technological advances, new procedures and more effective medicines. 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.

Health Insurance Policies

Mediclaim Policy

Mediclaim policies are Indemnity Policies which cover hospitalization expenses of an individual. The policy duration is generally of 1 year subject to yearly renewal thereafter on payment of the premium. The payout from these policies will be lower of the two values- sum insured or the actual expenses.


Note: The Insurance Companies offer cashless (at their approved hospital networks) as well as reimbursement facilities (if treated in a hospital outside the insurer’s network or the insurer does not offer cashless facilities). If the insurer is offering cashless facility, then one needs to pay just the amount which is in excess of the amount being covered. But in case of reimbursement, one needs to pay first and then claim reimbursement from the Insurance Company. Health Insurance policies may offer Cumulative Bonus wherein for every claim free year; the Sum Insured is increased by a certain percentage at the time of renewal subject to a maximum percentage (generally 50%). In case of a claim, CB will be reduced by 10% at the next renewal.


Mediclaim Policies can be of two types:

  • Individual Health Policy :This policy covers each of the insured members separately.

    Advantages of Individual Health Policy

    • The Individual medical insurance Policy is excellent for families comprising aged members where the health risk is more.
    • Generally no age restrictionis imposed on the maximum age for the members for renewal.
    • One can avail the benefits of Loading and Discounts until the policy lapses.

    Disadvantages of Individual Health Policy

    • The Policy is expensive for the families with low health risk.
  • Family Floater Health Insurance Policy :

    Advantages of Family Floater Health Insurance Policy:

    • It is less expensive than Individual Policy (taken for the entire family).
    • It is suitable for younger families with members having low health risk.
    • Another benefit is that family members gets a greater claim amount compared to what they might have received on an individual medical cover.

Fixed Benefits Plans

In Fixed Benefit Plans, the insurer pays a predetermined amount irrespective of actual expense in the event of hospitalization. Fixed Benefit Plan is meant to cover incidental expenses and loss of income due to hospitalization. Fixed Benefit Plans generally pay-

  • A certain amount for each day spent in hospital.
  • A certain additional amount for each day spent in ICU of the hospital.
  • A certain additional amount in the event of surgery at the hospital.
  • A certain additional amount for each day loss of income

Who should buy this ?

A fixed benefit plan suits people who want to enhance their existing health cover. Fixed benefit plans are a must for people who may apprehend loss of income due to hospitalization. Most salaried people get paid medical leave, but if any company does not offer this benefit, a fixed benefit plan comes to the rescue. Self-employed professionals are also advised to consider this plan.


Note: It is important to note that a policyholder can make a claim under a fixed benefit plan over and above his claim in an indemnity policy.

Critical Illness Plan

Critical Illness Plans are similar to fixed benefit plans in structure. But only pre specified diseases are covered. Any disease outside the pre specified diseases are not covered

Critical Illness Insurance assures the beneficiary a lump sum one time payment in case he/ she is diagnosed with any one of the specified illnesses as covered by the policy (the degree of seriousness is also specified in the policy conditions). The coverage is not for all kinds of illness but some serious ones viz. heart attack, multiple sclerosis, cancer, kidney disorder, artery bypass etc. The payment meted out is tax free and may be used by the beneficiary for payment of debts or to procure some medical assistance or in any other way that is necessary. Sometimes payments are also made on condition of being permanently being disabled. The policy automatically terminated once the payment is made.

Who should buy this?

Critical Illness Plan is especially beneficial for individuals with low savings and those whose employment conditions do not provide adequate medical coverage when the individual is off work due to some major illness. CIP is beneficial for all as it provides peace of mind and stress free recovery.

Points to check prior to buying

It is wise for the investor to check up on some pointers before he zeroes in on a Critical Investment Plan, viz. the illnesses being covered and NOT covered by a particular policy (including stages of illness), the formalities to be completed while filling up a claim, the time period between the filing of claim and the receipt of the proceeds, the network of hospitals covered, coverage for dependentsand last but not the least, the renewal benefits in case the insurer has not filed a claim for a particular year.

On the personal front, the insurer must choose a policy after properly calculating treatment cost, recurring cost, an financial liability in case of income loss. He/ she must also evaluate any history of critical illness in the family and also determine the age at which the illness surfaced. In case the age is young then a CI should be opted for without any hesitation.

Types

Critical Illness Plans may be taken in two forms, either a standalone policy or as a rider with any pre-existing policy of the insurer. The policy terms and conditions for both cases are more or less similar. Some subtle differences being that standalone policies cost more, yet offer larger covers compared to riders.


Things not covered by this plan

  • Any illness arising out of genetic disorder.
  • Illness arising due to consumption of alcohol, smoking or drug abuse.
  • Illness which is an offspring of HIV virus.
  • Illness arising due to intentional self-injury, attempted suicide etc.
  • Any preexisting illness that remained during purchase of the plan.

Tax implications of Health Insurance in India

Tax benefit is provided on the premium paid for health insurance under Section 80(D) of Income Tax Act, 1961.

1. a) In case the premium is paid by the assesse for himself or for spouse or dependent children, then the assesse gets a maximum deduction of Rs.25000.


    b) If the assesse is senior citizen, then the maximum benefit is of Rs.30000.


2. a) In case the premium is paid by the assesse for parents whether dependent or not, maximum deduction allowed is of Rs.25000.


    b) In case the parents are senior citizen, then the deduction allowed is of Rs.30000.

Why is Health Insurance Important?

Each of us is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is getting increasingly expensive, with technological advances, new procedures and more effective medicines. 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.

Our Recommendations

We are recommending the Health Insurance Plans of Religare Health Insurance Company Limited.

Religare Health Insurance Company Limited is a specialist health insurance company engaged in the distribution & servicing of health insurance products. Religare is promoted by the founders of Fortis Hospitals, which owns or manages 68 hospitals in India; SRL Diagnostics, Asia’s largest network of diagnostic labs with over 1100 collection centers and Religare Wellness, a nationwide chain of stores offering pharmacy and wellness products.


It should be also noted that we will earn commission for selling these Health Insurance Plans from the insurance company.

CARE (HEALTH INSURANCE PLAN)

Care is a comprehensive health insurance plan which provides protection at an affordable price. It covers cashless hospitalization, treatment for critical illness, accidents and much more.

Our Features

Features (Sum Insured Rs.)
3 Lac , 4 Lac 5 Lac , 7 Lac , 10 Lac 15 Lac , 20 Lac , 25 Lac 50 Lac , 60 Lac

Pre-hospitalisation:

(Pre-hospitalisation Medical Expenses means Medical Expenses incurred immediately before the insured person is Hospitalized provided that:

  • Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was required.
  • The In-patient Hospitalization claim for such Hospitalization is admissible by the Company.)

30 days 30 days 30 days 30 days

Post-hospitalisation:

( Post-hospitalisation Medical Expenses means Medical Expenses incurred immediately after the Insured Person is discharged from the hospital provided:

  • Such Medical Expenses are incurred for the same condition for which the insured person’s Hospitalization was required.
  • The In-Patient Hospitalization claim for such Hospitalization is admissible by the Company.)

60 days 60 days 60 days 60 days

Day Care Treatments:

(Day Care Treatment means Medical treatment and/or a Surgical Procedure which is:

  • Undertaken under general or local anaesthesia in a Hospital/Day Care Centre in less than 24 hours because of technological advancement
  • Which would have otherwise required Hospitalization of more than 24 hours.)

Yes Yes Yes Yes
Room Rent 1% of SI per day Single Private Room Single Private Room (Upgradable to Next Level) Single Private Room (Upgradable to Next Level)
ICU Charges 2% of SI per day No Limit No Limit No Limit
Doctor's Fee etc. No Limit No Limit No Limit No Limit
Other Medical Charges No Limit No Limit No Limit No Limit

Daily Allowance:

(Daily Allowance: The Company will pay the amount specified against this Benefit in the Policy Certificate for each continuous and completed period of 24 hours of Hospitalization of the insured Person provided that:

  • The Hospitalization is only for the In-patient Care
  • The Company will not be liable to make payment under this Benefit for more than 5 consecutive days of Hospitalization for Any One illness.)

Rs. 500 per day up to 5 days - - -
Ambulance Cover Rs. 1,500 per claim Rs. 2,000 per claim Rs. 2,500 per claim Rs. 3,000 per claim

Domiciliary hospitalisation

(Domiciliary hospitalization means medical treatment for an illness/disease/injury which in the normal course would require care and treatment at a Hospital but is actually taken while confined at home under any of the following circumstances:

  • The condition of the patient is such that he/she is not in a condition to be removed to a Hospital
  • ) The patient takes treatment at home on account of non-availability of room in a Hospital.)

Up to 10% of SI Up to 10% of SI Up to 10% of SI Up to 10% of SI
Organ Donor Cover Rs. 50,000 Rs. 1,00,000 Rs. 2,00,000 Rs. 3,00,000

Annual Health Check-up:

(On the Insured Person’s request ,the Company shall arrange for the Insured Person’s Health Check-up at its Network provider, provided that :

  • This Benefit shall be available only to those Insured Person that are Age 18 or Above on the Policy Period Start Date provided further that this Benefit shall not be available to any Insured Person who is covered under the Policy as the Policy Holder’s child.
  • This Benefit shall only be available once in every year during this Policy Year.)

Yes Yes Yes Yes

Second Opinion:

(Note: If the Insured Person is diagnosed with any Major illness during the Policy Year, then at the Policyholder’s /Insured Person’s request, the Company shall arrange for a Second Opinion from a Medical Practitioner.

This Benefit can be availed a maximum of one time by an Insured Person during the Policy Year for each Major illness.)

- Yes Yes Yes
No Claim Bonus Yes Yes Yes Yes

Auto-Recharge of Sum Insured:

( Note: The Recharge shall be available only for all future Claims and not in relation to any illness or injury for which a Claim has already been admitted for that Insured Person during that Policy Year. The Recharge shall be utilized only after the Sum Insured, No Claims Bonus and No Claims Bonus-SUPER have been completely exhausted in that policy year.)

Yes Yes Yes Yes

Care Anywhere:

(Note: The Medical Expenses incurred are in respect of the major illness specified below :

  • Cancer
  • Benign Brain Tumor
  • Major Organ Transplant/Bone Marrow Transplant.
  • Heart Valve Replacement
  • Coronary Artery Bypass Graft
The Medical Expenses incurred are only for In-Patient Care or Day Care Treatment undertaken in any Hospital.)

- - - Yes

Note: By paying a small premium one can take the benefit of “Super No Claim Bonus” Plan. In this plan the policy holder will get a super increase of 50% bonus in his/ her sum insured ever year (up to 100%) in addition to the normal 10% (up to 50%) benefit for any claim free year. For example, if a policy holder buys a 10lac Sum Insured plan with a “Super No Claim Bonus” rider, for every claim free year, his/ her Sum Insured will increase as follows:

At the end of 1st year At the end of 2nd year At the end of 3rd year At the end of 4th year At the end of 5th year
Initial Sum Insured 10lac 10lac 10lac 10lac 10lac 10lac
Super No Claim Bonus 5lac 5lac NA NA NA
Normal Bonus 1lac 1lac 1lac 1lac 1lac
Total Cover 10 Lac 16 Lac 22 Lac 23 Lac 24 Lac 25 Lac
It is assumed that the policy holder has not made any claims in those 5 years.
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Policy Terms:

Minimum entry age Individual: 5 years or above Floater: 91 days with at least 1 member of age 18 years or above
Maximum entry age No age bar
Maximum renewal age Lifelong renewability. The policy can be renewed under the then prevailing Health Insurance Product or its nearest substitute approved by IRDA.
Renewal Terms
  1. This policy will automatically terminate at the end of the Policy Period. All renewal applications should reach the Company before the end of the policy period. The same may be renewed by mutual consent and in such event the renewal premium will be paid to the Company on or before the date of expiry of the policy or of the subsequent renewal thereof.
  2. The Policy can be renewed under the then prevailing Health Insurance Product or its nearest substitute approved by IRDA.
  3. Renewal Premium – Premium payable on renewal and on subsequent continuation of cover are subject to change with prior approval from IRDA.
Grace Period – 30 days from the expiry of the Policy. The Company will not be liable for any claim which occurs during the Grace Period.
Increase of Sum Insured The policy holder can enhance his/ her Sum Insured under the Policy only upon renewal, subject to a review by the company.

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Our Advice

We will advise people below the age of 60 to go for a Family Floater Plans with “Super No Claim Bonus Rider” whereas people above the age of 60 should go for Individual Plans as it will costing less in comparison to Family Floaters.

But one should take a decision only after analyzing his needs and the money he can spend to buy the policy.

Frequently Asked Questions

Yes, with the ‘floater’ plan one can cover any member of his/ her immediate family for the sum insured in a single policy.
One has an option to choose a policy with a term of one, two or three years.
Yes, zero payment treatment at leading hospitals. With cashless hospitalization, the policy holder no longer needs to run around paying off hospital bills and then following up for a reimbursement. All is needed to do is to get admitted to any of the network hospitals.
  • Hospitalization for at least 24 hours: if the policy holder is admitted to a hospital for in patient care, for a minimum period of 24 consecutive hours, the company pays for – room charges, nursing expenses, intensive care unit charges, surgeon’s fee, doctor’s fee, anesthesia, blood, oxygen, operation theater charges, etc.
  • Hospitalization for less than 24 hours: The Company also pays for the medical expenses if the policy holder undergoes a day care treatment at a hospital that requires hospitalization for less than 24 hours. Religare Health covers a comprehensive range of day care treatments.
  • But there are times when going to the hospital is not possible: Domiciliary hospitalization will reimburse the medical expenses incurred by the policy holder during his/ her treatment at home, so long as it involves medical treatment for a period exceeding 3 days and had actually merited hospitalization.
  • Pre-hospitalization expenses: Examination, Tests, Medication etc. are covered.
  • Ambulance expenses will be reimbursed.
  • Post-hospitalization expenses: Follow-up visits, Consultations, Therapy, Medication etc. are covered.
  • And non-medical expenses are covered as well: transportation, attendant’s cost & other daily expenses with our ‘’Daily Allowance’’.
After purchasing the policy, if the policy holder finds it unsuitable, he/ she can cancel and return the policy. It comes with a free-look period of 15 days.
  • Any pre-existing ailment/injury that was diagnosed/acquired within 48 months prior to issuance of the first policy.
  • Any diseases contracted during first 30 days of the policy start date except those arising out of accidents.
  • Non-allopathic treatment.
  • Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide).
  • Expenses arising out of or attributable to alcohol or drug use/misuse/abuse.
  • Cost of spectacles/contact lenses, dental treatment.
  • Medical expenses incurred for treatment of AIDS.
  • Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences.
  • Congenital disease.
  • War, riot, strike, nuclear weapons induced hospitalization.
  • Tests and treatment relating to infertility and in vitro fertilisation.
  • Remember, there are some treatments such as non-infective arthritis, joint replacement etc., which are covered only after completion of 2 consecutive policy years.

Claim Process

  • Step 1:

  • In case of emergency, please intimate the company within 24 hours of hospitalisation. If planned hospitalisation, intimate the company 48 hours prior to your admission.

    Contact : 1800-200-4488

    Fax : 1800-200-6677

    Email : customerfirst@religarehealthinsurance.com

  • Step 2:

    1. Cashless, Request for Pre-Authorisation:
    2. Complete the pre-authorisation form available at the hospital's insurance/TPA Desk and send us through email/fax.
      Approval Approved letter sent by the claim management team
      Query Hospital / Insured to respond to any query raised by the claim management team
      Rejected You may initiate the treatment and file for re-imbursement claim
    3. Re-imbursement, Claim from submission
    4. Submission of claim from along with required documents, as per the policy terms & conditions.
      Approval Approved letter sent by the claim management team
      Query Insured to respond to query, if any, rose by the claim management team
      Rejected The Company will communicate the reason