Health Insurance

Health insurance is a contract that provides financial protection to you (the policyholder) for medical expenses covered by the insurer in exchange for a premium. If at all a health crisis or emergency occurs, or you require hospitalisation, the cost of expenses will be covered by health insurance. No need to worry about bills, health insurance ensures you receive quality healthcare facilities and focus on recovery rather than paying the bills. In today’s day and age, where medical inflation is on the rise, medical insurance will have your back financially.

Health Insurance or also known as Medical Insurance, covers medical expenses for you (the policyholder) for a simple premium price. It includes coverage for treatments, surgeries, prescriptions, and hospitalisation costs, ensuring financial security during medical emergencies. Health insurance is no longer an expense, but rather a necessity that will help you out financially in times of need. Having the right health insurance will give you peace of mind, complete coverage and also, under section 80D of the Income Tax Act 1961, get tax benefits on premium payment of health insurance online.

An ideal health insurance plan should cover all the potential diseases. A health insurance policy is highly customizable and should be tailored according to the policyholder’s requirements. The amount covered or sum insured should be enough to cover medical treatments. Sum Insured refers to the maximum amount your health insurance policy will cover for medical expenses during the policy period. The amount covered depends on the following factors:

• Location

Depending on the location where the policyholder resides, the sum insured should be adjusted. For example, an urban city like Mumbai is expensive than a rural area, hence someone residing in Mumbai would require a higher sum-insured amount.

• Age

The age of the policyholder is an important factor while deciding the sum insured amount. For example, an older person above the age of 60 may require more medical attention than a younger person who just turned 18, and hence would require a higher sum insured.

• Future Health Problems

If your family has a history of critical illnesses, it's wise to plan ahead and create a financial buffer to manage potential healthcare expenses. Securing a higher sum-insured now will pay its fruits later.

• Budget

As the sum insured amount increases, so does the premium. Find the perfect balance between the sum insured and the premium paid for an optimum health insurance.

Depending on the location, type of health plan, and approx health costs in the area, here’s how much you would require:

Disclaimer: These are assumptions made about healthcare costs in each city tier. For an accurate sum-insured amount, consider your medical conditions, their cost and other requirements.

These amounts are just estimates and should not be treated as the exact amount required in each city. You can always opt for more or get a top-up plan to further extend your sum insured amount. Nowadays, health insurance with ₹1 crore+ sum-insured is getting popular, and generally, the monthly premium for such costs an additional ₹1,500 only (Depends on age, insurer, location, etc. Compare through Coverfox for accurate pricing).

As there has been constant progression in the healthcare infrastructure in India, so has been the cost of availing these healthcare facilities. Without health insurance, you wallet is in grave danger if you get sick. Here are top reasons why you should by health insurance in India:

Purchasing medical insurance requires careful consideration to ensure you get maximum coverage and a smooth claim process. Use this checklist to evaluate the best plan for your needs:

Nowadays, you can sit on your chair, relaxing at home and buy a health insurance plan online. Here are the benefits of buying health insurance online:

So far it is clear that medical insurance is ideally extremely helpful. Some of its most highlighted benefits include:

• Sum Insured: Coverage ranges from ₹1 lakh to ₹6 crore.

• Hospital Stay: Room rent and ICU charges covered as per policy terms.

• Pre & Post-Hospitalisation: Expenses for 30–60 days before and after hospitalisation are covered.

• Treatment Coverage: Includes day care procedures, maternity expenses, and pre/post-existing diseases (after the waiting period).

• OPD Benefits: Doctor’s consultation fees and medication are covered.

• Additional Riders: Option to add extra coverage benefits through riders.

• Emergency Support: Ambulance charges and organ donor expenses are covered as per policy provisions.

• Wellness Benefits: Free health check-ups as per the insurer’s plan.

• Tax Savings: Eligible for tax benefits under Section 80D.

• Claim & Portability: Easy cashless or reimbursement claims with portability across insurers.

Disclaimer: For exact details, refer to your health insurance policy.

While health insurance provides extensive coverage, certain exclusions exist:

• Pre-existing conditions during the waiting period.

• Cosmetic surgeries and aesthetic treatments.

• Dental and oral treatments (unless accident-related).

• Illnesses within the initial waiting period (30-90 days).

• Injuries from war, terrorism, or hazardous activities.

• Substance abuse-related complications.

• Non-medical expenses like toiletries and administrative fees.

Health insurance riders or otherwise known as add-ons, are additional coverages that can be used to enhance your health insurance policy, to cover a wider array of aspects and benefits. It makes your health insurance policy more comprehensive, ensuring you receive coverage as per your needs. The price of the health insurance riders or add-ons depends on the health insurance policy online, and considers factors like age, type of coverage, total sum insured, location, etc. Here are a few common health insurance riders that are opted for along with health insurance policies.

• Room Rent Waiver

This rider ensures there is no limit on the type of hospital room you can opt for during treatment. Whether you choose a general ward, semi-private, or private room, the charges are fully covered under your policy as per the terms. This gives you complete freedom to select the level of comfort and privacy you prefer without worrying about extra costs.

• Maternity Benefits

Maternity benefits provide coverage for childbirth expenses, including prenatal and postnatal care. They often cover both normal and C-section deliveries, along with newborn care as per policy. This add-on is especially valuable for young couples planning a family, as it reduces the financial stress of maternity-related medical costs.

• OPD Coverage

Outpatient Department (OPD) coverage reimburses expenses for medical consultations, diagnostic tests, and medicines that don’t require hospitalisation. It’s ideal for people with frequent doctor visits or minor treatments. This rider ensures that everyday healthcare expenses are managed without affecting your main hospitalisation cover.

• Critical Illness Rider

This rider offers a lump-sum payout upon the diagnosis of specified severe illnesses such as cancer, stroke, or heart attack. The payout can be used for hospitalisation, alternative treatments, or even daily living expenses during recovery as per the terms of the health insurance policy. It’s an added layer of financial protection against high-cost, long-term treatments.

• Accidental Disability Cover

Accidental disability cover provides compensation in the event of permanent or partial disability caused by an accident. The payout helps in managing medical costs, lifestyle changes, or income loss due to reduced working capacity. This benefit ensures you can maintain financial stability even after an unforeseen mishap.

• Consumable Cover Rider

Non-medical expenses that are included in a treatment, like cotton, thermometer, syringes, etc are generally not covered by health insurance unless you have the rider “consumable cover”. This rider ensures you receive reimbursement or payment from the insurer on consumables that are not generally covered by a health insurance policy. Although this amount is small (around 15% of the total bill), this cover ensures out-of-pocket expenses are reduced.

In order to buy health insurance online, you must have the following criteria met:

Buying and renewing health insurance online is quick and convenient. Follow these steps:

1. Visit the Coverfox Website

Go to www.coverfox.com and navigate to the Health Insurance section. There, you will see an option to Buy or Renew your Plan.

2. Enter Your Basic Details

Fill in details such as your contact number, age, gender, pincode of where you reside, and whether you want coverage for yourself or your family. This helps the system suggest the most relevant plans.

3. Compare Plans

Browse through a curated list of plans from multiple insurers, showing premium amounts, benefits, and coverage details side by side. Use filters to refine your search based on your needs.

4. Check Key Features & Add-ons

Click on a plan to see detailed benefits like room rent limits, maternity cover, pre-existing disease coverage, cashless hospital networks, and optional riders such as critical illness or hospital cash.

5. Get a Premium Quote

The system will calculate your premium based on your details and chosen coverage. You can adjust the sum insured or add-ons to see how it impacts the premium.

6. Proceed to Prosper Details

Fill out the insurer’s proposal form with personal, health, and lifestyle information. Ensure accuracy to avoid claim issues later.

7. Complete Payment Securely

Pay online using debit/credit card, net banking, UPI, or wallets. Coverfox uses secure payment gateways for safety.

8. Schedule Medical Tests (if required)

Some policies may require a quick health check-up before issuance of health insurance online. This is generally free, depending on the insurer.

9. Receive Your Policy Instantly

Once approved, you’ll receive your e-policy in your registered email. You can also download it anytime from your Coverfox account.

Porting your health insurance policy means transferring your existing health insurance policy from one insurer to another while retaining benefits like your waiting period credits. At Coverfox, we make this process simple, quick, and fully guided, ensuring you choose a plan that suits your evolving needs without losing your hard-earned benefits. Here is a step by step guide to port your health insurance policy through Coverfox.

1. Visit the Coverfox Website

Go to www.coverfox.com and navigate to the Health Insurance section.

2. Go to the Compare Plans Page

Enter your details (age, gender, city, coverage type) to see plans from multiple insurers for comparison.

3. Click on the “Port Your Policy Made Easy” Option

Under the Port Your Policy section, click on Contact Now to be able to port your health insurance policy.

4. Provide Your Contact Number

Enter your phone number in the given field. This helps us connect you with a dedicated expert for personalised guidance.

5. Get a Callback from a Coverfox Expert

Our team will call you to understand your current policy details, requirements, and preferences for the new plan.

6. Receive Tailored Plan Recommendations

Based on your needs, our advisor will share suitable policy options, highlighting premium, coverage, and additional benefits.

7. Submit Required Documents

Share your existing policy details, ID proof, medical history, and any other insurer-required documents.

8. Complete Insurer’s Porting Formalities

Coverfox will coordinate with your chosen insurer to ensure a smooth porting process within the IRDAI timelines.

9. Get Confirmation & New Policy Document

Once approved, you’ll receive your new policy with ported benefits directly via email.

• Age proof like a passport, birth certificate, etc.

• Identity proof like a passport, Aadhaar Card, etc.

• Address proof like a passport, DL, utility bills, etc.

While most insurers today issue digital policies for quick access and eco-friendliness, many policyholders still prefer having a physical copy for record-keeping and ease of reference. A printed policy document serves as official proof of coverage and can be handy during emergencies when digital access is not possible. Coverfox ensures that getting your physical copy is simple and hassle-free.

Ways to Get a Physical Copy:

1. Print through Email

Download the e-policy sent to your registered email address by your insurer and print it for your records.

2. Visit Insurer's Office

Go to the nearest branch of your insurance provider with valid ID and policy details to request a physical copy.

3. Login to Your Account

Access your insurer’s official website or mobile app, download the e-policy, and print it directly.

4. By Contacting Support of the Insurer

Reach out to the insurer’s customer service via phone, email, or chat and request a printed copy to be sent to your registered address.

Coverfox is a commendable name in the health insurance India industry in India. Some of the significant reasons for purchasing best health insurance plans through Coverfox include:

• User-friendly: Coverfox maintains a simple and easy-to-understand interface for easy online health insurance purchases in India. You can even use their official site to renew health insurance online in India.

• Ample options: Coverfox offers best health insurance options considering the varied requirements of the wide customer base.

• Affordable: The health insurance options available on Coverfox are comparatively much more affordable and offer competent comprehensive coverage.

• Network hospitals: Coverfox maintains a wide network of hospitals throughout the country for easy cashless hospitalisation facilities.

Choosing the right health insurance policy can seem overwhelming, but breaking it down into a few key steps will make the process simpler and more effective.

1. Assess Your Needs

Start by evaluating your medical history, family health risks, lifestyle, and preferred hospitals. If you have dependents, consider whether you need a family floater plan or individual coverage.

2. Decide the Sum Insured

Estimate future healthcare costs in your city (Tier 1, 2, or 3) and choose a sum insured that offers adequate protection without straining your budget.

3. Compare Plans Online

Use Coverfox to evaluate multiple plans from different health insurance companies side-by-side. Check benefits, premiums, add-ons, and exclusions before shortlisting.

4. Check Network Hospitals & Cashless Claim Availability

Choose an health insurer company with wide hospital network, providing cashless claim facilities to ensure faster and stress-free treatment during emergencies.

5. Review Waiting Periods & Pre-existing Disease Coverage

Understand the waiting periods for illnesses and ensure your pre-existing conditions are covered as soon as possible.

6. Look for Add-on Benefits

Consider riders like critical illness cover, maternity benefits, or room rent waivers for more comprehensive protection.

7. Read the Policy Document Carefully

Before buying, go through the fine print to avoid surprises during claim settlement.

8. Leverage Online Discounts & Tax Benefits

Buying online often comes with exclusive offers, and you can claim deductions under Section 80D of the Income Tax Act.

Comparing health insurance plans before purchasing ensures you get the most suitable coverage at the best possible value. Since no single plan fits everyone’s needs perfectly, a careful comparison helps you choose one that aligns with your health requirements, lifestyle, and budget.

Key Reasons to Compare Health Insurance Plans Online:

• Better Coverage: Find policies that offer the most comprehensive benefits, ensuring you’re protected against a wide range of medical expenses.

• Cost-Effectiveness: Identify plans that balance premium affordability with strong coverage, making your investment worthwhile.

• Understanding Exclusions: Avoid claim surprises by learning what’s not covered before you buy.

• Customisation Options: Explore add-ons and riders to enhance your base plan for more tailored protection.

• Value for Money: Ensure you get the best benefits for the price you pay.

• Know the Terms & Conditions: Comparative study improves your understanding of policy clauses, waiting periods, and claim rules.

• Explore Additional Benefits: Discover unique perks, wellness programs, or extra covers offered by different insurers.

• Stay in Control: By comparing, you take charge of securing a policy that truly meets your personal and financial needs.

Health insurance premium is the amount you pay to your health insurance company or insurer to keep your policy active and enjoy its benefits. It can be paid monthly, quarterly, annually, or as per the insurer’s terms. The premium you pay is influenced by multiple factors, ensuring that the cost reflects the level of risk the insurer takes on your behalf. Understanding how it is calculated and the elements that affect it helps you make informed decisions while buying or renewing a policy.

How to Calculate Health Insurance Premium?

Health insurance is valid and effective only if a fixed premium is paid. This fixed premium is calculated on various factors – that affect its price. In order to calculate how much premium you will need to pay for health insurance, you can rely on Coverfox. Just visit the Coverfox website and follow these steps:

1. Enter your details.
2. Filter out your requirements (Sum insured, add-ons, type of insurance, etc).
3. You will be shown the premium price each insurer is asking for your requirements.

To understand how health insurance premium is affected, you need to understand the factors affecting health insurance.

What are the Factors affecting Health Insurance Premium?

1. Age

Premiums tend to increase with age because health risks rise as you grow older.

2. Medical History

Pre-existing diseases or a history of critical illnesses often result in higher premium amounts.

3. Lifestyle Choices

Unhealthy habits like smoking or excessive drinking increase the likelihood of claims and, therefore, premiums.

4. Coverage Amount & Add-ons

Opting for a higher sum insured or adding riders (e.g., critical illness, maternity) raises your premium.

5. Location

Living in metro or Tier-1 cities may lead to higher premiums due to higher medical costs in these areas.

6. Policy Tenure

Longer policy tenures may sometimes come with discounted premium rates.

Filing a health insurance claim is straightforward if you follow the insurer’s process, intimate on time, and submit the right documents. With features like Cashless Everywhere, policyholders can now request cashless treatment at many network and non-network hospitals (subject to insurer terms), reducing the need to pay large sums upfront. Whether you use cashless or reimbursement, timely intimation, accurate medical records and quick responses to insurer queries speed up settlement and reduce stress during recovery.

Two types of health insurance claims

• Cashless Claim

A cashless claim means the insurer settles eligible hospital bills directly with the hospital — you do not pay (or pay only non-covered amounts). The hospital raises a pre-authorisation request with the insurer, who checks policy coverage and approves payment per the policy terms. Cashless is ideal for planned and emergency admissions if the hospital and insurer agree.

• Reimbursement Claim

With reimbursement claims, you pay the hospital yourself and later submit bills and medical documents to the insurer fora refund. This is used when cashless is not available (non-empanelled hospitals or if pre-authorisation is not granted). Reimbursement requires careful documentation and can take longer due to verification.

Filing a Claim for Planned (Elective) Hospitalisation

• Check coverage & pre-authorisation requirements

Confirm that the proposed treatment is covered under your policy and whether pre-authorisation is required (many insurers require 48-hour intimation for planned admissions).

• Notify your insurer

Contact your insurer at least 48 hours before admission. Provide policy number, planned admission date, hospital details and tentative diagnosis.

• Receive Pre-Authorisation Form / Number

The insurer or TP A (third-party administrator) will issue a pre-auth number and list documents required; share this with the hospital.

• Hospital forwards pre-auth request

The hospital’s billing/insurance desk sends a pre-authorisation request with expected costs to the insurer.

• Insurer assesses & approves

Insurer verifies policy terms, check limits and approves (fully/partly) or requests clarifications. Keep the approval letter/number.

• Undergo treatment

Proceed with the admission and treatment; the hospital coordinates with the insurer for direct billing.

• Discharge & final bill settlement

On discharge, hospital finalises bills; insurer settles admissible amounts directly with the hospital. You pay only non-covered items, deductibles or co-pay, if any.

• Follow up

Keep the pre-auth number and discharge documents; if any post-hospitalisation bills arise, submit them as per insurer timelines.

Filing a Claim for Emergency Hospitalisation

• Seek immediate medical care

In emergencies, prioritise treatment. Inform the hospital you have insurance and share policy details on arrival.

• Intimate insurer ASAP (within 24–48 hours)

Contact your insurer or broker immediately or within the insurer’s stated window (many ask within 24–48 hours). For Cashless Everywhere, intimation within 48 hours is usually required.

• Hospital raises pre-auth (if cashless)

The hospital will attempt a cashless pre-authorisation with your insurer; the insurer may approve, seek clarifications, or request clinical notes.

• If cashless approved

Insurer and hospital agree payment; you remain focused on care and pay only non-admissible items.

• If cashless not possible

You may need to pay upfront (common in non-empanelled hospitals or medico-legal cases); keep all original bills and receipts.

• Collect discharge documents

Obtain discharged summary, final bills, investigation reports, doctor’s prescriptions and payment receipts. These are essential for any claim.

• Submit claim (reimbursement) promptly

Upload or send documents via the insurer’s portal/mobile app within the insurer’s deadline. Include claim form, policy copy, ID proof, hospital bills, discharge summary, investigation reports and any police/FIR if applicable.

• Follow up until settlement

Track the claim online or through the insurer’s helpline; respond quickly to any document or clarification requests.

Quick tips for faster settlement

• Intimate early and get a pre-auth number for cashless claims.

• Keep photocopies and digital scans of all documents; upload via the insurer’s app/portal for faster processing.

• Keep clear records of communications (names, times, reference numbers).

• Respond promptly to any insurer queries to avoid delays.

1). Documents Needed for Filing a Claim against Health Insurance Online

• A duly filled and signed claim form

• Recent passport-size photo

• All the hospital bills, receipts, documents, reports, prescriptions

• Pre-authorised claim form for cashless claim

• Identity proof

2). List of Documents Necessary to Claim Under Reimbursement

For reimbursement claim, you need the following documents:

• Discharge summary from the hospital

• All the receipts, bills, prescriptions, reports, and documents, issued during hospitalisation

• Identity proof

During any medical contingency, a cashless treatment facility comes in extremely handy. Some of the major benefits of cashless treatment include:

• Easy access to fast treatment

With the help of a cashless health insurance plans, you can easily access quality healthcare immediately without financial worries. You need to inform the authorities within 24 hours of emergency hospitalisation and 48 hours of planned hospitalisation.

• Comprehensive benefits

With the aid of a cashless treatment facility, you can utilize all the comprehensive benefits of your medical insurance plan.

• Coverage during travel

If you, unfortunately, fall sick while travelling, you can avail of a cashless treatment facility at any network hospital throughout the country.

• No immediate out-of-pocket burden

Cashless treatment spares you from arranging large sums of money upfront during medical emergencies. The insurer settles eligible expenses directly with the hospital, allowing you to focus on recovery instead of finances.

• Cashless Claim

  A process where medical expenses are directly paid to the hospital by the insurer, without the policyholder paying first. Requires treatment at a network hospital.

• Claim Settlement Ratio (CSR)

The percentage of claims settled by an insurer out of the total claims received in a financial year. Higher CSR indicates better reliability.

• Co-payment

A fixed percentage of the claim amount that the policyholder must pay, while the insurer pays the rest. Often applicable to senior citizen policies.

• Critical Illness Cover

A rider or standalone plan that provides a lump sum payout on the diagnosis of serious illnesses like cancer, heart attack, or stroke.

• Daycare Procedures

Medical treatments or surgeries that require less than 24 hours of hospitalisation due to advanced technology. Common examples include cataract surgery and dialysis.

• Deductible

The pre-decided amount you must pay out-of-pocket before the insurer starts covering costs. Higher deductibles generally mean lower premiums.

• Exclusions

Conditions, treatments, or expenses that are not covered by the insurance policy. Examples include cosmetic surgery or self-inflicted injuries.

• Free Look Period

A 15–30 day window after policy purchase during which you can review the terms and cancel the policy for a refund if unsatisfied.

• Grace Period

The time (usually 15–30 days) given after the premium due date to renew the policy without losing benefits. Claims during this period are not covered.

• Network Hospital

A hospital that has a tie-up with your insurer to provide cashless treatment. Bills are directly settled between the insurer and the hospital, reducing your upfront costs.

• No-Claim Bonus (NCB)

A reward for not making any claims during a policy year. Usually given as an increase in sum insured or a discount on the renewal premium.

• Pre-existing Disease (PED)

Any illness or condition that you had before purchasing the policy. Coverage is usually provided after serving a waiting period.

• Premium

The fixed amount you pay to your insurer, usually monthly or annually, to keep your health insurance policy active. Premium amounts depend on factors like age, coverage type, sum insured, and health status.

• Reimbursement Claim

A process where you pay the medical expenses yourself and then submit bills to the insurer for repayment. Used when treatment is taken at non-network hospitals.

• Restoration Benefit

A feature where the insurer replenishes the sum insured after it gets exhausted during the policy year. Often used for unrelated illnesses.

• Room Rent Limit

The maximum daily allowance for hospital room charges under your policy. Choosing a higher category room than your limit may lead to proportionate deductions in your claim.

• Sum Insured

The maximum amount your insurer will pay during the policy term for covered medical expenses. Any expenses beyond this limit must be borne by the policyholder.

• Super Top-up Plan

Similar to a top-up, but considers the total expenses in a year rather than a single claim to trigger the coverage beyond the deductible.

• Top-up Plan

An additional coverage plan that activates once a certain deductible amount is crossed. Helps increase overall coverage at a lower cost.

• Waiting Period

The initial period during which specific illnesses or pre-existing conditions are not covered. It typically ranges from 30 days to 4 years, depending on the condition and policy.