Mukesh
I appreciate the flexibility of this health insurance. There are plans to suit every budget, and I can easily customise it to meet my needs
30 Jan
Language
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.
| Feature | Details |
|---|---|
| Sum Insured | Range starting from ₹1 Lakh to above ₹1 Crore |
| Premium | Starting @ ₹8/Day |
| Ambulance Cover | Included in most policies |
| Day Care Procedures | Coverage for procedures not needing 24-hour hospitalisation |
| Free Health Check-ups | Offered under select plans |
| ICU Charges | Fully covered depending on the plan |
| Maternity Cover | Offered in specific plans with waiting periods |
| OPD Cover | Available for consultation, diagnostics, and minor treatments |
| Pre & Post-hospitalisation Expenses | Expenses before and after hospital stay are reimbursed |
| Pre-existing Diseases | Covered after a waiting period (varies by plan) |
| Room Rent Limit | Unlimited up to Sum Insured as per insurance policy |
| Tax Benefits | Tax deductions up to ₹1 lakh annually under Section 80D* |
Disclaimer: * Tax Benefits are maxed, including both parents as senior citizen benefits. Premium price may differ from location to location, and across different insurers. For coverage, check your health insurance policy for exact details.
The General Insurance Council (GIC), backed by the IRDAI, has launched a nationwide initiative to ensure 100% cashless hospitalisation for health insurance policyholders, including those covered under group policies. Rolled out in July 2024, this reform aims to eliminate the burden of paying hospital bills upfront and later filing for reimbursement. Over 40 insurance companies and over 7,700 hospitals have joined the mission. The initiative ensures faster claim settlement, transparency in billing, and greater policyholder convenience, regardless of whether the hospital is part of an insurer’s network. This move is especially beneficial in emergency situations where financial delays can impact treatment. It marks a shift towards a more customer-centric and digitally driven medical insurance ecosystem.
Disclaimer: *T&C Apply. Blacklisted hospitals are not included, and the facility is available subject to the hospital.
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:
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.
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.
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.
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:
| City Tier | Individual Plan | Family Floater Plan | Senior Citizen Plan |
|---|---|---|---|
| Tier 1 (Metropolitan cities) | ₹10-15 Lakhs | ₹25–50 Lakhs | ₹20+ Lakhs |
| Tier 2 (Developing cities) | ₹5-10 Lakhs | ₹20–30 Lakhs | ₹15+ Lakhs |
| Tier 3 (Rural/Other cities) | ₹5 Lakhs | ₹10–20 Lakhs | ₹10+ Lakhs |
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:
The cost of quality healthcare is rising exponentially due to medical inflation. A health insurance plan ensures you can access the best treatments without depleting your savings. From hospitalisation to medication, your policy acts as a financial cushion during unexpected medical emergencies.
Health insurance allows you to get treated in well-equipped private hospitals with better facilities. You can focus on getting the best care, rather than worrying about how you’ll afford it.
Health insurance allows you to avail of cashless treatments at network hospitals, reducing the financial burden during emergencies. You no longer need to arrange funds upfront; the insurer directly settles your bills with the hospital.
The prevalence of lifestyle-related diseases such as diabetes, hypertension, and cardiac conditions has increased due to sedentary habits and stress. Medical insurance offers coverage for these ailments, including routine check-ups, preventive care, and treatment costs.
Most medical insurance policies cover not only hospitalisation expenses but also the costs incurred before and after hospitalisation. These include diagnostic tests, follow-up consultations, and medications.
Modern health insurance plans provide critical illness coverage, offering a lump-sum payout if diagnosed with severe conditions like cancer, stroke, or organ failure. This ensures you’re financially prepared for advanced treatments.
Purchasing medical insurance helps you save on taxes. Under Section 80D of the Income Tax Act, you can claim deductions of up to ₹1,00,000 (for senior citizens) on premiums paid for yourself and your family.
With the right health insurance plan, you’re prepared for any medical emergency. This peace of mind allows you to focus on recovery rather than worrying about financial burdens during challenging times.
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:
| Checklist Item | Details |
|---|---|
| Inclusions and Exclusions | Review what is and isn’t covered under the policy to avoid surprises during claims. |
| Waiting Periods | Understand the waiting periods for pre-existing diseases, maternity benefits, and specific treatments. |
| Network Hospitals | Check the list of cashless network hospitals to ensure coverage in your area. |
| Sum Insured | Choose an adequate sum insured to meet potential medical expenses, considering rising costs. |
| Premium and Benefits | Compare premiums with the coverage offered to strike the right balance between cost and protection. |
| Claim Settlement Ratio | Look for insurers with high claim settlement ratios for faster and hassle-free claim processing. |
| Add-On Covers | Opt for riders like critical illness cover, maternity benefits, or room rent waiver if required. |
| Portability Options | Check if you can switch policies or insurers without losing accumulated benefits. |
| Free Health Check-Ups | Ensure the policy offers complimentary annual health check-ups for proactive health management. |
| Co-Payment | Opt for health insurance policies with no co-payment. This helps to reduce or remove totally the out-of-pocket expenses. |
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:
Coverfox allows you to compare multiple insurers side-by-side based on premiums, benefits, add-ons, and exclusions. This helps you choose a plan that best fits your health needs and budget without relying on agents.
As soon as you complete your application and payment online, your policy document is issued instantly. There’s no waiting for manual approvals or delays in courier delivery – it’s seamless and immediate.
Buying online eliminates middlemen, reduces paperwork, and brings down administrative overheads. These savings often get passed on to you in the form of discounted or lower premiums.
You can explore, compare, and purchase a policy any time – day or night, weekday or weekend. This flexibility makes it convenient, especially for working professionals with tight schedules.
Every detail – from inclusions and exclusions to waiting periods and co-pay clauses – is presented upfront. This ensures you know exactly what you're signing up for and avoids last-minute surprises during claims.
No more long queues or printing forms. You can upload the required documents and complete KYC online in minutes. The entire process is digital, user-friendly, and saves both time and effort.
Coverfox helps you track your policy status, file claims, and set reminders for renewals. It ensures you never miss a deadline and stay covered without gaps in policy validity.
You can read customer reviews, claim settlement ratios, and ratings for each insurer before buying. This added layer of insight builds trust and helps you choose a provider with a good service track record.
So far it is clear that medical insurance is ideally extremely helpful. Some of its most highlighted benefits include:
All standard health plans cover hospitalisation costs. However, claims are settled only for those health issues that were not present during the policy purchase. Several insurance providers offer plans like critical illness plans, offering coverage for listed critical ailments, accidental coverage plans, etc.
Several insurance providers offer plans without any room rent capping on ICU charges. The beneficiary can opt to live in a private cabin at the cost of the insurance provider. However, if it exceeds the plan terms, he/she has to settle the excess dues.
Health insurance plans also cover mental illness treatment costs. This has become mandatory as per the IRDAI norms, considering the steep rise in mental health issues.
Only a specific handful of health insurance plans offer coverage for obesity treatment. The premium rates are slightly higher.
Health insurance also includes coverage for Ayurveda, Yoga, Unani, Siddha and Homoeopathy treatments.
Some health insurance plans provide coverage for maternity expenses, including delivery costs, prenatal and postnatal care, and even medical expenses for the newborn for a specified period.
Health insurance plans usually cover room rents during hospitalisation. They previously disclosed the total disbursement amount in this context.
These are those medical procedures that require less than 24 hours of hospitalisation, like cataract surgery, angiogram, dialysis, etc. Most health insurance plans cover these.
General health insurance plans allow road ambulance cost coverage incurred during medical contingency.
Under such health insurance plans, you can make up to 2 claims per year within the specified sum insured limit, provided the health issues differ in both cases.
Best health insurance plans also offer daily cash allowance to compensate for the income loss incurred during the term of hospitalisation.
In terms of medical insurance, zones are classified as per the average medical expenses in the concerned city. They tend to be comparatively higher in the metro cities than in towns and other smaller cities. This particular add-on allows you to consider the cost disparity costing slightly additional premium charge. However, it subsequently saves your total premium payment cost by nearly 10% to 20%.
Certain treatments may require domiciliary treatment rather than hospitalisation as per the doctor’s advice. Some medical insurance plans even offer coverage for such treatments too.
If any major organ like the liver or kidney requires replacement, it becomes extremely expensive. However, health insurance plans cover organ donation costs depending on the terms of the plan.
| ELIGIBILITY | EXEMPTION LIMIT |
|---|---|
| For self, spouse, and dependent children | Up to ₹25000 |
| For self +spouse + dependent children + parents below 60 years | Up to ₹50000 |
| For self + family + parents above 60 years (the eldest member other than the parents must be a non-senior citizen) | Up to ₹75000 |
| For self + family + parents ( where both the eldest member and the parents are senior citizens) | Up to ₹1 lakh |
| Myths about Health Insurance | Reality |
|---|---|
| "I'm Young and Healthy; I Don't Need It." | Accidents and sudden illnesses can happen at any age. Early purchase locks in lower premiums. |
| "It Only Covers Hospitalisation." | Modern plans cover OPD, daycare treatments, pre- and post-hospitalisation, and mental health care. |
| "Pre-Existing Conditions Aren't Covered." | They are covered after a waiting period of 2–4 years, and policy portability can reduce this time. |
| "It's Too Expensive." | Affordable options, top-up plans, and tax benefits under Section 80D make it cost-effective. |
| "My Employer’s Plan Is Enough." | Employer coverage ends when you leave the job, and may have a low sum insured. A personal plan offers lifelong protection. |
Different health insurance plans cater to varied needs. Here are the most common ones:
Individual health insurance plan covers medical expenses for a single person. It includes hospitalisation costs, pre- and post-hospitalisation expenses, and other health-related benefits. It’s ideal for individuals without dependents or with specific medical needs.
In a Family Floater Plan, a single sum insured covers all members of the family under one policy, usually including self, spouse, and children. These plans are cost-effective compared to buying separate individual policies. The entire family can utilise the coverage based on their medical needs.
Critical illness plan offers a lump sum payout upon diagnosis of life-threatening illnesses like cancer, stroke, kidney failure, or heart attack. As these diseases are quite expensive to treat, having a critical illness insurance plan is generally advised to be bought as a standalone policy or as an insurance rider (add-on).
Top-up and Super Top-up plans provide additional coverage after a certain threshold (deductible) is crossed. While a top-up applies per claim, a super top-up considers total expenses in a year. They're ideal for enhancing existing coverage without buying a larger base policy.
Designed specifically for individuals aged 60 years and above, these plans account for age-related risks. They usually include higher medical cover, regular health check-ups, and coverage for pre-existing diseases with reduced waiting periods. Premiums may be higher due to age and risk factors.
Group health insurance is a type of health policy offered to a group of people, usually employees of a company, under a single master policy. The premium is often paid by the employer, and coverage typically includes the employee and, in some cases, their family members. It provides uniform benefits to all members of the group and can sometimes include added perks like wellness programs or health check-ups. While it offers cost-effective coverage, it usually ends when the member leaves the group or organisation.
Disclaimer: For exact details, refer to your health insurance policy.
While health insurance provides extensive coverage, certain exclusions exist:
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.
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 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.
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.
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 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.
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:
| Eligibility Factor | Details |
|---|---|
| Age of the Insured | Entry age: 18 to 65 years for adults, as early as 90 days for newborns in family plans. Senior citizen plans available for those above 60 years. |
| Medical History (PEDs) | Pre-existing conditions require a waiting period (2-4 years). Affects premium rates based on risk levels. |
| Risk Exposure and Lifestyle | Lifestyle habits (e.g., smoking) and high-risk jobs may increase premiums. Sedentary lifestyles may also impact premiums. |
| Geographic Location | Premiums may vary by location, with urban areas often having higher rates due to healthcare costs. Premiums may vary by location, with urban areas often having higher rates due to healthcare costs. |
Buying and renewing health insurance online is quick and convenient. Follow these steps:
Go to www.coverfox.com and navigate to the Health Insurance section. There, you will see an option to Buy or Renew your Plan.
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.
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.
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.
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.
Fill out the insurer’s proposal form with personal, health, and lifestyle information. Ensure accuracy to avoid claim issues later.
Pay online using debit/credit card, net banking, UPI, or wallets. Coverfox uses secure payment gateways for safety.
Some policies may require a quick health check-up before issuance of health insurance online. This is generally free, depending on the insurer.
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.
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.
Download the e-policy sent to your registered email address by your insurer and print it for your records.
Go to the nearest branch of your insurance provider with valid ID and policy details to request a physical copy.
Access your insurer’s official website or mobile app, download the e-policy, and print it directly.
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.
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.
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.
Use Coverfox to evaluate multiple plans from different health insurance companies side-by-side. Check benefits, premiums, add-ons, and exclusions before shortlisting.
Choose an health insurer company with wide hospital network, providing cashless claim facilities to ensure faster and stress-free treatment during emergencies.
Understand the waiting periods for illnesses and ensure your pre-existing conditions are covered as soon as possible.
Consider riders like critical illness cover, maternity benefits, or room rent waivers for more comprehensive protection.
Before buying, go through the fine print to avoid surprises during claim settlement.
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.
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.
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:
To understand how health insurance premium is affected, you need to understand the factors affecting health insurance.
Premiums tend to increase with age because health risks rise as you grow older.
Pre-existing diseases or a history of critical illnesses often result in higher premium amounts.
Unhealthy habits like smoking or excessive drinking increase the likelihood of claims and, therefore, premiums.
Opting for a higher sum insured or adding riders (e.g., critical illness, maternity) raises your premium.
Living in metro or Tier-1 cities may lead to higher premiums due to higher medical costs in these areas.
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.
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.
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.
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).
Contact your insurer at least 48 hours before admission. Provide policy number, planned admission date, hospital details and tentative diagnosis.
The insurer or TP A (third-party administrator) will issue a pre-auth number and list documents required; share this with the hospital.
The hospital’s billing/insurance desk sends a pre-authorisation request with expected costs to the insurer.
Insurer verifies policy terms, check limits and approves (fully/partly) or requests clarifications. Keep the approval letter/number.
Proceed with the admission and treatment; the hospital coordinates with the insurer for direct billing.
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.
Keep the pre-auth number and discharge documents; if any post-hospitalisation bills arise, submit them as per insurer timelines.
In emergencies, prioritise treatment. Inform the hospital you have insurance and share policy details on arrival.
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.
The hospital will attempt a cashless pre-authorisation with your insurer; the insurer may approve, seek clarifications, or request clinical notes.
Insurer and hospital agree payment; you remain focused on care and pay only non-admissible items.
You may need to pay upfront (common in non-empanelled hospitals or medico-legal cases); keep all original bills and receipts.
Obtain discharged summary, final bills, investigation reports, doctor’s prescriptions and payment receipts. These are essential for any claim.
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.
Track the claim online or through the insurer’s helpline; respond quickly to any document or clarification requests.
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
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:
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.
With the aid of a cashless treatment facility, you can utilize all the comprehensive benefits of your medical insurance plan.
If you, unfortunately, fall sick while travelling, you can avail of a cashless treatment facility at any network hospital throughout the country.
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.
While dealing with health insurance you must note that health insurance and MediClaim are different:
| Aspect | MediClaim | Health Insurance |
|---|---|---|
| Definition | A type of health policy that covers only hospitalisation expenses up to a predefined limit. | A broader policy covering hospitalisation, pre- and post-hospitalisation, OPD, critical illnesses, and more. |
| Coverage Scope | Limited to actual hospitalisation expenses due to illness or accident. | Comprehensive, includes hospitalisation, OPD, maternity, day care, and optional riders. |
| Sum Insured | Usually has a lower sum insured limit. | Offers higher sum insured options to suit different needs. |
| Illness Coverage | Generally does not cover critical illnesses separately. | Covers critical illnesses with lump sum payouts in addition to hospitalisation costs. |
| Claims Type | Reimbursement or cashless for hospitalisation only. | Cashless and reimbursement for a wider range of medical services. |
| Flexibility | Less flexible, standard coverage. | Highly customisable with add-ons and riders. |
| Premium | Usually lower due to limited coverage. | Slightly higher but offers broader protection. |
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.
The percentage of claims settled by an insurer out of the total claims received in a financial year. Higher CSR indicates better reliability.
A fixed percentage of the claim amount that the policyholder must pay, while the insurer pays the rest. Often applicable to senior citizen policies.
A rider or standalone plan that provides a lump sum payout on the diagnosis of serious illnesses like cancer, heart attack, or stroke.
Medical treatments or surgeries that require less than 24 hours of hospitalisation due to advanced technology. Common examples include cataract surgery and dialysis.
The pre-decided amount you must pay out-of-pocket before the insurer starts covering costs. Higher deductibles generally mean lower premiums.
Conditions, treatments, or expenses that are not covered by the insurance policy. Examples include cosmetic surgery or self-inflicted injuries.
A 15–30 day window after policy purchase during which you can review the terms and cancel the policy for a refund if unsatisfied.
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.
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.
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.
Any illness or condition that you had before purchasing the policy. Coverage is usually provided after serving a waiting period.
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.
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.
A feature where the insurer replenishes the sum insured after it gets exhausted during the policy year. Often used for unrelated illnesses.
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.
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.
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.
An additional coverage plan that activates once a certain deductible amount is crossed. Helps increase overall coverage at a lower cost.
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.
Ans: Policies are available from birth, but typically start from 18 years for adults.
Ans: No, there’s usually a waiting period of 2-4 years.
Ans: Cashless claims are settled directly by the insurer; reimbursement requires you to pay upfront and submit bills for repayment.
Ans: Purchase a top-up policy that extends your sum insured beyond a certain threshold.