Health Insurance

Health insurance is a financial safety net that helps manage medical expenses arising due to illness, injury, or hospitalization. It reduces the burden of rising healthcare costs and ensures timely access to quality treatment without disturbing long-term savings. With increasing lifestyle-related health risks and medical inflation, health insurance has become a basic necessity rather than an option.

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Cashless Hospitals

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Health Insurance Plans

BASE PREMIUM
₹4,103*/annum
  • Up to 15X Guaranteed Bonus over the base Sum Insured with Gullak Benefit
  • Hospitalisation coverage up to Rs. 3 Cr for Heart, Cancer, Stroke and major organ/bone marrow transplant
  • Additional 7.5% discount* for Claim free years.
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BASE PREMIUM
₹18,983*/annum
  • Option to cover Pre-Existing Diseases from 91st day onwards
  • Multiple Restorations of Sum Insured available for both related and unrelated illnesses
  • Guaranteed Cumulative Bonus of 10% every policy year
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BASE PREMIUM
₹17,182*/annum
  • Customizable plans as per changing life stages
  • Loyalty discount on premium from 4th Policy year onwards on the applicable premium
  • Coverage across the globe for Major illnesses including Cancer treatment
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Family health insurance illustration

What is Health Insurance?

Health insurance is a written contract between you and an insurance company. Health insurance plan covers medical, surgical, hospital (inpatient/outpatient), or sickness expenses for a premium, covering treatments, tests, medicines, and sometimes travel/accident benefits incurred either by themselves or others insured as a part of their health insurance plan.

ManipalCigna's Health Insurance Plans at a Glance

Plan Type
Who it is for
Coverage Overview
  • Individual Health Insurance Plan
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 Individuals looking for personal medical coverage Covers hospitalisation, day care treatments, pre- and post-hospitalisation expenses for a single insured person.
  • Family Floater Health Insurance Plan
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 Families wanting shared coverage under one policy. One sum insured shared across family members, covering hospitalisation and related medical expenses.
  • Senior Citizen Health Insurance Plan
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 Older individuals with age-specific healthcare needs. Designed to address higher medical risks with suitable coverage limits and benefits.
  • Top-up / Super Top-up Health Insurance
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 Those looking for protection against serious illnesses. Offers a lump sum payout on diagnosis of listed critical illnesses.
  • Critical Illness Insurance Plan
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 Those looking for protection against serious illnesses. Offers a lump sum payout on diagnosis of listed critical illnesses.
  • Group Health Insurance Plan
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 Offers coverage to members under an affinity or employer employee policy. Covers medical expenses for members enrolled under group policies.
  • Accident Insurance Plan
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 Individuals seeking protection against accidental injuries. Covers accidental death, disability, and injury-related expenses.
  • Disease-Specific Health Insurance
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 Individuals managing specific medical conditions. Focused coverage for particular diseases requiring long-term treatment.

Key Benefits of Having a Health Insurance Plan

Health insurance is more than just hospital bill coverage. A well-designed health insurance plan supports you through medical emergencies, planned treatments, and long-term healthcare needs. It reduces financial uncertainty, improves access to quality care, and helps you manage rising medical expenses with confidence. Below are the key benefits that make health insurance an essential financial safeguard:

  • Cashless Claim:

    Cashless claims allow customers to receive treatment at any network hospital without making upfront payments, as the insurer settles the bills directly with the hospital, subject to policy terms.

  • Coverage for Hospitalisation Expenses:

    Expenses related to room rent, doctor fees, medicines, and procedures are covered as per the policy terms.

  • Cashless Hospitalisation:

    With cashless hospitalisation, insured individuals can receive medical treatment at network hospitals smoothly.

  • Extensive Coverage at an Affordable Premium:

    The best health insurance plans offer wide coverage options at reasonable premium rates.

  • Coverage for Pre- and Post-Hospitalisation Expenses:

    Medical costs before admission and after discharge are covered within specified limits.

  • Financial Cover Against Medical Expenses:

    From minor procedures to major treatments, the best health insurance reduces personal financial burden.

Types of Health Insurance Plans Available at ManipalCigna Health Insurance

  • Senior Citizen Health Insurance:

    Senior Citizen Health Insurance plans are specifically designed to meet the healthcare needs of individuals in their later years. These plans offer coverage for age-related illnesses, frequent hospitalization, and long-term treatments that are more common after retirement. With features such as higher entry age, tailored benefits, and access to a wide network of hospitals, senior citizen health insurance helps ensure financial security and uninterrupted medical care during old age.

  • Top-up Health Insurance:

    Top-up health insurance plans provide additional financial protection once the sum insured of an existing base policy is exhausted. These plans are a cost-effective way to enhance overall health coverage without significantly increasing premiums. By covering large medical expenses beyond a predefined deductible, top-up health insurance ensures that high treatment costs do not impact savings during major medical emergencies.

  • Disease-specific Health Insurance:

    Disease-specific health insurance plans focus on providing coverage for particular medical conditions that require specialised and long-term treatment. These plans are ideal for individuals who are managing specific illnesses and want targeted coverage. By offering benefits aligned with the treatment requirements of certain diseases, disease-specific health insurance helps manage medical expenses more effectively while ensuring continuous care.

  • Maternity Health Insurance:

    Maternity health insurance plans are designed to cover expenses related to pregnancy, childbirth, and newborn care. These plans typically include coverage for delivery costs, pre- and post-natal care, and hospitalisation related to maternity. By reducing the financial burden associated with childbirth, maternity health insurance supports families during an important life stage while ensuring quality medical care for both mother and child.

  • Group Health Insurance:

    Group health insurance plans provide medical coverage to a defined group such as employees of an organisation or members of an association under a single policy. These plans offer comprehensive coverage at comparatively lower premiums due to group participation. Group health insurance ensures access to quality healthcare, enhances employee well-being, and helps organisations support the health needs of their workforce efficiently.

  • Individual Health Insurance Plan:

    Covers a single person with personalised benefits. Individual health insurance plans are designed to cover policyholders against illnesses with cashless hospitalisation and numerous other add-on features. Under this kind of policy, the entire sum insured covers only one individual. Hospitalisation cover makes up the most basic health insurance plans, but optional covers additional riders (added coverage features) and benefits can be customised according to the individual's needs and the insurer’s offerings.

  • Family Floater Health Insurance Plan:

    One sum insured is shared among family members under a single policy. A family floater is a health insurance plan with the benefits of individual plans, but extends the coverage to the entire family rather than just a single individual. A family floater plan ensures that all family members are covered under a single Mediclaim policy. However, any family member can make a claim. Being covered under a family floater health insurance plan is a smart choice, as every family member benefits, given that they come under a single large umbrella. The sum insured is generally really high, thus ensuring that everyone is still covered in spite of one of the members making a claim. One single policy also makes the management of finances easier than managing multiple individual health insurance plans.

  • Critical Illness Plan:

    Provides financial support upon diagnosis of the listed critical illnesses. A Critical Illness Policy covers the insured against life-threatening critical illnesses such as cancer, heart attacks, renal failure, etc. Since these specific illnesses are high-risk, they are not usually covered under basic hospitalisation plans and must be purchased as an additional rider. The benefit of this medical insurance policy is that it provides coverage in the form of a lump-sum amount that is handed over to the policyholder at the time of the first diagnosis. Since these illnesses are long-term, the lump-sum amount can be used for the treatment of expenses depending on the policyholder’s needs.

  • Accident Insurance Plan:

    Covers accidental injuries, disability, and accidental death benefits. Personal Accident Insurance policy provides complete financial protection to the insured members against uncertainties such as accidental death, accidental bodily injuries, and partial/total disabilities, permanent as well as temporary disabilities resulting from an accident. The benefit of this insurance policy is that it can be claimed as a lump-sum amount that is handed over to the policyholder at the time of the accident. This policy is like a contingency fund to protect against loss of income and additional costs that may arise as a result of serious accidents.

Click to know more about Personal Accident Cover Policy – Lifestyle Protection Accident Care

Key Features of a Good Health Insurance Plan

Choosing a good health insurance plan means focusing on features that deliver real value, not just low premiums. From cashless treatment and wider medical coverage to rewards for staying healthy, these benefits ensure easy access to quality care and complete peace of mind.

Cashless Hospitalization

Enables treatment without upfront payment at network hospitals.

No Claim Bonus

Rewards include claim-free years with increased coverage or reduced premiums.

Pre / Post Hospitalisation

Covers medical expenses before and after hospitalisation.

Day-Care Treatment Cover

Includes procedures that do not require 24-hour hospitalisation.

Room Rent Eligibility

Defines coverage limits for hospital room categories

Restore / Refill Benefit

Automatically restores the sum insured after exhaustion.

Health Check-Up

Encourages regular health monitoring.

AYUSH Coverage

Covers alternative treatments as per policy terms.

Cashless Hospitalization

Enables treatment without upfront payment at network hospitals.

No Claim Bonus

Rewards include claim-free years with increased coverage or reduced premiums.

Pre / Post Hospitalisation

Covers medical expenses before and after hospitalisation.

Day-Care Treatment Cover

Includes procedures that do not require 24-hour hospitalisation.

Room Rent Eligibility

Defines coverage limits for hospital room categories

Restore / Refill Benefit

Automatically restores the sum insured after exhaustion.

Health Check-Up

Encourages regular health monitoring.

AYUSH Coverage

Covers alternative treatments as per policy terms.

Documents Required to Buy a Health Insurance Plan

Applying for a health policy requires basic documentation. The required documents are generally uniform across insurers. Here is what you will need:

  • Proof of Identity: Acceptable documents include an Aadhaar card, passport, voter ID, or PAN card.
  • Proof of Address: Documents such as utility bills, a ration card, or any government‑issued address proof may be submitted.
  • Proof of Age: A birth certificate, school leaving certificate, or passport can be provided to verify age.
  • Passport-size Photographs: Recent photographs of the applicant are required.
  • Medical Reports: In the case of senior applicants or individuals with pre‑existing health conditions, a medical examination may be required, and the reports must be submitted to the insurer.
  • Income Proof: This may be requested when opting for higher sum‑insured plans.

Health Insurance Add-ons & Riders

Critical Illness Rider

Provides a lump-sum payout on diagnosis of specified critical illnesses, helping manage treatment costs, income loss, and recovery-related expenses.

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Maternity Add-On

Covers expenses related to pregnancy, childbirth, and newborn care, including delivery and hospitalisation, as per policy terms and waiting period.

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OPD & Dental Rider

Offers coverage for outpatient consultations, diagnostic tests, and dental treatments, reducing routine healthcare expenses.

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Room Rent Waiver Rider

Removes room rent limits, allowing you to choose a higher-category hospital room without additional out-of-pocket costs.

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Daily Hospital Cash Rider

Provides a fixed daily cash benefit for each day of hospitalisation, helping manage incidental expenses not covered under the base policy.

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Critical Illness Rider

Provides a lump-sum payout on diagnosis of specified critical illnesses, helping manage treatment costs, income loss, and recovery-related expenses.

KNOW DETAILS

Maternity Add-On

Covers expenses related to pregnancy, childbirth, and newborn care, including delivery and hospitalisation, as per policy terms and waiting period.

KNOW DETAILS

OPD & Dental Rider

Offers coverage for outpatient consultations, diagnostic tests, and dental treatments, reducing routine healthcare expenses.

KNOW DETAILS

Room Rent Waiver Rider

Removes room rent limits, allowing you to choose a higher-category hospital room without additional out-of-pocket costs.

KNOW DETAILS

Daily Hospital Cash Rider

Provides a fixed daily cash benefit for each day of hospitalisation, helping manage incidental expenses not covered under the base policy.

KNOW DETAILS

Critical Illness Rider

Provides a lump-sum payout on diagnosis of specified critical illnesses, helping manage treatment costs, income loss, and recovery-related expenses.

KNOW DETAILS

Maternity Add-On

Covers expenses related to pregnancy, childbirth, and newborn care, including delivery and hospitalisation, as per policy terms and waiting period.

KNOW DETAILS

OPD & Dental Rider

Offers coverage for outpatient consultations, diagnostic tests, and dental treatments, reducing routine healthcare expenses.

KNOW DETAILS

Room Rent Waiver Rider

Removes room rent limits, allowing you to choose a higher-category hospital room without additional out-of-pocket costs.

KNOW DETAILS

Daily Hospital Cash Rider

Provides a fixed daily cash benefit for each day of hospitalisation, helping manage incidental expenses not covered under the base policy.

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Why do you need Health Insurance?

Having a health insurance policy is vital for multiple reasons. People who are insured receive timely medical aid and suffer less financial stress when it comes to paying medical expenses during illness and/or injury. With medical inflation growing at nearly 14% annually in India healthcare cost will be increasing significantly and hence having health cover acts as a financial safety net to ensure minimum depletion of lifetime savings. Now it is a fact that no one plans to get injured or fall sick, but having a Mediclaim policy improves access to quicker and faster healthcare during an unforeseen medical event.

  • Reasons why everyone needs a health insurance plan:

    Health insurance is no longer limited to covering hospital bills alone. It plays a crucial role in safeguarding individuals and families against financial uncertainty caused by medical emergencies. With unpredictable health conditions, rising treatment costs, and increasing dependence on private healthcare, having a health insurance plan ensures uninterrupted access to quality medical care while protecting long-term savings and financial goals.

  • Dynamic lifestyle:

    With the way life has evolved, there are multiple reasons why having a health insurance policy in place is crucial. The shift in the way we lead our lives has made us prone to illnesses and lifestyle diseases. Traffic-laden commutes to work, hectic work schedules, unhealthy eating habits, preservative-laden food, increasing pollution, reduced sleep, and increased screen time have all added to the risk of developing health problems at a younger age.

  • Medical Inflation in India Is Increasing Every Year:

    Over the recent past, medical inflation is growing at nearly 14% annually in India . Hence, in case of a medical emergency, which always comes as a surprise, people end up spending their lifetime savings. That can take a toll on future financial plans. Hence, a health insurance plan can help ensure that people have timely, good-quality healthcare facilities, and their finances remain safe.

  • Cover for Both Pre and Post-Hospitalisation Expenditure:

    When someone gets hospitalised, the medical expenses don’t start or end on the day they get admitted. There are usually tests, doctor visits, and medicines before and after the hospital stay. This is where pre- and post-hospitalisation cover comes in. This coverage ensures that the entire treatment journey is financially supported from the initial diagnosis to full recovery.

  • Cover for Both Pre and Post-Hospitalisation Expenditure:

    When someone gets hospitalised, the medical expenses don’t start or end on the day they get admitted. There are usually tests, doctor visits, and medicines before and after the hospital stay. This is where pre- and post-hospitalisation cover comes in. This coverage ensures that the entire treatment journey is financially supported from the initial diagnosis to full recovery.

  • Gender-Based Health Risks in India:

    Health risks often vary based on gender due to biological, hormonal, and lifestyle factors. Women may face conditions such as maternity-related complications, anaemia, breast and cervical cancers, while men are more prone to heart diseases and lifestyle disorders at an earlier age. Timely medical care and preventive screenings are essential, and a comprehensive health insurance plan ensures coverage for gender-specific health needs without financial stress.

  • Increasing Cancer Risk:

    The number of cancer cases in India has been steadily rising due to factors such as pollution, lifestyle changes, genetic predisposition, and delayed diagnosis. Cancer treatment often involves prolonged hospitalization, expensive therapies, surgeries, and post-treatment care. Health insurance with critical illness cover helps manage the high cost of cancer treatment, ensuring access to timely care without exhausting personal savings.

  • Heart Diseases:

    Heart-related conditions have become one of the leading causes of hospitalization and mortality in India. Factors such as stress, sedentary lifestyles, unhealthy diets, smoking, and genetic history increase the risk of cardiac illnesses. Treatment for heart diseases often requires emergency interventions, surgeries, and long-term medication, making health insurance essential to manage high medical expenses efficiently.

  • Mental Health Disorders Are Becoming More Common:

    Mental health concerns such as anxiety, depression, stress-related disorders, and burnout are increasingly affecting people across all age groups. The growing awareness and acceptance of mental healthcare have led to higher demand for consultations, therapy sessions, and hospitalisation when required. Modern health insurance plans now include inpatient treatment coverages for mental health treatments, helping individuals seek professional care without hesitation.

  • Health Insurance Offers Financial Security in Emergencies:

    Medical emergencies often arrive without warning and can lead to sudden, substantial expenses. Without health insurance, individuals may be forced to rely on savings, loans, or external financial support. A health insurance policy acts as a financial cushion during emergencies, covering hospitalisation costs and allowing patients and families to focus on treatment and recovery rather than expenses.

  • Comprehensive Coverage Helps Manage Chronic Conditions:

    Chronic illnesses such as diabetes, hypertension, asthma, and arthritis require ongoing medical supervision, regular tests, and continuous medication. Over time, these recurring expenses can place a heavy financial burden on individuals. A comprehensive health insurance plan supports long-term disease management by covering inpatient, pre and post hospitalisation, consultations, and related medical expenses as per policy terms.

  • Peace of Mind for You and Your Family:

    Beyond financial benefits, health insurance provides emotional security and peace of mind. Knowing that medical needs are taken care of allows individuals and families to approach health challenges with confidence. With insurance support, one can prioritise recovery and well-being instead of worrying about treatment affordability and financial disruption.
Family health insurance illustration

Why buy Health Insurance Plans Online

Buying health insurance online offers greater convenience, transparency, and control. It allows you to compare plans, understand coverage details, and complete the purchase process at your own pace without paperwork or delays. Online platforms also make policy management and renewals simpler over time.

Steps to Buy Health Insurance Online

Here is a 5-step guide for how you can buy health insurance online. Buying a Mediclaim policy online is simple and quick. While you buy it online, if you have any queries, you can either get on to a chat or request a call back from the provider. Here are the steps that you should follow to generate a quick quote and then buy:

1

Visit the buy online ManipalCigna page on the brand website. There is a form that you need to fill out. You need to first have all the required information furnished and handy.

2

Choose the product that you are looking for from the three options stated at the top of the form.

3

Choose the kind of cover that you are looking for from the two options. The form changes based on your choice/requirement.

4

Once you do that, fill in all the details about yourself and your family. There is no need to worry, the information is safe.

5

Once you do this, you need to click on the quick quote to generate a quotation based on the details you filled in.

Family health insurance illustration

Why Should You Choose ManipalCigna to Get Health Insurance?

At ManipalCigna Health Insurance, we resonate with the commitment you make towards your health and well-being of your family. Through a wide range of comprehensive healthcare plans, we provide easy and lifelong access to quality healthcare. We are highly focused on protecting and improving your financial, physical and emotional health with our presence across the country and have a great international pedigree too. We are your partners in both illness and wellness, and would be the right choice to get health insurance. We hold a firm belief that “Health Hai Toh Life Hai.”

How to Choose the Right Health Insurance Plan for Your Needs

Adequate Sum Insured

Choose a sum insured that matches medical cost trends and family needs.

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Premium Option

Ensure the premium fits your budget without compromising coverage.

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Check the Network of Cashless Hospitals

A wider hospital network offers better accessibility during emergencies.

KNOW DETAILS

Opt for Plans Without Sub-Limits

Avoid plans with strict room rent or treatment caps.

KNOW DETAILS

Review Waiting Periods

Understand waiting periods for pre-existing conditions and specific treatments.

KNOW DETAILS

Choose a Trusted and Reliable Insurer

Reliability ensures smoother claims and long-term support.

KNOW DETAILS

Adequate Sum Insured

Choose a sum insured that matches medical cost trends and family needs.

KNOW DETAILS

Premium Option

Ensure the premium fits your budget without compromising coverage.

KNOW DETAILS

Check the Network of Cashless Hospitals

A wider hospital network offers better accessibility during emergencies.

KNOW DETAILS

Opt for Plans Without Sub-Limits

Avoid plans with strict room rent or treatment caps.

KNOW DETAILS

Review Waiting Periods

Understand waiting periods for pre-existing conditions and specific treatments.

KNOW DETAILS

Choose a Trusted and Reliable Insurer

Reliability ensures smoother claims and long-term support.

KNOW DETAILS

Adequate Sum Insured

Choose a sum insured that matches medical cost trends and family needs.

KNOW DETAILS

Premium Option

Ensure the premium fits your budget without compromising coverage.

KNOW DETAILS

Check the Network of Cashless Hospitals

A wider hospital network offers better accessibility during emergencies.

KNOW DETAILS

Opt for Plans Without Sub-Limits

Avoid plans with strict room rent or treatment caps.

KNOW DETAILS

Review Waiting Periods

Understand waiting periods for pre-existing conditions and specific treatments.

KNOW DETAILS

Choose a Trusted and Reliable Insurer

Reliability ensures smoother claims and long-term support.

KNOW DETAILS
Family health insurance illustration

Who Should Buy a Health Insurance Plan?

The clichéd and right answer to this question is that anyone and everyone should buy a health insurance plan. After all, it is a product that you are bound to benefit from when you buy it. However, if you are concerned about whether you should buy one or not, here is a list of people who should look to buy a health insurance plan.

  • Individual person / Bachelor / Spinster Family with spouse, kids & parents
  • Family with spouse, kids & parents
  • People with financial responsibilities
  • People with diabetes and hypertension
  • People with a critical illness history
  • People who have hereditary illnesses in the family
  • People looking to increase their health insurance coverage

Understanding How Your Health Insurance Premium Is Calculated

There are multiple factors which are taken into consideration when the premium is calculated. No two premiums for the same plan are identical. Here are some of the major factors that help in deriving the premium of your health insurance plan:

How Do Health Insurance Premiums Work?

A health insurance premium is the amount paid by a policyholder to keep their health insurance policy active and in force. This payment can be made monthly, quarterly, half-yearly, or annually, depending on the insurer’s options. The premium is calculated based on the level of risk the insurance company undertakes while providing coverage, considering factors such as age, health condition, and chosen benefits. As long as the premium is paid on time, the insurer continues to offer coverage as per the policy terms, ensuring financial protection during medical emergencies.

What Factors Influence Your Health Insurance Premium?

Your age, health condition, medical history, sum insured, plan type, and add-ons selected directly impact the premium amount.

  • Age:The first thing that insurance companies look at is your age. They do this to try to predict the likelihood that you will need to use the health insurance plan that you purchase. Hence, those who buy health insurance at a younger age usually pay lower premiums as they are less likely to fall ill or need planned medical attention. With age, your health insurance premiums are bound to increase. Hence, your age is directly going to affect your premium. This is one of the reasons you should buy a health insurance plan as soon as possible.
  • Type of cover: Plays a major role in determining your health insurance premium. The kind of plan you choose - Individual, Family Floater, or Multi-Individual directly impacts the pricing because each structure carries a different level of risk for the insurer.
  • Amount of cover:A simple thumb rule of insurance; the lesser the coverage, the cheaper the premium to be paid. This works as a rule, no matter what you are insuring. However, when it comes to increasing cost and inflation, it is important to have a reasonable amount of cover to ensure that your hard-earned savings are as untouched as possible.
  • Personal information:The insurance company will need you to furnish personal information, including your health insurance claims history, your gender, marital status, basic lifestyle, family medical history for hereditary illnesses, general health status (weight, height, etc.), habits such as smoking and alcohol intake, nature of your job, and place of residence. All such details affect the overall premium of your health insurance plan .

How Can You Reduce Your Health Insurance Premium?

There are several ways to manage and reduce your health insurance premium without compromising essential coverage. Purchasing health insurance at a younger age generally results in lower premiums due to reduced health risks. Choosing an appropriate sum insured based on current and future medical costs helps avoid overpaying. Opting for family floater plans instead of multiple individual policies can also be cost-effective. Additionally, maintaining a healthy lifestyle and a claim-free record may help you qualify for discounts or no-claim bonuses, thereby keeping premiums more affordable over time.

3 Tips to Keep in Mind Before Buying Health Insurance

We all already know the importance of getting health insurance for yourself and your family. However, it is essential for everyone to keep in mind the following three tips before they opt to purchase a health insurance plan.

  • Have Sufficient Health Insurance Coverage:

    It is important to note that, in spite of being covered via your company through a corporate group health insurance, you should still have a personal policy for yourself and your family. This is because your corporate cover will end once you switch jobs, retire or lose your job. Also, there is an uncertainty that the company might withdraw this benefit. Having additional coverage during times of inflation and increasing medical costs is a wise thing to do.

  • Choose the Right Amount as Sum Insured:

    It is important to note rising costs (inflation), increased medical expenses and the general cost of medical care while deciding the sum insured. By rule of thumb, if you are residing in a smaller city, then you should look for a health insurance cover of at least INR five lakhs, whereas, if you live in a metropolitan, then your cover should not be anything less than INR 10 lakhs.

  • Get Health Insurance at an Early Age:

    It is important to get health insurance as early in life as possible. You should definitely look at buying a health cover before you turn 40. The reason for this is the changing dynamic lifestyle, and in addition to that, you are less likely to make claims at that age, meaning you are liable to receive a no-claims bonus and other benefits that add up to the original coverage every claim-free year.
Family health insurance illustration

What is the Waiting Period in Health Insurance?

The waiting period is the amount of time a person who has bought an insurance policy has to wait before a part of or all of their coverage comes into effect and is ready to use. It is important to note that the person insured might not receive any benefits for claims that are filed during this waiting period. Waiting periods are also known as qualifying periods and/or elimination periods.

Family health insurance illustration

What is Maternity Benefit in Health Insurance?

Some maternity health insurance plans cover all expenses that are associated with childbirth. These expenses are covered up to a certain period, but not during pre- and post- pregnancy. There are two ways of insuring childbirth - it can be a standalone policy or be included as an add-on in your existing health insurance plan with maternity cover by paying an extra premium.

Family health insurance illustration

What are Riders in Health Insurance?

A rider is an additional benefit which can be added to your health insurance plan. The reason this is done is to ensure that you have a more extensive coverage for a few things that are not included in a basic health insurance plan.

Family health insurance illustration

Why is Critical Illness Coverage Necessary?

Health emergencies strike without invitation or intimation. It is very important to have a critical illness cover as it provides additional coverage for heart attacks, strokes or even cancer. The reason is that treatment for these medical emergencies and illnesses costs far more than average. These critical illness policies have a cash payout that helps in covering those expenses if you might fall short.

Family health insurance illustration

How to Use Health Insurance Portability?

So, what do you do when you want to port your health insurance policy between health insurance providers? All you need to do is approach the new health insurance provider about 60 days before your existing health insurance policy expires. Then you will need to fill out a proposal form for portability. You will have to furnish details and copies of your previous year's policy and then apply to port it from your existing provider to the new one.

Busting Myths and Misconceptions Regarding Health Insurance

There are a lot of myths and misconceptions that people have about health insurance. Here are five myths related to health insurance that you should be aware of to ensure that you are well-informed while buying/claiming your health insurance.

Myth 1: Young and Healthy Individuals Do Not Need a Health Insurance Plan

Reality: Even if you are young and healthy, you are at risk of getting sick anytime. No one plans to fall ill or sick. Especially taking the context of the current situation of the COVID-19 outbreak, lots of youngsters fell sick and had to be hospitalised. If they did not have a health insurance plan, they would have ended up paying out of their own pockets.

Myth 2: My Company has Me Covered Under a Corporate Health Plan, Hence I Do Not Need Another Personal Health Insurance Plan

Reality: It certainly is a good thing that your company offers a corporate health cover. It does certainly bring peace of mind, but more often than not, the coverager might not be sufficient to cover medical expenses. Hence, depending on that entirely is not the best choice. Also, if you quit your job or lose your job, then the health insurance benefit will also end. Hence, getting a plan for yourself and your family, other than corporate cover, makes a lot of sense.

Myth 3: Benefits of the Health Insurance Plan You Buy Begin on the First Day

Reality: This is a total misconception that many people have. All health insurance plans come with something called a waiting period. The usual waiting period is one month. During this period, you are not allowed to make any claim; however, some policies do cover accidental hospitalisation from the first day itself.

Alternative Treatment and Special Therapies 

It is a known fact that there is something called alternative medicine. Some people choose to try out alternative methods as they do not find the required relief through regular treatment. Such therapies, special treatments, alternative treatments, acupressure, magnetic therapy, naturopathy, Ayurveda, sound healing, etc., are not covered under a lot of medical insurance policies.

Myth 4: My Health Insurance Provider will Cover Unrevealed Pre-Existing Illnesses

Reality: It is never a good idea to conceal information from your health insurance provider. If the insurance provider does find out about a pre-existing health illness or a hereditary illness that was hidden from them, then the claim can be rejected. The health insurance company is always under the assumption that any pre-existing illness will be revealed to them during the time of purchase.

Myth 5: You Have to be Admitted to a Hospital for a Minimum of 24 Hours to Claim Insurance

Reality: It is important to know that apart from in-patient hospitalisation, you can claim your health insurance cover in case of day-care facilities also, which are completed in less than 24 hours. Some of these procedures include dialysis, chemotherapy, cataract surgery, and tonsil surgery, amongst others. On average, most health insurance providers cover up to 20 to 50 such day-care facilities.

Most Common Exclusions of Health Insurance Plans

Pre-Existing Health Conditions

Any sort of pre-existing health conditions, illness or medical conditions that the insured may or may not be suffering at the time of buying the health insurance plan are not covered. The insurance plan he/she opts for covers unforeseen medical situations. However, do note that pre-existing health conditions are covered, but with a waiting period. The waiting period for such pre-existing health conditions is defined in the policy kit.

Cosmetic Surgery

Any form of cosmetic procedures and dental procedures that are done to enhance the physical look and appearance is excluded from health insurance. However, it is essential to note that when it is recommended by a doctor, medical practitioner, specialist or general physician due to an accident and /or injury, then it is covered under your health insurance plan.

Injuries Caused by Intentional Self-Harm and Suicide Attempts

It is important to note that intentional suffering and injury caused to oneself or a harmful attempt to end one’s life is not covered under any health insurance plan. Do keep in mind that such physical injuries are, under all circumstances (waiting period included), never covered by any health insurance policy.

Alternative Treatment and Special Therapies 

It is a known fact that there is something called alternative medicine. Some people choose to try out alternative methods as they do not find the required relief through regular treatment. Such therapies, special treatments, alternative treatments, acupressure, magnetic therapy, naturopathy, Ayurveda, sound healing, etc., are not covered under a lot of medical insurance policies.

Health Insurance Glossary Terms That You Should Be Aware of Related to Your Health Insurance

Sum Insured

The maximum amount the insurer will pay for medical expenses during a policy year inclusive of Cumulative Bonuses and Base Sum Insured.

Premium

The amount paid to keep the health insurance policy active.

Waiting Period

The fixed time you must wait before certain coverages become active.

Pre-Existing Disease

Any illness or condition diagnosed before buying the health insurance policy.

Co-Payment

A fixed percentage of medical expenses that you pay from your own pocket at every claim.

Deductible

The fixed amount you must pay out of pocket each policy year before your health insurance coverage starts applying

Cashless Hospitalisation

Treatment at a network hospital where eligible expenses are settled directly by the insurer.

Network Hospital

Hospitals tied up with the insurer where cashless treatment is available.

Claim

A request made to the insurer for payment of covered medical expenses.

Reimbursement Claim

A claim where you pay hospital bills first and get reimbursed later.

No Claim Bonus (NCB)

A reward for claim-free years in the form of increased coverage or reduced premiums.

Sub-Limit

A fixed cap on certain expenses within the total sum insured that restricts how much the insurer will pay for specific expenses.

Room Rent Limit

The maximum room cost is covered per day under the policy.

Day-Care Procedure

Medical treatments that do not require 24-hour hospitalisation.

Policy Term

The duration for which the health insurance policy remains valid.

Portability

The option to switch insurers without losing accumulated benefits.

Sum Insured

The maximum amount the insurer will pay for medical expenses during a policy year inclusive of Cumulative Bonuses and Base Sum Insured.

Premium

The amount paid to keep the health insurance policy active.

Waiting Period

The fixed time you must wait before certain coverages become active.

Pre-Existing Disease

Any illness or condition diagnosed before buying the health insurance policy.

Co-Payment

A fixed percentage of medical expenses that you pay from your own pocket at every claim.

Deductible

The fixed amount you must pay out of pocket each policy year before your health insurance coverage starts applying

Cashless Hospitalisation

Treatment at a network hospital where eligible expenses are settled directly by the insurer.

Network Hospital

Hospitals tied up with the insurer where cashless treatment is available.

Claim

A request made to the insurer for payment of covered medical expenses.

Reimbursement Claim

A claim where you pay hospital bills first and get reimbursed later.

No Claim Bonus (NCB)

A reward for claim-free years in the form of increased coverage or reduced premiums.

Sub-Limit

A fixed cap on certain expenses within the total sum insured that restricts how much the insurer will pay for specific expenses.

Room Rent Limit

The maximum room cost is covered per day under the policy.

Day-Care Procedure

Medical treatments that do not require 24-hour hospitalisation.

Policy Term

The duration for which the health insurance policy remains valid.

Portability

The option to switch insurers without losing accumulated benefits.

Comparing Health Insurance Terms

Individual Plan vs Family Floater Plan

An individual health insurance plan provides coverage to a single person, with the entire sum insured dedicated solely to that individual. It is suitable for people who want personalised coverage based on their age and health needs. A family floater plan, on the other hand, offers a single sum insured that is shared among multiple family members such as spouse, children, and sometimes parents. This type of plan is generally more cost-effective for families, as all members are covered under one policy, though claims by one member can reduce the available sum insured for others.

Cashless Claim vs Reimbursement Claim

In a cashless claim, the insured can receive treatment at a network hospital without paying the hospital bills upfront. The insurer directly settles the eligible expenses with the hospital, making the process more convenient during emergencies. In a reimbursement claim, the policyholder pays for the treatment first at a non-network hospital and later submits the required documents to the insurer for repayment. The insurer then reimburses the eligible amount as per policy terms.

Sum Insured vs Sum Assured

Sum assured is a pre-defined amount that is to be paid in case of an eventuality. Life insurance works on the sum assured. While sum insured is the upper limit of the pay-out an insurer is liable to pay in case of any eventuality to the insured. Health insurance works on the sum insured.

Agent vs Aggregator 

An insurance agent is nothing but a sales representative of an insurance company. An aggregator is a platform where a buyer can see and compare several plans to suit his/her needs. Premium vs Deductible

Premium vs Deductible

A premium is the amount paid by the policyholder to keep the health insurance policy active. It can be paid monthly, quarterly, or annually and is mandatory to maintain coverage. A deductible is the fixed amount the insured must pay before the insurer starts covering expenses. Deductibles are commonly seen in top-up and super top-up plans and help lower premium costs.

Co-Payment vs Deductible

Co-payment applies each time a claim is made, where the insured shares a percentage or fixed amount of the treatment cost with the insurer. A deductible is paid once per policy year or per claim, depending on policy terms, before the insurance coverage becomes applicable. While both involve out-of-pocket expenses, deductibles act as a threshold, whereas co-payments apply continuously.

Network Hospital vs Non-Network Hospital

Network hospitals are healthcare facilities that have a tie-up with the insurance company, allowing policyholders to avail cashless treatment. Bills are settled directly between the insurer and the hospital. Non-network hospitals do not have such agreements, which means the insured must pay the medical expenses upfront and later file a reimbursement claim with the insurer.

Initial Waiting Period vs Specific Waiting Period

The initial waiting period is the fixed time you must wait after buying a health insurance policy before any claim (except accidental hospitalisation) becomes payable. A specific waiting period applies only to certain listed illnesses or treatments, which are covered after a defined duration from the policy start date

No Claim Bonus vs Loyalty Discount

A no claim bonus (NCB) is a reward given by insurers for every claim-free year, usually in the form of an increased sum insured or reduced premium at renewal. A loyalty discount is offered to long-term policyholders who continue renewing their policy with the same insurer, resulting in reduced renewal premiums or added benefits.

Room Rent Limit vs Room Rent Waiver

A room rent limit places a cap on the maximum room charges that can be claimed per day during hospitalisation. Exceeding this limit may lead to proportionate deductions on other expenses. A room rent waiver removes this restriction, allowing the insured to choose any room type without affecting claim settlements, leading to fewer out-of-pocket expenses.

Base Policy vs Add-On Rider

A base policy is the core health insurance plan that provides essential coverage such as hospitalisation, pre- and post-hospitalisation expenses. Add-on riders are optional benefits that can be purchased along with the base policy to enhance coverage for specific needs, such as maternity benefits, critical illness cover, or room rent waiver.

FAQ’s

FAQs on Health Insurance

  • What is a family health insurance plan?

  • Can a single individual have multiple health insurance covers?

  • How do I choose the right health insurance cover?

  • Can I increase the sum insured of my health insurance policy after purchasing it?

  • Am I allowed to cancel my health insurance policy once the period begins?

  • Is maternity cover available in a standard health insurance plan?

  • Am I liable to receive a loyalty discount during the renewal of my health insurance policy?

  • What is the best age to buy health insurance?

  • Can I increase my sum insured later?

  • What is a co-payment in health insurance?

  • What is the waiting period?

  • Does health insurance cover maternity?

  • Are AYUSH treatments covered?

  • Can I buy multiple health policies?