Types of Health Insurance Plans in India

Health insurance plans in India come in many types. Whether you want to cover yourself, your entire family, your elderly parents, or protect against a critical illness, there is a plan available in the market for it. The most common types of health insurance plans in India are individual plans, family floater plans, senior citizen plans, critical illness plans, group plans, top-up plans, maternity plans, personal accident cover, disease-specific plans, hospital daily cash, and ULIPs.

Here is a quick overview of all the types of health insurance plans available in India:

Let us understand each of these plans in detail. Please note that the examples shared below are for explanation purposes only and the details can vary on a case-to-case basis. Also, details related to the plans are subject to changes and dependent on the insurer’s underwriting clauses.

Individual health insurance covers one person under a dedicated sum insured. This means only you can claim against the policy, no sharing with family members.

For example, if you buy an Individual Health Insurance Policy with a sum insured amount of Rs. 5 lakhs, you can claim up to Rs. 5 lakhs.

Features of the Individual Health Insurance Policy

It covers a single person. 

Individual sum insured amount for each beneficiary.

It offers coverage for hospitalisation expenses incurred due to injury/illness, surgeries, daycare treatment, room rent, etc.

People in the age group between 18 and 65 years are eligible for this plan.

The Family Floater Health Plan is for the entire family. Under this type of health insurance policy, your family is covered in a single policy. The sum insured is equally shared by the beneficiaries of the plan. The premium is comparatively lower compared to the Individual Health Insurance Policy (considering each family member buys one).

For example, consider you have purchased a Family Floater Health Insurance. It covers your two children, your spouse, and yourself with a sum insured of Rs. 20 lakhs. If you are hospitalised for a covered surgery costing Rs. 10 lakhs, the policy shall cover the cost as per the terms and conditions. The remaining Rs. 10 lakhs is available for future medical emergencies or planned hospitalisation for you or the covered family members.

Features of a Family Floater Health Insurance Policy

The entire family is covered under a single health insurance plan.

The sum insured is shared by the beneficiaries.

It offers financial coverage against hospitalisation, surgeries, treatment, daycare, etc.

The Senior Citizen Health Insurance Policy provides coverage for those above 65 years of age. If you want to buy a health insurance plan for your parents or other senior citizens, you should opt for this plan. Typically, the Senior Citizen Health Plan’s premium is slightly higher than the above two types of health insurance plans.

For example, suppose your parents are more than 65 years of age and do not hold a health insurance plan. In that case, you can consider opting for this plan.

Features of Senior Citizen Health Insurance Plan

Critical Illness plan is designed to provide financial protection if you are diagnosed with a critical illness or condition. This type of health insurance policy offers coverage against critical diseases such as heart attacks, kidney failure, paralysis, stroke, cancer, etc. Typically, if you raise a claim against the policy, the insurer pays a one-time lump-sum payment.

For example, if you are diagnosed with cancer that is covered under a Critical Illness Health Insurance Plan of Rs. 15 lakhs, the insurer shall pay Rs. 15 lakhs as a one-time lump-sum payment, and terminate the policy.

Features of Critical Illness Health Insurance Plan

The Group Health Insurance Plan is designed to cover a group of people. The most common type of group plan is the Group Medical Cover (GMC). Typically, an employer or a company offers the GMC to its employees. 

The GMC policy can be for an individual employee, or it may allow you to include your family members in the same policy. You may have to pay an extra premium to include them, but that depends on your employer.

Features of a Group Health Insurance Plan

Learn more about the waiting period in health insurance.

The Top-up Health Insurance Plan is ideal if you are looking for coverage that replenishes the sum insured up to a certain amount. The plan gets activated once you have utilised the maximum claim amount.

Features of the Top-up Health Insurance Plan

Medical expenses arising from the treatment due to an accident can wreck your finances. Availing the Personal Accident Cover (PA) offers benefits against events such as partial/total disability and death due to an accident. 

Features of Personal Accident Insurance Policy

You can purchase the Maternity Health Insurance Plan as an add-on along with the basic plan. The add-on is designed to cover expenses incurred during the prenatal, delivery and postnatal stages.

If you are planning to start a family, you should consider buying this plan. It helps mitigate the expenses related to maternity.

Features of the Maternity Health Insurance Plan

The Mediclaim Insurance Plan usually covers the cost of hospitalisation related to accidents or illnesses. If you are looking for health insurance to cover only the in-patient expenses, you can consider Mediclaim Insurance. 

Features of Mediclaim Insurance Plan

It provides coverage for in-patient medical expenses such as doctor fees, surgery, nursing charges, oxygen, and anaesthesia.

Such a plan is usually available as Group Mediclaim, Individual Medical Insurance, Overseas Medical Insurance, etc.

The medical costs for certain treatments can leave you financially drained. For example, treatment for COVID-19. It is, therefore, wise to opt for a plan that has exclusive medical coverage for the treatment of such diseases. One such plan is the Corona Kavach Health Insurance Plan.

Features of disease-specific health insurance plan

Hospital daily cash is a type of insurance policy that provides a fixed amount of cash benefit for each day of hospitalization due to an illness or injury. The benefit is paid to the policyholder regardless of the actual medical expenses incurred during the hospital stay. This type of insurance can help offset some of the non-medical expenses associated with a hospital stay, such as transportation, food, and lodging.

Unit Linked Insurance Plan (ULIP) is a type of investment product that combines both insurance and investment components into a single plan. In a ULIP, a part of the premium paid by the policyholder goes towards providing life insurance cover, while the remaining amount is invested in various market-linked instruments such as equity, debt, or a combination of both.

Here’s why you should consider purchasing health insurance.

Protection against high medical costs: Health insurance can help you cover the costs of medical treatments and procedures, which can be very expensive without insurance coverage. This can help protect you from financial strain due to unexpected medical expenses.

Access to preventative care: Many health insurance plans offer coverage for preventative care services, such as routine check-ups, screenings, and immunizations. These services can help you stay healthy and catch any health issues early, which can improve your overall well-being and quality of life.

Network of healthcare providers: Many health insurance plans have a network of healthcare providers that you can access for medical care. This can be beneficial because you can often receive care at a discounted rate within the network.

Peace of mind: Having health insurance can provide peace of mind, knowing that you have coverage for unexpected medical events. This can help reduce stress and anxiety, and allow you to focus on other areas of your life.

Here are some tips to consider while purchasing a health insurance plan.

Deductibles: Ensure you check the amount of deductible stated in the policy before you purchase the health insurance plan. A deductible is an amount you must contribute during the settlement of the claim while the insurer pays the rest.

Sum insured: Check if the coverage amount is enough for you and the policy's beneficiaries to avoid shocks during claim settlement.

Waiting period: There are waiting periods for coverage of certain pre-existing diseases. Opt for health insurance policies with zero waiting period or no waiting period, such as the 1 crore health insurance plan offered by ACKO.

Medical history of family members: Consider the medical history of the policy’s beneficiaries when purchasing the health insurance plan. If any beneficiaries have a medical history, then the premium can rise.

Age of the beneficiaries: You must understand the importance of the age factor while purchasing a health insurance plan. There are different types of health insurance coverage that depend upon the buyer's age. The premium, waiting period and renewability rely on the age factors of the beneficiaries.

Exclusions: One of the most important factors to consider while buying a health insurance plan is to check the exclusions or what is not covered. By learning about the exclusions, you can opt for a plan that suits your needs.

Claim Settlement Process: Ensure you go through the claim settlement process of the insurer. The more straightforward the process, the easier and the faster the claim settlement process.

Annual health checkups and value-added services: Opt for health insurance plans that offer yearly health checkups. Also, consider a plan that provides value-added services such as online doctor consultations, lab tests, discounts on medicines, etc.

Maternity cover: Not all health insurance plans cover maternity. Read the benefits and features of the plan before you purchase it. If you are planning to start a family, it is better to choose a plan that includes coverage for maternity or if you can include the cover as an add-on.

Lifetime renewability: Check the renewability options since different health insurance plans have various renewability features.

Network hospitals: The more extensive the network of hospitals, the easier the access to medical care. Ensure you opt for an insurance company that has a vast network of hospitals to choose from.

Now that you understand the different types of health insurance plans, you can easily choose the right health insurance plan for you and your family. Here are some key takeaways.