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Health Insurance

ACKO Health Insurance

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What is a health insurance policy?

Health insurance is an effective way to secure yourself against medical expenses. Healthcare and wellness expenses are ballooning and do not look like coming down soon. Hence, a well-covered best online medical insurance plan in India has become one of the basic requirements. Health or medical insurance shields you from medical treatment costs arising out of an accident, sudden illness, or planned/emergency hospitalisation.

How does it work?

A health insurance policy is a legal contract between you and the insurance company. It highlights the insurance policy’s sum insured, inclusions, exclusions, benefits, etc. The contract also includes terms and conditions under which the insurer is bound to bear your medical expenses and/or your family. Depending on the type of health insurance plan, you can avail different types of coverage for expenses related to hospitalisation, surgery, critical illness, diagnostic tests, day care treatment, etc.

Importance

A comprehensive health insurance plan has become a necessity due to the ever-increasing costs of medical care. It protects you against emergency hospitalisation expenses for yourself or any family member. By ignoring it, all your financial planning will go for a toss. Worse case, you may even have to borrow funds for the unexpected hospitalisation. Hence, it is imperative to opt for health insurance and purchase a policy that will cover your family members as well.

Claim settlement

Insurance providers tie up with a group of partnered hospitals, known as network hospitals. Through these hospitals, you and your family can avail of cashless treatment for all your hospitalisation expenses. Most often, insurance companies offer to reimburse hospitalisation costs incurred in non-network hospitals.

Tax exemption

Besides protecting yourself and your family from unannounced medical costs, the Government of India also encourages citizens to avail of health insurance plans by offering tax exemptions on the premium paid up to Rs. 1 lakh under Section 80D of the Income Tax Act, 1961. Please note that these tax benefits are subject to changes.

Why do you need a health insurance policy?

Here are some of the benefits of a health insurance policy.

1. Comprehensive coverage such as in-patient hospitalisation, pre and post-hospitalisation, accidental hospitalisation, etc.

2. Cashless hospitalisation in any of the insurer’s network hospitals.

3. Expenses incurred towards domiciliary hospitalisation.

4. Ambulance charges are also covered subject to terms and conditions.

5. Add-on benefits such as Maternity Coverage and Critical Illness.

6. Get access to No Claim Bonus discount on renewal for every claim-free year.

Features of health insurance policy

Here are some of the features of health insurance plans in India.

Tax benefits

By availing of the family floater health insurance, you can claim tax deductions of up to Rs. 25,000 under Section 80D of the Income Tax Act, 1961. An additional exemption of up to Rs. 25,000 can be claimed if you are covering your parents below the age of 60 years. If either of your parents is over the age of 60 years, you can claim up to Rs. 50,000. And, up to Rs. 1 lakh if one of the family members and either of your parents are above 60 years. Please note that tax benefits might change in the next financial year.

Additional health coverage over and above your employer’s cover

Several organisations provide medical insurance policies to their employees with a group insurance plan. However, this type of insurance is not customised according to your requirements. By having additional medical insurance, it protects you in case you lose your job or move to a different organisation, thus ensuring you and your family are always insured.

What is covered under medical insurance plans online?

Health insurance providers offer different types of plans to suit your needs. Hence, different plans offer different features related to surgeries, medical treatments, etc. Your health insurance typically covers most doctor and hospital visits, hospitalisation costs, medicines and surgical costs. It also takes care of treatment in case of critical illnesses or serious medical conditions.

In-patient hospitalisation costs

Medical expenses incurred during hospitalisation for more than 24 hours, which includes room rent, doctor’s or surgeon’s fee, medicine costs, etc. are covered as per the policy terms.

Pre and post-hospitalisation expenses

Health insurances cover expenses incurred before and after hospitalisation. This is usually capped at 30 days prior and within 60-90 days after hospitalisation.

Medical treatments such as angiography, dialysis, radiotherapy, eye surgery, chemotherapy, etc. are considered as day care procedures. Some of the health insurance policies cover this type of medical treatment.

Pre-existing diseases

Some of the insurers do not cover pre-existing diseases such as diabetes, high blood pressure, while some of them do cover with a waiting period of 2-4 years of continuous coverage with the insurance company. In some cases, with a payment of an additional premium, insurers might cover pre-existing diseases.

Critical illness treatment

Based on the type of medical insurance policy, critical illnesses such as cancer, stroke, artery diseases, paralysis, amongst others are covered. Check with your insurance provider before buying the best health insurance if these critical illnesses are covered. Some insurers may offer it as an additional feature with an additional premium.

Preventive health check-up

You can make use of the health check-ups provided by some of the insurance companies. Typically, this benefit is available after the waiting period. It’s a good idea to check if the insurance company offers routine health check-ups so that you are aware of your current health condition.

Ambulance cost

Many insurers cover ambulance costs for transportation of the insured person in case of a medical emergency.

Domiciliary hospitalisation

Some insurance companies cover the cost of the medical treatment availed at home. Check with the insurance company if this feature is available in your policy.

OPD treatment

Out-patient treatment is generally not applicable in health insurance, although some insurance companies do offer the feature on payment of an additional premium. This includes cost towards diagnostic tests, pharmacy bills and doctor consultations.

What is not covered under medical insurance plans online?

While the basic medical insurance policy covers most of the hospitalisation expenses, there are treatments and medical conditions that are not covered.

Cosmetic surgery

Liposuction, Botox or surgeries of a similar kind are not considered life-threatening or dangerous. Hence, they are not covered under a health insurance policy.

Diagnostic expenses

Most of the costs incurred due to blood tests, CT scans performed at a diagnostic centre, nursing home or hospital are usually not covered under health insurance.

Minor injuries expenses

Health insurance policies will not cover expenses towards tooth filling or a broken finger.

Miscellaneous charges

Charges towards registration, admission and service fee are not covered under the medical insurance plan.

Certain drugs

Some drugs used during hospitalisation are not included under the basic health insurance plan.

Suicide/attempted suicide

Insurance providers do not cover illnesses or injuries due to any act of attempted suicide or self-inflicted injury.

Sexually Transmitted Diseases

Illnesses arising out of sexually transmitted diseases are generally excluded in health insurance plans.

Some of the critical illnesses related to substance abuse such as alcohol or tobacco or intoxicating drugs may not be covered.

Health insurance with tax benefits

The health insurance premium for the policy period offers tax relief under Section 80D of the Income Tax Act, 1961. And, for senior citizens, the Finance Act, 2018 provides higher tax benefits for premium paid towards medical insurance. The total tax exemption on health insurance under Section 80D is as follows.

Details Self, Spouse, Children Parents Total Deduction
All below 60 years Rs. 25,000 Rs. 25,000 Rs. 50,000
You and your family are aged below 60 years but your parents are above 60 years of age Rs. 25,000 Rs. 50,000 Rs. 75,000
Both you and your parents are above 60 years of age Rs. 50,000 Rs. 50,000 Rs. 1,00,000

Note:

  1. The premium can be paid in any mode other than cash.

  2. Tax benefits under Section 80D are in addition to the deductions of up to Rs. 1.5 lakh under Section 80C.

  3. You cannot claim tax exemptions for your in-laws, sisters or brothers.

  4. Single premium health insurance policies paid in a single year for a policy period of more than a year can claim tax benefits subject to the limits of Rs. 25,000 or Rs. 50,000.

  5. Preventive Health Check-Up Tax Deductions: Under Section 80D of the Income Tax Act, you can claim a tax deduction of up to Rs. 5,000 for an individual and family for expenses related to preventive health check-ups. This amount will be Rs. 7,000 for senior citizen parents. If you are below the age of 60 years, the maximum claim tax deductions is of up to Rs. 25,000 which covers you, your spouse and your dependent children.

  6. Tax savings and exemptions are as per section 80D of the Income Tax Act are subject to changes in the tax laws.

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Frequently asked questions about health insurance

Buying and renewing related FAQs

What is the difference between health insurance and Personal Accident Cover?

Below are the differences between the two types of insurance policies.

  1. Healthcare expenses in the Personal Accident Cover are not covered even if the costs were due to an accident. However, the health insurance policy offers claims towards injury, illness, and other medical conditions.

  2. Personal Accident Cover provides coverage due to accidental death while the health insurance policy does not.

  3. Disabilities are not covered under health insurance coverage.

What is the eligibility to avail of health insurance?

To avail of a medical insurance policy, the minimum age criteria vary from insurer to insurer. Usually, the minimum age is between 18 and 21, and the maximum age is between 60 and 100 years. As for the dependents, the entry age for children begins from 90 days until 18 or 25 years, while for adults, it remains the same as the primary policyholder.

Can I nominate a person for medical insurance?

Yes, you can nominate a person under Section 39 of the Insurance Act, 1938. While the policy is active, during your lifetime, you can nominate any person or persons to whom the insurance company will pay benefits under the health insurance upon your unfortunate death.

Is a medical test mandatory for all?

Insurance companies generally require a medical test generally for persons above the age of 45. However, this may vary in a few cases.

What are the factors which influence the calculation of a premium?

Below are the factors which influence the calculation of a premium.

  1. Individual or Family Floater Policy

  2. Sum insured

  3. Age of the senior-most member

  4. Add-ons (if selected)

  5. Sub-limit (if selected)

If my policy has expired, can I still renew my insurance policy?

Your health insurance policy offers a grace period of 15 days. Before this period ends, you can renew the policy to continue the policy validity. However, any claims raised during the 15 days will be rejected until the premium is paid. Additionally, if you do not renew the policy within the grace period, the policy will lapse.

Can I transfer my health insurance policy from one insurer to another?

Yes, you can transfer your policy from one insurance provider to another as per the circular issued by the IRDAI. This process is known as the portability of health insurance plans.

Can a person have more than one health policy?

Yes, you can own more than one health insurance policy. However, it is recommended to opt for another health policy if the value exceeds the premium cost.

Claims and coverage related FAQs

Are children covered in health insurance policies?

Yes, dependent children between the age of 90 days and 25 years are eligible to be covered under the policy.

Can I claim a tax exemption for the premium paid for a health insurance plan?

Yes, can claim tax deductions under Section 80D of the Income Tax Act and the Finance Act, 2018. It offers tax benefits of up to Rs. 25,000 for a family floater policy which includes the primary policyholder, spouse, and dependent children. In case you include your parents aged below 60 years, then you can claim an additional deduction of Rs. 25,000. And, if your parents are above 60 years, the deduction is up to Rs. 50,000. Please note that tax benefits are subject to changes on an annual basis.

What does permanent exclusion mean?

Diseases covered under the permanent exclusions will not be covered under the health insurance policy.

What is the maximum number of claims allowed in a year?

As per the terms and conditions, you can raise several claims during the policy period subject to a maximum of the sum insured.

Terminologies related FAQs

What is co-pay?

Under the co-pay clause of the policy, the policyholder along with the insurance company must share a part of the claim amount as per the policy.

What does pre-existing disease mean?

Any ailment, medical condition, injuries, or related medical conditions for which you have symptoms or signs, and/or diagnosed, and/or received medical treatment or advice within a stipulated time period prior to the first policy by the insurance company is considered as pre-existing diseases.

What is the annual sum insured?

The maximum amount that the insurer will pay in case of hospitalisation of the policyholder or the beneficiaries of the policy, which is as per the terms and conditions of the insurance policy, is known as the sum insured amount.

What is the waiting period in a health insurance plan?

The period only after which you can start availing of the benefits of the health insurance policy is known as the waiting period.

What does network hospital mean?

A hospital that has an agreement with the insurance company for offering cashless hospitalisation is called a network hospital. If treated at a non-network hospital, you must raise a claim through the reimbursement procedure.

What do you mean by cashless hospitalisation?

Under the cashless treatment, you need not settle the medical bills. Instead, the insurance company will settle the payment for your hospitalisation as per the policy terms.

What do you mean by premium?

To benefit from your health insurance plan, the amount you pay to the insurance company is known as a premium amount.

What is a health check-up facility?

Some insurance companies provide cover for general health check-ups, but it has a waiting period before you can take advantage of the benefit.

What does Family Floater policy mean?

A family floater health insurance plan covers you and your family members such as your spouse and dependent children and/or parents. Compared to individual plans, which cater to one individual, the family floater is robust, offering wide coverage for the family.

What does Critical Illness insurance mean?

Generally, the critical illness cover is offered through the insurance company’s add-ons. Under this coverage, the insurer covers the policyholder’s family against critical diseases such as stroke, heart attack, kidney failure, amongst others.

Buy/renew health insurance online

Managing health insurance can be complicated sometimes. However, you can now apply for health insurance online, which lets you compare, choose sum insured amount or increase coverage based on your needs.

You can also renew health insurance online from the comfort of your home or anywhere. Simply visit the website of the insurance company (Example: www.acko.com) and you can buy/renew the best policy online.

How to apply for health insurance online

It takes a few steps to ensure you and your family are well covered with a suitable health insurance policy. You can get a health insurance quote online by following the below steps.

Step 1

Visit the insurance company’s (example: ACKO) website or mobile app.

Step 2

Enter a few details such as your age, dependent details and choose from different types of insurance based on your needs.

Step 3

Get a health insurance quote, pay the premium and receive your policy document instantly to your email address.

Steps to renew medical insurance policy online

Step 1

If you are renewing your health policy with the same insurer (in this case ACKO), visit their website or mobile app. Log in to your account with the username and password.

Step 2

When you renew the medical policy with the existing insurer, then upon login, you will be prompted to renew the plan. Pay the renewal premium and receive the policy document to your email address.

Step 3

To renew health insurance with another insurance provider, visit their website for transfer or port the health insurance plan.

Benefits of buying health insurance online in India

Ensuring you are financially covered through health insurance is one of the primary objectives. Gone are the days when buying a health insurance policy was a tedious and time-consuming task. With the advent of digital platforms such as ACKO, buying a policy has become easier, super quick and simpler. Below are some of the benefits of buying health insurance online in India.

Buy as per your needs

Choose from different types of health insurance plans to buy a policy that suits your requirements and to avail maximum coverage at a lower premium.

Research becomes easy

Check claim settlement ratios and various other factors of health insurance companies.

Saves your time

It saves you time. You can buy the best health insurance from the comfort of your home or anywhere as far as you have an internet connection.

No middlemen involved

No need for an agent or middleman, thereby reducing the cost to get health insurance.

Make better decision

Can make an informed and unbiased decision, as there is no intervention from agents/middlemen.

Health insurance claim process

The settlement of claims is one of the primary aspects of a health coverage plan. As a policyholder, you can raise claims in two ways: Cashless and Reimbursement claims process.

Cashless claim

Cashless health insurance policies mean that ACKO will settle the medical bill directly with the hospital as per the policy terms. Cashless hospitalisation is a great way to lessen the financial burden. To avail of the cashless hospitalisation, you should get your treatment done at any of the ACKO's network hospitals.

Reimbursement claim

Through this method, you need to clear the medical care expenses arising out of hospitalisation first and then raise a claim for the reimbursement of the costs. You need to ensure that all hospitalisation-related documents and bills are with you to submit the same to ACKO.

Details to be kept ready while making a claim

When you intimate your insurance company about the hospitalisation, you need to have certain details ready to initiate the process.

1. Policy number

2. Policyholder’s contact details

3. Name of the person who is hospitalised

4. Relationship of the person who is hospitalised

5. Name of the hospital

6. Nature of ailment in the case of health claims

7. Nature of accident in the case of an accident

8. Time and date of the accident

How to raise a claim

Generally, the below steps are followed to raise a claim for hospitalisation.

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Cashless claim process

Inform ACKO about the hospitalisation. If it’s a cashless claim, then hospitalisation can be availed at one of the network hospitals. Under cashless hospitalisation, the network hospital will contact ACKO to arrange cashless treatment.

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Reimbursement claim process

If it’s reimbursement, undergo medical care at any non-network hospital and make the payment. Then submit the application along with all the required documents to ACKO within the stipulated time.

Health insurance claim process for cashless facility

Follow the steps below to raise a claim if you are utilising the cashless facility.

Step 1

Get admitted to one of the ACKO's network hospitals.

Step 2

Provide or show the medical insurance policy’s ID card to the hospital authorities.

Step 3

Duly fill the cashless request form and submit it to the hospital.

Step 4

The hospital will coordinate with the Third-party Administrator (TPA) or ACKO regarding your hospitalisation.

Step 5

Upon authorisation, your cashless hospitalisation will be initiated.

Step 6

Verify and sign all the medical bills upon discharge.

Health insurance claim process if cashless hospitalisation is denied

In case the Third-party Administrator or the insurance company denies your cashless hospitalisation, then follow the steps below.

Step 1

Settle all the medical bills.

Step 2

Ensure you get all the documents provided by the hospital such as discharge summary and bills.

Step 3

Raise a claim to be reimbursed by the insurance provider.

Documents required for health insurance claim

Below is the list of documents required while raising a claim with your medical insurance provider.

1. Duly filled health insurance claim form

2. Patients discharge summary

3. Prescription and cash invoice

4. Investigation report (X-Ray/ECG/Scan/Laboratory)

5. Medico-Legal Certificate (MLC) or FIR in case of an accident.

6. Copy of your insurance card

7. Cancelled cheque in case of reimbursement

8. Original medical bills and receipts

Common health insurance terminologies

Let’s look at a few of the commonly used health insurance terminologies.

Pre-existing illnesses

A health issue that has been diagnosed, or for which you have been treated before purchasing a health insurance policy.

Network hospital

A group of hospitals that insurance companies tie-up to offer medical services through a cashless process of hospitalisation.

Waiting period

It’s a period after which you can begin availing the benefits of the health insurance policy. The waiting period can vary between health insurance companies and the type of plan you opt for.

Inclusions

All that is included in your health insurance plan is considered as inclusions and it is listed under the terms and conditions in the policy document.

Exclusions

All that is not included in your health insurance is considered as exclusions. Similar to inclusions, exclusions are also mentioned in your policy document. It’s important to understand them before you buy a policy.

Sum insured

The total amount payable by the insurance company to a policyholder for medical expenses. In other words, it is the maximum amount that your insurer can pay you in a particular period in case you are hospitalised.

Claim request

A request by the policyholder for the insurance company to pay for medical expenses arising out of hospitalisation.

Dependent

Any individual, either spouse or child or parents, that is covered by the primary insured member’s policy is known as a dependent.

Effective date

The date on which your policy coverage starts.

Premium

The amount you pay annually/quarterly/monthly to the insurance company in exchange for insurance coverage.

Add-ons

Coverage options that enable you to increase your basic plan for an additional premium.

Documents required to buy health insurance policy in India

To avail of a health insurance policy, below is the list of documents required.

Proof of age

Documents such as your Driving Licence, Voter’s ID, Passport, Birth Certificate, etc. are accepted as proof of age.

Identity proof

Acceptable documents are PAN card, Passport, Driving License, Voter’s ID, etc.

Proof of address

Documents include Ration card, Passport, Voter’s ID, Aadhaar card, bank statement, telephone/electricity bill, etc.

Medical test report

If you are asked to furnish, then you’ll have to undergo a medical check-up and submit the report.

Photographs

You’ll have to submit the required number of passport size photographs.

Types of health insurance plans in India

To cater to different requirements, insurance companies have designed various types of medical insurance plans to suit customers’ needs. Below are the various types of health insurance policies in India.

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Individual Mediclaim Policy

Under this plan, the policy provides financial coverage to an individual policyholder. Generally, it covers certain illnesses and offers cashless hospitalisation, pre- and post-hospitalisation cover, reimbursement and several other add-ons.

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Family Floater Health Insurance Policy

Here, you can include family members in one single health insurance policy. Family members include you, your spouse, dependent children and parents. This type of medical insurance offers an assured sum amount to all the family members. While this policy demands a higher premium compared to an individual insurance policy, the cost to buy separate individual policies for each member can be higher.

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Senior Citizen Medical Insurance Policy

Designed exclusively for senior citizens, this type of health insurance in India provides medical insurance to individuals aged above 60 years. It offers cover against health issues during old age. Senior citizens may be asked to go through a medical check-up before the insurance policy is offered. Also, the Government of India offers tax exemptions on this plan, thus making it a good investment.

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Critical Illness Medical Insurance Policy

These plans are designed as a standalone or as add-ons to your base policy. They are targeted at critical illnesses such as cancer, heart attack, stroke, loss of limbs, organ transplant, blindness, coma, kidney failure, amongst others. Since this type of health insurance is made for specific illnesses, they do come with a higher premium. The insurance plan pays the amount specified as a lump sum which can be used for expenses related to the critical illness.

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Maternity Mediclaim Policy

These plans are designed especially for those who plan on bearing children. It may be offered as a standalone plan or as an add-on to the base policy. This policy covers medical expenses for the mother and the newborn, child delivery (normal or cesarean), pre and post-natal costs, hospitalisation expenses as well as any complications that may arise. It also covers the newborn up to the term period of the policy.

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Personal Accident Insurance Policy

Usually offered as an add-on to the base policy, Personal Accident health insurance provides compensation in case of death, injury, disablement, mutilation or impairment. Included as an add-on to the base policy, this policy provides extra coverage to the policyholder apart from hospitalisation due to an accident.

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Employee/Group Health Insurance Policy

Several companies offer medical insurance to their employees which is known as Group or Employee Health Insurance policy. These plans are described to include and exclude employees as they join or leave the organisation. The policy covers hospitalisation expenses, illness or accidents, pre and post-hospitalisation, domiciliary hospitalisation and day care treatments.

Eligibility for medical insurance policy

The eligibility criteria for health insurance may vary from one insurance company to another. However, the general criteria to be eligible for medical cover are mentioned below.

Policyholder's entry age

The entry age for the primary policyholder is from 18 to 65 years; however, some insurance companies may increase the limit.

Family members' entry age

The minimum entry age is 18 years and a maximum of 65 or 70 years for adults. In the case of dependent children, the minimum entry age is 90 days – although some insurers may even include them from 30 days – to a maximum of 25 years.

Medical condition

You may have to undergo a medical examination to get health insurance if you are buying a policy after the age of 45 years. You also have to declare any pre-existing diseases to the insurer. Based on your medical condition, the premium for the health policy may differ.

How to choose the best online medical insurance plan

Health insurance policies in India are varied. From individual to family floater plans, health insurance should be assessed based on your requirement. Here are a few tips to choose the best health insurance policy.

Get the right coverage as per your needs

To select the best health insurance coverage, it should cover you with a wide range of enhanced benefits. These can be pre and post-hospitalisation cover, home care treatment, daycare expenses, health check-ups, etc. Ensure you choose the health insurance plan that offers wide coverage at a lower premium.

Choose family floater over individual plan

Individual plans are suitable for individuals who prefer health insurance only for themselves. However, if you want health insurance that covers your family, then choose the family floater plan. It offers maximum benefits at a competitive price. Again, it is important to assess your requirements before deciding.

Compare health insurance quotes online

Use the health insurance premium calculator to understand the parameters which influence the price of the plan. This will let you know which parameters to tweak based on your preferences.

Check network hospital coverage

A health insurance policy that can be accepted across a wide range of hospitals and specialties will be of help to you at times of emergencies. Choose an insurance company that is tied with several good hospitals across the country.

Choose a policy with minimum waiting period

Like every other insurance policy, health insurance policies are not without terms and conditions. Hence, choose the one which has a lower waiting period for pre-existing conditions and diseases.

High Claim Settlement Ratio (CSR)

Insurance companies with high claim settlement ratios talks about their reliability while settling claims. It reflects that the insurance company will not reject a claim without a valid reason. It is your responsibility to read their terms and conditions about claims and use them to your advantage.

Difference between health and mediclaim insurance

Mediclaim policies are designed to cover basic hospitalisation costs and specified illnesses; however, the coverage or the sum assured will be compromised. Mediclaim cover can be viewed as a low-premium health insurance policy.

On the other hand, a health insurance policy is designed to cover the policyholder comprehensively. Apart from basic hospitalisation costs, it can cover pre and post-hospitalisation costs, critical illnesses, etc. depending upon the selected cover and policy wordings.

If you want a comprehensive health cover, health insurance offers the best benefits and features. However, if you want limited health coverage with a low-premium health cover, then a Mediclaim policy can be an option.

Health insurance portability

When you transfer your health insurance policy from one insurer to another or from one policy to another of the same insurance company, it is known as health insurance portability. This is subject to the policy being maintained without any break.

By porting your medical insurance plan, you also transfer any credit gained for pre-existing conditions and the waiting period of any exclusions.

Government health insurance plans vs. private medical insurance policy

To provide affordable and quality healthcare, the Government of India (GoI) has introduced several government health insurance schemes to cater to different requirements. The health insurance schemes offered by the government include both the Central and State Government initiatives. Both government and private health insurance policies have their unique features and benefits. It caters to different requirements of the policyholder. Let’s look at how they differ.

Features Government Health Insurance Plan Private Health Insurance Plan
Premium Lower premium Higher premium
Discount Highly discounted by the government Competitive pricing
NCB benefit NCB not available NCB available
Coverage Provides coverage with an upper limit Full coverage on most medical expenses
Sum insured amount Moderate sum insured amount Higher sum insured amount subject to payment of higher premium
Customers Targeted at low-income individuals or families Open to everybody

The regulator extends the deadline for remote health insurance services to March 2022

-September 15, 2021

The Insurance Regulatory and Development Authority of India (IRDAI) has again pushed the deadline for allowing health insurance companies to offer remote services to 31st March 2022. Earlier, a signed, hard copy was one of the most essential documents in the process of buying/renewing a health insurance policy or for raising a claim. However, due to the COVID-19 lockdown and social distancing, meeting the insurance agent or sending these documents via post is still not possible in many parts of the country. Thus, to avoid any obstacles in the continued health and general insurance coverage, the regulator has decided to permit the use of digital methods for issuing policies. Such a method of buying/renewing health insurance seems more convenient for isolated policyholders or those living in a situation of complete lockdown. As per the IRDAI guidelines, insurance companies must send the health insurance policy and the proposal form to the policyholders' registered email addresses and inform them via multiple touchpoints like SMS or mobile numbers. The policyholder must then confirm the acceptance via One Time Password (OTP) or a dedicated hyperlink. Even though the effects of the COVID-19 pandemic seem to have reduced in some parts of India, the risk of infection continues.

IRDAI Issues New Use-and-File Norms for Health Insurance

– February 09, 2021

As per an update on February 8, 2021, the Insurance Regulatory and Development Authority of India (IRDAI) has made changes concerning the Use-and-File norms for health insurance products. The insurance regulator has allowed insurers more freedom for products belonging to certain categories under the Use-and-File norms. As per these norms, insurers can offer policies to potential policyholders without seeking IRDAI approval. The new categories under health insurance are Personal Accident Insurance, Benefit-based Health Insurance and under travel insurance are Overseas and Domestic Travel Insurance.

The Corona Rakshak Policy that was launched in 2020 is an example of a Use-and-File product. The benefits of including more products under the Use-and-File category are increased innovation, better personalisation, and quick-to-market policies. Products filed post-April 1, 2021 will follow the new norms. The IRDAI circular issued on Monday has more details about their recent update.

New Rules For Health Insurance To Be Followed From October 01

– September 30, 2020

Recently the Indian health insurance industry has undergone a lot of changes. New rules have been laid down by the high court and IRDAI. These rules are to be followed from October 01, 2020. Here are the details: New illnesses like genetic diseases, mental illnesses, Neuro disorder, robotic surgery, oral chemotherapy, psychological illness etc. will form a part of a health insurance policy along with coverage for COVID-19. The pre-existing diseases clause previously had a waiting period imposed on the coverage of the policy, it lasted for years on some policies. Now the pre-existing diseases that are diagnosed 48 months ago can be covered within three months of buying the policy. Coverage for an implant and diagnostics, pharmacy bills, etc to be included in the health insurance policy. A claim cannot be rejected on the basis or misrepresentation or late filing if the policy has been actively renewed for eight consecutive policy periods. According to IRDAI, the insurance company has been given 8 years to investigate the medical history of a policyholder. Telemedicine to become a part of health insurance. Online consultation has gained much popularity during the COVID-19 pandemic. As per another rule that will be implemented, a policyholder can choose to buy multiple health insurance plans. He/she can apply for a partial payment to the health insurance company of his/her choice if one company cannot pay the full claim amount. All health insurance policies bought on or after October 01, 2020, will be as per the above-mentioned rules.

Health Insurance Industry Returning To Normalcy With 25% Growth In August 2020

– September 24, 2020

The IRDA regularly publishes consolidated reports about the performance of various insurance sectors in India. According to a report about the health insurance sector, there is a growth of 25% as compared to reports published in August 2019. It is being observed that these numbers indicate the return of normalcy in the health insurance sector that was affected by the economic downfall. This was caused due to the COVID-19 pandemic. The economy of India suffered massively since the outbreak, however it looks like there is a certain amount of improvement now that the government has eased lockdown restrictions, i.e. unofficially called Unlock 4.0. According to the official date, currently there are 966382 cases of COVID-19. 4674987 people have been discharged or cured and unfortunately 91149 have succumbed to the deadly virus. Considering the growth rate in the health insurance sector, it can be said that slowly the condition is improving.

Health and Auto Insurance Buying Process Becomes Totally Online

– September 14, 2020

The Insurance Regulatory and Development Authority of India (IRDAI) has made an important announcement with regard to buying and selling of insurance policies. This announcement has been made keeping in mind the ongoing COVID-19 pandemic. The apex insurance body has allowed insurance companies to sell health and auto policies in a totally online manner. Thus, the overall process of purchasing these policies has been made completely online. As a result, there will be no requirement of physical documents such as the application form or hard copies of the policy. This new change is applicable in cases where the sum insured does not go beyond INR one crore. This new rule is said to be applicable until March 2021. The IRDAI had issued a circular to all general and health insurance companies regarding this new rule on 10 September 2020.

Now Avail Group Covers for Newly Launched Health Plans

– July 31, 2020

The ongoing COVID-19 pandemic has caused turmoil across industries. To offer some sort of a backup to the public, the Insurance Regulatory and Development Authority of India (IRDAI) had recently launched two policies: Arogya Sanjeevani and Corona Kavach. These were launched as individual policies. However, recent updates suggest that these two policies can be availed as a group cover as well. Group insurance plans are standard plans that cover a group of people under one policy. Thus, employers can offer these policies to their employees as a part of Employee Health Insurance. It can be offered by both public as well as private-sector employers. In the case of these group plans, most of the terms and conditions remain the same but there can be a change in the premium. The insurers have some flexibility in charging the premium for group policies in accordance with IRDAI guidelines.

Date For Enrollment Under Sarbat Sehat Bima Yojana Extended For Farmers

– July 27, 2020

The date for Sarbat Sehat Bima Yojana that is the Ayushman Bharat Yojana in Punjab, has been extended to include farmers and their families under health insurance. The Ayushman Bharat Yojana is the Indian Government’s flagship program that provides free health insurance for low-income groups in the country. By extending the date of applying to the Sarbat Sehat Bima Yojana, the authorities aim to include 9.5 Lakh farmers under the benefit. Applications from farmers will be accepted until 05 August 2020. Farmers with ‘J’ form and ‘sugar cane weighment slips’ are expected to apply for the scheme with self-declaration and other documents as published by the authorities. Eligible families can get in touch with the Market Committee office or Commission Agent (Arhtiya) to apply under the Sarbat Sehat Bima Yojana on or before 05 August 2020. Eligible members and their nominees can avail cashless treatment in any of the empanelled hospitals, which include 208 government and 546 private hospitals. The coverage provided under this scheme is Rs. 5 Lakh per family per year that can be availed to get treatment for 1396 diseases.

Punjab: Farmers Can Submit Applications for the Rs. 5 Lakh Health Insurance by 24 July

– July 21, 2020

The state government of Punjab has asked farmers to avail the Rs. 5 lakh health insurance scheme by 24 July 2020 for the cashless treatment under the Ayushman Bharat Sarbat Sehat Bima Yojana Punjab for the current financial year. The premium for the insurance will be borne by the Punjab Mandi Board and the farmers need not pay the same. Both farmers and their families will be covered under the scheme through which they can avail cashless treatment at network hospitals for 1,396 ailments, which includes cancer treatment, heart surgery and accident-related treatments. Beneficiaries can avail treatment from 546 private hospitals and 208 government hospitals in the state. Farmers need to fill the ‘J’ form to enroll in the scheme. Also, the self-declaration is available with the market committee and commission agent or it can be downloaded from the mandi board website. Eligible beneficiaries will receive a special insurance card to avail the treatment.

COVID-19: Treatment At Makeshift Hospitals to be Covered Under Health Insurance

– July 21, 2020

The insurance regulator said that the treatment of COVID-19 at makeshift hospitals will be covered under health insurance approved by the government. The number of cases has been on the rise, which has prompted state governments to permit makeshift hospitals to treat COVID patients. In a circular, the Insurance Regulatory and Development Authority of India (IRDAI) said that in an effort to make sure that treatment of the novel coronavirus, temporary or makeshift hospital approved by the state or central government should be considered as a hospital and all insurance companies should settle claims from these hospitals. The circular further specified that if a patient is admitted to a makeshift or temporary hospital, then such hospital will be considered as a network hospital and the claim should be settled accordingly. It also asked third-party administrators to take note of the circular and honour claims raised by COVID-19 patients through these types of hospitals.

IRDAI Directs Insurers to Settle Health Insurance Claim for Hospitalisation in a Makeshift Hospital

– July 17, 2020

The Insurance Regulatory and Development Authority of India (IRDAI) in a circular said insurance companies should settle health insurance claims for hospitalisation in a makeshift hospital. The announcement comes amid rising COVID-19 cases across the country and metro cities are running out of beds, which has prompted state governments to provide makeshift hospitals. However, there have been several instances of claims being denied, especially if treated at makeshift hospitals. In a circular, the IRDAI said that to ensure that the cost of COVID-19 treatment is covered under the terms and conditions. Hence, temporary or makeshift hospitals approved by the respective state government regarded as a network of hospitals and insurance providers should settle the claims. It asked third-party administrators to adhere to the circular to allow claims to be settled for COVID-19 treatment at a makeshift hospital.

Punjab CM Gives Nod to Cover 9.5 Lakh Farmers Under Health Insurance Scheme

– July 16, 2020

Punjab Chief Minister Amrinder Singh gave nod to bring 9.5 lakh farmers & their families under the health insurance scheme of Ayushman Bharat Sarbat Sehat Yojana (ABSSY). Through the scheme, beneficiaries can avail treatment facilities such as cancer treatment, major surgical treatments such as heart surgery, accident cases and joint replacement. Treatment facility of up to Rs. 5 lakh can be availed by the beneficiaries at any of the 208 government hospitals and 546 empanelled hospitals. The health insurance scheme in Punjab was launched back in 2019 by the state government. The release said that the health insurance scheme will cover a total of 9.5 lakh farmers with effect from 20 August 2020. Farmers can get cashless treatment facilities and the Mandi board will pay the premium for the health insurance.

Insurance Regulator Allows Insurers to Launch Standard Corona Kavach Health Insurance

– July 14, 2020

India’s insurance regulator Insurance Regulatory Authority of India (IRDAI) has approved health and general insurance companies to launch the standard health insurance for COVID-19, Corona Kavach health insurance in the country. The Corona Kavach is an exclusive health insurance plan which covers treatment for COVID-19, including the cost to procure PPE, oxygen, gloves, masks, etc. The Sum Insured in this standard coronavirus health insurance is a minimum of Rs. 50,000 and a maximum of Rs. 5,00,000. The policy can be availed by people between the age group of 18 and 65 years. The policy can be purchased as a family floater type which includes spouse, dependent children and parents/parents-in-law. Also, it covers comorbidities and pre-existing conditions and can be bought for 3.5, 6.5 or 9.5 months of tenure. Policyholders can avail home treatment for up to 14 days under this plan.

IRDAI In Favour of Short-term Health Insurance Policies for Coronavirus

– June 25, 2020

Insurance companies can now offer specific short-term health insurance policies to cover the novel Coronavirus thanks to the Insurance Regulatory and Development Authority of India (IRDAI). Here, the short-term is defined as a period that is more than three months but less than twelve months. Now, insurers can offer a 3-to-11-month Coronavirus-related policy to the people. Note that a fixed policy period of 12 months will not be deemed as a short-term cover. IRDAI issued a circular on 23 June 2020 stating the guidelines to introduce the short-term health insurance plans, which can be offered by Life, General, and Health insurance providers. However, Life insurance providers can only offer benefit-based policies, whereas General and Health insurance providers can offer both benefit-based as well as indemnity-based policies to the people. These short-term health insurance policies can be for an individual and a group.

IRDAI Notifies Health Insurance Providers Not to Contest Claims After Eight Years of Premium Payment

– June 16, 2020

In a fresh set of guidelines, the Insurance Regulatory and Development Authority of India (IRDAI) has said health insurance providers cannot contest claims after eight continuous years of premium payment. The notification came after the insurance apex body said that the main aim is to simplify the general terms and clauses in indemnity-based health insurance plans. This does not cover personal accident cover and domestic/international travel. Also, this was done to ensure uniformity across the insurance industry by simplifying the policy wordings of the terms and conditions. The new guidelines will be applicable to all health insurance policies that are not in compliance with these guidelines. This will be revised when they are due for renewal from 1 April 2021. Also, the guideline says that health insurance companies cannot contest claims after 8 continuous premium payments unless permanent exclusions are specified in the policy or proven for fraud.

New IRDAI Directives Allow Telemedicine Coverage Under COVID-19 Health Insurance

– June 12, 2020

IRDAI has ordered insurance companies to extend coverage for including telemedicine in their health insurance plans. Insurance Regulatory and Development Authority (IRDAI) is a government body that governs the Indian insurance sector. Including Telemedicine under a health insurance coverage will prove to be beneficial especially in the current COVID-19 pandemic where patients are supposed to remain in quarantine. This will ensure patients get access to quality health care services and help in containing the spread of Coronavirus to some extent. An increasing number of COVID-19 cases among medical staff can also be reduced with telemedicine.Telemedicine is a method through which patients can get a professional medical opinion like treatment and prevention, or diagnosis via telecommunication technology. Medical practitioners are to adhere to the Telemedicine Practice Guidelines dated 25th of March 2020 laid down by the Ministry of Health and Family Welfare (MoHFW). The claim for Telemedicine consultation can be made by a policyholder under the Outpatient Department (OPD) coverage of their health insurance policy.

Maharashtra Announces Rs.50 Lakh Insurance for Journalists

– June 9, 2020

The Maharashtra State Government announced Rs.50 insurance coverage for journalists and media personnel under the State’s accident cover. This announcement was made by the Public Health Minister on Thursday. Previously, the government had included other COVID-19 frontline warriors such as doctors, police, nurses, Anganwadi workers and home guards under the scheme. Journalists and other media personnel who are on active duty will be part of the State’s comprehensive personal accident coverage of Rs.50 lakh. Until the details of the package are worked out and the scheme comes into force, COVID-19 warriors will be covered through ex-gratia assistance of Rs.50 lakh.

Free Health Insurance Policy To All Citizens in Maharashtra

– May 5, 2020

The state government of Maharashtra announced that it will offer a free health insurance scheme to all people in the state. Maharashtra will be the first state to announce such a scheme in the country. This will be extended through the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) scheme. Citizens of Maharashtra can avail free and cashless treatment or hospitalisation. To apply for the scheme one must provide their domicile certificate and ration card. The state health minister said that the scheme was extended until now to 85% of the population, now the remaining 15% will be covered under the scheme. Employees of state government, white ration cardholders and semi-government will be eligible to apply for the scheme. He added that a Memorandum of Understanding has been signed between the government and General Insurance Public Sector Association for the treatment of the novel coronavirus or COVID-19 cases at private hospitals in Mumbai and Pune.

Health Insurance Scheme for COVID-19 Warriors Announced by West Bengal Government

– May 3, 2020

The state government of West Bengal has announced a health insurance policy for COVID-19 warriors including journalists with a sum insured amount of Rs.10 lakh. On the occasion of Press Freedom Day, Chief Minister Mamata Banerjee said that the press should be respected for their contribution to the society and they are the fourth pillar of democracy and should be able to perform their duties without any fear. The health insurance scheme of Rs.10 lakh will cover frontline coronavirus warriors and journalists so that they can perform their duties fearlessly.

Insurance Regulator Directs Health Insurance Providers to Settle Claim in 2 Hours

– April 23, 2020

Insurance Regulatory and Development Authority of India (IRDAI), the apex body for insurance companies in the country has directed that claims should be settled within two hours by health insurance companies. The circular said that from the time they receive the authorisation request, the hospital should receive authorisation on cashless treatment within two hours. It also said that the decision of the final discharge should be communicated to the hospital within 2 hours from the time the insurers or the third party administrator receives the final bill or any necessary needs from the network provider or hospital. The IRDA also asked health and general insurance companies that appropriate guidelines are issued to their respective third party administrators during this time of lockdown in an effort to contain the spread of the coronavirus in the country.

COVID-19: Health, Vehicle Insurance Renewal Date Extended

– April 16, 2020

Amidst the ongoing lockdown to contain the spread of the infectious COVID-19 in India, the common man is facing several hardships. The Centre, in an effort to bring some relief to Third-party health and vehicle insurance policyholders, has extended the date to renew their policies without being affected by a lapse of the insurance coverage. Insurance policies which are falling due between 25 March to 3 May 2020 have been extended to be paid by 15 May 2020. Failure to renew third-party health insurance policies on the due date get an extension of one month; however, there is no coverage during this extended period. As for the third-party motor insurance policies, there is no grace period and a penalty is charged for failure to renew it by the due date. However, with this announcement by the Finance Ministry, policyholders can get some relief to pay the renewal premium of their health or vehicle insurance till 15 May 2020.

Indian Bank Offers Up to Rs.4 Lakh Insurance Cover To Business Correspondents

– April 15, 2020

Indian Bank said it has offered insurance coverage of up to Rs.4 lakh to business correspondents which are instrumental in ensuring the availability of essential banking services especially in the rural and unbanked areas during the ongoing lockdown to contain the spread of the novel Coronavirus. The public-sector bank is offering the cover under the Pradhan Mantri Suraksha Bima Yojana and Jeevan Jyoti Bima Yojana. Business correspondents of banking services include those providing primary banking services such as cash withdrawals, deposits and other services especially in the remotest regions of the country. The Centre has announced a second lockdown to contain the spread of COVID-19 in the country and only essential goods and basic banking services are available currently.

Health and General Insurers Cleared by IRDAI to Market COVID-19 Health Insurance Policy

– April 3, 2020

The Insurance Regulatory and Development Authority of India (IRDAI) has cleared Acko General Insurance and 29 other insurance companies to market COVID-10 health insurance policy in India. The COVID-19 health insurance scheme will cover the hospitalisation expenses airing out of treat for the deadly Novel Coronavirus infections. The policy will offer coverage of Rs.1 lakh and Rs.5 lakh and the idea behind the new policy is to streamline a policy exclusive for the treatment of the COVID-19 infection and offer a standard insurance policy with common features. The standalone policy will be launched by the selected insurance companies but will be known as ‘Aarogya Sanjeevani Policy’. The price will be decided by those insurance companies.

COVID-19: Health Care Workers to Get Rs.50 lakh Health Insurance for 3 Months

– March 20, 2020

The Indian government has proposed to offer health insurance to health care workers to the tune of Rs.50 lakh per person. This includes paramedics, sanitation employees, doctors and ASHA workers. During a press conference, Finance Minister Nirmala Sitharaman said that health insurance coverage will be provided to health workers for a period of three months. The health insurance comes into effect from 25 March 2020. The coverage will include ward boys, safai karamcharis, nurses, paramedics, ASHA workers, technicians, specialists, doctors and other health workers. They will be covered under the Special Insurance Scheme. About 22 lakh health workers are expected to benefit from this scheme.

IRDAI Asks Insurance Companies to Conduct Board Meeting Through Video Conference

– March 23, 2020

In the wake of rising Coronavirus infections in the country, the Insurance Regulatory and Authority of India (IRDAI) to conduct board meeting only through video conferencing till the end of June 2020. Also, insurers have been given 30 additional days to submit their third-quarter returns. The apex body of insurance in India has appealed to all insurers, its intermediaries and distribution channels to be more sensitive to requirements of policyholders during this trying times in the country. It also asked them to operate through telephonic or digital mode. It said that all details such as services, office working hours and the alternative arrangements for payment of premium, renewal or the claim process to be displayed on their respective website.

IRDAI Brings in Changes to the Definition of Pre-Existing Diseases

– February 12, 2020

The Insurance Regulatory and Development Authority of India (IRDAI) has recently changed the definition of pre-existing diseases in health insurance. In a circular, the IRDAI said that it has removed the modified or additional clause from the existing definition in an effort to make it more simple and customer-friendly. The IRDAI said that if some illnesses were identified within three months of purchasing the health insurance policy, then it would be considered under pre-existing diseases. However, as per the recent circular, these diseases will not be considered as pre-existing diseases.

Health Ministry Says Rs.3,520 crore Have Been Released to States in Two Year Under AM-PMJAY

– February 6, 2020

Under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Health Ministry has released Rs.3,520 crore to states in the last two years. The Ministry also said that the reasons for slow use of funds were because four states were not implementing the scheme. The four states include Delhi, West Bengal, Odisha and Telangana. Also, states such as Punjab and Rajasthan joined the scheme late 2019 hence the lower utilisation of funds. Also, large states like MP, UP and Bihar are implementing the scheme for the first time and hence, the traction has been slow. AB-PMJAY is India’s flagship health insurance plan, which is also considered the biggest in the world.

Budget 2020: Ayushman Bharat Scheme, Health Sector Gets a Boost of Rs.69,000 Crore Under

– February 4, 2020

Expanding the Centre’s flagship scheme, Ayushman Bharat, Finance Minister of India allocated Rs.69,000 crore in the current Budget 2020. The scheme is considered as the World’s largest government-funded health insurance plan. Through the expansion, the scheme will witness more hospitals being set up in Tier 1 and Tier 2 cities in the country under the Public-Private Partnership (PPP) model. Tax proceeds from the sale of medical devices will be utilised to fund government hospitals in these regions, while Rs.6,000 crore has been allocated for the PMJAY scheme.

Over 1 Lakh Community Health Officers to be Placed at Health Centres by 2022: Ayushman Bharat Scheme

– December 12, 2019

The Central government’s flagship health scheme, Ayushman Bharat, will employ 1,20,000 community health officers who will be assigned at health and wellness centres by 2022. All sub-centres, primary health centres, and urban primary health centres will be upgraded to Health and Wellness Centres (HWCs) in an effort to offer comprehensive primary health care. The plan is also to create 1,50,000 HWCs by the end of financial year 2022. The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to offer health insurance policy with a coverage of Rs.5 lakh per family per annum. The scheme will cover over 10 crore poor families across the country.

IRDAI Circular Allows Policyholders to Select Thier Own Health Insurance TPA

– December 11, 2019

A circular issued by the Insurance Regulatory and Development Authority of India (IRDAI) states that policyholders need not depend on the insurance company to choose a third-party administrator (TPA) while buying health insurance. Now, the policyholder can select a TPA of their choice from the host of TPAs engaged by the insurance company. In case, the TPA is terminated by the insurer, the policyholder has the choice to choose any TPAs listed by the insurer. If the policyholder does not choose any TPAs, the insurer may choose its choice of TPA.

Proposal to Lower Sum Insured Amount on Standard Health Indemnity Insurance

– November 29, 2019

The Insurance Regulatory and Development Authority of India (IRDAI), which is the apex body of the insurance sector in the country, has proposed to lower the sum insured amount from Rs.1 lakh to Rs.5 lakh on individual and family floater policies. Through this proposal, the public is allowed to opt a suitable health insurance cover, offering basic hospitalisation costs. The difference is the premium charged on these types of insurances. Earlier this year, the IRDAI had made it mandatory for all general insurance companies to provide a standard health indeminity insurance with a basic sum insured amount between Rs.50,000 to Rs.10 lakh.

NITI Aayog Report Proposes Mandatory Health Insurance for All

– November 18, 2019

The government think tank, NITI Aayog, in its report has proposed mandatory health insurance for all in India. It said that the current health insurance schemes in India are highly fragmented at the level of risk pools and payers. Apart from the Ayushman Bharat as well as the packages offered by the National Health Mission (NHM), the government may explore the mandatory health insurance for future risk pooling options.

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CIN: U66000KA2016PLC138288

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Category: Non-Life Insurance

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