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Types of health insurance: Different types of medical plans in India

Team AckoAug 25, 2021

There has been a rapid rise in healthcare costs in the past few years, and with the looming threat of the coronavirus pandemic, medical care has become crucial. A medical insurance plan plays a vital role in managing healthcare-related expenses as it provides you with financial backup in case of medical emergencies. There are a variety of insurance plans available that fits your requirement. Read ahead to know about different types of health insurance plans in India.

Types of Health Insurance Plan In India

Different types of health insurance policies in India

As mentioned earlier, a health insurance plan covers hospitalisation, daycare treatment, health check-up, ambulance charges, etc. Sometimes you tend to overlook the symptoms and delay the medical treatment due to lack of funds. However, with a medical insurance plan with extensive coverage, one can avail of medical treatment without worrying about the entire cost of treatment.

Below are the details about the different types of health insurance plans available in India.

  1. Individual Health Insurance Plan

  2. Family Floater Health Insurance Plan

  3. Group Health Insurance Plan

  4. Critical Illness Insurance Plan

  5. Personal Accident Insurance Plan

  6. Maternity Health Insurance Plan

  7. Senior Citizen Health Insurance Plan

1. Individual Health Insurance Plan

As the name suggests, this insurance policy is meant for an individual. This plan offers financial benefits in case of medical emergencies. You have to buy individual policies to cover each member in your family, and each covered member will have an individual sum assured amount.

Example scenario: If you purchase an individual health policy with a sum insured of Rs 3 lakhs for yourself, your spouse and two kids, each member will have an individual sum assured of Rs 3 lakhs. However, the premium for these kinds of plans is on the higher side.

Features of an Individual Health insurance Plan

  • It covers an individual. You need to buy separate policies to cover each family member (spouse, kids and parents).

  • Individual sum assured amount for each covered member.

  • Covers hospitalisation due to illness/injury, surgeries, room rent, daycare treatment, etc.

  • Individuals between the age group of 18 to 65 years can opt for this plan.

2. Family Floater Health Insurance Plan

The Family Floater Health Plan is an affordable insurance plan that covers all the members of the family under a single policy. That means the sum insured floats for all the covered members. The premium for this plan is comparatively lower than individual health policies that cover all the family members. The Family Floater Plan covers yourself, your spouse, children and parents.

Example scenario: Mr A purchases a Family Floater Plan with a sum assured of Rs 7 lakhs. The plan covers Mr A, his spouse and two kids. Now, Mr A is hospitalised for a hip replacement surgery, and the cost of treatment was Rs 3.5 lakhs. The cost of treatment is covered under the insurance plan,

Next time, Mr A’s wife and two kids are hospitalised due to food poisoning. The total cost of medical treatment turns out to be Rs 1.5 lakhs. The insurance plan covers the hospitalisation expenses. The remaining sum insured amount is Rs 2 lakhs, which can be utilised for any medical emergencies in the future.

Features of a Family Floater Health insurance Plan

  • A single policy covers the entire family.

  • Floating sum assured amount.

  • It covers hospitalisation, cost of treatment, surgeries, daycare treatment, etc.

3. Group Health Insurance Plan

It is a type of medical insurance plan designed for a group of people working for an organisation. Typically an employer/corporate company/start-up opts for this plan to secure the health insurance needs of its employees. It is also one of the essential benefits provided by an employer for its employees.

Features of a Group Health insurance Plan

  • The policy provides medical coverage to the employee and his/her dependents.

  • Basic coverage is free for an employee.

  • Covers hospitalisation due to an illness/injury, critical illnesses, etc.

  • No waiting period to avail of policy benefits.

  • Some group insurance plans also cover maternity, OPD and daycare treatment.

  • Floater sum assured

  • Can top-up the sum insured (if enabled by the employer).

4. Critical Illness Insurance Plan

It provides financial benefits to the insured if he/she is diagnosed with a critical illness/disease. It covers diseases like kidney failure, stroke, heart attack, paralysis, etc. The cost of treating these illnesses is on the higher side, and the Critical Illness Policy acts as a financial backup if you are diagnosed with any of the listed diseases.

Features of Critical Illness insurance Plan

  • It covers critical illnesses such as heart attack, stroke, kidney failure, paralysis, organ transplant, etc.

  • Provides a one-time lump sum benefit (up to the sum insured) upon being diagnosed with a critical disease.

  • The insured should survive for 30 days to avail of the policy benefits.

  • Some plans also offer complimentary health check-ups.

5. Personal Accident Insurance Plan

Accidents are unpredictable, and such events can drain your savings due to the medical expenses involved in treating the injury. A Personal Accident Insurance Policy covers the medical costs incurred due to an accident. The insurance policy also covers partial disability, permanent disability and death of the insured due to an accident.

Features of Personal Accident Insurance Plan

  • The policy provides coverage against accidental injuries, disability (partial/permanent) or death.

  • It covers the cost of hospitalisation due to an accident.

  • Death benefit (up to the sum insured) to the nominee in case of death of the insured.

  • It covers loss of income if the insured suffers permanent disability.

  • It covers the dependent child’s educational expenses in the case of death of the insured

  • The policy provides a daily cash allowance in case of hospitalisation due to an accident.

  • It covers ambulance charges.

6. Maternity Health Insurance Plan

A Maternity Health Insurance Cover can be purchased as a rider along with the basic health policy. It covers all the expenses incurred during the prenatal, delivery and postnatal stages. This plan has a waiting period that differs from one insurer to another. So, it is ideal to purchase this plan as early as possible.

Features of Maternity Health Insurance Plan

  • The policy covers pre- and post-hospitalisation expenses.

  • It also covers the cost of normal/cesarean deliveries.

  • It also provides coverage for termination of pregnancy due to a life-threatening situation.

  • Coverage for the newborn baby (first 90 days).

  • It covers the cost of vaccination for the newborn baby.

7. Senior Citizen Health Insurance Plan

It is a policy designed to meet the insurance needs of senior citizens who are above the age of 60. Since older people need more medical attention and are more likely to make a claim, the premium for this plan is on the higher side. The insurance policy covers pre- and post-hospitalisation, medical treatment, etc. Pre-existing diseases are also covered by this plan, and the coverage depends on the terms and conditions of the policy.

Features of Senior Citizen Health Insurance Plan

  • Ideal for senior citizens over the age of 60.

  • It covers pre- and post-hospitalisation due to accident or illness, medical treatment, domiciliary hospitalisation and psychiatric treatment.

  • A health check-up may not be required to purchase the policy (depends on the insurer).

Things to consider while buying health insurance plans

With so many health insurance plans available at your disposal, you may not be very clear regarding which policy is best for you. Here are some of the points that you should consider while purchasing the medical cover that best fits your needs.

  • Claim settlement process: Go through the insurer's claim process before opting for a health policy, the more straightforward the claim process, the faster the claim settlement. Also, look for the after-sales service. Good customer support is crucial while purchasing a health cover.

  • Sum insured amount: Choose the sum assured amount wisely when buying a health plan as it covers the medical expenses. Factors such as age, income, number of family members, pre-existing diseases, etc., play a part in choosing the correct sum insured for the medical cover.

  • Cashless treatment: Opt for an insurer that offers cashless treatment at network hospitals. It is ideal to choose an insurer that has a vast network of cashless hospitals. Cashless treatment avoids the hassle of settling the hospitalisation bills as the insurer directly pays the medical expenses to the hospital. Note that the policyholder needs to bear the deductibles (if any) during claim settlement.

  • Maternity cover: The medical expenses related to pregnancy can go very high. Hence, opt for a medical cover that provides maternity benefits. Check the waiting period for maternity claims and also check the sub-limit for the policy.

  • Medical check-up and value-added services: Look for a health policy that offers free health check-ups. Some insurers even provide value-added services such as lab tests, discount offers on medicines, etc.

Frequently asked questions

Here are some of the most commonly asked questions about health insurance plans in India.

Why should I buy a health insurance plan?

The cost of medical treatment is skyrocketing with each passing day. A serious illness or injury can drain your savings in no time. Hence, having a financial backup to cover your medical expenses becomes crucial. You can do that by purchasing a health insurance plan, as it covers medical treatment expenses.

How can I buy a Group Health Insurance Plan?

An employer provides a Group Health Plan to the employees. Corporate companies or start-ups can purchase this type of insurance plan. As an individual, you cannot buy a Group Medical Insurance Plan without an employer.

Which is the affordable health insurance plan for a family of four?

A Family Floater Health Insurance Plan is an affordable and ideal health policy for a family of four. A floater plan comes with a sum assured that can be shared with the covered members. Hence, the premium is on the lower side.

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