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What is Health Insurance ?

Health insurance provides financial protection for medical expenses, including hospitalisation, medications, and consultation fees

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Home / Health Insurance / What is Health Insurance?

Healthcare costs are going up rapidly, and it's important to have a health insurance policy to protect your savings and cover unexpected medical expenses. Experts suggest that you should get health insurance when you're young and responsible. This has many benefits, like more coverage, lower premiums, and no medical tests required. In this article, we'll explain health insurance policies, how it works, the types of health plans available, and more.

What is Health Insurance?
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Health insurance is an insurance product that covers medical and surgical expenses related to illnesses, injuries, pregnancy, and preventative care. It reimburses the insured for expenses incurred due to illness or injury or pays the care provider directly. In India, health insurance policies can be purchased from insurance companies or provided by employers. The policies can cover hospitalisation costs, consultation fees, and the cost of medicines. A premium is paid to the insurance company in return for the coverage provided.

When it comes to compensation for medical expenses, there are two primary methods used by insurance companies. Let's find out more!

Having a solid understanding of what health insurance is crucial, as it can offer peace of mind during unforeseen medical emergencies. So, take the time to research and select the appropriate policy that suits your needs and budget.

Types of Health Insurance policies
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Here are different types of health insurance plans in India.

Individual Health Insurance

  1. Provides coverage for an individual policyholder.

  2. Sum insured and benefits are dedicated to the insured individual.

  3. Offers financial help in case of a medical emergency.

  1. Covers the family under a single plan.

  2. Offers a collective umbrella of coverage.

  3. Sum assured is shared by all insured members.

  1. Catered to the specific health needs of senior citizens.

  2. Covers medical expenses related to age-related and other illnesses.

  3. Offers additional benefits such as regular health check-ups.

Critical Illness Insurance

  1. Provides a lump-sum benefit in case of a severe illness.

  2. Covers expenses related to treatment, hospitalisation, and recovery.

  3. Offers financial assistance to the policyholder during difficult times.

  1. Offers coverage to a group of individuals, such as employees of a company.

  2. Offers the advantage of a group discount.

  3. Sum assured coverage and benefits are shared among all members of the group.

How does health insurance work in India?
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In India, health insurance provides financial assistance to individuals in the event of medical emergencies or illnesses. Here the policyholder pays a premium for coverage, and the insurance company pays for the policyholder's medical expenses up to the agreed-upon limit.

To avail of health insurance benefits, the policyholder must first file a claim with the insurance company, which then verifies the claim and pays the approved amount directly to the hospital or healthcare provider. Some health insurance plans also offer cashless hospitalisation, where the policyholder can receive medical treatment without paying upfront, as the insurance company directly pays the hospital.

The cost of health insurance premiums in India varies depending on factors such as age, health status, and the type of coverage. Additionally, some health insurance plans may have certain exclusions or waiting periods before certain treatments or conditions are covered.

It's important to carefully read and understand the terms and conditions of a health insurance policy before purchasing it. It's also recommended to compare different health insurance plans and choose one that best suits your needs and budget.

The significance of Health Insurance
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Many of us don't think about health insurance until we really need it. But it's so important to understand the benefits of having a health insurance policy! You never know when an unexpected medical emergency might happen and it can be expensive. That's why experts suggest getting health insurance when you're young and healthy. 

You'll get better coverage at a reasonable cost, and you might even be able to get a tax break on your premium. So, why is health insurance so important? Here are a few reasons.

Factors that affect health insurance premiums in India
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Here are the factors that affect the premium of a health insurance plan in India.

Things to remember when buying health insurance
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Here are some things you must remember while buying a health plan.

Range of plans offered
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Look into the types of plans that each company offers, as well as their unique selling points. Some insurers offer a variety of products to cater to different coverage needs, so choose a company with a diverse range of plans to find the policy that best suits your needs.

Network of hospitals
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The network of hospitals that an insurer partners with is crucial for accessing cashless claims. The wider the network, the better it is for you as it enables you to easily locate the nearest cashless hospital.

Premium rates
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To determine the best insurance provider, compare the pricing of different insurers by examining the premium charges for similar plans. Look for an insurer that charges the lowest premium for the same plan, which indicates that they likely have a fair pricing policy across all their plans.

Ease of claim settlement
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Insurance providers have streamlined their claim process by introducing various convenient features such as AI-enabled claim processing, digital documentation, WhatsApp intimation, quicker approvals, app-based claim intimation and tracking, and other similar features. Look for an insurer that provides such facilities to ensure a quick and hassle-free claim settlement process.

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Go through customer testimonials and reviews. Insurers typically showcase their customers' reviews on their websites. Alternatively, ask your friends and relatives about their insurers and claim experiences to determine which company follows the best practices.



  1. Hospitalisation expenses: Coverage for hospitalisation expenses such as room rent, doctor fees, nursing charges, and cost of medicines.

  2. Pre and post-hospitalization expenses: Coverage for medical expenses incurred before and after hospitalisation, typically up to a certain number of days.

  3. Day care procedures: Coverage for medical procedures that do not require hospitalisation but still require medical attention, such as dialysis or chemotherapy.

  4. Ambulance charges: Coverage for ambulance charges incurred during emergency transportation.

  5. Organ donor expenses: Coverage for medical expenses incurred during organ donation surgery, including the donor's medical expenses.

  1. Undisclosed pre-existing medical conditions: Medical conditions that existed before purchasing the health insurance policy may be excluded if they are not declared while buying the policy.

  2. Cosmetic treatments: Purely cosmetic Treatments, such as plastic surgery, are typically not covered unless medically necessary as a result of an accident.

  3. Non-medical expenses: Non-medical expenses such as travel or food expenses are not covered.

  4. War or nuclear hazards: Expenses related to war, nuclear hazards or acts of terrorism might be excluded.

  5. Self-inflicted injuries: Injuries from self-harm or suicide attempts are generally not covered.

How to determine the right coverage amount for Health Insurance?
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Having a sufficient sum insured is crucial to ensure that your health insurance plan covers your medical expenses. A low sum insured defeats the purpose of investing in health insurance and is not recommended. Selecting the right sum insured is not as complicated as it may seem. You just need to consider the following factors.

Most insurers in India provide a tool to calculate the ideal sum insured based on your income, expenses, existing coverage, and family members to be insured.

Selecting the right Health Insurance Plan
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Choosing the right health insurance plan is a crucial step in safeguarding your health and finances. With numerous insurers offering multiple plans, it can be overwhelming to select one. However, considering some essential factors can help you choose the best plan that suits your needs.

Coverage benefits
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When selecting a health plan, the primary consideration should be the coverage benefits it provides. It is important to evaluate your specific coverage requirements and choose a plan that meets those needs. If you plan to have a child, for instance, you should look for plans that offer maternity coverage. Furthermore, look for additional features that extend your coverage. Opting for a plan with comprehensive coverage can help you reduce your out-of-pocket expenses during claims and provide better financial security.

Customization options
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Choose a plan that allows you to customise the coverage features according to your requirements. Look for plans that offer add-ons for additional coverage features that can make customization possible.

Premium amount
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When choosing a health insurance plan, it's crucial to consider the premium amount. You should compare the premiums charged by various insurers who offer similar coverage benefits to gain a clearer understanding. Even if it means selecting a different insurance company, opt for a plan that provides the most competitive premium rate for the same level of coverage benefits.

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Certain health insurance plans may have limitations on specific expenses such as room rent, ICU room rent, domiciliary treatments, and more. These limitations can limit the extent of coverage and potentially result in additional out-of-pocket expenses. It is advisable to choose a policy with no such limitations to ensure that you can receive the most comprehensive coverage possible.

Co-payment clause
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Health insurance plans might have co-payment clauses applicable in different instances. Choose a plan that does not have a co-payment clause. In unavoidable cases, opt for plans with a lower co-payment rate.

Waiting period
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Waiting periods are the period during which specific coverage is not allowed by the health insurance policy. Find a plan with a low waiting period, especially if you are looking for maternity coverage or coverage for pre-existing conditions.

Discounts available
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Health insurance plans offer various discounts such as two or three-year policy discounts, online policy purchase discounts, renewal discounts, etc. Choose a plan that offers the highest discount so that you can get the best deal on the premium.

How to make health plans affordable
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Health insurance plan premiums are affordable, and insurers also offer the option of instalment premiums, allowing you to pay the premium monthly, quarterly or half-yearly. This makes health plans more affordable.

If a high sum insured seems unaffordable, you can opt for a super top-up health plan. Super top-up plans enhance coverage while keeping premiums low. For example, if you need higher coverage but cannot afford one, you can split the sum insured into a base plan and a top-up plan. The aggregate premium would be lower than buying a health plan for the entire sum assured. This can help you make health plans more affordable.

Buying health insurance online
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Purchasing a health insurance policy online is a quick and easy process that can be completed in just a few minutes without any physical paperwork or signatures. To get started, you'll need to gather detailed information on various health insurance policies that fit your specific needs and requirements.

Next, you can compare different policies based on their coverage, benefits, and premium quotes. This research can be done conveniently online at your own pace and location. Once you have selected the best policy for your needs, it's important to carefully review the policy document and complete any necessary documentation.

After uploading the required documents, you can make the final payment using a credit card, debit card, or net banking. The insurance company typically takes seven to ten days to process the application and issue the policy document to you. It's important to keep this document safe as it serves as proof of your health insurance coverage.

Common mistakes while buying health insurance
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Here are some mistakes that you should avoid while buying the policy.

Rushing into a purchase
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Don't make the mistake of buying a health insurance plan hastily. Take your time to do proper research and choose the best plan for you and your family. You can research and compare premium quotes online before making a decision.

Choosing insufficient coverage
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While the premium cost is an important factor, it is important not to compromise on coverage. It's better to opt for a comprehensive coverage plan that takes into account your family size, medical history, and financial situation.

Hiding health-related details
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It is crucial to disclose all the necessary details about your health, lifestyle habits, and pre-existing diseases while purchasing a health insurance plan. Failure to disclose relevant medical history can lead to rejection of insurance claims.

Not buying a separate health insurance policy
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Relying solely on medical coverage provided by your employer is not advisable as it usually offers limited coverage. It's important to purchase a separate health insurance plan that provides sufficient coverage, which will not be affected by your employment status.

Ignoring terms and conditions of the policy document
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Be sure to read and understand the terms and conditions of the policy document. Everything related to coverage, premium costs, discounts, sub-limits, free-look period, waiting period, co-payment clause, and deductibles is clearly mentioned in the policy document. If you have any doubts, contact the insurance company for more information.

Buying a policy just to save on taxes
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While it's important to know the tax benefits of health insurance premiums, don't buy a policy just for the sake of saving taxes. The main aim of buying a health insurance plan is to get sufficient coverage that will financially support you and your family during medical emergencies.

Frequently asked question
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Here are the answers to the following questions related to what is health insurance


What is the waiting period in health insurance? 

The waiting period in health insurance is when the policyholder cannot make claims for certain illnesses or medical treatments. This usually applies to pre-existing conditions and can vary from policy to policy.

What is the premium in health insurance? 

The premium in health insurance is the amount of money paid by the policyholder to the insurer for the health insurance policy. It can be paid monthly, quarterly, half-yearly, or yearly, depending on the policy terms and conditions.

What is a network hospital in health insurance? 

A network hospital in health insurance is a hospital that has a tie-up with the insurance company to provide cashless treatment to the policyholders. If policyholders seek medical treatment in a network hospital, they can avail cashless treatment without paying any upfront costs.

What is the policy term in health insurance? 

The policy term in health insurance is the duration for which the policyholder is covered under the health insurance policy. It can vary from one year to multiple years, depending on the policy terms and conditions.

What is a pre-existing medical condition in health insurance? 

A pre-existing medical condition in health insurance is a medical condition that the policyholder has been diagnosed with or received treatment for, before buying the health insurance policy. It is important to disclose any pre-existing conditions to the insurer, as it can affect the coverage and premiums of the policy.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet, and is subject to changes.