Best Health Insurance in India – First Time Buyers Guide

Written By Mani Karthik

I share everything I learned in life on this blog. Everything from personal finance tips to life hacks that'll make you a smarter person. Founded BackToIndia - on a mission to help NRIs move back to India.

In India, health insurance is a must-have for most people. With the rising cost of medical care and treatments, it is becoming increasingly difficult to pay for everything out of pocket. Health insurance can help cover the costs of unexpected medical bills, as well as provide peace of mind in case of an emergency. There are many different health insurance policies available in India, so it is important to know what to look for when choosing one. This guide will provide you with all the information you need to make an informed decision about the best health insurance policy for you and your family.

Health insurance is an important part of financial planning in India. It helps protect you and your family from the high cost of medical care. There are many health insurance plans available, so it is important to choose the right one for your needs.

In India, roughly 5.8 million Indians die because of diabetes, cancer, stroke, heart and lung diseases each year. In other words, out of 4 Indians, 1 has the risk of dying from an NCD before the age of 70. About 1.7 million Indian deaths caused by heart diseases every year, according to the World Health Organisation. (Source – National Health Mission)

A good health insurance plan will cover the cost of medical care in the event of an accident or illness. It will also provide financial protection in the event that you are unable to work due to an illness or injury.

There are a number of factors to consider when choosing a health insurance plan. These include the type of coverage you need, the amount of coverage you need, and the premium you are willing to pay.

It is important to compare different health insurance plans before making a decision. Make sure you understand the terms and conditions of each plan before you enroll.

The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) launched in September 2018, and State Government extension schemes, provide comprehensive hospitalization cover to the bottom 50% of the population – around 70 crore individuals. Around 20% of the population – 25 crore individuals – are covered through social health insurance, and private voluntary health insurance. The remaining 30% of the population is devoid of health insurance. (Source – NITI Ayog)

The right health insurance plan can give you peace of mind and financial security. It is an important part of protecting your family and your assets.

A first-timer should know about the different types of health insurance, the benefits and coverage of each type, and the things that are not covered by health insurance.

Introduction: What is the best health insurance policy?

Have you decided to start your health insurance journey in India? If so, you’ve come to the right place. In this article, we’ll be looking at the different health insurance options available in India and deciding which is best for you.

Co-pay vs. Non-prepayment: What’s the difference?

Before we look at the different health insurance policies available in India, it’s important to understand the difference between co-pay and non-prepayment.

A co-pay is an amount that you pay at the time of service. For example, if you go to a doctor for a medical check-up, your insurance will cover some costs of the visit but the remaining balance will be repaid by you when you are leaving the doctor’s office.

On the other hand, a non-prepayment health insurance policy does not require any payment at the time of service. All costs are covered by the insurance provider.

In a non-prepayment policy, the provider of healthcare services may retain a part of the fee to recover their costs. The balance is usually remitted to the insurance company by the insured party or the provider.

Is advance premium tax needed for health insurance?

You will have to pay a certain amount of advance premium tax as part of your subscription to the health insurance policy.

How much amount should my health insurance policy be?

the amount required for health insurance will depend on various factors, such as the individual’s age, health condition, and coverage needs. It is advisable to speak to a health insurance agent to get a more accurate estimate of the amount needed for coverage.

What is the right age to take health insurance?

The right age to take out health insurance will vary depending on individual circumstances. Some factors that could influence the decision include whether you are likely to experience health problems in the future, whether you have dependents who would be affected financially if you became ill, and the cost of health insurance.

types of health insurance in India

There are many different types of health insurance policies in India. Some of the most common include:

1. Health Insurance Plans for Individuals and Families

These plans are designed to cover the medical expenses of an individual or a family. They typically have a deductible, co-payments, and co-insurance.

2. Senior Citizen Health Insurance Plans

These plans are specifically designed to cover the medical expenses of senior citizens. They often have lower deductibles and co-payments than other types of health insurance plans.

3. Group Health Insurance Plans

These plans are typically offered by employers and cover the medical expenses of a group of employees. They often have lower deductibles and co-payments than individual plans.

4. Student Health Insurance Plans

These plans are specifically designed to cover the medical expenses of students. They often have lower deductibles and co-payments than other types of health insurance plans.

5. Visitor Health Insurance Plans

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These plans are designed to cover the medical expenses of visitors to India. They typically have a deductible, co-payments, and co-insurance.

Health Insurance for Individuals & Family

Health insurance plans for individuals and families in India are typically provided by private health insurance companies. These plans can be purchased through an insurance broker or agent, or directly from the health insurance company.

The majority of health insurance plans in India are indemnity plans, which reimburse the policyholder for medical expenses incurred. Some plans may also provide coverage for preventive care, hospitalization, and prescription drugs.

When choosing a health insurance plan, it is important to compare the benefits and coverage of various plans before selecting one. It is also advisable to read the fine print carefully to understand the terms and conditions of the policy.

But should you take health insurance from your employer or from private companies?

You should always compare the two before making a decision. Sometimes, employers offer great health insurance plans that are cheaper than private plans. However, other times, private health insurance plans are a better deal.

benefits of having health insurance in India

There are many benefits of having health insurance in India. Some of these benefits include:

  1. Health insurance provides financial protection in the event of an unexpected illness or injury.
  2. It helps to cover the cost of medical treatment and can potentially save policyholders a lot of money.
  3. Health insurance can also provide peace of mind, knowing that you and your family are protected financially in the event of a health emergency.
  4. In some cases, health insurance may also cover the cost of preventive care, such as vaccinations.

So, now that you have an idea of why you need health insurance and its benefits, let’s look at the features of a good health insurance policy.

features in a good health insurance policy

Some of the features to look for in a good health insurance policy in India are:

Coverage

A good health insurance policy should offer comprehensive coverage for both inpatient and outpatient treatment. It should cover pre and post-hospitalization expenses, as well as day-care procedures.

Sub-limits

Most health insurance policies come with sub-limits on various expenses such as room rent, ICU charges, etc. A good policy should have reasonable sub-limits that would not put a financial burden on the policyholder in case of hospitalization.

No claim bonus

A good health insurance policy should offer a no claim bonus, which is a discount on the premium payable in subsequent years if no claims are made during the policy period.

Co-payment

A good health insurance policy should have a co-payment clause, which means that the policyholder has to bear a certain percentage of the medical expenses in case of a claim. This helps to keep the premiums affordable.

Pre-existing diseases

A good health insurance policy should cover pre-existing diseases after a waiting period of at least 2-3 years.

Most of the top health insurance plans in India have a good well-rounded score in the above points. Let’s look at which are the best health insurance plans in India.

NivaBupa Health Premia Insurance Plan

If you’re looking to get you and your family covered against emergency medical costs, then I think NivaBupa Health Premia is a good plan to consider buying.

What this medical insurance plan covers

  • Maternity and newborn coverage
  • Health checkup
  • Hospitalization costs
  • New age treatment coverage
  • Pre & post hospitalization expenses
  • Emergency assistance

Why is it good

  • Great coverage & benefits for the whole family.
  • Great features covering emergency medical expenses.
  • Good value for money.
  • Great network of hospitals.

How much will it cost?

Here’s a sample costing estimate for the entire family under their Silver plan.

  • Cover maximum – Up to 7.5 Lakh Rupees.
  • Health checkup – Up to Rupees 1,875 per person.
  • Premium – 12,488 /Year

Max Bupa Health Premia is a comprehensive health insurance plan that offers a wide range of features and benefits. Some of the key features of this plan include cashless hospitalization, global coverage, personal accident cover, and no pre-policy medical check-up. The plan also offers a wide range of additional benefits such as maternity cover, newborn baby cover, and critical illness cover. It also provides an option to customize the plan to suit the individual needs of the policyholder.

The key benefits of Max Bupa Health Premia include

Comprehensive health cover

The plan offers a comprehensive health cover of up to Rs. 10 lakhs. It covers expenses related to hospitalization, day care procedures, domiciliary hospitalization, and emergency ambulance charges.

Global coverage

The plan offers global coverage of up to Rs. 5 lakhs for treatment taken overseas.

Personal accident cover

The plan offers a personal accident cover of up to Rs. 5 lakhs.

No pre-policy medical check-up

The plan does not require a pre-policy medical check-up for individuals up to the age of 45 years.

Maternity cover

The plan offers maternity cover of up to Rs. 12 lakhs for three childbirths.

New born baby cover

The plan offers a newborn baby cover of up to Rs. 6 lakhs for the treatment of complications relating to deliveries in the first 30 days.

Critical illness cover

The plan offers critical illness cover of up to Rs. 2 lakhs for those caused by critical illnesses.

The maximum amount that you can claim under this plan is Rs. 10 lakhs. In case you require more than Rs. 10 lakhs for medical expenses, then you can opt for the extended critical illness cover (XIC).

Religare Care Health Insurance Plan

This plan from Religare is a good choice for small families (couples with kids) who wants to protect themselves against urgent medical treatment expenses from injury, illness, or accident. They boast of a 95% insurance claim settlement ratio.

This plan is very flexible and offers a maximum sum insured from Rs. 6 Lakhs to 6 Crores (unlike MaxBupa).

What this medical insurance plan covers

  • Annual health checkup.
  • Robotic surgery.
  • Emergency ambulance services.
  • Hospitalization expenses.
  • Post hospitalization expenses.
  • Room rent.
  • ICU charges.

Why is it good

  • Good range and choice of the sum insured.
  • Great coverage & benefits.
  • Plenty of add-ons (additional cost).
  • Good value for money for long-term coverage.
  • A good network of hospitals (7,400+).
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Religare Care is a health insurance plan offered by Religare Health Insurance. It provides comprehensive health insurance coverage for individuals and families. The plan covers both inpatient and outpatient treatment, as well as preventive care. It also offers a wide range of add-on covers, such as critical illness covers, personal accident covers, and hospital cash benefits.

The key features of the Religare Care health insurance plan are:

Comprehensive health insurance coverage

The plan covers both inpatient and outpatient treatment, as well as preventive care.

Wide range of add-on covers

The plan offers a wide range of add-on covers, such as critical illness cover, personal accident cover, and hospital cash benefit.

Affordable premiums

The premiums for the Religare Care health insurance plan are highly affordable.

Tax benefits

The premiums paid for the Religare Care health insurance plan are eligible for tax benefits under Section 80D of the Income Tax Act.

Access to quality healthcare

The plan provides access to quality healthcare services at over 5,000 network hospitals across India.

Cashless claims

The plan offers complete protection against claims made for services received under it.

Freezing of Annual Premium

You can fix the annual premium of the Religare Care health insurance plan for a period of 3 years with a target benefit of Rs. 10,000.

Apollo Munich Optima Restore Plan

With a sum insured of Rs.3 Lakhs to 50 Lakhs, this policy can be taken from anyone from 91 days to 65 years. No wonder why it is so popular in India.

Sum assured is not that great compared to Religare’s above-mentioned plan, but the features are amazing. Hospital coverage is good and the claim process is generally reported as effortless.

An interesting (and unique) feature of this plan is that it covers domiciliary treatment, which is the treatment done at home.

What this medical insurance plan covers

  • Comprehensive health checkup
  • Ambulance services 
  • Cover for daycare procedures & inhouse treatment
  • Increase in sum insured for every 2 claim-free years

Why is it good

  • Good sum insured.
  • Great coverage & benefits.
  • Have some unique features like in-house treatment.

The Apollo Munich Optima Restore Plan is a health insurance policy that offers several features and benefits to policyholders.

Some of the key features of this policy include cashless hospitalization, lifetime renewability, and no pre-existing condition exclusions. Additionally, the policy provides comprehensive coverage for medical expenses, including inpatient and outpatient treatment, as well as preventive care.

One of the main benefits of the Apollo Munich Optima Restore Plan is that it offers policyholders the peace of mind that comes with knowing they are covered in the event of an unexpected illness or injury. This policy provides comprehensive coverage for medical expenses, so policyholders can focus on getting better, rather than worrying about how they will pay for their treatment.

Additionally, the policy offers cashless hospitalization, so policyholders can receive treatment without having to worry about upfront costs. The policy also has a lifetime renewability feature, so policyholders can keep their coverage even if they develop a chronic or pre-existing condition.

Star Family Health Optima Plan

Let’s say you’re a small family of dad, mom, and kids and are looking for a good medical insurance plan that can cover all of you. Then, this might just be the best plan out there.

Star Health Optima Plan is an economical plan, one that doesn’t cost much but provides the basic necessary coverage. For every year, where you don’t claim anything, a health check-up is gifted free under this policy.

It covers pre-hospitalization, and post-hospitalization, domiciliary hospitalization (like Apollo Munich), donor expenses for organ transplantation, coverage for newborn babies cover, etc.

What this medical insurance plan covers

  • In-patient hospitalization.
  • Treatment at home (For a period exceeding three days).
  • Air ambulance charges up to 10%.
  • Pre and post-hospitalization expenses 60 days and 90 days respectively

Why is it good

  • Economical plan.
  • Flexible.
  • No unnecessary frills.

The Star Family Health Optima Plan is a comprehensive health insurance plan that offers a wide range of benefits for policyholders and their families.

Some of the key features and benefits of the plan include:

Coverage for medical expenses

The plan covers a wide range of medical expenses, including hospitalization, doctor’s visits, prescription drugs, and more.

Coverage for mental health and substance abuse

The plan provides coverage for mental health and substance abuse services, including counseling and therapy.

Coverage for maternity and newborn care

The plan covers the costs of maternity and newborn care, including prenatal care, delivery, and postnatal care.

Coverage for preventive care

The plan covers the costs of preventive care services, such as screenings and vaccinations.

Coverage for dental and vision care

The plan provides coverage for dental and vision care, including routine exams, cleanings, and vision correction.

Flexible spending account

The plan includes a flexible spending account (FSA) that can be used to cover eligible out-of-pocket healthcare expenses.

Discounts on health and wellness products and services

Policyholders can receive discounts on health and wellness products and services, such as gym memberships and fitness classes.

Star Family Health Optima Plan - Pros and Cons

Pros:

  1. One of the most comprehensive health insurance plans available.
  2. No sub-limits on room rent, ICU charges, etc.
  3. Covers pre and post-hospitalization expenses.
  4. Covers alternative treatments like Ayurveda and homeopathy.
  5. Health check-ups are covered from the first year itself.

Cons

  1. The plan is only available to people between the ages of 18 and 65.
  2. The sum insured cannot be increased once the policy is purchased.
  3. There is a waiting period of 3 years for certain conditions like cataracts, hernia, etc.

HDFC Ergo Health Suraksha Gold Plan

From 3 Lakhs to 10 Lakhs available on the sum assured, plus some wisely crafted features, this medical insurance plan is an excellent choice for those looking to get good value for money.

Loaded with features like organ donor expenses, inpatient hospitalization, and daycare procedures, this plan has just what you need to cover the normal medical expenses.

I wish it was more flexible with addons but they do have different tiers (Gold, Platinum, etc) where you can choose the different sum assured options.

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What this medical insurance plan covers

  • Treatment at home (For a period exceeding three days).
  • In-patient hospitalization charges.
  • Pre and post-hospitalization expenses 60 days and 90 days respectively

Why is it good

  • Economical plan.
  • Lean and without any frills or unwanted benefits.

HDFC Ergo Health Suraksha Gold Plan is a health insurance policy that offers comprehensive cover for individuals and families.

The key features and benefits of this policy are:

Coverage for inpatient hospitalization expenses

The policy covers all expenses related to inpatient hospitalization, including doctor’s fees, room charges, and nursing expenses.

Coverage for outpatient treatment

The policy also covers expenses incurred on outpatient treatment, such as consultation fees, diagnostic tests, and medicines.

Pre and post-hospitalization expenses

The policy covers expenses incurred before and after hospitalization, such as transportation and medication costs.

Daycare procedures

The policy covers expenses incurred on daycare procedures, such as chemotherapy and dialysis.

Health check-ups

The policy covers the cost of health check-ups once every year.

No claim bonus

The policy provides for a no claim bonus, which increases the sum insured by 10% for every claim-free year, up to a maximum of 50%.

Tax benefit

The policy provides for a tax benefit under Section 80D of the Income Tax Act.

The HDFC Ergo Health Suraksha Gold Plan is an extended health insurance policy that offers an extra for CoD and SCD. The maximum out-of-pocket expense for a qualifying individual (with no claims) under this plan is Rs. 5,500.

HDFC Ergo Health Suraksha Gold Plan - Pros and Cons

Pros:

  1. Coverage for a wide range of health conditions and treatments.
  2. No sub-limits on room rent, ICU charges, etc.
  3. Covers pre and post-hospitalization expenses.
  4. Covers alternative treatments like Ayurveda and homeopathy.
  5. Health check-ups are covered from the second year onwards.

Cons:

  1. The plan is only available to people between the ages of 18 and 65.
  2. The sum insured cannot be increased once the policy is purchased.
  3. There is a waiting period of 3 years for certain conditions like cataracts, hernia, etc.

Health Insurance Policies by India Government

The Indian government offers a wide variety of health insurance policies for its citizens, ranging from basic coverage to more comprehensive plans. Which policy is right for you will depend on your needs and budget. In this guide, we’ll take a look at some of the best health insurance policies available in India, so you can make an informed decision about which one is right for you.

Aarogya Sanjeevani

The Arogya Sanjeevani product aims to solve that problem by offering a common policy across health insurers where they can compete on the premiums, service quality, and provider network. Additionally, it will also facilitate seamless portability between insurers.

What does Arogya Sanjeevani cover?

The Arogya Sanjeevani is an indemnity health insurance plan covering hospitalizations, including pre and post-hospitalization expenses. The sum insured is flexible – varying between Rs. 50,000 to Rs. 10 lakhs – based on the needs of the individual, or the family.

Who can be covered under Arogya Sanjeevani?

Anyone aged below 65 years can enroll for health insurance under Arogya Sanjeevani with any of the health insurance companies. It is available on an individual, family floater, and group insurance basis. Health insurance companies are free to decide the family configurations they want to offer. For example, some companies do not offer a plan which includes a dependent parent. Individuals greater than 65 cannot enroll in the plan but
can continue the plan if they enrolled prior to turning 65.

What is the premium?

The premium for Arogya Sanjeevani is not fixed for a given sum insured and family configuration. It varies between insurers. Figure 8 benchmarks the premium for a sum insured of 5 lakhs for two different family configurations. The average annual premium for a family of 4 (2 adults and 2 children), and a family of 5 with one additional dependent parent are ~Rs. 12,000 (or ~Rs. 8 per day per person), and ~Rs. 26,000 (or ~Rs. 14 per
day per person) respectively.

Official website

How to choose the best health insurance policy for yourself?

There is no definitive answer to this question. Some factors to consider include whether you are single or have a family, your age and health status, your income, and whether you have any pre-existing medical conditions. You may also want to compare different health insurance policies to see which one offers the best coverage for your needs.

How to make a claim under a health insurance policy in India

In order to make a claim under a health insurance policy in India, the policyholder must first notify the insurance company of the event or illness that has occurred. The policyholder will then need to submit a claim form, along with any supporting documentation, to the insurance company. The insurance company will then review the claim and make a determination as to whether or not the policyholder is eligible for benefits.

So, there you have it. The best medical and health insurance plans available in India as of now (2020).

If you have taken any of the above-mentioned plans, please let me know in the comments what your experience has been. Thank you.

Which is the best medical insurance plan in India?

The best medical insurance plan in my opinion is the MaxBupa Health Premia plan. But all the other plans mentioned in this article are also great options.

What are the exclusions in medical insurance plans?

Common exclusions in medical insurance plans are hospital expenses from self inflicted wounds, treatment of mental disorders, cosmetic surgeries, accidents by war-like situations etc. This may differ for each plan.

What is free look period?

Free look period in medical insurance plans is defined as a required period of time in which a new policy owner can terminate the policy without penalties.

Which is the cheapest medical insurance policy in India?

The cheapest medical insurance policy in India is Star Family Optima plan. However you can pick and choose features and other policies can get cheaper as well.

1 Comment on “Best Health Insurance in India – First Time Buyers Guide”

  1. This is good. However, what about plans for individuals ? Does it make sense to go for one of the above or are there better options for individuals ?
    Also, the elephant in the room is COVID. The health insurnace I was covered under did not cover consumables and a few other things; as a result employee negotiated a top up plan specifically focussed on COVID. For unemployed individuals though they have to find something which is not an overkill (for eg family plan) and something which does not leave them exposed to financial risk.

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