How Does Health Insurance Work in India?

How does health insurance work in India
How does health insurance work in India

The rising cost of medical care and our sedentary lifestyle make health insurance essential. It protects you from a variety of medical conditions and enables stress-free living. In this article we will tell you about How does health insurance work in India? Individual plans and family floater policies for health insurance are frequently purchased in India. With the use of the sum insured, the coverage’s scope is the same for both.

What is Health Insurance?

A health insurance is a contract between the person who buys the policy and an insurer whereby the insurer promises to provide financial coverage for significantly higher medical expenses in return for comparatively lower premiums.

In other words, health insurance protects your finances against medical emergencies in exchange for small premium payments.

Based on your personal information, including your gender, age, medical condition, location, etc., the insurer determines the premium amount for your health insurance plan.

You might also need to have health screenings because most insurance companies require applicants over the age of 45 to evaluate their health.

How does health insurance work in India?

In order to protect against various illnesses, health insurance is very beneficial. You are required to pay a premium to the insurer in exchange. Your age and medical history are the most crucial variables that affect this product’s price, along with a few other factors.

You have the right to benefits as the policy owner up to the insured amount. The following costs are typically covered by medical insurance policies:

  • Pre and Post-hospitalization expenses
  • Daycare procedures
  • AYUSH treatment recognized by government institutions
  • In-patient expenses
  • ICU charges
  • Indoor expenses

One should never forget that different insurers may have different levels of coverage. Every policy has a waiting period, after which benefits become payable. Therefore, it is crucial to carefully review the policy’s wording.

Another crucial aspect to take into account is deductibles. It’s the cash outlay required at the time of settlement. There are two types of deductibles which are- required and optional. In case you increase the optional your liability will increase but your amount of premium will go down.

How to choose the best health insurance in India?

There are numerous medical insurance providers in India, and they all provide a variety of plans and policies. It can be difficult to decide which is best for you and your family as a result.

It can also be difficult to decide which policy to consider for you and your loved ones. Thus here are some factors that you should consider:

Type of coverage provided: The first factor to consider I’d the type of coverage offered by the insurance providers like-
comprehensive coverage that pays for hospitalization, doctor visits, prescription drugs, and other related costs.

Amount of Insurance: In case of a claim, this is the sum that the insurer will pay. Various health insurance companies offer a range of insured amounts, so it’s crucial to pick a plan that provides the right level of protection for your requirements.

Type of hospitals and doctors covered by the plan: Different health plans offer varying levels of coverage for various types of healthcare, including the hospitals and physicians they cover. Public and private hospitals and physicians are both covered by some plans, while others only cover government facilities.

Customer services: It’s critical to pick a health insurance provider with a solid track record of providing excellent customer service because doing so will guarantee that you receive the best support possible in the event of any problems.

Cost of the plan: Health insurance premiums are charged by various companies, varying in price. Comparing various plans is crucial in order to select one that both satisfies your needs and is within your price range.

What is health insurance renewal?

The duration of the health insurance benefits is set. You must pay the necessary premium to renew your policy after this time period has passed. You can add riders to your policy renewal to broaden the coverage.

Your insurance coverage will increase up to a certain amount if you don’t file any medical claims. Insurance companies now offer both online and offline renewal options.

What happens during health insurance claims?

The majority of health insurers offer reimbursement claims as well as cashless claim benefits. They have contracts with a number of cutting-edge hospitals across the nation where you can receive treatment without paying anything.

A third-party administrator (TPA) is used by each network hospital to ensure that your application for cashless treatment is processed without any hiccups. If you receive care at a hospital that is not in the network, you must submit a reimbursement claim.

You will need to provide the original hospital invoice, medical screening report, and prescription costs to the insurance company. If everything checks out, they will verify the documents, and the claim will be resolved within a few days.

Why should you get a Health Insurance?

Getting early health insurance is very essential. Here are some of the most significant advantages of health insurance plans:

Relaxation in rising medical costs

To protect their finances from the steadily rising cost of healthcare, people buy health insurance policies. You might have to pay more than a few thousand rupees if you have an accident or a medical emergency.

It is simpler for you to receive the care you need to recover when you have medical insurance coverage for everything from ambulance fees to nursery procedures.

Insurance for Critical Illnesses

Critical illness coverage is frequently available as an add-on to many health insurance plans. This is yet another essential cover to have in light of the rising prevalence of lifestyle-related diseases today.

If you are found to have one of the critical illnesses covered by the policy, you will receive a lump sum payment. A critical benefit of having health insurance is critical illness coverage because dealing with and managing these problems can frequently be very expensive.

Health Insurance for Seniors

Senior citizens’ medical needs and requirements have been specifically considered in the design of these health plans. Most senior citizen insurance policies provide extra coverage, including some psychiatric benefits and even domiciliary hospitalization.

These policies may demand a thorough medical examination before purchase and may be more expensive than standard insurance policies because older people are more likely to have health issues.

Health Insurance for Families

With a family floater plan, you can insure everyone in your family under a single policy, and the total amount insured is split equally between all of the insured parties. Due to the fact that the sum insured is shared, these plans are usually more affordable than individual ones.

Also read: Can I buy multiple term insurance?


In this article we discussed how does health insurance works in India? It’s not particularly difficult to understand health insurance and other similar insurance products. You can understand how good an insurance company is just by reading their policy terms online.

The waiting period, claim process, renewal process, exclusions and inclusions, and other essential topics should always be considered. Call the customer service number listed on the insurance company’s website for assistance if you need help understanding the terms used in insurance.