Health Insurance

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Health Insurance-Definition

Health Insurance is an insurance product that covers the whole or part of the risk of person incurring medical expenses. Health Insurance is estimated by the overall risk of health care and health system expenses over the risk pool To provide the money to pay for health care benefits specified in the insurance agreement, a routine finance structure can be developed.

Importance of Health Insurance

For every individual in India, These days health insurance has become a necessity. It provides risk coverage against expenditure which is caused by unforeseen medical emergencies. Today, failing to hold an adequate health cover can prove costly financially when the medical inflation rates are so high. However, the awareness about health insurance is on the rise in urban India. A study jointly conducted by Max Bupa and Nielsen in 2014-15 which covered 1500 consumers revealed that 70% of the respondents felt that health insurance was more important than life insurance. 60% of the consumers were aware that health cover provided by the employer may prove to be inadequate.



  • Covers Room and boarding expenses
  • Nursing expenses
  • Fee of doctors, surgeons, other specialists and consultants, etc.
  • Health check up, laboratory fee and charges Sum insured for individual/family Cumulative bonus
  • Hospitalisation charges Pre and post hospitalisation charges Cashless facility Critical illness benefits Top-up policies Ambulance charges

Documents Required for Medical Insurance Policy

There are few documents that you need to provide if you have decided to buy health insurance online such as:

  • Age proof – Any one of Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter ID, etc
  • Identity proof – Driving License, Passport, Voter ID, PAN Card, Aadhar Card, which proves ones citizenship
  • Address proof – Electricity Bill, Telephone Bill, Ration Card, Driving License, Passport, should clearly mention the permanent address.
  • A medical check-up is taken usually for elder people above the age of 45 years in order to make sure that the insured does not suffer from any chronic illness.
  • Passport Size Photo to have a record of the insured person`s identity for future references.

List of Medical Insurance Companies in India

There are few documents that you need to provide if you have decided to buy health insurance online such as:

  • Aic Of India Health Insurance
  • Apollo Munich Health Insurance
  • Bajaj Allianz Health Insurance

  • Bharti Axa Health Insurance

  • Cholamandalam Ms Health Insurance

  • Ecgc Health Insurance

  • Cigna TTK Health Insurance

  • Future Generali Health Insurance

  • Hdfc Ergo Health Insurance

  • Iffco Tokio Health Insurance

  • L & T Health Insurance

  • Max Bupa Health Insurance

  • National Health Insurance

  • New India Health Insurance

  • Oriental Health Insurance

  • Reliance Health Insurance

  • Religare Health Insurance

  • Royal Sundaram Health Insurance

  • Sbi Health Insurance

  • Shriram Health Insurance

  • Star Health Insurance

  • Tata Aig Health Insurance

  • United India Health Insurance

  • Universal Sompo Health Insurance

Compare and Decide

LegalRaasta allows you to compare the best deal on insurance and let you choose by yourself which will help you in save more money. To protect yourself and your family from unwanted medical costs-health plans are the best ways. Buying health plans provide risk coverage against expenditures caused by any unforeseen medical emergencies.

LegalRaasta helps you to compare and choose the best health insurance plan for you.

The level of coverage mostly depends upon the type of the Medical insurance policy. A lot of companies now offer health insurance in India and therefore as a consumer, you have multiple choices from leading brands. You should take advantage of our comparison services to choose the best deal. Some of the brands offering health plans are MaxBupa, Bharti-AXA, Tata AIG, Apollo Munich, Star Health etc.

Choose the best health Insurance in India

In current times of high medical inflation rates, failing to hold adequate amount of health insurance cover can prove to be a major personal finance disaster. This could lead to either poor health care because of non-affordability or spiral an individual into financial distress due to high medical bills. This is where the whole concept of medical policies comes into play. Best health insurance plans cover medical costs during hospitalization as well as pre and post stages of hospitalization.

Types of Health Insurance in India:

  • Individual Mediclaim-This is the simplest type of all health insurance schemes and is called the individual healthcare policy. Such a scheme covers hospitalization expenses for a person up to the sum assured. The yearly premium payable is usually directly proportional to the sum assured. Example- All the policies are independent of each other if there are three members in your family, each of them can buy a standalone cover of Rs2 lakhs each.. If all three members require hospitalization, all can get their hospitalization expense covered by up to Rs 2 lakhs.
  • Family Floater Policy-These are enhanced versions of the individual mediclaim policy. Here, the sum assured is floated among family members named in the policy. That is, it covers the medical expenses of the full family, up to your sum assured. Family floater policy is usually less than individual policies taken by each family member. Suppose, there are four members in your family; you can buy a family floater mediclaim for? 6 lakhs. Now anyone of the four insured can claim up to the full amount for expenses. But the cover will come down by the claimed amount for that policy year. So when a member of your family gets hospitalised and expenses in this regard is? 4.5 lakhs, the cover for the family floater policy would be reduced to? 1.5 lakhs. The policy will again resume from? 6 lakhs, upon renewable. A family floater mediclaim policy makes sense because each member gets a big cover. Also the chance of more than one member getting hospitalised in the same year is quite low.
  • Unit Linked Health Plan (ULHP)-Health insurance companies have recently introduced ULHPs that combine health insurance and investment, and return an amount once the term of insurance ends. The return, of course, depends upon the market conditions at that time. But these plans are still in the development stage and are recommended for those who can handle products like unit linked insurance plans (ULIPs) and unit linked pension plans (ULPPs).
  • Note-It is advisable to stay away from ULHP’s for some reasons. Treat health insurance just as an expense. This is because unlike life insurance, you don’t get back the premium you pay at the end of the term, if there’s no claim. Select an individual healthcare policy if you are single and a family floater if you have a family. You can get a tax exemption of up to Rs.15,000 under section 80D of the Income Tax (IT) Act, if the amount of premium is paid by credit/debit card or cheque.

Health Insurance by Employer

Several companies provide mediclaim for their staff. It also often covers hospitalization expenses of the spouse, dependent children, and parents. It is always advisable to take the mediclaim irrespective of the amount covered because you don’t have to pay any premium for that. Now, whether you need to take another health insurance policy will depend on a few factors. Is the cover provided by your employer sufficient? Is the insurance company good enough? What will happen when you change jobs?

Mediclaim is provided as an incentive to employees. So it’s important that you understand the insurance policy is details and also check the coverage. Ask your human resource (HR) department for the details; what’s covered and what’s not covered. Employees are satisfied over the fact that their company is providing health insurance, only to find out later that several things were not included at all or were covered only in parts.

Health Insurance For senior Citizens

Mediclaim companies were unwilling to extend cover to the aged and senior citizens, a decade back. But of late, several insurers are providing health insurance policies for them. Insurance cover paid to an individual aged 65 years or above can lead to an additional tax relief of up to Rs20,000 but remember that premium payable for senior citizens are much higher.

If you are employed and have a mediclaim cover from your employers, approach your HR manager and negotiate with the insurance company to provide an additional cover for your parents. Because of the high volume, the insurer may provide the cover at an attractive premium

Third Party Administrators

A third party administrator, commonly known as TPA, is an organisation that processes claims and extends cashless facilities to the insured as a separate entity. TPAs, in effect, act as a middleman between the insurance company and the insured. A customer can deal directly with the TPA for settlement of claims and the organisation will help the insured with the process. TPAs are a specialised healthcare service provider and render a variety of services that include networking with hospitals and arranging for hospitalisation. The TPA concept was introduced by the Insurance Regulatory and Development Authority of India (IRDAI), to benefit both the insurer and the insured. While insurers benefit via reduction of their overheads and administrative costs, fake claims, and ultimately reducing claim ratios, the insured can take advantage of better and prompt healthcare service.

An insurer may have several TPAs. Similarly, a TPA can serve as an agent of multiple insurance companies.

Some of the key services rendered by a TPA are as follows:

  • Maintain a database of all policyholders
  • Issue identity cards to policyholders
  • Provide ambulance services
  • Give information to healthcare policyholders about networked and empanelled hospitals
  • Check with various investigations
  • Extend cashless mediclaim services
  • Process health insurance claims

TPAs settle claims in two ways.


You can avail cashless treatment facilities only in the networked hospitals of the insurance company. The TPA must be notified beforehand in case of a planned hospitalization, or within a specified timeframe in case of an emergency. All the paperwork will be done by hospital’s insurance desk. The TPA has to approve the mediclaim amount and the hospital will settle it with the insurer. There are likely to be exclusions i.e. expenses that the TPA won’t pay. Such expenses must be settled by the patient party directly at the hospital cash counter.


The insurer can avail the reimbursement facility both at networked and non-networked hospitals. Here, you can avail treatment facilities and settle the bill directly with the hospital. You can then claim reimbursement of the expenses from the TPA by submitting the relevant bills and receipts.

Let’s Compare- Health Insurance Vs Mediclaim

Health Insurance


Policy holders will get the comprehensive coverage that will cover pre and post hospitalization as well. The upper limit of a health insurance policy can go to as far as Rs 60 lakhs. Normally, health care policies also offer discounts on a regular basis over a definite period of time. When it comes to tax deduction, there is also a difference in health insurance and mediclaim. A mediclaim policy provides coverage for hospitalization expenses for a definite pre specified illness till a certain time as per the sum insured. The maximum limit for all claims is fixed at a definite amount under mediclaim policy. It works on the principle of indemnity in which hospitalization is a specific requirement to think about any claim. Even those people who are insured under a mediclaim policy need to pay hospitalization expenses from their pocket and the insurer will pay them later.
Health insurance premium paid towards a health insurance policy provides a tax exemption under section 80D of Income Tax Act. The funds paid towards mediclaim premium paid for self or spouse or children are appropriate for tax exemption of Rs 15,000 under section 80D.

Some Important Health Insurance Terms

Here are some of the important terms that you will come across while subscribing to a health insurance policy.

Sum Assured:

The sum assured, in simple terms, is the maximum coverage amount you can get in a policy year. It forms the basis of all your claims. Consider the increasing costs of hospitalisation, medicines, and treatment before you decide on your sum assured. It’s advisable to select a higher cover. At the same time, the cover shouldn’t be high enough for you to dig into your pockets for paying the premium.

Co-pay and Sub-Limits:

The co-pay and sub-limit system is introduced by some health insurance companies to prevent hospitals from billing unreasonable room rents to patients. In a co-pay policy, you need to pay a part of the expenses irrespective of the sum assured. If a policy has 10% co-pay, then the insurance company will pay 90% of the expenses and you have to bear the rest. Besides, some insurers cap the expenses of treatments to reduce the claims of hospitals. This is known as sub-limit. While buying a mediclaim, choose a policy which has fewer sub-limits. There are some mediclaim policies that do not have co-pay or sub-limits. Try to select such a plan.

Comprehensive Cover:

Some employers provide health insurance to their staff under group insurance plan. But you can still have a mediclaim of your own which covers the entire family. Second mediclaim policy may not considered if your employer allows you transfer the policy if you leave your job. It’s important that you compare several policies before buying one.

Critical illness:

Majority of the comprehensive mediclaim policies cover critical illness. You don’t need to purchase another policy. It’s advisable to subscribe to a comprehensive plan and then top it up with an accident insurance plan which doesn’t cost much. To serve your mediclaim needs, there are two policies which are enough. If there’s a family history of a certain illness like thyroid or blood sugar, you should ideally buy a separate critical illness mediclaim. If your family has no such history, then there’s no need for a critical illness plan.

Restore benefit:

If you have already exhausted the same as well as the multiplier benefit within your policy year. But in most cases, the benefit is not available on the same illness if the limit is already used up.
But a restoration benefit can be useful if you have subscribed to a family floater plan where the full sum assured is exhausted for treating only a single family member. The remaining members will have no cover to fall back upon in case of hospitalisation for the rest of the policy year. In such a case, some of the members can get covered for other ailments than the one for which expenses have been already paid by the insurance company.

No claims bonus (NCB):

If there has been no claim in the preceding year Insurers usually extend a NCB to a policyholder. Check the NCB while buying mediclaim, amount before signing on the dotted lines. NCBs can range from 5% to even 100% of the sum insured. A high NCB gives cover against medical inflation and you don’t need to worry about increasing your coverage year-on-year.

Pre-existing illness, waiting period, exclusions:

Pre-existing diseases are the ones you have while subscribing to the mediclaim policy. Most health insurance companies specify a waiting period for these illnesses. The insurance company is unlikely to give a cover against the same. In most cases, a pre-existing illness is covered after at least two years of buying the policy.
Exclusions simply mean the diseases that are not covered under the mediclaim. For instance, if you suffer from diabetes while taking the policy, then kidney ailments are likely to be excluded from cover if the same happens because of the diabetes. Never hide any pre-existing ailments from your insurer while buying a mediclaim policy. It may reduce your hospitalisation claims.

Free Check-up:

Most health insurers provide free health check-up to the policyholder. But what’s termed “free” is actually not such. The cost of the check-up is included in the premium. Buy such a policy only when you are keen to get the facility each year. Also check whether the mediclaim policy, renewed every year, gives coverage for the entire life. This is important because life expectancy is increasing due to improved medical technology. While most insurance companies give full life coverage, some provide cover only up to 75-80 years.

Maternity and Daycare:

Medical insurance policies provide cover on hospitalisation that doesn’t require overnight stay. These are called daycare procedures. Check out how many procedures are covered in the plan. Also, most insurers don’t consider maternity as medical emergency. So don’t look for a maternity cover if you have no plans for a baby.

Top up Plans:

Medical costs are increasing. It calls for large covers. But not all can afford a high premium. A top up plan can come useful in such a case. It reduces cost of deductibles i.e. the amount you pay before the insurance company pays up. The insurance company will only pay up to the sum assured. A top up plan, on the other hand, doesn’t pay until the hospital bill breaches a specific limit. Say, if the hospital bill is ?8 lakhs with Rs3 lakhs as deductible, you need to pay the latter, while the insurer pays the balance Rs5 lakhs. But you can use your individual/group policy to pay the deductible amount. Combination of a basic mediclaim plan along with a top up plan is much cheaper than a single cover. For instance, premium for a Rs5 lakhs regular cover for a 26-year old male, will be around Rs6,500. A top up with Rs15 lakh cover will entail an additional premium of Rs5,000, which is far cheaper than a standalone policy of identical amount.

FAQ’s On Health Insurance

Get answers to all your questions

1. Is health Insurance is better than mediclaim?

These two terms are too often used interchangeably. However, there are some sharp differences between them. A health insurance is much more comprehensive and provides a cover that extends beyond hospitalization, while mediclaim limits itself specifically to hospitalization expenses.

2. Why do I need Health Insurance?

Healthcare is expensive. Technological advances, new procedures and more effective medicines have driven up the cost of healthcare. This increase has to be borne by the consumer, making treatment unaffordable for too many. All the obstacles can be overcome by insurance so that you remain free of anxiety regarding your health. Think for a moment about the enormous medical costs you would incur if you suffered a major accident tomorrow or were suddenly stricken by an illness. Uninsured people live with such risks everyday. Health insurance seeks to shield you from that risk. It provides the much needed financial relief.

3. What is cashless mediclaim?

These days, most insurers have arrangements with various hospitals spread across the country as part of a network. Under a policy,if an individual is insured which offers cashless facility, can get treated in any hospital of the network without paying hospital bills because the same is paid directly by the third party administrator (TPA), on behalf of the insurer. However, all expenses beyond the sum insured or the ones not covered under the policy, have to be paid by the insured directly to the hospital. Cashless facility is not available if the hospital is not included in the network. In such cases, payment by the insurance company to the hospital, is usually carried out on reimbursement basis.

4. What factors affect the premium payable for a health insurance policy?
  • Age is the biggest factor which determines the premium payable. The older you are, the higher will be your premium.
  • Your medical history is another factor that will go into determining the premium. If you don’t have any medical history, the premium would be naturally lower.
  • You are eligible for a discount on further premium payable for the years for which there has been no claim of the insurance money. Add-on benefits like free medical checkups and/or diagnostic tests in case of no claim is also offered by the insurance companies cover
5. What about the waiting period?

As already said, there is usually a 30-day waiting period when you buy a new policy, starting from the day you enrolled in the health insurance scheme. During this period, the insurance company won’t pay any hospitalisation charges. But this is not applicable in case of an emergency hospitalisation arising out of an accident. The waiting period is not applicable for renewal of the policy for subsequent years.

6. Will I get covered for my pre-existing illnesses?

For certain tenure at the starting of the policy every insurer excludes coverage on the pre-existing illness. You need to find out what this waiting period for your pre-existing illness is and how soon can you be covered for your pre-existing illnesses. You need to understand whether your pre exiting condition is temporarily not covered or is it completely excluded from the scope of coverage.

7. What to do if I am admitted in a non-network hospital?

In case you are admitted in a non-network hospital and knowing the claim protocol at that time is imperative in an emergency situation. Always remember that treatment in a non-network hospital would be on a reimbursement basis only where you would have to shoulder the medical bills and then get them reimbursed from your insurer.

8. What happens to the coverage amount when a claim is filed?

Once an insurance claim is filed and settled, the coverage gets reduced by the amount paid on settlement.

9. Is my health insurance policy transferable, sans losing renewal benefits?

Yes. According to a circular issued by the Insurance Regulatory and Development Authority (IRDA), with effect from 1 October, 2011, the insured can transfer a policy from one insurer to another, and also from one plan to another. No renewal credit will lose for pre-existing health conditions which he/she enjoyed in the incumbent policy. But the credit would be limited to sum insured and the bonus eligible under the present policy. Check with your insurance company for the detailed clauses in this regard.

10. What is the basic difference between individual and group health insurance coverage?

An individual policy is purchased by you directly from us, the employer or legally constituted group is the policyholder and the insurance company contracts with the employer or legally constituted group. Group health insurance often contains special coverage’s that are not available or are very expensive on an individual basis. The purchasing power of the group makes this economically feasible. Moreover since the insurance contract is between insurer and employer or legally constituted policyholder there is no guarantee that policy would be renewed further.