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Health insurance is a type of plan that helps you pay for medical costs when you're sick or injured. Paying a premium covers expenses like hospital stays, small treatments, critical illnesses, ambulance charges, home care, medicines, and even AYUSH treatments. It protects you and your family from unexpected medical bills and gives financial relief during emergencies. Plus, it helps you save money on taxes under Section 80D of the Income Tax Act, of 1961.
What is Health Insurance?
Health insurance is an agreement between you and the insurance company, where the insurer provides financial support for your medical expenses up to a set coverage limit. It covers costs for both emergency and planned hospitalizations.
Choosing the right health plan keeps you and your family financially secure during unexpected sickness or injury. Compare health insurance plans with Square Insurance to protect your family’s future.
Features of Health Insurance
Now, that we understand the health insurance meaning, let's understand some of its features that you can get
| Features | Specifications |
|---|---|
| Sum Insured | ₹1 lakh to up to ₹6 crore |
| Pre & Post-hospitalization Expenses | Covered |
| ICU Charges | Covered |
| Day Care Procedures | Covered |
| Maternity Cover | Available |
| OPD Cover | Available |
| Pre-existing Diseases | Covered after waiting period* |
| Ambulance Cover | Available |
| Free Health Check-ups | Available annually |
| Alternative Treatments (AYUSH) | Covered |
| No Claim Bonus | Up to 50% increase in sum insured |
| Critical Illness Coverage | Available |
| Tax Benefits | Up to ₹1,00,000 per financial year# |
| Room Rent Limit | No capping on room rent in many plans |
| Preventive Healthcare Services | Covered |
Importance/Benefits of Health Insurance
Health insurance helps you pay for medical expenses, so you don’t have to worry about high costs during emergencies. Here are some health insurance benefits
- 01
Protection Against Rising Medical Costs
Medical treatments are becoming more expensive every year. Health insurance makes sure you are covered, so you don’t have to bear the burden of rising healthcare costs.
- 02
Access to Quality Medical Facilities
With health insurance, you can get treated at top hospitals without worrying about the costs. It ensures you and your family receive the best care available.
- 03
Protection from Unexpected Medical Expenses
Unexpected illnesses or accidents can drain your savings. Health insurance helps you manage these sudden expenses without financial stress.
- 04
Better Health Outcomes
By covering timely treatments and regular check-ups, health insurance helps improve your health and recovery. It ensures you get the care you require when you need it.
- 05
Critical Illness Coverage
Health insurance can cover costly treatments for serious illnesses like cancer, heart problems, or kidney failure. This helps reduce your financial burden during tough times.
- 06
Peace of Mind
With health insurance, you don’t have to worry about how to pay for medical bills. It gives you confidence and peace, knowing you are prepared for any health emergencies.
- 07
Tax Benefits
Health insurance also helps you save money on taxes under Section 80D of the Income Tax Act. This means you can secure your health and also reduce your tax payments.
Types of Health Insurance Plans
Family Health Insurance
This plan covers your whole family, including your spouse, parents, and children. All members share the total coverage amount under the policy.
Senior Citizen Health Insurance
This plan is for elderly people above 65 years old. It provides coverage for their specific health needs, like treatments for age-related illnesses.
Individual Health Insurance
Individual health insurance plans are for one person, offering full coverage for their medical expenses. Some plans also let you add your spouse for joint coverage.
Critical Illness Insurance
This plan covers expensive treatments for severe diseases like cancer, heart attack, or kidney failure. It ensures financial support for life-threatening conditions.
Personal Accident Health Insurance
This plan covers medical expenses for injuries caused by accidents. It also provides financial help if there’s a disability or death due to the accident.
Health Insurance for Parents
This plan is designed for parents above 60 years old. It helps cover medical costs for age-related health issues, like heart or kidney problems.
Group Health Insurance
This plan is for a group of people, like employees in a company. Each member gets a fixed amount of coverage. Sometimes, family members can also be added to the plan.
Critical Illness Health Insurance
If you are diagnosed with a serious illness like cancer or paralysis, this plan gives you a lump sum payment. It can be a separate policy or an add-on to your existing health insurance.
Coronavirus Health Insurance
Special health plans for COVID-19, like "Corona Kavach" (for families) and "Corona Rakshak" (for individuals), provide financial help for treatment and hospitalization costs during the pandemic.
How to Choose the Right Health Insurance Coverage?
A simple rule is to buy health insurance with a coverage amount that's at least half of your yearly income. Experts suggest a minimum of ₹10 lakh coverage due to rising medical costs. However, the ideal amount varies based on your needs.
The right health insurance coverage depends on three main factors:
City of Residence
Costs in tier-1 cities are higher than in tier-2 or tier-3 cities.
Age or Life Stage
Younger people generally need lower coverage than older individuals.
Future Hospital Costs
Consider rising medical expenses over time.
For example, a ₹5 lakh plan may be enough for a young person in a tier-3 city with no health issues. However, older people, those with pre-existing conditions, or residents of tier-1 cities may need ₹10-20 lakh coverage for better protection.
Check the table below to find your ideal coverage.
| Types of Plans |
| ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Individual health plan | Rs. 10 Lakhs & above | Rs. 5 to 10 Lakhs | Rs. 5 Lakhs | ||||||
| Family health plan | Rs. 30 Lakhs & above | Rs. 20 Lakh & above | Rs. 10 Lakh & above | ||||||
| Senior Citizen plan | Rs. 20 Lakhs & above | Rs. 15 Lakh & above | Rs. 10 Lakh & above | ||||||
Disclaimer: The given sum insured is for suggestion. It may vary according to the age and medical needs of the people.
What Are The Advantages Of Having A Health Insurance Policy In Your Life?
- 01
Cashless Treatment
Today various insurance companies have collaborated with a wide range of hospital networks, which allows you to get cashless treatment during any illness. These facilities can provide huge relief if you are facing a financial crisis. It lowers the stress to a certain extent, as you don't have to worry about the bills and expenses of your hospitalization.
- 02
Pre And Post Medical Coverage
If you choose your policy wisely then you don't have to be worried about the pre and post-hospitalization charges. Nowadays many companies are providing this facility for a fixed duration (maximum 60 days), depending on the type of medical plan you purchase.
- 03
Transportation Charges
The charges of the ambulance are covered by your policy, which provides easy and fast transfer to your desired hospital.
- 04
(NCB) No Claim Bonus
It is one of the best things about health policy. No claim bonus is the amount that is paid to the policyholder if he doesn't claim for any treatment in the previous year.
- 05
Tax Benefits
According to the Income Tax Act under 80D your premium is tax-deductible. It lowers your taxable income resulting in the reduction of your tax bill.
Checklist for Buying Health Insurance
Health Insurance Riders
Personal Accident Rider
This rider helps you get financial support if an accident causes a disability or death. For a total disability, the insurer pays the full insured amount. For partial disability, you get a part of the amount based on the injury. In case of accidental death, your family gets a death benefit, which is why it's also called a double indemnity rider.
Maternity Cover Rider
This rider pays the maternity-related expenses that include childbirth, pre-natal, and post-natal care. Some plans have newborn baby expenses covered up to the time the policy expires. However, the waiting period for this rider varies between 9 months to 6 years depending on the insurance provider.
Room Rent Waiver
This feature lets your health insurance cover the cost of any hospital room you choose during your stay. There’s no limit on room rent, so you can pick a room with higher or no limits without paying extra from your pocket.
Consumables Cover Rider
This add-on covers non-medical items used in the hospital, such as cotton, bandages, thermometers, gloves, and masks. These costs, which could contain 10-20% of your hospital bill, are usually not included in regular policies. This rider can save you money and quality care.
Hospital Cash Rider
This add-on gives you a fixed daily cash amount to cover extra costs during your hospital stay. If you’re in the ICU, you’ll receive double the daily amount for a set number of days. To activate this benefit, you need to be hospitalized for at least 24 hours.
Critical Illness Rider
This rider provides a lump sum payout if you’re diagnosed with a critical illness like cancer or heart disease for the first time during your policy period. The payout is given regardless of actual medical costs. It usually has a 90-day waiting period and a 30-day survival requirement. Most plans cover 10 to 40 critical illnesses.
What is Covered and Not Covered in a Health Insurance Plan?
Covered
In-patient Hospitalization Expenses
It covers hospital stays and treatment costs when admitted for more than 24 hours.
Pre and Post-Hospitalization Expenses
This policy includes medical expenses incurred before and after hospital stays, as per policy terms.
Day-Care Procedures
Covers treatments like cataract surgery that don’t require a 24-hour hospital stay.
Pre-existing Illnesses or Diseases
Covered after completing a waiting period specified in the policy.
AYUSH Benefit
Covers treatments under Ayurveda, Yoga, Unani, Siddha, and Homeopathy systems.
Ambulance Charges
Pays for ambulance services used during medical emergencies.
Mental Healthcare Cover
Provides coverage for mental health treatments and therapy sessions.
Preventive Health Check-ups
Includes free health check-ups as part of the policy benefits.
Maternity Cover
Covers delivery expenses and newborn care under select plans.
Home Treatment Cover
Offers coverage for treatments received at home due to specific medical conditions.
Not Covered
Initial 30-Day Exclusion Period
Claims (except accidents) during the first 30 days of buying the plan are excluded.
Pre-existing Disease Waiting Period
Coverage starts only after a waiting period of 2 to 4 years.
Critical Illness Waiting Period
Requires a 90-day waiting period before coverage begins.
War or Terrorism Injuries
Injuries caused by war, terrorism, or nuclear activities are excluded.
Self-Inflicted Injuries
Claims for suicide attempts or self-harm are not covered.
Terminal Illnesses
Excludes coverage for terminal diseases unless specified otherwise.
Cosmetic or Plastic Surgery
Non-essential procedures like cosmetic or hormone replacement surgery are excluded.
Non-Accidental Dental Treatments
Regular dental treatments unrelated to accidents are not covered.
Bed Rest or Rehabilitation
Claims for hospital stays without active treatment are excluded.
Diagnostic Tests
Standalone diagnostic tests without subsequent hospitalization are not covered.
Adventure Sports Injuries
Injuries caused by risky adventure activities are not included.
Factors of Buying the Best Health Insurance Plans
- 01
Policy Type
Select the health insurance plan that is best suited to your needs, such as an individual or family-floater health insurance plan. Choosing the right one guarantees the best results from a good health insurance policy.
- 02
Waiting Period Clause
Check how long you’ll need to wait before coverage for pre-existing conditions starts. The best health insurance plans have less waiting (Time) and quicker benefits (GFR values).
- 03
Scope of Coverage
The best health insurance plans should also include important areas such as hospitalization, daycare therapies, or mental health in their coverage. A wider scope means better financial security.
- 04
Sum Insured
Pick a health insurance plan with a high enough sum insured to cover medical expenses in your area. The best health insurance plans are those that provide optimal protection without any extra payments.
- 05
Claim Settlement Ratio of the Insurer
Look for a company with a high health insurance claim settlement ratio to ensure smooth and quick claim processing. A good health insurance policy will come from a trusted insurer.
- 06
Co-payment Clause
Understand if you need to pay a part of the treatment cost. The best health insurance plans either avoid co-payments or offer minimal amounts for better affordability.
- 07
Network of Cashless Hospitals
Choose a health insurance plan with a wide network of cashless hospitals nearby. This ensures hassle-free treatment under a good health insurance policy without upfront payments.
Who Can Buy a Health Insurance Plan?
To buy a health insurance plan, you need to meet certain conditions like your age and health history. Most health insurance plans have these basic requirements
| Age Criteria for Adults | Entry Age for Adults: 18 to 65 Years |
|---|---|
| Age Criteria for Dependent Children | Entry age for Children: 90 days to 25 years |
| Pre-medical Screening | Above the age of 45/55/60 years |
| Pre-existing Disease waiting period | 2 years to 4 years |
Why Should You Compare Health Insurance Plans Online?
- 01
Get the Right Information
Performing a comparison of health insurance plans online gives you a complete picture of benefits, costs, and coverage benefits in one place, allowing you to make the most suitable decision.
- 02
Compare Different Plans Easily
You can quickly check and compare features of various health plans side by side without any hassle. This saves time and ensures you pick the right one for your needs.
- 03
Choose Affordable Premiums
Online comparisons enable you to discover the best health insurance plans that have premiums in the range that you are willing to pay, yet provide adequate protection.
- 04
Read Reviews for Better Decisions
Search for and read reviews and ratings to assess the quality of service and trustworthiness of the insurance provider or plan before your decision.
What Are The Healthcare Schemes Introduced By The Indian Government?
The Indian government has introduced several schemes to help safeguard your life. Take a look at some of them below.
Rashtriya Swasthya Bima Yojana (RSBY)
Pradhan Mantri Suraksha Bima Yojana
Central Government Health Scheme (CGHS)
Aam Aadmi Bima Yojana (AABY)
Janashree Bima Yojana (JBY)
Employment State Insurance Scheme (ESIS)
Universal Health Insurance Scheme (UHIS)
What Documents Are Required To Purchase Health Insurance?
Here are the important documents you’ll need to buy health insurance online:
- 01
Identity Proof
Documents like Passport, Driving License, Voter ID, PAN Card, or Aadhar Card to prove you are an Indian citizen.
- 02
Address Proof
Papers such as an Electricity Bill, Ration Card, Telephone Bill, Passport, or Driving License showing your permanent address.
- 03
Medical Report
Some health insurance plans may need a health check-up to confirm you don’t have serious health issues.
- 04
Age Proof
You also need documents like a Birth Certificate, School Mark Sheet, Driving License, Passport, or Voter ID to verify your age.
- 05
Medical History
Details of any pre-existing illnesses or past hospitalizations, including medical reports and records.
Steps to Buy Health Insurance Plan Online From Square Insurance
Buying health insurance online with Square Insurance is quick and easy.
Select if you're male or female and add the family members you want to insure along with their ages.
Step 1
Enter your full name and phone number.
Step 2
Answer if you or any family member being insured has a current illness.
Step 3
Pick a health insurance plan from the options shown or click ‘Get Free Advice’ for suggestions.
Step 4Compare different health insurance plans on www.squareinsurance.in/ and customize your search to find the best option.
Step 5
Once you choose a plan, you can pay the premium or talk to our customer care team for more guidance.
Step 6
After completing the steps, your policy will be sent to your registered email.
Step 7
How to Calculate Health Insurance Premiums?
You can use a health insurance premium calculator to find out how much your premium will be. This is an online tool that calculates the premium based on the details you enter, like the sum insured and the age of the insured. At Square Insurance, you can easily calculate your premium online using a health insurance calculator, and it’s completely free!
Health insurance premium calculator
Factors Affecting the Health Insurance Premium
- 01
Gender and Age
Your health insurance premium depends on your age and gender. Younger individuals usually have a lower health insurance price compared to older people.
- 02
Type of Health Insurance Plan
The type of plan you choose affects the health insurance price. Comprehensive plans have higher premiums, while basic plans cost less.
- 03
Lifestyle Habits
Unhealthy habits like smoking or drinking can increase your health insurance premium. A healthy lifestyle can help keep the price lower.
- 04
Medical History
If you have a history of illnesses, the health insurance price may be higher. Insurers consider the risk of health issues while calculating the premium.
- 05
Policy Term
Long-term policies may offer discounts, lowering the health insurance premium compared to short-term plans renewed yearly.
- 06
No Claim Bonus
If you don’t make any claims in a policy year, you may get a discount on your next health insurance premium, reducing the overall price of your insurance.
How to File a Health Insurance Claim?
There are two ways to file a health insurance claimReimbursement Claims
If you get treatment at a hospital that is not part of the insurance company’s network, you can file for reimbursement. After paying the bill yourself, collect all the documents and submit them to the insurance company to get your money back.
Cashless Claims
If you get treatment at a hospital in the insurer’s network, you can use the cashless option. The insurance company pays the hospital directly, so you don’t need to settle the bill yourself.
Documents Needed for a Health Insurance Claim
Hospitalization bills signed by you for verification
A copy of your ID card- Valid medical investigation reports
- Copies of the health insurance policy for both the current and previous year
Bills for doctor consultations- Completed claim form with your signature
- Details and bills for consumables and disposables prescribed by the doctor
Discharge card provided by the hospital
Doctor's prescriptions and pharmacy bills
Any additional documents requested by the TPA
Common Health Insurance Terms That You Should Know
- 01
Free Look Period
The free look period is the first 30 days after buying a health insurance policy. In that period, it is allowed to cancel the policy or to transfer to another insurer without paying a cancellation fee. If canceled, your premium will be refunded.
- 02
Network Hospitals
Network hospitals are healthcare facilities that are partnered with your insurance policy. Cashless treatment is available at the network hospitals where the insurer directly pays the bill to the hospital. This makes hospitalization stress-free.
- 03
AYUSH Treatment
Medical disciplines, including Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy, are included in AYUSH treatment. Most health insurance plans cover these traditional treatments and thus provide choice in healthcare.
- 04
Dependent
A dependent is a member of your extended family, spouse, child, or parent, who may be covered under your health insurance policy. Having dependents covered under a single policy makes it easy to handle the medical expenses of dependents.
- 05
Room Rent Limit
The room rent limit is the highest amount for which your Insurer will pay for a hospital bed during admission. If the room costs more than this limit, you’ll need to pay the difference out of pocket.
- 06
Waiting Period
The waiting period is the initial time after purchasing the policy during which claims cannot be made. For example, there may be a waiting period for pre-existing conditions or critical illnesses, ranging from a few months to years.
- 07
Domiciliary Treatment
Domiciliary treatment refers to the delivery of medical care in the home setting where admission to the hospital is difficult or impossible. This is normally covered by health insurance on specific conditions, for example, serious illness or the absence of hospital beds.
- 08
Preventive Health Check-up
Preventive health check-ups involve regular tests in order to preserve and detect any possible problems as soon as possible. As part of preventive care, these checkups are covered by health insurance plans on an annual basis to prevent later serious diseases.
- 09
Family Floater
A family floater is a type of health insurance policy where the sum of the insured is divided among all family members. It is more affordable than buying separate policies for each member and covers all members in a single policy.
- 10
Co-payment
Co-payment means the policyholder is required to contribute a sum of money from the amount of the claim, and the insurer pays the rest of the sum. For instance, if the co-payment is 10% the patient pays 10% of the bill, and the insurer pays 90%.
- 11
Restoration Benefit
Restoration benefit refills the policy limit if exhausted, during the policy year. This means even if you’ve used up your coverage, you’ll still have protection for future claims within the same year.
- 12
Sub-limits
Sub-limits are caps on particular costs, e.g., room rate or surgical fee, under your health insurance policy. As you exceed the limits of your expenses, you are required to pay for the rest of the amount yourself.
- 13
Cumulative Bonus
The cumulative bonus is a reward for not submitting any claims in a policy year. It raises the combined sum insured for the following year without the extra premium which means that you can get additional coverage for free.
- 14
Indemnity Plan
An indemnity plan reimburses your actual medical expenses based on the bills you submit. For example, if you spend $5,000 on hospitalization, the insurer will pay back the same amount after verifying the bills.
- 15
Portability
Portability allows you to switch your health insurance policy or insurer without losing benefits like the waiting period. It is helpful when you’re dissatisfied with your current policy or want better coverage.
- 16
Top-Up Plan
A top-up plan is an add-on policy that offers extra coverage above a certain deductible amount. It’s a cost-effective way to increase your sum insured without buying a new policy.
- 17
Underwriting
Underwriting is the process where an insurer reviews your personal and medical details to decide your premium and coverage. It ensures that the policy terms are fair based on your health condition.
- 18
Medical History
Your medical history includes all your past illnesses and treatments. Insurers use this information to determine your premium and decide what conditions they can cover.
FAQs
Health insurance is a type of plan that helps you pay for medical costs when you get sick or injured. It covers expenses like doctor visits, hospital stays, medicines, and surgeries, so you don't have to pay all the money yourself.
In India, there are several types of health insurance plans. These include individual plans, family floater plans, senior citizen plans, critical illness plans, and group health insurance offered by employers.
Being covered by health insurance means that your medical expenses will be paid by the insurance company according to your policy. This helps you get the healthcare you need without worrying about high costs.
The role of health insurance is to protect you from big medical bills. It ensures you can afford treatment when you're sick or injured, giving you peace of mind and access to good healthcare services.
Health insurance is important because medical treatments can be very expensive. It helps you manage these costs and ensures you get timely care without financial stress.