This is a type of insurance bought by an individual towards expenses incurred for medical and
surgical expenses. The individual who is paying for the policy is known as “insured” and “provider” is
the hospital, clinic, doctors and pharmacy. The company providing the services are agents who
collect the premium and make sure that the insured is provided services as per the agreement by
the provider, in lieu of the premium being paid by the insured. All these agents have a network of
hospitals in almost every part of the country where the hospitalisation cover can be provided. In
most of the cases, if the patient gets treated in any of the network hospitals, the procedure is “cash-
less” whereas in non-network hospitals, the expenses are reimbursed.
The cost of the health insurance depends upon the type of policy bought, age of the insured, pre-
medical conditions, number of people being insured and also the location of residence of insured
and the lifestyle.
There are different types of health insurance policies in India. Some of the most popular are,
Individual health policy: In this type of policy, an individual is covered for the agreed sum
insured towards expenses for hospitalization, pre and post hospitalisation care, ambulance
charges, medicine charges etc. This can also be taken for a family but individual members
have the limits defined and each member is treated as individual.
Family Floater health policy: This type of health policy is taken by a family and the sum
insured is available for all the family members. The entire amount can be spent either on a
single member or on multiple members, multiple times, till the sum insured is not
exhausted. Sum insured can be spent on all expenses during hospitalisation, pre and post
hospitalisation care/ tests, hospital room rent, medicines etc.
Pre-existing illness cover: Generally, the pre-existing disease or illness is not covered from
day 1. However, some pre-existing diseases can be covered after a waiting period of 2-4
years. To get the pre-existing disease(s) covered from day 1, then this policy need to be
added along with the individual or family floater cover.
Maternity health insurance: Usually the expenses towards the maternity are not included in
the health insurance. To get the expenses covered, this policy need to be added to the
existing policy which covers all the expenses towards pre and post natal care, baby delivery,
normal and caesarean. However, this has a waiting period of one year from the day, the
policy is bought.
Senior citizen insurance policy: The health insurance is provided till the age of 65 years, as
per the IRDA guidelines. However, to continue the policy beyond 65 years of age or to get
one insured after the age of 65 years, this senior citizen policy needs to be bought.
Critical illness cover: Some disease like cancer is not covered under the regular health
insurance policy. In that case, companies have designed a critical illness cover, which insures
major critical diseases such as heart-attack, cancer, AIDS etc. at an additional cost.
Disease specific insurance plans: If someone does not want to cover all the critical illness,
policy can be bought for specific disease. Depending upon the type of disease and the risk
factor of the individual, premium shall be charged and is added to the existing medical
Top-up Insurance plans: Most of the insurance policies have a facility of automatic restore
where the sum insured is automatically restored once it has exhausted. However, the
restore does not work with the disease for which the claim has already been taken. In order
to get the same disease covered again, or to get more coverage in a specific time period,
top-up plan is taken and the sum insured is increase only for the remaining period. This can
be bought at an additional cost.
The premium for the health insurance can be paid upfront at the start of the policy or these
days, many for the companies are providing the premium to be paid in instalments.