11 Best Health Insurance Plans in India 2025 (Plan Reviews)

I have categorized health insurance plans into 4 categories depending on different requirements. Based on your requirements pick a health insurance policy that suits your needs.

• Best Family Floater Health Insurance Plans in India
• Best Health Insurance in India for Individual
• Top Up/Super Top Up Health Insurance Policy
• Best Health Insurance Plan for Parents (Senior Citizen)

Before moving to the list of best health insurance policies in India 2025 let’s look at the important factors to consider before getting health insurance.

5 Factors You Should Consider Before Buying Health Insurance Plan in India

#1. Claim Settlement Ratio (CSR): It is the ratio of the total number of claims settled by the insurance company to the total number of claims received in the same year.

Expert tip: A high CSR indicates that the company is more likely to settle a claim without much hassles.

But consistent & reliable information on CSR is not available on the regulator’s or any website.

#2. Incurred Claim Ratio (ICR): is the ratio of the total amount of all claims received by a company to the total premiums collected in the same year.

Here is what it means:

• ICR > 100% – The insurance company is paying more in claims than it receives in premiums. Good for customers but bad for the financial stability of the company. Your insurance company will hike premiums or reject borderline claims.
• ICR between 50% – 100% – The insurance company is paying out claims and also getting new clients, i.e. financially stable.
• ICR < 50% – The insurance company is profitable charging high premiums but may be rejecting more claims.

#3. Network Hospitals: The insurer should have a good number of hospitals in its network in each city, which cater to various classes of people. Network hospitals should include nursing homes, day-care centers, and multi-specialty hospitals.

#4. Waiting Period for Pre-existing Illnesses:  A longer waiting period for pre-existing illnesses can mean that you can’t make a claim for hospitalization, even though you are paying the premium.

Expert Finding: 2 years is the waiting period for pre-existing illness. However, there are some insurers who specify the waiting period to be 4 years.

#5. Cost of Premiums: The premiums no doubt vary across insurers, but what matters is – the benefits that you are going to get for the money you pay.

The premium should cover an acceptable room rent in any city, medical & surgical costs and also cover – cataracts, knee surgery and dialysis.

The insurer should have different types of plans suitable for different sections of people such as individual health plans, family floater plans, senior citizen health plans, top-up plans, and plans suitable for people with certain health conditions such as cancer and heart disease.

Top 5 Best Health Insurance Companies in India 2025

Let’s see what fits into our requirements from the list of best health insurance companies in India.

#1. Care Health Insurance

Care Health Insurance was earlier known as Religare health insurance.

Care Health Insurance is one of the best health insurance in India which offers coverage for health insurance, critical illness, personal accident, top-up coverage, international travel insurance, and maternity along with group health insurance.

The incurred claim ratio of Care health insurance is 53.82% and has over 24,800+ hospitals in its network.

#2. Tata AIG Health Insurance

Tata AIG Insurance is a trusted 23-year-old joint venture between Tata & AIG Group that carries a AAA (Stable) rating by ICRA for its ability to pay claims and policyholder obligations in a timely manner. The incurred claim ratio for 2022-23 was 78.33%.

The company has access to 11,000+ network hospitals.

#3. Niva Bupa Health Insurance

Niva Bupa was earlier known as Max Bupa Health Insurance.

Niva Bupa insurance offers coverage for a number of illnesses, access to hospital networks, and cashless claims.

Incurred claim ratio of Niva Bupa is 54.05%. Max has over 10,000+ hospitals in its network.

#4. ICICI Lombard Health Insurance

ICICI Lombard has a network of 10,800+ hospitals to avail cashless facilities.

According to IRDA, ICICI Lombard has a high ICR of 77.33% which indicates that people are renewing the policy and also making claims.

#5. Star Health Insurance

Star Health Insurance company provides a wide range of health insurance policies for individuals, families, senior citizens and those who need specialized care like heart patients and cancer patients.

Star has an Incurred Claim Ratio of 65% with a large network of 14,000+ hospitals.

Best Family Floater Health Insurance Plans in India 2025

#1. CARE Advantage Rs. 6 Crore Health Insurance Plan

Care Health Insurance was earlier known as Religare health insurance.

CARE Advantage health insurance offers high-policy coverage family floater plans in India. Care has launched the 6 Crore health plan with a motive to provide a higher health cover starting from Rs. 25 Lacs and up to Rs. 6 crore for small to large families. The floater combinations can be up to 2 Adults + 4 Children.

In the case of a claim-free year, the sum insured is increased by 10% as a No Claim Bonus (NCB). The increase is limited to a maximum of 50% in 5 consecutive years.

Highlights of Religare Care Advantage 6 Cr Plan

• Higher coverage for a large family
• Pre and post-hospitalization expenses cover
• Up to 50% no-claim bonus
• Organ donor cover
• Daycare treatment cover
• Emergency ambulance

Features & Benefit

Minimum age for cover	Named ailment wait period – 24 months Pre-existing disease wait period – 48 months
Maximum age for renewal	Lifelong renewability
Waiting period to cover pre-existing illness	Named ailment wait period – 24 months Pre-existing disease wait period – 36 months
Pre-hospitalization	Covers expenses like doctor consultations, diagnostic tests, and medications up to 60 days post-hospitalization.
Post-hospitalization	Recharge of the sum insured at no extra cost. But not for ailment already claimed during the same year.
Restoration benefit	Recharge of sum insured at no extra cost. But not for ailment already claimed during the same year.
Room Rent / ICU Charges	No sub-limits for Room Rent charges or ICU Charges.
Exclusions	Self-inflicted injuries (suicide), injuries caused by alcohol or drug use, congenital disease, Infertility and sterility, change of gender treatments and expenses related to any admission primarily for diagnostics and evaluation purposes only.

Advantages

• 6 Crore policy cover at a reasonable price
• No capping on Ambulance charges
• No cap on Room rent & ICU charges
• No maximum entry age

Disadvantages

• 20% Co-payment if the sum insured person takes medical treatment at any hospital not listed in the policy document
• 3 years of continuous coverage required to cover pre-existing illness

You can check out the different care insurance plans for different requirements like family floater, insurance for parents, or insurance for any specific disease.

#2. Tata AIG Medicare Premier Family Health Insurance Plan

Tata AIG carries an AAA rating by ICRA for its ability to pay claims and policyholder obligations in a timely manner.

Tata AIG Medicare is a comprehensive “Health Insurance” plan initially offered for 1,2 or 3 years. One can avail a long-term premium discount of 5% on a 2-year policy and 10% on a 3-year policy.

The best part is that the policy covers medical expenses incurred outside India with an optional Global cover rider. However, the initial diagnosis should have been done in India.

Tata AIG Medicare Premier sum insured ranges from Rs. 5 Lacs to Rs. 3 Crores.

Features & Benefits

Minimum Age for cover	Dependent children between 91 days and 5 years, only when both parents are getting insured
Maximum Entry Age	65 years
Initial Policy issued for the period	1/2/3 years with life long renewal option
Policy Coverage	Individual or on a family floater basis. Maximum 7 members
Waiting Period	Specified disease waiting period – 24 months Pre-existing disease waiting period – 24 months
No-Claim Benefits	50% increase in cumulative bonus for every claim-free year
Pre-hospitalization	Medical Expenses incurred for In-patient treatment taken under Ayurveda, Unani, Sidha, or Homeopathy.
Post-hospitalization	Medical expenses incurred in the 90 days immediately after the discharge for SI up to Rs. 50 Lacs. For SI above 75 Lacs – 200 days.
Restoration Benefit	100% restored once during the policy period
Preventive Health Checkup expenses	Up to 1% of the previous sum insured
Day Care Procedures	541 daycare procedures are covered
Domiciliary Hospitalization	The plan covers medical expenses incurred during treatment at home
Alternative Treatments – AYUSH	Medical Expenses incurred for In-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy.
Exclusions	Injuries caused by alcohol or drug use, mental disorders, weight control, congenital disease, treatment for correction of eyesight, change of gender treatment, maternity, miscarriage, self-inflicted injuries (suicide), an act of war, riots, strike and nuclear weapon induces hospitalization, hazardous or adventure sports.

One can have a family floater discount on premium:

• 2 members – 20%
• 3 members – 28%
• >3 members – 32%

The unique coverage under the policy includes:

• Bariatric Surgery cover
• Medical and surgical expenses for organ donor
• OPD dental treatment
• Health Check-up (max Rs. 10,000)
• Vaccination cover

What I Liked

• Optional “Global” medical cover
• 11,000+ Network hospital
• 1,2, and 3-year policy
• Up to 32% family floater discount on premium

What I didn’t like

• Cover for individuals aged 5 years onwards
• Limit on ambulance cover
• More benefits for SI over Rs. 75 Lacs

#3. Niva Bupa Heartbeat Family Floater Health Insurance Plan

Heartbeat Family is comprehensive health insurance best suited to a family’s needs with emergency medical evacuation coverage outside India.

There are two variants in this plan – Gold, and Platinum.

Gold variant – The Gold plan sum insured starts from Rs. 5 Lacs and covers up to Rs. 1 Crore. You have higher coverage for maternity benefits and health checkups on a higher sum insured.

Platinum variant – Offers insurance coverage from Rs. 15 Lacs to Rs. 1 crore and all features of the Gold plan with additional features as below:

• Emergency medical evacuation & hospitalization facility.
• Covers international treatment for specified illnesses like cancer.
• Charges for OPD treatment and diagnostic services if required.
• Second medical opinion.
• Vaccination expenses for children up to the age of 12 years.
• Higher maternity benefit coverage of up to Rs. 2 Lacs.

Features

Minimum Age for cover	Entry age for adults is 18 to 65 years. The entry age for dependent children is from 91 days to 21 years. Family members covered – up to 6 members
Maximum Age for Renewal	Lifelong renewal is allowed.
Waiting Period to cover pre-existing illness	Expenses for consultation, medical tests, and medicines incurred up to 60 days prior to hospitalization are covered.
No-Claim Benefits	Irrespective of claim status, you will get a 10% per annum increase in the Sum Insured, up to a maximum of 100% of the Sum Insured for the Gold and Platinum plan
Pre-hospitalization	Expenses up to 90 days post-discharge are covered.
Post-hospitalization	Provided only if there is no bed available in the hospital and a minimum of 3 days of treatment is taken at home.
Refill Benefit	In case the base sum insured is exhausted, you can have 100% of the base sum insured refilled.
Day Care Procedures	536 daycare procedures are covered.
Domiciliary Hospitalization	Eyesight, and optical services, suicide, illnesses due to alcohol & drug abuse, IVF treatment, cosmetic & plastic surgery, robotic-assisted surgery and AIDS
Alternative Treatments – AYUSH	Covered in all the variants
Exclusions	Eyesight, and optical services, suicide, illnesses due to alcohol & drug abuse, IVF treatment, cosmetic & plastic surgery, robotic-assisted surgery, and AIDS

Advantages

• 19 different relations including spouse, children, parents, parents-in-law, dependent brothers, and dependent sisters are allowed to be covered in the policy
• Maternity Benefits for delivery of up to 2 children
• A newborn is covered immediately without any additional premium
• Vaccination expenses are covered in the Platinum plan
• International treatment is covered in the platinum plan
• 2 year waiting period for PED

Disadvantages

• Emergency medical evacuation & hospitalization facility, OPD treatment and diagnostic services are available only under the Platinum plan
• Higher maternity benefit coverage of up to Rs. 2 Lacs in Platinum plan

#4. Bajaj Allianz Health Guard Family Floater Plan

Health-Guard is a comprehensive family floater policy from Bajaj Allianz. The Sum Insured under the floater policy can be used to meet hospitalization or other permitted expenses for any of the insured members under the policy.

The biggest advantage of this policy is that the common surgeries that are carried out for aged people such as hernia, piles, cataracts and sinusitis are covered after a waiting period of 2 years.

Health-Guard family floater has three variants

• Silver Plan with sum insured up to Rs. 2 Lacs
• Gold Plan having sum insured up to Rs. 50 Lacs
• Platinum Plan offering sum insured up to Rs. 1 Crore

Features

Minimum Entry Age	Adult – 18 to Lifelong Dependent children/ grandchildren – 3 months to 30 years
Maximum Age for Renewal	Renewable for lifetime
Waiting Period for pre-existing disease (PED)	3 years
No-Claim Benefits (NCB)	For every claim-free year, you will get 50% of the base sum insured per annum for 1st two years and later 10%.
Pre-hospitalization	Expenses for consultation, medical tests, and medicines incurred up to 60 days immediately before hospitalization are covered.
Post-hospitalization	Expenses incurred during the 90 days immediately after discharge are covered.
Reinstatement Benefit	100% of the base sum insured specified under inpatient hospitalization treatment cover
Day Care Procedures	399 daycare procedures covered
Domiciliary Hospitalization	Not covered
Alternative Treatments – AYUSH	Covered under all the plans.
Exclusions	Change of gender treatments, plastic surgery, treatment for alcoholism & drug abuse, dietary supplements, intentional self-injury, sterility & infertility treatment, dental treatment and any treatment received outside India

Advantages

• Children/grandchildren, up to 30 years of age can be covered
• No restriction on room rent under the Gold & Platinum variants
• Diseases like hernia, piles, cataracts, and sinusitis are covered after a waiting period of 2 years
• Complimentary health checkup during a block of 3 years for the Silver & Gold plan / 2 years for the Platinum plan
• Known for smooth and quick processing of claims

Disadvantages

• 20% co-payment if you avail treatment in Zone A cities but pay Zone C premium
• Domiciliary treatment not allowed
• Lower NCB for later years

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Best Health Insurance in India for Individual 2025

#5. Aditya Birla Activ One NXT Health Plan

Benefits like – No capping on hospitalization expenses and 100% annual super credit irrespective of claims (up to 500% max) make the Aditya Birla Activ One NXT plan unique.

The policy also covers a few non-medical expenses under the rider “Claim Protect” like – expenses on oxygen masks, gloves, and nebulization kits needed during surgery.

The base sum insured ranges from Rs. 2 Lacs up to Rs. 6 Crores.

Features

Minimum entry age for cover Maximum entry age	Min – 18 years Max – No capping
Maximum Age for Renewal	Renewable for life
Waiting Period to cover pre-existing illness	36 months for pre-existing disease 24 months for the specified disease
No-Claim Benefits (NCB)	Expenses for consultation, medical tests, and medicines incurred up to 90 days prior to hospitalization are covered.
Pre-hospitalization	Reload the sum insured from day 1 providing 2X cover with 100% restoration.
Post-hospitalization	Medical expenses incurred up to 180 days immediately after you are discharged from the hospital are covered.
Restoration Benefit	Treatment for alcoholism, drug or substance abuse, obesity & weight control, attempted suicide, prostheses & devices, sterility & infertility treatment like IVF, dental treatment & surgery, and treatment taken outside India.
Day Care Procedures	Covered.
Domiciliary Hospitalization	Covered
Alternative Treatments – AYUSH	Covered provided that the treatment is carried out on an in-patient basis.
Exclusions	Treatment for alcoholism, drug or substance abuse, obesity & weight control, attempted suicide, prostheses & devices, sterility & infertility treatment like IVF, dental treatment & surgery and treatment taken outside India.

Advantages

• Wide range Rs. 2 Lacs to 6 Cr health plans
• 100% Super credit irrespective of claims
• No capping on hospitalization expenses
• Listed non-medical expenses, organ donor, and obesity treatments are covered

Disadvantages

• 36 months waiting period for pre-existing disease
• 100% Super credit and Claim Protect are optional

#6. Manipal Cigna ProHealth Plus Insurance Plan

Manipal Cigna ProHealth plan is suitable for couples who have or are planning kids. The policy offers additional coverage for maternity, newborn baby (up to Rs. 25, 000), and vaccination expenses for 1st year.

The base sum insured ranges from Rs. 4.5 Lacs to Rs. 50 Lacs and includes worldwide emergency cover.

Features

Minimum Entry Age for cover	Child – 91 days Adult – 18 years
Maximum Age for Renewal	Lifelong renewable
Waiting Period to cover pre-existing illness	3 years
No-Claim Benefits	For every claim-free year, you will get a 10% per annum increase in the Sum Insured, up to a maximum of 200% of the Sum Insured.
Pre-hospitalization	Expenses for consultation, medical tests, and medicines incurred up to 60 days prior to hospitalization are covered.
Post-hospitalization	Expenses incurred up to 180 days after hospitalization is covered.
Restoration Benefit	Dental treatment, birth control procedures, routine medical checkup & diagnostics, AIDS/HIV, ailments arising due to alcohol or drug abuse, non-allopathic treatment, and robotic or remote surgery.
Day Care Procedures	546 types of daycare procedures covered.
Domiciliary Hospitalization	If you need to be treated at home due to a bed shortage at the hospital or even if your doctor prescribed home care, it will be covered up to the sum insured.
Alternative Treatments – AYUSH	Inpatient hospitalization under Ayush covered up to the sum insured.
Exclusions	Dental treatment, circumcision, sterility & infertility procedures, routine medical checkups & diagnostics, AIDS/HIV, ailments arising due to alcohol or drug abuse, non-allopathic treatment unless specifically covered, and cosmetic surgery.

Advantages

• Ambulance cover of Rs. 3,000 for every time you get hospitalized.
• Organ transplant costs including donor hospitalization is covered.
• Reimbursement up to the Sum Insured in case of emergency hospitalization worldwide.
• Health Maintenance benefit of up to Rs. 2,000
• Free comprehensive health checkup at every renewal.
• Add-on benefits such as waiver of mandatory co-pay (for 65+ years), deductible option, and critical illness cover are available.

Disadvantages

• Maternity expense coverage is normally available after a waiting period of 4 years.
• 20% co-pay in respect of claims for insured above 65 years and above.

#7. HDFC Ergo Optima Restore Health Plan

Optima Restore health plan was initially launched by Apollo Munich Health Insurance. Post merger of Apollo Munich health insurance HDFC Ergo renamed the plan.

You benefit by having a 100% cover restored instantly after the first claim. The benefit will restore the amount equal to your base sum insured on both partial & complete utilization. The restoration can be used once in every policy year for a lifetime.

In addition to the above the Optima Restore plan offers you an option of – Unlimited Restore Benefit which will allow you to make unlimited claims in a year. But the premium is higher if you avail this option.

HDFC Ergo Optima Restore is an individual plan that covers up to Rs. 50 Lacs with affordable premium rates as compared to the other plans on this list and has tie-ups with over 13,000+ network hospitals for cashless treatment.

Features

Minimum Entry Age for cover	Adult – 18 years Child- 91 days
Maximum Entry Age for cover	Adult – 65 years (but covered for life long) Child- 5 years
Maximum Age for Renewal	Lifelong renewable
Waiting Period to cover pre-existing illness	3 years
No-Claim Benefits	All daycare treatments are covered.
Pre-hospitalization	Expenses for consultation, medical tests, and medicines incurred up to 60 days prior to hospitalization are covered.
Post-hospitalization	Expenses for consultation, investigations, and medicines incurred up to 180 days after to hospitalization are covered.
Restoration Benefit	100% Basic Sum Insured. Unlimited restorations in a policy year if you choose “Unlimited Restore Benefit”. This is optional.
Day Care Procedures	Attempted suicide, war, self-inflicted injuries, adventure sports, IVF treatment, alcohol & drug abuse, treatment of obesity & cosmetic surgery, and AIDS/ HIV.
Domiciliary Hospitalization	If you need to be treated at home due to a bed shortage at the hospital or the condition of the patient is such that he/she cannot be removed to a hospital, it will be covered up to the sum insured.
Alternative Treatments – AYUSH	Covered
Exclusions	Attempted suicide, war, self-inflicted injuries, adventure sports, IVF treatment, alcohol & drug abuse, treatment of obesity & cosmetic surgery and AIDS/ HIV.

Advantages

• Organ donor costs including hospitalization are covered
• Unique – Unlimited Restore Benefit
• No sub-limit on room rent
• 50% bonus as no-claim benefits
• 13,000+ network hospitals to avail cashless facility.

Disadvantages

• 50% reduction in bonus in case of claim.
• 3-year waiting period for pre-existing disease

Top Up/Super Top Up Health Insurance Policy 2025

#8. ICICI Activate Booster Super Top-Up Policy

ICICI Activate Booster is a super top-up policy that is similar to other health insurance policies except that it comes with a deductible amount. The greatest advantage of top-up policies is getting high health coverage at a low premium.

With a top-up policy, you have to bear the hospitalization expenses equal to the deductible amount. All hospitalization expenses over and above the deductible amount will be covered by the policy.

For example, you have bought a top-up policy with a sum insured of Rs.10 Lacs and a deductible amount of Rs. 3 Lacs.

Suppose you get hospitalized and the total expenses come to Rs. 7 Lacs. Since the deductible amount is Rs. 3 Lacs, you have to bear expense of Rs. 3 Lacs, and the policy will give you the rest amount of Rs. 4 Lacs.

NOTE: You don’t have to bear the deductible amount from your pocket if you have an individual or family floater policy. The policy can be used to pay the deductible amount.

In short, a super top-up policy is good if you already have a health insurance policy and you want to increase the sum assured at a lesser cost.

ICICI Activate Booster offers sum insured up to Rs. 3 crores and deductible up to Rs. 20 Lacs.

Features

Minimum Age for cover	Adult – 6+ years Children – 91 days to 5 years (under floater)
Maximum Age for Renewal	Lifelong renewability
Waiting Period to cover pre-existing illness	3 years
No-Claim Benefits	NA
Pre-hospitalization	Plan A – 90 days Plan B – 60 days
Post-hospitalization	Plan A – 180 days Plan B – 90 days
Restoration Benefit	NA
Day Care Procedures	Covered up to the sum insured based on written advice of a medical practitioner
Domiciliary Hospitalization	Covered up to the sum insured based on written advice of medical practitioner
Alternative Treatments – AYUSH	Covered up to the sum insured
Exclusions	Obesity & Weight control, attempted suicide, routine medical, alcohol & drug abuse, cosmetic surgery, dental treatment, AIDS, birth defect treatment, adventure sports, and treatment received outside the country.

Advantages

• Deductible applicable on aggregate basis per policy year
• Option for – deductible reduction
• Complimentary health check of Rs. 5,000 every year
• Bariatric surgery and in-patient treatment for surrogate mothers are covered
• Unlimited teleconsultations

Disadvantages

• 20% co-payment if treatment is taken outside the “Preferred Network Hospitals”

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Best Health Insurance Plan for Parents (Senior Citizen) 2025

#9. Star Senior Citizen Red Carpet Health Insurance Plan

Star Senior Citizen Red Carpet plan is exclusively for senior citizens aged between 60 and 75 years. The policy covers pre-existing diseases from the second year onwards (after 12 months) and carries lifelong renewals.

The best part is – you don’t have to undergo pre-medical screening irrespective of age.

Star Senior Citizen Red Carpet plan is available both as an individual and floater policy with a sum insured up to Rs. 25 Lacs.

Features

Minimum Age for cover	60 years up to a maximum of 75 years
Maximum Age for Renewal	Lifelong renewable
Waiting Period to cover pre-existing illness	After 12 months of continuous coverage
No-Claim Benefits	NA
Pre-hospitalization	Medical expenses incurred up to 30 days prior to the date of hospitalization is covered.
Post-hospitalization	No pre-acceptance medical screening
Co-payment terms	Co-payment of 30% for all claims
Day Care Procedures	All daycare procedures covered
Domiciliary Hospitalization	Not applicable.
Medical Screening	Inpatient treatment at Ayush Hospital covered
AYUSH Treatment	Sterility & Infertility treatments, attempted suicide, intentional self injury, dental treatments, Laser surgeries for the eye, adventure sports and for treatment of disease by system of medicine other than allopathy
Exclusions	Sterility & Infertility treatments, attempted suicide, intentional self-injury, dental treatments, Laser surgeries for the eye, adventure sports, and for treatment of disease by the system of medicine other than allopathy

Advantages

• A pre-insurance medical test is not required
• Outpatient consultations in networked hospitals.
• Covers pre-existing disease from the second year onwards

Disadvantages

• Sub-limits applicable for specific diseases
• Room rent limits apply
• Surgeon, Anaesthetist, Medical Practitioner, Consultants, and Specialist Fees are subject to a maximum of 25% of the sum insured per hospitalization.

#10. Bajaj Allianz Silver Health Insurance Plan

This policy can be bought by anyone who is between the age of 46 and 80 years of age and can be renewed lifelong.

But the sum insured is only up to Rs. 10 Lacs. Yet it covers modern treatment expenses and advanced technologies like robotic surgeries and stem cell therapy.

Features

Minimum Age for cover	46 years up to a maximum entry age of 80 years
Maximum Age for Renewal	Lifelong renewable
Waiting Period to cover pre-existing illness	12 months
No-Claim Benefits	For every claim-free year, you will get a cumulative bonus of 10% of the Sum Insured, up to a maximum of 100% of the Sum Insured
Pre-hospitalization	30 days
Post-hospitalization	60 days
Restoration Benefit	Not available
Day Care Procedures	130 types of daycare procedures covered
Domiciliary Hospitalization	10% of sum insured
Alternative Treatments – AYUSH	Not covered.
Exclusions	Cosmetic or plastic surgery, attempted suicide, dental treatments, obesity & weight control, dietary supplements, refractive error for the eye less than 7.5 diopters, and treatment received out of India

Advantages

• 80 years maximum entry age
• Free health checkups up to Rs. 5,000 in a block of 2 years
• No sub-limit on the surgery costs

Disadvantages

• 10% co-payment on all claims
• Domiciliary treatment is limited to 10% of the sum insured
• Pre-medical tests are mandatory

#11. Manipal Cigna Prime Senior Elite Health Insurance Plan

Manipal Cigna Prime offers “Prime Senior” health insurance plans for senior citizens in the entry age group of 56 to 75 years. The sum insured ranges up to Rs. 50 Lacs.

The plan comes in two variants – Classic & Elite. Elite allows unlimited restoration or sum insured and a facility to avail domestic second opinion for critical illnesses.

But there is a mandatory co-payment of 20% per claim.

All the other features of this policy are similar to other health insurance plans.

Features

Minimum Age for cover	56 years up to a maximum of 75 years
Maximum Age for Renewal	Lifelong renewable
Waiting Period to cover pre-existing illness	24 months
No-Claim Benefits	Cumulative bonus of 10% of the sum insured up to 100%
Pre-hospitalization	Expenses for consultation, medical tests, and medicines incurred up to 60 days prior to hospitalization are covered.
Post-hospitalization	Expenses for consultation, medical tests, and medicines incurred up to 90 days post-hospitalization are covered
Restoration Benefit	Unlimited restoration
Day Care Procedures	Up to the sum insured
Domiciliary Hospitalization	Upto sum insured
Alternative Treatments – AYUSH	Up to sum insured
Exclusions	Obesity & weight loss, change of gender treatments, attempted suicide, maternity, dental treatments, cosmetic surgery, adventure sports and for treatment outside India

Advantages

• Maximum entry age of 75 years
• Unlimited restoration of the sum insured
• Cover for mental illness, HIV/ AIDS, and Modern treatments
• 90 days waiting period for PED

Disadvantages

• Co-pay of 20% of each claim
• 90 days post hospitalization expense cover and not 180 days
• Add on to reduce the PED waiting period

5 Types of Health Insurance Policies in India

#1. Individual Health Plans

If you have an individual health insurance policy, you alone will be eligible to claim the benefit of the entire sum assured. All the benefits covered in the plan are available to you and cannot be transferred to anyone else.

The greatest advantages of individual health plans are

• Offers higher protection for each person rather than as a family.
• The policy can be renewed without any age restrictions.
• Suitable for people with health risks.
• No risk for other family members even if the cover gets exhausted in a single year.

#2. Family Floater Health Insurance Policies

Family floater health policies are umbrella health cover tailored for the entire family. A single premium is paid to obtain a cumulative health cover for the entire family and the amount of health coverage can be utilized for hospitalization expenses of any member of the family.

The advantage of a family floater insurance policy is that

• You can get your entire family covered by single health insurance at a lesser cost.
• You can cover 4 children for each policy along with 2 adults.

The biggest disadvantage of the family floater health policy is that

• There is a high possibility of the entire cover getting exhausted due to the hospitalization of one family member.

If your family members have frequent illnesses then opt for individual plans.

#3. Senior Citizen Health Insurance Policies

Buying health insurance at an old age is difficult or unaffordable. I suggest you buy a health insurance policy for your parents before they get too old.

The Senior citizen policies are similar to individual health policies but come with stringent medical checkups, high premiums, limits on room rent and treatments, compulsory co-payment, lower sum insured, and a greater number of exclusion clauses.

These policies are usually bought by people who have already crossed 60 years of age but do not have any health insurance with them.

#4. Top-up and Super Top-up Insurance Policies

Top-up and super top-up policies are health policies that come with a ‘deductible’ clause. These policies come into effect after the amount specified as the deductible is incurred as hospitalization expenses.

For example, assume that you have bought a top-up/super top-up policy of Rs.20 lacs with a deductible of Rs.5 lacs. If you get hospitalized, you are eligible to claim from the top-up/super top-up policy for all your hospitalization expenses over Rs. 5 lacs.

The biggest advantage of these policies is that you can get a large cover for a low premium. Even though there is a deductible clause applicable, you can take a basic health policy whose sum assured will be equal to the deductible.

#5. Policies Covering Specific Illnesses Such as Cancer or Heart Disease

The biggest advantage is that these policies cover specific illnesses like heart disease or cancer, which are usually avoided by many insurers. The premiums for such policies are high as the risk is high for the insurer.

These policies are designed for people who are already diagnosed with certain diseases or are at high risk of getting certain diseases.

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Don’t Rely Solely on Your Employer-Provided Health Insurance

One of the main reasons why people avoid taking health coverage is because they get employer-provided group health coverage. But no matter how much health coverage your employer provides, it has its own drawbacks.

Let’s understand why having your own health coverage is important:

• Employer-provided insurance benefits will end the moment you leave or change the job.
• You can not carry forward the benefits of employer health insurance.
• Having your own health cover early in life will always help in case you are diagnosed with any illness. This is because the waiting period will be over and any illnesses you catch at a later stage get covered.
• Employer-provided insurance clauses can change at any time.
• Employer-provided health coverage can exhaust in a single hospitalization. You must have a backup policy.
• Would you buy an expensive health cover post-retirement?

13 Practical Tips to Choose the Best Health Insurance Policy

Tip #1.

Always buy an individual policy at a young age. Otherwise, insurance becomes expensive as you grow old.

Tip #2.

Choose the right amount of sum insured as per your family size. Smokers, obese individuals and people with inactive lifestyles have higher health risks and need higher cover.

Tip #3.

If you are buying health coverage for a family of 4 (2 adults and 2 kids), you can either

• Buy individual covers for each family member and buy an additional family floater to increase the cover.
• The second option is to buy a family floater and then buy a top-up/super top-up policy whose deductible is equal to the sum insured by the family floater policy.

Tip #4.

Choose a policy with minimal exclusions. Buy a plan that covers 100% of the costs of hospitalization, common daycare procedures, and a part of pre and post-hospitalization costs. Do not opt for plans which have a co-pay option.

Tip #5.

Choose a policy that offers lifetime renewability.

Tip #6.

Do not buy a policy that has sub-limits on per-day expenses or room rent

Tip #7.

Your health plan should cover hospitalization expenses for critical illnesses also. There should be no “claim loading” in case you or your family are diagnosed with a critical illness.

Claim loading is a feature in which the insurance company can keep increasing your premiums year on year if you are diagnosed with a critical illness.

Tip #8.

Check the waiting period for pre-existing illnesses. A good insurance policy will have 2 years as the waiting period but some have up to 4 years.

Tip #9.

Check the clauses for getting treated at network and non-network hospitals. Many insurers reimburse only 70-80% of the costs if you get treated at a non-network hospital.

Tip #10.

If you are buying health cover for aged parents, check the list of illnesses and medical procedures that are not covered. Your policy should provide cover for common surgeries required by aged people such as cataract and knee surgery.

Tip #11.

Buy the policy before you get any critical disease (health, lungs, cancer). Health insurance policies have a clear-cut clause – that the policy needs to be bought before the onset of any such illness.

Tip #12.

Buy a top-up/super top-up policy at a less premium to get a large cover if you want to increase your health cover.

Tip #13.

Buy separate individual policies for yourself and your spouse as you grow old.

This is an important step because family floater policies are issued against the name of the oldest person listed in the group. If the oldest person passes away, the policy ceases and the remaining family members have to buy a new policy at higher premium rates.

Glossary

AYUSH: stands for Ayurvedic, Unani, Siddha, and Homeopathy. If a health insurance policy provides coverage for AYUSH treatments, it means that the insured can undergo treatments suggested by the AYUSH doctors and make a claim for it.

Restoration Benefit: It is a benefit that allows an insured to reinstate (refill) the entire sum insured in the policy year when it gets exhausted due to claims. You can reinstate up to 100% of the sum insured in a year. But it costs slightly more than standard health insurance.

Daycare Procedures: A daycare procedure is a surgery or medical procedure that can be completed in less than 24 hours.

Domiciliary Hospitalization: It means medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a hospital but actually taken while confined at home under any of the following circumstances:

i) The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing Home or

ii) The patient cannot be removed to the Hospital/Nursing Home for lack of accommodation/ bed.

Things You Should Know About Health Insurance

• It is always better to buy from a reputed insurance broker. Verify the credentials of the insurance agent before you buy a health policy. If any claims get rejected, your agent may not be able to help you.
• You can also buy health policies online at a lower price than offline. You have to make sure that you declare all the requested data correctly and honestly.
• You can actually bargain for lower premium rates if you have healthy living habits such as maintaining a good BMI, exercising regularly, and avoiding smoking.
• No insurer will provide cover for a person aged above 90 years. Any existing policies also cease to be effective once the insured crosses 90 years of age. This applies to employer-provided health insurance for retirees also.
• The family floater policies are issued with the eldest member as the policyholder. If the eldest in the family deceases, a fresh policy has to be taken by the surviving family members at prevailing premium rates.
• Always declare every detail of your illness, if any, even if it seems insignificant. Insurers have experts to determine if you have not declared any pre-existing illness and may deny your claims.
• If you are not satisfied with your existing health insurance policy, you can always ‘port out’ to another policy. However, you have to pay the applicable premium for the new policy. However the greatest advantage is that the waiting period for the pre-existing illness will not apply.

Final Words

By now you have gauged that you and your family’s health insurance needs will be unique. You have to choose a policy based on various factors such as sum insured, co-pay, sub-limit clauses, and network hospitals, and not just about quoting low premiums.

Always buy a health policy early in life as it works out cheaper and you will be covered if you fall ill later in life.

FAQs

Which Senior citizen health insurance plans will be good for my parents?

Senior citizen health insurance policies come with various terms & conditions like –

• compulsory medical checkups
• high premiums
• limits on room rent and treatments
• compulsory co-payment
• lower sum insured

Pick health insurance after evaluating your needs.

Whether I need to wait for 2-4 years to cover PED?

Yes, the health insurance companies cover PEDs after a waiting period of 2 to 4 years after you have taken a policy. During this waiting period, your health plan should be in force.

The waiting period is irrespective of the date of diagnosis of disease and is not related. The waiting period starts from the date you buy the health policy.

What happens to family floater health insurance when the eldest member (also policyholder) dies?

In most cases, unless clearly stated the health insurance policy stops coverage.

But a few health insurance plans have a “Death Benefit” clause under which it continues offering coverage to the remaining insured members. You need to check our policy documents.

Is it necessary to get a health insurance policy from an agent or insurance broker?

No, it is not necessary to buy a policy through an agent. You can directly apply on the insurance company’s website.

Which medical health insurance is best in India?

Health insurance plans come with different benefits, limits, waiting periods, discounts, coverage terms, exclusions, and costs.

You need to check your requirements first and then pick the health insurance that matches your needs.

Is 5 lakh enough for health insurance?

This depends on what age group you are in, your present health condition, and your lifestyle habits.

Rs. 5 lacs cover should be enough if you are young (age 22-25 years) without any medical condition and lead an active healthy lifestyle.

But looking at the present lifestyle of people, increasing heart diseases and rising cost of treatment Rs. 5 lacs insurance seems to be less. You may not be adequately covered.