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Experts advise on taking separate health insurance even if your employer is providing it as jobs have uncertainty attached to them.

• When you change the job you might not be covered during the transition period or your new employer may not provide you with health insurance.
• Employer provided health cover lapses the moment you retire.
• There are hardly any health insurance policies for people nearing retirement age as the insurance entry age has either passed or the premiums are too high to be effective.
• Services and conditions covered in a group insurance plan by an employer may differ from your own requirement.

As much health insurance as you can afford is what you need. It is difficult to anticipate the emergency that you might get into. A look into family medical history, your age and past medical records, your lifestyle hazards, and you can get a rough estimate insurance required. How much premium you can afford to pay and how much sudden expenditure you can bear during an emergency also are the questions that decide the insurance cover you finally opt for.

There are largely two types of health insurance covers available in India:

• Individual Health Insurance
• Family Health Insurance

Along with these there are individual policies and riders like personal accidental benefit, critical illnesses plan, senior citizens policy and hospital cash.

Requirement and choice can be based on individual age, family status, and health condition as to what type of policy or rider may be most suitable.

It is the most traditional health plan wherein an individual is covered for medical and hospital expenses up to the sum insured. The insured individual is entitled to the entire amount of the policy. Such plans are most suited for high risk individuals or the families in higher age slabs. The Insurance proposer (buyer) can extend an individual health policy to parents, siblings or the rest of the extended family. Individual health plans have higher premiums as the cover offered is also higher per individual.

This type of a policy covers more than one member of the immediate family under a single plan and the sum insured is available to any insured family member of the plan. One can buy a family floater policy for self, self and spouse, spouse and kids or self and kids. The premium paid is less than the one paid for individual cover for all in family. This is most suited for young nuclear families with lower health risks. When required each insured individual is entitled to part or total ensured amount for the family. A limitation may arise in case of more than one claim in a year as the amount remaining after the first claim is reduced.

A good health policy covers accidents, surgeries, hospitalisation costs, most critical illnesses and related tests, and medication. Still it is always better to go through the whole policy document to know where you stand when you make the claim. Look for the specific wordings in the policy document regarding Exclusions, Cashless Hospitalisation, Reimbursement, Network Hospitals, Room Rent, No Claim Bonus, Loading and Copayment, Upper Age Limits and critical illnesses.

Exclusions list consultations, tests, and hospitalisations that are not covered in a mediclaim or covered after a fixed duration. For example, some policies cover OPD costs, ambulance costs and tests which others don’t. Any health policy comes into play at least 30 days after it has been bought, for some insurers it is up to 90 days.

The exclusions list of different insurance companies may vary. There are certain general exclusions:

• AIDS, cosmetic surgery and dental surgery are permanently excluded.
• Mental illnesses and drug abuse conditions are not covered.
• Alternate therapies like naturopathy, homoeopathy, and ayurveda are not covered.
• Certain conditions like cataract or hernia may not be covered during the first year.
• Illnesses existing prior to buying the health policy (pre-existing) may not be covered or be covered after four years or more.
• Maternity and pregnancy may or may not be covered.

Cashless facility allows the insured to be treated at select hospitals without paying in cash. Most insurers provide this facility at their network hospitals. To avail this facility, the insurer or the assigned TPA must be informed in advance in case of planned treatment and within a stipulated time in case of emergencies.

In some instances, it may be required to take the insured to a hospital that is not a network hospital. In such cases the insured can claim the medical expenditure within a stipulated time of the commencement and completion of the treatment.

Every health insurance company has tie ups with various hospitals through their TPA where they provide cashless facility to their customers. It always comes handy to know the network hospitals of your insurer in your vicinity or look for a company that has one in your surroundings. Also take into account the quality of these hospitals.

Hospital charges rent on the room that one takes up at the time of hospitalisation. Some insurance companies put a cap or a limit on how much a person is eligible for the room rent of the hospital. One needs to compare it with the rates of the hospitals one visits. These norms vary for each health insurance company.

When the insured sticks to one company, he is assured certain benefits over the years in case of no claim. Some offer more sum assured and others offer some reduction in future premiums. Some insurers may stick to the same premiums but may offer other kind of benefits or services for continuity.

In a health insurance policy, loading is the amount that is added to the premium after a claim is made. The percentage increase depends on the age of the insured amount and type of claim. Certain types of loadings can be there even at the time of buying a policy depending upon the age, pre-existing conditions etc.

Co-payment is when the insured has to make partial payment of the treatment. This comes into play usually in the higher age slabs. Every company offering health insurance has a different rule pertaining to loading and co-pay and it is always better to go through the norms before buying.

To cater to specific requirements of individuals and families most health insurance companies provide customisation of a medical policy by giving riders or add-on benefits like critical care policy or personal accidental benefit to the main policy. Opting for these adds to the premium cost but at the same time adds to the sum assured in critical situations.

Critical care policy provides an added cover over a regular health plan in case of critical illnesses like heart attacks, heart surgery, cancer (baring certain kind), organ transplant, stroke, paralysis, burns, and other prelisted illnesses. List of critical illnesses covered may vary for each insurance company.

Critical illness cover can also be taken as a rider along with health insurance and life insurance. In this case, the person insured becomes eligible for increased cover if diagnosed with a critical illness i.e. sum assured for critical illness + sum assured for health insurance.

The disbursement rules may vary. Usually the insured amount is disbursed as a lump sum, the moment an illness is diagnosed. Some companies may disburse it in parts at regular intervals or as the bills are produced up to the sum assured.

Personal Accident Policy is suitable for people facing high accident risk. It can be taken for self as well as for family. Amount of claim depends on the type of disablement (permanent, temporary, partial, and total) up to the limit as mentioned in the policy wording.

There was a time when people above a certain age usually the age of 65 years or 75 years, were not entitled for health insurance. Now there are a few insurance companies offering senior citizen health plans or have increased the upper age limit. Senior citizen health insurance plans may have a higher premium and may also have an upper age limit for entry into a policy or the maximum age up to which they will be provided the cover. It is very important to go through the terms of policy regarding exclusions, upper age limit, co-payment terms, and coverage for facilities like room rent and ambulance cover.

Hospital cash is a fixed allowance that one is entitled to in case of hospitalisation. The daily cash allowance can be used to cover miscellaneous expenditures that may otherwise not be covered in a health plan. One may take hospital cash along with a regular health policy.

Most insurance companies do not cover maternity or pregnancy related medical expenditures though some companies offer this cover for people who have already been insured with them for a fixed minimum duration.

If the consultation and diagnostic charges are a part of an ongoing treatment for which you have been admitted to hospital or result in diagnosis of a situation for which you have to be admitted to hospital within a fixed duration (generally 30 days), only then the diagnostic and consultation charges are covered. If the tests conducted are not related to the hospitalisation for a specific treatment then they are not covered.

Every health policy has a maximum age for entering into a policy and the maximum age up to which the person might get the health cover. Most health insurance companies limit the upper entry age into health insurance between 55 to 60 years and provides health cover till the age of 65 to 80 years. Some insurers have different premium plans after the insured reaches a certain age. Some companies offer health insurance for life and provide insurance to senior citizens with specific conditions attached as per the company policy.

Yes, you and your family can be covered under the same family policy even if you are staying in different cities in India. You just need to make sure that the network hospitals are available at both the places for ease of claiming the cashless facility.

No alternate medicine like ayurveda, naturopathy, or homoeopathy is covered in health insurance. It covers only the allopathic treatments.

Yes, you can buy up to two health policies provided you declare the same to both the insuring companies. You cannot claim the whole amount from both the companies and the claim is divided amongst the two companies in the ratio of sum insured from both the companies.

For buying a new health policy, medical examination may be required for people over 40-45 years of age depending upon the company policy.

There is a minimum 30 days waiting period from the date of the policy coming into effect when you are not covered for anything except accidents. For some companies this waiting period may extend up to 60 to 90 days.

Further there are waiting periods for specific medical conditions during which you may not be covered for that particular illness e.g. for cataract surgery most companies have a waiting period of one year of policy duration.

Yes, it is possible to seek treatment at home and be reimbursed for it provided certain conditions are fulfilled:

• The person is not in a condition to be shifted to the hospital
• The person cannot be accommodated in the hospital for lack of beds or other infrastructure.

It is always better to seek advice from the company representative regarding such issues as they are always treated as exceptions.

There are certain medical treatments that do not require you to get admitted to the hospital for more than a few hours like dialysis or chemotherapy etc. Such treatments are called day-care procedures. Many of these are covered by health insurance. The list of day care procedures covered may vary for different insurance companies.

Any health Insurance is for a maximum duration of one year and needs to be renewed after that though some companies may offer it for 24 months.

Coverage amount is the maximum amount you are eligible for in case of a claim for a policy term (usually one year).

You are insured for a fixed amount in a year called the coverage amount or sum insured. You can make as many claims till you reach the value of sum insured.

Pre-existing illnesses are the medical conditions of the person prior to opting for the health insurance. There is a waiting period of up to four years of continued insurance to be covered for pre-existing diseases.

When you fill the proposal form for your health insurance you need do declare any medical condition you may have and you also need to declare family medical history. Based on the details given, the insurance company decides if you have a pre-existing disease. It is done in good faith as per the declaration made by you. It is advisable to fill the form true to your knowledge as a claim may be denied if the situation is found to be otherwise at a later stage.

It is insurance company’s discretion to except or reject your proposal if you have a pre-existing problem. If the case is accepted then there might be a loading on premium or a waiting period for that condition to be covered in a health policy as per the company norms.

Anyone living in India or visiting India for employment, education, or even tourism is entitled to buy health insurance here provided the person is not visiting here for medical tourism or for treatment. The coverage area is limited to India.

Waiting period for the insurance to be effective remains the same (30 days), so it is not advisable for those on a short visit.

If you wish to cancel your policy before the maximum duration of the policy, your insurance will cease to exist and a part of your premium will be refunded to you. Terms of policy cancelation are mentioned in the policy document and may vary for every company.

Yes, a company can deny health insurance to a person based on certain conditions like pre-existing diseases, general health conditions, or age.

After you file a claim, the total cover available for the rest of the year is reduced by that much amount.

In case of cashless treatment, the bills will be settled directly with the hospital. In case of reimbursement, the amount is paid to the nominee or the legal successor on presentation of proper documents like bills, death certificate, succession certificate etc.

Other than the proposal form, premium cheque, and individual photographs of the insured persons, you may need a photo ID proof, age proof, and medical examination papers as per the norms of the insurance company.

Yes, you can avail annual deduction of Rs. 25,000 from taxable income (30,000 for senior citizens) on payment of health insurance of self and dependants under section 80D. (Tax benefits under section 80D are different from the Rs1,50,000 exemption under Section 80 C.)

Age of the person to be insured and the amount of cover required are the two main factors that decide the premium of health insurance. There might be other factors like pre-existing diseases, facilities covered etc.