Types of Health Insurance Plans in India

Types of Health Insurance Plans: Indemnity Vs Fixed Benefit Plans

The different types of health insurance plans mentioned above can be divided into two major categories:

• Indemnity plans

• Defined benefit plans

- Indemnity Plans

Indemnity policies are traditional health insurance plans that offer comprehensive coverage for the hospitalisation expenses up to the sum insured as per the policy. However, in these types of health insurance policies, the claim is equal to the medical expenses you incur. However, you can make multiple claims in a policy year till the maximum limit is reached.

Some popular indemnity health insurance in India:

• Individual insurance

• Family Floater Insurance

• Group Health Insurance

• Top-Up Health Insurance

- Fixed Benefit Plans

Under fixed insurance plans, a lump sum amount is paid to you by the insurer upon fulfillment of a condition, such as detection of an illness, personal accident, hospitalisation, etc. In these plans, the insurance company pays out for those health conditions that are specified under the policy.

In the fixed cover category, some of the most popular types of health insurance include:

• Critical Illness Insurance

• Personal Accident Plan

• Hospital Daily Cash

Individual Health Insurance

An individual health insurance is curated to cover a single individual. In this policy, the insurer pays out the expenses you incur during hospitalisation, emergency treatment, pre- and post-hospitalisation, surgical procedures, etc. You can claim up to the sum insured under the policy. Besides, you can include other individuals, such as your spouse, children and parents under the same policy.

Features:

• Appropriate for a single person.

• Each beneficiary gets a separate sum assured.

• Individuals aged 18 to 65 years can opt for this policy.

• Suitable for comprehensive coverage.

Family Floater Insurance

A family floater insurance is one of the best health insurance plans in India, as it protects the entire family under a single plan. Instead of paying separate premiums for each individual, you pay a single premium. All family members share the sum insured and can be used till it is completely exhausted. If two members are undergoing medical treatments simultaneously, both of them can get the insurance claim till the sum insured is exhausted.

Features:

• It has affordable premiums as compared to individual plans.

• Suitable for couples and those with dependent family members.

• The premium is decided based on the age of the eldest family member.

• Some plans may also allow the inclusion of parents-in-law.

Critical Illness Insurance

A critical illness insurance plan is designed to provide financial assistance if an insured gets diagnosed with a critical and life-threatening illness, such as heart disease, stroke, cancer, kidney failure, etc. In this type of health insurance policy, TATA AIG pays a lump sum amount, which can be used to cover treatment and other expenses as the insured may require.

Features:

• The policy expires as soon as the sum insured is paid out.

• The insured must live through the survival period. (0/7/15 days as mentioned in the policy).

• The illness must be diagnosed after 90 days from the commencement of the policy.

• It comes with a lifelong renewal option.

Senior Citizen Insurance

Among different types of health insurance, the TATA AIG senior citizen plans are apt for elderly individuals above 61 years. It takes care of their medical requirements, such as hospitalisation expenses, domiciliary charges, pre- and post-hospitalisation expenses, etc. Some plans may also provide Wellness Services, such as tele-consultation, diet and nutrition consultation for the betterment of elderly citizens.

Features:

• Senior citizen insurance can be issued for 1/2/3 years.

• It can be issued to individuals and families.

• It does not have any maximum cover ceasing age.

• There is a discount for opting for a long-term policy tenure.

Personal Accident Insurance

Under individual personal accident insurance, TATA AIG pays a lump sum to the family in case of your death or permanent partial or total disability (leading to loss of income) due to an accident. The amount under this insurance plan will be paid to the surviving nominee.

Features:

• It covers death, dismemberment and disability arising due to an accident.

• Some plans also provide repatriation benefits.

• There is no waiting period under this policy.

• It may also provide a free look-up option to policyholders.

Maternity Insurance

Under maternity health insurance in India, women get coverage for expenses related to childbirth. TATA AIG offers maternity insurance as an add-on, covering maternity expenses 30 days prior to delivery, childbirth charges, 60 days post-delivery expenses, and newborn baby coverage.

Features:

• It comes with a waiting period of 9 months to 3 years.

• It may also cover the charges related to pregnancy termination.

• You also get coverage for vaccination and pediatric care for the newborn.

Top-Up Health Insurance

Health top-up plans are a type of health insurance plan that is available as an additional policy that you can buy over and above a base health insurance plan. These plans kick into action once the sum assured on your base plan is exhausted. These are great options for people who wish to increase their health insurance benefits without changing their existing base policy. Tata AIG offers the MediCare Plus Super Top-Up Health Cover to boost your existing health insurance coverage and protect your savings.

Features:

• It offers cashless claim facilities across any hospital in India.

• It comes with a life-long renewability option.

• You can opt for the global cover to get treatment abroad.

• It comes at affordable premiums.

Group Health Insurance

A group health insurance plan is a unique plan that covers a group of people, including employees and non-employees. Under group insurance, covered individuals and their dependents may get assistance for expenses related to hospitalisation due to illness or injury, maternity, daycare treatment, etc.

Features

• It provides comprehensive coverage.

• Covers a broader range of expenses than individual plans.

• May provide immediate coverage, without a waiting period.

• More affordable than individual plans.

• Does not require pre-medical screening.

Personalised Health Insurance

Every individual has unique healthcare requirements. A personalised health insurance plan allows you to decide the coverage you need. TATA AIG’s MediCare Select offers a wide range of features, optional covers and riders that let you customise your policy. This way, you pay only for what you choose and truly need in your health insurance plan.

Features

• Unlimited restoration of the base sum insured

• Optional covers available for consumables, maternity care, room category select and more.

• Multiple rider options for OPD care, preventive health check-ups, women-specific coverage, mental wellbeing and more.

• Available for a policy term of 1, 2 or 3 years. Opt to get full access to the entire sum insured any time under multi-year policies.

• Can be purchased as an individual or family floater policy.

Present Health Condition

It is very important to assess your present health condition before you buy health insurance. You may undergo some basic tests to find out if you have any pre-existing diseases. If you are fit and healthy, you can buy a regular health plan for contingencies. However, if you have any disease, it is wise to opt for a plan with disease-specific coverage.

Age

Young individuals in their 20s, 30s and 40s are healthier and individual health insurance plans may cover their medical needs. However, an elderly person in his 50s or 60s may require intensive health coverage due to increasing medical problems. Hence, they must opt for TATA AIG senior citizen insurance for age-specific cover.

Premium

The insurance premium for any health plan is based on the age, coverage, health conditions and other factors. While purchasing an insurance policy, look for affordable premium plans that match your budget. However, it is important to stay away from very cheap premium policies as they may offer inadequate coverage.

Sum Assured

The sum assured is the maximum amount that you can get under an insurance plan. When selecting an insurance plan, opt for a higher sum assured so you can get wider coverage. Choosing a policy for a lower sum insured may cost less premium, but you may have to incur out-of-pocket expenses as the sum assured may be insufficient to cover the medical costs.

Inclusions and Exclusions

Before purchasing an insurance policy, be aware of the inclusions and exclusions. Inclusions will tell you which expenses will be covered under the plan, such as hospitalisation charges, medical bills, etc. Exclusions are those charges that are not covered under the insurance plan and must be borne by you. For example, pre-existing diseases, cosmetic procedures, pregnancy, etc., may be excluded.

Co-Payment Clause

A co-payment clause in health insurance requires the insured to pay a portion of the medical expense, while the insurer manages the rest. One must opt for insurance policies with affordable copayment amounts to reduce out-of-pocket payments.

Deductibles

A deductible is another out-of-pocket payment that the insured must make before the insurance policy kicks in. Many health policies offer voluntary and involuntary deductible options, which you can choose based on your preference.

Waiting Periods

Most health insurance in India has a waiting period of 2-4 years before a pre-existing disease is covered. Thus, if you want insurance for a specific disease, it is best to opt for the relevant plan, which covers the disease from day 1. For instance, TATA AIG offers the Corona Kavach Policy, which specifically covers COVID-19 from day 1.

Lifetime Renewability

As you get older, there may be limited health insurance plans available for you and the premiums may be high, too. Hence, a wise step is to look for an insurance plan that offers lifetime renewability, providing you with continuous coverage as you grow older.

Additional Benefits

Many insurance plans offer extra benefits under their coverage. These additional benefits are available at zero cost and aim to keep the insured healthier. TATA AIG offers wellness programs and services as an added feature under its insurance plans. Under these programs, you are eligible for unlimited teleconsultations, ambulance booking facility, redeemable vouchers, health assessments, wellness rewards and much more.

Provides Financial Protection

Health insurance plans are an investment that offers financial assistance to the insured during medical emergencies. They cover hospitalisation, medical and other expenses, saving you from emptying your bank account and preserving money for the future.

Saves Taxes

The premium paid towards health insurance policy types helps you to save on taxes. The amount that you pay towards the policy premium can be claimed as a deduction under section 80D of the Income Tax Act, which reduces your tax liability. Thus, you get the dual benefit of tax savings as well as savings on high medical expenses.

Annual Health Check-ups

You can also access free health check-ups under your insurance plans as per the policy’s terms. Regular health check-ups allow you to know your present health condition and take the necessary steps as soon as possible. TATA AIG provides health check-up benefits up to 1% of the sum insured under its Medicare Premier Plan with a maximum cap based on the sum insured amount.

Covers Alternate Treatments

TATA AIG health insurance plans also cover expenses for alternate treatments (AYUSH). Thus, you can get treated using UNANI, Ayurvedic, Homeopathy and other types of treatments.

Provides Quality Healthcare Facilities

With the help of a health insurance plan, you get access to top-class healthcare facilities if you face a medical emergency without worrying about spending huge amounts from your pocket.

Cashless Treatment Facility

TATA AIG insurance plans also provide you with the benefit and convenience of a cashless facility when getting medical treatments. Under the cashless claim facility, you can get treatment across any hospital in the country while we settle the bill directly with the hospital.

Coverage for Complex Procedures

TATA AIG health insurance provides you coverage against complex health procedures, such as bariatric surgery. It ensures that you get access to the best doctors and medical facilities where the procedure can be done successfully.

Given the myriad of health insurance plans available in the market, you are bound to get overwhelmed while making a choice. Now that we have listed the different health insurance policy types along with their features, it will be easier for you to pick the right one. It is important that you assess which one of these policies best fits your needs (budget, lifestyle, health condition, family members, etc.), and then go ahead and select the desired plan.

TATA AIG offers multiple types of health insurance plans, which cover different medical requirements and offer various sum insured options, too. For example, our Medicare Premier insurance plan is a holistic one with several benefits, wide coverage and affordable premiums.

We have varying sum insured options, between 5 lakhs to 3 crores as per your budget and requirement. Besides, the coverage includes inpatient treatment, high-end diagnostics, organ donor expenses, compassionate travel, second opinion, health check-ups and much more.