Health Insurance: 5 Things That Every Individual Needs to Know Before Buying Health Policy in India

Health insurance in India can be a complex terrain to navigate. It’s not just about choosing a perfect health policy; it’s about making the right choices to safeguard your health and finances. In this comprehensive guide, we’ll decode the intricacies of health insurance, empowering you to make better investment choices.

Health Insurance Plans in India

In the world of health insurance, India offers a diverse array of plans tailored to cover medical expenses in the event of illness or injury. These plans not only furnish financial security but also harbour a lesser-known advantage: tax benefits.

India hosts a variety of health insurance plans, including individual plans, family floater plans, senior citizen plans, top-up plans, critical illness plans, and more. Each health insurance plan boasts its unique attributes, coverage, exclusions, benefits, and limitations. Therefore, a prudent approach involves comparing these diverse plans from various insurers prior to making a selection.

5 Things to Keep in Mind

Understanding Waiting Periods in Health Insurance Policy

When considering a health insurance policy, you must grasp the concept of waiting periods. These periods determine when your coverage kicks in. There are three main types:

  1. Standard Waiting Period: This is a universal 30-day waiting period during which expenses related to any illness are not covered, except for accidents.
  2. Pre-Existing Diseases (PED) Waiting Period: PED coverage starts two to four years from policy issuance for conditions diagnosed or treated up to 48 months before policy inception. For instance, if you were diagnosed with diabetes in March 2018 and obtained a policy in January 2021, diabetes qualifies as a PED. Coverage begins in January 2024, assuming a three-year waiting period.
  3. Specified Disease/Procedure Waiting Period: Some policies include waiting periods for specific diseases or procedures, often around two years.

Room Rent Capping

Health insurance policies often limit room rent expenses, even if your hospitalisation bill is within the sum insured. Your insurer may cover room rent up to a specific limit, or they might specify the type of room you’re entitled to.

Example: Manipal Cigna ProHealth Prime Active caps room rent at 1 percent of the sum insured for those with Rs 3 lakh coverage, while higher sums insured can enjoy a private air-conditioned room.

Pre and Post Hospitalization Coverage

Beyond hospitalisation expenses, health insurance covers expenses incurred before and after hospitalisation. This applies to both in-patient and domiciliary treatments.

Example: HDFC ERGO Optima Restore covers expenses up to 60 days before hospitalisation and up to 180 days after discharge. However, coverage varies, so always review your policy.

Restoration of the Sum Insured

Some policies offer sum-insured restoration, a valuable feature that reinstates your coverage to the original sum insured after it’s used up. However, it comes with conditions.

Example: Restored sum insured may not cover the same illness or injury already claimed in the same year in some policies. Review the terms carefully.

Complimentary Health Check-ups

Many insurance policies provide annual complimentary health check-ups, but the specifics vary.

Example: Niva Bupa Health Premia Policy offers annual tests based on the sum insured. ManipalCigna ProHealth plans have different intervals, so check your plan details.

Health Insurance Tax Benefits in India

In India, Section 80D of the Income Tax Act, of 1961, extends tax deductions for health insurance premiums. These deductions apply to premiums paid by individuals and Hindu Undivided Families (HUFs) for themselves and their dependents.

Here are the deduction limits under Section 80D:

  • Individuals under 60 years: Up to Rs 25,000 for self, spouse, and dependent children, plus an additional Rs 25,000 for parents. If either parent is over 60, the limit for them rises to Rs 50,000. This means individuals under 60 can claim up to Rs 50,000 or Rs 75,000, depending on their parents’ age.
  • Individuals above 60 years: Up to Rs 50,000 for self, spouse, and dependent children, with an additional Rs 50,000 for parents. This grants individuals above 60 a maximum deduction of Rs 1 lakh.
  • HUFs: Up to Rs 25,000 for family members below 60, and Rs 50,000 if any member is above 60. HUFs can claim a maximum of Rs 25,000 or Rs 50,000, depending on the age of their members.

Section 80D doesn’t stop at health insurance premiums; it also allows deductions for other health-related expenses:

  • Preventive health check-up expenses: Up to Rs 5,000 per year, included within the overall deduction limit of Rs 25,000 or Rs 50,000, as applicable.
  • Medical expenses for senior citizens without coverage: Up to Rs 50,000 annually.
  • Contributions to government health schemes, like CGHS.

To claim these benefits, you need to provide payment proof, such as receipts or certificates from the health insurance company or medical institution. Payments can be made through any method except cash, though preventive health check-ups can be paid in cash.

Explaining Health Insurance Policy Claim Process

Filing a health insurance claim can seem daunting, but it doesn’t have to be. Follow these steps for a smoother process:

  1. Notification: Inform your insurer of your hospitalisation or treatment.
  2. Documentation: Gather essential documents such as medical bills, prescriptions, and discharge summaries.
  3. Claim Form: Fill out the claim form accurately.
  4. Submit: Submit the form and documents to the insurer.
  5. Processing: The insurer assesses your claim and processes it accordingly.
  6. Reimbursement or Cashless Treatment: Depending on your policy, you receive reimbursement or cashless treatment.

Additional Things to Remember While Buying Health Insurance

Network Hospital Benefits

Choosing network hospitals can simplify the claims process. They offer cashless treatment and streamlined documentation.

Policy Renewal Essentials

Never let your policy lapse. Timely renewal ensures continuous coverage. Familiarise yourself with the grace period and avoid gaps in coverage.

Exclusions in Detail

Know what’s not covered in your policy. Common exclusions include cosmetic surgeries, self-inflicted injuries, and non-allopathic treatments.

Family Floater vs. Individual Policies

Choosing between family floater and individual policies depends on your family’s healthcare needs. Evaluate the pros and cons to decide.

Premium Payment Options

Select the premium payment frequency that suits you – annual, semi-annual, or monthly. Each option has its advantages and disadvantages.

Add-On Riders for Enhanced Coverage

Enhance your policy with add-on riders for critical illnesses, maternity, accidental injuries, and more. Tailor your coverage to your specific needs.

Customer Support Accessibility

For any queries, assistance with claims, or policy-related concerns, reach out to customer support. Keep their contact details handy for a seamless experience.

In conclusion, mastering health insurance in India requires knowledge and careful consideration. Always read policy documents, compare options, and stay informed about the latest developments in the insurance landscape. Your health and financial well-being depend on making the right choices.

For the exact terms and conditions of any health insurance policy, refer to the insurer’s website or policy document downloads section.


  1. Which health insurance plan is the best? 

The best health insurance plan depends on various factors like coverage, premium, claim settlement ratio, network hospitals, and more. Websites like offer comparisons and information on different health insurance plans in India.

  1. What makes a health insurance policy the No. 1 in India? 

A top health insurance policy should have comprehensive coverage, reasonable premiums, sufficient sum insured, minimal exclusions, and shorter waiting periods. 

  1. What are the most common types of insurance? 

The most common types of insurance include life insurance, health insurance, motor insurance, home insurance, and travel insurance. These provide various forms of protection and financial security.

  1. What are the four most common health insurance plans? 

The four most common health insurance plans are individual health insurance, family floater health insurance, senior citizen health insurance, and critical illness health insurance. Each caters to specific needs and preferences, offering coverage for different situations.



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