Health Insurance-Definition

Health insurance is an insurance product that covers whole or part of the person’s risk by incurring medical expenses. The health insurance risk pool is estimated from the overall risk of health care and health system spending to provide money to pay for the health care benefits specified in the insurance agreement, a regular finance structure can be developed.

Importance of Health Insurance

Health insurance has become a necessity for every person in India these days. It provides risk coverage against expenses incurred due to unforeseen medical emergencies. Today, failing to hold enough health cover can prove to be economically costly when the medical inflation rate is so high. However, awareness about health insurance is increasing in urban India. A study jointly conducted by Max Bupa and Nielsen in 2014-15, covering 1500 consumers, showed that 70% of respondents felt that health insurance is more important than life insurance. 60% of the consumers were aware that the health cover provided by the employer could be inadequate.



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  • Covers Room and boarding expenses
  • Nursing expenses
  • Fee of doctors, surgeons, other specialists and consultants, etc.
  • Health check up, laboratory fee and charges Sum insured for individual/family Cumulative bonus
  • Hospitalisation charges Pre and post hospitalisation charges Cashless facility Critical illness benefits Top-up policies Ambulance charges

Documents Required for Medical Insurance Policy

There are few documents that you need to provide if you have decided to buy health insurance online such as:

  • Age proof – Any one of Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter ID, etc
  • Identity proof – Driving License, Passport, Voter ID, PAN Card, Aadhar Card, which proves ones citizenship
  • Address proof – Electricity Bill, Telephone Bill, Ration Card, Driving License, Passport, should clearly mention the permanent address.
  • A medical check-up is taken usually for elder people above the age of 45 years in order to make sure that the insured does not suffer from any chronic illness.
  • Passport Size Photo to have a record of the insured person`s identity for future references.

Documents Required for Medical Insurance Policy

  • Aic Of India Health Insurance
  • Cholamandalam Ms Health Insurance
  • Hdfc Ergo Health Insurance
  • National Health Insurance
  • Religare Health Insurance
  • Star Health Insurance
  • Apollo Munich Health Insurance
  • Ecgc Health Insurance
  • Iffco Tokio Health Insurance
  • New India Health Insurance
  • Royal Sundaram Health Insurance
  • Tata Aig Health Insurance
  • Bajaj Allianz Health Insurance
  • Cigna TTK Health Insurance
  • L & T Health Insurance
  • Oriental Health Insurance
  • Sbi Health Insurance
  • United India Health Insurance
  • Bharti Axa Health Insurance
  • Future Generali Health Insurance
  • Max Bupa Health Insurance
  • Reliance Health Insurance
  • Shriram Health Insurance
  • Universal Sompo Health Insurance


Crontax allows you to compare the best deal on insurance and let you choose by yourself which will help you in save more money. To protect yourself and your family from unwanted medical costs-health plans are the best ways. Buying health insurance plan provide risk coverage against expenditures caused by any unforeseen emergencies.

Crontax helps you to compare and choose the best health insurance plan for you. The level of coverage mostly depends upon the type of the Life insurance policy. A lot of companies now offer Life insurance in India and therefore as a consumer, you have multiple choices from leading brands. You should take advantage of our comparison services to choose the best deal. Some of the brands offering life insurance plans are MaxBupa, Bharti-AXA, Tata AIG, Apollo Munich, Star Health etc.

Choose the best health Insurance in India

At the current time of high medical inflation rates, failing to hold sufficient amount of health insurance cover could prove to be a major personal finance disaster. This could be due either to poor health care because of non-affordability or high medical bills a person spirals into financial crises. This is where the whole concept of medical policies comes into play. Best health Insurance plans cover medical costs during hospitalization as well as in pre and post phases.

Types of Health Insurance in India:

  • Individual Mediclaim - It is the simplest type of all health insurance schemes and it is called personal health policy. In such a scheme, expenses of hospitalization are included for the person upto the sum insured. Annual premium payable is usually proportional to the sum assured. Example-all policies are independent of each other if your family has three members, each of them can purchase a standalone cover of RS2 million. If all the three members are required to be hospitalized, all the hospitalization expenses can be taken up to Rs 2 lakh.
  • Death certificate - These are enhanced versions of the individual Mediclaim policy. Here, the insured amount is invited between the members of the nominated family in the policy. That is, it covers the medical expenses of the whole family, up to your insured amount. A family floater policy is generally less than individual policies taken by each member of the household. Suppose there are four members in your family; Can you buy floater Mediclaim for a family? 6 lakh. Now none of the four insurers can claim the entire amount for expenses. But the cover will come down from the amount claimed for that policy year. So when a member of your family is hospitalized and spent in this regard? Rs 4.5 lakh, will the cover for family floater policy be reduced? Is 1.5 lakh. Will the policy resume again? Rs. 6 lakhs, on Akshay. A family floater mediclaim policy makes sense because each member gets a big cover. Also, more than one member in the same year, the chance of hospitalization is very low.
  • Unit Linked Health Plan (ULHP) - Health insurers have recently introduced ULHPs that combine health insurance and investment, and return an amount once the insurance period ends. The return of course depends on the market conditions at that time. But these plans are still in the development phase and have been recommended for those who can handle products like unit linked insurance plans (ulips) and unit linked pension plans (ULPPs).

Note: For some reasons, it is advisable to stay away from YULHP. Just treat health insurance as a expense. This is because unlike life insurance, you don’t get back the premium you pay at the end of the word, if there is no claim. If you are single and have a family floater, then select an independent healthcare policy. If the amount of premium is credit/ By debit card or cheque, you can get tax exemption of up to 15,000 rupees under section 80D of Income Tax (IT) Act.

Health Insurance by Employer

Many companies provide mediclaim for their staff. It also often covers the hospitalization expenses of spouse, dependent children, and parents ‘ hospitalization. It is always advisable to take mediclaim without covering any amount because you do not have to pay any premium. Now, you will depend on some factors whether you need to take another health insurance policy. Is the cover provided by your employer sufficient? Is the insurance company good enough? What will happen on changing jobs?

Mediclaim is provided as an incentive to the employees. Therefore, it is important that you understand the insurance policy and check the coverage also. Ask your Human Resources (HR) Department for details; What is covered and what is not covered. The employees are satisfied that their company is providing health insurance, only to later find out that many things were not covered at all or were covered only in parts.

Health Insurance For senior Citizens

Mediclaim companies were not ready to cover old and senior citizens a decade ago. But, of late, many insurance companies are providing health insurance policies for them. The insurance cover given to a person of age 65 years and above may lead to additional tax relief of up to RS20, 000, but remember that the premium payable to senior citizens is very high.

If you have employed and covered a mediclaim from your employers, approach your human resource manager and provide an additional cover for your parents to interact with the insurer. Due to the high volume, the insurer can provide cover at attractive premiums.

Third Party Administrators

A third party administrator, commonly known as TPA, is an organization that processes claims and provides cashless facilities to the insured person as a separate entity. TPAs, in effect, act as intermediaries between the insurance company and the insurer. A customer can deal directly with the TPA for settlement of claims and the organization will help the insured with this process. TPAs is a specialized health service provider and provides various types of services including networking and hospitalisation with hospitals. The TPA concept was introduced by the Insurance Regulatory and Development Authority (IRDAI) to benefit both the insurance company and the insurer. While insurance companies benefit through their overheads and administrative costs, a reduction of counterfeit claims, and ultimately reduce claim ratios, insurance can take advantage of better and quicker health services.

An insurer may have several TPAs. Similarly, a TPA can serve as an agent of multiple insurance companies.

Some of the key services rendered by a TPA are as follows:

  • Maintain a database of all policyholders
  • Issue identity cards to policyholders
  • Provide ambulance services
  • Give information to healthcare policyholders about networked and empanelled hospitals
  • Check with various investigations
  • Extend cashless mediclaim services
  • Process health insurance claims

TPAs settle claims in two ways.


You can avail only the facility of cashless treatment in networked hospitals of the insurance company. In case of a planned hospital or in a state of emergency, the TPA should be notified in advance within a stipulated time frame. All paperwork will be from the hospital insurance desk. The TPA is to approve the Mediclaim amount and the hospital will settle with the insurer. Such exclusions are likely to be made not payable by TPA. Such expenses should be decided by the patient party directly at the hospital cash counter.


Insurer can avail reimbursement facility in both network and non-network hospitals. Here you can avail the treatment and dispose of the bill directly from the hospital. You can then claim reimbursement of the expenses arising out of TPA by submitting relevant bills and receipts.

Let’s Compare- Health Insurance Vs Mediclaim

Health Insurance Mediclaim
The policyholders will get comprehensive coverage, including before and after hospitalization. The upper limit of one health insurance policy can go up to Rs. 60 lakh. Generally, health-care policies also offer discounts on a regular basis over a certain period of time. Health insurance and Mediclaim also vary when it comes to tax deductions. A Mediclaim policy provides coverage for hospitalization expenses for a certain pre-specified disease up to a certain period of time according to the sum insured. For all the claims, a certain amount has been fixed under the ceiling mediclaim policy. It works on the principle of indemnity in which hospitalization is a specific requirement to think of any claim. Even those insured under the Mediclaim policy will also have to pay hospitalization expenses from their pockets and the insurer will pay them later.
Health insurance premium paid towards a health insurance policy provides a tax exemption under section 80D of Income Tax Act. The funds paid towards mediclaim premium paid for self or spouse or children are appropriate for tax exemption of Rs 15,000 under section 80D.


Here are some of the important terms that you will come across while subscribing to a health insurance policy.

Sum Assured:

In simple terms, the sum insured can be the maximum coverage amount in a policy year. It forms the basis of all your claims. Consider the increasing costs of hospitalisation, medicines and treatment before deciding on your insured amount. It is advisable to choose a higher cover. At the same time, the cover should not be high enough for you to dig into your pocket to pay the premium.

Co-pay and Sub-Limits:

The co-pay and sub-limits system has been introduced by some health insurance companies to prevent the patients from billing improper room rent to hospitals. In a co-payment policy, you have to pay a portion of the expenses irrespective of any sum insured. If a policy has a co-payment of 10%, the insurer will pay 90% of the expenditure and you have to bear the balance. In addition, some insurers limit the expenses of therapies to reduce the claims of hospitals. It is known as sub-limits. While buying Mediclaim, choose a policy that has less sub-limits. There are some mediclaim policies, which do not have a co-pay or sub-limit. Try to select such a plan.

Comprehensive Cover:

Some employers provide health insurance to their staff under the Group Insurance scheme. But you can still have a mediclaim of your own which covers the whole family. The second Mediclaim policy cannot be considered if your employer leaves your job and you can transfer the policy. It is important that you compare several policies before you buy one.

Critical illness:

Most comprehensive mediclaim policies are covering serious illness. You don’t need to buy another policy. It is advisable to subscribe to a comprehensive plan and then do it with a crash insurance plan which does not cost much. Two policies are enough to meet your mediclaim needs. If there is a family history of a certain ailment like thyroid or blood sugar, then you should ideally buy a different serious illness mediclaim. If there is no such history in your family, then there is no need for a critical illness plan.

Restore benefit:

If you have already finished the multiplier benefits within the year as well as your policy. But in most cases, the benefit on the same disease is not available if the limit is already used.
But a restoration benefit can be useful if you have a family floater plan where the full insured amount is subscribed to only one family member is terminated for treatment. The remaining members will not have any cover to come back in case of hospitalisation for the remainder of the policy year. In such a situation, some members may be covered for other diseases, which have already been paid by the insurance company.

No claims bonus (NCB):

If no claim has been made in the preceding year, the insurer usually expands the NCB to a policyholder. Please check the NCB while buying a mediclaim, before signing the dotted lines. NCB may range from 5% to 100% of the insured amount. A higher NCB gives cover against inflation and you don’t need to worry about increasing your coverage year by year.

Pre-existing illness, waiting period, exclusions:

There are people who already have existing diseases when you subscribe to the Mediclaim policy. Most health insurance companies specify a waiting period for these diseases. The insurance company is unlikely to cover against it. In most cases, a pre-existing disease is covered after less than two years of buying a policy.
Exclusion means the diseases which are not covered under the Mediclaim. For example, if you are suffering from diabetes while taking a policy, kidney diseases are likely to be excluded from the cover if it is caused by diabetes. Never hide any pre-existing diseases from your insurer when purchasing a mediclaim policy. This may lead to reduction in your hospitalisation claim.

Free Check-up:

Most health insurers provide free health check-up to the policyholder. But what is called Free “That’s not really so. The cost of check-up is included in the premium. Buy such a policy only when you are eager to get this facility every year. Also check whether the Mediclaim policy gives coverage for the entire life afresh every year. This is important because life expectancy is increasing due to improved medical technology. While most insurance companies provide full life coverage, some cover only up to 75-80 years.

Maternity and Daycare:

Medical insurance policies provide cover on hospitalisation, which does not require overnight stay. These are called daycare processes. See how many processes are involved in the scheme. In addition, most insurers do not consider motherhood as a medical emergency. So do not look for a maternity cover if you have no plan for a child.

Top up Plans:

The medical costs are increasing. It adds to the large cover. But not all can afford a higher premium. In such a case, the top up plan may come useful. This reduces the cost of deductibles i.e. you pay the amount before the insurance company pays. The insurance company will pay only upto the sum insured. A top scheme, on the other hand, does not pay unless the hospital bill has a specific border violation. Say, if the hospital is billed? As a deduction of Rs 8 lakh with RS3 million, you need to pay later, while the insurer pays the remaining Rs5 lakh. But you have to pay the deductible amount to your personal/ Can use Group Policy. The combination of a basic Mediclaim plan with a top plan is much cheaper than a single wrapper. For example, for a 26-year-old male, the premium for RS5 million regular cover would be around RS6, 500. The top up with RS15 million cover will have an additional premium of RS5, 000, much cheaper than the standalone policy of the same amount.


These two words are also often used interchangeably. However, there are some sharp differences between them. A health insurance is more comprehensive and provides a cover that extends beyond hospitalization, while mediclaim limits itself to hospital expenses in particular.

Healthcare is expensive. Technological developments, new processes and more effective drugs have fuelled the cost of health care. This increase is to be borne by the consumer, thereby making the treatment even cheaper for many. All obstacles can be overcome by insurance so you stay free from worries about your health. Think for a moment about the heavy medical costs you will incur if you suffered a major accident yesterday or were suddenly plagued by an illness. The uninsured people live with such risks every day. For health insurance you want to shield you from that risk. It provides much needed financial relief.

These days, most insurers have arrangements with various hospitals spread across the country as part of a network. Under a policy, if an individual is insured who provides cashless facility, the hospital can get treatment at any hospital in the network without paying the bills as the same is paid by the third party Administrator (TPA) directly on behalf of the insurer. However, all expenses not covered under the sum assured or policy are to be paid by the insured directly to the hospital. Cashless facility is not available if the hospital has not been included in the network. In such cases, payment to the hospital is usually made by the insurance company on reimbursement basis.

  • Age is the biggest factor which determines the premium payable. The older you are, the higher will be your premium.
  • Your medical history is another factor that will go into determining the premium. If you don’t have any medical history, the premium would be naturally lower.
  • You are eligible for a discount on further premium payable for the years for which there has been no claim of the insurance money. Add-on benefits like free medical checkups and/or diagnostic tests in case of no claim is also offered by the insurance companies cover

Bonuses are offered under participating life policies i.e. policyholders can participate in the profits of the policyholder’s fund. A reversionary bonus is declared as a percentage which applies to the chosen sum assured. Reversionary bonuses can be simple or compounded bonuses. One-off reversionary bonuses are those that are paid out of one-time profits that may not occur again. A terminal bonus is the residual bonus declared on maturity or the policy i.e. if after declaration of all reversionary bonuses, there are still profits accrued to the fund, it may be paid out to the policyholder in the form of a terminal bonus.