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SMC Insurance Brokers Pvt. Ltd.
Parsvnath Metro Mall, Near Pratap Nagar Metro Station, Pratap Nagar, New Delhi-110007
Registration No: 289, Registration Code No: IRDAI/DB-272/04/289, Valid till: 27/01/2026, License category: Direct Broker (Life & General), CIN: U66000DL1995PTC172311
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Top 10 Health Insurance Plans
by SMCIB on Thursday, 19 January 2023
| Last Updated on Thursday, 02 May 2024
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What do you do when you go to a grocery shop? You have a list of the products you want to buy and pick out the brands you feel are most bankable and worth your money, right? This is because these brands and products fit your needs the best, they work for you the best.
When you apply such a rigorous selection process for something as basic as your grocery list, why not apply it to your health insurance? After all, it’s an investment that will last you a long time and take care of your and your loved ones’ health. And, the top health insurance plan for you will depend on what you want from it - because you are a unique individual with your own set of needs and requirements.
In this article, we’ll talk about the factors you should consider when purchasing health insurance and list the top health insurance plans available in the market. Let’s have a look!
What is Health Insurance?
A health insurance plan is, in the most basic of explanations, a contract between you and the insurance company wherein you pay the required premiums and the insurance company covers your hospitalisation and medical treatment costs. A health insurance plan usually covers the costs of hospitalisation, medicines, tests, checkups, doctors’ fees, etc.
Key Factors To Consider Before Buying Health Insurance
Here are some pretty important aspects to look at before you invest your hard-earned money in a health insurance plan (because, well, it doesn’t make sense to pay premiums if you won’t be covered when you actually need it) -
- The premium and sum insured should go hand-in-hand
Always try to pick a plan that balances your premium payment liability and the sum insured you get in return. So, skip choosing a plan with low premiums as this might result in you missing out on good coverage. Ensure that you create a good balance between what you have to pay versus what you get, so the money you’re spending is worth your while and will give you broad coverage.
- Be aware of the policy inclusions and exclusions
The inclusions and exclusions of a health insurance plan will determine how wide its ambit is. Situations that are covered under the plan are called the ‘inclusions’ and situations that are not covered under a policy are referred to as ‘exclusions’.
- Be mindful of the waiting periods
Your health insurance plan will usually come with inbuilt waiting periods. A waiting period is essentially a time span wherein the insurer will not give you coverage for certain illnesses or treatments. You should be aware of the same to avoid any unexpected shocks when you actually make a claim!Waiting Periods are generally of three types -
30-day Initial Waiting Period
The insurer will impose a 30-day initial waiting period for all treatments, barring those related to accidents. Accidents are covered from day 1.Waiting Period for a Specific Illness or Treatment
There is a 2-4 years waiting period before coverage for conditions like hernias, haemorrhoids, chronic kidney disease, etc. kicks in. This period is known as the Specified Disease/Treatment Waiting Period.Pre-Existing Disease Waiting Period
A pre-existing disease (PED) is defined by the IRDAI as any medical condition that has been diagnosed or treated within 4 years of purchasing health insurance. PEDs usually have a waiting period of 2-4 years.
Always choose a health insurance plan with the lowest waiting periods, to get the best coverage. - Understand the policy limits
Room Rent Limit
It is the limit up to which your health insurance will cover the per-day hospital room charges. If you pick a room with a rent that is more than what you are eligible for, insurers won’t only deduct the difference in room charge, but also proportionately deduct all associated medical expenses.Sub-limits
Sub-limits on surgeries for frequent or major lifestyle diseases ensure the claims are under control for insurers. Some financial limits may be implemented on cardiac treatment or joint replacement surgery, or the payments may be standardised for high-frequency surgeries, like cataracts and hysterectomies.Copay
A copay is a part of the approved claim amount that you need to pay from your pocket. The remaining amount will then be paid by the insurance company.
Always choose a plan with zero or minimal financial limits and restrictions - so you can use the policy to the maximum and avoid any surprises when you make a claim. - Know about network hospitals
A network hospital is one that has a tie-up with an insurance company to provide cashless treatments, i.e., the costs of which are settled directly between the hospital and the insurance company. You don’t have to pay anything from your pocket, except unapproved expenses.Always choose an insurance company that has an extensive list of network hospitals, as this will help you avail treatment wherever you need it. And, make sure that your preferred hospitals and the ones in your vicinity are included too.
- Understand the claim settlement process
Every insurance company has a claim settlement process. So, before purchasing any health insurance policy, go through its policy wording. A hassle-free claim settlement process will save you time and make the entire process smooth. You can also go through customer reviews, and check the number of claims resolved by a particular insurance company in a year, the time taken to resolve claims, etc. - to understand the claim settlement process better.
Top 10 Health Insurance Plans
Here’s a comparison of the top 10 health insurance plans available in the market -
| Aditya Birla - Activ Fit (Preferred) | Care Insurance - Care (Supreme) | HDFC Ergo - Optima (Secure) | HDFC Ergo (Optima Restore) | ICICI Lombard - Complete Health Insurance (Health Shield) | Manipal Cigna - ProHealth Prime (Protect) | Niva Bupa (Health ReAssure) | Reliance General - Health Gain (Power) | Star Health (Assure) | Tata AIG - Medicare (Premier) | |
|---|---|---|---|---|---|---|---|---|---|---|
| Room Rent Limit | No limit | No limit | No limit | No limit | No limit | No limit | No limit | No limit | Up to 1% of Sum Insured or up to Rs. 20,000 per day, whichever is less | Sum Insuredngle Private AC Room |
| Pre-hospitalization Expenses | Covered up to Sum Insured Covered for 90 days | Covered up to Sum Insured Covered for 60 days | Covered up to Sum Insured Covered for 60 days | Covered up to Sum Insured Covered for 60 days | Covered up to Sum Insured Covered for 30 days | Covered up to Sum Insured Covered for 60 days | Covered up to Sum Insured Covered for 60 days | Covered up to Sum Insured Covered for 90 days | Covered up to Sum Insured Covered for 60 days | Covered up to Sum Insured Covered for 60 days |
| Post-hospitalization Expenses | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 60 days | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 180 days | Covered up to Sum Insured Covered for 90 days |
| Domiciliary Treatment Exoenses | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to 10% of Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured |
| Organ Donor Expenses | Harvesting expenses covered up to Sum Insured | Harvesting expenses covered up to Sum Insured | Inpatient expenses covered up to Sum Insured | Harvesting expenses covered up to Sum Insured | Harvesting expenses covered up to a maximum of Rs. 10 Lakhs | Inpatient expenses covered up to Sum Insured | Inpatient expenses covered up to Sum Insured | Inpatient expenses covered up to 50% Sum Insured or a maximum of Rs. 5 Lakhs | Inpatient expenses covered up to Sum Insured | Harvesting expenses covered up to Sum Insured |
| Modern Treatment Expenses | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured | Covered up to Sum Insured |
| Day Care Treatment Expenses | All treatments covered | All treatments covered | All treatments covered | All treatments covered | All treatments covered | All treatments covered | All treatments covered | All treatments covered | All treatments covered | 541 treatments covered |
| Refill/ reload of sum insured | Available | Available | Available | Available | Available | Available | Available | Available | Available | Available |
| No Claim Bonus |
Available (10% increase, for every claim free year, up to a maximum of 100% of Sum Insured) |
Available (50% increase, for every claim free year, up to a maximum of 100% of Sum Insured) |
Available (50% increase, for every claim free year, up to a maximum of 100% of Sum Insured) |
Available (50% increase, for every claim free year, up to a maximum of 100% of Sum Insured) |
Available (10% increase, for every claim free year, up to a maximum of 50% of Sum Insured) |
Available (25% increase, for every claim free year, up to a maximum of 200% of Sum Insured) |
Available (50% increase, for every claim free year, up to a maximum of 100% of Sum Insured) |
Available (33.33% increase, for every claim free year, up to a maximum of 50% of Sum Insured) |
Available (25% increase, for every claim free year, up to a maximum of 100% of Sum Insured) |
Available (50% increase, for every claim free year, up to a maximum of 100% of Sum Insured) |
| Super No Claim Bonus |
Available (50% increase every year, max up to 100% of Sum Insured) |
Available (100% increase every year, max up to 500%) |
Not Available | Not Available |
Available (50% of increase every year, max up to 100% of Sum Insured) |
Available (50% of increase every year, max up to 100% of Sum Insured) |
Not Available | Not Available | Not Available | Not Available |
| PED Waiting Period | 48 months | 48 months | 36 months | 36 months | 24 months | 24 months | 36 months | 12 months | 36 months | 24 months |
| Specific disease Waiting Period | 24 months | 24 months | 24 months | 24 months | 24 Months (3 Months for HypertenSum Insuredon, Diabetes and Cardiac conditions) | 24 months | 24 months | 24 months | 24 months | 24 months |
| Annual premium | ₹ 22046 | ₹ 18213 | ₹ 25828 | ₹ 27489 | ₹ 16540 | ₹ 21340 | ₹ 20112 | ₹ 20840 | ₹ 24593 | ₹ 24029 |
Note: The premiums are taken on 10.01.2023 for a family of 3 including a 30-year-old male, a 30-year-old female, and a 1-year-old son. The sum insured is Rs 10 Lakhs, and the premium is inclusive of taxes.
Wrapping it Up
We hope this article has given you a broad idea about choosing a health insurance plan for yourself or your loved ones. You can choose a plan from the top 10 insurance plans discussed above as per your needs and requirements.
