A health insurance policy covers medical expenses including in-patient hospitalisation, surgery, emergency ambulance, hospital daily allowance, and medicines — if you fall ill or are injured in an accident.
A mediclaim policy is similar but narrower in scope. It covers accidents and a pre-specified list of illnesses up to a fixed sum insured.
A health insurance policy goes further — covering critical illness, a wider range of diseases, and giving you the flexibility to review your sum insured and policy term over time. Mediclaim policies do not offer this flexibility.
Health insurance covers medical treatment and surgery expenses. To claim benefits, you generally need a minimum of 24 hours of continuous hospitalisation.
Some daycare procedures that do not require an overnight stay are also covered, subject to hospitalisation at a network facility.
Always read your policy document carefully to understand exactly what is included and excluded under your specific plan.
Yes. Buying health insurance when you are young and healthy has two key advantages.
Anyone from 3 months (for a family floater plan) up to 65 years of age can typically take out a health insurance policy.
The insurer may ask you to undergo a medical check-up before issuing the policy. Final eligibility is determined by their underwriting guidelines, which consider your age, health condition, and family medical history.
A cashless health policy lets you receive treatment at network hospitals without paying out of pocket at the time of admission.
For planned procedures, you need prior approval from your insurer or assigned TPA. For emergencies, approval must be sought within the stipulated time frame.
To use cashless treatment, present your insurer-issued health card along with valid identity proof at the hospital or TPA desk.
TPA stands for Third-Party Administrator. TPAs act as intermediaries between the insurance company, the policyholder, and the hospital.
They manage communication between all three parties to ensure your claim is processed smoothly and without unnecessary delays.
Network hospitals are hospitals and health units that have a formal tie-up with your insurer or their TPA.
Receiving treatment at a network hospital allows you to use the cashless facility, subject to your policy terms. The list of network hospitals varies by insurer.
If no network hospital is nearby, get treatment at any hospital of your choice and pay all medical bills at discharge.
You can then file a reimbursement claim with your insurer. After review, they will reimburse the eligible medical expenses as per your policy terms.
Employer-provided group cover is a useful benefit, but it has limitations. The sum insured is often low — it may not be enough to cover a serious medical emergency.
Many group policies also include built-in co-payment and high deductibles, meaning you could still end up paying a significant amount from your own pocket.
There is also a continuity risk. When you change jobs, your employer cover ends. A new employer may not offer equivalent benefits, and buying a fresh individual policy means losing the pre-existing condition waiting period credits you had built up.
A personal policy gives you control — you choose your own sum insured and benefits, and coverage continues regardless of where you work.
Premium is important, but it should not be the only deciding factor. Always check that the sum insured is truly sufficient for your family's needs.
Key factors to evaluate before buying:
