Health Insurance Plans: Best Medical Insurance Policy in India | Max Bupa
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What is health insurance policy ?

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A health insurance policy serves as a financial cover for unforeseen medical expenses. With a health insurance policy, you and your insurance provider have an agreement that in the case of a medical emergency, the policyholder will be covered financially by the insurer. As with any kind of insurance, health insurance is an investment made over time with the goal of continuing your coverage in order to protect your hard-earned savings.

 

Insurance providers are mindful that there is no one size fits all, which is why there is not just one type of health insurance out there for every individual. There are actually several different kinds of health insurance plans in India to fit individual needs.

 

As a careful customer,

 

  • You should pick the best health insurance for your family and yourself, so that you no longer have to worry about paying hefty medical bills. Depending on the type of plan you choose,

  • You are not only covered for your medical bills but also cashless treatment at our network of hospitals.

  • Bid adieu to medical expenses when you decide to invest in a health insurance policy for yourself and your family.
What Is Health Insurance Policy

Things to consider before buying health insurance plans in india

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Today, you are spoilt for choice with the slew of offerings for health insurance available on the market. Ensure you get all the information you need before buying a policy.

 

Keep the following factors in mind when choosing the best health insurance policy for yourself.

 

  • Always choose a policy with adequate coverage and ensure that this amount is sufficient to financially protect you as well as your entire family. 
  • Although most employees today are covered by their own company’s group health insurance, it is always an added benefit to choose and purchase one’s individual health insurance plan after being aware of all the terms and conditions. 
  • Ideally, one should attempt to avail some kind of compensation for their losses which are non-payable by combining hospital cash, critical illness care, and other benefits from their base cover.
  • Ensure you are keeping your health insurer well informed and up to date with any diagnoses of pre-existing diseases. 
  • Ensure you keep a note of your waiting period, maximum limits, and covers provided. 
  • Ensure you are aware of all the terms and conditions attached to your health insurance policy. This includes facets like the cumulative bonus, deductible, waiting period, and any pre-existing illness clauses, among others. 
  • Opting for a policy that offers a high sum insured is recommended due to there being a steep rise in medical costs every year. 
  • Ensure you are renewing your health insurance plan on a regular basis. In case there is a break between the expiry of your policy and renewal of it, you could lose out on the benefits of your insurance. 
  • The earlier you invest in health insurance, the lower your premium’s coverage amount for the amount of coverage you will receive.
Things to consider

Family Health Insurance Plans

Here are our family health insurance plans which provide you comprehensive hospitalization coverage.

Individual Health Insurance Plans

Here are our individual health insurance plans which provide you comprehensive hospitalization coverage.

How to buy health insurance plans online ?

Earlier, health insurance companies had to make infrastructure investments and take the help of various brokers, agents and financial consultants to sell health insurance plans in India. The procedure was arduous and time consuming with reams of paperwork to boot.
However, in today's digital age, buying a health insurance plan is almost as easy as ordering a pizza online. The internet can provide you with a wealth of information regarding various health insurance plans, their features, benefits and also quick and simple tips on how to buy a health insurance plan online.
The process has evolved to become extremely efficient, transparent and cost-effective with minimal paperwork and intermediaries. So, the only question left is, how to apply for health insurance plan in India?
Do your research
Most people who are looking to buy a health insurance plan either speak to family and friends or go online to look for the best-rated health insurance providers. There are also many forums on social media where real customers post their experiences regarding their interaction with health insurance companies, service quality, etc. which should give you a fair idea of which health insurance companies you should consider.
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Visit website
The websites of insurance providers are one of the best sources of information available about health insurance plans in India. All you need to do is take a look at the plan that suits your needs and take notes. After that, you can compare one policy with another to see which ones offer you more comprehensive coverage at a lower premium. If this gets too confusing, many independent online agencies allow you to compare a plan before you zero in on a policy. Thus, you can access information about all prominent insurance providers and their plans in one place!
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Provide details
An important thing to keep in mind before comparing plans is that each health insurance provider will ask you for your personal information such as your age, income, health status, area of residence, etc. to assess your eligibility online. This will also help you estimate your health insurance needs and which plan suits your needs and pocket best.
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Finalise the plan
Once you zero in on a policy, double-check the plan's reviews online. Things to look for include the final cost after-tax, the renewability clause of the plan and the loyalty benefits. For instance, Max Bupa offers some plans, which give you loyalty benefits and discounts upon opting for a longer tenure. If you still have any doubts, call the provider's helpline number available online or shoot them a mail. Note: Some health insurance providers may ask you to upload basic documents online to verify your details.
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Purchase
You can purchase your plan directly from the insurer’s website or through the website of an intermediary. Sometimes, there can be a slight difference in the price of the same plan when purchased from different places. Some insurance companies also have tie-ups with banks and credit card companies that offer additional discounts or cashback offers on using their facility. Another thing to remember is keeping important documents such as age and address proof handy as you may be asked to provide these to complete your purchase.
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Health Insurance Plans for Large Family

Here are our health insurance plans which provide comprehensive hospitalization coverage to extended and large families.

Health Insurance Plans For Large Families

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Plans For specific Needs

Max Bupa health insurance plans which takes away the financial pain of an accident or critical illness.

 

Key Benefits of Health Insurance Plans in India

Comprehensive health insurance policies are full of benefits for their policyholders that most people may not be aware of.

Key Benefits of Health Insurance Plans in India

Comprehensive health insurance policies are full of benefits for their policyholders that most people may not be aware of.

Cashless Medical Treatment
Every health insurer has tie-ups with a network of hospitals across the country. In case you are admitted to any of these ‘empanelled hospitals’ you need not pay anything for your treatment. Your insurer and hospital will take care of all your costs after you provide your policy number. Cashless claims are preferred in a health insurance policy due to the no hassle claim disbursement and documentation process.
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Coverage both Pre and Post Hospitalization
Health insurance today offers its clients coverage beyond solely their hospitalization costs. Nowadays, there are pre and post-hospitalization expenses that are covered by traditional health insurance. Good health insurance plans also cover the cost of medicines, doctor consultations, ambulance charges, and more.
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No Claim Bonus
Some health insurance policies offer their policyholders the benefit of a no-claim bonus. As the name suggests, if no claim has been in the prior year of holding the policy, one is likely to receive a bonus in the form of a discount on their premiums or an increment in their coverage. Once you renew your policy, you get the avail of the no claim bonus.
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Medical Checkup Facility
When one opts for a health insurance plan that they need to use, they are also entitled to regularly getting medical check-ups. insurers offer this facility as part of one’s health plan.
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Co-payment
Some policies offer the option to copay, where the voluntary deductibles are predefined. This means the customer simply needs to pay defined amount of their bill. Once the pre-decided amount is exceeded, the insurer will cover the remaining payment. With a copayment facility, you can reduce the cost of your premiums significantly.
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Types of Health Insurance Plans in India

Buying health insurance is an inexpensive way to secure medical care for individuals and their families during emergencies. There is a multitude of health insurance plans available in India, which aim to provide coverage against various health risks along with a host of other benefits. However, in order to choose a plan that is best suited to you, you must know all the options available to you.
Here is a quick look at the most popular health insurance plans available in India -

Choose the health insurance plan best suited for your needs.

Wellness Plans

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Wellness Plans
Here are our health insurance plans which work for you every day.

Top Up Plans

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Top Up Plans
Our top up plans provide flexible and additional coverage.

Health Insurance Portability

Does Health Insurance Cover Covid-19/Coronavirus?

Health Insurance Portability - +

Health insurance providers offer policyholders portability. This is a feature of certain policies that allows one to switch across health insurance providers without losing any of the benefits that are associated with their existing health insurance plan. In cases of the policyholder not being satisfied with their current medical insurance plan, and seeking out something more comprehensive, they have the option to change their health insurance provider or their policy within the same company. One will still retain all the original credits that they had gained in their current medical plan.

 

Health insurance portability works in the following ways:

 

  • You can opt to switch between health insurance providers. Hence you can take a new policy with a different provider while retaining the credits earned from your existing policy.
  • You can also switch health insurance policies by sticking with the same insurance provider.
  • You can choose to switch from an individual policy to a family floater and vice versa.
  • You can apply for a revised sum insured amount with your new insurer.
  • Portability also includes enhancing the range of coverage you receive from health plans. You can enhance this range with the same insurance policy. To do so there may be medical testing and new waiting periods.

Safeguard you and your family with Health Insurance Plan.

What is the difference between health insurance and mediclaim policy?

Once you decide to sign up for health insurance and begin researching to pick the best suited plan, you may come across certain terms that may confuse you. 'Health insurance' and 'mediclaim' may appear in most articles and might even be used interchangeably. This is because of the popular misconception that 'mediclaim' is synonymous with 'health insurance'. But this is far from the truth. While they both have a similar purpose – to offer financial aid during a health emergency, they widely differ in the coverage they provide. Read on to compare the two:


Health insurance:


Health insurance provides comprehensive coverage for most types of healthcare expenses, such as pre-hospitalisation, post-hospitalisation and critical illness. You can opt for cashless claims, where the insurance company contacts your healthcare provider directly and pays the amount owed (if the healthcare provider is a part of the network hospitals of the insurance company). And if not that, you can pay your medical bills upfront and then claim reimbursement from your insurer.
Max Bupa health insurance plans come with value-added benefits such as free medical check-ups, no-claim bonus, health coach etc. You can even opt for additional covers such as personal accident cover and maternity cover.


Mediclaim:


Mediclaim policies are dedicated to hospitalisation expenses – it covers only your hospital/treatment expenses following an accident or a specific disease. This means that other medical expenses are not covered. But like a health insurance plan, you can choose between reimbursement and cashless options for claim settlement.


When it comes to health insurance, it is best to choose a plan that suits your individual needs. If you have pre-existing diseases, a comprehensive health insurance plan with inclusions and add-ons specific to your condition could be your best bet. However, a mediclaim policy can be an option if you need a basic and low-cost cover.


Here are the key differences between health insurance and mediclaim at a glance:

Coverage

Add-on coverage

Flexibility

Cost

Plan features

Claims

Critical Illness Cover

Sum Insured

Hospitalisation

Coverage - +

Health Insurance

Comprehensive medical and surgical coverage, including hospitalisation, diagnostic tests, medicines, ambulance services, daycare treatments, AYUSH treatments, e-consultation, modern treatments, OPD etc.

Mediclaim

Limited to hospitalisation expenses and pre-existing diseases. Extends coverage for treatment due to accidents and specific diseases

Who are Third-Party Administrators (TPA) in Health Insurance?

If you are planning to buy a health insurance policy anytime in the near future, the third-party administrators (TPA) for the health insurance sector will have a direct bearing on you. This is because they are the agency that you will be dealing with directly while making your claims.

Who are Third-Party Administrators (TPA) in Health Insurance?

If you are planning to buy a health insurance policy anytime in the near future, the third-party administrators (TPA) for the health insurance sector will have a direct bearing on you. This is because they are the agency that you will be dealing with directly while making your claims.

TPA
The third-party administrator, or the TPA, is not an employee of any health insurance company but an independent and separate entity that acts as the bridge between you and your insurance provider. The TPA is licensed by the IRDAI to execute this task for insurers across categories, and not just for players engaged in health insurance. It can be an individual, an agency or could be a company that is retained by the insurer to perform several administrative services such as managing customer services on its behalf. Typically, it receives a fee of 5.5% of the premium amount. However, for the customer, the services provided by the third-party administrator are for free – there is no hidden cost in the contract.
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Scope Of Work for a TPA
The tasks that make TPA a key cog in your relationship with your health insurance provider is primarily customer service. This includes claims processing which makes it necessary for you to interact with a TPA. Insurers across verticals, including health insurance companies, outsource their claims process (a portion of it or entirely) to a TPA of their choice. In the case of health insurance-related claims though, the third-party administrator also coordinates with the network hospital or any other hospital where the policyholder has undergone treatment before filing their claim. In India, many health insurance companies have their own dedicated departments for claims processing. For instance, MaxBupa health insurance processes your claims without any TPA, which significantly reduces the time taken to process your claims.
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Role/Importance Of TPA
While some of the functions of the third-party administrator have been touched upon earlier, let’s get into further details for a better insight. Broadly, the TPA is supposed to- Promote cashless facilities Provide customer service Process claims
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Customer Service
The work of the third-party administrator – vis-à-vis you – begins the day the policy is sold to you,i.e. when you enter your health insurance provider’s database. Any service of your’s which is due, is now the responsibility of the TPA. Some of these services include- delivery of the health/identity card, attending to your grievances if any and of course, settling claims. The TPA streamlines costs and services and keeps you posted on network hospitals and addresses any concern that you may have. The TPA also makes payments to the hospital (in the case of non-cashless cases) and aids the reimbursement process with the help of your provider.
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Cashless Service
The TPA is also responsible for building the network of hospitals for the health insurance company. In the process, it brings the cashless facility to you as the insured. It takes the call on empanelling a hospital-based on its service track record, infrastructure and facilities, management background and IT infrastructure.
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Claims Processing
This is the role that the TPA is most known for. It coordinates with the hospitals for claim settlements, verifies bills for treatments, checks for false claims and even settles payments with hospitals in case of cashless facilities.
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IRDAI Amendments
Until recently, a policyholder had to accept any third-party administrator their health insurance provider chose. This changed on December 3, 2019, when the IRDAI announced amended regulations giving customers the right to choose a TPA from the list suggested by their health insurance provider. To be precise, “The policyholder can choose a TPA of their choice from amongst the TPAs engaged by the insurer” as stated in the notification on the website. Keep in mind though that as a policyholder, you can only choose the TPA from the list suggested at the time of buying or renewing the policy. If you do not choose any of the suggested TPAs, then the health insurance company can allot you a TPA of its own choice. IRDAI also allows the health insurance company to limit the TPA list based on the health insurance product and geographical location of the policyholder. Hence, if the insurer engages the services of only one TPA because of those factors, you will have no option but to go along with that particular TPA. The regulator also says that it is the insurer’s “prerogative” to engage or discontinue the services of a TPA for a particular health insurance product. Also, the only time you can choose (an alternate) TPA is if the services of the original TPA are terminated during the period of your health insurance coverage.
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What is covered in Health Insurance Plans?

Curious about what all is covered under traditional health insurance? Look no further. Here are some of the guaranteed inclusions and exclusions that a standard health insurance policy takes care of. While the following list may help you predict what is covered and what is excluded from your policy, ensure you check with your health insurance provider and read your policy’s documents carefully to know for sure.

Inclusions
Exclusion

Health Insurance Inclusions:

● Inpatient hospitalization

● Pre and post-hospitalization care

● Day care procedures

● Ambulance charges

● Covid-19 coverage

 

Health Insurance Exclusions

● Dental treatment (unless cancer/ acute trauma relate).

● Purchase of external devices like spectacles, hearing aid, artificial limbs, crutches, artificial teeth, veneers, are all excluded.

● Instances of self-inflicted injury are not covered by a health insurance policy.

● Any type of cosmetic surgery such as plastic surgery or botox, are excluded. Exceptions include surgery for burns or accidental bodily injuries or surgeries for the treatment of cancer.

Want to know more about buying health insurance online
Want to know more about buying health insurance online

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Health Insurance Claims

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Health Insurance Claims

Claims
  • Locate the nearest network hospital on the Max Bupa Health app where you can avail cashless claim with Max Bupa. 
  • Collect your health insurance related forms from the hospital. Fill and submit those forms back to the hospital. You could be required to submit your health insurance policy number, photo ID, and other proofs. 
  • Once your documents are received, the internal claims committee will either approve or reject your claims based upon the course of treatment, documents, and coverage you have. If in the rare case your claim is rejected, you have the option to appeal to the grievance team to re-investigate your claim.
  • Once claims are approved, you can receive your medical treatment without having to pay anything to the hospital, or pay only for consumables or items/procedures listed in the exclusions charter. Once you are discharged, your insurer will check your discharge summary and documents before processing the claim. 
  • At every stage of your claim request, you can check its status on the Max Bupa website. Cashless claims are normally processed in 30 minutes or less by Max Bupa.

Health Insurance Myths

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Health Insurance Myths

Health Insurance  Myths

There are certain misconceptions about health insurance. Here’s a definitive myth-busting guide to health insurance.

 

  • Health insurance is not to be considered when one is young and healthy: Not only is this a false statement, but it also leads to higher costs if the policy is not purchased at a younger age. If you wait till you grow older, you may end up facing a lot of exclusions while buying health insurance or may not even be able to get it on account of existing conditions. Health insurance is best purchased when one is in their prime so that lower premiums can gradually build up to a massive sum insured.
  • Any healthcare costs will be covered by your health insurance: While these days most of the insurance companies cover for almost all healthcare costs but there still might be some exclusions and limitations. Few of those exclusions could be coverage for any war-related medical emergencies or any self-inflicted injuries, etc. There might be more such exclusions depending on your health Insurance policy and insurance company policies. Keep in mind that being well versed with your policy’s exclusions is crucial.  
  • If one has group coverage, there is no need for their own health insurance plan: Group health insurance oftentimes provides a smaller sum insured to individuals and the range of coverage is also not as extensive as that afforded by individual health insurance. If you solely rely on a group health policy, you and your family are likely to be underinsured.

 

Health Insurance Terms

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Health Insurance Terms

Health Insurance  terms

Ensuring one is well versed with the language of insurance is crucial before opting for a policy. Health insurance comes with its own set of fresh terms. These are as follows:

 

  • Room rent limit: This is a limit that puts a restriction on the amount of room rent a policyholder can claim per day. This is linked to one’s Sum Insured or the total coverage that one is entitled to. Room rent also includes the payout you receive for consultancy charges, surgical fess, operation theatre costs, and more.
  • Sub-limits: Insurance companies put a limit on coverage for some common conditions like knee replacement, cataract, cancer, etc, these are knows as sub-limits. This applies to specific costs such as the coverage one gets for surgical fees or doctors' fees. Sub-limits are applicable to such common conditions, irrespective of the total Sum Insured.   
  • Co-payment: A co-payment also knows as Co-pay is the percentage of your total claim amount that is payable you and the rest of the payment is paid out by your insurer. It basically means that the insurance companies pay a part of the claim and the other part of the claim is borne by the policyholder for every claim .
  • Deductible: Deductible means a certain amount that the policy holder needs to pay before the insurance company starts paying up. In other words, the insurance company is liable to pay the claim amount only when it exceeds the deductible amount.
  • Waiting period: This is the time between the policy being issued for the first time and coming into effect. It is normally 30 days after the policy has been issued for conditions like dengue, malaria, and other common conditions. Max Bupa has reduced initial waiting period to 15 days for Covid-19 coverage.

Factors Affecting Health Insurance Premiums in India

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Factors Affecting Health Insurance Premiums In India

Factors affecting Health Insurance premiums

When it comes to the cost of your health insurance premiums, many factors can affect its price. Some of these are as follows: 

 

  • Age: Undeniably one’s age is among the most prominent factors that affect your health insurance premiums. This is why financial advisors recommend opting for a health insurance policy when you are younger since premiums increase with advancing age.
  • Pre-existing illnesses: Any diagnosed health conditions before you opt for health insurance are referred to as pre-existing illnesses in policy terminology. Any pre-existing illnesses may result in an increase in the cost of your premiums. Opting for health insurance at a point in your life when you do not struggle with any pre existing illnesses will allow you to skip on high premium costs.
  • Family History: If you have a family history of certain chronic illnesses like diabetes, cancer, or stroke, there is a chance you may acquire those illnesses later in life. As a result, your insurance premiums could be higher.
  • City of residence: The city you reside in also affects the cost of your premiums. If you reside in a Tier 1 or a metropolitan city, premiums are likely to be higher as medical costs are higher in these cities as compared to Tier 2 or Tier 3 cities.
  • Body Mass Index: Those with a skewed body mass index may be asked to pay higher insurance premiums due to their probability of falling chronically ill being higher. High BMI individuals normally struggle with higher BPjoint pain, asthma, and other ailments, putting them in a higher risk category.
  • Smoking and Drinking: Insurance providers also consider smokers to be in a higher risk category than non-smokers. Smoking puts one at risk of developing severe respiratory illnesses such as bronchitis and lung cancer. Chronic drinkers are also at risk of developing liver disease, lapses in judgment, memory, and more severe conditions. Insurance premiums are high for those with either of these habits.

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Frequently Asked Questions

Why Do You Need Health Insurance?

How can I buy this policy?

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How to renew your health insurance policy?

What documents do you require to buy health insurance?

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What are the benefits of comparing health insurance plans online?

Do health insurance plans cover Ayurveda and other alternative treatments?

Which medical insurance plan is best for you?

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Why Do You Need Health Insurance? - +

Beyond saving on medical expenses, there are multiple reasons why you should get insured. In fact, it is advisable that you buy a policy while you are still healthy and young. The sooner you opt for a health insurance policy the better, as premiums and exclusions increase with age.

Here are four reasons why you should consider buying a health insurance policy for yourself and your family.

 

1) Increase in lifestyle-related illnesses

Although the human lifespan has grown over the years, stress levels have grown in parallel. Due to advancements in the field of medicine, people may live longer, but lifestyle-related habits can severely impact the quality of this ‘long’ life. Many people choose to live a sedentary lifestyle and opt for unhealthy meals to go with it. Pair this lifestyle with chronic stress and you have a recipe for early onset of conditions like hypertension and diabetes, which may lead to critical illnesses like stroke, heart attack and more. By choosing health insurance, one is choosing to mitigate the financial impact of being diagnosed with this kind of lifestyle ailment.

2) Group Health Cover is Usually Insufficient

According to a survey by Big Decisions, about 95% of Indians today are not sufficiently insured, with individuals above the age of 45 in the highest risk group. Many rely on their group health plan to cover their medical costs. However, a group plan may not cover your entire family’s medical expenses. Additionally, the total sum insured you get through a group plan most likely will not be sufficient to meet all your medical expenses. Do not put yourself at risk of being underinsured by relying solely on group health coverage. Opt for a comprehensive health insurance policy instead.

3) You Are Covered for More than Just Hospitalization

Health insurance provides coverage beyond your hospitalization costs. It covers medical bills, doctor’s consultations, ambulance charges, and more. Nowadays, there are pre and post-hospitalization expenses that are covered by traditional health insurance. This means you are getting more bang for your buck when you choose to invest in a comprehensive health insurance policy.

4) Inflation is leading to Out of Pocket Expenses Increasing

Not only is the cost of living on the rise, but healthcare expenses are likely to be sky-high in the next ten years. India’s healthcare industry is experiencing inflation in the double digits. Your out-of-pocket expenses are likely to grow over the years unless you have financial measures in place to mitigate the impact of inflation. One such measure is investing in a health insurance policy. Health insurance can fortify you with the emergency finances necessary if you are ever in need due to unforeseen medical emergencies.

Know more about the premium for your health insurance policy