Best Health Insurance Plans in India 2019

Health Insurance plans

Let us discuss the best Health Insurance Plans in India in 2019. But before I do, I would recommend each and everyone must have Health Insurance for yourself and the family.

Hospital bills have risen like anything and we never know when we become unwell or may face an accident. Hence choose the best health insurance plans for you and your family.

It is good if nothing happens, but you live with peace of mind when something happens and you are at least not worried financially. Do not depend on your employer’s insurance only as it is not sufficient and risky due to moving out of the job for any reason.

Some of the best health insurance plans in India are:

  1. Star Family Health Optima Insurance Plan
  2. Apollo Munich Optima Restore
  3. Aditya Birla Activ Assure Diamond – Family

Let us understand the 13 major factors which you should look for while choosing the best Health Insurance Plan.

1) Sum Insured to Premium for Health Insurance Plans

This is basically the cost of health insurance. You should compare the cost of all the health insurance plans that you have zeroed for the same premium amount that you are looking for.

For example, if you are looking for health insurance of Rs 5 Lacs, compare the premium of different health insurance plans for Rs 5 Lacs each and then make a decision based on this and other important factors.

Do not go for the one which is giving the insurance for the lowest premium as you may get hassled in claim approvals. This should be an important factor for choosing the best health insurance plan but make a decision after considering all below.

2) Claim Settlement Ratio

This ratio tells you how many claims were approved by the company to the number of claims that were applied for. You do not want to go for the claim provider whose track record of approving claims is low.

So look for ones where the claim ratio is nearing 100%.

3) Incurred Claim ratio

This ratio helps you to understand the financial health of the company with which you are buying the insurance. This ratio means claim expenses made by the company divided by total health premium received.

So let’s say that a company reimburses applicants for 1 Cr in a year and receives Rs 2 Cr as health insurance premium then this ratio would be 1/2 or 50%.

The idea here for you would be to check that the company you are choosing for health insurance should be financially sound and over the years it is not having this ratio of more than 100% as then the company might get closed.

4) Pre Existing diseases factor for Health Insurance Plans

This should be an important factor for you to choose the right health insurance plan. This is the reason why most of the claims are rejected.

Pre Existing disease means any disease that was existing when the claim was bought for the first time. The Insurance company only covers the risk of the illness that may happen but if some disease is already there, they do not cover the same for some time.

In general, pre-existing diseases are covered after 2 – 4 years.

5) Number of diseases covered

Though most of the diseases are covered by the leading health insurance companies, it is best to have a check on what is covered and what is excluded so that you are not surprised later.

6) Waiting period

For certain ailments, the insurance company put a waiting period. Like accidental insurance is covered after 30 days of buying the policy by most of the leading insurers.

7) Copay

Few insurance companies charge you some % on the final bill of the hospital after a certain age in general after 60 years.

8) Pre & Post hospitalization expenses

Most of the leading insurers provide Pre and Post hospital expenses. Usually 30 days of pre hospitalization existing cover and 60 days of post hospitalization existing cover.

9) Maternity Cover

This is covered by most of the leading insurance companies but do watch out for the coverage and the amount covered if you may plan for baby in the future.

10) Room Rent Limit for Health Insurance Plans

This is an important factor that you should look for. As you may have an insurance coverage of Rs 5 Lacs and the total hospital bill could be Rs 3 Lacs only and you may think that all is covered but you may be surprised with the reimbursement amount.

Insurance companies generally do a capping of the room based on the plan that you have selected. Sometimes, they cap your insurance coverage on the basis of Rs per night, for example, Rs 3000 per night and if you choose a room above Rs 3000, then you have to put your money.

At other times, they may cap your eligibility as cheapest single AC room in the hospital but you opt for the deluxe room. In this case again, you would have to put in the difference amount from your own pocket.

11) Cashless Hospital Network

It is always easy when you plan for any hospitalization and use the cash less method as this way you are at easy recuperating from the ailment while Insurance company pays for your expenses automatically.

Also, it is easy for the claim to be approved from the network hospital as compared to the non network hospital.

12) No Claim Bonus for Health Insurance Plans

Medical costs just keep increasing and hence many times, the insurance company offers you an increase in your health insurance coverage on the same premium for no claims made in a financial year. This could help you in the longer run.

13) Permanent Exclusions for Health Insurance Plans

Some diseases like AIDS etc are not covered by the Insurance companies. Look out for the permanent exclusion list before making your mind to buy any health insurance plan.

Keeping the above factors in mind, let us explore the above-mentioned health insurance plans in detail. For you to compare the below plans effectively, we will use the below factors in common

  1. Insurance amount of Rs 5 Lacs
  2. Coverage for a family of 2 adults and 2 children
  3. Date of Birth for the oldest member is 1st June 1984
  4. Location – Jaipur

Star Family Health Optima Insurance Plan

Star Health is one of the largest private health insurers in India. The Star Family Health Optima is certainly one of the best health insurance plans that one can opt for.

Features of Star Family Health Optima Insurance Plan

Premium amount for the above referenceRs 13,919
Number of Network Hospitals9300+
Waiting Period for Pre-existing Diseases4 years
Pre-hospitalization medical expenses coveredfrom 60 days before hospitalization
Post-hospitalization medical expenses coveredtill 90 days post hospitalization
PortabilityYes
Room limit Single Standard A/C Room
Renewability of the PolicyLifetime
Co-pay20% of final bill amount after 60 years
NCB Bonus10% – 25%* (subject to policy conditions)
TPA No. Star health do direct claim settlement.
Claim Settlement Ratio98.72%
  • Health Checkup benefit for every claim free year
  • 3 times Automatic restoration of Sum insured by 100% each time upon complete exhaustion
  • Donor expenses for organ transplantation up to 10% of sum insured or Rs 1 lac whichever is maximum.
  • AYUSH Treatment – Ayurvedic, Homeopathic, etc treatment to a limit of Rs 15,000.
  • A grace period of 120 days from the date of the expiry of the policy is available for renewal.

What I like about Star health insurance is

  1. Low premium
  2. A wide network of hospitals
  3. The customer support one gets and the ease with which the claims get approved. I am not talking here about the local branches.

What you should be watchful for this health insurance plan is the waiting period of 4 years for pre-existing diseases.

Apollo Munich Optima Restore

Apollo Munich Optima Restore is quite a popular health insurance plan in India specially for its insurance coverage restore benefits.

Features of Apollo Munich Optima Restore are:

Premium amount for the above referenceRs 16,442
Number of Network Hospitals5000+
Waiting Period for Pre-existing Diseases3 years
Pre-hospitalization medical expenses coveredfrom 60 days before hospitalization
Post-hospitalization medical expenses coveredtill 180 days post hospitalization
PortabilityYes
Room limitNo
Renewability of the PolicyLifetime
Co-pay 0%
NCB Bonus10% – 50%* (subject to policy conditions)
TPAYes
Claim Settlement Ratio98.18%
  • Health checkup of up to a maximum of Rs.2,500 per policy, only once at the end of a block of every continuous 2 Policy Years
  • If you do not claim for 2 consecutive years, your Sum Insured will be doubled.
  • Restoration of insurance limits for a new illness and not the one arising out for which hospitalization happened.
  • Medical expenses on harvesting the organ from the donor for organ transplantation.
  • Daily Cash for choosing Shared Accommodation – Rs.800 per day up to a maximum of Rs.4,800

What I like about this policy are

  1. The No claim benefits which helps you in increasing the insurance coverage.
  2. Restore benefits of the plan as mentioned above.
  3. Opting for a shared room helps in daily cash of Rs 800 as mentioned above.
  4. No Copay

What you should look out in this policy is that premium is a bit high with Aayush treatment not being provided.

Aditya Birla Activ Assure Diamond – Family

Aditya Birla has also come up with a family floater plan at a reasonable premium.

Features of Aditya Birla Activ Assure Diamond – Family Insurance Plan

Premium amount for the above referenceRs 14,856
Number of Network Hospitals5700+
Waiting Period for Pre-existing Diseases4 years
Pre-hospitalization medical expenses coveredfrom 30 days before hospitalization
Post-hospitalization medical expenses coveredtill 60 days post hospitalization
PortabilityYes
Room limitSingle Private A/C Room
Renewability of the PolicyLifetime
Co-pay20% of final bill amount after 60 years
NCB Bonus10% * (subject to policy conditions)
TPAYes
Claim Settlement Ratio 89.05%
  • Annual Health Checkup
  • 30% reduction on the next premium based on HealthReturns app.
  • Donor expenses for organ transplantation
  • AYUSH Treatment – Ayurvedic, Homeopathic, etc treatment to a limit of Rs 20,000.
  • Daily hospitalization allowance of Rs 500 to a maximum limit of 4 days.

What I like about Aditya Birla Active Diamond insurance plan is

  1. Low premium
  2. HealthReturns app
  3. The daily hospitalization cash allowance

What you should be watchful for this health insurance plan is the waiting period of 4 years for pre-existing diseases and a bit low claim settlement ratio.

Tips for taking the best health insurance plans in India

  1. Start early. Premiums are quite low at an early age. You also most likely increase the insurance coverage with the no claim bonus.
  2. Choose the right sum insured. most of the financial problems happen due to medical emergencies. Hence choosing the right insurance amount is critical. I would recommend a health insurance plan of Rs 3 – Rs 5 lacs for a small city and Rs 5 – to Rs 8 lacs for a metro.
  3. If you are looking for a family plan and have Sr citizens at home. Choose a different plan for them and choose a family floater for you and family. As pricing for family floater depends on the age of the senior most member, having senior citizens in the same, increase the premium a lot.
  4. Always tell the truth while requesting for a quote. You might get a little less premium hiding but you significantly increase the chance of your claim being denied in case of any eventuality. This defeats the purpose of taking health insurance.

Note: Govt of India also provide you with tax benefits on taking health insurance under section 80 D.

Hope I helped you in some way with this article. Please note the above is to my best understanding and I do not wish to make any claims on accuracy. Insurance companies also change their policies time to time.

If you need help in buying any insurance, whatsapp me by clicking below. My services are free.

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