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Instant Coverage Health insurance is a type of insurance that covers the costs of medical treatments in case of illnesses or accidents. It allows policyholders to receive financial support for hospitalisation, medical emergencies, critical illnesses, and more. Additionally, medical insurance includes benefits such as cashless hospitalisation and complimentary medical check-ups.
At Okbima, we're here to assist you in finding the best health insurance plans for your needs based on the sum insured, network hospitals & claim settlement ratio.
Care Heart
Health Gain (Plus)
ReAssure 2.0 Titanium +
Health insurance is an agreement between the policyholder and the insurance provider in which the insurer offers financial protection to the insured up to a specified coverage limit. This type of insurance covers medical expenses for both emergency and planned hospitalisations. Additionally, policyholders can benefit from tax savings on the premiums paid under Section 80D of the Income Tax Act 1961.
| Categories | Specifications |
|---|---|
| Sum Insured | Rs.50,000 to up to Rs.6 crore |
| Maternity Cover | Available |
| Pre & Post-hospitalization Expenses | Covered |
| OPD Cover | Available |
| ICU Charges | Covered |
| Free Health Check-ups | Available |
| Pre-existing Diseases | Covered |
| Ambulance Cover | Available |
| Day Care Procedures | Covered |
| Tax Benefits | Up to Rs.75,000 per financial year |
Buying health insurance plans online has many benefits, such as providing hospitalisation expense coverage, ICU charges, ambulance cost reimbursement, etc.
Hospitalisation Expenses Coverage
The health insurance policy covers the expenses incurred during hospitalisation, extending coverage to room rent, doctor’s fees, medication costs, and diagnostic test fees.
Pre & Post Hospitalisation Expenses
Comprehensive coverage extends to pre & post-hospitalisation expenses, reimbursed for a fixed number of days, as specified in the policy document.
ICU Charges
Health insurance policy also covers the costs associated with availing treatment in an Intensive Care Unit (ICU) during hospitalisation which helps to reduce the financial burden of critical care.
Ambulance Cost Reimbursement
It covers expenses incurred for availing ambulance services during a medical emergency, ensuring transportation to the nearest hospital without financial strain.
Cashless Treatments at Network Hospitals
All insurers in India offer cashless treatment at their network hospitals. This eliminates the need to arrange funds for hospital bills.
Day Care Procedures Coverage
It covers the costs of daycare treatments that require hospitalisation for less than 24 hours.
Pre-existing Diseases Coverage
The best health insurance plans cover pre-existing diseases, subject to the waiting period.
AYUSH Treatment
It covers the costs of medical treatments offered by AYUSH (Ayurveda, Unani, Homeopathy, Siddha, and Yoga) schools of medicine, promoting healthcare options.
Comparing health insurance plans online helps you find the best option for your needs without the hassle. With so many plans available, it’s easy to get confused. Platforms like Okbima.com simplify the process, letting you compare features, coverage, and prices quickly.
Accurate Information
Access all the details you need without relying on agents, avoiding biassed advice.
Convenience
Compare plans and manage everything—paying premiums, renewing policies—easily from home.
Cost Savings
Compare premiums and avoid agent fees, helping you stick to your budget.
Reviews and Ratings
Check customer feedback and claim settlement ratios to choose a trusted provider.Make an informed choice by comparing health insurance plans online.
Waiting Period
The waiting period is the time during which you cannot make claims on your insurance. This time varies between companies, so check this before buying a policy. Ideally, pick an insurer with a shorter waiting period.
Co-payment
Co-payment is the amount you have to pay from your own pocket for treatment. It’s better to choose a plan with low or no co-payment so that you don't have to pay much. However, if you agree to a higher co-payment, the premium will be lower.
Grace Period
The grace period is the time after your policy expires, during which you can still renew it. Choose a company that offers a longer grace period, and make sure to check this detail before buying a plan.
No Claim Bonus
No Claim Bonus is a reward you get if you don’t make any claims during a year. This bonus is applied when renewing your policy. Be sure to check if your plan offers this benefit.
Network Hospitals
Network hospitals are those where you can get cashless treatment. It’s better to choose a company with a larger number of network hospitals so that it’s easier to get treatment without worrying about paying huge bills.
Restore Benefits
Restore benefits mean that if you use up your insured amount, it automatically gets restored. Choose a health plan that offers good restoration benefits, ideally 100% restoration.
Preventive Health Check-up
This benefit allows you to get a free annual health check-up. Check with the insurer if your plan offers free health check-ups each year.
Sub-limits
Some plans have limits on how much you can claim for certain treatments. It’s better to pick a plan without these sub-limits, so make sure to review the policy carefully for this information.
Medical costs are rising, making treatments expensive. If you are hospitalised due to a serious illness or a lifestyle disease, it could drain your savings. The best way to afford quality treatment during such emergencies is by buying health insurance. Here are some key reasons to consider getting a health insurance plan.
Beat Medical Inflation
Health insurance helps you cover your medical bills, including before and after hospitalisation, even with the rising costs of healthcare.
Afford Quality Treatment
It allows you to receive the best medical care so you can focus on recovery without worrying about the cost.
Fight Lifestyle Diseases
Health insurance covers long-term treatments for diseases like cancer and heart issues, which are becoming more common due to lifestyle changes.
Protect Your Savings
By covering medical expenses, health insurance ensures you don't have to dip into your savings for treatment.
Cashless Hospitalisation
You can get cashless treatment at any of the insurer's network hospitals by making a cashless claim.
Tax Benefits
You can save on taxes under section 80D of the Income Tax Act for the premiums you pay, aiding in financial planning.
Peace of Mind
Health insurance provides peace of mind as you don’t need to worry about hefty medical bills during a health emergency.
A health insurance plan covers many medical expenses like hospitalisation, doctor’s visits, emergency services, preventive care, maternity care, etc.
It covers expenses related to inpatient care, such as room charges, nursing care, surgical procedures, and medications.
A health insurance plan covers the expenses of consultations, examinations, diagnostic tests & treatments provided by physicians or specialists.
Health insurance policy also covers visits to the emergency room for sudden and unexpected medical conditions or accidents.
They cover many prescribed medications, either in generic or brand-name, depending on the plan.
This covers costs associated with different lab tests, including blood tests, imaging studies (like X-rays, CT scans, MRIs) & pathology examinations.
A Medical insurance policy covers preventive services, such as vaccinations, screenings & preventive screenings like mammograms, pap smears, or colonoscopies.
It provides coverage for prenatal care, maternity consultations, delivery & postnatal care for both the mother and the newborn.
It offers coverage for physical therapy, occupational therapy & other types of rehabilitation services needed for recovery from illness, injury, or surgery.
Some health insurance plans in India cover the medical care or nursing services provided at home for those individuals who are unable to leave their homes due to medical conditions.
A health insurance plan does not cover cosmetic procedures, experimental or investigational treatments, non-emergency medical services abroad, etc.
Health insurance does not cover cosmetic procedures, such as facelifts, liposuction, or breast augmentation, unless medically necessary for reconstructive or therapeutic purposes.
If a treatment is considered experimental, unproven, or not widely accepted within the medical community, health insurance won't cover it.
Some health insurance plans in India may not cover alternative or complementary treatments, such as acupuncture, chiropractic care, naturopathy, or herbal medicine.
Unless specified in the policy, health insurance doesn't cover medical services received outside India, except in cases of emergencies.
It does not cover over-the-counter drugs or medications not prescribed by a healthcare professional.
Insurance companies may exclude coverage for pre-existing medical conditions for a certain period, especially in individual policies.
There are many types of health insurance plans in India such as individual health insurance, health insurance for family, health insurance for senior citizens, health insurance for critical illness, etc.
Individual health insurance helps protect you by covering your medical expenses and hospital bills. It gives you peace of mind knowing that you're financially covered if you get sick or need hospital care.
Family health insurance plans provide comprehensive coverage for all family members, including spouse, children & parents alike.This type of plan provides coverage to the entire family by covering the sum assured amount.
Senior Citizens health insurance plans are specifically designed for individuals who are above 60 years old &. It offers coverage for age-related illnesses and provides higher sum assured amounts.
Critical illness plans cover cancer, heart attack, stroke, kidney failure, etc. The full amount of insurance coverage is paid all at once if the policyholder is diagnosed with any of the specified critical illnesses.
Health Insurance For Parents covers hospital expenses and provides financial security for their medical needs, which becomes crucial as they grow older.
Health insurance plans for diabetes provide coverage for hospitalisation expenses incurred by diabetic patients, addressing the challenge they face in getting insurance. These policies include coverage for both Type 1 and Type 2 diabetes, along with associated medical complications.
Personal accident insurance is a type of health policy that reimburses medical expenses resulting from hospitalisation due to death or disability caused by an accident. Depending on the nature of the disability, the insurance company provides a specified payout amount.
When choosing a health insurance plan, keep these important factors in mind:
Scope of Coverage
The coverage determines which illnesses and surgeries you can claim for. Check benefits like hospitalisation expenses, daily cash, COVID cover, critical illness, maternity cover, etc., before selecting a plan.
Sum Insured
The sum insured is crucial. With rising costs, it's advisable to get at least Rs.10 lakh coverage, or even Rs.1 crore for wider coverage. For family floater or senior citizen plans, a higher sum insured gives better protection.
Riders in the health insurance policy is an additional coverage that can be added to a base policy. These riders provide extra benefits to meet the unique needs of individuals and families.
Maternity rider
It provides coverage for prenatal, childbirth & postnatal expenses, doctor visits, hospital stays, laboratory tests & delivery-related services.
Dental and Vision rider
This rider offers coverage for dental treatments like regular check-ups, fillings, extractions & vision-related expenses such as eye exams, glasses & contact lenses.
Critical illness rider
Critical illness riders offer coverage for life-threatening conditions such as cancer, heart attack, stroke & kidney failure.
Hospital cash rider
Hospital cash riders offer a fixed daily cash benefit for each day spent in the hospital due to illness or injury & help cover incidental expenses like transportation, meals, etc.
To be eligible to get a health insurance policy in India, individuals need to meet certain criteria set by insurers. While specific eligibility criteria can vary slightly between insurers and policies, here are the requirements.
Most medical insurance policies have a minimum and maximum age limit for entry. The minimum age is around 18 years & the maximum age can be from 65 to 80 years depending on the policy. Some insurers offer specific policies for senior citizens with higher age limits.
Depending on your age and health condition, insurers may require a medical check-up before issuing the policy. This is more common for older applicants or those with pre-existing medical conditions.
Insurers may have specific guidelines for pre-existing medical conditions. Some policies may exclude coverage for certain pre-existing illnesses for a specified waiting period, while others may offer coverage after a waiting period or immediate coverage with higher premiums.
Insurers may assess your financial stability to determine your ability to pay premiums regularly and to assess the risk of providing coverage.
Before buying health insurance, it’s important to understand how it works. Here are some common myths that many people believe:
Even if you’re healthy, unexpected events like seasonal illnesses or accidents can happen at any time. Hospitalisation costs are high, especially in cities. Just 2 days in a hospital can cost Rs.60,000 to Rs.1 lakh or more. Health insurance can help cover these expenses and save your money.
All health insurance plans have exclusions and limits. Your insurer will only cover the expenses mentioned in the policy and only up to the sum insured. It's important to read the policy carefully to know what’s covered and what’s not.
You must declare all pre-existing diseases when buying health insurance. Hiding or not providing complete information can lead to claim rejections or even cancellation of the policy.
Many smokers believe they can’t buy health insurance, but that's not true. Smokers can get coverage, although they may need to undergo medical tests and pay higher premiums due to the increased health risks.
While most plans cover hospital stays, many also cover daycare procedures like cataract surgery or treatments that don’t require 24-hour hospitalisation. Some plans even cover OPD treatments without hospitalisation.
Relying only on your company’s health insurance can be risky. These plans often have limitations, may not cover your family or critical illnesses, and end when you leave the job. Getting health insurance after retirement or quitting can be costly and difficult.
With better medical facilities, healthcare costs have gone up. Health insurance helps cover these expenses, giving you and your family financial protection during unexpected serious illnesses or accidents that could drain your savings. Here’s how your insurance premium is calculated.
Medical History
Your health history plays a big role in deciding your premium. Most insurers require medical tests after a certain age. They also look at your current health, lifestyle habits, and family medical history. For example, smokers often pay higher premiums due to the added health risks.
Gender and Age
Age is another key factor. Premiums increase as you get older, so it's cheaper to buy health insurance when you're young. Senior citizens usually face higher premiums due to the risk of critical illnesses. Women generally pay lower premiums than men, as they have a lower risk of heart attacks and strokes.
Policy Term
A 2-year policy has a higher premium than a 1-year plan, but many insurers offer discounts for long-term policies.
Type of Plan
The broader the coverage, the higher the premium. You can compare premiums for different plans using an online premium calculator before choosing a policy.
No Claim Bonus (NCB)
If you haven’t made any claims during the policy term, you can get a discount on your renewal premium through the No Claim Bonus, saving between 5% and 50%, depending on the claim-free years.
Lifestyle Habits
Regular smokers and drinkers are likely to be charged a higher premium. In some cases, insurers may even reject your application due to health risks.
Filing a medical insurance claim can be a hard task, but it is essential to ensure that you receive reimbursement for your medical expenses.
Filing a cashless health insurance claim in India involves a few systematic steps to ensure smooth processing.
Choose Network Hospital: Select a hospital that is in-network with your medical insurance provider. This ensures you can avail of cashless treatment.
Inform Insurance Company: Inform your insurance company about the hospitalisation as soon as possible. Many insurers have a helpline or online portal for intimation.
Pre-Authorisation Request: Submit a pre-authorisation request form provided by the insurer to the hospital's insurance desk. This form includes details like policy number, patient details, nature of illness, estimated treatment cost, etc.
Verification and Approval: The hospital will verify the details and send the pre-authorisation request to the insurance company for approval. This process may take a few hours, depending on the insurer.
Approval Communication: Once approved, the insurer will communicate the approval to the hospital and you via SMS or email. This confirmation allows you to proceed with treatment without paying cash upfront (except for non-medical expenses).
Treatment and Discharge: Receive treatment as prescribed. Ensure any additional expenses not covered by insurance are paid separately.
Claim Settlement: After discharge, the hospital will prepare the final bill and send it to the insurer for settlement. The insurer will settle the approved amount directly with the hospital.
Review and Follow-up: Review the final bill for accuracy and ensure all necessary documents (discharge summary, investigation reports, bills, etc.) are collected. Follow up with the insurer for any clarifications or additional documentation if required.
Health insurance is essential for financial planning, shielding you from unexpected medical expenses. Understanding how to file reimbursement claims can simplify the process and expedite your refund.
Understand Reimbursement Claims: Reimbursement claims mean you pay for medical expenses yourself first and then ask your health insurance company to pay you back. This happens when you get treatment at a hospital that is not part of your insurance network or in situations where you can't use cashless claims.
Collect Essential Documents: Before initiating the claim process, collect the necessary documents such as hospital discharge summary, doctor's prescriptions and reports, hospital bills and receipts, pharmacy bills & claim forms.
Inform Your Insurance Provider: Inform your insurance provider about the hospitalisation and treatment within 24-48 hours for emergency hospitalisation and 3-7 days for planned hospitalisation.
Fill Out the Claim Form: Complete the claim form accurately, providing details about the policyholder, the insured person, and the treatment received. Ensure all information matches the documents submitted.
Submit the Claim: Submit the completed claim form along with all required documents to your insurance provider. This can be done through courier or online submission.
Follow Up on Your Claim: After submission, regularly follow up with your insurance provider to track the status of your claim. Many insurers provide online tracking facilities for real-time updates.
Respond to Queries: Health Insurance companies may request additional information or clarification during the claim processing. Respond to these queries to avoid delays in claim settlement.
Receive the Reimbursement: Once your claim is approved, the insurance provider will reimburse the eligible amount directly to your bank account. Ensure you provide accurate bank details in the claim form.
When filing a health insurance claim in India, it is crucial to have all the necessary documents to ensure a smooth and hassle-free process. The exact requirements may vary depending on the insurance company and the type of claim (cashless or reimbursement), but generally, the following documents are needed.
Completed Claim Form
Ensure that you have filled out the claim form correctly with all necessary details. This form is provided by the insurance company and is the primary document for initiating the claim process.
Policy Copy
A copy of your medical insurance policy document or the policy number is essential to validate your claim and check the coverage details.
ID Proof
A government-issued identity proof such as an Aadhaar card, PAN card, passport, or voter ID.
Medical Reports & Doctor’s Prescription
All medical reports, diagnostic test results, and prescriptions related to the treatment.
Hospital Bills and Receipts
All original hospital bills with detailed information, including room rent, doctor's fees, medical tests, etc & receipts of all payments made to the hospital.
Discharge Summary
The hospital discharge summary or card that details the treatment provided and the patient's condition at the time of discharge.
Medicine Bills
Original pharmacy bills for medicines purchased during the treatment period, along with the prescriptions.
Diagnostic Reports
Reports of all diagnostic tests (e.g., blood tests, X-rays, MRIs) conducted during the treatment period.
Certificate of Treatment
A certificate from the attending doctor or surgeon detailing the nature of the treatment, duration, and necessity of hospitalisation.
Bank Details
A cancelled cheque or a document providing your bank details for reimbursement purposes.
Pre-authorisation Form
This is required for cashless claims and must be filled out and submitted by the hospital to the insurance company for approval.
Previous Medical Records
Any past medical records that are relevant to the current treatment.
At Okbima, your well-being is our priority. We offer a comprehensive range of health insurance options to meet your specific needs.
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