Medical costs in India are rising every year. A single hospital stay can wipe out years of savings. Health insurance is a contract in which the insurer agrees to pay your hospital bills, up to a limit, in return for an annual premium.
How Health Insurance Works
You pay a premium and choose a sum insured, which is the maximum amount the insurer will pay in a policy year. If you are hospitalised, the insurer pays the eligible expenses either directly to the hospital (cashless) or by refunding you (reimbursement).
What Does It Usually Cover?
- Hospital room rent and nursing charges
- Doctor, surgeon and ICU charges
- Medicines, diagnostic tests and operation theatre costs
- Pre-hospitalisation and post-hospitalisation expenses for a set number of days
- Day-care procedures that do not need a 24-hour stay
- Ambulance charges up to a limit
What Is Usually Not Covered?
Cosmetic surgery, dental treatment (unless due to accident), and treatments not medically necessary are generally excluded. Every policy also has a waiting period for some conditions. Always read the exclusions list.
Key Terms to Know
- Sum insured: Maximum cover per year
- Premium: Amount you pay for the policy
- Deductible / co-pay: The portion you pay yourself
- Network hospitals: Hospitals where cashless treatment is available
- Waiting period: Time before certain claims are payable
Types of Health Plans
Individual, family floater, senior citizen, critical illness and top-up plans are the common types. Each one suits a different need.
Why Buy Early?
Premiums are lower when you are young and healthy, and waiting periods start running from day one. Waiting until you fall sick may lead to higher premiums or rejection.
Frequently Asked Questions
What is the ideal health cover for a family?
Many experts suggest starting with at least ₹10 lakh or more in metro cities, then adding a top-up. Your city and family history matter.
Is employer health insurance enough?
It is a good start, but it ends when you leave the job, so keep a personal policy too.
Can I buy health insurance if I have a pre-existing disease?
Yes, but you must disclose it. Cover for that condition usually starts after the waiting period.
