HomeCoverWhat Are The Different Types Of Health Insurance Coverage

What Are The Different Types Of Health Insurance Coverage

How To Get Claims Faster

Types of Health Insurance & Coverage Tiers Explained
  • The Star Health website contains a list of network hospitals, including Agreed network hospitals.
  • Search from the network list from our website and locate the nearest network hospital to your residence.
  • For planned surgery, approach the hospital prior to the date of admission who will send the completed pre-authorization form.
  • In the pre-authorization form, you are required to furnish your contact number.
  • If details are not complete, approval of the authorization request may be delayed.

Get Coverage For New Drugs

Many new drugs or services introduced in the market undergo trials to test additional benefits or uses. Consumers can try to get into one of the trials and get the service or product as part of the trial. However, although each trial is designed differently, many have a group of participants who receive a “placebo,” a fake treatment, so you are not guaranteed the drug or service. Your physician should be able to help you learn of any trials available as the Food and Drug Administration requires the listing of drug trials.

What Is Considered Private Insurance

Private health insurance is any health care coverage that is offered by a private company or entity as opposed to state or federal health care coverage, such as ACA, Medicare, CHIP, Medicaid, etc.

For the most part, private health insurance plans cover the minimum essential coverage requirements of ACA plans. Private insurance also offers more choices than public plans. Private insurance can also offer shorter wait times at doctors offices and medical centers, and better-specialized attention. One of the disadvantages of private health insurance can be the costs. Private plans for individuals as well as family plans are typically more costly than ACA plans. Another main difference is eligibility.

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How To Choose The Best Health Insurance Plans In India

There is no one health insurance plan that fits the requirements of all. When buying health insurance online, you must look for a policy that not only suits your budget, but also offers you adequate cover.

Following are the things that you must consider when buying health insurance plans online:

1. Adequate Cover: The first thing that you must look for when buying a health insurance policy online is to check its inclusions. Ensure that the policy keeps you covered at all times by offering protection against a wide range of medical expenses. It is also recommended to take your familys health history into account and seek cover for any disease that runs in your family. For instance, diabetes, heart ailments, etc.

2. Affordability: To continue availing coverage benefits under the policy, you will be required to pay health insurance premiums on a regular basis. So, when choosing a health insurance plan for yourself and your loved ones, you must go with the one that you find affordable, so that you are able to pay the premium for a long term.

3. Flexibility: Flexibility means that you should be able to add coverage benefits as per your requirement, under a health insurance plan. There are several add-on benefits that you can choose voluntarily under your health insurance plans, by paying an extra premium at the time of policy purchase.

Senior Citizen Health Insurance Plans

Different Types of Health Insurance Plans

These plans are designed for people above the age of 60 years. Elderly people are more vulnerable to serious illnesses, and the cost of treatment for such diseases is also expensive. Therefore, it is better to buy a senior citizen plan for your elderly parents to ensure adequate medical coverage in their post-retirement years.

The premium is usually higher because of the extensive coverage benefits. However, you can also avail of tax benefits under Section 80D on the premium paid. So, if you are purchasing it for your elderly parents and yourself, you can avail of a total tax benefit of Rs. 55,000. .

Read here: 6 Things To Remember While Buying Health Insurance For Senior Citizens

Also Check: How Do I Get A Health Insurance Card

Smokers Can Not Buy A Health Insurance Plan

According to the survey, almost 49% of the applicants who consume alcohol or smoke are perplexed to buy a health insurance policy. But some health insurance companies give medical insurance coverage to them. But considering the risks, alcohol consumers and smokers will have to undergo a stringent pre-medical examination process and pay a higher premium to get health insurance coverage.

Types Of Health Insurance Policies


Health insurance refers to a type of general insurance, which provides financial assistance to policyholders when they are admitted to hospitals for treatment. Additionally, some plans also cover the cost of treatment undertaken at home, prior to a hospitalisation or after discharge from the same.

With the rising medical inflation in India, buying health insurance has become a necessity. However, before proceeding with your purchase, consider the various types of health insurance plans available in India.

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How Do Consumers Buy Health Insurance Coverage

If you dont have access to coverage provided by an employer, youll need to obtain your own health insurance in the market for individuals and families. You can visit your states marketplace/exchange to see the options that are available to you and how much the monthly premiums would be. If youre not eligible for premium subsidies or cost-sharing reductions , you might want to also check with a broker to see if there are additional plans available outside the exchange in your area.

If you feel that you can confidently manage your own enrollment and health coverage, you can enroll on your own. But the services of brokers and enrollment assisters are available free of charge, and they can help you manage the process.

Depending on your income and where you live, your state may provide you with Medicaid coverage. If youre eligible, your states marketplace will direct you to the application portal for Medicaid, and there are people available in your state who can help you complete the enrollment and answer any questions you may have.

If youre eligible for Medicare and dont have supplemental coverage provided by a current or former employer, youll also likely need to seek out supplemental coverage on your own, via Medicare Advantage or Medigap plus Medicare Part D.

What Is The Benefit Of Health Insurance

Types of Health Insurance Payers and Plans

The following are the benefits available under this insurance:

What is the benefit of health insurance?

A. Hospitalization Expenses

In-patient Care: For this to be active, the hospitalization should have been for at least 24 hours. Health insurance companies will pay for the resulting medical expenses. But please note, it is done through Cashless or, in some cases, Reimbursement but only for maximum up to Sum Insured . Please do refer to the documents for further information on this.

Day Care Treatment: It only takes place when hospitalization is less than 24 hours. This is because some surgeries dont require or need not necessarily require hospitalization for less than 24 hours. It may also happen that the surgery is minor or is of intermediate complexity. The health insurance company will pay through Cashless or Reimbursement Facility but for a maximum up to sum Insured.

Advance Technology Methods: Health insurance companies will compensate for expenses incurred under Hospitalization Expenses for treatment taken through advanced technology methods. See your health policy documents for more details.

B: Pre-hospitalization Medical Expenses and Post-Hospitalization Medical Expenses

Health insurance companies will also cover the medically necessary expenses incurred for 60 days. Please note: Payment made under this benefit will only be on a reimbursement basis.

C. Alternative Treatments

D. Ambulance Cover

E. Domiciliary Hospitalization

F. Automatic Recharge

A. OPD Care

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How Health Insurance Works

Like every kind of insurance policy, health insurance also helps you deal with the financial repercussions of an accident or emergency. Let’s take a look at how health insurance actually works. The process starts when you apply to purchase a plan. Depending on your age, medical background, sum insured required and the type of plan youve selected, you will be provided with premium quotes. In some cases, you might be asked to do a few medical tests before the insurance provider decides whether they’d like to provide you with the required cover. Once the terms and conditions are finalised, you will be provided with a policy. Each policy comes with a few waiting periods. The initial waiting period is only for a few weeks or a month. During this time, you will not be able to make any non-emergency claims. Let’s say that you require some kind of surgery after the waiting period. If you’re able to get the treatment in a network hospital, you can let us know about the surgery, and we’ll get in touch with the hospital directly to settle all the payments. When you’re discharged from the hospital, you will only have to pay for additional expenses that are not covered and the voluntary co-pay amount, if any. If you’re getting treatment in a non-network hospital, you can make all the payments and then file for a reimbursement claim. Either way, you can get the treatment you require without fretting about burning a hole through your pocket.

Here Are Our Health Insurance Plans:

  • Diabetes Safe Health Insurance Plan
    Diabetes is among one of the most common disorders with a huge number of 50.9 million people, driving India to the second position of the most affected country in the world, says Diabetes Foundation of India in a recent survey. A sedentary lifestyle, usage of tobacco, unhealthy food habits are the factors that stands foremost leading to diabetes, according to WHO.
    Star Diabetes Safe Health Insurance Plans offers coverage for regular in-patient hospitalization due to illness/accidents and diabetes complications arising out of Type 1/Type 2 . This is a specialized plan designed for people already with a history of diabetes. The plan covers diabetic complications and all other illnesses that require 24 hours of hospitalization on both individual and family floater basis.
    Know more
  • Super Surplus Top-Up Health Insurance Plan
    During the pandemic, even the best coverage is not sufficient. The Super Surplus Health Insurance Plan is a top-up plan that will cover medical costs, over and above a threshold limit. The plan is designed to cover exorbitant medical expenses with affordable premiums up to 1 crore sum insured. The Super Surplus Top-Up plan is available both on an individual and floater basis that can cover your family too.
    Know more
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    Importance Of Health Insurance Policies

    Health insurance plans provide you financial security, especially when healthcare inflation is on the rise. With rapidly changing lifestyle habits, increasing pollution, the evolution of new diseases and expensive healthcare facilities, it is important to have a health insurance policy. These plans prevent you from out-of-pocket-expenditures in times of sudden emergencies.Health insurance policies are customised as per the individuals needs, providing coverage for all kinds of health issues. The plans enable you to avail timely and quality health solutions without worrying about the expenses. Having a health insurance plan also helps you keep your savings intact and financially plan your future better.

    Find Out Which Services Most Plans Decline

    Types Of Health Insurance Plans ...

    Kirsten Rohrs Schmitt is an accomplished professional editor, writer, proofreader, and fact-checker. She has expertise in finance, investing, real estate, and world history. Throughout her career, she has written and edited content for numerous consumer magazines and websites, crafted resumes and social media content for business owners, and created collateral for academia and nonprofits. Kirsten is also the founder and director of Your Best Edit find her on LinkedIn and Facebook.

    Navigating health insurance coverage is a monumental task. Consumers generally have no say in which services are rendered, which services are covered, and how much they will ultimately be responsible for paying. It is not an uncommon scenario that a doctor requests a service, the patient follows the doctor’s orders, insurance pays only a portion or none at all, and the patient is left holding the bagand the bill.

    Other common scenarios: A patient calls the doctor to ask for the price of a particular test or treatment, only to be told the price is unknown. Or a plan participant calls their health insurer to ask for the customary fee for a serviceto determine how much of it will be coveredonly to be told “it depends.” No one would go into the local electronics store and buy a TV without being told the price, but in medical care, this is basically what patients are expected to do.

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    What Are Private Health Insurance Plans

    Any health coverage thatâs not received through a government program is considered private health insurance, the other main type of health insurance.

    Many people get health insurance through a group plan from their workplace. This employer-sponsored health insurance is also a type of private health insurance. With a workplace health plan, your employer pays part of the cost, giving you lower premiums.

    An individual health plan purchased on healthcare.gov, the health insurance marketplace, or outside of it â like directly from an insurer’s website or through an insurance broker â is also a form of private health insurance coverage.

    Regardless of where you get private health insurance, the plan must provide the insured with ten essential health benefits, like preventive care and ambulatory services, as set out in the Affordable Care Act, which weâll discuss more later.

    If youâre buying health insurance through the Obamacare marketplace, you may need to buy during the open enrollment period. There are different enrollment periods for buying a public health plan, depending on the program.

    Outside of the open enrollment period, youâll need to have a qualifying life event to initiate a special enrollment period to buy a marketplace health insurance plan.

    Check out your private health insurance options.

    Why Comparing Health Insurance Plans Is Important

    It is understood that it can be difficult to choose the most suitable health insurance plan from a pool of them in the market. This is why you must compare health insurance plans using InsuranceDekhos health insurance premium calculator. The free tool not only allows you to calculate premiums for health insurance plans, but also lets you compare them in terms of premium and coverage benefits.

    Comparing health insurance plans is hence recommended instead of buying the first plan you saw, as it helps you choose the most suitable one as per your requirement and make an informed decision.

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    Why Choose Iffco Tokio

    With a wide network of cashless hospitals and proven excellence in service, IFFCO-Tokio General Insurance Co. Ltd. is a trusted name in the field of health insurance in India. We offer affordable health insurance plans that are customisable so you get the exact coverage you need as per your requirementfor peace of mind.

    What Is Waiting Period In Health Insurance Plans

    Health Insurance 101: Types of plans

    Waiting period or cooling period in health insurance is time period you need to wait at the start of your policy. In the waiting period, you will not be able to avail any health insurance benefits. No health insurance claim during this period is accepted by the insurer. Some of the Health insurers might accept claim during waiting period. You should connect with your health insurance provider to know more about waiting period of your health insurance policy. Also, check the health insurance claim settlement ratio beforehand to avoid any future disappointments.

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    Type Of Health Insurance Plans

    There are a variety of health insurance plans in India. Listed below are some of the popular plans:

  • Individual Health Insurance Plan

    As the name suggests, An individual health insurance plan offers cover for the individual only. This plan covers your medical expenses for hospitalisation, injury, room rent, and more. This policy offers sum insured which can be used by only one person i.e. the individual covered under the plan.

  • Family Floater Insurance Plan

    Under a family floater plan, you can cover your entire family under a single policy. The sum insured for these policies are usually higher than regular individual health insurance plans. The sum insured is available for all the family members insured under the plan. The best part about this plan is that you can get cover for your entire family for a small premium amount.

  • Group Medical Insurance Plans

    Group health insurance plans are highly popular in the corporate sector. Medium and large-sized enterprises use this insurance policy to offer cover for their employees in time of a medical crisis. It is a benefit that most employees expect when joining a company and this helps the employer retain their employees.

  • Some Disadvantages Of An Hsa

    • Youll have a deductible cost, which represents the money youll have to pay out of pocket before your insurance will cover anything
      • The KFF finds that the average HDHP deductible is $2,303 for a single plan and $4,552 for a family plan.
    • The money you contribute to your HSA is exclusively meant for medical expenses, so if you take it out for another reason, youll pay a penalty

    For more information, see Can I have an HRA and an HSA at the same time?

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    What Is Sum Insured In Health Insurance

    Sum insured is the amount that the Insurance Company is liable to pay. It works on the principle of compensation. Let me explain that with an example, consider the sum insured is Rs 5 Lakh under health insurance. The hospitalization expenses are Rs. 2.5 Lakh only. In this case, the health insurance company is liable to pay Rs 2.5 Lakh towards the claim.

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