What is Health Insurance?

Reduces the burden of expensive medical care and saves your long-term savings.

How Does Health Insurance Work? 

Choose a plan and pay the premium (monthly/quarterly/yearly).

If you get hospitalized or need treatment, you file a claim.

The insurer either reimburses the expenses or pays the hospital directly (cashless).

Example: 

If you have a ₹10 lakh health cover and undergo a ₹5 lakh heart surgery, the insurer pays the bill as per policy terms—saving you from a huge expense.

Why Do People Need Health Insurance? 

Medical inflation is rising rapidly in India.

Insurance ensures you can afford treatment without draining your savings.

Offers tax benefits under Section 80D of the Income Tax Act.

Key Features of Health Insurance in India (2025) 

✔ Cashless Hospitalisation Over 12,000+ network hospitals in India.

✔ Digital Policies E-cards, online claim submission and paperless buying.

✔ Customized Plans Plans for individuals, families, seniors, critical illnesses and more.

✔ No Claim Bonus (NCB) Your sum insured can increase by up to 200% for claim-free years.

✔ Lifetime Renewability IRDAI mandates lifetime continuation of retail health insurance plans.

✔ Tax Benefits Up to ₹1,00,000 deduction under Section 80D.

Types of Health Insurance Plans in 2025 

✔  Individual Health Insurance Covers hospitalisation, surgeries, day-care procedures and more for a single person.

✔ Family Floater Health Plans One policy for the entire family—ideal for young families.

✔ Senior Citizen Health Plans Higher coverage, yearly health check-ups, and domiciliary (home care) benefits.

✔ Critical Illness Insurance One-time lump sum payout on diagnosis of major illnesses like cancer, stroke or kidney failure.

✔  Top-Up & Super Top-Up Plans Increase your insurance coverage without changing your base policy.

✔  Maternity & New-Born Cover Covers maternity expenses after a waiting period.

✔ Personal Accident Cover Protects against disability, accidental death and hospital cash benefits.

✔ Arogya Sanjeevani A standard IRDAI-regulated basic health plan with affordable premiums.

✔  OPD & Wellness Plans Covers doctor consultations, pharmacy bills, and basic OPD treatments.

✔ Corona Kavach Still available as a standalone plan for virus-related hospitalisation.

Choosing the Best Health Insurance in 2025 

(What to Compare Before Buying)

Network Hospitals – Ensure your preferred hospitals are covered.

Sum Insured – For families: 10 lakh; seniors: 5 lakh and above.

Room Rent Limit – Prefer policies with no cap for smoother admissions.

Waiting Period – Shorter waiting periods for pre-existing illnesses & maternity.

Day-care Procedures – At least 500+ procedures included.

Co-Pay Terms – Common in senior plans; check affordability.

Exclusions – Dental, cosmetic treatments or OPD (unless add-on is chosen).

Health Insurance Comparison Snapshot (2025)

Eligibility in India (2025) 

Adults: 18 to 65 years

Children: Can be added from 3 months onward

Senior plans: Entry starts at 60 years

All plans offer lifetime renewability

Documents Required (2025) 

Aadhaar or PAN

Address Proof (Passport, Voter ID, DL)

Age Proof (Birth Certificate, School Certificate)

Passport-size photos

Medical reports (if required for higher coverage or older age)

New IRDAI Guidelines for 2025 

✔ Lifetime Renewals No policy can be denied renewal due to age or past claims.

✔ Standardized Exclusions Most insurers now follow a uniform exclusion list for better clarity.

✔ Faster Claims Insurers must settle claims within 30 days, else they pay interest.

✔ Pre-Existing Disease Rules All pre-existing diseases must be covered after 36 months maximum.

✔ Portability You can switch insurers at renewal while keeping your benefits intact.

Claim Process in 2025 

Cashless Claim Show your digital e-health card at a network hospital

Hospital sends pre-authorisation online

Insurer approves in 2–6 hours

Treatment continues, insurer pays the bill directly

Reimbursement Claim Pay the hospital bill

Upload documents (bills, ID, discharge summary)

Claim processed within 7–15 days

Amount credited to your bank account

What is Covered? 

✔ Room rent & ICU charges 

✔ Doctor fees 

✔ Surgery & OT charges 

✔ Medicines & consumables 

✔ Diagnostics & imaging 

✔ Pre & post hospitalisation 

✔ 500+ day-care procedures 

✔ Ambulance charges 

✔ AYUSH treatments 

✔ Home hospitalisation 

❌ What is Not Covered? 

Dental, vision & hearing aids

Cosmetic surgeries

OPD (unless add-on selected)

Self-inflicted injury, substance abuse

Non-medical consumables

Which Companies Offer Good Health Insurance in India (2025)? 

Top insurers include:

HDFC ERGO

Star Health

Niva Bupa

ICICI Lombard

Care Health Insurance

Tata AIG

Aditya Birla Health

Bajaj Allianz

SBI General

Reliance Health

Many insurers now provide digital policies, tele-consultation, AI-based claim tracking and wellness rewards.

Cost of Health Insurance in 2025 (Approx.)

Premiums vary based on age, city, medical history, and insurer.

Frequently Asked Questions (FAQs) 

Q. When does health insurance coverage start? 

Accident coverage begins immediately; illness coverage usually after 30 days.

Q. What if I get admitted to a non-network hospital? 

You can file a reimbursement claim with bills and documents.

Q. Do plans offer yearly health check-ups? 

Yes, many plans include annual check-ups—especially after claim-free years.

Q. Can I increase my sum insured later? 

Yes, at renewal through top-ups or higher coverage.

Q. What does portability mean? 

It allows you to switch insurers while retaining waiting period benefits.

Q. What if my claim is denied or delayed? 

You can escalate the matter to the insurer’s grievance cell, the Ombudsman or IRDAI.

Need Help Choosing the Right Plan? 

📞 Call Bharat Finserv for Expert Guidance 

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