Types of Health Insurance Plans in India

Individual, family, critical illness, top-up, and more, explore every type available. 

Health insurance plans in India come in many types. Whether you want to cover yourself, your entire family, your elderly parents, or protect against a critical illness, there is a plan available in the market for it. The most common types of health insurance plans in India are individual plans, family floater plans, senior citizen plans, critical illness plans, group plans, top-up plans, maternity plans, personal accident cover, disease-specific plans, hospital daily cash, and ULIPs.

Contents

• Different Types of Health Insurance in India
  • Individual Health Insurance Plan
• Senior Citizen Health Insurance Plan
  • Critical Illness Insurance Plan
  • Features of Critical Illness Health Insurance Plan:
  • Group Health Insurance Plan
  • Top-up Health Insurance Plan
  • Personal Accident Insurance Policy
  • Maternity Health Insurance Plan
  • Mediclaim Insurance Plan
  • Features of Mediclaim Insurance Plan:
  • Disease-specific health insurance plans (Corona Kavach, etc.)
  • Features of Disease-Specific Health Insurance Plan:
• Hospital Daily Cash
  • Fixed benefit health insurance plans
• Why Should You Buy Health Insurance?
• Consider These Factors When Purchasing Health Insurance
• Conclusion
• FAQs

Different Types of Health Insurance in India

Here is a quick overview of all the types of health insurance plans available in India:

Individual Health Insurance Plan

Individual health insurance covers one person under a dedicated sum insured. This means only you can claim against the policy, no sharing with family members. 

For example, if you buy an Individual Health Insurance Policy with a sum insured amount of Rs. 5 lakhs, you can claim up to Rs. 5 lakhs.

Features of the Individual Health Insurance Policy

• It covers a single person.

• Individual sum insured amount for each beneficiary.

• It offers coverage for hospitalisation expenses incurred due to injury/illness, surgeries, daycare treatment, room rent, etc.

• People in the age group between 18 and 65 years are eligible for this plan.

Family Floater Health Insurance Plan
The Family Floater Health Plan is for the entire family. Under this type of health insurance policy, your family is covered in a single policy. The sum insured is equally shared by the beneficiaries of the plan. The premium is comparatively lower compared to the Individual Health Insurance Policy (considering each family member buys one).
For example, consider you have purchased a Family Floater Health Insurance. It covers your two children, your spouse, and yourself with a sum insured of Rs. 20 lakhs. If you are hospitalised for a covered surgery costing Rs. 10 lakhs, the policy shall cover the cost as per the terms and conditions. The remaining Rs. 10 lakhs is available for future medical emergencies or planned hospitalisation for you or the covered family members.
Features of a Family Floater Health Insurance Policy

• The entire family is covered under a single health insurance plan.

• The sum insured is shared by the beneficiaries.

• It offers financial coverage against hospitalisation, surgeries, treatment, daycare, etc.

Senior Citizen Health Insurance Plan

Senior Citizen Health Insurance Policy provides coverage for individuals above 60 years of age. Premiums are higher than individual or family floater plans since older individuals are more likely to need medical care.

For example, if your 63 year old mother is hospitalised for a knee replacement surgery costing Rs. 4 lakhs, a senior citizen plan with a Rs. 5 lakh sum insured will cover the surgery, hospitalisation, and post-discharge expenses without dipping into your savings.

Features of the Senior Citizen Health Insurance Policy:

• Covers pre and post-hospitalisation expenses for illness and accidents.

• Includes psychiatric treatment and domiciliary expenses.

• Available for parents who were previously uninsured.

Critical Illness Insurance Plan

Critical Illness plan is designed to provide financial protection if you are diagnosed with a critical illness or condition. This type of health insurance policy offers coverage against critical diseases such as heart attacks, kidney failure, paralysis, stroke, cancer, etc. 

For example, if you are diagnosed with cancer that is covered under a Critical Illness Health Insurance Plan of Rs. 15 lakhs, the insurer shall pay Rs. 15 lakhs as a one-time lump-sum payment, and terminate the policy.

Features of Critical Illness Health Insurance Plan:

• Pays the full sum insured as a one-time lump sum upon diagnosis

• The payout can be used for treatment, recovery, or any other expense, entirely your choice

• Most plans require a 30-day survival period after diagnosis to make a claim

• Policy closes after the lump sum is paid out

• Some plans even offer complimentary annual health checkups.

Group Health Insurance Plan

Group Health Insurance Plan is what your employer provides as part of your job benefits. Most companies offer this as a Group Medical Cover (GMC). Some employers also allow you to add your spouse, children, or parents to the same policy, at an extra premium.

For example, if you are hospitalised for appendix surgery costing Rs. 1 lakh, your group plan will cover it without you paying a single rupee from your own pocket, as long as it is within your sum insured.

Features of a Group Health Insurance Plan:

• Basic coverage is free for the employee

• Zero waiting period in most plans. This means the coverage starts from day one

• Covers hospitalisation, daycare, maternity, and Outpatient Department (OPD) in many health plans

• Family members can often be added at an extra premium

• May offer a top-up of the sum insured amount

• May include value-added benefits like health check-ups and online consultations

• Best for salaried employees who want immediate health coverage without paying premiums themselves.

Learn more about the waiting period in health insurance.

Top-up Health Insurance Plan

Top-up Health Insurance Plan is ideal if you are looking for coverage that adds to your existing sum insured. The top-up plan gets activated once you have exhausted your base policy's coverage. 

For example, if your base plan covers Rs. 3 lakhs and your hospital bill is Rs. 7 lakhs, a top-up plan with a Rs. 3 lakh deductible covers the remaining Rs. 4 lakhs.

Features of the Top-up Health Insurance Plan:

• Offers the option for a higher sum insured amount over and above the basic plan.

• Most plans may require you to pay a fixed deductible amount.

• Can also opt for the Super Top-up Health Insurance Plan for a higher sum insured amount.

Personal Accident Insurance Policy

Medical expenses arising from the treatment due to an accident can wreck your finances. Availing the Personal Accident Cover (PA) offers benefits against events such as partial/total disability and death due to an accident.

Features of Personal Accident Insurance Policy: 

• Covers accidental death and permanent/partial disability caused by an accident.

• May offer weekly compensation in case of permanent or partial disability.

• Offers lump-sum payments in case of death or permanent disability.

Maternity Health Insurance Plan

Maternity Health Insurance provides coverage for the medical expenses that come with pregnancy and childbirth. Starting from your first prenatal check-up to post-delivery care for both you and your newborn. Some plans also cover medical termination of pregnancy. Maternity plans often come with a waiting period. It ranges from 9 months to 4 years, depending on the plan. 

Features of Mediclaim Insurance Plan:

• Provides coverage for in-patient medical expenses such as doctor fees, surgery, nursing charges, oxygen, and anaesthesia.

 Disease-specific health insurance plans (Corona Kavach, etc.)

Disease-specific health insurance plans are designed to cover the treatment of particular illnesses. For example, Health insurance for diabetes, Corona Kavach Health Insurance Plan health insurance built specifically for heart conditions or cancer. These plans cover the costs of treating a specific disease. They do not offer broad coverage like regular health insurance.

Features of Maternity Health Insurance Policy: 

• Covers hospitalisation, treatment, and medication costs for the specified disease

• Covers pre and post-hospitalisation expenses related to the condition

• Available as both individual and family floater plans

• Some plans cover AYUSH treatment for the specific condition

• No deductibles in most plans, full coverage from the first rupee

Mediclaim Insurance Plan

Mediclaim Insurance Plan usually covers the cost of hospitalisation related to accidents or illnesses. If you are looking for health insurance to cover only the inpatient expenses, you can consider Mediclaim Insurance.

Features of Mediclaim Insurance Plan:

• Provides coverage for in-patient medical expenses such as doctor fees, surgery, nursing charges, oxygen, and anaesthesia.

Disease-specific health insurance plans (Corona Kavach, etc.)

Disease-specific health insurance plans are designed to cover the treatment of particular illnesses. For example, Health insurance for diabetes, Corona Kavach Health Insurance Plan health insurance built specifically for heart conditions or cancer. These plans cover the costs of treating a specific disease. They do not offer broad coverage like regular health insurance.

Features of Disease-Specific Health Insurance Plan:

• Covers hospitalisation, treatment, and medication costs for the specified disease

• Covers pre and post-hospitalisation expenses related to the condition

• Available as both individual and family floater plans

• Some plans cover AYUSH treatment for the specific condition

• No deductibles in most plans, full coverage from the first rupee

Hospital Daily Cash

Hospital daily cash is available as an add-on to your existing health insurance plan, but it can also be purchased as a standalone benefit policy. This type of health insurance policy provides a fixed amount of cash benefit for each day of hospitalisation due to an illness or injury. The benefit is paid to the policyholder regardless of the actual medical expenses incurred during the hospital stay.

Features of Hospital Daily Cash Plan:

• You get the fixed daily amount even if your hospital bill is higher or lower.

• The cash can be used for anything, such as food, transport, lodging, or any out-of-pocket expense during your hospital stay

• Benefit is paid directly to you, not to the hospital

Health Insurance Plans: Indemnity vs Fixed Benefit

The above types of health insurance can be broadly classified into indemnity and fixed benefit plans.

Indemnity health insurance plans

Indemnity Health Insurance Plan covers your medical expenses up to the specified sum insured. For example, if your policy comes with a sum insured of Rs. 10 lakhs, medical expenses only up to Rs. 10 lakhs shall be covered. These plans include:

• Individual Health Insurance

• Family Floater Health Insurance

• Senior Citizen Health Insurance

• Maternity Insurance

• Mediclaim Insurance

• Top Up Health Insurance

Fixed benefit health insurance plans

Fixed Benefit Health Plan is a health insurance plan that pays a one-time lump-sum payment (sum insured) to cover the cost of a predetermined illness or medical condition. These plans include:Fixed Benefit Health Plan is a health insurance plan that pays a one-time lump-sum payment (sum insured) to cover the cost of a predetermined illness or medical condition. These plans include:

• Critical Illness Plan

• Daily Hospital Cash Policy

• Personal Accident Cover

Why Should You Buy Health Insurance?

Here’s why you should consider purchasing health insurance.

Protection against high medical costs: Health insurance can help you cover the costs of medical treatments and procedures, which can be very expensive without insurance coverage. This can help protect you from financial strain due to unexpected medical expenses.

Access to preventative care: Many health insurance plans offer coverage for preventative care services, such as routine check-ups, screenings, and immunizations. These services can help you stay healthy and catch any health issues early, which can improve your overall well-being and quality of life.

Network of healthcare providers: Many health insurance plans have a network of healthcare providers that you can access for medical care. This can be beneficial because you can often receive care at a discounted rate within the network.

Peace of mind: Having health insurance can provide peace of mind, knowing that you have coverage for unexpected medical events. This can help reduce stress and anxiety, and allow you to focus on other areas of your life.

Consider These Factors When Purchasing Health Insurance

Here are some tips to consider while purchasing a health insurance plan.

Deductibles: Ensure you check the amount of deductible stated in the policy before you purchase the health insurance plan. A deductible is an amount you must contribute during the settlement of the claim while the insurer pays the rest.

Sum insured: Check if the coverage amount is enough for you and the policy's beneficiaries to avoid shocks during claim settlement.

Waiting period: There are waiting periods for coverage of certain pre-existing diseases. Opt for health insurance policies with zero waiting period or no waiting period, such as the 1 crore health insurance plan offered by ACKO.

Medical history of family members: Consider the medical history of the policy’s beneficiaries when purchasing the health insurance plan. If any beneficiaries have a medical history, then the premium can rise.

Age of the beneficiaries: You must understand the importance of the age factor while purchasing a health insurance plan. There are different types of health insurance coverage that depend upon the buyer's age. The premium, waiting period and renewability rely on the age factors of the beneficiaries.

Exclusions: One of the most important factors to consider while buying a health insurance plan is to check the exclusions or what is not covered. By learning about the exclusions, you can opt for a plan that suits your needs.

Claim Settlement Process: Ensure you go through the claim settlement process of the insurer. The more straightforward the process, the easier and the faster the claim settlement process.

Annual health checkups and value-added services: Opt for health insurance plans that offer yearly health checkups. Also, consider a plan that provides value-added services such as online doctor consultations, lab tests, discounts on medicines, etc.

Maternity cover: Not all health insurance plans cover maternity. Read the benefits and features of the plan before you purchase it. If you are planning to start a family, it is better to choose a plan that includes coverage for maternity or if you can include the cover as an add-on.

Lifetime renewability: Check the renewability options since different health insurance plans have various renewability features.

Network hospitals: The more extensive the network of hospitals, the easier the access to medical care. Ensure you opt for an insurance company that has a vast network of hospitals to choose from.

Conclusion

There are different types of health insurance available. So, the right plan is the one that matches your life stage, your family's needs, and your budget. If you are single, an individual plan gives you dedicated coverage for your own medical needs. If you have a family, a family floater keeps everyone covered under one policy. For elderly parents, a senior citizen plan is built for their specific needs. Having a health insurance plan is an important part of financial planning in India, given how expensive serious illness treatment has become.

FAQs

Here are some common questions and answers about the types of health insurance plans.

How many types of health insurance plans are there in India? 

There are 11 types of health insurance plans available in India. It includes individual health insurance, family floater health insurance, senior citizen health insurance, critical illness health insurance, group health insurance, personal accident health insurance, mediclaim policy and disease-specific health insurance. 

What are the top 5 best health insurance plans? 

The best health insurance plan depends on your needs. For individuals, an individual health insurance plan is the best option, as it provides coverage for a single person. For families, a family floater plan offers shared coverage under a single policy. For elderly parents, a senior citizen plan is ideal. A critical illness plan provides a lump sum on diagnosis of serious diseases, and a top-up plan adds extra coverage once your base policy limit is used up.

Is Hospital Daily Cash cover part of health insurance? 

Hospital Daily Cash is an add-on benefit that can be attached to your existing health insurance policy. It pays a fixed daily amount for every day you are hospitalised, regardless of your actual medical bills.

Which is the least expensive type of health insurance?

Group Health Insurance is the least expensive since the basic coverage is provided free by your employer. Among plans you purchase yourself, a basic mediclaim policy is the most affordable option as it covers only inpatient hospitalisation expenses.

Can I have multiple health insurance plans in India?

Yes, you can hold more than one health insurance plan in India. For example, you can have a group plan from your employer and an individual plan for additional coverage. 

What is cashless health insurance?

Cashless health insurance means you can get treated at a network hospital without paying the bill at the time of treatment. The insurance company pays the hospital directly. You only need to pay for expenses that are not covered under your policy.

What are the 4 most common health insurance plans?

The 4 most common types of health insurance plans in India are Individual Health Insurance, Family Floater Health Insurance, Critical Illness Insurance, and Group Health Insurance. These four plans cover the widest range of needs. 

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