Health Insurance in India: Importance, Eligibility, and Application Process

India, with its rich cultural heritage and diverse landscapes, is a land of contrasts and contradictions. Amid the progress and prosperity, there are significant healthcare challenges that millions of Indians face. It’s in this complex healthcare landscape that health insurance’s importance is realised. In this blog, we’ll delve into the health insurance importance in India, how it serves as a vital safety net, and the key benefits it offers to individuals and families

1. Rising Healthcare Costs

One of the primary reasons health insurance is essential in India is the escalating cost of healthcare. Medical expenses, including hospitalisation, surgeries, and diagnostic tests, have been on the rise. Without health insurance, these costs can quickly deplete your savings or even push you into debt. Health insurance provides financial protection, covering a significant portion of your medical expenses and ensuring you receive the necessary treatment without worrying about the financial burden.

2. Access to Quality Healthcare

Health insurance in India often allows individuals to access quality healthcare services that might otherwise be financially out of reach. It provides the flexibility to choose from a network of hospitals and healthcare providers, ensuring that you receive the best possible care when needed.

3. Protection Against Critical Illnesses

In recent years, India has witnessed an alarming increase in the prevalence of critical illnesses such as cancer, heart diseases, and diabetes. Treating these conditions can be expensive and emotionally taxing. Health insurance plans often include coverage for critical illnesses, offering financial support for specialised treatments, surgeries, and medications.

4. Family Well-Being

Health insurance isn’t just about individual coverage; it extends to the well-being of your entire family. Family health insurance plans provide coverage for your spouse, children, and, in some cases, dependent parents. This ensures that your loved ones have access to medical care when they need it most.

5. Preventive Care and Wellness Programs

Many health insurance providers in India offer wellness programs and preventive care benefits. These programs encourage policyholders to adopt a healthier lifestyle through regular health check-ups, discounts on gym memberships, and access to wellness resources. By focusing on prevention, health insurance contributes to a healthier society.

6. Tax Benefits

Under Section 80D of the Income Tax Act, premiums paid for health insurance policies are eligible for tax deductions. This not only reduces your taxable income but also incentivizes individuals to invest in health insurance for their well-being.

Health Insurance Eligibility in India

Considering that health insurance providers try to minimise their risk, whether a person in eligible for health insurance depends on a plethora of factors, including the following main ones:

Age: The minimum age to buy health insurance is 15 days and the maximum age is 65 years. However, some insurers may allow you to buy health insurance even after the age of 65, but the premium will be higher.
Pre-existing medical conditions: If you have any pre-existing medical conditions, you may be asked to undergo a medical examination before you can buy health insurance. In some cases, insurers may not cover pre-existing conditions at all, or they may cover them only after a certain waiting period.
Occupation: Some insurers may not cover people who have certain occupations, such as pilots, firefighters, and miners. This is because these occupations are considered to be high-risk.
Income: Some insurers may require you to have a minimum income before you can buy health insurance. This is to ensure that you can afford the premiums.

Consider the following situations to understand whether and why you need health insurance:

Situation	Should You Get Health Insurance?	Reason
You are a retired individual	Yes	Health risks are higher in older ages.
You are diagnosed with a terminal disease	Yes	Health insurance can help cover medical costs and daily cash.
You are under 18 years old	Yes	Minors in the family should also be covered against health uncertainties.
You are prone to accidents	Yes	Having health insurance can save you a lot of financial trouble.
You have a family history of diseases	Yes	Family medical history can affect health risk and result in high medical costs
You are unemployed	No	Employment status is not a direct factor influencing health insurance decisions.
You live in a metropolitan city	Yes	Individuals in cities are more exposed to pollution and related health risks.

How to Get Health Insurance?

Now that you know the significance of having health insurance, follow these steps to financially safeguard yourself from any health concerns:

Step 1: Assess Your Needs:

Determine your specific healthcare needs, including coverage for yourself, family members, or dependents.
Consider factors like your age, health condition, anticipated medical expenses, and budget.

Step 2: Research Insurance Providers:

Research and compare health insurance providers in India. You can do this online, visit insurance company websites, or consult with insurance agents.
Look for insurers with a good reputation, a wide network of hospitals and healthcare providers, and a history of timely claims settlement.

Step 3: Choose the Type of Health Insurance:

Select the type of health insurance policy that best suits your needs. Common types include:

Individual Health Insurance: Covers an individual’s medical expenses.
Family Floater Health Insurance: Covers the entire family under a single policy.
Group Health Insurance: Offered by employers for their employees.
Senior Citizen Health Insurance: Tailored for individuals above a certain age.
Critical Illness Insurance: Covers specific critical illnesses and their associated costs.

Step 4: Compare Policies:

Compare policies from different insurance providers to evaluate premiums, coverage, exclusions, waiting periods, and other terms and conditions. Use online comparison tools or seek advice from insurance professionals. Consider factors such as claim settlement ratio and if the provider has a network of hospitals and healthcare providers in your area or preferred locations.

Step 5: Understand Policy Terms:

Carefully read the policy document, terms, and conditions, including coverage limits, waiting periods, co-payment clauses, and exclusions. Ask the insurer or agent to clarify any doubts or concerns you may have.

Step 6: Apply for the Policy:

Once you’ve chosen a policy, you can apply for it online or through an insurance agent.
Complete the application form accurately, providing all required details and documents, such as identity proof, address proof, and medical history (if requested).

Step 7: Medical Examination:

Depending on your age and health condition, the insurer may require a medical examination. Attend the examination at the designated healthcare facility.

Step 8: Premium Payment:

Pay the premium as per the insurer’s instructions. Premiums can be paid annually, semi-annually, quarterly, or monthly, depending on the policy and insurer.

Step 9: Policy Issuance:

Once your application is approved and the premium is paid, the insurer will issue the policy document. Review it carefully to ensure it matches your expectations.

Step 10: Maintain the Policy:

Keep the policy document in a safe place.
Pay premiums on time to keep the policy active.
Familiarise yourself with the claim process and contact the insurer if you need to make a claim.

Conclusion

In India, health insurance is more than just a financial product; it’s a lifeline that ensures access to healthcare and financial security in times of need. With the ever-increasing healthcare costs and the unpredictable nature of illnesses, having health insurance is not just a choice but a necessity. It safeguards your well-being, promotes a healthier lifestyle, and offers financial protection for you and your loved ones. It’s an investment in your health and future, ensuring that you can face life’s uncertainties with confidence and resilience.

AMIT ARORA

I am a seasoned retail banker with over 21 years of global experience across business, risk and digital. In my last assignment as Global Head Digital Capabilities, I drove the largest change initiative in the bank to deliver the end-to-end digital program with over US$1 billion in planned investment. Prior to that, as COO for Group Retail Products & Digital, I implemented a risk management framework for retail banking across the group.