Author: Vinod N

There are more than 30 insurance companies in India offering health insurance policies. Each of these insurers has its own network of empanelled hospitals, and they continuously add more to their network. Every hospital signs separate agreements with different insurance companies—these agreements cover things like applicable rates for treatment and discounts on the final hospital bill. For example, Max Hospital in Gurgaon might have 30+ different agreements with 30 different insurance companies. Each agreement can have different treatment rates and discount terms. So, if one person is insured with Star Health and another with Care Health, both might end up…

Every health insurance policy includes a list of exclusions, these may be specific diseases, conditions, procedures, or equipment that are not covered by the policy. If a person already has a disease at the time of purchasing the policy, the insurance company may still offer coverage, but with a waiting period for that pre-existing condition. The pre-existing disease (PED) gets covered after this waiting period ends. However, in addition to these standard exclusions, some insurance companies may offer policies where certain diseases are permanently excluded from coverage. In this post, we will discuss what these diseases are, and why and…

We all know that a Health insurance policy doesn’t cover everything. There are certain treatments, medical conditions, and even items like equipment or supplies that insurance companies do not pay for. These are listed under the “exclusions” section of the policy. But while most people are aware of what a health insurance plan does cover, very few pay attention to what it doesn’t. Insurance companies, agents, and intermediaries usually highlight the coverage benefits of health insurance policies, the exclusions are often ignored. Yet, the list of exclusions is usually long and becomes painfully relevant when it’s time to make a…

National Insurance Parivar Mediclaim is a floater health insurance plan where you can choose a sum insured between ₹1 lakh and ₹10 lakh for the entire family. In this post, we will discuss the key positive features and limitations of this policy in detail. Good features of this policy Policy covers hospitalization expenses for 45 days prior to admission and 75 days after discharge. This includes expenses for consultation, diagnostics, and even medicines. Generally, the cover for pre-hospitalization and post-hospitalization is limited to 30 and 60 days respectively, but here it is extended to 45 and 75 days, which is…

You may not be aware that your health insurance policy covers Lasik surgery for correction of refractive errors. If your specs number is higher than +7 or -7 (what doctors refer to as a refractive error above 7 diopters), you may be eligible for Lasik surgery coverage under your health insurance. However, most people are not aware of this because it is mentioned under the exclusion clause of the policy. All health insurance policies in India have standard exclusions as mandated and defined by IRDAI (Insurance Regulatory and Development Authority of India). IRDAI has defined 18 standard exclusions that must…

IRDAI carried out a remote inspection of Heritage TPA in November 2021, and based on this inspection, IRDAI issued a show cause notice to Heritage TPA in 2024 and now a warning and advisory. IRDAI, during its inspection, found that the TPA was closing health claims citing pending documents from claimant, while informing only to insurance company in communication. There was no evidence to show that query letters or reminders were actually sent to policyholders before closing the claims. Third Party Administrator(TPAs) work on the claim servicing part and collect all the required documents from policyholders or hospitals and settle…

Health insurance premiums in India are rising every year, making it a growing concern for policyholders. Take Ramesh, for example. Last year, he paid INR 30,000 for his family health insurance policy. Now, on renewal, Star Health has increased the premium to INR 40,000 – a steep 33% hike. This is not an isolated case; many policyholders are facing similar increases. So, what causes these premium hikes, and how can one mitigate their impact? Let’s explore this in detail. Major Reasons for Rising Health Insurance Premiums Health insurance premiums increase due to a mix of economic, healthcare, and regulatory factors.…

According to the ICMR-INDIAB study (2019-2021), an estimated 101 million people in India were living with diabetes in 2021, corresponding to a national prevalence of 11.4%. Additionally, 136 million people (15.3% of the population) were identified as having pre-diabetes, a condition that indicates a high risk of developing diabetes in the near future. Given the significant number of people who are diabetic or pre-diabetic, securing health insurance becomes essential, as not everyone may qualify for coverage under government schemes. Understanding how to obtain health insurance as a diabetic or pre-diabetic is crucial to ensure comprehensive coverage without the risk of…

ICICI Lombard launched its Elevate Health insurance plan in July 2024 with much fanfare, claiming to introduce some innovative, industry-first features. One such optional cover is ‘Infinite Care,’ which appears to be the first of its kind in any health insurance policy in India. Shortly after, Star Health also introduced its Superstar policy, featuring a similar benefit named ‘Limitless Care.’ In fact, the Superstar policy by Star Health was launched as a competitive product to ICICI Elevate. How Does Infinite Care Work? Is There a Hidden Catch? Infinite Care is an optional add-on that covers expenses for one claim during…

The Insurance Regulatory and Development Authority of India (IRDAI) has published its annual report for the financial year 2023-24, offering a comprehensive analysis of insurance sector in India. The report covers key areas like industry growth, new initiatives introduced by IRDAI, and the latest additions to insurance companies and more. I’ve extracted the health insurance highlights from this report to give you a clear view of where this sector stands and what’s on the horizon. Let’s dive in. Who’s Providing Health Insurance in India? As of the end of FY 2023-24, 33 insurance companies were operating in India’s health insurance…