The ongoing COVID-19 pandemic has changed the way we live. The new normal includes wearing masks, sanitisers, social distancing, restricted movement, work from home, online shopping and more. Another important aspect of this new normal is getting vaccinated against COVID-19 and get covered with good health insurance. While doctors believe that getting the covid vaccine may not be enough in avoiding infection, but it can certainly contain the severity of the condition. In India, the two most popular options for COVID-19 vaccines are—Covaxin and Covishield. Are you finding it difficult to choose one?

Covaxin

Made by Bharat Biotech, a Hyderabad-based biotechnology company, Covaxin is the first Indian vaccine against the COVID-19 causing coronavirus. It is made from an inactivated virus; the virus was killed before incorporating it into the vaccine. When introduced to a healthy human body, the inactivated virus triggers an immune response, developing antibodies to fight it. These antibodies prove useful in preventing a severe case of COVID-19 when the person is exposed to live coronavirus. The vaccine, stored between 2 to 8 degrees Celsius, is taken in two doses with a gap of four to six weeks between the two shots.

The common side effects of Covaxin include fever, nausea, headache, pain and swelling at the site of injection, muscle ache and even fatigue in some cases.

Covishield

Covishield was developed by Oxford-AstraZeneca and its Indian variant is manufactured by Serum Institute of India (SII), Pune. While Covaxin is made using an inactivated coronavirus, Covishield is made from a viral vector obtained from a different virus usually found in Chimpanzees. The viral vector is modified to imitate the novel coronavirus. Covishield can be stored for up to six months at a temperature of 2 to 8 degrees Celsius. This too is taken in two doses at a gap of 6 to 8 weeks. Moreover, Covishield is claimed to develop more antibodies in the human body, thus needing a longer time gap between the two shots.

Covishield’s side effects are more or less the same as Covaxin and include pain and tenderness at the injection site, fever, nausea and weakness.

In May, the Indian government had expressed confidence in achieving 100% COVID-19 vaccination of adults by the end of 2021. While India is running a global race to achieve complete vaccination to beat the novel coronavirus, there are four types of Covid vaccine in India that are being used to contain the pandemic among the masses. It is important to get covered with good health insurance which covers corona related expenses in this pandemic. Let us take a look at these vaccine options, their similarities and differences, and cost.

Covishield

Manufactured by India’s largest vaccine maker, the Serum Institute of India, Covishield was developed by Oxford University, in collaboration with Cambridge-based pharma and biotech company AstraZeneca.

Covishield has been developed on the viral vector platform using a modified version of a common cold virus. The vaccine is taken in two doses and is found to have an efficacy of 76%, which increases up to 82% with a gap of 12 or more weeks between the two shots. Covishield has been cleared for vaccination by 117 countries so far. Many countries have opened their international borders for Covishield-vaccinated people, including 10 countries from the European Union.

In India, Covishield is being offered free of cost at government vaccination centres. However, if you get the jab in a private hospital, you may have to pay up to Rs 780 per dose—Rs 600 as the price of the dose, Rs 30 as GST and Rs 150 as the service charge.

Covaxin

Covaxin is developed by Hyderabad-based Bharat Biotech in association with the Indian Council of Medical Research and the National Institute of Virology. Covaxin contains dead coronavirus, which prompts the immune system to develop antibodies against it. Covaxin is administered in two doses that should ideally be four weeks apart. Phase 3 trials of Covaxin showed a 77.8% efficacy. Although 13 countries have approved the use of Covaxin, the World Health Organization (WHO) is yet to give its nod to the vaccine.

In India, Covaxin is offered free of cost in government medical centres, while private hospitals can charge not more than Rs 1,410, which is inclusive of Rs 1,200 as the price of the dose, Rs 60 as GST and Rs 150 as the maximum service charge.

One of the largest joints in the body, the knee is often a cause of concern for most individuals. A healthy knee, which allows us to move, walk and run around with fluidity and flexibility, is now facing the brunt of modern lifestyles and habits. With increasing disposable incomes, availability of home delivery of food and everyday items, and easy transportation people have become less mobile.

Right from clothing to grocery, everything can be ordered and delivered from the comfort of your home or office, without the need for visiting the store. Moreover, the unhealthy lifestyle including reduced physical activity and poor eating habits are adding onto the burden on the knees along with causing other problems such as obesity, high blood pressure, diabetes, and putting the heart at risk.

Having a knee replacement surgery could be a life changing decision, irrespective of your age. However, make sure you ask yourself and your doctor these 5 questions before opting for knee replacement surgery.

1. Have you tried enough alternative options?

Usually doctors first suggest non-operative options such as physical therapy, weight loss, suitable light exercises or medications to strengthen the knee. Knee surgery is more of an “elective” procedure rather than a prescribed option. Hence, make sure you evaluate these options and try them to check if it alleviates the pain and makes life easy with natural remedies and less invasive procedures.

2. Are you doing it at the correct age?

Knee replacements are not as durable as your natural knee structure and lasts for only 15-20 years. If you are getting a knee replacement done at the age of 50 then you may want to reconsider a revision surgery at the age of 65 or 70. Moreover, considering that you will be older by the time you reach your 60s or 70s, the second surgery would be more difficult and harder to perform successfully. Hence, it is advisable to consider knee replacement surgery if you are over 50 years.

3. Which would be the ideal surgery for your knee?

Getting a total knee replacement surgery is not the solution for your knee pains. Your knee surgery depends upon a variety of factors which include your age, physical health, extent of the pain and discomfort, and other factors. Hence, it is best to take opinions for the ideal surgical procedure for your knee pain. There are various knee surgery options such as total knee replacement, partial knee replacement, knee arthroscopy, cartilage treatment as well as knee osteotomy.

4. What could be the outcome of your surgery?

Knee surgery could be a life-altering decision as it will not only affect you physically but mentally too. It is best to research and take different opinions from trusted and experienced surgeons to evaluate the possible outcomes once you undergo the surgical process. Knee replacement does not guarantee improved mobility or pain alleviation, although it may certainly help your cause. Hence, it is important to have appropriate expectations and prepare yourself mentally to undergo the treatment.

5. What could be done to increase the odds for a successful surgery?

As life swings back to the new normal after the lockdown has lifted, we are faced with newer challenges. The biggest one is stepping out of our homes to resume our work life in times when COVID-19 cases in India have not even ceased to multiply. So what could be that one thing that can guard us against the COVID-19 pandemic other than wearing a mask, using a hand sanitizer, maintaining social distancing and getting a Complete Health Insurance ? It’s our very own immune system! It is a pre-requisite to keep it strong and what could be a better way to do so naturally than through some easy yoga poses.

Yoga has proven time and again that it can help reduce our stress levels and keep us calm. Stress, on the other hand, is known to have an adverse impact on our immune system because of the chronic inflammation that it triggers. So when yoga has an anti-inflammatory effect on our body, in a way it ends up keeping our immune system intact. As a result, we are in a better position to defend our health from infections or flu.

Read more about how you can support your immunity against COVID-19

Now, yoga can’t do much for you if you only keep watching some amazing ‘How to do yoga to boost immunity’ videos all the time. Also, it won’t help to start practicing yoga and then give up in 3-4 weeks. For yoga to work for you, you need to keep practicing it with consistency. Don’t be turned off thinking you don’t have a fancy mat, activewear, belts, or bricks to get started with yoga. Yoga, in its purest form as practiced in ancient India, still proves to be equally fruitful to health. Hence, on the occasion of International Yoga Day, we have put together a yoga sequence that will help you reduce stress and boost your immune system without you having to depend upon any extra gears.

Though yoga keeps you healthy and safe physically as well as mentally, a health insurance plan keeps you safe financially, so that you grab your yoga mats and practice yoga stress-free.

Start by doing a gentle warm-up of 5-10 minutes:

• Rotate your head clockwise and anti-clockwise.
• Swing your arms in circles.
• Do some jumping jacks.
• Twist your waist, stretch towards the left side and then right.
• Move your ankles in circles.

Once you feel your heartbeat rising gradually, it’s about time to begin the yoga asanas.

1. Trikonasana (Triangle pose)

Known to strengthen your shoulders, chest, core and legs, this pose leaves you feeling relaxed.

 
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Duration:: Hold the pose for 30 seconds. Take 5 to 10 deep breaths. Repeat 3 times on every leg.

Benefits of triangle pose: Releases the tension in your shoulders, reduces stress and anxiety, improves blood circulation, concentration and balance. It is considered to be one of the best yoga poses that boost your immune system.

2. Uttanasana (Forward Fold)

This is a powerful pose where oxygen reaches your brain since it is at a lower position than your heart, leaving your cells energized..

 
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Duration: Hold the pose for 15-30 seconds and take deep breaths.

Benefits of forward fold: Eases congestion in sinuses, thereby boosting your immunity. Relieves stress, anxiety and beats insomnia. Keeps you calm.

3. Bhujangasana (Cobra pose)

This pose falls under Suryanamaskar (sun salutation). It opens your lungs, strengthens your spine and increases your energy.

 
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Duration: Hold the pose for 15-30 seconds and breathe normally.

Benefits of corbra pose:Relieves stress and fatigue, elevates your mood. Also helps with asthma and breathing problems.

4. Shishuasana (Child pose)

This pose will help you relax after you have nailed the earlier three poses. Unlike the others that must be done in the morning, you can do this pose whenever you need a break in the middle of a stressful day.

 
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Duration: Hold for 1 to 3 minutes.

Benefits of child pose: Works best for getting a sound sleep, eases back pain, relaxes your entire body and boosts your immune system by stimulating the lymphatic system.

5. Matsyasana (Fish pose)

When you get into this pose, the thyroid gland is stimulated, which further helps to boost your immunity. Matsyasana also eradicates toxins from your digestive system.

 
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Duration: Hold the pose for 30-60 seconds. Breathe normally.

Benefits of fish pose: Combats anxiety and fatigue. Helps with respiratory problems, eases back pain, releases tension in your neck and shoulders.

6. Viparita Karani (Legs up the wall)

A fairly simple pose, but you can’t imagine a yoga sequence to boost your immune system without it. It relaxes your nervous system and thus helps to strengthen your immunity.

 
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Duration: Start by holding the pose for 5 minutes, then increase the duration with practice.

Benefits of legs up the wall pose: Relieves stress, headache, migraine, insomnia, anxiety and menstrual cramps. It is also known to help with fertility problems.

7. Anand Balasana (Happy baby pose)

It can help you end your yoga session on a fun note. It is a great pose to detoxify your hips and calm your mind.

 
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Duration: Hold the pose for 30-60 seconds. Breathe normally.

Benefits of happy baby pose: Releases tension from your lower back, increases vitality, reduces stress and fatigue, elevates mood and rejuvenates your mind. Thus, working wonders to boost your immunity.

5 health tips you should not miss to follow even on a busy day:

• Meditate
• Eat on time
• Get enough sleep
• Drink enough water
• Add green veggies to your diet

Health insurance is an important part of financial planning. It helps protect you and your family from the high cost of medical treatment. Two of the most common health insurance policies are individual health insurance and corporate health insurance. Each has its benefits, and choosing the right one depends on your needs.

Let’s find the differences between the two and how to decide which is right for you.

What is individual health insurance?

An individual health insurance policy is a type of policy that you buy for yourself or your family. It is not linked to your job. You can choose the insurance provider, the type of cover, the sum insured and the benefits that best suit your needs.

This kind of insurance is flexible. For example, you can continue your policy even if you change jobs or become self-employed. Some policies also offer add-ons like maternity cover, critical illness benefits or OPD (Outpatient Department) expenses.

What is corporate health insurance?

Corporate health insurance is offered by your employer as part of your employee benefits. It usually covers you, and sometimes your dependents, like your spouse or children. The main benefit of corporate insurance is that it comes at no extra cost to you, or at a very low cost. Employers often pay the full premium or share it with employees.

However, this type of policy only lasts as long as you work for the company. If you leave your job, the coverage usually ends, unless you are given the option to convert it into an individual plan (which might be more expensive).

Corporate vs individual health insurance: Which is better?

Both individual and corporate health insurance have their advantages. Here’s a comparison table:

How to choose the right health insurance policy?

Here are a few tips:

• Assess your needs: Do you have dependents? Are there any existing medical conditions?
• Check the sum insured: Make sure it covers hospital costs in your area.
• Look at add-ons: Features like maternity, dental or critical illness cover can be helpful.
• Consider portability: An individual plan stays with you throughout your life.
• Think long-term: Corporate policies can change or end, but an individual policy is under your control.

Conclusion

A corporate health policy offered by your employer may cover your family members but may not be sufficient to deal with high medical costs. Also, you lose the cover once you retire or change jobs. On the other hand, a regular health insurance policy will offer you a range of coverage amounts and provide additional advantages.

The premium that you pay towards your health insurance policy is also tax-deductible under Section 80D of the Income Tax Act. So, you can be stress-free, financially protected and save more on your earnings.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

Spike in medical inflation has significantly pushed up hospitalisation expenses, making health insurance an absolute must. Knowing about the list of network hospitals is among the several things you must consider while buying a health plan. There are several benefits on offer while undergoing treatment in a network hospital.

However, that doesn’t mean that you can’t avail of treatment in a non-network hospital. It’s essential for you, as a policyholder, to understand the difference between network hospitals and non-network hospitals so that you can make a prudent choice when the need arises. This article aims to decipher the differences between the two on different parameters. Let’s get started.

Meaning of Network Hospitals in Health Insurance

Network hospitals in health insurance refer to hospitals and clinics with which your health insurer has a collaboration, and these hospitals are on the empanelled list of your insurer. Every health insurer has a tie-up with different hospitals (in your state and outside), clinics, and treatment care centres.

These are known as network hospitals with which your health insurance company has a contract. When you get admitted to any network hospital, you are eligible to receive cashless treatment facilities, subject to the policy’s terms and conditions.

Meaning of Non-network Hospitals in Health Insurance

Non-network hospital means hospitals, clinics, and treatment centres that are not on the empanelled list of your health insurance. In other words, your insurer doesn’t have a collaboration with them. If you end up hospitalised in a non-network hospital, you can’t avail cashless treatment facility.

Though every health insurance company strives to have an extensive network of hospitals, some are left out. No health insurance company can have a tie-up with all the hospitals and medical treatment centres present in the country. However, leading hospital chains and reputed clinics are on the empanelled list of health insurance companies.

Parameters on Which Network and Non-network Hospitals Differ

1. Cashless Treatment Facility

Cashless treatment facility is one of the fundamental differences between a network and a non-network hospital.  It essentially means that you don’t have to end up paying upfront when you are hospitalised in a network hospital. Inform your insurer about hospitalisation and submit the relevant documents to the third-party administrator (TPA).

In a network hospital, your insurer directly settles hospitalisation expenses incurred. However, the case is different in the case of a non-network hospital. When you get yourself treated in a non-network hospital, you have to make payments upfront.

Once you are discharged, you need to submit the relevant bills and reports to your insurer. After due diligence, the insurer reimburses you the hospitalisation expenses incurred based on the policy purchased by you.

2. Documentation and Formalities

Documentation and formalities are a straightforward process in a network hospital. Present your health card to the TPA (third-party administrator), get in touch with your health insurer, and you are done. They take the process forward. You don’t have to undergo the cumbersome process of keeping all documents, including doctor’s reports, bills, etc to claim your insurance.

However, things are different in a non-network hospital. You have to keep all the documents carefully as misplacing them can lead to claim rejection or being reimbursed a lower claim amount. If you happen to lose any document, arranging a duplicate for the same can be challenging. This will also delay the claim settlement process.

3. Cash Arrangement

When you get treated in a network hospital, you don’t have to worry about cash arrangements. As said, everything is cashless. However, if you get treated in a non-network hospital, you may need to deposit some cash upfront for admission. Also, you need to make regular payments during the course of treatment, which can be pretty challenging.

During testing times such as these — when income is under stress due to the COVID-19 pandemic — arranging and paying cash in short intervals can be an uphill task. In such situations, you may end up borrowing money on high-interest rates that can further dent your finances.

Breakfast is important because it is the first meal after the longest period of fasting in a day. Usually, there is a gap of 10-12 hours between the previous day’s dinner and the next day’s breakfast. Whether you are a school-going kid, a gym enthusiast, a workaholic professional or a stay-at-home person, skipping breakfast can not only make you weary throughout the day but also increases your risk of developing a variety of diseases and illnesses. According to experts, integrating a healthy breakfast into your daily routine not only benefits your physical health but also enhances your mental wellbeing. However, many people are unaware of what to eat for breakfast and some even skip their morning meals. Today, in this article, we will focus on what to eat for breakfast and why.

What to eat for breakfast?

Whole grains:

Whole grains are the grains of pseudo-cereals and contain all three parts of the grain—the bran, endosperm, and germ. Some of the common whole grains breakfast foods that are healthy include: 

• Multi-grain dosa
• Oatmeal
• Barley
• Whole-wheat bread

Why are whole grains a key to a healthy breakfast?

• Whole grains provide fibre as well as a variety of essential nutrients and minerals. Some of the vital minerals in whole grains include zinc, iron, magnesium, and phosphorus. 
• Whole grains contain antioxidants, fibre, and vitamin K, which helps in lowering the risk of a heart attack.
• Since whole grains are high in fibre, most health experts believe that it helps in preventing obesity and helps in weight loss.
• Replacing refined grains from your morning breakfast and replacing them with whole grains lowers your risk of type 2 diabetes.

Whole grain wheat fibre components act as a prebiotic, aiding digestion by feeding beneficial gut bacteria.

Lean Protein:

Lean protein foods are those that are high in protein but also low in less healthy nutrients such as dietary cholesterol and saturated fat. If you are looking for healthy breakfast food options that are rich sources of lean protein, consider including the following in your meal plan: 

• Sprouts salad
• Scrambled egg or cottage cheese (paneer)
• Tofu chilla

Oats uttapam and idli

Why include lean protein foods in your breakfast?

• Lean protein keeps your body healthy by helping you lose extra weight.
• If you are a gym enthusiast, incorporating lean protein in your breakfast can help you gain muscle.
• Since lean protein contains very little amount of saturated fat, it lowers the risk of cardiovascular diseases.
• Many lean protein sources such as yoghurt and chicken have high levels of zinc that help in boosting our immune system.
• Lean proteins not only help you lose weight but also provide your body with the vitamins and minerals it needs to keep your metabolism functioning smoothly.
• Lean proteins are known for lowering blood pressure levels and increasing LDL cholesterol or, say, the good cholesterol in your body.

Low-fat dairy:

When compared to full-fat milk, low-fat dairy products have fewer calories and more protein. Consuming low-fat dairy products for breakfast lowers the risk of heart diseases since they contain less saturated fat. Some of the healthy low-fat dairy products that you can add to your breakfast are:
• Skimmed milk
• Yoghurt
• Ice cream
• Cottage cheese

Why include low-fat dairy in your breakfast?

• Low-fat dairy products such as yoghurt and cottage cheese are abundant in protein and calcium that help in building your muscles and improving your bone density.

Including low-fat dairy or fat-free dairy in the diet helps in lowering the risk of cardiovascular diseases, metabolic syndrome, obesity, and diabetes.

Fruits and vegetables

Including fruits and vegetables in your breakfast is also a great way to reduce your calorie intake. Since they are an excellent source of vitamins and minerals, fruits and vegetables come with a host of advantages. Some of the healthy fruits that you can include in your breakfast are:

• Pineapple and cherry for anti-inflammation
• Grapefruit, strawberries, and kiwi for boosting your immune system
• Pomegranate for antioxidant
• Watermelon for body detoxification

We generally tend to lead our lives within a fixed routine. Tasks like cooking, driving, cleaning do not require us to exhibit our mental strength. Just as you take steps to ensure your body is fit and healthy, you need to do brain exercises for your mind to remain healthy.

These monotonous tasks do not provide our brain with enough stimulation, which is needed to keep our brain active and functioning well.

Here are eight ways to not only achieve brain fitness but also make your day enjoyable and exciting:

Meditation

Beginning your day with mediation is one of the great techniques for brain exercises. It helps you feel refreshed overall and energized. According to studies, mindful meditation is highly effective. It stimulates new neural pathways, thereby improving your self-observational skills and helping you increase your mental flexibility.

Besides, meditation has also been found to help improve your attention span and focus, empathy, and even build your immunity. Moreover, it has also been observed that meditation has the power to enhance your working memory's capacity, thus helping you keep your brain sharp.

Use non-dominant hand

The most effective techniques for brain exercises are those that are not necessarily easy. Using your non-dominant hand or the hand you don't usually use is one of the interesting ways to increase your brain sharpness.

For instance, if you use your right hand for most tasks like brushing your teeth or even gardening, try doing that with your left hand. Since your brain is used to your dominant hand, using your opposite hand is challenging and one of the great brain exercises and stimulators.

Try crosswords

Indulging in crosswords or Sudoku or playing games like Tetris for approximately 15 minutes is another effective technique for brain exercises and a fun way to challenge your brain. These activities can significantly help you improve your brain's speed and memory and your analytical skills since they rely on logic, word skills and maths besides also being fun.

Studies have found that crosswords improve your attention span and focus on desired tasks while enhancing your working memory, cognitive abilities, and overall functioning.

Eat healthy

Studies have found a link between green leafy vegetables, fruits, whole grains, legumes, nuts, fish, and olive oil in your diet and improved brain sharpness, cognitive skills, and overall mental health.

Regular intake of these foods reduces the risk of Alzheimer's by more than 50%. Eating healthy is thus extremely good for achieving brain fitness and maintaining good brain health.

Body fitness = brain fitness

Exercise helps you achieve brain sharpness and fitness and prevents your brain from ageing fast. When you do physical exercise, it is as good as your brain indulging in activities. A study found that doing physical exercise and thus indirectly doing brain exercises reduces your risk of experiencing dementia and cognitive impairment.

Doing exercise such as walking or doing push-ups has been found to increase the generation of new brain cells, thus enhancing your brain's sharpness.

The COVID-19 pandemic tossed life off gear in a matter of weeks throwing global economies in disarray. While the trail of devastation because of the deadly virus is well-documented, it also gave several critical lessons on different aspects, with health insurance being one of them.

The once-in-a-century pandemic gave essential lessons on imbibing health insurance, which can help you stay better prepared should such an event occur in the future. What are these? Let’s find out.

Health Insurance is Not a Want Anymore

While the need for health insurance plans was always there, many people took it as an unnecessary expense. There was no significant urge to buy health insurance among the majority of the people. However, the pandemic changed this outlook. Data shows that people purchasing comprehensive health insurance plans stood at approximately 32% during pre-COVID times, and it shot up to 55% after the pandemic.

Insurers witnessed a significant demand for health plans coming their way - a testament that health insurance is not a want but a modern-day need. Financial literacy advocates have always highlighted the need and importance of health insurance in one’s portfolio; it took a pandemic of this magnitude to drive home the point.

So, if you don’t want your finances to take a dip because of COVID-19, it’s paramount to buy a health insurance plan at the earliest.

Have Adequate Sum Insured

Sum insured is one of the vital aspects to look for while buying health insurance, and it is the maximum amount your insurer pays in case of hospitalisation. The COVID-19 pandemic has changed the dynamics of purchasing health insurance plans and what was earlier thought to be adequate is not the case now.

Many cases have come to the fore where hospitalisation bills have run into lakhs of rupees and are significantly higher than the sum insured offered by the policy. Hence, it’s essential to opt for a plan with a high sum insured to minimise out-of-pocket expenses. If you live in a metro, where treatment costs are higher than non-metros, it’s prudent to opt for a policy with a sum insured of at least Rs. 15 to 20 lakhs.

Though it pushes up the premium, it will come to your rescue, should you need hospitalisation. Another way to ensure adequate coverage is to avail a top-up plan. A top-up plan is cheap and works on the concept of deductible. Once you have paid the deductible amount mentioned in the top-up plan through your base policy, the benefits kick in. It’s a cost-effective way to ensure you have a wider net to deal with large COVID-19 bills.

After two years since the imposition of Covid-19 restrictions in Mumbai and Maharashtra, the Maharashtra government withdrew all Covid-19 curbs on 1st April 2022. The decision was made following a sharp decline in cases during a state cabinet meeting chaired by Chief Minister Uddhav Thackeray on 31^st March 2022.

Covid-19 in Maharashtra took a significant toll on life, as the state was one of the worst hits during the pandemic. Cases were significantly high during the first, second and third wave of the pandemic. 

However, things have changed over the past few months with concentrated efforts from the authorities and front-line workers. Hence, the Maharashtra Government decided to withdraw all the Covid-19 restrictions imposed under the Disaster Management Act, 2005.

Understanding Health Insurance Exclusions: What Your Policy May Not Cover

Imagine your claim being denied during an emergency due to a lack of coverage. Shocking, right? This can happen when you’re unaware of the exclusions hidden in your health insurance plan.

Many people buy a health insurance plan thinking it covers everything. However, here’s the truth: every policy has exclusions. If you don’t know them, you might end up paying huge bills yourself.

Knowing the exclusions and inclusions upfront and understanding how add-ons can fill the gaps can save both your money and peace of mind.

What are Health Insurance Exclusions?

Health insurance exclusions refer to the situations, medical conditions, or treatments excluded from your health insurance policy coverage. These are mentioned in the policy document and highlight what the insurer will and will not cover.

For instance, if a policy excludes cosmetic surgeries, any expenses related to such treatments will not be reimbursed, even if the policyholder files a claim.

Exclusions generally fall into two categories:

• Permanent exclusions: Conditions or treatments never covered by the policy.
• Temporary exclusions: Conditions or treatments excluded for a specific period (e.g., pre-existing diseases during the waiting period).

Common Health Insurance Exclusions

Every health insurance policy has certain conditions that are not included in the coverage. Knowing these exclusions helps you avoid surprises when making a claim.

Waiting Period Clause

All health insurance plans in India have waiting periods, usually 30 days initially and 1–2 years for certain illnesses. Claims aren’t accepted during this time, except for accidents.

Pre-existing Diseases (PED)

A pre-existing disease is any condition you had before buying health insurance. In India, plans usually cover these only after a waiting period of up to three years.

Pregnancy and Childbirth

Most health insurance plans do not cover pregnancy and childbirth-related medical expenses. These include costs of delivery, pre- and post-natal care, abortion, miscarriage, etc.

Non-medical Expenses

Insurance plans do not cover non-medical costs during hospitalisation, such as charges for needles, syringes, cotton, bandages, gloves, sanitisers, masks, gowns and PPE kits.

OPD Treatments

Most health insurance plans do not cover outpatient department (OPD) expenses, including doctor consultations, medicines and diagnostic tests.

Obesity Treatments

Many plans do not cover the cost of obesity treatments and bariatric surgeries, such as sleeve gastrectomy.

Cosmetic or Plastic Surgeries

Usually, Indian health insurance plans do not cover cosmetic or plastic surgeries unless they are needed due to an accident.

Infertility Treatments

Infertility treatments, including IVF and artificial insemination, are not covered.

Sexually Transmitted Diseases (STDs)

Diseases like gonorrhea, syphilis, HIV and HPV infections are permanently excluded from coverage.

Dietary Supplements

Generally, costs for dietary and health supplements are not covered under most health insurance plans.

Dental, Vision and Hearing Problems

Dental, vision and hearing treatments are excluded unless hospitalisation is required.

Self-inflicted Injuries or Drug Abuse

Intentional harm, including suicide attempts or deliberate injuries, is not covered. Treatments related to substance abuse, detoxification or rehabilitation are also typically excluded.

Why Do Health Insurance Plans Have Exclusions?

Health insurance policies include exclusions to limit coverage to genuine cases and keep premiums affordable. This ensures responsible use, prevents misuse and keeps claims legitimate.

How Do Insurance Companies Decide Exclusions?

Insurance companies set exclusions based on multiple factors, including medical, financial and regulatory considerations:

Actuarial Risk Assessment

Actuaries analyse disease prevalence, treatment costs and claim frequency data to identify high-risk conditions.

Regulatory Guidelines

Regulatory bodies like the IRDAI provide guidelines for exclusions to ensure fairness across policies.

Market Trends

Insurers consider customer behaviour, coverage demand and industry norms when deciding on exclusions. For example, plans without maternity benefits may target younger, single individuals.

Cost-benefit Analysis

Treatments or conditions with a high cost but low probability of occurrence are often excluded to maintain financial viability.

Focus on Insurable Risks

Insurers exclude non-measurable risks such as substance abuse or experimental treatments.

How to Check Your Policy for Exclusions

Carefully read your policy document, which details coverage, restrictions, deductibles and co-payments. You can also check your insurer’s website or contact customer service with your policy number for clarification.

Optional Add-ons to Cover Exclusions

Optional add-ons can cover some exclusions, providing protection for procedures and costs not covered by your base plan:

• Critical Illness Insurance Cover: Provides a lump-sum payout for critical illnesses like cancer, heart attack, or stroke.
• Consumables Cover: Covers expenses for hospital supplies such as bandages, gowns, gloves and PPE kits.
• Home Care Treatment: Covers home-based treatments when hospitalisation isn’t possible.
• Maternity Cover: Covers pregnancy-related medical expenses, delivery, and newborn care.

Conclusion

Health insurance is essential for financial security. However, it doesn’t cover every medical condition or treatment. Always review your plan’s exclusions to understand what’s covered and what’s not. This ensures you choose a plan that best suits your needs.

Wondering which would be an ideal health insurance plan? Fill out the form on this page to get tailored advice on choosing the right plan.

FAQ

1. Why are there exclusions in health insurance plans?

Exclusions help control risk, maintain affordable premiums, and prevent misuse of the policy.

2. Does health insurance cover pre-existing conditions?

Yes, but only after a waiting period. In India, most policies cover pre-existing conditions after one to three years.

Disclaimer: The information provided is for educational purposes only and may contain outdated data. Verify details before making decisions. ICICI Lombard is not liable for inaccuracies or consequences resulting from outdated information.

The COVID-19 disease, which gripped the world during early 2020 after the rapid spread of coronavirus, has had detrimental effects on the world till now. Not only it has resulted in the untimely death of millions of people around the globe but also it ruined the economy of many countries. In India, the coronavirus has caused the death of more than 1.6 lakhs people till now.

However, things are expected to improve after the vaccines for covid-19 were introduced by different countries around the world. In India, the Serum Institute of India (SII) and Bharat Biotech released the covid-19 vaccines known as ‘Covishield’ and ‘Covaxin’ respectively. In January 2021, the Health Ministry of India introduced its plan to begin a vaccination drive to vaccinate the Indian population against this disease.

However, not everyone or anyone is supposed to take the vaccine right away. In the first phase of the vaccination drive, the healthcare workers and frontline warriors against the covid-19 disease received the vaccine. Whereas, during the second phase, people above the age of 60, and those above the age of 45 with co-morbidities are being vaccinated.

Both SII and Bharat Biotech as well as the Government of India have listed the risks and side-effects associated with the covid vaccines. Read on to know who should and who should not take the covid vaccine in India.

Who can take the vaccine?

During the second phase of the vaccination drive, the Government of India has allowed the people above the age of 60 and those between 45 to 59 with co-morbidities to take the vaccine. It means that anyone falling in this age range (barring a few exceptions which we have mentioned later) can take the covid-19 vaccine in India.

Those with co-morbidities are required to submit a certificate of co-morbidity, duly signed by a registered medical practitioner, for taking the vaccine. This certificate can either be uploaded at Co-Win 2.0 by the beneficiary itself while registering for the vaccine or a hard copy can be submitted at any covid vaccination center.

Here is the full list of co-morbidities:

• Heart failure during the past year
• Post cardiac transplant or Left Ventricular Assist Device (LVAD)
• Valvular Heart Disease
• Congenital heart disease with severe PAH
• Coronary Artery Disease with past Hypertension or diabetes
• Angina with past Hypertension or diabetes
• CT/MRI documented stroke with past hypertension or diabetes
• Diabetes or Hypertension for more than 10 years
• Kidney/Liver/Hematopoietic stem cell transplant
• End-stage kidney disease on Haemodialysis or CAPD
• Current and prolonged use of oral corticosteroids or immunosuppressant medications
• Decompensated cirrhosis
• Severe respiratory disease requiring hospitalization in past two years
• Lymphoma or Leukaemia or Myeloma
• Cancer or cancer therapy
• Sickle cell disease or Bone marrow failure or Aplastic anemia or major Thalassemia
• HIV or AIDS infection
• Persons with disabilities

The COVID-19 pandemic struck in December 2019 and since then, have wreaked havoc in the entire world. Till date, approximately 19 crore cases of Covid-19 have been reported across the globe, resulting in more than 40 lakh casualties. The spread of this disease reached its pinnacle by mid-2020 but slowed down a bit in 2021.

However, just when the world thought that the end of the pandemic is near, a new covid variant named “Delta Plus” was spotted by the experts. This strain of coronavirus, which has been found in more than ten countries so far, is seen as a cause of concern among the health experts as it is believed to mutate rapidly and can transmit much more easily. Buying health insurance would be the great option in this pandemic to save your savings.

Also, the doctors believe that the new covid delta variant can cause more severe symptoms in the infected patients, as compared to other strains. Continue reading to know all the information that is there in the public domain about this covid variant so far.

What is the Delta Plus variant of COVID-19?

The new Delta Plus variant of COVID-19 has been formed due to a mutation in the delta variant of the coronavirus, which is also known as the B.1.617.2 variant. As per the experts, the cause of this mutation is the delta variant acquiring the spike protein mutation K417N to form a new variant which is scientifically called AY.1 variant.

According to the doctors, the new covid variant has almost 40-60% increased ability to transmit and can cause more serious symptoms in the infected patients. Also, the positivity rate as well as death rate can go up due to this variant.

Where was this variant first found?

The first case of the covid delta plus variant was found in Europe in March 2021. Since then, health experts around the globe along with the World Health Organization (WHO) have been keeping a close watch on the impact and transmissibility of this covid-19 variant.

England was one of the first countries where the delta plus variant began to spread. Till date, this variant of the coronavirus has been found in more than 10 countries, including India and Nepal. As per the Union Health Ministry of India, around 300 cases* of Delta Plus variant of Covid-19 has been detected in our country so far.

Apart from India, the cases of delta plus variant has also been found in the United States of America (USA), UK, Portugal, Spain, Switzerland, Japan, Russia, China, Nepal, and Poland.

What risks does this variant pose?

As we have already mentioned, the new Covid variant possesses 40 to 60% increased ability to transmit*. As per the WHO, “the delta plus and other circulating variants of the coronavirus pose a high risk to public health, as they have demonstrated an increased transmissibility”.

Furthermore, the Government of India as well as health officials have declared this variant of coronavirus as a “variant of concern”. Also, this variant is believed to reduce the effectiveness of monoclonal antibody treatment technique, where an antibody cocktail of Casirivimab and Imdevimab is used to treat the patients infected with the coronavirus.

As per the SARS-CoV-2 Consortium on Genomics (INSACOG), the delta plus variant of Covid-19 is a cause of concern due to the following reasons:

• Increased transmissibility
• Strong binding impact on receptors of lung cells
• Potential reduction in monoclonal antibody response

Coronavirus vaccine: What happens if you delay your second dose of vaccination?

The COVID-19 disease that gripped the world during the early months of 2020 after the rapid spread of the COVID-19 variant had detrimental effects on the people and the economy. It led to the untimely death of millions of people across the globe and adversely affected the economy of many countries. In India, the number of deaths due to COVID-19 is more than 4 lakh to date. So, it is important to be covered with a good health insurance plan which can cover COVID-19 related expenses.

However, the situation has started to improve, and the death rates are declining, after the introduction of COVID-19 vaccines by different countries around the world. In India, the Serum Institute of India (SII) and Bharat Biotech released the two COVID vaccines labelled ‘Covishield’ and ‘Covaxin’, respectively. In January 2021, the Health Ministry of India started possibly the biggest vaccination drive anywhere across the world to vaccinate the Indian population against this disease. Vaccines have shown promising results in minimising the threat of the virus that causes the COVID-19 disease. The immune response to vaccines is so reliable that the public health department has started a mass drive to provide booster shots to frontline workers. The disease control and prevention departments are confident in the booster shots' effectiveness. However, the additional shots are only available to a selected group of people and will be made available to the general public following the authorisation or approval of the government.

Gaining immunity against the coronavirus requires a person to get two full shots or doses of the COVID vaccine. The second dose of Covaxin can be taken after 28 days of the first dose, whereas for Covishield, the time between the first and second doses should be at least 84 days. However, due to multiple reasons, many Indians have missed the timeline for taking the second dose of the COVID vaccine.

In this article, we will evaluate what can happen if you delay your second dose of COVID vaccination. But first, let’s look at some possible reasons that can lead you to miss your second dose of vaccine:

1. Health concerns

Some health concerns and recent complications can prevent you from taking your second dose of the COVID vaccine on time. As per the doctors, if you’ve contracted COVID-19 during the last two-month period, or if you are experiencing COVID-like symptoms presently, you should not take the vaccine shot.

2. Pregnancy

If you get pregnant after the first shot of COVID vaccination, your second shot might get delayed. Right now, there is not much data and additional information on how COVID vaccination can impact an expecting mother and the foetus. Hence, it’s advisable to consult your Ob-Gyn physician before taking your second vaccination dose during pregnancy.

3. Unavailability of vaccine

The unavailability of vaccine doses is one of the major reasons behind many Indians missing their second dose of COVID vaccination. Although the Government of India has initiated the biggest vaccination drive in our country, India's huge population means that we can't rule out inadequate vaccine supply.

4. Lockdown

The second wave of coronavirus in India was devastating. As a result, strict lockdowns were imposed by various state governments across the country, which prevented many people from going to the vaccination centres for taking their second jabs.

What if you miss your second dose of vaccination?

It’s never advisable to miss your second dose of COVID vaccination. You must positively try to get your second shot within the window mentioned in your vaccine certificate. If you fail to take the second shot, you may remain less protected from the deadly coronavirus. And in case you get infected with the virus, the chances are that the vaccine will not be effective.

As per a statement from the Former Head of the Indian Council for Medical Research, the first dose of the COVID vaccine only does the “Priming” job. It means that it creates a booster immunity in a person’s body against COVID-19. However, complete immunity is attained only after receiving the second dose of vaccine within a stipulated period.

Also, the partial immunity achieved from the first dose can diminish over time if the second dose is not taken. The majority of people who died after receiving their first dose died due to their vaccination being incomplete. Hence, it’s very important to get the two doses of COVID vaccination within the pre-determined period.

And if, for any reason, you miss your second dose of vaccine, visit the CoWin app or portal and schedule your appointment for your second dose of vaccination as early as possible.

The second wave of the COVID-19 pandemic hit India severely. The Delta variant (also call the Indian variant) of the coronavirus, which is believed to be behind the rise of second wave of COVID-19 in India, spreads much faster and can have a very drastic effect on the infected patients. As a result, the positivity rate of coronavirus as well as the mortality rate is much higher this time around. Buy health insurance policy that provides coverage against all hospitalization-related expenses, including coronavirus and black fungus treatment.

Even as India continue to struggle with the impact of COVID-19’s second wave, rising cases of black fungus infection among those recovering from the virus brought fresh concerns for the Government and citizens alike. As per the Central Government’s data, there were about 8,848 cases of black fungus infection in India on 22^nd May, 2021. And these figures were spiraling at a rapid rate.

Experts are calling this infection “A Pandemic within Covid-19 Pandemic”. As per the reports, number of people dying due to black fungus infection in India is steadily increasing. From black fungus symptoms, to causes, to its treatment, we have discussed everything you need to know about this disease in this article. Continue reading.

What is Black Fungus?

Also known as Mucormycosis, black fungus disease is a fungal infection which is presently seen in patients who are suffering from COVID-19 with co-morbidities such as HIV/AIDS, uncontrolled diabetes, and Mellitus cancer. If not controlled during its initial stages, black fungus infection can prove to be fatal for the patients.

What causes Black Fungus?

Black fungus or Mucormycosis is basically a rare fungal infection which is caused by a group of moulds or fungus known as Mucormycetes. These moulds are considered separate from plants and animals kingdom, and are found in plants, soil, water, decaying organic matter, and sometimes in animals and humans.

As per the doctors, the primary reason behind the development of fungal infection in a COVID-positive patient is prolonged exposure to moisture during oxygen therapy. Use of ordinary tap water in flow meters of oxygen cylinders are also believed to cause black fungus infection. This can also be triggered due to the use of mould-tainted oxygen pipes and humidifiers.

Who all are at risk?

As per the Ministry of Health, black fungus infection in India is mostly detected amongst people who are recovering or have recovered from the COVID-19 disease. This infection can occur anytime to a coronavirus patient i.e. either during his/her hospital stay or several days to few weeks after discharge.

People who have sinus problems or those who are on medications for lung problems are most susceptible to catch black fungus infection during the treatment of COVID-19. Besides, those who are suffering from diabetes, cancer, blood malignancies, and iron deficiency are prone to this fungal infection.

Updated on - 23 Oct 2025

Health insurance plans are crucial monetary safety nets for countless families in India these days. Each year, the medical expenses keep on rising, and thus having a good policy will guarantee that you get financial support for the treatment and hospitalisation costs. However, when buying health insurance, it is important to understand certain terms like co-payment, because it helps you fully understand your coverage and make informed decisions.

Let’s know in detail the co-pay in health insurance.

What is a co-pay in health insurance?

The co-pay feature is an optional clause offered by health insurance companies in their policy. It is an arrangement between the policyholder and the insurance company wherein they share the medical expenses based on a mutually decided percentage.

The co-pay percentage is the share of medical expenses that shall be borne by the policyholder in the event of a medical eventuality covered by the policy. For example, Ananya takes a health insurance cover with a co-pay feature of 15%. She incurs a medical bill amounting to Rs. 1 lakh. With the co-pay feature, Ananya will have to pay Rs. 15,000 (1,00,000 x 15%), and the insurance company shall cover the balance.

How does co-payment work?

Co-pay functions in a straightforward manner. All insurance firms add this specific clause to lower their monetary risk and to boost responsible usage of the plan. Here is how the co-payment feature works:

• Step 1: You purchase a health plan with the co-payment clause.
• Step 2: When you get hospitalised, you can raise a claim.
• Step 3: The insurance firm will approve the claim, but apply the co-payment rule.
• Step 4: You pay your share of the bill (10% or 20%), and the insurer will pay the rest.

It’s also crucial to keep in mind that the co-payment is applied whenever you raise a claim and just once.

Types of co-pay in health insurance

Co-payment is not applied in the same manner for all health insurance plans. There are several types of this feature, relying heavily on the policy terms:

• Age-based co-payment: This one is normally applied for all older adults, as the chances of ailments are much higher with age.
• Location-based co-payment: This is applied when you receive treatment in cities, such as Delhi or Mumbai, where the hospital bills are pretty high.
• Voluntary co-payment: When you willingly pick to share a much higher percentage of the medical expense in exchange for lower premiums.
• Illness-specific co-payment: This one applies only to specific conditions or ailments, such as chronic illnesses or cancer.

What is the difference between a co-payment and a deductible?

Many individuals often confuse deductible with co-payment. Both of these features involve out-of-pocket costs, but they are completely different from one another.

While a co-payment is a fixed percentage of each claim that you have to pay, the deductible is a fixed amount that you have to pay just once during a policy year, right before the insurer starts covering the costs.

For instance, suppose your health insurance policy has a co-payment of 10% and a deductible of Rs. 20,000. You have a hospital bill of  Rs. 50,000. First, you pay the deductible of  Rs. 20,000 and the remaining Rs. 30,000 is shared according to the co-payment. With a 10% co-payment, you pay Rs. 3,000, and the insurer pays the remaining Rs. 27,000.

Co-payment is something that is applied to every claim. Deductible, on the other hand, applies only when a specific limit is reached.

What are the benefits of co-pay in health insurance?

Even though you have to pay from your pocket, a co-payment comes with many advantages:

Reduced premium

Co-pay feature provides the insured person with a direct benefit in the form of a reduced premium amount, which is otherwise quite significant. The higher the co-pay percentage, the lower the premium amount.

Direct savings

Health insurance policies are of a pre-determined tenure, and you have to pay the same premium amount every time, irrespective of whether you file a claim or not. With a co-pay, you pay a relatively lower premium amount. If you do not have any claim during the policy period, you have direct savings in the form of a lower premium amount.

What are the disadvantages of opting for co-pay in health insurance?

The co-payment also has some drawbacks, which you need to consider carefully. Some of these include:

• Higher out-of-pocket expenses: In case of a massive hospital bill, your share might turn into a burden.
• Not fit for regular healthcare needs: When you or someone from your family often requires treatment, a co-payment might lead to much higher costs in the long run.
• Uncertainty: It’s not possible to predict how much you have to pay during emergencies.
• Not helpful for older adults: Since senior citizens have a much higher chance of being hospitalised, co-payment can increase their out-of-pocket expenses.

Things to consider before opting for a co-pay in health insurance

Right before you finalise a family health insurance plan with a co-payment, you should keep the following pointers in mind:

• Policy terms: You should read the policy wording to know how much co-payment is needed and when it will be applied.
• Your health and age: If you’re healthy and young, a co-payment might save you money. However, if you or your parents are older, it might cost a lot more.
• Treatment expenses in your area: In all the metro cities, a co-payment might lead to higher spending from your pocket because of expensive medical treatments.
• Your budget: You must always check whether or not you have the funds to pay for your share of the bill during emergencies.

Who should buy health insurance with a co-pay?

Not every individual should opt for the co-payment policy. This is mostly ideal for the following groups:

• Individuals who reside in small towns where treatment expenses are much lower.
• Young professionals who have no primary health problem and want lower premiums.
• Individuals who have a restricted budget and cannot afford high-premium plans but still want a health policy.

For all those individuals who suffer from frequent health issues or are older adults, a no co-payment plan might be a better option despite the higher premiums.

Conclusion

The co-payment in health insurance policies is a helpful feature that can lower the premiums, but it can also increase your part of the medical bills. Right before you opt for a policy with co-payment, you should consider your budget, location, health issues and age properly.

While you make the effort to enhance your health protection with a health insurance plan, allow us to help you in choosing the right policy for you. Receive tailored advice and solutions on health plans by filling out the form provided on this page.

FAQs

• Is the co-payment compulsory in all health policies?

No. Not every health insurance plan needs to have a co-pay. Some provide this as an option, while others make it mandatory, particularly for all the senior citizen policies.

• Is it possible to pick how much co-pay I need?

Yes. In voluntary co-payment, you can pick the percentage you’re comfortable paying. Higher co-payment simply means lower premiums.

• Is co-payment a good option for older adults?

Usually, a co-pay is not a good choice for senior citizens. It’s because they need more regular medical care, and this feature can lead to much higher costs for them.

• Does co-payment affect cashless hospitalisation?

No, you will still receive cashless treatment. However, during discharge, you have to pay your share of the medical bill directly to the hospital.

Disclaimer:

The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

India, went through a tough time during the second wave of coronavirus. The symptoms experienced by the infected patients were much more severe this time around. In fact, during the second wave of coronavirus in India, a greater number of middle-aged people (those who are aged between 30 to 50 years) and pregnant ladies got infected.

As per a recent study by Oxford University, pregnant ladies who are COVID-19 positive and their unborn babies might face a higher risk of complications than what was known previously. Women with co-morbidities are at an even higher risk. In many cases, the virus affects the unborn baby by reducing the amniotic fluid around it.

However, that doesn’t mean there is a need for panic. Not every pregnant woman, who is infected with the coronavirus, faces the same symptoms. Though, there could be some complications during the advanced stages of pregnancy as the immunity of a mother becomes weak during this time, mild cases of COVID-19 during pregnancy can be tackled at home with proper diet, rest, and exercise. Securing yourself with Health Insurance that covers covid-19 will be the best solution you have.

In case you’re pregnant and have tested positive for COVID-19, here’s what you should do to keep yourself and your baby safe.

1. Take all necessary precautions and follow Covid-safety protocols

We all know that prevention is better than cure. Make sure you are following all COVID-safety protocols laid down by the Government. It includes practicing social distancing, staying away from public places, and avoiding meeting anyone who has possible COVID-19 symptoms. Also, wash hands frequently or use hand sanitizers whenever you touch any high-contact surface.

It’s understandable that as a pregnant lady, you can’t avoid going out completely. You might have to visit your gynecologist or go out for antenatal activities. However, whenever you step out of your home, don’t forget to wear your mask, and take hand sanitizer with you.

2. Don’t panic and stay positive

Even if you’ve tested positive for coronavirus during your pregnancy, there is no need to panic. Don’t run immediately for hospitalisation as mild cases of COVID-19 can easily be cured at home with a few precautions and medications. Take proper rest and have a healthy diet.

Another thing is you should stay as happy and positive as possible. This will not only provide you the strength to fight with the disease but also keep your child in a good shape.

3. Isolate yourself. Get teleconsultation with your doctor

It’s obvious that you would never want someone else in your family to get infected with the virus and suffer. The first thing you need to do when you notice the coronavirus symptoms in yourself is to get isolated. Do not let anyone enter your room except if there’s an emergency.

Take regular teleconsultations with your doctor. Follow his/her advice strictly while taking your medicines. Keep checking your body temperature and blood’s oxygen saturation level every three to four hours. In case you notice anything adverse, inform your doctor immediately. Do not self-medicate in any case.

Health insurance is an essential part of financial planning, protecting against unexpected medical expenses. Whether you're insuring yourself or looking for coverage for your entire family, understanding how health insurance premiums are calculated can help you make better choices and avoid overpaying. Let us look at the key factors that affect your premium and tips to manage your costs effectively.

What is a health insurance premium?

A health insurance premium is the amount you have to pay monthly to keep your insurance policy active. This is separate from other out-of-pocket costs like deductibles, co-pays or coinsurance. Essentially, your premium ensures that you remain covered by your chosen policy, even if you don't use medical services in a given month.

What factors determine health insurance premium?

Many factors influence the cost of your health insurance premium, including:

• Age: It is a vital factor affecting health insurance premiums. Premiums increase with age. This is because the body is more susceptible to diseases and ailments as and when you age. The insurer thus covers a greater risk and hence charges you more.
• Lifestyle: The lifestyle you lead has a direct bearing on health insurance premiums. If you are addicted to smoking or drinking, it will push up the premium amount. On the other hand, if you don’t, the insurer charges you less for the same policy offering the same coverage.
• Coverage Amount: Health insurance premiums are directly proportional to the coverage amount. It means higher the amount, higher the premium. To put it numerically, you need to pay more for ₹ 10 lakh coverage than ₹ 5 lakh.
• Age of the Eldest Member in Case of a Family Floater Plan: In case you are willing to buy a family floater plan which provides coverage to all family members, the premium amount depends on the age of the eldest member. More the age, higher the premium.
• Pre-existing Ailments: If you have any pre-existing ailments or diseases, premium increases. For example, if you are suffering from diabetes or hypertension, you need to pay more towards your health insurance plan.

How is health insurance premium determined?

Insurers use actuarial data and risk assessment tools to determine your premium. They consider your personal details and health history, the sum insured (i.e., the maximum amount the insurer will pay) and the policy type (individual or family).

For instance, with a health insurance policy for family, the insurer considers the age of the oldest member, the number of members covered and the overall health profile of the family. These policies are usually more cost-effective than buying separate individual plans for each family member.

What is a health insurance premium calculator?

A health insurance premium calculator is an online tool provided by insurance companies or third-party platforms. It helps you estimate the premium for your desired health insurance plan based on inputs like age, number of insured members and coverage amount.

How to use a health insurance premium calculator?

Using the calculator is straightforward:

1. Enter personal details: Age, gender, smoking status, etc.
2. Select type of policy: Individual or family floater.
3. Choose sum insured: The total coverage amount you need.
4. Pick add-ons: You can include maternity benefits, critical illness cover, etc.
5. View results: The tool will generate an estimated premium for your selected inputs.

For example, if you're planning to buy a health insurance policy for family, the calculator will ask for each member's age and generate a combined premium based on a family floater plan.

Benefits of health insurance premium calculator

Below are some of the advantages of health insurance premium calculator:

• Quick and easy: It offers an instant estimate of premiums.
• Comparison-friendly: You can compare premiums across insurers.
• Customisation: Allows you to adjust inputs and see how changes affect costs.
• Transparency: Helps you understand what you’re paying for.

How to calculate health insurance premium?

While calculators do the heavy lifting, it’s useful to understand the basic formula:

Premium = Rate(base) + Factors + type of plan adjustments.

Here’s a breakdown:

• Base Rate: Depends on age group, health status.
• Factors: Exact age, geographic location, plan type, lifestyle history, family size, income and subsidies.
• Type of plan: Individual, family floater, etc.
  
  

For family policies, the premium is often calculated based on the eldest member's age. A younger family with no major health concerns might enjoy a lower premium.

How to reduce health insurance premium?

Here are some helpful tips to lower your premium:

• Buy early: Younger individuals get lower premiums.
• Choose a higher deductible: You pay more out-of-pocket, but premiums are lower.
• Opt for family floater plans: These are more affordable than multiple individual policies.
• Maintain a healthy lifestyle: Non-smokers and those with a healthy BMI may receive lower rates.
• Avoid unnecessary add-ons: Only include extras you truly need.

FAQs

1. Is a family health insurance policy more affordable than individual plans?

Yes, family floater plans generally offer more economical coverage for families under a single premium.

1. Can I customise the sum insured in a family plan?

You can certainly choose a sum insured based on your family’s healthcare needs and budget.

• Are online calculators accurate?

They provide close estimates but the final premium may vary slightly after underwriting.

• Can I reduce my premium without compromising on coverage?

Yes, by buying early, opting for essential coverage and maintaining good health.

• Can I include my parents in a family health insurance plan?

Yes, many insurers do allow you to include parents in a family floater plan, though it may increase the premium. Alternatively, buying a separate senior citizen health policy for parents may offer better benefits suited to their age and health needs.

Conclusion

Knowing how health insurance premiums are calculated can really help you to make quite better financial and healthcare decisions. If you’re buying a plan for yourself or securing coverage for your entire family using tools like health insurance premium calculators can offer valuable insights and help you select the most cost-effective option.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

A health insurance policy has become a necessity in today’s times. It protects the policyholder against the skyrocketing medical costs he/she may incur during a medical emergency. A standard health plan covers a range of expenses, including hospital’s room rent, doctor’s consultation fees, costs for medicines and diagnostic tests, etc. But, do you think having only regular health insurance is enough?

Sedentary lifestyle and increasing complexities in our living standards have made us more prone to serious illnesses and diseases. In India, more than 5 lakhs people are diagnosed with cancer every year and approximately 24 lakhs people suffer from cardiovascular diseases. The treatment of such diseases is usually very expensive, and a normal health insurance plan may not cover it by default.

It means that in case you contract a critical illness, your regular health insurance policy may fail to cover you adequately and you might end up losing all your life-savings. That is why, you must procure a separate critical illness insurance policy or attach a critical illness rider to your regular health insurance plan.

It will keep you financially protected against some life-threatening diseases such as cancer, heart attack, stroke, kidney failure, and paralysis.

Below are the five vital reasons to include critical illness rider in your health insurance plan:

1. Coverage against several chronic ailments

As mentioned above, the critical illness rider will provide you financial protection against several chronic ailments which generally include cancer, heart attack, stroke, kidney failure, organ transplant, liver diseases, and paralysis, among many others.

Though the number of ailments which is covered by the policy varies from insurer to insurer, usually a critical illness insurance rider helps covering all major life-threatening diseases.

2. Fixed sum assured upon diagnosis

Critical illness insurance plans are fixed benefit plans. It means that by attaching a critical illness rider to your regular health plan, you will become eligible to receive a fixed amount of money in case you get diagnosed with any critical ailment mentioned in the policy document. This sum assured will be paid to you irrespective of the actual amount you incur for your treatment.

Also, this sum assured will be paid directly to you which means that you can use it in whatever way you need. For example, you can use it to pay for the treatment costs, medicines, diagnostic tests, and also for paying your EMIs and meeting daily living expenses of yourself and your family members when you’re not able to earn a livelihood.

3. Tackle the huge medical expenses

As mentioned above, critical illnesses such as cancer, heart attack, and kidney failure are usually very expensive to treat and care for. For example, average cost of treatment for cancer is estimated at ₹ 10 lakhs, whereas certain lung diseases can take up to ₹ 20 lakhs for treatment.

In the absence of a critical illness cover, tackling such huge medical expenses can become next to impossible for a common person. Also, the critical illness insurance will ensure that you get the best possible treatment for covered diseases at the best healthcare facility around the world.

How To Choose Right Health Insurance At Different Stages Of Life?

Today, a health insurance policy has become imperative for everyone. Rising cases of lifestyle diseases and constantly increasing cost of healthcare facilities have made health insurance a necessity for everyone. Apart from covering almost all healthcare expenses a policyholder may incur during a medical emergency, a health insurance plan also helps him/her avail regular health check-ups and income tax benefits.

But, have you ever wondered if a specific health insurance policy is enough to provide you sufficient coverage for your entire life? The answer is “No”. As your health condition keeps on changing throughout your life, your health insurance needs also change accordingly. For example, a young person who is usually fit and healthy require a relatively smaller health insurance cover than an elderly person who is more prone to diseases and infections.

In this article, we’ve tried to explain the health insurance needs of a person during the different phases of his/her life and how should he/she choose the right health insurance cover for himself/herself at every stage. Read on.

When you’re young and single (in early 20s)

During this phase of a person’s life, he/she is pretty healthy and barely has any responsibilities. That is why, a large health insurance cover is not required at this stage. Hence, you can take a standard health insurance policy with a coverage amount of around ₹ 2 to 5 lakhs. Additionally, you should also consider the points mentioned below:

• Opt for a health insurance plan which fits your budget. As, at this stage of life, you are either not earning or have just started your career, paying high premiums for a health plan makes no sense.
• If you can, go for a health insurance policy with higher co-pay or deductibles.
• Consider your health condition and pre-existing diseases. If you have some pre-existing diseases or if you pay frequent visits to doctors, you should opt for a health insurance plan with higher coverage.
• Also, consider your profession while choosing a health plan. If you’re in a profession which involves working in conditions which are hazardous for your health, opt for a plan with high coverage.

When you are in your 30s or late 20s

When you enter this phase of life, you will suddenly find a plethora of responsibilities on your head. During this stage of your life, you could either be already married or have started planning for your marriage. You might have even started thinking about having a child in future.

Keeping in mind the number of dependents and responsibilities on you, you will need to increase your health insurance cover during this phase. Also, this is the time when you could be facing a lot of stress while managing your professional and personal life. Ideally, you should opt for a health insurance cover of ₹ 10 to 15 lakhs during this stage. You should also keep in mind the points mentioned below:

• You should get regular medical check-ups to find out if you have any pre-existing diseases. It’s common to develop certain lifestyle diseases such as Type II diabetes, hypertension etc. in this stage of life.
• You can opt for a family floater health insurance policy. It will provide comprehensive medical coverage to you, your spouse, and your children (if any).
• If you’re planning for a kid, you should go for a health insurance plan which comes with maternity benefits and new-born cover. In case your health insurance policy doesn’t provide maternity cover by default, you can add it as a rider.