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.

Health insurance is essential in order to ease the financial burden that arises due to a medical emergency, surgery, or critical illness. There are many health insurance plans offered by different insurance companies with different add-on covers and benefits. You should opt for the policy that best suits your needs and gives you respite in difficult times, such as the hospitalization of yourself or a loved one due to an untimely injury or illness. At the same time, it is important to know the kind of treatments and health conditions your medical insurance plan does not cover. Understanding these exclusions is crucial to avoid surprises during critical times.

What are Health Insurance exclusions?

Health insurance exclusions refer to the situations, medical conditions, or treatments excluded from your health insurance policy coverage. These exclusions are mentioned in the policy document and highlight the boundaries of 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:

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

Common Health Insurance exclusions

Below are some of the most common exclusions in health insurance policies:

1. Cosmetic Surgery

A surgery of this kind is not life-threatening or dangerous, thus Liposuction, Botox, or surgeries of a similar kind are not covered under a health insurance policy.

2. Pre-existing Diseases

Now this varies from one insurance provider to the other. Some insurance providers do not provide coverage for high blood pressure and diabetes, while some do. Some insurance companies offer cover for pre-existing diseases if the insured continues with the policy for a considerable period of time such as 12 - 48 months. In the case of some insurers, payment of additional premiums will cover the insured for pre-existing diseases.

3. Pregnancy and Abortion

Medical treatment expenses for pregnancy and abortion are not covered under health insurance. Even if it is a cesarean section or complication due to pregnancy, insurers do not consider pregnancy as a condition to be included in a health insurance plan. Most of the insurance providers do offer financial protection for abortion unless it is crucial in saving the mother’s life. In such an unfortunate instance, the case should be presented post-certification by a medical practitioner to the insurance company. Some companies also provide additional maternity covers. Note that voluntary abortion is not covered under health insurance. 

4. Diagnostics Expenses

Charges incurred to identify the virus or pathological surveillance (blood test, CT Scan) of your body performed at a hospital or a nursing home are not accounted for in a health insurance policy.

5. Miscellaneous Charges

Registration charges, admission fees, and service charges are not considered for claims by a medical insurance plan.

6. Health Supplements

Health tonics and protein shakes, which is not consumed by an individual to counter disease are not included under health insurance. However,  if these supplements are recommended by a medical practitioner as part of treatment while the individual is hospitalized, only then it rightfully falls under an insurance plan.

Why Do Health Insurance Plans Have Exclusions?

Health insurance exclusions are not arbitrary; they serve specific purposes:

1. To Keep Premiums Affordable

By excluding high-risk or non-essential treatments, insurers can offer affordable premiums to a broader customer base. Covering every possible condition or scenario would make health insurance unaffordable.

2. To Reduce Fraudulent Claims

Exclusions act as safeguards against false or inflated claims for non-essential or self-inflicted injuries, ensuring fair play for all policyholders.

3. To Align with Risk Management

Insurers calculate risk based on historical data and trends. Excluding high-risk activities or conditions helps manage financial liabilities.

4. To Focus on Essential Treatments

Exclusions allow insurers to prioritise coverage for essential and widely needed conditions, such as hospitalisation and critical illnesses, rather than niche or cosmetic procedures.

5. To Set Clear Policy Boundaries

Clearly defined exclusions prevent ambiguity and help policyholders understand the scope of their coverage.

How Do Insurance Companies Decide Exclusions in Health Insurance Policy?

Insurance companies set exclusions based on multiple factors, including medical, financial, and regulatory considerations. Here’s how they decide what to exclude:

1. Actuarial Risk Assessment

Actuaries analyse disease prevalence, treatment costs, and claim frequency data to identify high-risk conditions that could financially burden the insurer.

2. Regulatory Guidelines

Regulatory bodies like the Insurance Regulatory and Development Authority of India (IRDAI) provide guidelines for exclusions to ensure standardisation and fairness across policies.

3. Market Trends

Insurers consider trends in customer behaviour, demand for certain coverages, and industry norms to decide on exclusions. For example, policies without maternity benefits cater to younger, single individuals.

4. Cost-Benefit Analysis

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

5. Focus on Insurable Risks

Insurers focus on risks that are insurable and measurable. Non-measurable risks, like those associated with substance abuse or experimental treatments, are excluded.

FAQs

1. Can exclusions in a health insurance policy be removed?

Some exclusions, like pre-existing diseases, can be covered after completing the waiting period. Riders or add-ons can also remove certain exclusions, such as maternity coverage.

2. Are exclusions the same across all health insurance policies?

While many exclusions are standard, specific exclusions can vary between insurers and policy types. Always read the policy document carefully.

3. How can I minimise the impact of exclusions?

• Opt for policies with fewer exclusions.
• Use add-ons or riders to extend coverage.
• Choose comprehensive plans with features tailored to your needs.

4. Are alternative treatments like Ayurveda or Homeopathy excluded?

Many insurers now cover alternative treatments recognised by the AYUSH system. However, unproven therapies may still be excluded.

5. What happens if I file a claim for an excluded condition?

Claims for excluded conditions will be rejected. Ensure you understand your policy’s exclusions to avoid such scenarios.

6. What are common exclusions in health insurance policies?

Pre-existing health issues, cosmetic surgeries, self-harm done on purpose, optional medical therapies, and experimental treatments are standard exclusions under any health insurance.

7. Do health insurance policies in India have exclusions for international or foreign individuals?

Yes, insurance policies in India may exclude foreign nationals from their coverage unless they are mentioned and included in the policy.

8. Are there age-related exclusions in medical insurance?

Yes, several health insurance policies have limitations on coverage, especially for older policyholders. People above 60 are thus advised to go for Senior Health Insurance plans, which are better suited for their advanced age and medical conditions.

Conclusion

Exclusions under a health insurance policy are as important as the inclusions. They ensure that policies are affordable and sustainable for larger groups of people while catering to the medical needs of each policyholder. It is advisable to familiarise yourself with things like exclusions at the time of buying the policy. Read the documents carefully and consult the insurer in case of any questions. Remember, by being aware of the nitty-gritty of your insurance, you can ensure that it becomes your safety net when you need it the most.

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.

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.

The spread of coronavirus during the start of 2020 wreaked havoc in the entire world. More than a 100 million people got infected with the virus, resulting in the death of more than 2 million people. India was no different with more than 10 million cases and around 1 lakh deaths due to coronavirus. In fact, India ranked third among the worst affected countries after the USA and Brazil.

When the coronavirus vaccine in India was launched on 16^th January 2021, we all thought the pandemic days are gone and started to breathe freely. However, the joy was short-lived. The disease hit the country even harder in the form of the second wave of coronavirus. As a result, the number of coronavirus cases in India started going up rapidly and this time, the symptoms were even more severe.

As per the official records, as much as 2,16,828 new COVID-19 cases were recorded in India on 15^th April 2021. This was the highest number of cases recorded in our country in a single day till date. As a result, many state Governments including Maharashtra, Uttar Pradesh, Gujarat, Punjab, Delhi, and West Bengal announced either complete lockdowns or night curfews.

A negative COVID-19 report obtained within 72 hours was also made mandatory by many state Governments for air travellers from other states of India. In this article, we have explained how this second wave of coronavirus in India has been different and more severe than the first wave. Continue reading.

First wave vs Second wave

The surge in COVID-19 cases during the second wave in India has been more rapid than the first wave during August to October last year. The cases rose at double the pace in the second wave of coronavirus in India. While it took 32 days for cases to rise from 18,000 to 50,000 during the first wave, it took only 17 days for the cases to rise from 18,377 to 50,000 during March 2021.

The total number of cases being recorded in a single day was also much higher during the second wave. During the first wave, the highest number of cases recorded in a single day stood a little over 1 lakh. However, the number of cases in a single day during the second wave had touched the figure of 4 lakh.

India becomes second worst-hit country in the world

After the onset of the second wave of coronavirus, India overtook Brazil to become the second worst-hit country in the world. So, far the country has recorded around 3 crore COVID-19 cases, which keeps it only behind the USA (3.27 crore cases). India surpassed Brazil in terms of total number of COVID-19 cases only in April 2021 after staying at third position for several months.

When it comes to the total caseload, Maharashtra remains the worst-hit state during the second wave as well, followed by Uttar Pradesh, Punjab, Chhattisgarh, and Kerala. Along with the number of active cases, the fatality rate has also gone up during the second wave of coronavirus in India. The death count on 14^th April stood at 4.22 lakh.

A health insurance policy has become imperative for everyone today. Not only does it provide thorough coverage against the healthcare expenses the policyholder may incur during a medical emergency, but also it allows the insured person to avail free health check-ups and timely treatment for illnesses.

However, you should remember that most health insurance plans come with lots of terms and conditions. You should know these terms and conditions before buying the policy to avoid any rude shocks during the time of claim settlement. One such term associated with health insurance plans is “room rent limit”.

Room rent limit is a common sub-limit found in many Mediclaim policies. Before knowing more about health insurance room rent limit, let us first discuss what room rent is in health insurance.

What is Room Rent in Health Insurance?

When a person gets admitted to a hospital, he/she has to pay daily rent or per day room charges to occupy a room or bed in that hospital. Room rent in health insurance refers to the coverage for these boarding charges or per day room charges that the policyholder may have to pay while he/she remains admitted to a hospital.

Room rent largely depends upon the type of room and hospital a policyholder opts for. For example, room rent for a single or double occupancy room is more than a ward or a multiple-occupancy room. Similarly, room rent for private hospitals is much higher as compared to the same type of rooms at government hospitals.

Understanding Hospital Room Rent Costs in India

Hospital room rent costs in India differ based on the city, type of hospital, and room category. For instance:

• General wards in urban hospitals typically cost ₹1,000–₹2,500 per day.
• Semi-private rooms range from ₹3,000–₹7,000 per day.
• Private rooms can cost ₹5,000–₹15,000 per day.
• Deluxe or suite rooms in high-end hospitals may charge ₹20,000 or more per day.

These costs can quickly add up during extended hospital stays, making it critical to understand how your medical insurance handles room rent.

How is Room Rent Limit Specified in the Health Insurance Policy?

Now that you know about the room rent, it would be fairly easy for you to understand the concept of room rent limit in health insurance. It is the capping or limit imposed on the coverage of room rent of a hospital by a health insurance policy. The room rent limit can either be expressed as an absolute amount or as a fixed percentage of the sum insured.

In other words, the room rent limit in medical insurance policy is the maximum amount of per day room charges a policyholder can claim when he/she gets admitted to a hospital. Any amount above this sub-limit will have to be borne by the policyholder himself/herself.

For example, if your health insurance room rent limit is ₹ 5,000, then the maximum room rent you can claim under the policy is ₹ 5,000. In case the limit is expressed as “2% of the Sum Insured”, and you have chosen ₹ 5 lakhs as the sum insured, your room rent limit will be ₹ 10,000.

Types of Room Rent Limits in Health Insurance Coverage

Room rent limits in health insurance can be classified as follows:

1. Capped Room Rent:

Policies with capped room rent specify a fixed amount or percentage of the sum insured. For example:

• Fixed cap: ₹3,000 per day.
• Percentage cap: 1% of the sum insured per day.

2. Category-based Restrictions:

These policies cover specific room categories, such as semi-private rooms. Choosing a private or deluxe room may result in a higher co-payment by the policyholder.

3. No Room Rent Limit:

Some comprehensive plans do not impose any restrictions on room rent, allowing policyholders to choose any room type.

How Does Room Rent Limit Impact Your Overall Health Insurance Claim?

Room rent limit in health insurance is a very important concept. Your entire claim for health insurance coverage will depend on this room rent limit. Not only does it cap the maximum per day room charges you can claim on a policy, but it also limits other expenditures such as doctor’s fees, treatment costs, etc. Let’s understand this with the help of an example.

Suppose, you purchased a health insurance plan with a Sum Insured of ₹ 5 lakhs where the room rent is 1 percent of the Sum Insured. This means that the actual room rent limit for your policy will be ₹ 5,000. Now, if you get hospitalised and choose a room whose rent is below ₹ 5,000 per day, you will be able to claim for all expenses incurred on hospitalisation, without any deductions.

It means that if you incur ₹ 3 lakhs during the hospitalisation, you will get the entire ₹ 3 lakhs amount from the insurer upon filing a claim.

However, if you choose a room whose rent is more than ₹ 5,000 per day, your claim amount will be deducted in equal proportion by which the room rent exceeds the room rent limit of your policy. It means that if your room rent is ₹ 7,500, then you will get only 5000/7500 i.e. only 67 percent of the total expenses incurred by you during hospitalisation.

It means that if you incur ₹ 3 lakhs during hospitalisation, you will get ₹ 2.01 lakhs only (3,00,000 * 0.67) from the insurance provider. This is because hospitals charge differently for the same services for different room types. It means that the fee for a doctor’s visit in a shared room can be ₹ 1,000, whereas the fee for a visit by the same doctor in a private room can be ₹ 2,000. Hence, insurance companies pay a proportionate claim if the policyholders opt for expensive rooms.

Benefits of Health Insurance Plans Without Room Rent Charge Caps

Choosing medical insurance without room rent limits offers several advantages:

1. Flexibility in Room Selection:
   Policyholders can choose any room type, including private or deluxe rooms, without worrying about additional costs.
2. No Proportionate Deductions:
   Since there’s no cap, there are no proportionate deductions on the overall hospital bill.
3. Comfort and Privacy:
   Patients can opt for more comfortable and private rooms, which can positively impact recovery.
4. Hassle-free Claims:
   With no room rent restrictions, the claim process becomes simpler and less stressful for the policyholder.

While such health insurance plans may come with higher premiums, they offer more benefits and comprehensive coverage, proving useful in times of critical illnesses and hospitalisations. 

FAQs

1. What is the room rent limit in insurance?

The limit on the cost of a hospital room covered by a health insurance policy is called the room rent limit. It can be between 1% to 2% of the total insured amount, but it varies for each insurance provider.

2. What happens if I exceed the room rent limit specified in my policy?

If you choose a room with rent higher than your policy’s cap, the insurer may apply proportionate deductions to the entire bill. Additionally, you’ll need to pay the excess rent out of pocket.

3. Are ICU charges included in the room rent limit?

ICU charges are typically higher and may have separate limits in the policy. It’s essential to read your policy documents for specific details.

4. Can I upgrade my policy to remove the room rent limit?

Yes, most insurers allow policy upgrades to include features like no room rent cap. Contact your insurer for details on premium adjustments.

5. Is it worth paying higher premiums for a policy without a room rent limit?

Policies without room rent limits offer greater flexibility and reduce the risk of out-of-pocket expenses during hospitalisation, making them worth considering for those who prioritise comfort and convenience.

6. Do corporate health insurance plans have room rent limits?

Many corporate health insurance plans impose room rent limits. It’s advisable to review the terms and consider additional personal health insurance if needed.

Conclusion

The concept of room rent limit in health insurance is beneficial only till you are choosing a room whose rent is below the capping. Otherwise, it can significantly affect the claim amount that you will get. Hence, the best option is to go for a Mediclaim policy with no room rent limit. By opting for such a policy, you will be able to avail treatment in the room of your choice, without worrying about the capping.

For instance, you can purchase ICICI Lombard’s Complete Health Insurance Policy which has no capping on room rent. Additionally, this policy is easy to purchase and comes with an option of lifetime renewability.

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.

Time and again, the Government of India has taken steps to ensure optimum care and protection of its citizens. From bringing about developmental and infrastructural changes in the healthcare industry to providing social security through various subsidised health insurance policy schemes, the Indian Government has left no stone unturned in showing concern for its citizens.

Back in the year 2015, the then Finance Minister of India – Late Mr. Arun Jaitley – launched three social security schemes during the Budget Speech. All these schemes were aimed to provide social security to those working in the unorganised sector in India. One of these three schemes was Pradhan Mantri Suraksha Bima Yojana (PMSBY).

Through this article, we have tried to throw some light on the PMSBY scheme and what it is all about. Continue reading to know more.

What is Pradhan Mantri Suraksha Bima Yojana (PMSBY)?

As mentioned above, the Pradhan Mantri Suraksha Bima Yojana (PMSBY) is one of the social security schemes which was launched by the Government of India during the 2015 Budget Speech in the Parliament. The PMSBY scheme is a Government-backed accident insurance scheme which provides protection against accidental death and disability to individuals between 18 to 70 years of age.

This scheme is highly helpful in preparing an individual for unexpected emergencies by providing an accident insurance coverage of up to ₹2 lakhs at a highly affordable premium of ₹20 per annum.

PMSBY scheme details

The primary features of the PMSBY insurance scheme include:

• Coverage for a year and is renewable on annual basis
• Indians as well as NRIs can avail the benefits of this scheme
• Provides coverage of up to ₹2 lakhs against death and full or partial disability caused due to an accident
• The annual cover will remain valid from 1st June till 31st May
• To avail the benefits under this scheme, each member will have to pay an annual premium of ₹20
• Annual premium of ₹20 will be auto-debited from the beneficiary’s bank account

Inclusions & exclusions under the PMSBY scheme

Here is what will be covered and what won’t, under the PMSBY insurance scheme:

• Accidental death of the applicant will be covered by the scheme.
• If the applicant dies by suicide, it won’t be covered by the scheme.
• If the applicant dies because of murder, it will be covered by the scheme.
• Permanent total disability, i.e. loss of both eyes, hands, or feet will be covered.
• Permanent partial disability, i.e. loss of one of the eyes, hands, or legs will also be covered.
• A compensation of ₹2 lakh will be paid in case of accidental death or permanent total disability. Whereas, in case of partial disability, a compensation of ₹1 lakh will be paid.

Benefits of PMSBY

Here are some benefits of the Pradhan Mantri Suraksha Bima Yojana:

• Affordable Premium: Just ₹20 per annum, ensuring cost-effective coverage.
• Financial Security: Helps families cope with financial stress in case of accidents.
• Easy Enrolment: Can be linked to any bank account with minimal paperwork.
• Nationwide Availability: Open to all eligible individuals across India.
• Supplement to Family Health Insurance: Complements existing family health insurance plans by covering accidental risks.

How to apply for PMSBY?

The PMSBY scheme will be administered through public sector general insurance companies and private insurance companies such as ICICI Lombard. You can apply with any of these insurance companies through SMS or Net Banking to become a beneficiary under this scheme.

All you need to do is download the PMSBY form the Government website and approach a bank or insurance company with the duly filled form.

Steps to enrol for PMSBY through SMS

• Step 1 – Send a message on the onboarding organisation’s toll-free number
• Step 2 – You will receive an activation message
• Step 3 – Reply to the activation message with “PMSBY Y”
• Step 4 – You will receive an acknowledgement message
• Step 5 – The bank will process your request as per the information in your savings account

Steps to enrol for PMSBY through Net Banking

• Step 1 – Log in to your net banking account
• Step 2 – Click on “Insurance”
• Step 3 – Select the bank account to be used for premium payment
• Step 4 – Verify the details and click on “Confirm”
• Step 5 – Download and save the acknowledgement receipt for future reference

Documents required under PMSBY Scheme

Give below is a list of documents needed for PMSBY scheme-

• Aadhaar Card (linked to the bank account).
• Bank Account Details (for auto-debit of premium).
• Application Form (available at banks and online portals).
• Nominee Details (to ensure smooth claim settlement).

How to file a claim under PMSBY?

In case of accidental death or disability of the beneficiary, he/she or his/her nominee can file a claim under the PMSBY insurance scheme. Here’s what needs to be done:

• Step 1 – Reach out to the bank or insurance company from where the scheme was purchased.
• Step 2 – Obtain a claim form and fill it. It may ask for your name, address, contact details, and accident details. You can download the PMSBY claim form Jansuraksha
• Step 3 – Submit the duly filled claim form with relevant supporting documents, including the death certificate or disability certificate.
• Step 4 – After verifying the documents submitted by you, the insurer will transfer the claim amount to the specified bank account.
  

FAQs

1. Does PMSBY cover hospitalisation costs for accidents leading to death or disability?

No, PMSBY does not reimburse hospitalisation expenses. The scheme only provides financial assistance in case of accidental death or permanent disability.

2. Who can receive the insurance payout if the insured person passes away?

The nominee mentioned in the enrolment form will receive the insurance amount. If no nominee is registered, the legal heir can apply for the claim.

3. How is the insurance claim amount paid?

For disability claims, the insured person receives the amount in their bank account. In case of death, the payout is transferred to the nominee’s or legal heir’s account.

4. Will the insurance cover apply if the policyholder dies by suicide?

No, PMSBY does not provide benefits in case of suicide.

5. Is a police report necessary to file an insurance claim for an accident?

Yes, for accidents such as road mishaps, drowning, or criminal incidents, an FIR is required. However, in cases like snake bites or falls, hospital records can serve as proof.

6. If a person goes missing, will their family receive the insurance payout?

No, the claim is approved only when death is confirmed with valid documentation proving it was due to an accident.

7. What compensation is given for partial disability?

The scheme only covers complete and irrecoverable loss of sight in one eye or total loss of function in a hand or foot. Partial disabilities that do not meet these criteria are not covered.

8. Can someone claim benefits from multiple banks if they have enrolled in PMSBY through different accounts?

No, even if an individual has registered through multiple banks, they can claim the benefit only once.

9. Is it possible to enrol in PMSBY through multiple bank accounts?

No, a person can enrol only once, even if they hold multiple bank accounts.

10. What is the eligible age range for joining PMSBY?

People aged between 18 to 70 years can enrol in the scheme.

11. How is the insurance premium paid?

The premium is automatically deducted from the insured person’s bank account every year.

12. If I missed enrolling in the first year, can I join later?

Yes, if you didn’t enrol initially, you can join in later by providing consent and ensuring your bank account has sufficient funds for premium deduction.

13. Can someone rejoin the scheme after leaving it?

Yes, individuals who exit the scheme can re-enrol in the following years by paying the premium again.

14. Can PMSBY benefits be claimed along with other insurance policies?

Yes, PMSBY benefits are independent of other insurance plans and can be claimed even if you have additional coverage.

15. Does PMSBY cover accidents due to natural disasters? What about cases of murder or suicide?

Yes, PMSBY covers accidental death or disability caused by natural disasters like floods and earthquakes. It also covers murder cases, but it leaves out suicide cases from ts coverage.

16. Can all members of a joint bank account enrol in PMSBY separately?

Yes, all joint account holders can individually register for the scheme, provided they pay the premium separately.

17. What types of bank accounts qualify for PMSBY enrolment?

Any savings bank account with an auto-debit facility is eligible for enrolment.

18. Can NRIs enrol in PMSBY?

Yes, NRIs can join the scheme, but claims are payable only in Indian currency and will be given to a nominee or legal heir residing in India.

Conclusion

The essence of the PMSBY scheme is to provide social security to the citizens through personal accidental cover at a much lower price than the prevalent market rate. It is a yearly scheme that needs to be renewed every year through auto-debit of the premium amount of ₹20. The policyholder or his/her nominee will get a fixed sum of ₹1 lakh or ₹2 lakhs upon filing a claim. With its affordable premium, easy enrolment and significant benefits, it is a valuable addition to your health insurancepolicy. Enrolling in PMSBY is a simple yet effective step toward securing your family’s financial future against accidental risks.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the Insurance industry and products. It is advised to verify the currency and relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information. 

Leprosy, also known as Hansen disease, is a bacterial infection affecting a person's skin, nasal lining, and peripheral nerves. This disease has prevailed across the globe but commonly affects the residents of warm tropical and subtropical regions. According to the World Health Organization (WHO), there are around 2,08,000 leprosy patients worldwide, mostly from Asia and Africa.

One of the oldest diseases existing since biblical times, leprosy was always considered a highly infectious and dangerous condition. Till date, many leprosy patients across the world are forced to live in isolation and suffer social stigma. This article will talk about the causes and symptoms of leprosy, its treatment, and eliminate misconceptions surrounding the disease.

What causes leprosy?

Leprosy is caused by Mycobacterium leprae (M. leprae) or Mycobacterium lepromatosis (M. lepromatosis) which affects the skin, eyes, respiratory tract and peripheral nerves of the infected person. Skin lesions appear mainly in the colder areas of the body. The disease can spread through cough or sneeze droplets from an infected person or direct contact with an untreated leprosy patient.

A person with a weaker immunity can get infected with the disease quickly. Children may be more susceptible to this disease than adults.

What are the types of leprosy?

There are several classifications of leprosy. The two main categories are the Ridley-Jopling classification and the World Health Organization (WHO) classification.

Ridley-Jopling classification identifies the following five gradations of the disease:

• Tuberculoid leprosy: Fewer lesions; some are large and numb with nerve enlargement
• Borderline tuberculoid leprosy: More but smaller lesions with more nerve enlargement
• Mid-borderline leprosy: Reddish plaques with moderate numbness and swollen lymph nodes
• Borderline lepromatous leprosy: Many lesions with raised bumps, plaques and more numbness
• Lepromatous leprosy: Several lesions, disfigurement, limb weakness and hair loss

The number of skin lesions defines world Health Organization (WHO) classification:

• The first form is paucibacillary; wherein there are fewer skin lesions with no bacterium seen on the skin smear.
• The second form is multibacillary; wherein there are multiple skin lesions with bacterium seen on the skin smear.

What are the symptoms of leprosy?

Leprosy doesn't show immediate symptoms. The infection gradually develops into the disease, and it may take between one to 20 years for the infected person to show the first signs of leprosy, which include:

• Skin lesions paler than the person's normal skin tone
• Skin lesions with reduced sensation
• Foot ulcers
• Dry and cracked skin
• Muscle weakness
• Numbness in the hands and feet
• Curled fingers
• Facial disfigurement
• Hair loss
• Dry eyes, ulcers and maybe blindness

Diagnosis of leprosy

The doctor will first examine the patient for physical signs of symptoms of leprosy. Based on this, the doctor will conduct a biopsy on a small skin sample. This may be followed by a skin smear test to identify paucibacillary or multibacillary leprosy.

The doctor may also conduct a lepromin skin test to diagnose the type of leprosy further. In this process, the patient is injected with a small dose of inactive leprosy-causing bacterium on the forearm. The skin patch will be observed after a few days. A patient infected with tuberculoid or borderline tuberculoid leprosy will show a reaction to the injection.

Treatment of leprosy

Leprosy can be cured if detected early. In 1995, the World Health Organization (WHO) introduced Multi-drug Therapy (MDT) to combat it. And this treatment is available for free across the world. Depending on the type of leprosy, the doctor may prescribe treatment for six months or longer, in case of severe leprosy. A combination of the following antibiotics is used for leprosy treatment:

• Dapsone (Aczone)
• Minocycline (Minocin)
• Ofloxacin (Ocuflux)
• Rifampin (Rifadin)
• Clofazimine (Lamprene)

For nerve damage, the doctor may prescribe anti-inflammatory medication such as prednisone (Rayos), aspirin (Bayer), or thalidomide (Thalomid). However, since thalidomide leads to a congenital disability, it should be avoided by pregnant women or women who plan to have a child soon.

Breaking the stigma

For decades, leprosy has been considered a highly contagious disease and the patients are banned from society. Many are denied employment opportunities and thus lead a life in financial struggles and emotional turmoil. The social stigma associated with the disease prevents patients from getting treatment at the right time.

In 1954, French humanitarian Raoul Follereau started the World Leprosy Day to honour Mahatma Gandhi's compassion towards leprosy patients. Across the world, the last Sunday of every January is observed as the World Leprosy Day to create awareness of leprosy. Besides, WHO has been working towards public awareness about leprosy and removing this social stigma.

However, leprosy is not highly contagious. The disease is transmitted through direct physical contact with an infected person. Sitting next to an infected person or shaking hands doesn't spread the disease. Also, the condition isn't transmitted from pregnant lady to her unborn child. Contrary to the misconception, animals like armadillos, chimpanzees and mangabey monkeys may rarely transmit the bacteria to humans.