Health Insurance Plan

Types of Health Insurance Coverage

Health insurance usually offers two kinds of claim settlement options:

1. Cashless Treatment

If admitted to a network hospital, you do not need to pay the hospital bills upfront. The insurance company directly settles the bill with the hospital post-claim approval.

2. Reimbursement Claim

If you opt for treatment at a non-network hospital, you make the payment first and submit all the documents asked for (bills, discharge summary, etc.) for reimbursement from the insurer.

How to Choose the Right Sum Insured?

Choosing the correct health insurance cover depends on your lifestyle, medical needs and rising healthcare expenditures. While a common rule suggests cover must be at least 50% of your annual income, many experts now suggest a minimum of ₹10 lakh for adequate protection, particularly in urban areas.

Based on Policy Type
 

What is your best pick as per the tier city and your needs? Want to know? Read on. 

Individual Plans (Just for one person)
 

Best for young adults or single individuals with no dependents.

• Tier 1 City: ₹10 lakh plus
• Tier 2 City: Between ₹7 and ₹10 lakh
• Tier 3 City: Between ₹5 and ₹7 lakh

Family Floater Plans (covers multiple members)
 

Best for families looking to share a single coverage pool.

• Tier 1 City: ₹30 lakh plus
• Tier 2 City: Between ₹20 and ₹30 lakh
• Tier 3 City: Between ₹15 and ₹20 lakh

Senior Citizen Plans (for people aged 60+)
 

Designed to cover higher medical risks in old age.

• Tier 1 City: ₹25 lakh+
• Tier 2 City: Between ₹15 and ₹25 lakh
• Tier 3 City: Between ₹10 and ₹15 lakh

Based on City Tier
 

• Tier 1 cities (Metro) have higher medical costs – opt for higher coverage.

• Tier 2 cities (Urban) might manage with moderate plans.

• Tier 3 cities (Rural) regions can begin with lower sums but must factor in rising healthcare inflation.

Tip: Consider zeroing in on top-up plans or ₹1 crore super top-ups for critical illness or international treatments, which are often available at affordable premiums.

What is the best health plan offered by HDFC Life?

HDFC Life offers a rock-solid health insurance solution through its Click 2 Protect Optima Secure plan. This is a holistic plan that covers life and health really well under a single umbrella.

Designed to cater to individuals and families alike, this plan provides multiple layers of protection, customisation options, and added benefits to handle medical uncertainties with confidence.

HDFC Life Click 2 Protect Optima Secure

A comprehensive plan that offers life and health cover for you and your family.

Features of HDFC Life Click 2 Protect Optima Secure

1. Dual Protection

Avail the advantage of both life cover and health insurance in one seamless plan.

2. Choose from 4 Tailored Health Cover Options:

• Secure Benefit

Endows an additional cover equalling 100% or 200% of your base sum insured—just right for boosting your protection without buying a separate policy.

• Plus Benefit

Your base sum insured doubles in just 2 years, even if you’ve filed a claim during that period.

• Automatic Restore Benefit

After you use up your insured amount, this feature automatically restores 100% of it—covering Base, Secure, Plus, and Cumulative Bonus.

• Protect Benefit

Pays for non-medical expenses during hospitalisation like gloves, PPE kits, food charges, and more—expenses often excluded from regular health plans.

3. Tax Benefits

   You can claim tax deductions under Section 80D of the Income Tax Act 1961¹ on the premium paid, making this plan financially rewarding as well.

Additional Benefits of Health Insurance

Many modern health insurance plans in India come with value-added features, such as:

• Coverage for ambulance charges

• Pre- and post-hospitalisation expenses (usually 30 to 90 days)

• Tax benefits under Section 80D of the Income Tax Act 1961¹

• Coverage for daycare procedures (e.g., cataract surgery)

• Alternative treatments like AYUSH (Ayurveda, Homoeopathy, etc.)

• Critical illness cover for conditions—cancer, heart attack, stroke, etc.

• Access to wellness programs as well as telemedicine services

Always go through the policy brochure and terms and conditions very carefully to understand inclusions, exclusions and waiting periods.

How to Choose the Best Health Insurance Plan in India?

Zeroing in on the correct health insurance plan does not have to be overwhelming. Follow the prudent steps mentioned here to find a policy that matches your healthcare needs and your budget:
 

1. Assess Your Healthcare Needs
   

Start with a simple question: What kind of medical coverage do I really need?

Factor in:

• Your age and life phase

• Medical history of family

• Prevailing health conditions (i.e., diabetes, asthma)

• Lifestyle or any job-linked risks

A young professional might require a very basic plan. However, a family or senior citizen might need broader protection.

2. Check the Sum Insured
   

With medical expenditures rising really fast—particularly in metro cities—it is a prudent move to go for a sum insured that is high enough to actually cover big hospital bills. Experts usually recommend starting with at least ₹10 lakh as your base coverage. 

So, don’t rely only on your office health cover—particularly if you are living in a metro city, where treatment costs can be sky-high. Having your own retail health insurance ensures that you and your family are truly protected, without any last-minute financial stress during medical emergencies.

3. Review Network Hospitals
   

Make sure the insurer has a wide network of cashless hospitals, especially those near your home or workplace. This makes emergency care smoother and more accessible.

4. Compare Coverage and Benefits
   

Not all plans are created equal. Choose one that covers:

• Hospitalisation (inpatient care)

• Pre- and post-hospitalisation expenses

• Daycare procedures

• Critical illnesses

• Outpatient treatments (OPD), if needed

Look for value-added benefits like health checkups, wellness rewards, or maternity coverage if relevant.

5. Evaluate Premiums vs. Deductibles
   

An affordable premium is great—but check:

• What’s included in the coverage

• Any co-pay or deductible clauses

• What benefits might be missing in lower-cost plans

Balance cost with coverage—don’t go for the cheapest blindly.

6. Understand the Fine Print
   

Always read the policy’s terms and conditions, especially:

• Waiting periods for pre-existing conditions

• Exclusions (what’s not covered)

• Claim settlement ratio and process

• Renewability age

Tip: Plans with fewer restrictions and a transparent claims process are always a better choice.

Still unsure? Use comparison tools or consult a licensed advisor before making a decision.

To choose the best health insurance plan in 2025, you need to consider coverage options like hospitalisation, outpatient services, and critical illness benefits. You should prioritise health insurance companies with a high claim settlement ratio (CSR) of at least above 90%. You can check if the premiums are justified against the coverage amount, co-payments and waiting periods. For a smooth claim settlement process, check the insurer's network hospital list.

What Does a Health Insurance Plan Cover?

A majority of the health insurance plans in India cover the medical expenses given below:

• In-patient Hospital Cost

If a patient is hospitalised for more than 24 hours, the insurance plan covers the medical expenses incurred during the treatment of an injury or an illness.

• Pre-existing Illnesses or Diseases

Once the waiting period is over, health insurance gives you the option of filing a claim on the expenses undertaken for the treatment of a pre-existing disease or illness. 

• Expenses before and after hospitalisation

Expenses incurred for medical check-ups, x-rays, and blood tests before hospitalisation, and medicines necessary for smooth recovery are covered under health insurance plans.

• Ambulance Charges

Many health insurance plans also cover the expenses incurred for emergency ambulance services. However, the amount covered differs from insurer to insurer.

• Maternity Cover

Expenses associated with pregnancy, delivery and newborn care are also covered by health insurance plans in India.

• Preventive Health Check-ups

Most health insurance plans in India also cover regular health check-ups to promote regular health checks and timely detection of illnesses.

• Procedures for Daycare

Treatments that take less than 24 hours and do not require hospitalisation are also covered by health care policies. These include dialysis, eye surgery, and other daycare surgeries that are mentioned in your health insurance policy.

• Home Treatment Cover

For patients who have been advised by their medical practitioner to seek home treatments, health insurance also covers expenses incurred on such healthcare.

• AYUSH Benefit

Many health insurance plans cover the expenses incurred on treatments like Homeopathy, Yoga, Siddha, Unani, or Ayurveda.

• Mental Healthcare Cover

A health insurance policy in India covers mental health illnesses under the Mental Healthcare Act of 2017. They cover illnesses like schizophrenia, acute depression, bipolar affective disorder, etc.

What Does a Health Insurance Plan Not Cover?

Given below are some of the health insurance exclusions in India:

• Insurance claims that arise as a result of injuries due to adventure sports.

• You are not eligible to file for an insurance claim for healthcare expenses occurring within 30 days of buying the insurance plans unless an accidental emergency occurs.

• Diagnostic tests are not covered.

• Health insurance coverage for pre-existing diseases has a waiting period of two to four years.

• Rehabilitation and bed rest.

• Coverage for critical illnesses has a waiting period of 90 days.

• Non-accidental dental procedures.

• Injuries caused by nuclear activity, terrorism, or war.

• Hormone replacement surgery and cosmetic surgery.

• Terminal or chronic illnesses.

• Suicide attempts or injuries that are self-inflicted.

Do Health Insurance Plans Cover COVID-19 Claims?

COVID-19⁷ claims are covered under health insurance subject to the following conditions:

1. The patient has valid and ongoing health insurance at the time of hospitalisation⁹.

2. Minimum 24-hour hospitalisation⁹ at government-accredited hospitals or hospitals permitted by ICMR.

Note: Other policy-specific conditions might exist and these conditions are subjective. So every individual must check the terms and conditions of their policy thoroughly to know if COVID-19⁷ claims are covered. 

How to Calculate Health Insurance Premium?

Health insurance premium calculation is based on several factors, including:

• Age: Premiums generally increase with age as the risk of medical conditions and complications increases.
• Sum Insured: A higher sum insured leads to a higher premium.
• Medical History: Existing medical conditions and medical history of the insured can impact the premium amount.
• Lifestyle Habits: Certain lifestyle habits like smoking, drinking alcohol, and lack of physical activity may result in higher premiums.
• Policy Type: The type of health insurance plan and coverage options chosen can also impact the premium amount.
• Family Coverage: If you opt for a family health insurance plan that covers multiple family members, the premium will be higher.

How to get a copy of your health insurance policy online?

Here are the steps to be followed to get a copy of your health insurance policy online:

• Step 1 : Login into your Account with  using your ID and password..
• Step 2 : Once you have access to your account, you can go to the policies section.
• Step 3 : Select ‘download’ for the policy whose copy you want.  
• Step 4 : Once downloaded, you can take a printout of the document for keepsake. You can also store it electronically on your laptop or mobile device. 

The above step may vary depending on company process.

Steps to Renew Your Health Insurance Online
 

You can easily renew your health insurance online by following the steps given below:

• Step 1 : In most cases, you will receive a policy renewal email with a link to your policy renewal page. Simply enter your password to access and follow through. You can go ahead and make a quick and secure payment via net banking or any of the UPI apps of your choice.
• Step 2 : Alternatively, you can visit the insurers website and log into your account. Now select the policy you want to renew and make a quick and easy payment via net banking or any of the UPI apps of your choice.
• Step 3 : Once the payment is made, you can expect to get an email confirmation regarding the same and a renewed policy document as well. 

The above step may vary depending on company process.

To Sum Up

Health insurance is not just a financial product—it’s a vital part of securing your health, peace of mind, and future. Whether you’re young and healthy or managing a family, the right plan ensures access to quality healthcare without draining your savings. 

With rising medical costs and unexpected emergencies, being prepared makes all the difference. Explore options like HDFC Life’s Click 2 Protect Optima Secure to find a plan that fits your needs. Remember, the best time to buy health insurance is when you don’t yet need it—so act early and stay protected.

ARN- ED/08/25/25606