Types of Health Insurance Policies

Indemnity-based health insurance plans

The most popular form of health insurance in the market, indemnity-based health insurance plans, more commonly known as “mediclaim”, cover the costs you have incurred. These plans provide cashless hospitalisation or reimburse you for any expenses incurred in the event of hospitalisation and also cover expenses associated with diagnostic or screening requirements before hospitalisation or post hospitalisation medical care. The mediclaim policy can be offered as:

Individual Health Insurance Plan
Individual Health Insurance Plan

Individual health insurance provides a separate sum insured for each insured member.

In individual health insurance policies, one member’s expenses do not impact the other family member’s cover. In the unfortunate incidence of more than one member being hospitalised in a given policy year, their individual plan is bound to cover their expenses if they have selected an adequate sum insured.

Family Floater Health Insurance Plans
Family Floater Insurance Plan

Made for families, a family floater medical insurance policy provides coverage to the entire family under a single sum insured.

Under this, a fixed sum insured is available for any or all the members insured for one or more claims during the tenure of the policy. Thus, if any of the insured members falls sick and needs hospitalization, the sum insured of the policy can be utilised by them.

A family may include individual, spouse, dependent children, parents and parents-in-law.

In a family floater policy, the sum insured is shared by all the family members. Thus, if one member ends up using a large portion of the sum insured, the other member may fall short of cover when needed.

Our Optima Restore plan offers a Restore Benefit wherein your base sum insured is restored in case the entire sum insured gets exhausted in a policy year. This way, your family can still get coverage even if one member has used up the sum insured.

Who should buy

A reimbursement-based health insurance policy is the base coverage that everybody must have in order to ensure that they are protected against the less frequent but the large expenses related to hospitalisation.

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Fixed benefit plans

Fixed benefit plans offer fixed benefit payouts on the occurrence of pre-defined medical events, such as on the diagnosis of a critical illness, hospitalisation caused due to an accident, etc. These plans not only attempt to partly cover costs associated with hospitalisation but also tend to compensate for loss of income.

The biggest advantage of these plans is that they offer coverage or payout even if you have claimed from any other health insurance plan (you can consider it as an additional payout for the same illness).

However one must always consider these fixed benefit plans as a top-up or add on cover to your current plan and never mistake them for complete solutions, due to the following reasons:

  • As the payout is not related to your actual health expenses incurred, it may be lower than the actual cost
  • As the coverage is offered for set of defined benefits. it may or may not cover all medical contingencies
Fixed benefit medical insurance plan variants
Critical illness plans
Critical illness plans

These plans offer a fixed lump sum benefit in case of a critical illness being diagnosed. The critical illness or disease covered should be covered under list defined under the plan. Apollo Munich’s Optima Vital critical illness plan covers 37 critical illnesses and offers an e-opinion in case of the diagnosis of a critical illness as well. The lump sum benefit offered by this plan can help cover not only the treatment cost but also act as an income supplement.

Hospital Cash benefits in Apollo health plans
Hospital Cash/Surgical benefit plans

These plans offer fixed payouts in case of defined hospitalisation events which may include being admitted to the hospital, daily stay- recuperating benefit in case of prolonged stay and also lump sum payouts for a listed surgery.

accident insurance plans
Accident insurance plans

These plans offer a pre-defined lump sum amount on the occurrence of death, disablement or broken bones due to an accident. An accident insurance plan may also cover medical expenses & emergency ambulance charges and provide an education fund for dependent children.

Who should buy?

All such fixed payout plans are top-up plans or add-on policies, which can be used to supplement your base coverage, and in no way substitute the need for indemnity based health insurance policies. Hence, these plans should be bought by someone who would like to enhance their current coverage and would like to provision themselves for

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