The Indian healthcare landscape has evolved significantly over the years. You might have witnessed medical costs soaring higher than ever before as per health insurance industry data. Amidst this backdrop, one common question lingers in the minds of many Indians while purchasing health insurance: How much coverage is enough?
The answer to this crucial question isn’t a one-size-fits-all solution. It requires a careful consideration of various factors. While there are several choices available, one number that often stands out as a common choice is Rs. 10 lakh health insurance.
What does 10 lakh health insurance signify? Is it enough for your health, or should you look for other options?
To comprehend the significance of 10 lakh health insurance, you first need to grasp the shifting sands of healthcare expenses in India. Over the past decade, healthcare costs have surged exponentially, as per healthcare industry statistics. From routine check-ups to critical surgeries, medical bills can quickly spiral out of control and can drain your savings quickly to jeopardize your financial stability.
The COVID-19 pandemic further spotlighted the importance of health insurance. Hospitalization expenses during the pandemic led to financial crises for many families who had inadequate coverage. In the current scenario, a health insurance policy with a sum insured of Rs. 10 lakh can be a lifeline for many. It can help you stay healthy in distressing times and lay a helping hand when you need it the most.
What is 10 Lakh Health Insurance?
A 10 lakh health insurance policy is nothing specific but a health insurance plan that provides coverage up to Rs. 10 lakh for medical expenses incurred during the policy period. In simpler terms, it means that your insurance provider will cover eligible expenses up to a maximum limit of Rs. 10 lakh whenever you face a medical emergency or require hospitalization, subject to the terms and conditions of the policy.
Recommended Read: All About Sum Insured
What are the Benefits of 10 Lakh Medical Insurance?
Selecting a 10 lakh health insurance policy offers a plethora of advantages that go beyond just financial security. Let’s delve deeper.
One of the primary benefits of a 10 lakh mediclaim policy is its comprehensive coverage. With a substantial sum insured, you will be better equipped to handle a wide range of medical expenses, including routine check-ups or major surgeries. This level of coverage ensures that you receive the best quality healthcare services without worrying about the financial burden.
In the event of a medical emergency or a serious illness, the last thing you want is to drain your savings or dip into your investments. A 10 lakh medical insurance policy provides a solid financial safety net and ensures that you don’t have to compromise your financial stability when faced with unforeseen medical costs.
Coverage for critical illnesses
Most comprehensive health insurance policies include coverage for critical illnesses such as cancer, heart disease, stroke, and organ transplant. These conditions often require specialized and costly treatments, which in turn makes 10 lakh health insurance crucial for your recovery and peace of mind.
Flexibility in selecting the right hospitals
With such a higher sum insured by your side, you will also have the flexibility to choose from a wider network of hospitals and healthcare providers. This means you can opt for the best medical facilities and specialists without being limited to a specific set of hospitals.
Reduced out-of-pocket expenses
A mediclaim policy for 10 lakhs sum insured can significantly reduce your out-of-pocket expenses. While some expenses may still require co-payments or deductibles, the bulk of your medical bills will be covered by the insurance. This will reduce your financial load to a great extent.
If you’re considering covering all your family members under one plan, a family floater health plan with a 10 lakh sum insured can provide comprehensive coverage for all family members. This way, your entire family can access quality healthcare without worrying about individual policy limits.
10 lakh health insurance premiums are also eligible for tax deductions under Section 80D of the Income Tax Act. Such a policy provides protection and tax benefits and helps you save on your tax liability.
Peace of mind
Perhaps the most significant benefit of all is the peace of mind that comes with knowing you and your family are adequately protected. A 10 lakh medical insurance policy ensures that you can focus on your recovery during a health crisis, rather than worrying about how to pay for medical bills.
Also Read: What is Copay in Health Insurance?
What are the Key Features of 10 Lakh Health Insurance?
A 10 lakh health insurance plan, as the name suggests, provides coverage up to Rs. 10 lakh. Besides this, here are some common key features associated with it:
- In-patient hospitalization to cover expenses related to hospitalization, including room charges, doctor’s fees, surgical procedures, and nursing care during your stay in the hospital
- Pre and post-hospitalization expense coverage, including diagnostic tests, consultations, and prescription medications
- Coverage for critical illnesses like cancer, heart disease, and stroke, which often require expensive and prolonged treatment (as per policy terms)
- Daycare procedure coverage for medical procedures that do not require extended hospitalization (as defined in the chosen policy)
- Cashless hospitalization to help you avail cashless treatment
- Optional riders or add-ons to your policy for enhanced coverage, such as maternity benefits, critical illness riders, etc.
- Lifetime renewability so that the policy can be renewed annually for a lifetime
Keep in mind that the exact features and terms of your health insurance policy depend on the insurance provider and the specific policy you select. You are advised to carefully review the policy document, ask questions, and compare options from different insurers to find the one that aligns best with your unique healthcare needs and preferences.
Recommended Read: How to Interpret Incurred Claim Ratio?
What are the Common Add-ons for 10 Lakh Health Insurance?
While a 10 lakh health insurance policy offers adequate coverage, you can further enhance its benefits by adding specific riders or add-ons to your policy. These add-ons are designed to address specific healthcare needs and provide additional benefits beyond the standard coverage.
The following table covers some common add-ons you can consider for your health insurance policy:
|Critical illness rider
|Provides a lump-sum payout if you are diagnosed with a critical illness that is defined under the policy
|Covers expenses related to pregnancy, childbirth, newborn care, hospitalization, pre- and postnatal care, vaccination expenses for the newborn, etc.
|Hospital daily cash
|Provides a daily cash benefit for each day of hospitalization period to cover expenses such as transportation, food, and other incidental costs incurred during the hospital stay
|Room rent waiver
|Allows you to choose a room without worrying about exceeding these sub-limits on room rent
|Extends coverage to outpatient expenses like doctor’s consultations, diagnostic tests, and medications
|Alternative treatment cover
|Covers alternative therapies such as Ayurveda, Homeopathy, or Naturopathy
The availability of these add-ons may vary from one insurance provider to another, and their cost will be added to your premium. When considering add-ons, you need to assess your specific healthcare needs, lifestyle, and budget to determine which ones are most beneficial for you.
What is Not Covered Under 10 Lakh Health Insurance?
Here are some common exclusions you may encounter in a 10 lakh mediclaim policy:
- Many policies have a waiting period before they cover pre-existing medical conditions. During this period, expenses related to these conditions are usually not covered. The waiting period varies among insurers but typically ranges from 1 to 4 years.
- Most policies have an initial waiting period, often 30 days, during which only accidental injuries are covered. This prevents individuals from buying insurance only when they require immediate medical attention.
- Some policies impose specific waiting periods for particular illnesses or treatments. For instance, surgeries like hernia or cataract may have a waiting period of 1 to 2 years.
- Treatments received from non-allopathic systems of medicine, such as Ayurveda, Homeopathy, or Naturopathy, are usually excluded unless explicitly covered by an add-on or rider.
- Procedures or treatments sought primarily for cosmetic purposes, such as elective plastic surgery, hair transplants, or weight loss surgeries, are typically not covered.
- Routine dental and vision care, including check-ups, cleaning, and eyeglasses, are usually excluded. These may require separate dental and vision insurance or add-ons.
- Injuries sustained while participating in hazardous activities such as adventure sports, racing, or extreme sports may not be covered.
- Deliberate self-inflicted injuries, including suicide attempts, are generally excluded from coverage.
- Injuries or illnesses resulting from the consumption of alcohol or illegal drugs are typically not covered.
- Some policies have an initial waiting period (usually 9-12 months) before covering pregnancy-related expenses, including maternity and childbirth.
- Non-medical expenses such as transportation, cosmetic products, or alternative therapies not covered under the policy are generally excluded.
- Injuries sustained while engaged in illegal activities or criminal acts may not be covered.
How Much Does 10 Lakh Health Insurance Cost?
The 10 lakh health insurance premium varies significantly based on several factors, such as:
- Your age
Generally, younger individuals pay lower premiums, while older individuals typically pay higher premiums for a policy with the same sum insured because they are considered to be at higher risk of requiring medical care.
- Your health condition
Your current health status and medical history play a vital role in premium calculation. Individuals with pre-existing medical conditions may face higher premiums or waiting periods for coverage related to those conditions.
- Your location
The city or region where you reside can affect the premium. This is because medical costs and healthcare infrastructure can vary significantly from one location to another.
- Your lifestyle habits
Certain lifestyle choices, such as smoking or excessive alcohol consumption, can lead to higher premiums due to the associated health risks.
- Coverage type
The type of health insurance policy you choose also impacts the premium. For example, an individual policy may have a different premium than a family floater policy covering multiple family members.
- Selected add-ons and riders
If you opt for additional riders or add-ons to enhance your coverage, they will come at an extra cost and increase your overall premium.
- Deductibles and co-payments
Some policies may have deductibles (the amount you pay before the insurer covers the rest) and co-payments (a percentage of the medical expenses you must cover). Higher deductibles and co-payments can lead to lower premiums.
- Your claim history
Your past claims history can impact your premium. If you’ve made multiple claims in the past, insurers may consider you a higher risk and charge a higher premium.
To get an accurate estimate of the premium for a health insurance policy tailored to your specific needs, you can request quotes from different insurance companies or use online 10 lakh premium calculators provided by insurers.
How to Find the Right 10 Lakh Medical Insurance Policy?
Selecting the right 10 lakh health insurance policy requires careful consideration of your unique healthcare needs, budget, and preferences. Here’s a step-by-step guide to help you find the perfect policy:
Step 1: Healthcare needs assessment
- Start by evaluating your current health status, including any pre-existing conditions.
- Consider your family’s healthcare needs, including the age and health status of family members.
- Think about the specific treatments, surgeries, or healthcare services you anticipate needing in the future.
Step 2: Budget setting
Determine how much you can comfortably allocate to 10 lakh health insurance premiums on a regular basis. While affordability is important, striking a balance between cost and coverage is crucial.
Step 3: Insurance provider selection
- Look for reputable insurance companies with a strong track record of customer service and claims settlement.
- Read customer reviews and check their claim settlement ratios to gauge reliability.
Step 4: Health insurance policy comparison
- Obtain quotes from multiple insurance providers for 10 lakh health insurance policies.
- Compare the coverage, inclusions, exclusions, and premium rates offered by each insurer.
- Pay close attention to the coverage limits, sub-limits, waiting periods, and exclusions.
- Assess whether you require any additional coverage provided by add-ons or riders, such as maternity coverage or critical illness riders. Evaluate the cost-effectiveness of these add-ons in meeting your specific needs.
Step 5: Network hospitals consideration and more
- Check network hospitals nearby where you can avail of cashless treatment. Ensure that the network includes hospitals you prefer or ones that are easily accessible to you.
- Be aware of waiting periods for pre-existing conditions, specific illnesses, or treatments. Choose a policy with waiting periods that align with your needs.
- Inquire about the NCB benefits offered by different insurers. Some policies may offer an increasing sum insured for claim-free years.
Recommended Read: All About Cashless Mediclaim
Step 6: Claim process review
- Understand the insurer’s claim settlement process. A straightforward and efficient claims process is essential during medical emergencies.
- If you’re unsure about which policy to choose or need assistance in understanding the intricacies of health insurance, consider consulting an insurance advisor or agent.
- Look for feedback from policyholders who have experienced the claims process with the insurer you’re considering. This can provide valuable insights into their service quality.
- Opt for insurers who are transparent in their communication and policies. Ensure that they provide clear information and are responsive to your inquiries.
Step 7: Policy customization
Customize your 10 lakh health insurance policy to align with your specific preferences. If you need clarification about a particular policy, seek opinions from friends, family members, or healthcare professionals who have experience in dealing with health insurance.
How to Buy 10 Lakh Health Insurance?
You can purchase a 10 lakh health insurance policy through the following channels:
Visit a local insurance branch or consult with an insurance agent in person to discuss your options and complete the policy purchase process.
Utilize the internet to research, compare, and purchase policies directly from insurance company websites. These platforms provide a convenient and transparent buying experience.
- Insurance aggregators
Use insurance aggregator platforms or apps to compare policies from multiple insurers in one place. They offer a comprehensive view of available options, which can make it easier to make an informed choice.
What is the average premium for 10 lakh health insurance?
The average premium for a 10 lakh health insurance policy can vary significantly based on factors like your age, health condition, location, and the insurance provider. On average, it can range from a few thousand rupees or more annually. It’s essential to obtain personalized quotes from insurers to determine the precise premium for your specific circumstances.
Is 10 lakh medical insurance good enough?
A 10 lakh medical insurance policy can provide adequate coverage for many healthcare needs. However, whether it’s good enough for you or not depends on individual circumstances. You need to consider factors like your health status, family size, lifestyle, and budget when deciding on coverage. Therefore, it’s essential to assess if it adequately addresses your potential healthcare costs and requirements.
What is the maximum coverage for 10 lakh health insurance?
A 10 lakh health insurance policy typically provides coverage up to a maximum limit of 10 lakh rupees. The insurer will cover eligible medical expenses up to this limit during the policy period, subject to policy terms and conditions.