Health Insurance

A health insurance policy is a protective cover and an assurance that provides financial help in case of any medical emergency.

What can it do for you?

Covers medical expenses before, during, and after hospital stays.
Reimburses treatments, hospital, and surgical bills, and other expenses.
Gives an option of cashless claims through a large network of hospitals.

Preferred Health Insurance Options

Individual

Family

Senior Citizens

SuperTop-up

Highlights of Health
Insurance Plans

COVID-19 coverage included.

Covers pre-existing diseases for 1-4 years.

Covers ranging from ₹1 lakh to ₹1 crore.

Analyse and compare 20+ insurance companies & 100+ top health insurance policies.

Types of Health Insurance Plans

You can choose plans for individuals, family, senior citizens, parents, and super top-up options. There are also health insurance plans for maternity, critical illness and personal accident.

Individual health insurance plan

In addition to yourself, these plans cover your spouse, children, and parents, with individual sum assured for each member.

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Family health insurance plans

These plans cover the immediate family members with a single sum insured under one policy.

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Senior citizen health insurance plans

These plans cover medical expenses of individuals who are 60 years and above in age.

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Super top-up health insurance plans

These plans help you enhance your existing plan’s sum insured at an affordable price.

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Maternity Insurance

If you want coverage against all kinds of maternity- related costs like hospitalization, childbirth, medicines, and pre-and post-natal expenses, maternity insurance is the right support

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Critical Illness

A critical illness insurance policy that protects the insured from life-threatening critical diseases. This includes cancer, heart attack, renal failure etc

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Group Mediclaim

Personal Accident Insurance covers an insured against severe injury or disability caused by an accident. It also compensates the family of the insured in case of the death of the individual.

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Sahi Advice,
Sahi Insurance

Confused about which is the most appropriate plan that suits your needs as per your life stage? Don’t worry! Our IRDAI certified advisors will guide you at every step.

Call at 1800 267 67 67 from 10 AM to 7 PM

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Mail us at care@paybima.com

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Health Insurance
Everything You Need to Know

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Benefits and Features

In-patient hospitalisation

Covers hospital stays of 24 hours or longer, including room, doctor, boarding, nursing, and more.

Domiciliary hospitalisation

Covers doctor-prescribed home treatment when medical facilities are limited during emergencies or epidemics.

Maternity cover

Plans that cover childbirth and postnatal care for mother and baby.

Organ donor

Plans that cover organ transplant and donation expenses.

Tax benefits

Plans that offer benefits under Section 80D of the Income Tax Act.

Cashless medical treatment

Plans that offer cashless claims at network hospitals.

Coverage of pre- and post-hospitalisation expenses

Plans that cover diagnosis, care, therapy and much more.

Daycare treatment

Plans that cover treatments and procedures under 24 hours.

Ambulance fee

Plans that cover patient transportation.

Pre-existing disease cover

Plans that cover previous illnesses after a waiting period.

Medical check-up

Plans that include annual health check-ups or are available as add-ons.

Sum insured restoration

Option to recharge up to 100% of sum insured for another hospitalisation in the same year.

Simple Steps and Assistance for Buying a Health Insurance Plan

At Paybima, buying an insurance plan is easy and you can opt for an advisor’s help anytime.

Simple and
Easy-to-follow Steps

Comparison of Top
Plans for Free

Help from Certified
Advisors Anytime

Honest Advise.
No Force Selling

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Health Insurance Plan – Inclusions

What is covered in health insurance

Hospitalisation expenses

Covers serious injuries that need overnight stays.

Organ donor expenses

Covers up to a set amount for organ transplants.

Pre-existing diseases

Plans that cover after a 2 to 4-year waiting period.

Pre- and post-hospitalisation

Plans that cover for a specific number of days.

Ambulance charges

Covers up to a certain limit for hospital transportation.

Room rent

Plans that cover up to a set sub-limit.

Health check-ups

Top plans that include annual check-ups.

Maternity and newborn expenses

Plans that cover delivery costs, and in some cases even pre- and post-natal care is included.

Daycare treatments

Covers treatments that require less than 24 hours.

Home treatment

Covers doctor-prescribed home care in case hospitalization isn't easily available.

Health Insurance Plan – Exclusions

What is not covered in health insurance

Self-inflicted injuries

Plans that exclude injuries caused intentionally by the insured.

Dental treatment

Plans that do not cover preventive or cosmetic dental care.

Substance abuse

Plans that don’t include treatment for drug/alcohol or any other intoxicant abuse.

Infertility

Plans that do not cover treatment for infertility.

Cosmetic surgery

Plans that do not cover costs for cosmetic procedures.

Dangerous sports

Plans that exclude injuries from risky sports.

HIV/AIDS

Plans that do not cover treatment costs for HIV/AIDS.

Nuclear weapons

Plans that do not cover costs from nuclear weapon injuries.

Experimental treatments

Plans only cover the standard allopathic and AYUSH treatments.

Got Existing Illness?

Select the appropriate plan that covers more than 50* existing illness

*The number of illness covered values for different insurance companies.

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How to Select the Best Health Insurance Plan

While choosing the right health insurance plan as per your needs and the life stage you are in, it's extremely crucial to consider several factors to ensure comprehensive coverage for yourself and your loved ones.

The first step would be to assess your medical needs, including any pre-existing conditions or potential future requirements. Secondly, evaluate the coverage options, premiums etc. There are multiple other factors that need to be considered.

Here’s a guide on how to choose the best health insurance policy in India.

A well-chosen health insurance plan not only provides financial security but also peace of mind, knowing that you and your loved ones are covered in times of need.

Comprehensive coverage

Look for a policy that covers various medical conditions and does not have added costs.

Best protection

Choose a plan with maximum benefits.

Budget-friendly

Select a plan within your budget; add-ons can be chosen later.

Lifetime renewability

Opt for policies with lifetime renewability for continuous benefits.

Cashless hospital network

Ensure your plan includes a wide network of hospitals for cashless treatment.

Coverage amount

Verify the sum insured to cover medical expenses adequately.

Pre-existing conditions waiting period

Check waiting periods for immediate treatment needs.

Add-on benefits

Confirm availability of add-ons before choosing a plan.

Sub-limits

Be aware of disease-specific or room-rent sub-limits.

Medical examination

Most providers don't require pre-screening, but some may ask for tests.

Tips on how to Minimise Health Insurance Premium

Age

Starting early lowers premiums due to lower disease risks.

Health history

Healthy individuals pay less than those with health issues.

Policy duration

Long-term policies have lower premiums.

Payment frequency

Annual payments often get discounts as compared to monthly payments.

Base plan choice

Opt for a plan that meets your needs without extra riders.

Avoid harmful habits

Smoking, drinking, and chewing tobacco can raise premiums.

Location

Premiums vary based on the geographic location – metro, tier 1 or 2 or climate, and other medical and healthcare facilities.

Plan starts from

₹550_{/ month *}

*The starting price is Indicative and may vary. Pricing and eligibility depends on the profile. Standard T&C apply.

Health Insurance - Premium Calculator

The Earlier You Buy, Lesser the Premium

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Age of the Eldest Member

Age of the Eldest Child

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All About Health Insurance Claims

Steps to Follow for Health Insurance Claims

Step 1

Step 2

Determine Claim Type Identify if it’s a cashless or reimbursement claim.

Step 3

Notify TPA or Insurer Inform them within the specified time frame on your claim type.

Step 4

Document Submission Provide the necessary documents as per your claim type.

A detailed description of ‘steps for cashless’ or ‘reimbursement claim’ is given below-

Steps:

Hospital Selection: Choose a network hospital as mentioned in the policy document/insurer’s website.
Visit the TPA: Inform the hospital’s TPA counter at least 2-5 days before admission.
Document submission: Provide the required documents such as health ID card, policy, Aadhar card and diagnosis reports/ doctor’s prescription.
Document inspection: The insurer/TPA will review the documents and issue an initial authorisation letter to the hospital. There may be a nominal refundable security deposit as per hospital regulations.

Approval

Insurer will provide final authorisation against hospital bills during discharge, which excludes non-consumables, instruments, and various charges as per IRDAI guidelines.

Rejection/disapproval of cashless claim

In case the cashless claim gets denied, the insured can submit the claim for reimbursement. TPA verifies the documents and claim based on policy terms and conditions.

Steps:

Hospital Selection: Choose a network hospital as mentioned in the policy document/insurer’s website.
Visit the TPA: Inform the hospital’s TPA counter within 24 hours after admission along with photo ID proof, health ID card and policy.
Document submission: Provide the required documents such as health ID card, policy, Aadhar card and diagnosis reports/ doctor’s prescription.
Document inspection: The insurer/TPA will review the documents and issue an initial authorisation letter to the hospital. There may be a nominal refundable security deposit as per hospital regulations.

Approval

Insurer will provide final authorisation against hospital bills during discharge, which excludes non-consumables, instruments, and various charges as per IRDAI guidelines.

Rejection/disapproval of cashless claim

In case the cashless claim gets denied due to non-availability of documents, the insured can submit the claim for reimbursement. TPA verifies the documents and claim based on policy terms and conditions.

In case a cashless claim is not approved by the time of discharge or if the insured is admitted to a non-network hospital, a reimbursement claim can be submitted.

Notify

Inform the insurer/TPA through the toll-free number or connect with Mahindra Paybima store, within 48 hours of admission.

Get claim form

Download from insurer’s website/TPA.

Submit the following documents

Claim Form - Filled and signed by the insured – Part A
Claim Form - Filled and signed by the hospital – Part B
Original discharge summary/discharge card
Original payment receipts (advance receipts & final bill payment receipts)
Original bills of doctors’ consultations and prescriptions
Bills and receipts of all investigations (MRI, Xray, Pathology, etc.)
Original pharmacy bills
Copy of in-patient records
Copy of age proof (driving license / PAN card/Aadhar card/ passport)
Personalised cancelled cheque (name printed) of the proposer or bank passbook copy
Prescriptions and hospital bills 30 days pre- and 60 days post-hospitalisation. In such cases, the expenses for post-hospitalisation can be claimed after 60 days.
Attested hospital registration certificate
** Depending on the specific case, additional documents may be asked

Document Inspection

The insurer/TPA will review the documents submitted, confirm if they are in order and settle the reimbursement amount via electronic transfer within 10 to 15 working days.

Tips to Maximize your Claim

To get the most out of the premium you have paid for your health insurance policy, here are some tips to be kept in mind.

Provide Accurate Information

Fill out your application accurately and honestly, including medical history and lifestyle details like smoking and drinking habits.

Know Your Plan

Understand your policy's features, inclusions, exclusions, and clauses.

Understand The Claim Process

Learn about the claim process, required documents, and other requirements.

Notify Timely

Inform your insurer promptly, within 24 hours, especially for cashless claims.

Keep Documents Ready

Have all necessary documents ready, including health card, hospital bills, prescriptions, claim form, and insurer's checklist.

Guaranteed Claim Support

Call at 1800 267 67 67 from 10 AM to 7 PM

Schedule a Callback

Mail Us at care@paybima.com

Visit Paybima Store

We will guide you from start till end in your 'claim journey'. Start your claim process with us to get our support.

Health Insurance - How to Avoid Rejections

Waiting period

Be aware of waiting periods for coverage of a particular ailment.

Uncovered illness

Ensure that the ailment or treatment is covered in your policy.

Fraudulent claim

Avoid fake claims.

Documents for Claiming Health Insurance

For a seamless claim process, keep these documents handy.

Policy Copy/Health Card

Filled Claim Form

Doctor-signed Medical Form

Original Discharge Summary

Hospital Bills and Receipts

Medical Prescription and Cash Memos

Investigation Reports

Accident Reports (FIR/MLC or Medico Legal Certificate, if applicable

Do You Have any Insurance Related Concerns?

Our IRDAI Certified insurance advisor is a click away.

Get in Touch with an Advisor

All About Buying Health Insurance

How to Buy Health Insurance at Mahindra Paybima

Share personal details

Provide personal and health information to begin the policy procedure.

Browse plans

Analyse the plans, compare quotes, features, network hospitals, waiting period and other details.

Compare shortlisted policies

After shortlisting 2-3 policies as per your requirements, review them together by clicking the ‘compare product’ box.

Choose your plan

Select the most suitable plan as per your requirement after comparing the benefits.

Add riders

Select the appropriate riders or add-ons for extra cover.

Complete proposal form

Enter required details for e-KYC.

Make payment

Pay online using credit/debit cards, UPI, wallets, or net banking.

Document upload

Upload the required documents.

Get the policy

Post insurer’s approval, the policy is sent on the registered email id.

How to Compare Health Insurance Policies

Here are some of the factors you should consider while comparing health insurance policies.

Premium vs. Coverage and Benefits

Network Hospitals

Pre-existing Diseases Coverage

Waiting Period

Cost-sharing Features (co-payment, deductibles)

Discounts, Benefits, Reward Points and Bonuses

Claim Settlement Ratio

Insurer's Reputation & Financial Strength

Start Early for a Lower Premium

Your Age

Cover Amount

View Plans

Plans Starting @

₹197 / month*

View Plans

*The starting price is Indicative and may vary. Pricing and eligibility depends on the profile. Standard T&C apply.

Compare Top plan From Top Health Insurance Companies

	Star Comprehensive	Niva ReAssure 2.0 Bronze+	ICICI Lombard Health Advantage	Care Supreme
Features
Network hospitals
Claim settlement ratio (avg. of last 3 years)
Co-payment
Room rent
Disease sub-limit
Pre-existing diseases waiting period
Pre/Post hospitalization
No claim bonus
Domiciliary treatment
Ayush treatments
Restoration benefit
Health check-up
Maternity
Out Patient Department
Day care

Speak to Advisor

Compare Top plan From Top Health Insurance Companies

Star Comprehensive

Niva ReAssure 2.0
Bronze+

ICICI Lombard Health
Advantage

Care Supreme

Features

Network hospitals	<	<	<	<
Claim settlement ratio (avg. of last 3 years)	<	<	<	<
Co-payment	<	<	<	<
Room rent	<	<	<	<
Disease sub-limit	<	<	<	<
Pre-existing diseases waiting period	<	<	<	<
Pre/Post hospitalization	<	<	<	<
No claim bonus	<	<	<	<
Domiciliary treatment	<	<	<	<
Ayush treatments	<	<	<	<
Restoration benefit	<	<	<	<
Health check-up	<	<	<	<
Maternity	<	<	<	<
Out Patient Department	<	<	<	<
Day care	<	<	<	<

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Benefits of Buying and Comparing Health Insurance Policies Online

It is important to compare the best health insurance policy in India, and here are some of the reasons why:

Get the best rate

Every person has different healthcare needs and budget. By comparing various policies, you can pick a suitable health insurance policy that matches your budget and fits your requirement.

Understand the features

A comparison of plans online helps you understand the exact various features and benefits of each plan, letting you make an informed decision about choosing a health insurance plan.

Get the maximum coverage amount

Getting the widest coverage at the best possible price is the key to buying a health insurance plan. And when you compare you get to pick the best ones.

Wellness and discount opportunities

Different companies offer deals and discounts that benefit you at the buying stage or renewal stage. Comparing helps you with that too.

Buy from India’s Top Insurers

Ask Anything as We Have Answers to Everything in Health Insurance

We recommend coverage of ₹10 lakhs per insured member, which means coverage of ₹40 lakhs for a family of four. However, with a slightly extra amount, one can go for ₹1 crore coverage, which gives complete peace of mind.

Buy health insurance not only for parents but for in-laws is possible. Just be aware of their pre-existing conditions, if any, for the policy proposal purpose.

Yes, almost all insurers allow adding a spouse in case of marriage or a child born during the policy period.

One must buy health insurance as young as possible. Here’s why:

Buy policy since policyholder are fit and fine
Complete the waiting periods at a young age
The premiums are very less

Yes, all the above can be included in one health insurance policy. In-laws can also be included in place of parents. However, considering the age of parents and their pre-existing health conditions, they should take one policy for them and a separate one for themselves, spouse, and children to get the best premium options.

They can definitely buy health insurance for their parents but please keep in mind that all the pre-existing conditions must be declared with the insurer in the proposal form for successful approval and subsequent policy generation.

A regular health insurance policy covers in-patient hospitalisation expenses, which include room rent, doctor fees, diagnostic tests, and medicines. It also pays for any expenses towards doctor consultations, diagnostic tests, etc. which are undertaken pre- and post-hospitalization.

Initial waiting period - Usually 30 days from the start date of the policy. Only claims related to accidents are admissible in the first 30 days.
Specific disease waiting period - Usually 2 years from the start date of the policy. Claims related to slow-growing diseases (ex. Hernia, cataract etc,) are paid only after continuing the policy for 2 years.
Pre-existing disease waiting period - Usually 4 years from the start date of the policy. Claims related to any pre-existing condition such as heart disease/diabetes etc. are paid only after 4 years of continuing with the policy

Critical illness plans pay a lump sum amount on detection of a major critical illness, such as Cancer, First Heart Attack. They cover for loss of income, whereas a regular plan pays for hospitalization costs.

A general list of exclusions from a health insurance policy is as follows:

Infertility
Injuries/illnesses that result from illegal activities
Injuries suffered as a result of engaging in adventure sports
Addiction treatments
Dental treatments (unless the dental injury results from an accident)
Genetic disease/Congenital conditions
Cosmetic treatments
Treatment for self-harm
Alternative therapies

Some health insurers may provide coverage for the above exclusions basis their plans and additional benefits (riders) as the list varies from insurer to insurer.

We suggest they should because coverage in most corporate health policies is,

Limited to only ₹2-3 lakhs, which is quite inadequate given the high costs of treatment
Stops immediately in case of a job switch, job loss, or retirement
Is subject to change as per employer’s discretion

Therefore, one must always have a personal health insurance policy to take care of any medical expenses at any time.

Super top-up is a very low-cost plan that provides additional coverage, over and above the base health insurance plan.

For Example: If they have a base policy of ₹5 lacs, they can buy a Super top-up of ₹95 lakhs at a very minimal cost to make their overall health cover of ₹1 crore.

Policy copy is issued instantly in case there are no adverse medical conditions to declare. In case any medical conditions are declared, it takes 3-4 days, after the submission of past medical records.

Health insurance premiums are adjusted as per the rising medical costs. Few insurers increase the premium in a block of 5 years, while others increase marginally each year. Hence it is always advisable to go for a multi-year policy to get discounts and save more.

Yes. Insurance companies reward the customers with a 'No Claim Bonus' for not making any claim. This means the coverage increases at no extra cost. This can vary from 10% to 50% depending on the plan.

Yes. It’s highly recommended to disclose all past and current health conditions or any lifestyle habits such as smoking or drinking at the time of purchasing the policy. This ensures smooth claims processing.

Tax deduction u/s 80 D of the Income Tax Act is applicable for the premium paid towards health insurance as per the limit below:
For Self and Family (All members below 60 years), the maximum amount that can be saved under section 80D is ₹25,000
For Self and Family + Parents (All members below 60 years), the maximum amount that can be saved under section 80D is ₹50,000 (₹25,000+₹25,000)
For Self and Family (all members below 60 years) with Senior Citizen Parents, the maximum amount that can be saved under section 80D is ₹75,000 (₹25,000 + ₹50,000)

An insurer can decline a claim due to the following reasons:

Non-disclosure: if a person did not completely disclose any past or present medical condition or lifestyle habit, such as smoking or drinking
Claim Made in Waiting period: The person files a claim even though the waiting period is not over for the particular disease
Policy in Grace Period: If a person hasn’t renewed the policy before the expiry date, the policy enters a grace period, where the insurer isn’t liable to pay claims

Insured can use up to the Sum Insured in a policy year. However, few policies provide the benefit of Automatic Restoration of Sum Insured. This means if sum insured is exhausted, the insurance company will restore the sum insured at no extra cost. Lot of insurance companies now provide Unlimited Auto Restoration of Sum Insured.

Yes, individuals can have health insurance from multiple insurance providers. At the time of claim, they can choose to pay from one policy or multiple policies.

NRIs are eligible to purchase a health insurance plan in India and just need proof of residence, IT returns, and other related documents for making the purchase. Please note that most of the health insurance policies come with a clause of ‘geographical restrictions’, which indicates that the policy will not cover any expense of the insured outside India. Eg: If USA residents are seeking medical supervision, the insurance company in India will not cover for the expenses incurred.

Health Insurance

Preferred Health Insurance Options

Individual

Family

Senior Citizens

SuperTop-up

Highlights of Health Insurance Plans

Types of Health Insurance Plans

Individual health insurance plan

Family health insurance plans

Senior citizen health insurance plans

Super top-up health insurance plans

Maternity Insurance

Critical Illness

Group Mediclaim

Most Popular Health Insurance Plans

Star Comprehensive

Health Returns TM

Expert Health Coach

ReAssure 2.0 Bronze+ (Direct)

Assisted Reproductive

Unlimited E-Consultation

ReAssure 2.0 Platinum +

Booster+

Unlimited E-Consultation

ReAssure 2.0 Titanium +

Booster+

Unlimited E-Consultation

Star Comprehensive

Health Returns TM

Expert Health Coach

ReAssure 2.0 Bronze+ (Direct)

Assisted Reproductive

Unlimited E-Consultation

ReAssure 2.0 Platinum +

Booster+

Unlimited E-Consultation

ReAssure 2.0 Titanium +

Booster+

Unlimited E-Consultation

Star Comprehensive

Health Returns TM

Expert Health Coach

ReAssure 2.0 Bronze+ (Direct)

Assisted Reproductive

Unlimited E-Consultation

ReAssure 2.0 Platinum +

Booster+

Unlimited E-Consultation

ReAssure 2.0 Titanium +

Booster+

Unlimited E-Consultation

Star Comprehensive

Health Returns TM

Expert Health Coach

ReAssure 2.0 Bronze+ (Direct)

Assisted Reproductive

Unlimited E-Consultation

ReAssure 2.0 Platinum +

Booster+

Unlimited E-Consultation

ReAssure 2.0 Titanium +

Booster+

Unlimited E-Consultation

Star Comprehensive

Health Returns TM

Expert Health Coach

ReAssure 2.0 Bronze+ (Direct)

Assisted Reproductive

Unlimited E-Consultation

ReAssure 2.0 Platinum +

Booster+

Unlimited E-Consultation

ReAssure 2.0 Titanium +

Booster+

Unlimited E-Consultation

Star Comprehensive

Health Returns TM

Expert Health Coach

ReAssure 2.0 Bronze+ (Direct)

Highlights of Health
Insurance Plans