A layman’s Guide to Health Insurance Coverage

Medical emergencies can put a strain on your finances. For instance, If you require hospitalization owing to some illness but don’t have a health insurance policy, then be prepared to pay out of your pocket for it. To avoid concerns pertaining to healthcare expenses, it is prudent to opt for a health insurance cover as it gives sufficient protection against the ever-increasing medical costs.

Spiraling Medical Bills

Over the last few years, healthcare expenses have gone up by a significant margin. This is very much reflective of the rising cost of hospitalization and medical treatments. It is true that hospitals these days offer excellent facilities. However, they come at a substantial cost for the patients. To help you tide over these medical crises, insurers these days offer several health insurance plans. However, the challenge lies in selecting the health insurance policy that suits your requirements. How do you do that? To help you choose the ideal policy, let us start from scratch.

What do you Mean by Health Insurance?

As said earlier, medical costs are going through the roof. In such a scenario, health insurance can prove to be a boon. An insurance policy gives you adequate protection against medical, hospitalizations & diagnostic costs. To put it succinctly, an insurance policy protects your financial health in case of medical treatment or medical exigencies.

Types of Health Insurance

In India, there are many health insurance companies, offering several plans. These can be broadly categorized as Individual Health Insurance and Family Floater health insurance.

Individual Health Insurance

As is evident from the name, this plan offers coverage to an individual. The insured amount is basically for a single person only.

Family Floater Health Insurance

This policy gives a single sum insured for the entire family. If you want insurance for more than one family member, the family floater health insurance is the best option. For example, if a family consisting of 3 members (Father, Mother, and Child) chooses a Family Floater policy with a sum insured of Rs.5 Lakh, any insured member can claim the specified amount during the policy period.

Selecting a Suitable Health Insurance Plan

As said earlier, with so many plans floating around, it can be very daunting to select the right plan. So for the sake of your convenience, here are a few tips to follow to make an informed choice.


It is very important to ensure that your health insurance policy covers all the critical illnesses. Always go through the coverage aspect before buying one. It can be very harsh on an insurer if a medical emergency happens to be of an illness not covered under the policy. It has to be kept in mind that a policy should not be chosen on the basis of the premium amount alone. If the premium of a policy is low, then the coverage will be curtailed to a great extent. So, select a policy only after thoroughly going through its scope of coverage.

Individual or Family Cover

Be clear about the policy that suits you the best. If more than one person requires insurance, then family floater becomes the natural choice. However, if the oldest person in the household happens to be over 50, then it advisable to opt for a separate Individual Policy for him/her. The premium of the family floater policy is based on the age of the eldest member, so including him/her in the floater policy would significantly increase the policy premium. Choose wisely and according to your needs.

Hospital Room Rent Ceiling

Once you are clear about the kind of policy you require, focus on the room rent cap. It’s in your best interest to select a plan that has no ceiling as far as room rent is concerned. If your policy caps room to rent, and during hospitalization, you choose a room with a higher rent, then the insurer’s settlement amount you will be based on the room rent ceiling. This implies that the hospital will charge you according to your room rent, but the insurance company’s settlement amount will be based on the room rent capping. This is where IFFCO Tokio Health insurance signs, as it does not have any room rent capping above 7 lakh, making it a highly dependable option.


Each policy has a sub-limit when it comes to specified illnesses or treatments. Sub-Limit is the amount the insurer pays you for the treatment of ailments covered under the policy. So, before opting for an insurance policy, get clarity on such conditions. Choose the one which has fewer constraints.

Hospital Network

These days, most of the insurance companies offer cashless facilities. However, the same facility can be availed only in-network hospitals. So, you should choose a policy after factoring in the number of network hospitals near your area for a smooth and seamless cashless treatment in case someone gets hospitalized. At IFFCO Tokio, our network of hospitals spans over 4200+ hospitals across the country.

To summarize, analyze your requirements, compare the various policies online for the suitability, and if possible, seek clarification before you select one. At the end of the day, it’s your financial well-being, which is you should ensure that you have adequate financial protection against any expected or unexpected medical expenses.

**To understand exactly about the policy coverage, exclusions etc read the Policy Wordings carefully.**

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