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15 Most Commonly Health Insurance Frequently Asked Questions (FAQs), India 2025
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Have you ever thought about what would happen if you or someone in your family had a serious health problem that required a lot of money to treat? How would you manage without having good health insurance?
Buying health insurance is one of the best ways to protect yourself from unexpected health issues. With so many new diseases, including those caused by lifestyle choices and serious illnesses, having health insurance has become very important these days.
When it comes to getting health insurance, many people have a lot of questions. In this post, we’ll try to answer some of the common questions you might have about health insurance.
Health Insurance FAQs in India (2025)
- What is Health Insurance?
- Why Should I Buy Health Insurance?
- What are the Different Types of Health Insurance Plans in India?
- What Does Health Insurance Cover?
- How Do I Choose the Right Health Insurance Plan?
- What is the Sum Insured?
- What is the Premium?
- What is a Waiting Period in Health Insurance?
- What is Pre-Existing Disease?
- How Does the Cashless Treatment System Work?
- What is a Co-payment Clause?
- Can I Buy Health Insurance for My Parents?
- What Are No Claim Bonuses?
- Is There Any Tax Benefit on Health Insurance?
- How Can I Make a Claim?
15 Most Commonly Asked Health Insurance FAQs in India (2025)
Health insurance is essential for everyone, but it can sometimes feel confusing, especially with all the terms and options available. In this blog, we answer some of the most commonly asked questions about health insurance in India to help you make an informed choice in 2025.
1. What is Health Insurance?
Health insurance is a contract between you and an insurance company, where the company covers your medical expenses in exchange for regular premium payments. This coverage can include hospitalization, doctor visits, surgeries, and sometimes even preventive care.
2. Why Should I Buy Health Insurance?
Health insurance provides financial protection against the high costs of medical care. It helps cover hospitalization expenses, surgeries, and sometimes even outpatient treatments. With rising healthcare costs, it ensures that you don’t face a financial burden during emergencies.
3. What are the Different Types of Health Insurance Plans in India?
There are several types of health insurance plans in India:
- Individual Health Insurance: Covers one person.
- Family Floater Plans: Covers the entire family under a single policy.
- Critical Illness Plans: Provides coverage for specific serious illnesses like cancer or heart disease.
- Top-up Plans: Additional coverage over your existing health insurance.
- Maternity Plans: Covers expenses related to pregnancy and childbirth.
4. What Does Health Insurance Cover?
Health insurance generally covers:
- Hospitalization and surgery costs.
- Doctor consultations.
- Pre- and post-hospitalization expenses.
- Daycare procedures.
- Ambulance charges.
- Some plans also cover alternative treatments like Ayurveda or Homeopathy.
5. How Do I Choose the Right Health Insurance Plan?
When choosing a health insurance plan, consider:
- The coverage amount (sum insured).
- The network hospitals for cashless treatment.
- Premium cost that fits your budget.
- Inclusions and exclusions.
- The claim settlement ratio of the insurance company.
6. What is the Sum Insured?
The sum insured is the maximum amount the insurance company will pay for your medical treatment. A higher sum insured gives you better coverage but may come with higher premiums.
7. What is the Premium?
The premium is the amount you pay to the insurance company for your health insurance policy. It can be paid annually, semi-annually, or monthly. The premium depends on factors like your age, health condition, coverage amount, and the insurer.
8. What is a Waiting Period in Health Insurance?
The waiting period is the time you must wait before your policy covers certain treatments or conditions. For example, there may be a waiting period for pre-existing diseases or maternity benefits.
9. What is Pre-Existing Disease?
A pre-existing disease is any medical condition that you already have before purchasing the health insurance policy. Many policies have a waiting period before they cover these diseases.
10. How Does the Cashless Treatment System Work?
Cashless treatment means that you don’t need to pay the hospital upfront. The insurance company directly settles the bill with the hospital, but only if the hospital is part of the insurer's network.
11. What is a Co-payment Clause?
A co-payment clause means that you, as the policyholder, will need to pay a certain percentage of the treatment cost, while the insurance company will cover the rest. For example, if your policy has a 20% co-payment, you pay 20% of the cost, and the insurer pays 80%.
12. Can I Buy Health Insurance for My Parents?
Yes, you can buy health insurance for your parents, even if they are senior citizens. There are special health insurance policies available for elderly people, but the premiums may be higher due to age-related health risks.
13. What Are No Claim Bonuses?
A no-claim bonus is a reward for not making any claims during the policy year. This bonus often comes in the form of an increase in the sum insured without an additional premium.
14. Is There Any Tax Benefit on Health Insurance?
Yes, under Section 80D of the Income Tax Act, you can claim deductions on the premiums you pay for health insurance policies. This deduction is available for yourself, your family, and your parents.
15. How Can I Make a Claim?
To make a claim, you need to contact your insurance company or the hospital. In case of hospitalization, inform the insurer about the admission. For reimbursement, submit the required documents like bills, reports, and claim forms to the insurance company.
FAQs on Health Insurance Policy
A health insurance policy is the basic requirement if you want to secure yourself as well as your family against medical emergencies and the impending expenses that it causes. With a health insurance policy, you can ensure that you do not touch your savings or do not lose any money that you have kept for a different purpose due to paying bills for a medical emergency.
Yes, it is possible to get a refund on health insurance plans during the free-look period offered by insurers. The free-look period ranges from 15 days to 1-month during which the policyholder can cancel it and get a complete refund. The only deductions in this case would be the stamp duty and the proportional risk (deduction or incremental) charges.
A policyholder can claim as many times as they want during a policy year. However, the total claim amount including all the claims shouldn’t exceed the maximum amount of sum assured.
Yes, it is okay if an insured wants to pay his/her health insurance premium on installment basis. The instalments can be paid as per monthly, quarterly, half yearly or yearly basis.
Yes, the critical illness insurance plan allows numerous benefits. These plans ensure the safety of policyholder and his/her family members from the life-threatening diseases like cardio-vascular disease, cancer, stroke, heart attack, kidney failure and so on.
Yes, there are many insurers offering plans that cover maternity and pregnancy related conditions. However, you have to check with the insurance company to make sure about the coverage. However, the premium of such plans is much higher as compared to the regular health insurance plans.
Generally, a health insurance policy offers PAN India coverage. However, there are some companies that offer coverage outside India as well.
Generally, the regular health insurance policy may not cover expenses of naturopathy and homeopathy treatments. However, these treatments come under AYUSH cover and are allowed coverage by some standard health insurance policies. On the other hand, there are certain plans which may cover such treatments as an add-on coverage.
Yes, foreigners living in India can purchase a health insurance plan in India sold by Indian insurers. However, depending on the policy terms and conditions, the coverage of the plan might be restricted within India only.
Cashless Claim settlement means that the policyholder can have cashless claim of their treatment if the treatment is done in a network hospital of the insurer. Unlike in the reimbursement claim, under a cashless claim the insured doesn’t have to pay any money from his/her pocket. Rather the hospital bills are settled by the insurer directly.
As per the income tax act of India, tax benefits are available under health insurance in the form of tax deductions under section 80D. An annual deduction of over INR 25,000 is available under 80D for every citizen, except for senior citizens, whose taxable income is INR 50,000. The policyholder can avail this benefit on tax by showing proof of income.
Depending on the plan and the policy provider, a health insurance policy can have a set of exclusions, such as;
It doesn’t cover diseases like AIDS, Cosmetic Surgery and Dental Surgery etc.
Many policies do not cover cataract and sinusitis in the first year of policy. Though, they are covered in the subsequent years
Pre-existing diseases (PED) are also not covered under many policies before the completion of the PED waiting period of 2-4 years
For most policy seekers above the age of 50 years, it is compulsory to undergo a medical check-up before buying a policy. For some policies, medical check-ups are a requirement at the time of policy renewal.
Top-up and super top-up plans are used at the threshold limit of health insurance plans. Threshold limit is the deductible limit of an insurance policy. Hence, the top-up and super top-up plans become active when the claim amount of policyholder is higher as compared to the top-up deductible limit. Both these plans are almost similar to each other with the only difference being that the top-up plan covers a single claim over and above the threshold limit, while the super top-up plan covers multiple claims over and above the threshold limit.
Below documents are required to purchase a top-up health insurance:
Proof of Age
Proof of identity
Proof of Address
However, if the age of the policyholder is above 50 years, a medical check-up report is also required to buy a top-up health insurance plan.
Author Bio
Paybima Team
Paybima is an Indian insurance aggregator on a mission to make insurance simple for people. Paybima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. Paybima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.
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