How Do I Get Health Insurance?

The process of getting health insurance is fairly simple. Yet, there are certain nuances that you have to be mindful of when purchasing a policy. In order to fully reap the benefits of your health insurance, you have to choose one that aligns with your unique needs. 

This article outlines the process of getting health insurance, from applying for a policy to making a claim. We’ll also discuss the most prominent health insurers in India in 2025 and their top policies. Let’s get into it: 

Pro tip: The health insurance market can be a labyrinth. Instead of spending hours navigating through the hundreds of policies out there, why not book a 30-minute call with our expert IRDAI-certified advisors? We don’t spam or pressure you to buy. Just honest insurance advice.

How to get a health insurance policy?

Getting health insurance isn’t just about picking a plan and paying its premium. It involves several steps, from researching policies to ensuring a smooth claims experience. Here’s how the process works: 

• The first step in getting health insurance is to research different policies. You can explore options through brokers and agents, using online aggregators, visiting insurer websites, or directly going to an insurer’s branch nearby for in-person assistance. Banks also offer health insurance through their relationship managers, who can be another source of guidance for people looking to get a health insurance plan. Pro Tip: Banks often offer group health insurance, which does not have lifelong renewal. Even when they do offer personal plans, their claims support is not very efficient.
• Once you have a list of potential insurers, it’s important to analyze their key metrics before making a decision. Look at factors like the Incurred Claim Ratio (ICR) to assess financial stability; the ICR should ideally range from 55%-80%. Another important metric that you can use is the Claim Settlement Ratio (CSR). This helps us understand the percentage of claims that are settled every year; ideally, the CSR should be equal to or more than 90%. Apart from CSR and ICR, check their Average Annual Business Income to gauge market presence and size. Additionally, check their Complaint Volume per 10,000 claims and the number of network hospitals, especially those in your vicinity, to ensure easy access to cashless treatment. The number of network hospitals should ideally be more than 10,000.
• After selecting a reliable insurer, compare the insurer’s policies based on their features instead of just their affordability. Look for comprehensive coverage, including a high sum insured, minimal waiting periods,  restoration benefits, no room rent limits, no co-payment clause, and no disease-specific sub-limits.
• Once you’ve chosen the right policy, you’ll need to obtain the proposal form. This can be done online, either through the insurer’s website or through an intermediary like Ditto or through an agent. You can also fill out the form in person at an insurer’s branch. The form requires you to complete KYC formalities and provide essential details, including your personal information and information about the insured members, the chosen sum insured, the complete medical history of insured individuals, the proposer’s bank details for payments and reimbursements, and nominee information.

The Documents Required

Category	Documents Needed
Proof of Identity	Passport, AADHAR Card, Voter ID, Driving License
Proof of Residence	Electricity bills, Rent agreement
Personal Information	Completed Proposal Form, Name, Age, Gender, Occupation, Contact Details
Financial Information	Bank Account Details (Cancelled Cheque or Statement) & PAN Card
Medical Information	First-diagnosis report, Prescriptions, Biopsy report, Bloodwork, etc.

• The next step is payment.  You can either pay your premiums annually or use the multi-pay feature to cover 2-3 years upfront. However, note that only some insurers offer this option. Depending on your age, medical history, and coverage amount, the insurer may require a tele-medical consultation or a physical medical check-up at an approved diagnostic center. If the reports indicate any concerns, such as pre-existing diseases (PEDs), you may be asked to undergo further tests or provide additional medical details such as past prescriptions, recent blood test reports, etc.
• Based on the assessment, the insurer may issue the policy or make a counter-offer. The latter could mean increased premiums, additional exclusions, or extended waiting periods. If you accept the counter-offer, the policy will be issued. However, if you choose to decline, the premium amount you paid will be refunded to the proposer’s bank account. If medical tests are done, their cost will be deducted from the refund if the policy is rejected or canceled during the counter-offer.
• When filing a claim, timely communication is crucial. For planned hospitalizations, such as scheduled surgeries, you must inform both the hospital and the insurer at least 2-3 days in advance to ensure timely claim processing and pre-authorization of expenses. In case of emergency hospitalizations, where immediate treatment is required, you must notify the hospital’s insurance desk and the insurer within 24 hours of admission to initiate the claim process. However, it’s important to remember that cashless claims will only be possible at the insurer’s network hospitals.
• If your cashless claim is approved, the insurer will settle the bill directly with the hospital, and you’ll only need to cover any policy exclusions or non-medical expenses such as consumables. If the claim isn’t approved for cashless settlement, you may have to pay the hospital upfront and apply for reimbursement by submitting medical bills, reports, and discharge summaries.
• In cases where your claim is rejected, you still have options. First, review the reason for rejection and provide any missing documents or clarifications. If the issue isn’t resolved, seek assistance from your agent or intermediary. You can also escalate an unfairly denied claim to the Insurance Ombudsman for an independent review and resolution.

Things to remember when buying a health insurance policy

1. The insurer must be credible
   Here’s a list of the top 5 insurers that we consider to be the most credible:

Health insurance provider	Avg CSR (in %)	Avg ICR (in %)	Avg Annual Business Income	Network Hospitals	Best health insurance plans available
HDFC ERGO	98	86	₹5,942.58 Cr	13,000+	Optima Secure, Super Secure
Aditya Birla	95	68	₹3,447.15 Cr	12,000+	Aditya Birla Activ One Max, Activ Fit
Bajaj Allianz	95	83	₹6,522.38 Cr	12,000+	Health Guard, Health Care Supreme
Care	90	59	₹6,545.58 Cr	11,400+	Care Supreme
Niva Bupa	91	58	₹5,494.43 Cr	10,000+	Niva Bupa Aspire Titanium +, Reassure 2.0

2. Medical track record must be clarified
   When applying for health insurance, your medical history plays a crucial role in determining your eligibility and premium. Insurers assess factors like (PEDs), BMI, and lifestyle habits (such as smoking or drinking) to underwrite your policy and present you with a counter-offer after applying loading charges, which are generally in the range of 10%-40%.
   
   While PEDs are typically defined as conditions diagnosed within 36 months before policy application, it’s essential to disclose your entire medical history since birth to the best of your knowledge. Remember, even older conditions can impact your policy acceptance, premium, or exclusions.
   
   Most importantly, non-disclosure of medical history can lead to claim rejection or even policy termination, potentially leaving you without coverage when you need it most. Essentially, being transparent from the start ensures smoother claim approvals and avoids unpleasant surprises later.
3. Comparison of policies is a must
   Not all health insurance policies are created equal, and picking the wrong one could leave you with unexpected costs when you need coverage the most. That’s why a thorough comparison is essential—ensuring that your policy doesn’t come with hidden limitations that could impact your claim. Here’s what to watch out for:
   1. No room rent restrictions – Some policies cap the amount you can claim for room rent, which means you might have to pay out of pocket if you choose a higher-category room. This extra amount is not just limited to the hospital room charge; it also includes all other services rendered by the hospital. Ideally, your plan should offer no restrictions so you have complete flexibility during hospitalization.
   2. No co-payment clause – Co-payment means you have to bear a certain percentage of your medical expense before the insurer covers the rest as per policy terms. While this reduces premiums, it can become expensive at the time of treatment, especially if you require multiple hospitalizations. A zero co-pay policy ensures that the insurer covers the full amount without you having to share the cost.
   3. No disease-specific sub-limits – Some policies impose sub-limits on specific treatments (e.g., capping the maximum coverage for heart disease, joint replacement,  etc). This could leave you underinsured for critical procedures. The best policies avoid such sub-limits, ensuring full coverage for any illness up to the sum insured.
   4. Unlimited restoration of coverage – If you exhaust your sum insured during a claim, restoration benefits refill your coverage. However, many plans limit this benefit to once a year or only for unrelated illnesses. A superior policy provides unlimited restoration upon partial exhaustion—meaning your sum insured gets replenished as many times as needed for the same illness or different illnesses.
   5. No-claim bonus & renewal bonus without conditions – Many insurers reward policyholders with a no-claim bonus (NCB) if they don’t make any claims in a year. However, the best plans offer a renewal bonus even if you do make a claim—ensuring that your coverage keeps growing over time without an increase in premiums.
   6. Domiciliary & daycare coverage – Some treatments don’t require hospitalization but are still medically necessary. Domiciliary hospitalization covers treatments taken at home due to medical conditions or hospital unavailability, while daycare procedures cover surgeries and treatments (like cataract surgery or chemotherapy) that don’t require a 24-hour hospital stay. A comprehensive policy should cover both.
   7. AYUSH coverage: If you’re more inclined toward traditional and alternative medicine, you’d be better off opting for a policy that covers AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) treatments. However, be warned that it is quite difficult to get a claim approved for AYUSH treatments.

By considering these factors, you ensure that your health insurance plan provides seamless coverage without unexpected financial burdens.

4. Expert advice can always be counted on
   Despite these guidelines, if you want personalized help in selecting your policy, don’t hesitate to get some. A health insurance plan is a crucial commitment, and making a hasty decision is bound to do more harm than good. If you’re wondering where you can get expert advice from, you’re at the right place. 
5. Add-ons must be chosen with premiums and utility kept in mind
   Add-ons are a great way to customize your plan, as they offer specialized coverage at a relatively inexpensive rate. You can choose your add-ons according to the features and facilities you’d like to have in your policy. Choosing add-ons that align with your usage pattern and medical needs is always best. For example, if you visit the doctor frequently, consider an OPD add-on. If you’re a fitness freak, consider a fitness add-on like Care’s Be-Fit. Another example of a helpful add-on is a consumables cover, which helps reduce the hospital bill by 5%-15%. 

Why Approach Ditto for Your Health Insurance Plan?

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Conclusion

Getting health insurance might seem like a long journey, from comparing policies to handling medical evaluations and claims. However, once you find the right plan, it’ll all be worth it. The effort that you put into research and honest disclosures today will ensure your peace of mind tomorrow. And remember, you don’t have to figure this out alone. Whether it’s deciphering policy jargon or choosing the best add-ons for your lifestyle, our IRDAI-certified advisors are just a call away.