There are Three Basic Types of Health Insurance Policies

Mediclaim Policy

Fixed Benefit Plans

Critical Illness Plans

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Mediclaim Policy
It is an Indemnity Policy Case 2 Actual treatment expense Z (> X)
Amount Reimbursed = X

Your Insurance Cover, The Sum Insured - X

Case 1 Actual treatment expense Y (< X)

Amount Reimbursed = Y

Your insurance payout will be the lower of the two values SecureNow the sum insured and the actual expenses

If the insurer is offering cashless facility at its approved hospital networks.. . You would need to pay only the amount in excess of the amount being covered If you are being treated in a hospital outside the insurers network OR the insurer does not offer cashless facilities, you need to pay first and then claim reimbursement
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Family Floater Policy manages your risks better than individual policies in most circumstances. Illustration for a family of 3 (2 adults, one child)

Individual and Family Floater Mediclaim Policies

Individual Cover
Family Floater

Actual Expense during a year

In case of individual policies, 2L for member 1 and 50,000 for member 3 will be paid out. 50,000 of first members expenses will not be paid

Member 1

2 Lakhs

2.5 Lakhs

Total Premium paid pa Rs 7,912.

Member 2

2 Lakhs

4 Lakhs
50 Thousand

Member 3

2 Lakhs

In case of a floater policy cover of 4 Lakhs, the entire amount will be paid out. Total Premium paid pa Rs 7,702.

Fixed Benefit Plans

In the event of hospitalization, the insurer pays a predetermined amount irrespective of actual expense A certain amount per day spent in hospital A certain addl. amount per day spent in ICU of the hospital A certain addl. amount in the event of surgery at the hospital

Whether the actual expense is more or less than the actual expense, the benefit SecureNow a given premium paid. is fixed for

Critical Illness Plans

Similar to fixed benefit plans in structure Only pre specified diseases are covered range from 9 to 35 for various insurers Any disease outside the pre specified diseases are not covered Ideal for diseases that are debilitating but may not require constant hospitalization - for example cancer or renal failure

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Our Recommendation
Buy the Comprehensive Medicare Policy first as your basic cover. It takes care of most of your needs Every 5 years or so, add a fixed benefit Plan to take care of added costs of medical care. Buy a critical illness plan as a rider plan to take care of the rare but debilitating diseases

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