Health Insurance in India

Health insurance is a growing industry in India, with a penetration rate of around 30% in 2020.
The Indian health insurance market is expected to grow at a CAGR of 15-20% from 2020 to 2025.

Individual Health Insurance: Covers individual family members, with sum insured ranging from ₹50,000 to ₹50 lakh.
Family Floater Health Insurance: Covers entire family, with sum insured ranging from ₹50,000 to ₹50 lakh.
Group Health Insurance: Covers employees of an organization, with sum insured ranging from ₹50,000 to ₹5 lakh.
Senior Citizen Health Insurance: Designed for individuals aged 60 and above, with sum insured ranging from ₹50,000 to ₹5 lakh.
Critical Illness Insurance: Covers specific critical illnesses, such as cancer, heart disease, and stroke.
Top-up Health Insurance: Additional coverage for individuals already having a basic health insurance policy.

Pre-hospitalization: Covers medical expenses incurred 30-60 days before hospitalization.
Post-hospitalization: Covers medical expenses incurred 60-90 days after hospitalization.
Day Care Procedures: Covers medical expenses for procedures that do not require hospitalization.
Domiciliary Hospitalization: Covers medical expenses for treatment at home.
Maternity Benefits: Covers medical expenses for pregnancy and childbirth.
Newborn Baby Cover: Covers medical expenses for newborns.

Public Sector Insurers:
- National Insurance Company Limited
- New India Assurance Company Limited
- Oriental Insurance Company Limited
- United India Insurance Company Limited
Private Sector Insurers:
- Aditya Birla Health Insurance Company Limited
- Apollo Munich Health Insurance Company Limited
- Bajaj Allianz General Insurance Company Limited
- HDFC ERGO Health Insurance Company Limited
- ICICI Lombard General Insurance Company Limited
- Max Bupa Health Insurance Company Limited
- Reliance Health Insurance Company Limited
- Star Health and Allied Insurance Company Limited

Ayushman Bharat Yojana: A national health insurance program launched in 2018, aiming to cover 100 million poor and vulnerable families.
Pradhan Mantri Jan Arogya Yojana (PMJAY): A flagship program under Ayushman Bharat Yojana, providing health insurance coverage of ₹5 lakh per family per year.

Low Penetration Rate: Only 30% of the population has health insurance coverage.
High Out-of-Pocket Expenditure: 70% of healthcare expenditure is out-of-pocket, leading to financial burden on individuals.
Lack of Awareness: Limited awareness about health insurance and its benefits.
Rural-Urban Disparity: Limited access to health insurance in rural areas.

The health insurance industry in India had a penetration rate of around 30% in 2020.
The industry is expected to grow at a CAGR of 15-20% from 2020 to 2025.

Individual Health Insurance covers individual family members with a sum insured ranging from ₹50,000 to ₹50 lakh.
Family Floater Health Insurance covers entire families with a sum insured ranging from ₹50,000 to ₹50 lakh.
Group Health Insurance covers employees of an organization with a sum insured ranging from ₹50,000 to ₹5 lakh.
Senior Citizen Health Insurance is designed for individuals aged 60 and above with a sum insured ranging from ₹50,000 to ₹5 lakh.
Critical Illness Insurance covers specific critical illnesses such as cancer, heart disease, and stroke.
Top-up Health Insurance provides additional coverage for individuals already having a basic health insurance policy.

Pre-hospitalization covers medical expenses incurred 30-60 days before hospitalization.
Post-hospitalization covers medical expenses incurred 60-90 days after hospitalization.
Day Care Procedures covers medical expenses for procedures that do not require hospitalization.
Domiciliary Hospitalization covers medical expenses for treatment at home.
Maternity Benefits covers medical expenses for pregnancy and childbirth.
Newborn Baby Cover covers medical expenses for newborns.

Public Sector Insurers include: • National Insurance Company Limited • New India Assurance Company Limited • Oriental Insurance Company Limited • United India Insurance Company Limited
Private Sector Insurers include: • Aditya Birla Health Insurance Company Limited • Apollo Munich Health Insurance Company Limited • Bajaj Allianz General Insurance Company Limited • HDFC ERGO Health Insurance Company Limited • ICICI Lombard General Insurance Company Limited • Max Bupa Health Insurance Company Limited • Reliance Health Insurance Company Limited • Star Health and Allied Insurance Company Limited

Ayushman Bharat Yojana is a national health insurance program launched in 2018 aiming to cover 100 million poor and vulnerable families.
Pradhan Mantri Jan Arogya Yojana (PMJAY) is a flagship program under Ayushman Bharat Yojana providing health insurance coverage of ₹5 lakh per family per year.

Only 30% of the population has health insurance coverage, resulting in a low penetration rate.
70% of healthcare expenditure is out-of-pocket, leading to a financial burden on individuals.
Limited awareness about health insurance and its benefits exists.
There is limited access to health insurance in rural areas, leading to a rural-urban disparity.