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Key differences in commercial health insurance vs. government schemes

30 October, 2024

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Commercial vs. government health insurance differences

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India has become the world's most populous country, achieving immense success in GDP, science and technology, medicine, services, and every other industry in which it participates. However, as with any other country, India is facing hardships in securing all citizens' health and financial well-being. This is where private health insurance companies providing commercial health insurance fit in, whether it is to suit the diverse needs of its citizens or to cater to the missing middle class, who can’t afford health insurance on their own but are also not covered by government schemes through group health plan.

 

Keep reading to learn what commercial health insurance and health insurance under government schemes mean, the differences, and some pointers to consider when choosing a policy.

 

What is commercial health insurance?

Commercial health insurance is any health insurance sold or offered by non-governmental organisations. This means that all health insurance policies sold by private insurers are considered commercial health insurance. Policyholders who have opted for commercial health insurance receive financial protection through reimbursement or cashless claims from covered risks in exchange for the premium charged. These policies are open to everybody and customisable to suit their particular needs.

 

What does health insurance under government schemes mean?

Health insurance policies provided under government schemes are subsidised policies provided at a preferable rate under central or state government initiatives. These policies offer primary coverage with an upper limit; however, they are an integral investment that enables Indians without the financial capability to have the security they need to live properly. These policies are typically suited for low-income individuals and families.

 

What are some key differences between commercial health insurance and government schemes?

Here are some of the key differences between commercial health insurance and insurance provided by the government under various schemes.

 

Features

Commercial health insurance

Government health plans

Coverage options

A commercial insurance policy covers dozens of risks that can cause medical expenses.

These policies cover limited risks and provide adequate coverage for them.

Premium price

The premium charged for commercial policies varies depending on several factors. These include age, sum insured, benefits opted for, and risks.

The government highly subsidises these low-cost policies, allowing anyone to use them and secure themselves.

No claim benefits

Private organisations provide up to 100% no-claim bonus depending on the policy and insurer.

There is no no-claim bonus for government plans.

Sum insured

Depending on the specific insurer and policy opted for, these policies can have a very high sum insured.

These policies typically have a lower sum insured compared to commercial plans.

USP

Enables individuals and families with the capability to afford health insurance with specialised policies providing better protection.

Enables Indians to avail of health insurance for low-income individuals and families to secure their health and financial well-being.

Add ons

It is possible to add add-ons to a commercial insurance policy.

Government plans come with limited customisability and the potential to add add-ons.

 

What are some things to consider when purchasing or availing of either type of policy?

Individuals considering opting for either of these policies to secure themselves and their loved ones must consider certain factors. Here are some of the key factors to keep in mind:

 

  • Eligibility

    Before considering whether to buy one or the other, consider the eligibility criteria to purchase an insurance policy under the government scheme.

  • Budget

    Consider the budget you can allocate for the policy based on yearly income, present and historical medical conditions, rising medical inflation, and other factors.

  • Needs

    Consider your and your family’s needs and opt for coverage accordingly.

  • Sum insured

    Assess the maximum sum insured and compare it with your needs for an accurate understanding.

  • Specific illness coverage

    Remember any specific illnesses and risks, such as critical illnesses, to look out for in a policy.

 

Also Read: The Future of Commercial Health Insurance.

 

Conclusion

In 2024, health insurance will play an integral role in securing individuals and families from financial and medical risks. You can secure yourself and your loved ones with health insurance, whether it is access to proper healthcare services or financial security from additional medical expenses. While there are differences between health insurance commercial and government health plans, by considering the eligibility and planning accordingly, individuals can assess their needs and make the right choice for their particular needs.

 

So secure your health and finances with the right health insurance and live your life to the fullest.

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