best health insurance
Discussions on "best health insurance" in "Health" forum.
21st Jun 2014, 05:22 PM #1Newbie
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- Jun 2014
best health insurance
i am planning to take health insurance but confused to select which one is best? please help me how to select best health insurance.
22nd Jun 2014, 09:42 AM #2
Re: best health insurance
Hi Sathiks, welcome to penmai.com!
22nd Jun 2014, 09:48 AM #3
Re: best health insurance
Basics of a Health Insurance Policy
What is Health Insurance?
Health Insurance is the medical insurance provided to you by an insurance company, wherein it reimburses the medical expenses you incur as a result of your valid hospitalization. All you do is to pay a certain amount (subject to conditions) once each year, known as premium, which keeps your health insurance policy active. So, health insurance helps you get a good medical treatment and a smooth hospitalization recovery.
Who needs a Health Insurance policy?
Well, a better question would be, ‘Who does not need Health Insurance?’ and the answer is everybody needs it, but few are aware and realize its importance. While you may not suffer from any ailments and this may give you the impression that you may never need to be hospitalized, life may surprise you any moment with accidents and illnesses. And if you do get hospitalized, then over-the-top healthcare expenses may be difficult to pay from your own pocket.
What does Health Insurance cover and what does it exclude?
As health insurance in India is synonymous with “hospitalization”, your health insurance policy will mainly cover hospitalization expenses provided, you undergo treatment in the hospital for at least for 24 hours. The expenses for hospital bed, nursing, surgeon’s fees, consultant doctor’s fees, cost of blood, operation theatre charges are all covered. While, certain diseases that are specified under the policy’s terms and conditions may be excluded from coverage or may be covered only after one or two years of the policy issue date. Also, cosmetic treatments, and those that do not involve hospitalization, are not covered.
What are pre-existing diseases?
Pre-existing diseases are those that a person may have suffered from, or sought treatment for, or even such a disease which he may have had, but may not have been aware of, before the date of issue of the Health Insurance policy. Normally there is a waiting period of two to four years before which preexisting diseases are covered under health insurance policies.
What’s the difference between individual insurance policy and family floater policy and which one is better?
An individual Health Insurance policy means that a particular policy can cater to one particular individual only, namely the holder of the policy. So, in case the individual has taken a policy for a coverage amount of 1,00,000, then he will be covered for one lakh only, and in case the expenses go over this limit, he would have to pay by himself. As against this, with a family floater policy, if a family of three is covered for Rs 3,00,000 in all, then each member is eligible to use the entire amount of three lakhs as hospitalization expenses. Hence, a family floater health insurance policy gives you a benefit of additional coverage, which is absent in case of individual health policies.
The disadvantages of a family floater policy
The family floater plan offers flexibility in terms of utilizing the overall insurance coverage among the family as a group. However, there are certain clauses which you need to be aware of. First, the policy will be renewed only till the senior most member reaches the maximum age of renewability allowed by the particular insurance company, after which other family members will need to take a fresh policy without having the benefit of their claim history and pre-existing disease coverage that comes from continuous renewal of the policy. Second, children who reach 25 years of age, will need to buy a separate policy for themselves without the benefit of the earlier continuous coverage that they have got under the family floater plan. Third, in case of an accident or any kind of illness, where all the members have to hospitalized, the cover amount may be insufficient.
When is the right time to buy a health insurance policy?
It is better to be insured at an early age when your chances of being prone to ailments and diseases are less. This can be advantageous, if you buy health insurance at a time when you are healthy, your years will be claim free and you will be eligible for a discounts in premium rates, also your chances of getting stuck with a pre-existing disease and being denied claim, would be nil. Hence, it is advisable to buy a policy before you enter late 30s. Go for an independent health insurance policy even when you are covered by your employer, so that you’ll be sufficiently covered even if you change your job. Buying a health insurance policy, just when the disease strikes is a bad, irresponsible move, which may not even guarantee reimbursement
What is CashlessMediclaim?
Service is a service through which all the medical bills are paid by the Insurance company directly to the hospital, and the insured has not to pay anything at all. Basically this service is only applicable in hospitals which are in the insurance company’s “network hospitals” list. Every insurance policy has a list of hospitals where the insured can avail of this service. The policy holder simply has to call the toll free number present on the Health Card and then the co-ordination between the hospital and the company takes place.
Health Insurance Tax Benefit
The maximum deduction for an individual, spouse and children is Rs 15,000 per year. Senior citizens (65 years old or higher) get a tax exemption upto Rs 20,000. The premium is allowed as deduction from the total income of the assessed. Hence if you are paying medical premium for yourself, your family and parents you can get a health insurance tax benefit up to Rs. 35,000.
Health Insurance Claims Service
You can make a claim in two ways: Firstly, if the nursing home or the hospital you get treated in, is in the “network hospitals” list and provides cashless service, then you need to give details of your policy to the nursing home and the nursing home will claim the money directly from the insurance company. You, don’t need to pay the bills in this case.But if the nursing home does not provide cashless service, then you need to pay the medical bills first and later get the money reimbursed from the insurance company by submitting the relevant documents and the original bills and receipts. The insurance company will then refund the money to you.
What are the different Waiting periods associated with a Health Insurance policy?
Firstly, there is a two-to-four year waiting period before which for pre existing diseases can be covered under the health insurance policy. Secondly there is a 30 day waiting period from the date of issue of the policy, within which you will not be reimbursed the hospitalization expenses, unless, the treatment refers to accidental injuries. Thirdly, certain specific diseases are not covered for certain periods of time, varying from policy to policy, for instance, hypertension may not be covered for two years from the date of policy, while joint replacement may not be covered before four years from the date of issue of the policy.
Last edited by sumitra; 22nd Jun 2014 at 09:50 AM.
22nd Jun 2014, 09:54 AM #4
Re: best health insurance
With so many Insurance companies , so many health insurance policies with different names and complex features, it becomes an impossible task for a common man to pick a policy and be confident about it .
Health Insurance, as its’ known worldwide is the only effective mechanism known and available that can ensure you to get the best healthcare at affordable price. Whereas, the healthcare industry being more organized abroad, has resulted in insurance companies offering more comprehensive range of products overseas. Comparing this to the Indian Healthcare system, in its current form, can be actually be called by ‘Hospitalization Insurance’. The products that are available in country, only covers for the expenses related to hospitalization charges for accidents as well as sickness. This benefit of course is subject to a looooong list of term and conditions.
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22nd Jun 2014, 09:58 AM #5
Re: best health insurance
1. Cut out the frills. Go Basic
Most frilled products in India are not at all cost-effective. They are the products which take almost double the median premium and offers unnecessary frills is a strict no no. We have all traditionally lived with and survived the cost of routine medical expenses like Consultation expenses, Dentists bills, Medicine bills, and such costs are therefore manageable by most of us, unlike a huge hospitalization bill which could eat way more than a couple of months’ salary or savings.
You should first look at covering ALL members of your family for the larger “unmanageable” costs, which could burn a hole in your overall financial planning before signing for any fancy product.
2. Don’t Compare Premiums
Never start by comparing premiums. Health Insurance is long-term purchase and it is more than a Mumbai-Delhi Air Ticket, which you can compare and buy from comparison/aggregator websites. Health Insurance is a long-term complex contract coupled with complex services. Comparison of premiums could be largely misleading and could result in a disaster. Comparing Health Insurance requires deeper insights into the overall insurance contract (called policy wordings) over and above price comparison. Either you need to get yourself into comparing the features in detail, or take help of an unbiased health insurance advisor.
Understanding the benefits and terms is more important than the cost you are paying.
3. Look for Maximum Renewal Age
Maximum Renewal age is the age on which the coverage on your health insurance would discontinue. This could be for all members or for a specific proposer/member, depending on product to product. Remember, your core goal, when you buy Health Insurance is to save yourself from mounting healthcare costs right through your life. A product, which ceases renewal, while you are still alive and when you need it more than any time before, is a BAD product. Shift through all products and find out the maximum renewal age. Better, look for Lifetime products. Rule out all products, which do not cover your family members for a reasonable lifetime. As medical science progresses and becomes more accessible to the common man, life expectancy in India will move higher from the current average of around 70 years. A product with a lower renewal ceasing age than 70 years is a complete no no.
An insurance product which does not work, when you most need it, is not insurance.
4. Look for Limits (Treatment wise limits & Copay)
Look for treatment wise limits in the products. Treatment wise limits basically cap the amount you can claim for a particular surgery under the policy. Say, there could be limits for Cardiac treatments of Rs. 1.50 Lakhs or for Cataract for Rs. 20000 per eye. Such limits would cap your claim, even n when you have a large sum insured under the policy. You need to weigh this in, before you sign up. Some products I remember are United India’s Family Medicare, Star Health’s Red Carpet have such limits. Bajaj Allianz General and ICICI Lombard have a limit only for Cataract.
22nd Jun 2014, 10:01 AM #6
Re: best health insurance
Another condition is the COPAY it is basically the share of admissible claim that the customer would have to pay from their own pocket. For instance, with copay option of 10%, the claim amount is of Rs. 50,000, and the admissible claim is Rs. 48,000 then the copay amount would be Rs. 4800. The Total amount you would have to pay is Rs. 6800/- (Rs. 2000 deduction in the policy + Rs. 4800 of Copay) .
Couple of products which have Copay
- Oriental Happy Family Floater at 10% of the Sum Insured upto Rs. 5 Lakhs Sum Insured.
- Bajaj Allianz has a copay of 10% for treatment at Non-Network Hospitals in their Health Guard products, and 20% in Silver Health.
- Star Senior Citizen Red Carpet has a copay of 30%. For Pre-existing the copay is 50%.
Know what you will not get paid.
5. Understand Day wise Cash limit Health Products
There are some products marketed and sold as Health Insurance (Aegon Religare Life, Tata AIG General are the popular ones) which provide a daily cash benefit for the no. of days one is hospitalization. Most surgeries require an average of 6-10 days, so at the Rs. 5000 per day limit multiplied by 10 Days would pay Rs. 50000 per hospitalization, irrespective of the actual charges incurred. An Angioplasty in this will unknowingly burn a big hole in your pocket. Please avoid this product for your core healthcare expenditure risks or as an alternative to a Standard Health Insurance product. This product is more like an add-on cover, than the bigger solution.
Important Note : Do not confuse the above with products that have specific limits on Room Rent. Room Rent Limits, to an extent, make sense both for the customer, as well as the Insurance Company, as they categorize people paying a higher premium in the higher eligibility bracket. This has been further discussed in detail below in this article.
All plans which are called Health Insurance may not be what you are looking for.
6. Zero in on a Coverage amount/Sum Insured
Sum Insured is the total annual liability under the policy. Since this is a long-term product, you should look at the maximum available cover you can afford. Remember, a sum insured of Rs. 2 to 3 Lakhs will have no value, by the time you start using it. As per a very recent report on Healthcare in India by Tower Watson, the medical inflation in India is rocketing anywhere between 17 to 20% annual
Option of Upgrading Sum Insured: The option of upgrading the cover at a later stage when you are older is dicey and complicated. There could be a requirement for a medical test. Moreover, if you or any of the family members contact a new disease in the interim, the ailment would be excluded for the upgraded amount. Upgrade would be almost like taking a new policy at that age, which I would not recommend.
Look for the highest cover affordable. An I-will-upgrade-it-later option may not work.7. Compare Premiums for age bands higher than 45 years
Premium in Health Insurance increases as per increase in your age, but, there’s something about the no. 45. Insurance Companies dislike this no. Have a look at the rate charts, and you will be surprised to see good jump in premiums after one cross the age of 45 yrs. In some cases, the increase in premium is as high as 50%. You need to factor this, before you sign up. Ensure premium remains affordable in your retirement days, and does not kill your hard-earned retirement savings.
Note: You need to factor in that these premium charts can change even tomorrow, like they have changed earlier, but looking at the current charts for older brackets would get you a flavour of the company’s pricing philosophy for older age bands.
8. Credibility, Check. Look at the history of the company
Generally, a company or set of promoters known for their ethics and excellent governance, venturing out into Insurance would be a decent bet. Get information from your advisor, on the overall claims experience, on responsiveness, about changes and number of changes in the product, since it was launched. Too many or too large changes, indicates there could be more tomorrow.
22nd Jun 2014, 10:02 AM #7
Re: best health insurance
9. Products for older age/Senior Citizen family members.
Most Insurers, including the ones ‘specialized’ in Health Insurance resist covering members above 45 years. Remember, you need to somewhere take the responsibility of not covering your parents, earlier in their life, and not completely blame Insurance Companies for not covering them, now.
There is no perfect product available for Senior Citizens. All products for senior citizens are restrictive. You need to settle for a product, best affordable to you, even if it has co-pay, exclusions and other restrictions. Again, if your parents have existing ailments, then this becomes more complicated.
There is no Perfect Product. Definitely not, if you are a Senior Citizen.10. TPA V/s Non TPA Insurance Companies
TPAs have unnecessary got caught in the blame game of high claims burning the health insurance industry. The point is, TPAs are just BPOs of Insurance Companies, and are therefore as good as the Insurance Company itself. Remember, India is the world’s processing house, and there are Indian BPOs which handle more complex health claims for large Insurance companies, the world over. Insurance Companies that have engaged TPAs better and insisted on execution of hardbound contractual agreements have not faltered on their service.
11. Government V/s Private Insurance Companies
Some consider Private Insurers better due to their modern infrastructure, their responsiveness. Some consider Public Sector to be more reliable. Private Sector would run for business and hence would be very responsive. Public Sector, are the Government’s mechanism to ensure a great healthcare infrastructure, and hence somewhat have a social angle, changes in the policy are not driven only by profits but also need to socially acceptable. You need to understand the pros and cons diligently and hence set your own expectations right for your choice.
12. Finally, Ensure you have a Good Advisor
I have always said this, ensure you spend good time in deciding, who is your intermediary. Once you have taken pain to finalize a good advisor, you are more than half way done. A good advisor is one who would provide -
a) Unbiased advice, without any special affiliation to any Insurance Company.
b) Provides Routine services like Pickups, Renewals etc.
c) Assists and Guides you at the time of Claims.
Health Insurance industry is witnessing huge changes both in products, price as well as processes, being an insider, it is sensible to have an expert on your side, who updates you on changes, their impact on your coverage and suggest change in course, in case necessary.
Insurance Companies will always have their own vested interests. Have someone on your side.Note: The other terms & benefits comparable are Pre and Post Hospitalization, Benefits like No Claim Bonus/Discount, Loading of Premium, 1-2 or 4 year waiting Period for Specified Ailments have not been considered as they do not make a very big impact on the decision to purchase Health Insurance.