Health insurance suggestions

@VaibhavJain wrote:

:)

Very Helpful

@cybertechie
All private life insurance companies are profit making organization’s and unfortunately the easily reject claims. Beware or religare they have the cheapest policies with maximum benifits but the condition being would they ever accept ur claim. Read monthshut for complaints about religare and others. In terms of security the national insurance companies are preferred but then again carefully read their clauses. Ideally opt for a plan which doesn’t include a cap on the room rent. Since all insurance companies from 2011 have started capping the room rent to 1% of the sum assured. So if u have a 5 lac policy u will only get 1 % of it as room rent ie 5000 rs per day as ur charges. So if u stay in a deluxe room costing 10000 then they will proportionately give u only 50% of the room rent and also all the other charges like operation expenses medical expenses will be reimbursed only to the extent of 50% ( here assumption of insurance companies is that diferent fees is charged from different categories of customers and hence if ur plan has capping u will lose quite a lot) . I personally faced this problem where I and my family were unaware of this clause which was made in 2011 by all companies in unison. A claim of around 60000 I got merely rs 13000 due to this clause. There are companies which give u without room rent clause but they charge more premium. Also remember to take plan which has a TPA which has a wide coverage of cashless facility. Cashless facility is important these days due to manual claims are being rejected by tpas rampantly siting some or other document missing. Also one important factor is that one single policy for the entire family will only be beneficial if u are young. They normally cover u ur spouse and max 2 children below the age of 23. U might save a bit on premium and could have a higher cover for ur entire family if u opt for those plans but ideally u should read the policy t&c in detail when u opt for any policy. Also another important factor is checking what is covered and what is not. Some policies cover pre and post hospitalisation. Flat 500 rs per day when hospitalisation is for a long period say a week or so. Pregnancy related costs, annual health check up etc etc.

As u have got a breif idea now lets decide how to choose the policy for u

1) which insurance company: the irda issues a yearly annual report somewhere in November or December each year and there are some details which will help u decide which insurance company is the best value for money . Here is the article which explains the incurred claim ratio alongwith how to read it

http://www.basunivesh.com/2015/01/12/irda-incur...

So the best option is wait for a month or two before u take ur next insurance policy till the annual report is out and judge on the basis of it

From my view I would suggest u go with either L&T or Reliance which are better than other private players. national insurance companies are most beneficial ( but I don’t know if they offer any plan without room rent clause) . Also while comparing plans do visit coverfox it has comprehensive details of the plans. For example religare plans have some bonus of which will make ur 500000 policy to 1200000 in 5 years time. But what they don’t tell u the premium after the 3rd year increases. So if a 500000 policy today is the cheapest at 3500 ( approx) then the insurance premium for 4th and 5th year is around 5500 ( approx) . So ur not saving much with those super cheap religare plans. Also critical illness cover is important since the normal polices do not generally cover this unless u pay higher premium. Also very important is the TPA which the insurance company has tie up with. The claim processing is done by them. I guess the IRDA annual report also has a list of tpas and the no of cashless hospitals they cover. Do remember to choose a insurance company who has its TPA cover a wide range of hospitals for cashless claims in ur locality ( the hospitals covered in cashless are either mentioned on the TPA website or sometimes even on the insurance companies website)

2) which policy should u choose and which amount

- no cap on room rent is essential
- which has the most features
- covers critical illnesses
- policy should be future oriented accounting for the cost inflation ( u may keep the same policy for years if ur satisfied so the cover amount ideally should be a little on the higher side)
-do cost benefit analysis of the policy ( for very elderly citizens sometimes the cost exceed the benefit. Also sometimes there may be a 5 to 10 year period without any medical costs so all the premium u pay is basically ur sunk cost. So be wise in determining the amount and the premium u pay. Another way is to pool funds every year and invest it and once u require the amount break it. This is especially good as u always carry a risk with health insurance since people face bad experienced some times.
- don’t keep the child’s policy with ur policy if ur above 50. Because for family floater the cost is generally calculated using the age of the senior most person so separate policies for each of u may lead to lower premium. ( but again there’s this problem of lower cover. Think wisely and select)

Finally over with the post gosh seems a big one to read

Ps: ignore typos writing it from mobile website

@PaytmKaPoojari

That’s a lot of great information. Thanks.. KG given.

Seems like most of the policies are not covering critical illness. Policies from state run companies such as New India assurance seems to be a better bet. Do you recommend any particular policy? If it helps, i’m 29 years old .

@cybertechie wrote:

@PaytmKaPoojari

That’s a lot of great information. Thanks.. KG given.

Seems like most of the policies are not covering critical illness. Policies from state run companies such as New India assurance seems to be a better bet. Do you recommend any particular policy? If it helps, i’m 29 years old .

National insurance companies seem the safest bet but again they too aren’t much better than private cos. For cashless u dont have to worry ever as the claims are obviously settled within 6 to 8 hrs but the TPAs of national insurance cos these days are equally bad if u don’t opt for cashless ( all will site some or other document missing as an easy ground for rejecting ur claim application) . Also I don’t know if the national insurance companies provide polices without room rent clause and whether they cover critical illnesses.

From my knowledge I am inclined towards L&T policy ( I forgot the name of their TPA but it’s available somewhete on the net. They have around 6000 or 7000 cashless hospital network) . And they have a policy to cover critical illnesses as well albeit a higher premium( for an individual of my age 22 they have a policy of 5lacs with critical illness for around 6.5 k) . Don’t have data about reliance polices but the irda reports suggest them to be better than some other big names in the amount they collect and the amount they disburse. Wait for a month or two for irda annual report for 2014-15 to be published check the latest trends and then decide the company and policy ( unless ur turning 30 before that and the policy ur inclining to has a higher premium for age 30 and above). Also do visit coverfox as it has a really comprehensive details of different premiums charged by same insurance company with or without room rent clause, for covering critical illnesses etc. etc. I prefer u don’t go for religare cause it’s a huge risk since there are two many online complaints about it. Apart from it might be Icici lombard and hdfc health insurance might be giving a look.

Also do note that there are reports that L&T only provides insurance to healthy people ( u might find it difficult if u have BP, diabetics and other ailments though I don’t think u might be suffering from those at this age) . Also they get a health checkup done before getting u a policy and charge u for that ( possibility to negotiate to split the cost of 1 time medical checkup) . Also since ur 29 go for a floater plan to cover ur wife and ur children.

Personal experience
Go with National Insurance, i guess u r from Delhi NCR and i m also from Delhi NCR. My father having family cover for 6-7 years now. Covers all major hospitals for cashless claims. I would suggest u to contact a local agent for mediclaim insurance because it helps a lot. In case of non cashless they will help you. In our case we just give all the reports and documents that we receive from hospital to him and he forwards it. So we don’t need to contact anyone else.

Regarding room rent all major hospitals charge Rs.5000 or more per day for private rooms and less than Rs.5000 for semi private rooms. Regarding TPA, as far as i know the TPA changes every 3 years i.e. a TPA is for a block of 3 years and after that the TPA changes.

After lot of research I took family floater health insurance policy with Bharathi Axa. (Health Insurance Option 3 [SmartHealth Optimum] plan).

Here are the pros and cons which attracted me on choosing this plan.

pros:

• Critical illness cover for entire family (many not even provides critical illness cover)
• 20 main Critical illness cover (no other insurance companies provides with 20 critical illness cover)
• Additional sum insured for Critical illness cover (Double the sum insured)
• No room sub limit
• Rs.5,00,000 (lumpsum) on
• Premium will be revised every 10 years (others are for every 5 years)
• Cataract, laser surgery is covered after 2 years (few others do not cover and few covers after 4 years)
• Add on cover available for additional premium; Like if you used you sum insured limit, and if you need additional cover for that year, you can request for that and you have to pay additional premium for that year.

cons:

• maximum sum insured is Rs.5,00,000

@cybertechie which policy u opted for .Looking to change my insurer to L&T .

@PaytmKaPoojari

I got too busy with other engagements in life that i completely forgot about the health insurance thing.

Most of the reviews i read only about Indian private insurance was poor especially regarding claims during the first 3 years time where most of the insurance companies reject the claims basis of pre existing illness.

any other suggestions acc. to irdai report 14-15. i downloaded but didnt understand the report to compare health products