All you should know about health insurance before buying

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Last Comment 2023-12-03

2020-05-04

If you compare health Insurance plans on Insurance web aggregator (Like policybazaar), you will find almost same features in all of them. So, you might get confused & fall in trap of cheapest plan or suggested by agent without knowing complete policy wording. So, here I am summarizing all you should know about health insurance plan with emphasis on hidden Terms & Condition. 1) No Claim Bonus (NCB) / Multiplier Benefit This is the benefit Insurer gives to customer for not taking claim in single year. Unlike vehicle insurance policy where NCB benefit is in terms of discount in subsequent renewal, in health insurance majority of time NCB is in the form of increased in Sum Insured (SI) (Coverage limit of your health insurance). Points to Note: - Rate of increase in sum insured limit will differ in different plans of same insurer & also from 1 insurer to another. Faster the rate, better it will be. E.g. Apollo Munich (Now HDFC Ergo) optima restore plan gives NCB as 50% increase in SI - Max. cap of increase in SI. Higher is better. Some plan gives max. upto 50%, some gives upto 100% - Penalty for taking claim. Whenever you take claim in a year, your insurer will penalize you for it (Usually by reducing accrued NCB by same rate as of in increase). No penalty or low penalty is better. E.g. Max bupa doesn’t penalize for taking claim - Majority of PSU insurer (National, united etc.) don’t provide this feature. - Best thing about NCB is, Increased in SI has no extra terms & condition & it is equivalent to your base plan with higher coverage. So your policy should have this benefit. 2) Restoration benefit / Refill benefit Agents sell policy saying total 10 lac coverage (5 Lac base SI + 5 lac restoration). Restoration benefit means once your SI (+ NCB, if any) get exhausted insurer will refill same amount as base SI (like 5 lac) once in a year. All hidden Terms & condition lies here. So, read policy wordings & don’t rely on agent. Like, - Some insurer has T&C that - Restoration can’t be used in same person with same disease (Not even complication of same disease) E.g. – Max Bupa E.g. Person detected with cancer & total bill (In single claim or multiple claim – like in chemotherapy cycle) goes above 5 lac, still he can’t get restoration benefit. - Can be used in same person, same disease but with gap of minimum 45 days - Single claim in policy year can’t exceed basic SI + NCB (Indirectly saying restoration can’t be used in single claim however it can be used in subsequent claim with gap of 45 days) – E.g. Apollo Munich My take is, don’t fall in trap of this benefit. If they are giving it at no additional cost, go for it. Because you can use it for other family members. 3) Co-pay Co-pay is the amount in percentage you have to pay out of your pocket for every claim. Usually co-pay plan is offered at reduced rate compare to normal plan to attract people. But never go for any plan, which has co-pay. Beware: Some insurer have same base plan but if you opt for discount, they will convert it to Co-pay plan. E.g. Religare. Religare offers 15% discount to customer who opt for co-pay feature under their Religare care plan. Some of agents, Including policybazaar (Which will always try to sell Religare plan) try to attract customers by saying we will offer 15% additional discount without telling about this Co-pay. (I myself fall in trap of policybazaar, thank god I was saved my research. I do complaint against them on twitter too) 4) Zone/Geography base charges This might find unusual but many companies levi Co-pay charges if you change your Zone for treatment. Like if you have taken policy in Agra & if u want to hospitalized in Delhi, then you have to co-pay 20% amount. E.g. Hdfc Ergo policy In few insurer, it is optional to choose zone wise charges. Don’t fall in trap of it to save few bucks. Because agent might give you Zone B policy at lower rate & you might end up paying 20% co-pay for taking treatment in Zone A. Choose Insurer which don’t have such geographical/Zonal restrictions. 5) Life-long renewal without Co-pay Some insurer put additional co-pay terms for renewal after age of 60/65 years. Avoid such plans. 6) Sub Limit or Capping Many policy have sub limits on Room rent, ICU charges, capping on cataract, Knee replacement surgery etc. If ur bill goes beyond these permissible limit, they will deduct all charges on pro-rata basis & not alone room charges (Like doctor consultation, laboratory charges, OT charges, procedure charges etc.) Also keep in mind that these sum limit of Room rent includes – Room charges, nursing charges, injection charges, Ventilator charges (if used in ICU) etc. So better to choose plan which don’t have sub limits or capping. 7) Pre/post Hospitalization Higher number of days coverage, better it is. Like Apollo optima restore gives 60 & 180 days pre/post benefit compare to others who usually gives 30 & 60 days respectively. 8) Free health check-up Don’t get lure with this free benefit. This freebie shouldn’t be prime deciding factor while taking plan. If this benefit is there it is better. 9) AYUSH Benefit If you want to get treatment for Ayurvedic/Homeopathy etc. check Aysuh benefit. Some insurer provide Aysuh benefit for full SI E.g. Max Some insurer provide Aysuh benefit with some capping like max. 20k/50K E.g. Religare Some insurer don’t provide Aysuh benefit E.g. Apollo Imp Point: This benefit is only available for hospitalization in Government AYUSH hospitals or NABH accredited private hospitals. Only few private AYUSH hospitals take NABH. 10) Stay healthy Discount Very nice initiative by some insurers (like Apollo, Hdfc etc.). If you stay healthy they will provide you additional discount at renewal. For which you have to download app/wear digital watch & they will calculate daily walking steps & give discount slab wise with max. 8-10%. Those who are already doing such exercise daily, will get this discount & for others this discount will lure to be healthy. 11) Waiting period for Pre-existing disease Pre-existing diseases are covered after 3-4 years (Max, Apollo 3 years, Star 4 years). Shorter the duration better it is. While for slow growing diseases waiting period is usually 2 years. 12) TPA (Third Party Administration) Many general insurance companies (like National, United etc.) don’t have their own medical team to verify claim details & they rely on TPA for claim settlement. So, customer has to deal with TPA first for claim & then TPA approved amount released by Insurer. While some other insurer (like Apollo, Hdfc, Religare, Max etc.) have their in-house settlement team & don’t have TPA, which fasten the process of claim & refund. Go for companies without TPA 13) Daily Cash benefit Over & above your actual claim amount, some insurer gives daily cash benefit for miscellaneous expenses but with lots of T & C like - Admission should be in network hospital, Minimum stay 48 hrs., Room should be twin sharing room etc. & upper cap is also there, Not valid for ICU admission - However if this benefit is there at no extra cost, its good. 14) Exclusion There are some common exclusion in each policy, which many are not aware. - Admission, discharge, record section, RMO, Administrative, registration, service charge etc. (Many corporate hospital levy Administrative service charge at whopping 15% of total bill amount excluding medicines & these charges are straight away rejected in claim - Cosmetic surgery - Experimental, unproven treatment - Hospitalization just for investigation or diagnosis - Circumcision - War like situation, Terrorism, Hazardous activity – like Scuba diving etc. - Dental / Eye treatment like Laser - HIV, STDs - Alcohol, substance abuse - Assisted Reproduction (IUI, IVF etc.), birth control related procedures - Obesity & its complication (Keep this thing in mind, anywhere during admission if doctor writes your diagnosis as Obesity – case gone. Your claim will be rejected) - Maternity (Some plans do offer this benefit but has long waiting period of 3 years), infertility, birth control treatment etc. - Non-medical expense (like cotton, loose gloves etc.) - Apart from this common list, many insurer have added some more exclusions (E.g. Some Specific medicines are excluded) & some black listed hospitals. Do check for it in policy wordings or I have highlighted such comapny specific unique exclusion in my google spread sheet, u can go through it. Apart from these following are excluded in majority policy (Except Apollo has recently added it in inclusion list) - Neurological diseases like Parkinson’s, Alzheimer’s disease etc. - Stem cell transplant - Robotic surgery, LASER, Light treatment (Remember if you are living in metro cities then some of sophisticated hospitals do have Da vinci Robot & they use it frequently – but your insurance won’t cover it) 15) Availability of Insurer / TPA office in your city - In case of reimbursement availability of Insurer nearby to you will be helpful for documentation & if any query arises. 16) Network hospital list - Don’t just check number of hospitals. It will be more or less same in each insurer. But most important thing is to check whether these hospitals are well-known & according to your preference or not. 17) Individual Vs. Family Floater If you take Individual health insurance for each family member, it will be costly affair compare to taking Family floater. Suppose three are 3 persons in Family (2 Adult & 1 Child) looking for Sum Insured of 5 lac. Simple reason to understand cost difference is because in Individual policy Insurer is liable to pay max. up to 15 lacs (If all 3 gets sick & put claim), while in family floater Max. liability is only 5 Lacs. However, as per my opinion there is rare possibility (Unless in accident) that all of the family members need it at a time. So, better to go with family floater plan with higher Sum Insured at same rate as compare to Individual plan. In family floater plan children are allowed only till they reach 21 year of age (E.g. Max) or 25 year of age (e.g. Apollo, HDFC). 18) Pricing Majority insurer increases price of premium in the slab of every 5 year. Like for age 31-35 premium remains same then increases at 36 age which remains same till 40 years. However Max is following increase in premium every year by 100-200 rs., unlike sudden rise of premium with age slab changes. So do check it. 19) Top-up / Super Top-up plan Rather than going for higher Sum insured in base policy, one should go with super top-up policy if person feels that Base policy is inadequate. Because these policies are cheap. Again all hidden T&C are there in these plans. So read carefully before buying it. Top-up policy – As the name suggests, it is top-up to your existing policy. Lets understand terminology first. Deductible Amount – It is the minimum amount one has to pay (Either through base policy or through their own) to get triggered top-up policy. Sum Insured – In top-up policy sum insured includes base sum insured also. E.g. Your base policy is 5 lac. You have taken top-up policy of 10 lacs. Deductible amount will be 5 lacs Sum Insured – 10 lacs Actual coverage in your top-up policy – 5 lacs (10 lacs- 5 lacs base policy) Now Important T&C in Top-up policy is you have to pay deductible amount during each claim separately to get triggered Top-up policy. E.g. You have taken 5 lac base + 10 lac Top-up policy (Here Actual coverage in top-up is 5 lac) Case 1: You get accident & your bill goes to 7 lac. Here, in single admission you have used deductible amount (Of 5 lacs), your top-up policy will get triggered & remaining 2 lacs will get paid from top-up plan. Case 2: You get dengue & bill of 4 lac has been settled from base policy. Now you have 1 lac remaining in base policy + 5 lac top-up. After few months you get accident & bill becomes 3 lac. In this case your top-up policy will not get triggered. Because as per T&C bill should be more than deductible amount (here 5 Lac) in single admission to get triggered top-up policy. Difference between Top-up & super top-up policy is that in super top-up policy they calculate deductible amount cumulatively. So, in above case 2, super top-up policy will pay remaining 2 lacs but not top-up policy. Super-top up policy is somewhat costly compare to top-up. But always buy Super-top & not Top-up policy. For easy comparison of all features of different company’s plan at one place, I have made Google Spread Sheet. This sheet will help everyone to compare & decide best policy for them. Those dimers who want it can request it here or pm me. Also I am in the process of making another similar sheet for comparison of Top-up / Super-top plan & also for special need plan Like maternity, cancer, cardiac, senior citizen Etc. Disclaimer: I am doctor by profession but I have interest & knowledge in Finance. Prime purpose is to help people & prevent victim of mis-selling of insurance. If u have any query, ask it here or Pm me.

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Created by : Amit.Saha 2022-01-06

How to Choose the Right Health Insurance in India?

Best Health Insurance Buying Guide is here -

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https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6669208

smartfriend85

2020-05-17

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Very Good elaboration.

So you sell insurance policies?

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6669567

drjpatwa

2020-05-17

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Thanks.

Brother I have already put my disclaimer in 1 of the previous post. I m Doctor by profession. But i have interest in Finance & other things. Lockdown gave me spare time to post here in detail & now making spread sheet to make it more easier to compare. I haven’t recommended only single company in all my previous post. I give suggestion based on need of people & not advocating single product or company policy.
Yes I have taken sub agency to sell insurance policy of family member’s name. Those dimer who wants to purchase through me, I can give additional discount to them. But prime purpose is it make people aware about detail T&C of health insurance which they are buying.
Any problem in it brother?

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6670599

drjpatwa

2020-05-18

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What information I received today is – National Insurance has increased premium rate by whopping 50% & if now I compare rates of National Insurance with other private players in 60+ age, premium is more in National !!!

Also Apollo (Now Hdfc) has increased premium by around 25% in easy health plan & around 5% in Optima restore plan.

So this is the answer to some people here who were arguing with me when I told premium will increase where business is not viable. (I said SBI Arogya plan is good for old age people but premium won’t sustain at such low rate for long)

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6670608

iamshashikant

2020-05-18

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When increased? Psu bhi?

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https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6671472

devbehel172

2020-05-19

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In Arogya plus people can take policy of 3 years once and get long term discount too total premium for three years will be 24775
including all taxes and the i think 3 year option is better option if any body has doubt
People were doubting since 10 years approx on this policy till now nothing changed till now so use the best opportunity right now
u can port or either take new policy at above premium one year premium is 8927 including taxes and 15 percent Discounts and
disclaimer- dont expect any type of cash back as i cant offer any as i am a employee not a agent so cant offer any so kindly dont ask any and what i can provide is i can provide is mentioned above and my one of my friend is agents and insurance broker and they can provide you only cash back and Discount any applicable for other policies either motor,health,or life
I you want one can pm me….
BE wise Choose wisely….

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6671486

garv986274

2020-05-19

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Thanks for the insight

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6672736

drjpatwa

2020-05-19

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Just for clarification to all Dimers – Why I am saying that SBI arogya plus premium won’t sustain at this level

Total premium amount is 10500

- Remove 18% Gst from it – 8900rs. remaining

- Remove 15-20% commission – 7120rs. remaining

- Remove 20% for staff salary, TPA expense, Rental Offices, advertisement, miscellaneous expense – 5700rs. remaining

(This expense applies to all company & not only SBI)

So, total 10502rs. u pay, actual amount company has to settle claim is only 5700rs. Now for normal malaria, dengue, typhoid, diarrhoea we are seeing bill amount of 1 lac. How will they settle it? Rough calculation – Any one who take this policy & make only 1 claim of 1 lac within next 17 years then only company can bear it. Any frequent claim or more than this amount claim then from where money will come?

Just think logical & do some maths. How this rate is sustainable? Also remember it is subsidiary company of SBI. They won’t be getting direct support from government like some of other PSU getting. Also they are planning for IPO & within next 2 years, they will be listed on exchanges (like SBI life, SBI card etc.). If they are here for profit making then how they can bear loss in case of higher claim amount? Also do check their Claim incurred ratio – Whether it is stable or increasing. Once it will be above 100% be ready for premium hike.

I am here in DD since may be last 7 years & I will be here after 5 years also. We will check whether after 5 years, they are giving this policy at same rate or not…

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6672812

devbehel172

2020-05-19

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Doctor sahab dont be a Actuary SBI GIC dont only sell Sbi health policy we sell all general insurance products and ACTUARY know what they doing and at what price they are issuing policies and if you are a ACTURY and not a agent then please guide dont think you are more knowledgeable person than the people who are running insurance company.

Please dont provide provide your illlogical logics and they know more than you what they are doing and what products they have designed.
Do you know ABOUT AROGYA PREMIERE POLICY this policy is the answer to all your query like features you were providing check yourself and compare features and Premium too and for your Information this group is created for welfare of dimers and people and i am also a member of desidime and i have to right to express my feelings too..
disclaimer-
AGENT ARE NOT ALLOWED TO SELL AROGYA PREMIERE Policy
Only employees can sell Policy with 15 percent discount and For your information we can also provide Policy to single person say a lady for 10 lakhs at 9000 Rs approx With Maternity or Pregnancy cover,Air ambulance cover and Organ donor expenses tooo like optima restore and other benefits sum insured 10 lakhs.
Which No agent or broker Can provide that the reason agents prefer selling High Premium Policy as they are not allowed to Sell this policy of SBI AROGYA PREMIERE AND SOME OTHER PRODUCTS LIKE GHI and they are Digging holes in Peoples and dimers pockets
So Dimers be wise and choose Wisely…..
Some policies were made for the welfare of the people where product are designed at no Profit and No loss ratioes too Like PMSBY accident insurance 12 rs one and PMJJY Life insurance policy of 2 lakhs at 330 rs only… So dimers be wise choose wise
Listen to everyone’s advice, but take your own decisions.…

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https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6674470

mazaz1988

2020-05-20

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How is edelweiss Tokyo for term insurance, claim settlement ratio is 97.8%

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6691160

Manitian

2020-05-29

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Edelweiss is a fairly new player and it has been in operation only few years. Also of you check their counts, they are very less. Hence that would define the ratio. Obviously they are trying to go big in general insurance category.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6702096

drjpatwa

2020-06-04

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Health insurance update – I posted last time that Apollo Munich has increase rate by 5-25% in various plan.

In this revision, they have included many disease / procedure which were earlier in exclusion list like oral chemotherapy, stem cell therapy, robotic surgery, parkinson’s disease, alzhiemer’s disease, peritoneal dialysis, artificial life maintenance, genetic, mental disease etc.

What I was waiting for most – Monoclonal antibodies have also been added. (Routinely use in many cancer treatment) & same I mentioned in my comparison sheet with negative remarks.

A welcome step by company but with increase in premium…

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6702438

super_rock

2020-06-04

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Hi, my mom was detected with oral cancer in 2017 and was operated for the same and now is cancer free I just wanna ask is there any company that offers health insurance for such people

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6702623

drjpatwa

2020-06-04

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Check for star health cancer care plan.

If I will come across any other similar plan, will post it here…

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6703142

snipersharma

2020-06-05

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Any comparison for Super Top up? Looking for a deductible of Rs. 3 lac and sum insured of around Rs.10 lac. No co-pay.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6704160

drjpatwa

2020-06-05

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I m yet to make detail sheet on it. T&C of super top-up are more complicated than base policy…

It also depends on whether later on u want to convert super top-up into base policy, as only few insurer gives that option…

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6703176

samguru

2020-06-05

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You can buy manipal cigna plan …i got 20L cover with 3L deductible for a family of 3 at 999/year

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6704407

drjpatwa

2020-06-05

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Are u referring Ola money manipal cigna plan?

Don’t just go for cheap plan. Read T&C carefully bro.

If u r talking about ola money cigna super top-up plan then, For calculating deductible amount – They have written only hospitalization claim will be admissible. It means that u have to achieve deductible amount for only In-patient hospitalization claim.

Let me give u example. (for super top-up plan with 5 lac deductible)

In claim no. 1 – Suppose u have pre hospitalization amount (Diagnostic, medicine, doctor consultation) of 20k & hospitalization amount of 4.5 lac & post hospitalization amount of 30k. So total 5 lac used in this claim.

In claim 2 – u have to pay 20+30k by urself (pre & post hospitalization amount) & then only ur super top-up policy will trigger!!!

This is called hidden T&C. They will rob u at the time of claim. They made plan cheaper by just adding 1 word in policy wordings – hospitalization !!!

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https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6705365

s_u_r

2020-06-06

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मैंने medical insurance लिया है pnb से जो कि new india assurance से colaborrate है इसे लिए हुए मुझे 3 साल हो गाये है इस बार कैरोना की वजह से में बैंक नही जा पा रहा हूँ क्या मुझे इस साल का premium भरना चाहिए ?
या कैरोन के खत्म होने के बाद भारु कही मेरा insurance खत्म तो नही हो जाएगा ?

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6706348

drjpatwa

2020-06-06

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Usually insurance company gives grace period of 15 days. If u don’t pay even during grace period, ur policy lapse.

However due to covid condition, do check if they have given any extra time to pay (Like LIC did for life Insurance i guess)

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6705824

abcdpvk872

2020-06-06

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Kindly suggest a good policy for 5-7 lac cover ( 4 person) father (47) mother (45) me (20) sis (12)
Fam Floater

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6706754

devbehel172

2020-06-07

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https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6706779

devbehel172

2020-06-07

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Please check sbi general insurance top up and check features can provide Policy wording too check compare with super top up and buy
Its best for persons required for High suminsured
For example for people upto 55 years age any one have 10 lakhs policy opt deductable of 10 lakhs and take sum insured 50 lakhs premium will be 200 to 300 rs only please check policy wording and compare features with other company super top up before buying as per above communication above i think its better to opt for top up instead of super top up due to high premium and only hospitalization cover etc….
Be wise and choose wisely..
You Can pm me for any help…

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6707645

drjpatwa

2020-06-07

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There is some confusion among dimers regarding my previous post of calculating deductible. Let me clarify.

I have never said that super top-up policy doesn’t cover pre & post hospitalization. Almost all super top-up cover it.

Catch is – how they calculate deductible amount after which ur super top-up policy gets triggered. If they have mentioned only hospitalization expense in wordings then be prepared to give difference amount under the deduction head of – Threshold level not reached before triggering super top-up policy.

Now read my example again. Still any query or confusion is there, pm me.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6707802

drjpatwa

2020-06-07

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Guys if u have to choose Gun to shoot someone, what will u choose

1) A gun worth 300rs., but uncertain about triggered (late triggered, no triggered etc.) Or

2) A gun worth 1000rs. But certain about triggered?

Now corelate ur answer with Top up policy, cheap super top-up policy with hidden T&C & good super top-up policy.

Be smart & wise, don’t just go for cheap alone without reading T&C

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6707809

Baal_Narendra

2020-06-07

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https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6710711

drjpatwa

2020-06-09

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@MJ911
Need to update following things in 1st post. Kindly do needful.

6) 6th Point (sub limit on room rent)

Change title to – 6) Sub Limit or Capping

Change writing to – Many policy have sub limits on Room rent, ICU charges, capping on cataract, Knee replacement surgery etc.

If ur bill goes beyond these permissible limit, they will deduct all charges on pro-rata basis & not alone room charges (Like doctor consultation, laboratory charges, OT charges, procedure charges etc.)

Also keep in mind that these sum limit of Room rent includes – Room charges, nursing charges, injection charges, Ventilator charges (if used in ICU) etc.

So better to choose plan which don’t have sub limits or capping.

14) Exclusion

Remove point no. 2 (Neurological ….), 6 (stem cell transplant), 11 (Robotic surgery…)

Add following points in it

- Cosmetic surgery
- Experimental, unproven treatment
- Hospitalization just for investigation or diagnosis
- Assisted Reproduction (IUI, IVF etc.), birth control related procedures

Apart from these following are excluded in majority policy (Except Apollo has recently added it in inclusion list)

- Neurological diseases like Parkinson’s, Alzheimer’s disease etc.
- Stem cell transplant
- Robotic surgery, LASER, Light treatment (Remember if you are living in metro cities then some of sophisticated hospitals do have Da vinci Robot & they use it frequently – but your insurance won’t cover it)

19) Top-up / Super Top-up plan

In this section below the case 2 wordings over (Whole paragraph – this has to kept unchanged),
starting from ( After extensive research……… till last line of that post delete everything)

& add following thing

For easy comparison of all features of different company’s plan at one place, I have made Google Spread Sheet. This sheet will help everyone to compare & decide best policy for them. Those dimers who want it can request it here or pm me.

Also I am in the process of making another similar sheet for comparison of Top-up / Super-top plan & also for special need plan Like maternity, cancer, cardiac, senior citizen Etc.

Disclaimer: I am doctor by profession but I have interest & knowledge in Finance. Prime purpose is to help people & prevent victim of mis-selling of insurance. If u have any query, ask it here or Pm me.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6717551

drjpatwa

2020-06-13

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@MJ911

Some minor correction needed in 1st post.

In point no. 14 (Exclusion) – Assisted Reproduction (IUI, IVF etc.), birth control related procedures is written twice. Kindly delete 1 of them.

& Previously it was there but somehow deleted in above edit version. So, kindly add following lines in same point no. 14 (Exclusion).

- Apart from this common list, many insurer have added some more exclusions (E.g. Some Specific medicines are excluded) & some black listed hospitals. Do check for it in policy wordings or I have highlighted such comapny specific unique exclusion in my google spread sheet, u can go through it.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6717626

drjpatwa

2020-06-13

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Those people who are worrying extremely about claim rejection by company arguing Disease was pre-existing & not disclosed by insured person – Here is 1 good article worthing reading.

https://www.basunivesh.com/2020/06/10/health-in...

Conclusion is – You are liable only if you know that u had disease in the past & still u didn’t disclose it to company. If there was hidden disease which u weren’t aware about at the time of policy purchase, then u r not liable for it & ur insurer have to pay claim amount in such cases.

Also I have found 2 very good documents where insured person have complaint against insurance company for various reasons.

http://ecoi.co.in/GIC/mediclaim/Individual%20Me...

http://www.ecoi.co.in/GIC/mediclaim/Individual%...

It is kala chithha of all insurance company & those who thinks PSU is most generous to give claim, above 2 pdf will be eye-opener for them !!!

Don’t hide any information. Go with best company & still they reject ur claim (Bad luck) then insurance ombudsman, consumer courts are there to listen (Ofcourse its headache, that’s why we need to go with least notorious company.)

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6717734

ankitmania1394

2020-06-13

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Hi, i am planning to buy health insurance from universal sompo or SBI retail health insurance with no capping please suggest.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6717923

oot02wAI

2020-06-13

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How is Medi claim plus policy issued by Mobikwik in partnership with max bupa…?

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6718303

drjpatwa

2020-06-13

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I haven’t gone through details of this policy. But I would refrain myself from buying such group policy.

Recently we were discussing similar kind of ola money cigna policy. But T&C says policy exists only till ur active customer of ola. If ur account blocked by any reason, ur policy gone. So better check such thing before purchasing.

Also mobikwik’s existance in long way itself is questionable & only few company is accepting port request from such group policy.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6724980

drjpatwa

2020-06-17

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COVID-19 update:

Icici health insurance have shorten waiting period for Covid-19 cases from 30 days to 15 days for new purchase of policy.

Aditya birla health insurance have agreed to pay for PPE kits – Maximum 2500rs per day in wards, Maximum 5000rs. Per day in ICU.
Usually this charges are not payable in any health insurance policy.

A welcome step blush

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6733425

baadshah

2020-06-21

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How is the overall review of icici health insurance ?

Additionally option to enroll policy with Opd claims at extra premium
.
Rewards program if insured has gym membership, marathon participation and few other ways to earn tiny rewards
.
No cap on room rent

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6734329

drjpatwa

2020-06-22

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Heard good reviews of Icici. Although I haven’t read policy wordings so can’t comment on it (Need to check features, exclusion, pricing etc.).

Kindly pm me brochure & policy wordings, if u have. I will read it & revert back.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6734513

baadshah

2020-06-22

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https://www.icicilombard.com/docs/default-sourc...

you can add this company to health insurance comparison.
3 products they have
iHealth Budget
iHealth Value
iHealth Plus

View 5 more replies

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6734805

Thunder766

2020-06-22

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How’s GoDigit health insurance? Has anyone tried them out?

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6735365

baadshah

2020-06-22

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something new way of setting the limit for Post discharge.

Post Hospitalization Lumpsum
The lumsump amount for the same will be 1.5% of your approved claimed amount.

View 2 more replies

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6737023

harshm124

2020-06-23

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Plz share/pm me the spreadsheet link

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6737725

vijay518

2020-06-23

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Check, Manipal Cigna health insurance, I have taken this insurance Pro Health Insurance Policy… comparatively better..

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6738054

Manitian

2020-06-23

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I have same, and works out pretty good for me after 2k OTC claims per person per year.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6749291

rovio.29

2020-06-29

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Will there be waiting period of 30 days for all policies
https://www.policyx.com/health-insurance/star-h...
?

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6749503

drjpatwa

2020-06-29

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Except for accident, all other diseases have minimum waiting period of 30 days in all policy.

View 2 more replies

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6749651

rovio.29

2020-06-29

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Thanks .
Also which one do u suggest for a family ?
Looking for a premium of approx 25 L .

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6749671

vasanth_ece

2020-06-29

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I need to take policy for my father.He has done angioplasty 3 years back and he is 62 years old..No other pre existing disease…I tried star health cardiac care plan,but they asked to go for comprehensive plan which I rejected since too expensive.

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6750148

drjpatwa

2020-06-30

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For pre-existing cardiac disease, I am only aware about Star health cardiac plan. Cardiac care plan has very less waiting period while comprehensive plan has higher waiting period too.

View 1 more reply

https://www.desidime.com/discussions/all-you-should-know-about-health-insurance-before-buying?page=4#post_6756438

r3d-d3v1l

2020-07-03

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@drjpatwa Thank you for your wonderful initiative; really appreciate it. Would you be kind enough to share the link to the spreadsheet that you created? Thanks!