OUR BOOKS

16 personal finance principles every investor should know how to be your own financial planner in 10 steps 11 principles to achieve financial freedom

How to choose Medical Insurance Policy ?

by Manish Chauhan · 186 comments

Does premium amount guide your decision on whether to buy a medical insurance policy? No. Premiums are not the only factor to consider when buying a medical insurance policy. These factors need to be taken into consideration before looking at the premiums.

1# TPA (Third Party Administrator)

These days, companies have an in-house settlement process and thus do not outsource their settlement processes to outside TPA’s. Why do we need to look at a companies providing an in-house settlement process? This is very much-needed in case of cashless settlements. Settlement processes are easier when handles in-house. Also make sure, that the company’s in-house settlement process is in your own city or in your own state. (TPA list in India)

Some of the General Insurance Companies having In house TPA’s are :

  • Bajaj Allianz General Insurance Company (Basic)
  • Star Health And Allied Insurance Company
  • ICICI Lombard
  • Max Bupa Health Insurance

2# Network of Hospitals

The next really important factor, is the network hospitals of the company. In case of a hospitalization, the hospital that you would visit should be there on the Insurance company’s network hospital list. Not only the number, but the quality of the hospitals should also be taken into consideration.

Eg:- If you fall ill and need to get admitted, which are the first few hospitals that you would go to in your locality? Check, if these hospitals are part of the Insurance company’s network hospital list.

3# Relation of the Insurance Company with the Network Hospitals

It’s important to note, how fast the Insurance company/TPA makes the settlement with the Hospital in case of cashless hospitalizations. This is a major factor, but only few of us understand its importance. The Insurance company may provide us cashless hospitalization, but if the Insurance does not settle the Hospitals claims on time or only has a partial payout, then there’s an increasingly likely that the hospital will increase your bill to claim the amount. If the company pays the claims on time and in full, then the Hospital would not try to increase the bills as they know, that particular insurance company is a prompt paymaster.

See how your Life + Health Can be covered for less than 5% of your salary

Family Floater or Individual Cover Policy ?

For people who do not understand Individual and Family Floater Policies please read about it here. Most of the people think that Family floater’s are always the best choice compared to Individual health plans, which is totally wrong. Your requirement and your situation, should guide your decision, on which kind of cover, you should choose. There are many problems which buyers do not have any idea of. They do not care to read fine prints and get nasty surprises after many years and at crucial junctures. (compare Health Insurance)

Features of Family Floater Policies

  • Turns out to be cheaper for younger families and less maintenance, as there is just one single policy for every one .
  • Limited cover for other members in family, if one person claims health insurance in any given year .
  • The Policy expires on the death of the oldest member of Family or if he/she reaches the maximum age of renewability, depending on the policy. So 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.
  • Only immediate family members are included in the policy, not your parents or siblings. So it does not suit people with dependent parents or siblings in family.
  • When Children turn 25 , then they are not part of policy and will have to take a fresh policy. Apart from this, any pre-existing disease will not be covered at that time .

Features of Individual policies

  • Extra maintainance of each policy separately.
  • Turns out to be generally costlier than Family Floater plans
  • Lower coverage for each family member at the same cost of Family floater in case of single claim in any given year.
  • There are no age restrictions on the maximum age for the members for renewable.
  • You can avail the benefits of Loading and Discounts until the policy lapses.

Hence, a Family Floater will not suit a Family where the oldest member is in his 40’s and they are more prone to health issues. However, younger families might want to consider Family floater plans as they are less prone to health ailments and can afford lesser premiums in the beginning. Look at Harsh Roongta talking about Family Floater Vs Individual Plan in following Video

How much of Sum Insured would be sufficient ?

Do you know, what disease you could be diagnosed with tomorrow? So you can never say that Rs.1,00,000 cover is sufficient :) The basic rule here, is to take whatever you think you can afford. If a person can afford say Rs.5,000/- as the premium per year, check as to how much of Sum Insured he would get, and take the amount of insurance offered. That would be sufficient to cover at least some risk. So never think, that you cannot afford any medical insurance policy. Take what you can afford, so that at least you know that you can be rest assured, that you have covered some risk.

IMPORTANT: It’s never too early to take medical insurance and critical illness policy, because once you are diagnosed with any illness, then the insurance company will have the liberty, of not issuing you an insurance policy. So take it as early as possible and have your risks covered.

Comments ? What are the other difficulty or doubts from investor point of view to select a medical policy ?

Want FREE HELP in buying right health insurance policy for you ? Get Free Help Now


Subscribe via RSS or Email:
What do you want to read about
Mutual Funds Life Insurance BankingHealth Insurance Credit Report and ScoreMost Commented ArticleReal Life Experiences Share MarketLoans Real Estate Income TaxCredit Cards For Begineer Investors Succession Laws EPF ULIP Product ReviewsBest of Jagoinvestor Other Products & Concepts How-TO GuidesBooks, Launches, Initiatives Investors Myths Psychology & Wisdom PPF General  
Buy Jagoinvestor Books in Ebook Format

{ 186 comments… read them below or add one }

1 S K Sagar June 13, 2010 at 8:10 am

I am planning to buy ICICI Prudential Health Insurance Family floater policy ? How is that , I don’t understand any thing about health insurance, at our family we don’t have any health problem, I am thinking paying Rs 27000.00 per year is more.

Reply

2 Manish Chauhan June 13, 2010 at 9:07 am

S K Sager

Its tough to comment on policy per se, however why 27k ? How much of cover its providing and for how many ? Read recent article please

Manish

Reply

3 S K Sagar February 20, 2011 at 4:10 am

ICICI Prudential Health Insurance (Health Saver) -sum assured Rs 5,00,000/- and I have paid already two years 27,000/- but till now no claims by any of our family members towards medical expenses etc., .I am think should I continue with this policy or switch some other policy .
Please suggest me.

Reply

4 Manish Chauhan February 20, 2011 at 12:49 pm

SK Sagar

Health insurance is for long term , you will loose the benefits of existing diseases etc if you switch right now , i think you can wait till July 2011 , when portability will come in, then you can switch to other health insurance

Reply

5 pattu June 13, 2010 at 11:35 am

Manish,

I have a individual mediclaim from United India. One of the important things is to look for sub-limits on room rent etc. and choose a polity which has minimal sub-limits.

I feel its better to go for trusted companies like United India, Oriental Insurance, National insurance and not trust private companies: The main reason is number of claims: Unlike life insurance, medical insurances has lots of claims. If the company honours everyone of them they would run in loss which is indeed the case for many companies in India. Hence its best to go with ones with govt backing. I am very happy with united Indias and TPA’s TTK health care service

As regards critical illness opinion is divided on whether to take individual policy or as rider with term insurance. Also one can claim for only few illnesses.

I have an group mediclaim which offers a small critical illness cover. I feel that it is most important to build a health corpus either by MFs or buying health-Ulips which can be complementary to a mediclaim. Health-Ulips are still in their infancy and hopefully with evolve with time in terms of benefits etc.

Reply

6 Manish Chauhan June 15, 2010 at 4:39 pm

Pattu

Thanks for your views . Health Insurance is tough to choose in todays environment and given so any choices . What policy do you hold and what kind of people does it suit for ? Can you give a brief overview .

Manish

Reply

7 sachin March 7, 2011 at 12:28 pm

Agree with Pattu. It is better to go with nationalized companies as these companies will be there in market for long, same may not be true for private.

Reply

8 shyam June 13, 2010 at 12:17 pm

Hi all,

with respect to medical insurance its better if we take the medical insurance from banks rather than directly from the insurance. The advantage is that the insurance from bank will be like group insurance and that keeps your premium very low compared to if you take the policy directly. you need to have an account in the bank in order to take the policy and the premium will be paied through your bank account. check the banks like 1) bank of india 2) bank of borada(best for senior citizens because they will give policy till 80 years) and indian overseas bank. in order to maintain an account you need very less amount also unlike private banks where you need to maintain certain amount quarterly. check out!!

Reply

9 Manish Chauhan June 13, 2010 at 10:56 pm

Shyam

But how do we buy from Banks ? Health Insurance products can only be sold by General Insurance or pure Health Insurance companies . Do you buy from Banks ? Its not possible .

Manish

Reply

10 Shyam June 14, 2010 at 3:06 pm

Manish,

The banks have developed co-branded insurance products for the account holders. e.g. Bank of Baroda have the tied up with National Insurance to offer”Baroda Health” (Mediclaim Insurance Policy)” for their account holders

In the case with Bank of India it is “BOI National Swasthya Bima policy is a unique Health insurance Policy designed especially for the Account holders of Bank of India. The entire family consisting of the account holder, spouse and two dependent children can be covered under this policy”

Please see the links for details:
1) http://www.bankofbaroda.com/pfs/barodahealth.asp
2)http://bankofindia.com/swasthy.aspx

I have taken the BOI National Swasthya Bima policy for my mother. The good feature I found is that the premium is very low compared to if you take the policy individually from these or other insurance companies.

Let me know your thoughts!

Reply

11 Manish Chauhan June 15, 2010 at 4:41 pm

Shyam

This is a very good idea , I didnt knew about this thing. Its like a specia product designed for a class of people . Will have to study further on this . Keep us posted on these things :)

Manish

Reply

12 mukul June 16, 2010 at 12:20 pm

Andhra bank is also having some health policy

Reply

13 Krishna June 16, 2010 at 7:35 pm

Manish,

Even Canarabank provides the Mediclaim Policy in partnership with United India Insurnace but the premium wise Bank of India is the cheapest one. I have downloaded the Document of Canarabank I can provide if anyone needs it.

Reply

14 Jithesh June 24, 2010 at 10:08 am

Following Banks have this option
Syndicate, Bank of Baroda, Canara, Bank of India. NMGB (small bank in north kerala)
You need to be account holder in any of branch.. Fact is many bank managers of these branch does not know of these policies :)
I went into canara, and Snr Mgr /Chief Mgr had no clue and confirmed there is no such policy where as it was there as per their website. So do you homework well.

Within these there are 2 types 1) One covering member and family 2) One covering family (wife and children) + Dependent pararents. As said before premium is low compared to buying directly.

Some of these policies has built in accident protection. So in unfortunate death, they pay a percentage of sum assured depending on relation (bank acc holder – 100%).

There is also another cheap policy 450 Rs premium for 30K Rs coverage by most of the general insurance company but cap for each time is 5K. Though this is not a good option, one with extreme tight situation (money wise) can take this but for around 900Rs we can get 50K coverage pa on any of the above policies though.

Reply

15 babu June 25, 2010 at 10:18 pm

check out Punjab National Bank Policy called royal mediclaim in association with Oriental Insurance. Details are available in my website. This one offers floater cover upto 5 lacs and entry age is upto 80 yrs[Bank of baroda entry age is upto 65Yrs--but cover upto 80yrs]. i am an advisor and i feel this is the best health policy till date. but portability is the issue. what if the bank chose to close the policy after some years. The waiting period cannot be ported to the new policy. We are awaiting the portable health policies.

Reply

16 Manish Chauhan June 26, 2010 at 11:19 pm

babu

Great . Thanks for the info :) . Can you give examples of other policies which are portable .

Manish

Reply

17 Sohil June 26, 2010 at 10:27 am

Even our family has a floater mediclaim insurance of oriental insurance…
Its via jagruti club…which gives insurance to needy people who cant afford…
Their maximum coverage is 1 lakh rupee per family for 6 members…though a basic skeleton is shown but most of it doesnt follow and can still use the insurance
The amount is 1750 for whole family…Its via RAksha TPA

Reply

18 Manish Chauhan July 24, 2010 at 6:14 pm

Thanks for providing your information , keep commenting

Reply

19 premal September 12, 2011 at 4:46 pm

how one can avail insurance through jagruti club???

Reply

20 premal September 21, 2011 at 7:58 am

kindly send me details of jagruti club thank u

Reply

21 Manish Chauhan July 26, 2010 at 10:48 am

Jithesh

Thanks for the information , I am sure there will be people for whom it would be beneficial .

Manish

Reply

22 deepaliaggarwal October 6, 2011 at 12:29 am

yes please provide 4 me

Reply

23 Dhawal Sharma August 23, 2010 at 7:37 pm

Sorry for being so late in commeting to this thing :-(

Dear Shyam, i was just going through the broucher of SWASTHYA BIMA YOJNA for BANK OF INDIA customers from NATIONAL INSURANCE and wants to bring certain HIDDEN FACTs from policy to you, more so because you have taken it for your mother..
1) First thing, it says coverage upto the age 85 with 25% LOADING of premium..Loading is extra amount which you would have to pay, come what may..So it may sound reasonable and low premium but it is bound to INCREASE and become EXPENSIVE :-(
2) Cashless facility in NETWORK HOSPITALs through TPA..As you must have seen or read now a days in newspapers, these PSU companies have stopped cashless facilities in TOP-END Hospitals like MAX, APOLLO, ESCORTS etc..So God forbids, if you have to take your mother for any kind of treatment, these hospitals will not be there to help you..
3) REIMBUSTMENT through TPA..Claim settled through TPA charge 10.38% SERVICE TAX which in effect reduce your cover by the same percentage..For eg: claim is Rs 100000 and through TPA with its service tax becomes Rs 1,10,000..The PSU mediclaim company or TPA is not going to pay this Rs 10,000 from there pockets..What they’ll do is reduce your claim by Rs 10,000 meaning if you put forward claim of Rs 1,00,000 only Rs 90,000 will be reimbursed..Bad deal :-(

Just an okay policy, launched in collaboration with a BANK, just to boost certain numbers by luring innocent bank account holders..nothing more..

Reply

24 Navin Kapur January 17, 2012 at 1:31 pm

I respectfully disagree with what you have said. The policy does not have any capping as is in case of other policies which is the best feature. Moreover, now Companies pay the amount of service tax in addition to the claim amount over and above the insured value even

Reply

25 Ashwini June 13, 2010 at 3:42 pm

Hi,

As NRI’s do you suggest we go for a medical insurance in India…currently we do have a medical insurance cover in the country we reside..As of what i know(correct me if im wrong)all critical illness and other medical insurances have a term of max 5 yrs in India…so guess it wud not make sense for us to buy a medical insurance at this point of time as we do not have ne plans to settle back in India in the near future…

Please let me know your views on this and if there is any other medical insurance which covers you for 20-25 yrs

Reply

26 Manish Chauhan June 13, 2010 at 10:58 pm

Ashwini

Yes , it would make sense to buy Health Insurance in India from cost point (have to find more) . also you can always renew it every year or after two years , Have you come across policy which you can take just 5 yrs and then not renew it ?

Manish

Reply

27 Ash June 14, 2010 at 5:36 pm

No have not seen any such insurance which is not renewable given my age…But guess these medical insurances have a age limit till which they can cover.
So you are saying,if we buy it now and keep renewing it after the term gets over the premium cost will be much lower….But,even if we renew it the cost will definately go higher as we age/ if we have ne other medical illness(at that time) …
If i buy insurance now,will be away from India,will not avail the insurance …pay premium and again renew it at the end of term……..
Will the diffrence between the premium of Renwed insurance and fresh insurance be the same or lower .(after a period of say 5 yrs)

Reply

28 Manish Chauhan June 15, 2010 at 5:15 pm

Ash

Definately it will be different . Its like term insurance , If your premium is Rs XYZ today , then even after 3 yrs it will be same as Rs XYZ , but if you take it fresh after 3 yrs, the premium will be Rs XYZ + something .

Definately taking insurance early will help you in premium part :)

Manish

Reply

29 Anunay June 17, 2010 at 5:06 pm

I have a point here, in term insurance same premium is guaranteed till the policy expires/matures, however in health insurance premium can change everyyear and premium rate is guaranteed for 1 year only in most cases.

I had Reliance healthwise policy issued last year in which i paid Rs 3900 for 5 lac cover for family floater which included my wife, now at renewal they are asking for Rs 13600/- this year. yesits not spelling mistake they are asking for Rs 13600 i.e. around 4 times of last year premium rates.

Reply

30 Ashwini June 17, 2010 at 9:53 pm

Hey ,thanks a ton for your responses ya…really luv your site…its really very informative for newbies like me :) have been reading your archives and glued to your site in free time :D..am luvin it :)

Reply

31 Ashwini June 17, 2010 at 9:55 pm

Hey ,thanks a ton for your responses ya…really luv your site…its really very informative for newbies like me have been reading your archives and glued to your site in free time ..am luvin it

Reply

32 Manish Chauhan June 20, 2010 at 4:51 pm

Ashwini

Great to hear that, be in touch .

Manish

Reply

33 Rakesh June 13, 2010 at 3:44 pm

Manish,

I am satisfied with National Insurance Company though they took over 2 months to settle my claims. Also had a good experience with TTK.

Rakesh

Reply

34 Manish Chauhan June 15, 2010 at 5:18 pm

Rakesh

Nice to hear that :) . TTK is known for good service and National Insurance is one of the best in general insurance companies .

Which policy do you have , please share .

Manish

Reply

35 Raja June 14, 2010 at 10:42 am

Hi Manish,

I had sent you a mail with subject line ‘Enquiry about your CFP services’ from the same email id as mentioned here on last Sunday afternoon.

Can you kindly revert.

Regards
Raja

Reply

36 Manish Jagtap June 14, 2010 at 11:16 am

Is there any reliable website where we can read reviews or customer feedback of various Health insurance companies? Whether there are frequent customer complaints or not?

Reply

37 Manish Chauhan June 15, 2010 at 6:07 pm

http://www.consumercomplaints.in/ and http://www.mouthshut.com/ are two sites where you can read reviews and complaints :)

Manish

Reply

38 Manish Chauhan June 15, 2010 at 5:21 pm

Will mail you soon .

Manish

Reply

39 Sagar Pednekar June 14, 2010 at 12:32 pm

Hi Manish,
My company provides me Bajaj Allianz Medical Policy from last 2 years and there settlement record is very good no complaints from any employee.
Our previous Govt. Medical insurance track record was very bad, claim not settles.
I personally suggest don’t buy govt. company medical insurance policy.
Sagar

Reply

40 Manish Chauhan June 15, 2010 at 6:12 pm

Sagar

There are mixed reactions , some people like Govt companies, you might want to debate with Pattu

Manish

Reply

41 Manish June 14, 2010 at 2:47 pm

Can u give some detail on Health Insurance rider with Term insurance………?

Reply

42 Manish Chauhan August 7, 2010 at 2:36 am

Manish

What exactly u want to know , there are many riders like Critical illness or waiver or premium riders with term insurance .

Reply

43 Nilesh Panchal June 14, 2010 at 7:48 pm

Selecting a Mediclaim Insurance Policy is definitely one of the important task, because like Life Insurance Policies there are now many competitors in the market offering this product with little bit of variants. One of the important point to note is about the Co-Payment. There are few companies who requires to pay a Co-Payment before they settle the claim and this amount varies from 5% to 20% from company to company.

Mediclaim is also offered by Life Insurance Company which comes at a high cost.

Reply

44 Manish Chauhan June 15, 2010 at 5:32 pm

Nilesh

Co-Payment should be taken as a positive thing I think . Its just to make sure to keep a check on the claim amount, a lot of time people dont care how big it is as they dont have to share any amount .

Manish

Reply

45 Abhiit June 15, 2010 at 12:04 am

Hi Manish,
My company has provided me Medical policy of TTK for my self and my dependents and cover is up to 5 Lacks per annum, I am 25 years old now. Do I need to go for separate medical policy ??

Please suggest.

Thanks

Reply

46 Manish Chauhan June 15, 2010 at 5:57 pm

Abhiit

TTK is just a TPA , health insurance company will be some one else .

5 lac cover is a very good cover , just make sure that the policy fulfils your need or not . I think you can do with company cover for now :)

Manish

Reply

47 Anunay June 17, 2010 at 4:57 pm

Fine that company has provided the health cover but what when you leave the company and join another company after 15 years, or you retire? entering late for a health cover will not be costly? will not insurance company demand higher premium if you enter late and god forbid if we suffer from any disease like BP, diabites etc. In my opinion its always better to have self financed family floater policy in addition to cover provided by our employer.

Reply

48 Manish Chauhan June 17, 2010 at 5:05 pm

Anunay

While what you say is true, I said that “for now” he can do without Seperate cover ,reason being that he is adequately covered for now .

As you said , his premium will he higher later , but for these years he will also save on premiums. Not getting a seperate cover is desiarable and a good option. however I what I meant was that he can do with this existing company cover for now .

Manish

Reply

49 Manoj July 10, 2010 at 9:42 am

Dear Manish

The suggestion you have given for continuing with company policy, is not apt for employees. Suppose the person parts with the company, GOD forbid, if he needs medical help, then either he has to bear the brunt of high fees or even if he goes for some policy at that age, the pemium would high as compared to that if he takes at yonger age.
Its always advisable to take a personal health cover even if the company is giving so.

Regards

Reply

50 Manish Chauhan July 10, 2010 at 11:33 am

Manoj

Its generally advisable always what you are saying , even I suggest it generally , however in real life , its very rare that a person leaves a job , sits at home without a job for some months and then join another job , so even though there can be few days of gap and there is risk involved there , its a small one and depending on a person risk capability a person can take that risk , only if a person is adequately covered with company policy , no compromise on the amount of cover .

Manish

Reply

51 Saurabh June 15, 2010 at 2:02 am

I want to have your suggestion regarding ICICI Health Saver. I have taken it for my family and am paying 15K / annum for Rs 2 Lac. Hows it?. Its Linked to the Market.

Reply

52 Manish Chauhan June 15, 2010 at 5:40 pm

Saurabh

Basically its a ULHP it seems . We dont recommend Market linked products . more analysis is required :)

Manish

Reply

53 Shyam June 15, 2010 at 5:47 pm

I have taken Apollo Munich’s Family floater plan, I have paid two premiums(yearly..), I have not yet claimed. The hospital chain provided by them is good, and they are also having in-house TPA.
There is any age limit for this mediclaim policy, i.e one advantage I see.

Reply

54 sarita June 15, 2010 at 6:07 pm

Nice one

Reply

55 Murali August 2, 2010 at 6:14 pm

Apollo Munich depends on a TPA (Family Health Private Limited (FHPL)) and claims are not dealth in-house. I too have a Standard Plan from them that I took recently.

Reply

56 Mukul June 16, 2010 at 12:18 pm

Manish
Good to see that you keep your word. I really appreciate that.
I agree with what Pattu has said by checking on sub-limits.

All the providers more or less offer a cap of 1% or 1.5% of Sum assured for room charges etc.
These caps can handicap a family when it comes to settlement of bills. Check any decent hospital and you will find that a private or semi-private room cost 2500.00 more or less (am taking a and b cat cities)so 3 lakhs cover with such a limit makes no sense.
also there is limit on ICU charges.it is usually double of the charges mentioned above. Again ICU charges in any hospital can be more.So it makes sense to read it all and do calculations before hand.

I found the offerings from United India and Royal Sundaram to be very competitive. Also Max Bupa was good.

I am of opinion that in addition to a family floater one should go for critical illness cover.The premuims are very less.I checked the one with Bajaj Allianz.

I have one doubt here. If one has more than one health policy, and if he incurs expense more than single policy coverage how will it be treated.

Reply

57 Manish Chauhan August 7, 2010 at 2:38 am

Mukul

In that case its distributed amount the insurers in the ratio of cover .

Manish

Reply

58 mukul June 16, 2010 at 1:26 pm

another thing is that, if a bank is providing a policy like bank of baroda or andhra bank are then premuims are less compared to others. check the premuims for arogyadaan scheme by andhra bank. family floaters are cheapest so far by what i have seen.also bank of baroda is good but i could not check the premuim chart.it seems even axis bank is providing critical care (bajaj allianz is their partner in it).check it out guys for others details.

Reply

59 Seema June 16, 2010 at 5:46 pm

Manish

For those persons who are suffering from some disease already,will it be a good idea to build a corpus for medical expenses through mutual funds?Should profit-booking be done regularly in such case to build a corpus for emergency needs?

Reply

60 Manish Chauhan August 7, 2010 at 2:40 am

Seema

It would be a good idea to build corpus for old days , Health insurance companies wont provide coverage for those , and even if they do , it would cost too much .

Its not advised to time the markets and liquidate the money , better let it grow .

Manish

Reply

61 dr kishan June 17, 2010 at 2:16 am

manish
good that u picked up this issue. its very necessary that the indians are enlightened about this topic. the video was very educative and helpful. shyam’s suggestion regarding taking mediclaim by banks is really a commendable one.
in this matter please elaborate what are the disadvantages of taking policies like health protection plus of LIC and similar unit linked health policies. one advantage i know is that the premium doesn’t change over the years as it would in other plans. secondly the money which we give is linked to market which makes it work for us as compared to the other policies where the money is just utilised for the health insurance.
are these type of policies very costly as ULIPS are ? are there any other disadvantages? please elaborate
can we take the risk of paying a costly premium for the probable benefit of our money growth? isn’t LIC more dependable than other institutes with respect to claim settlement?
ur comment is eagerly awaited

dr kishan

Reply

62 Manish Chauhan August 7, 2010 at 2:41 am

Dr kishan

wait for more articles, I would write more in future.

Manish

Reply

63 Rahul Bajaj June 20, 2010 at 1:30 am

Hi, I plan to buy a new policy for myself. Please suggest the better ones in the market now, How is maxbupa , apollo munich and starhealth ? i have a 30 % no claim bonus which can be transferred from the old policy which was part of the family floater plan. Also i want my parents to change their policy from new india insurance to a better one, please suggest on that as well. they have a 50% no claim bonus. Also can only 20% be transferred from the old policy to the new policy ?
It will be also great if i can talk to someone who is more knowledgeable about health insurance industry, as its difficult to get the truth out from the agents.
Thanks

Reply

64 Manish Chauhan June 20, 2010 at 12:19 pm

Rahul

What are the existing issues with your current policy and why you want to change ?

Manish

Reply

65 Rahul June 20, 2010 at 1:31 pm

Hi Manish, thanks for responding
The existing policy is with new india assurance, and i am looking for a change as i have read complaints about the TPA online and the last time i saw at Indian Spinal Injuries Centre that they don’t accept raksha TPA( was considering for some treatment for my dad). So i started thinking that if such good hospitals are not on its panel then what’s the use. And as it is time to renew for my parents and for me to get a separate policy after turning 26 now, i would like to compare and shift to better options.

Reply

66 Manish Chauhan June 20, 2010 at 4:34 pm

Rahul

In that case its a good choice to go for seperate policy and change it . Make sure the coverage of hospitals is nice and spread across city .

Manish

Reply

67 Rahul Bajaj June 20, 2010 at 5:56 pm

Ya that’s the conclusion i also came to, but which one is better ? out of the choice we have got.

Rahul

Reply

68 surya June 21, 2010 at 12:46 pm

there is life insurance & health insurance…but do we have any policy that covers life if you are unable to continue work & earn…health crisis or permanent disability due to accident or health..like a coma or stroke…yr life insurance for which u paid thru yr nose will say, you are alive …. yr health insurance will treat you to a certain extent & will vanish……unfortunately you have paid, planned for calamities like death & illness but not for this…
consumer illiteracy on this is helping insurance companies go scot free without providing any such clause…IRDA & SEBI needs to look into this…not only turf violations regarding ULIPS….

Reply

69 Manish Chauhan June 21, 2010 at 5:16 pm

Surya

What you say makes sense, Accidental rider solves this to some extent but not fully . It will cover a person if a person becomes partial or fully disabled .

Manish

Reply

70 Tushar Khirwadkar August 7, 2010 at 9:46 pm

What you have mentioned makes a lot of sense and the need to insure this situation is of more importance than death (as you will have extra expenses of total disability of the breadwinner who may not be the breadwinner and all regular family expenses will continue in future).

I am also looking for such Insurance coverage and found Tata-AIG’s Income Guard policy that fits this need to some extent and good part is it can cover family as well (as any other member of family would also need to be insured for disability).

Though there are quite a few things in this policy that are not clear (I have sent email to Tata-AIG to clarify the same). I am also trying to check if there is any other good option to this policy.

Manish / All other Jagoinvestor readers: Please provide your inputs on any other good poalicy available?

Regards, Tushar

Reply

71 Manish Chauhan August 7, 2010 at 10:40 pm

Tushar

I will come up with some reviews , but it will take some time :)

Manish

Reply

72 Neeraj June 21, 2010 at 2:57 pm

Nice article. I’m also in the process of finding a suitable mediclaim policy for my family. Though I’ve cover provided by my employer, but this year when we renewed the policy, the premium amount was almost double as compared to last year (around 18K for a family of 5 for 4 L of family floater). Would like to see people sharing their views and recommendation about Mediclaim policies specially for the senior citizens.

Neeraj

Reply

73 Manish Chauhan June 21, 2010 at 5:14 pm

Neeraj

Almost double ? DId you guys have any claim in this year or anyone developed any disease in between . Did you try to get some reason from company for increase in premium ?

Manish

Reply

74 Neeraj June 22, 2010 at 3:32 pm

Well, the insurer says that major reason is manyfold increase in number of claims.

Reply

75 Rupali June 22, 2010 at 1:57 pm

Hi Manish,

I m covered with the Company Mediclaim whrein i am liable to pay 10% medical expenses and rest is by company. As a rule its never too early i m thinking of mediclaim and i recd call for HDFC ergo which has following features and the monthly premium is around Rs.376 and yearly 4512. i think its family floater but as i m single yet what should i prefer. Pls suggest and for what more features i should i ask for? Whether to for invidual and Family floater. Should i go for this orelse search for others.
Covers Self, Spouse, Children & Family Floater
2. Hospitalisation Cover 2 Lacs
3. Pre & Post Hospitalisation Expenses 60 days Prior and 90 days Post
4. Personal Accident upto 10 Lacs
5. Hospital Cash Rs.1000/- Per day ( Max of Rs.30000/- for 30 days) Only to the seniormost adult in the Policy
6. In Patient Treatment or Specified Day Care
7. Ambulance Charges Upto Rs.2000/-
8. Covers Domicilary Treatment
9. Covers Non Allopathic ( Ayurvedic & Homeopathy ) Upto Rs.20000/-
10. Organ Donor expenses covered
11. Pernanent Total Disability Cover of 12.5Lacs

Reply

76 Manish Chauhan July 26, 2010 at 11:12 am

Rupali

You should not take family floater if you are just 1 person , the benefits is something you should be deciding , no one else on your behalf can decide that for you .

Manish

Reply

77 ABHI June 24, 2010 at 12:41 pm

Hi Manish,

Please add ” Max Bupa Health Insurance” to you list of
the General Insurance Companies having In house TPA’s

Regards
Abhi

Reply

78 Manish Chauhan June 24, 2010 at 1:05 pm

Abhi

Thanks for the update , I have added it .

Manish

Reply

79 Martha July 6, 2010 at 11:39 pm

I have mediclaim from ICICI lombard provided by my company for 1L. As you know this is not sufficient, I am planning to buy additional cover. I have following questions:
1. Is it advisable to buy additional cover from ICICI-Lombard or chose the better one
2. Is there any company provides health cover for the ‘New-Born’ baby?

Reply

80 Manish Chauhan July 7, 2010 at 9:17 am

Martha

You should compare the cost and benefits of other providers and take decision , how can some one tell which mediclaim is better for your situation ?
Also I am not aware of any policy which covers a new born baby , There is high risk with a new born baby in term f mediclaim and its very logical to not cover it for normal premium , Even if they are covered , the premium will be very high .

Manish

Reply

81 saurabh July 8, 2010 at 6:21 pm

Dear Manish

is it possible to change TPA while renewing the policy? Thanks

Saurabh

Reply

82 Manish Chauhan July 8, 2010 at 6:39 pm

Saurabh

thats a good question , however i am not sure :( . Anyone ?

Manish

Reply

83 Dhawal Sharma July 9, 2010 at 1:25 pm

no, you can’t change TPA..its the parogative of the insurance company, not the policy holder..TPA and insurance companies are already in agreement for so many years..so they can’t change it for a few policy holders.

Reply

84 Manish Chauhan July 9, 2010 at 4:14 pm

Dhawal

thanks for the info , Is this documented some where or you are telling this out of your experience ?

Manish

Reply

85 saurabh July 12, 2010 at 5:49 pm

Thnx Manish and Dhawal

I understand that an Insurance company has agreements with many TPAs. So if I am not satisfied with a TPA’s service, can I change it when I’ll renew it next year? e.g. National Insurance has agreement with Vipul, Paramount, TTK etc…Now if in 2010 I have Paramount as my TPA, can I change it to TTK in 2011 if I am not satisfied, keeping the policy with National insurance only.

Thanks to clarify once again.

Saurabh.

Reply

86 Manish Chauhan July 15, 2010 at 10:11 am

Saurabh

I dont know that , but I think it should be possible to do that if they have tie ups with many TPA’s , the people person to tell you about this is company itself , did you try customer care of health insurance company ?

Manish

Reply

87 Murali August 2, 2010 at 6:21 pm

My question is similar to one asked earlier in this chain but not been answered. Suppose one has a Group Health Insurance with their company (say 2 L) and also has a medical insurance from another provider (assume for 2 L). If the medical costs are 3 L, how can this amount be claimed? I think Aegon Religare is one provider that allows you to claim again (using copies of bills) but do the others also allow this?

Reply

88 Manish Chauhan August 2, 2010 at 9:00 pm

Murali

generally the insurance covered is divided between the insurers , so your insurers will divide 50:50 if their share is 50:50 .

Manish

Reply

89 RAM August 14, 2010 at 9:22 pm

Hi,
This is a wonderful space and got a lot of information. Recently came across Aegon Religare Health Plan and was wondering that nobody seems to have mentioned about it. I am 35+ and with a family of 4 (Spouse and 2 kids). I am finding it difficult to chose between the Apollo Munich Premium and Aegon Religare Diamond Plans. Dont know if I am spending too much for a cover around 10L. Is it worth it?

Reply

90 Manish Chauhan August 14, 2010 at 10:02 pm

Ram , Aegon Religare Health Plan looks good at a quick look , you should compare them on things which you want really , not on just things which they provide . http://www.aegonreligare.com/Health_Plan.pdf

Manish

Reply

91 abhishek August 23, 2010 at 4:21 pm

My insurance agent has informed me that in a family floater policy ( by any company) only 50% of the claim amount is reimbursed as compared to an individual mediclaim policy where 100% claim amount is reimbursed.

Also ,premiums for individual polices are higher and additionally one gets a no claim bonus in an individual mediclaim policy.( no claim bonus adds to the sum assured).

…is this true?????????

Reply

92 Dhawal Sharma August 23, 2010 at 7:17 pm

ABSOLUTELY FALSE…Nothing of this sort is there with any of the MEDICLAIM policy..Yes, there is a factor called CO-PAY which means policyholder too is required to pay certain portion of the bill but that portion is not 50%..CO-PAY is applicable only in case of elder citizens, mostly above the age 65…No claim bonus gets added up, if you make no claim in any given year, whether it is an individual policy or family floater..

What must be going through your agents mind is that if you have 4 family members, then instead of giving you one FAMILY FLOATER POLICY, why not sell you 4 INDIVIDUAL POLICIES and make more commission, thats all ;-)

You can check out the premium for individual as well as family floater for MAX BUPA on the following link and see for yourself the so called DIFFERENCE..

Reply

93 Manish Chauhan August 23, 2010 at 7:21 pm

Dhawal

Thanks for contribution :) .

Manish

Reply

94 abhishek August 24, 2010 at 10:57 am

Hi Dhawal /Manish

I called up the National Insurance office today and enquired about there FAMILY FLOATER MEDICLAIM POLICY.

They informed me that during the policy year only 50% of the claim can be reimbursed to the family member and balance is kept as a reserve for the rest of the policy year for other family members .

pl comment

Reply

95 Dhawal Sharma August 24, 2010 at 11:07 am

@ABHISHEK – Yesterday only, i met one of my client having family floater for himself, his wife, and two of his sons…and the cover of 2 lakhs is divided in the below mentioned way
FATHER – 75,000
MOTHER – 50,000
SON 1 – 45,000
SON 2 – 30,000

This is just another way of putting CAPPING on the cover amount..That means if the FATHER is in need of mediclaim for any given ailment/accident, he can avail only upto Rs 75,000 even if he has to incurr expenses upto Rs 1,00,000..Yes Abhishek, in this way, your policy is really limiting and will be settling your claim for less than or equal to 50% of the claim..THIS IS PURE & SIMPLE LOOT by these PSUs in the most BLATENT & BIZARRE MANNER..

There is no such sublimit in private mediclaim companies..Take for eg; MAX BUPA..If an individual has FAMILY FLOATER for 2 lakhs and God forbids, if he is admitted to the hospital, he can avail services upto Rs 2 lakh and not limited by catagory put in as in above example of Oriental Insurance….

Really-Really Bad and sorry for you ABHISHEK if you have such policy..My advice is THROW it right away because it is already of no use to you if some emergency befalls you..Look out for better options; there are plenty now a days in the market..

Reply

96 abhishek August 24, 2010 at 2:07 pm

Dhawal,

Thanks for your prompt response.

Currently, I have an individual mediclaim policies and after reading through this blog I found FAMILY FLOATER more suitable and so I have been enquiring!

One more issue I have been told is that PRIVATE INSURANCE COMPANIES are RELUCTANT TO RENEW mediclaim policy for policy holders who are suffering from diseases like cancer etc because they know that they have to pay the sum assured. PUBLIC INSURANCE COMPANIES on the other hand dont hesitate to renew.

THIS IS A PRACTICAL OBSERVATION!

pl comment

Reply

97 Dhawal Sharma August 24, 2010 at 8:34 pm

@Abhishek – There is nothing of that sort to worry about…What about the PRACTICAL PROBLEM currently going on where all of a sudden PSUs stopped CASHLESS FACILITIES..Its not that PUBLIC SECTOR INSURANCE companies are out there to serve society at large ;-) ..There is always an element of profit making, be it PSUs or PVT companies..You may have come across 3 to 4 such cases but then there are lakhs of policies issued and serviced every year and there is certainly a possiblity of a few getting dissatisfied but same is the case everywhere, be it PSU or PVT company..

As far as the renewal point of yours, go for Max BUPA..[sorry that i bring up Max BUPA at every given point cuz i am an agent of MAX BUPA :-) ] ..In the product broucher, it is clear mentioned that ASSURED RENEWAL FOR LIFE..So no matter if the policy holder develops any illness/problem, even then his renewal is guaranteed..Check out the link…

http://www.maxbupa.com/WhyBuyMaxBupa.aspx

Reply

98 abhijeet September 3, 2010 at 6:48 pm

i am 45 and have a family floater from bajaj allianz for 3lacs from last 2 years..i want to switch to apollo as it is cheaper , has extra benefits, and also provides PORTABILITY option i.e. they cover all the yearly benifits(like 2 year exclusions, preexsisting etc)that i enjoyed with my earlier insurer…does it make sense to switch….???
Is Apollo TPA claim settlement as good as others

Reply

99 Manish Chauhan September 4, 2010 at 8:14 pm

Abhijeet

I dont have that much information on how Apollo TPA is doing, you might want to find it on net .

Manish

Reply

100 Pankaj November 16, 2010 at 12:41 am

Hi Manish/Dhawal,
Thanks for the wonderful writeup and also to answer the posts and queries posted by other users. Keep up the good work!

Thanks,
P Gera

Reply

101 Manish Chauhan November 16, 2010 at 9:50 am

Pankaj

THanks :) .

Reply

102 Amit November 16, 2010 at 3:01 pm

Query 1.
Can health insurance sum be increased after a few years?
Say today I take up a policy of 5Lacs, which I think is sufficient for me today. But, after 5 Years due to increase in Medical Costs 5Lacs wont be sufficient, so after 5 years can I increase the sum to say 10Lacs in the same policy without losing the benefits I have earned in the first 5 years, like after 5 years I would be covered for most of the diseases which wont be covered in the first or second year.

Query 2.
Say I require a health insurance of 6 Lacs.
So would it be a good idea to buy say 3 Policy each of 2 lacs, to mitigate the risk of some company not providing certain benefits which another provides.

Also If I go for the case above, practically is it possible to settle claims from all three policies at the same time, say at some point of time I require a claim of Rs.5lac for some single hospitalization?

Reply

103 Manish Chauhan November 16, 2010 at 3:54 pm
104 mukesh February 16, 2011 at 11:40 pm

hi manish,
i m a great fan of u. thanks for so much of knowledge,
i m planning to buy pnb royal mediclaim, but , two points are to be cleared.

1. it has critical illness cover included or not.
2. premium will be same till last or change every year.
if u wanna suggest any other better than this ,please do tell

Reply

105 Manish Chauhan February 19, 2011 at 3:31 pm

Mukesh

1) Anything which requires hospotalization is covered .
2) Its not fixed, its a annual contract and it can be revised later

Manish

Reply

106 mukesh February 19, 2011 at 10:40 pm

hello manish,
i wanted to ask premium will be same means, as in some of the company, premium is calculated as per age slab like they have divided premium rate
20-35age ——premium xyz
35-45 age—— premium xyz+somemore
45-55 age—— premium xyz+ much more
as i saw the prospectus of pnb oriental insurance, it is showing same rate for all age groups, so please get me know, if u please also suggest is it good

one more question is it any difference to buy health insurance from oriental( high premium ) directly or through pnb-oriental( less premium)..
will it make any diff.. in services.
regards
mukesh

Reply

107 Manish Chauhan February 21, 2011 at 8:32 am

Mukesh

better to ask in detail at : http://www.jagoinvestor.com/forum/

Reply

108 mukesh February 20, 2011 at 11:30 pm

hi manish,

HI TO ALL OF YOU, LET ME GIVE ALL OGF YOU A VERY GOOD NEWS REGARDING HEALTH INSURANCE.
WE ALL WERE WAITING PORTABLITY TO COME IN INDIA ( LIKE IN ALL OTHER COUNTRIES), FROM JULY 2011, IN INDIA ALSO PORTABLITY FACILITY BE THERE

IT MEANS THAT M IF WE ARE NOT SATISFIED WITH OIR CURRENT HEALTH INSURER, OR WE WANT TO BUY ANOTHER PLAN FROM ANOTHER COMPANY , THEN WE CAN CHANGE THE COMPANY , WITH THE TIME BENEFIT, ELAPSED WITH OLDER COMPANY

Reply

109 babu February 21, 2011 at 7:00 am

Hi Mukesh,
Thanks for the good news, which unfortunately has been in the backburner for long. Even in developed countries, this remains a challenge in some form or other. Portability is now being proposed only for select coverages and select sum assured, targeting the socio economic poor segment. It would take much time before complete portablity comes through. So, it is imperative for the health insurance buyer to select a good policy at first instance.

Reply

110 prajith March 5, 2011 at 1:55 pm

Hi mukesh,
I ‘m looking for a health insurance policy for my family. My age is 36.I ve come across a policy name ICICI hospital saver which we need to pay 5 installments of 25000 and it will cover upto the age of 70 But now they have stoped this one.please suggest is there any policy similar available as well as is there any draw backs for this kind of policies. Please suggest me if you have a better one

Reply

111 Hemal Mehta March 30, 2011 at 5:49 pm

Hi Manish,

I hv bought BOI Swasthya bima policy for my parents, just want to know is this a gud option and is it covering any critical disease…. thnx in advance….

Reply

112 Manish Chauhan March 31, 2011 at 10:27 am

Hemal

You can ask it here : http://www.jagoinvestor.com/forum/

Manish

Reply

113 Hemal March 31, 2011 at 11:03 am

Manish, I dont know why but i m not able to write in the forum…. i m not able to get registered… Can u answer it here itself…. thnx in anticipation

Reply

114 Manish Chauhan March 31, 2011 at 11:10 am

Hemal

I have created an id and send the password to you

Reply

115 babu March 31, 2011 at 11:04 am
116 Adesh May 5, 2011 at 9:58 pm

hello Manish,
I was searching for this topic recently on net and i got it here..very nicely presented..i want to take mediclaim policy for my parents in 50’s…
which mediclaim will be most suitable as there are few in top MAX BUPA, Apollo Munish,Star health,National Insurance to name a few good ones.
Every policy has something or other missing..some is not giving cashless facility and other is having too much waiting period..too much confusion..
please guide me on this one..your guidance is highly appreciated…

Reply

117 Manish Chauhan May 12, 2011 at 12:56 am

Adesh

As you said , not every policy is complete . So you have to find out which comes closer to your requirement .

Reply

118 Dr Adesh May 12, 2011 at 7:15 pm

hello manish,

thanks manish for ur response which is so well crafted that it caused me to look up the policies again and i found Max Bupa the best policy beyond 55 years age group..bit costly but honestly saying, for parents i can do that.
thanks Manish..God bless u.

Reply

119 Manish Chauhan May 13, 2011 at 12:17 am

Max Bupa is a good one . I recommend it , a bit costly , but they seem to have most of the things covered . the probability of not getting satified is much samller :)

Are you around NCR ? we have dhawal sharma in delhi who can be your agent ,a nice guy .

Manish

Reply

120 Dr Adesh May 13, 2011 at 8:01 pm

ya i live on NCR region..i live in gurgaon.

Reply

121 Dr Adesh May 13, 2011 at 8:16 pm

manish,
i already got Max bupa..thanks for ur support.
keep sharing ur knowledge.
good luck.

Reply

122 aadarshh May 12, 2011 at 11:31 am

which companies are offering unit linked health insurance polices…how do u rate these policies?

Reply

123 Manish Chauhan May 13, 2011 at 12:34 am

Aadarsh

They are again same old thing in new bottle , its “unit linked” . Not recommended for a common man

Manish

Reply

124 raj May 14, 2011 at 12:17 pm

1. I understand that a health policy taken through a Bank is a Group Health policy? Then what happens if the contract between Bank & Insurance company terminates?
(a) The pee-existing cover is transferred i.e. is taken to One’s next Policy from same insurance company? OR
(b) Loose all the benefits incurred till that date & Start afresh.

2. Is it possible, there could be difference in coverage aspects between policies taken from same Insurance Company through an Agent or BANK AS AN AGENT?

3. What about portability differences of these health policies? (Same insurance company but one purchased through an Agent & other through a Bank (as an agent))

4. Why such a huge difference between premium of Policy taken through an agent VERSUS Policy taken from BANK (as an agent) from same insurance company?

Regards and thanks

Reply

125 santosh June 4, 2011 at 3:31 pm

can any one tell me which medical insurance policy dont charge loading charges?

Reply

126 Manish Chauhan June 6, 2011 at 1:07 pm

Santosh

There is no company which does not have loading charges . And why should one not put loading , its a valid and obvious thing to be charged from business point of view . If some one is not in normal health , then there has to be loading !

Manish

Reply

127 Vishal August 17, 2011 at 11:11 am

Hi Manish,
Thanks for giving such a wonderful information about health Insurance.it is almost 2-3 months I am exploring the health insurance plans of Nationalized companies as well as PVT players.

In beginning I was more inclined towards Govt Heath Insurance companies like United, Oriental but I am also impresses by Pvt players like TATA AIG wellness and Max bupa.

The good thing I find in Tata AIG wellness plan is that they even cover individuals with Good Amount in Family Floater also. Like Father and Mothers are covered upto 6 lac and Children is cover up-to 3 lacs in Small Premium of 9 thousand annually.

And I find Max Bupa Health insurance has nice feedback.

Still very confused about which policy to take. But have clear in certain things like

1.) It should be lifetime
2.) Family Floater is better

Reply

128 Mahavir Chopra August 24, 2011 at 9:39 am

Vishal,

Tata AIG has defined benefit products which are supplementary to Traditional Mediclaim. Max Bupa’s Family First is certainly a good product, but there are many others like Oriental Happy Family, Bajaj Family Health Guard etc. you can consider.

Ensure you have a good mediclaim advisor to help you buy, and service your policy for renewals and more importantly Claims.

Please spread the word regarding Action Month to more people around you. Push people, move them out and encourage them to ACT NOW.

Regards,
Mahavir Chopra

Reply

129 Suresh K Narula August 22, 2011 at 2:11 pm

Dear Manish,

I have been getting insured from my employer group medi-claim policy for myself, spouse , two children and parents since 9 years for sum assured to the tune of Rs 2. lac to 2.50 lac. Since, it is time to renew the same, I would like to know to you main features to be considered of that policy are maximum 60% of the sum insured can now be utilized for the parental claims.

The co sharing for the claims will be as under:
Parental claims – 15%
Maternity claims -15%
Other claims -10%

Moreover, this time annual premium is two times over from outside insurance company(Apollo Munich). Further be noted that, being central govt retired my father and mother may cover from CGHS scheme while paying a life time lump sum premium of Rs 27000(approx) with unlimited sum assured with lifelong.

Please advise me, may I opt for Apollo Munich floater policy for my own family instead of taking employer’s policy. If no, How can I consider for the same.

Reply

130 Mahavir Chopra August 24, 2011 at 10:09 am

Hello Suresh,

Yes, this is the reality forward. Copay, Surgery Limits, Claim Limits would be added by your employer, to ensure the premium paid by them meets their internal budgets. We foresee Large no. of parents would be left uncovered or under-covered in 5 years time, with no Insurance Co. interested in providing them Mediclaim.

With Healthcare inflation rising by 20% in India, its high time, you need to have your own Mediclaim, to be in control of the risk cover of your family, specially your parents.

Regarding selection of product, we would suggest you first take time out in selecting a good mediclaim advisor, who will provide you unbiased advice and insights on various products, and also provide renewal and claims service.

Reply

131 Mahavir Chopra August 24, 2011 at 10:46 am

And yes Suresh,

Hope you are aware of the Action Month, and being a part of it. Let’s push ourselves to action. http://www.jagoinvestor.com/action-month.html

Reply

132 Dilip October 30, 2011 at 2:38 pm

Hi Manish,

Its really great to see you all are helping people to clarify their doubts regarding health insurance.

I’m also planning to buy a medical insurance and would like to seek your advise for the same. I have a medical insurance from my Company with 3 Lcs coverage for me, my wife but it does not cover my parents (my parents stays in different city). I’m just confused about different health insurance policies and not been able to decide whether I should go for a policy which covers the whole family (including parents) or take it only for my parents.

Please help me out to choose the right policy.

Thanks in advance.

Rgds,
Dilip

Reply

133 Manish Chauhan November 5, 2011 at 4:24 pm

Dilip

There are policies from MAX BUPA and Oriental health insurance which you can look at , contact medimanage.com for a detailed suggestion ..

Manish

Reply

134 Mohankumar M December 26, 2011 at 12:00 pm

My dad is 61 n mom 50.
Iam 28 n wife 23 now iam thinking to have health insurance policy for us.
Iam an account holder of Canara Bank n United India Health Insurance is available for me since it gives cover for age upto 65.
Is it a good policy to take up plz suggest.

Reply

135 Manish Chauhan December 26, 2011 at 6:39 pm

Mohan

We will publish an article in few weeks .. you can ask this question on that.. or else ask it on our forum : http://www.jagoinvestor.com/forum/

Reply

136 sourabh February 7, 2012 at 2:09 pm

Is it better to buy health insurence from private companies or government?
Which companies have good claim settlement ratio?
Is it all insurence companies will sanction claim if someone have problem every year? Do they charge additionaly?
What about the the rules and regulations on which basis companies rejecy claims?where can we see those rules?because companies reject on very stupid reasons sometime..eg. If someone crossing road and got accident they will reject saying he was not crossing by zebra crossing likewise they dont sanction if twowheeler has got accident on 4 lane road?
I want to see all those hidden rules and regulation?Is there is any control on there rejection of claims..?Does IRDA allows such rules?
regards
sourab

Reply

137 Manish Chauhan February 7, 2012 at 9:37 pm

Sourabh

Most of the companies have loading provision if there is a claim , so your premium increases . do see IRDA report for claim settlement

Reply

138 SHAKSHI February 16, 2012 at 8:46 am

I am 58 years old, my spouse is 48, two children 17 and 20. I would like your advise whether to take individual health policies or Floater. PSU or Private. would it cover the rest of the family on the demise of the eldest?

Reply

139 Mahavir Chopra February 16, 2012 at 11:32 am

Hello Shakshi,

Individual option is better, but turns out to be very expensive. Go for a good floater cover of minimum Rs. 5 Lakhs sum insured.

You have various choices from Apollo, to Max Bupa to Oriental Insurance. Please let us know if there is any medical history or condition for any member. The choice of PSU/Private etc. would depend on various parameters including your budget.

Floater continues, even after death of the eldest.

Also, ensure you take time out to find the right adviser who would provide you unbiased advise as well as end-to-end service including claims.

Reply

140 SHAKSHI February 20, 2012 at 10:04 am

Both my wife and I are on minimal hypertension medication. No other history.
lifetime coverage is preferred. Please suggest best policy and also right adviser.
Thanks

Reply

141 Manish Chauhan February 17, 2012 at 5:44 pm

Shakshi

the new plan from Apollo looks good .. have a look at it

Reply

142 Varun Pawar February 21, 2012 at 5:18 pm

I have my parents who are around 55 and i was looking forward to Mediclaim policy which will cover their health related problems later.. kindly suggest what all things to be kept in mind… and i can afford 15k at present….

Reply

143 Ravi March 5, 2012 at 5:00 am

Dear Manish,

I have been following your blogs regularly since sep 2011. Since then i have purchased Term Insurance, PA policy, CI policy. Now i am finally addressing Health Insurance. I would like to read some comments about Family floater plans in comparison to Individual policies on the following queries:

1. Does a Family floater expire on death of Highest aged individual / proposer?
2. Does a child cover be only uptil the age of 25 years?
3. What is the minimum age for a child to get indivdual health insurance?

Reply

144 Manish Chauhan March 5, 2012 at 9:50 am

Ravi

1. No , the second oldest member will then become the eldest member

2. Yes . Its because the family floater is for dependent and self

3. Depends from company to company , some give from birth and some start from 2-3 yrs . So look at different policies

Manish

Reply

145 Ravi March 5, 2012 at 5:33 am

Dear Manish,
Is there a comparison chart available for Apollo Munich Optima Restore and Max Bupa Heart Beat for reference?

Reply

146 Manish Chauhan March 5, 2012 at 9:49 am

Ravi

Nope .. have not done that !

Reply

147 Dr Santosh March 20, 2012 at 11:56 am

Hi Manish,

Query: “Medical tests before taking Policy” in age group of below 35 years

I had read a article in Newspaper that if you are taking Individual Health insurance, then your premium would would be based on Multiple risk factors of particular cohort of individuals in that specific age group. A low risk individual premium may be say Rs 4000 & high risk would be Rs 6500, Then without asking for undergoing medical examination, saying “No medical tests required”, Everyone is put across a moderate risk & premium is fixed around Rs 5000/-.
This would be a loss to healthy individual with low risk, and would like to ask “Are there any companies in India, which ask for medical tests & premium is then based on the risk factors of that particular individual ???

Reply

148 Manish Chauhan March 20, 2012 at 12:37 pm

Yes Santosh

All the companies have premiums based on what is your risk , but thats mostly done if your sum assured is more than 50 lacs. only ICICI icare does not have MEDICALS for any amount , for rest of the companies there will be medicals if your sum assured is more than 50 lacs.

Manish

Reply

149 Mahavir Chopra March 20, 2012 at 1:02 pm

Hello Dr. Santosh,

You are somewhat right. There are currently no ways created to measure and incentivise healthy people buying health insurance in India. Niether is there a product, I know, which encourages Medical tests for younger groups, and pays through incentives.
In the West, since there is credible personal data available, there are incentives, through discounts, or better coverage provided to people.

The Health Insurance proposal process looks for adverse details in the proposal, and hence may either apply a loading, an additional condition (like a copay, or a permanent exclusion) or worse deny the proposal.

The benefit of being healthy is that you get a clean policy with the minimum restrictions possible.

Reply

150 Rampratap Barai March 27, 2012 at 1:20 pm

Hi Manish,

MY Financial Planner is suggesting me Bajaj Allinaz Family Floater is it the best option.

Reply

151 Mahavir Chopra March 27, 2012 at 4:31 pm

Hello Rampratap,

Bajaj Allianz is a good product, and has a good claims settlement record. You can go for it. Ensure you take the non-network hospital copay waiver, by paying the additional premium. The policy currently is not lifetime, and expires at age 80.

Reply

152 Swapnil April 22, 2012 at 11:10 pm

Hello,
I’m comparing Max Bupa Heart Beat Silver Floater with Apollo Munich’s Easy Health Family Floater plan. Which one is good for my parents aged 60 and 52.
Sum insured – 2 Lakhs. Both are generally health without any chronic illnesses or complaints. Please suggest..

Thanks!

Reply

153 Yogendra Singh July 9, 2012 at 1:23 pm

I am working in software company and have a health insurance from Bajaj Allianz for myself and my family via my employer(software firm) of 3L sum insured.
My wife been to hospitalized due to pre-mature delivery and delivered twins which are kept in NICU because of Pre-term born. I used my health policy for my wife’s hospitalization exepneses during delivery ( 1 Laks) and got reimbursemnt of (60k).
Now its been 1 months of NICU hospital care of my new born baby and baby get discharged and total hospital expenses is 1.8 L for baby.
I want to know is my new born baby will have health covergae from my exiosting policy ? can I get her hospital expenses reimbursed ? If yes what would be the approx amount of coverage possible in my case?
Thank you

Reply

154 Manish Chauhan July 9, 2012 at 6:51 pm

Yogendra

Obviously you will not have a cover for the new born baby , it was never covered from start , now you need to add the baby to the existing plan and dont be late for it !

Reply

155 Krishna September 12, 2012 at 4:38 pm

I am 37. I have presently Rs.3 lakhs for me, self and for Rs.1 lkh for my 4 year kid. I am looking at enhancing coverage to Rs.10 lakh. What is best option individual or floater and which insurance company. please advice. Thanks.

Reply

156 Manish Chauhan September 13, 2012 at 10:52 pm

There are good plans from Oriental , Apollo and MaxBupa

Reply

157 SOUMEN DAS September 18, 2012 at 10:14 am

sir,
i am working with Times of India & have corporate policy from Raksha TPA.
My wife will undergo operation (Histo/ Laproscopy) for primary infertility treatment. will it be covered in Raksha TPA.

regards.

Reply

158 Manish Chauhan September 18, 2012 at 10:18 am

If its covered under your policy then it will be paid for !

Reply

159 Sandeep September 27, 2012 at 3:18 pm

Dear Manish ji

I am looking for one additional health (Family Floater ) insurance policy for the cover of up to INR 3,00,000/- .

Kindly suggest which one should i select ???

Reply

160 Manish Chauhan September 29, 2012 at 10:58 am

Sandeep

You can look at MaxBupa or Apollo policies !

Reply

161 Monika October 27, 2012 at 2:24 pm

Hi,

My dad is PNB’s ex-employee and account holder too. I want to buy PNB Oriental Royal Medi claim policy for him and my mother for 5 lacs coverage. My dad is a cancer patient. can somebody share that what are the exclusions of this policy and whats the coverage time for pre-existing diseases in this policy.

Please guide by dropping a mail to me.

Regards

Reply

162 Manish Chauhan October 30, 2012 at 11:55 am

Monika

I am sure the existing illness will not be covered, only those existing illness are covered which have chance to come again, but incase of cancer,its already there. So I dont think it will be covered

Reply

163 venu November 15, 2012 at 2:48 pm

sir,
I have AB Arogyadaan medical policy since 2007 dec 17th, now I want to change my policy from AB Arogyadaan to Apollo munich optima restore or star health insurence. Is there any portability for that? please suggest.

Reply

164 Manish Chauhan November 15, 2012 at 7:11 pm

You can only get that info from Apollo !

Reply

165 Jhuma January 8, 2013 at 11:36 am

Hi,

I stay at ulhasnagar which is deep central suburbs. I have not forund any hospitals listed in my city except one or two. How should that impact my decision of buying a health insurance?

I am interested in taking up for my husband and my son.

I was offered religare and Max Bupa but I am confused.

Please advice.

Reply

166 Manish Chauhan January 8, 2013 at 11:43 am

Its just a convinience issue , In case of any mishap, you can go to any hospital , and reimburse later, but for cash less facility, you can go to any listed hospital only .

Reply

167 Swapnil January 16, 2013 at 5:43 pm

Dear Manish,

How good is the Religare Care Health Insurance vis-a-vis Apollo Munich Restora Health Insurance Policy?

Your judgement would be of great value to me.

Thanks.

Regards,

Swapnil.

Reply

168 Manish Chauhan January 18, 2013 at 10:19 am

Religare is a little new one .. other wise its pretty good overall

Reply

169 AMRESH KUMAR CHAUDHARY February 27, 2013 at 8:43 am

I am 29yrs old, My wife is 31yrs old and My son is 6months old. I am searching family floter health policy for my family. Please suggest me which is the better in Apollo munich easy health stander and Max Bupa heart beat.

Please help me by reply…………

Reply

170 Manish Chauhan February 27, 2013 at 9:47 am

Both of them are good overall , Did you read their detailed features ?

Reply

171 Ashish March 18, 2013 at 4:47 pm

Hi Manish,

I am planning to buy Mediclaim policy and i have zeroed on LT Insurance classic with CI included and room rent waived.

My Queries:

1) Do family flaoter plan tranfers the policy to the family members incase of the death of the proposer? Is this point covered in LT’s classic ?I couldnt find anything in policy wording or on website.
If yes, wouldnt it make sense to not to go for an individual policy rather a family floater policy.

2) Your take on company and policy, Claim settlement et al
3) YOur take on 10% co-pay feature after 80 years.

Regards,
Ashish

Reply

172 Manish Chauhan March 19, 2013 at 10:43 am

Ashish

1. No

2. there is a good review about the policy overall , but there are other good options also like religare Care , Apollo .. did you look at those ?

3. I think its overall good ..

Reply

173 srinidhi October 3, 2013 at 10:15 am

I would like to buy a Health Insurance ( family floater sum assured 2 lakhs )for my family members consisting of self (aged 24) , father(aged 64) & mother (aged 55).
I also wanted choose Mediassist as Third Party Administrator (TPA)
anybody suggest me which one should i select ??
Following Banks have this option for low premium
Syndicate, Bank of Baroda, Canara, Bank of India can i believe in above bank policy

Reply

174 Manish Chauhan October 7, 2013 at 8:04 am

Srinidhi

Note that you can choose Insurance company , not TPA . because TPA is choosen by health insurance company itself . Oriental is a good option to choose from.

Reply

175 Naveen November 25, 2013 at 1:49 pm

Hi Manish,
I would like to buy health insurance for my family (4 lakhs, 2+2). I need you suggestion on below policy
Religare (Premium 10226)
Oriental Family Floater Silver (Premium 7607)
PNB Oriental Royal medical policy (5780)

Reply

176 SONU January 25, 2014 at 3:43 am

Hi Manish,
Hats Off !!! So such bundle of hidden facts & situations regarding health insurance policy.

1) Is there any policy that cover new born child automatically ?
2) Can that cover the expenses due to pre-born baby to keep in NICU like charges ?
3) If yes for above, Will above expense be covered if pregnancy is due to result of IVF i.e. child is test tube baby (I know that NO policy covers the charges for cause of such birth i.e. IVF treatment charges)
4)Min. waiting period in such policy.

I have heard that Star Wedding Gift has some features but not sure.

Can anyone throw light on matter as thinking for IVF… Already I have gone Hydro laparoscopy two years back.

Reply

177 Manish Chauhan January 30, 2014 at 6:29 pm

1. No , you have to add them manually by asking to company

2. If its covered, then yes

3. I have no idea on that

4. may be 2-4 yrs , depends on the policy !

Manish

Reply

178 SONU January 25, 2014 at 3:50 am

Hi Manish,

To bother you again –

Suppose we have taken floater policy for Husband-Wife (2 Adults) and policy does not cover new born child automatically.But we want immediate cover in the same floater policy. Will it be allowed with paying extra premium difference of (2A + 1C) to that of (2A) immediate in same policy year or we have to wait till next renewal ? Any condition of minimum age entry is to be fulfilled in such case ?

Thanks always.

Reply

179 Manish Chauhan January 30, 2014 at 6:28 pm

I think it can be added immediately, and you will have to pay the extra premium at the same time, but better make sure you ask for this to your insurance company !

Reply

180 HARSHA February 13, 2014 at 12:14 pm

Hi Manish,

I want to buy a reliable and efficient Health Insurance for my mother (aged 59) in India. Following are some of the key requirements to be included as a part of Insurance package:

1. On-call Doctor availability – At any point of time, 24/7, the doctor / physician must be available to visit Home. Further, regular check-ups to be done at Home

2. Percentage of Claim settlement to be high

3. The policy must not come with too many pre-existing disease clauses

4. Cashless settlement even in the case of Consultation fees and medicines

Please advice suitable Health Insurance policy along with Annual Premium rates. Thanks

Reply

181 Manish Chauhan February 14, 2014 at 4:28 pm

Hi Harsha

I must say that you are over expecting things here, you are “demanding” things . It does not work like that. There is no policy which will fit in your requirement. Health Insurance is just a protection cover, not a facility provider .

1. This point is hospital specific, not health insurance specific
2. Yes you can choose a company on this parameter
3. Again, this is not what you can demand, all the companies have a standard list of pre-existing illness clause
4. Thats not possible

I suggest you read this article – http://www.jagoinvestor.com/2014/02/health-insurance-exclusions-waiting-period.html

Reply

182 vasantha n k April 24, 2014 at 10:16 pm

Dear Sir,

I need some clarifications from you, please help.

My brother has taken mediclaim policy from National Insurance Company Ltd. (tied up with State Bank of Mysore for his customers) since my brother was having savings bank account with SBM. After expiry of 3 years renewal, they told my brother that they have cancelled the tie with SBM, hence, we cannot renew the policy. Policy was in force from 4.11.2009 to 3.11.2012. They have not intimated in writing about the tie-up cancellation. Afterwards, since he is having an SB account with Canara Bank, he has taken a policy from United India Insurance Company Ltd. (tied up with Canara Bank for his customers) w.e.f. 15.11.2012 and got renewed from 15.11.2013 to 14.11.2014. But he has paid the premium amount of Rs.4875 on 9.11.2012. My sister-in-law was hospitalised due Heart Attack on 21.2.2014 at Hassan and shifted to Mysore for Angiogram and Angioplasty at Mysore and totally we have spent around Rs.2.55 lakhs. Which was intimated to United India Insurance Company Ltd. on the same day. After submission of bills for claim, now they mentioning that since, you were having Sugar from past years, since policy switched over from National Insurance to United India gap of (3.11.2012 to 14.11.2012) 11 days, you are not eligible. Still we have not received any communication from them. Are we eligible for Claims. Can we approach court of law. Can you suggest suitable mode of getting the claims.

Reply

183 Manish Chauhan April 29, 2014 at 9:40 pm

First check if there is no violation of their terms and conditions .. If no , then yes – you should contact consumer court !

Reply

184 vasantha n k April 30, 2014 at 11:42 am

Thank you very much sir.

Can we approach Consumer Court or Hyderabad Insurance Ombundsman ?

Reply

185 Manish Chauhan May 7, 2014 at 4:19 pm

You can approach consumer court of the place where incident has happened !

Reply

186 kamlesh M shah June 26, 2014 at 11:47 am

My age is 61, My wife age is 58 [BOTH RETIRED ] &my son 23; as per IRDA rules & regulation,what is the Best medical insurance policy.Is it better to have individual policy or flotter policy is advisable. How much amount of premium cost to by from Bank of baroda?Let me know about PNB mediclaim policy.

Reply

Leave a Comment