Review of HeartBeat Health Insurance Policy from Max Bupa

Max Bupa Health Insurance Company Limited is the latest health insurance company to join the ever growing list of health insurance companies in India. It is a joint venture between Max India (promoters of Max New York Life Insurance) and Bupa (UK based Health Insurance Company). Max Bupa has come out with a Family Floater Health Insurance Product by the name of Heartbeat. So is Heartbeat Health Insurance Plan also one of the family floater products offered by other health insurance companies? What is it that makes Heartbeat different from other health insurance plans already available in the market? Let us take a closer look at this product. (Download Brochure)

Three Variants

Heartbeat comes in 3 different variants

  • Heartbeat Silver Plan
  • Heartbeat Gold Plan
  • Heartbeat Platinum Plan

Features of Heartbeat

Life Long Renewal

Yes you read it right. The company assures you life long renewal year after year during your lifetime. This feature of the product makes it stand out among the numerous other family floater products available in the market. Lot of health insurance companies don’t offer renewal of health insurance policies after the age of 65 years or 70 years.

No Maximum Enrolment Age

There is no minimum or maximum age for enrolment. Lot of insurance companies have a maximum entry age of 55 years or 60 years for health insurance. After this age they don’t take new enrolments. Also lot of companies have restrictions on the minimum entry age for enrolment. But in this policy there is no minimum entry age for enrolment. A new born baby can be covered right from day.

Maternity Benefits

The policy provides maternity benefits for upto 2 deliveries. To avail this benefit the individual and spouse should have been covered for 3 years continuously. All new born babies where the company has paid the maternity claim are automatically covered from birth until next renewal. The plan also covers 1st year vaccinations for new born babies where the company has paid the maternity claim.

No TPA’s Involved

The company has not tied up with any Third Party Administrators (TPA) for claim processing and settlement. All the claims are handled by the company personnel inhouse . Read more about TPA’s in How to choose Medical Insurance Policy ?

Dedicated Relationship Manager

The company assigns a Personal Relationship Manager for Gold and Platinum variants of the product. The relationship manager helps at the time of hospitalisation and also at the time of claim settlement.

Online Tracking

The company offers all the details of the policyholders on the website. The policyholder can access his personal details, profile, claim history etc on the company website.

Other Features

Other features of the product include general features which are offered by most of the health insurance companies in their policies. Some of these features are as below:

  • Cashless Treatment: The company has tied up with a number of network hospitals and offers its customers the facility of cashless treatment by providing them health identity cards.
  • Free Look Period: The product comes with a 15 day free look period. Within this period if the policyholder is not satisfied with the terms and conditions of the policy, then he can return the policy. The company will return the premium after deducting few charges.
  • Wide Range of Covers: The product comes in 3 variants offering a wide range of cover from a minimum of Rs 2 Lakhs to 50 Lakhs.
  • Health Check-up on Renewal: The company offers a health check-up on renewal under some of its variants.
  • 24/7 Support: The company offers customer service round the clock even in case of late night emergencies.
  • Pre and Post Hospitalisation Expenses: The policy covers medical expenses incurred upto 30 days prior immediately before admission to the hospital and 60 days after discharge from the hospital.
  • Tax Benefits: The premium paid under the policy is eligible for tax deduction under Section 80D of the Income Tax Act.

Read More on company website

What is not covered ?

  • Benefits will not be available for Pre-existing Conditions until 48 months of continuous coverage have elapsed since the inception of the first Policy with us.
  • No treatment taken during the first 90 days since the commencement of the Policy, unless the treatment needed is a result of an Accident or Emergency.
  • It will not cover some things permanentaly like Addictive conditions and disorders; Ageing and puberty; Artificial life maintenance; Circumcision; Conflict and disaster; Congenital conditions; Convalescence and rehabilitation; Cosmetic surgery; Dental/oral treatment; Drugs and dressings for outpatient or take-home use; Eyesight; Experimental treatment; Health hydros, nature cure, wellness clinics etc.; HIV and AIDS; Hereditary conditions; Items of personal comfort and convenience; Non-allopathic treatment; Obesity; Out Patient Treatment; Neurological and Psychiatric Conditions; Self-inflicted injuries; Sexual problems and gender issues; Sexually transmitted diseases; Sleep disorders; Speech disorders; Treatment for developmental problems; Treatment received outside India; Unrecognised physician or facility.

Read in detail  Here

Conclusion

As we saw above, the policy offers some very good benefits compared to other health insurance products available in the market. But it may just be a matter of time before other companies also follow suit. If that happens the customer will truly be spoilt for choice of good plans available in the market. This will ultimately benefit the customer.

Note: Please check the company website or the product brochure for the latest features of the product carefully before deciding to buy the product. You can also buy it from Coverfox.com

This is a Guest post by Gopal Gidwani , He writes on his blog www.bachatkhata.com

313 CommentsAdd Comment

  1. Abhishek Gupta

    Even Apollo Munich covers the Maternity Benefits and the Life Long Renewal.. Relationship Manager and Enrolment at any age is really different..

    • Abhishek

      Nice , I didnt knew that Appolo Munich also provides life long renewal , do have any experience of reviewing their products ? I still didnt understand how much beneficial will these relationship managers will be ?

      Manish

        • Yes they are , but there is class of people who feel its more suited for them . What do you say , are you saying that this is “avoid at all cost” health insurance policy ?

          Manish

          • @ Manish

            You have rightly said “class of people”, this policy is not for everyone. It’s 25-30% expensive in comparison to other policies. People need to analyse what are there requirement & on that basis they should choose health policy.

            • Gopal Gidwani

              @ Hemant
              I agree that the premiums for this policy are 25-30% (not sure how high exactly % wise). But I feel the premiums have been kept high with a purpose. The company might have felt since they are covering everyone with no restriction on age, the 1st persons to enrol will be all persons above 60 years of age who at the moment dont have too many other options to enrol with other health insurance companies. Also young people like us will not enroll for this policy that easily as we have other cheaper options available to us. So the overall ratio of persons enrolled for this policy will be very much skewed towards senior citizens. Now with that kind of high % of senior citizens enrolled the claim ratio will be much higher than the claim ratios of other health insurance companies. So to cover those additional claims the company must have kept the premium higher than other policies in the market. That is the only logical reason I can think of for higher premium. I dont know whether I am right or wrong. Please correct me if I am wrong.

              Also the policy has some unique features compared to other health insurance policies in the market. I hope the other companies take notice of this and introduce these features in their policies and competition forces all the companies to bring down the premium to reasonable levels so the customer ultimately benefits.

              • @ Gopal

                I agree with you points & agents will sell this policy like ‘senior citizen mediclaim’. It’s wrong on cos. part that young policy holder will share the burden of old ones.

                In 2007 I met one Insurance Agent who was selling some insurance policy of Tata as term plan for senior citizen. It insured individual upto 80 or 85 years. Overall risk of that policy should have went high due do such type of selling.(This may impact claim settlement ration)

                • Kapil

                  I totally agree with Hemant. This product is not at all suitable for young generation.

                  @Manish,
                  I double about the success of this policy. As I said, this policy doesn’t look suitable for young people and also for old people, the list of exclusion is very vague and goes totally against their requirements. Please read this copy paste from your own article:

                  “It will not cover some things permanentaly like Ageing ; Artificial life maintenance; Circumcision; Drugs and dressings for outpatient or take-home use; Eyesight; Obesity; Out Patient Treatment; Neurological and Psychiatric Conditions; Sleep disorders; Speech disorders;”

                  DOES NOT COVER THINGS LIKE AGEING (PLEASE READ THE FIRST LINE OF PREVIOUS PARA. ) Now this exclusion word is very ambiguous and company can deny suitable reimbursement to elder people in many cases. Why you didn’t raise this point?

                  -Kapil

                  • dhawal sharma

                    @Kapil – First let me make clear, as an agent of Max Bupa, our company since starting its operations in April 2010 has covered 15000 lives till date…FASTEST in the insurance industry..So please dont worry about the success of this policy, its a SMASH HIT..already declared on CNBC-AWAAZ as comparitivly expensive but BEST VALUE for MONEY…

                    Now let me take you through the EXCLUSION part pointwise..
                    * NOT COVER AGEING & PUBERTY – the complete explanation is “TREATMENT TO RELIEVE SYMPTOMS CAUSED BY AGEING SUCH AS MENOPAUSE & HEARING LOSS CAUSED BY MATURING OR AGING..i dont think its a vague definition..Company is making clear that something a policyholder has developed due to old age will not be covered..But if same complication, like hearing loss has occured due to an accident, will be COVERED

                    *ARTIFICIAL LIFE MAINTENANCE – The complete explanation is LIFE SUPPORT MACHINE USE, WHERE SUCH TREATMENT WILL NOT RESULT IN RECOVERY OR RESTORATION OF THE PREVIOUS STATE OF HEALTH…So if some treatment or artificial life maintenance is taken where the patient is sure to die, does it make sense to continue such expenses..In most of such cases, family themselves take their relative back to home..and its SO ARTIFICIAL LIFE MAINTENANCE WILL BE COVERED UNDER THIS POLICY where the chance of survival is there..& doctor will be in a better position to say so..

                    * EYESIGHT – Who says heartbeat policy dont cover eyesight?? the complete explanation is “TREATMENT TO CORRECT EYESIGHT, UNLESS REQUIRED AS THE RESULT OF AN ACCIDENT..So its actually cosmetic surgery like LASIK/eye sight correction is not covered..

                    * OBESITY – again the complete explanation given is “TREATMENT FOR OBESITY WHERE THE BODY MASS INDEX (BMI) IS GREATER THAN 29..

                    All in all, the points forwarded by you are mostly related to treatment opted for COSMETIC SURGERIES (like treatment of eye sight, fat reduction etc) which are not covered..not only by Max Bupa but also by anyother company in the market….

                    Actually what happens is that in most of the cases, public just read the statement and not the explanation/justification behind those points..Each and every exclusion is explained in detail in Sales book of Max Bupa..just need time to check them out..

                    Hope i am able to settle some of your queries Mr Kapil..If you Want to know EVERYTHING in detail, then mail me at dk.dhawal@gmail.com and i will be able to provide you EVEYR DETAIL…

                    • dhawal sharma

                      @KAPIL – Now its your turn to settle few of my queries dear 😉

                      As you have put the clause of OBESITY, EYESIGHT, CIRCUMCISION, OUTPATIENT etc…can you please name a few policies by any MEDICLAIM company offering these facilities of covering all these illness/problems?? Let me make your task easier, there is NONE..

                      Good point with Max BUPA is that it is showing you ALL THE EXCLUSIONS in its broucher, on its site..Tell me how many companies do so?? Most of the mediclaim companies, especially PSUs..what they do is they say no medical at the time of policy and they do their underwriting at the time of claim and hence most of the time reject the claim..Where as Max Bupa will be giving you in WRITING (As part of its policy documents) what is exclused from day one..So you have clear idea what all will be covered under your mediclaim policy and what is not..

                    • Kapil

                      Hi Dhawal,
                      No, I was not worried about the success of your policy. I was just making a point here. Please do not take it personally.

                      Now Regarding your point on Artificial Life Maintenance, are you permanently excluding it under any situation or are you adding that it will be excluded only if patient’s dies while on life support system but if he responds to treatment well then you are going to reimburse the expenditure incurred on life support system. Please comment.

                      Regarding your point on Ageing: You have added that-“Company is making clear that something a policyholder has developed due to old age will not be covered”. Now are you saying that only these 2 medical condition mentioned by you are excluded and everything else is included. What about conditions like Alzheimer and Arthritis etc ( which troubles elderly very much). Are you covering in case treatment of these requires hospitalization.
                      Now I’m most concern about the ageing thing because if you exclude ageing related problems then lifelong renewal is a nothing but a mirage, atleast for me.

                      Regarding Neurological and Psychiatric Conditions; Sleep disorders; Speech disorders. I hope you cover them in your new mail. ( I wan’t able to find details about exclusion list on your website so can you please forward the link also. There is a Whatisnotcovered.aspx page but details about exclusion are not there)

                      Last point, do you cover day care treatment also?

                      Please do not think that I’m an agent of some rival health insurance company who is unnecessary putting your policy/company down. I have no such intention. I do agree that there are certain good points about your policy like: Lifelong renewal, No TPAs, maternity benefits.

                      -Kapil

                    • Byju

                      The explanations are good. Then they must be made part of the sales brochure. Else how do we expect the layman to understand and go for this policy.

                    • kumar

                      aree bhevakoof idiot

                      Let me tell u the clear definitions

                      Accidental insurance costs 75rs for each lac Includes loss of anything connected with the accident.

                      Due ageing hearing is nt covered is a bullshit reason diabettis of any other sort of diseases cronic or nt will occur upon ageing of person

                      Find sum other bakras plz

                  • dhawal sharma

                    @Kapil/Hemant/Gopal – want to list a few points in favor of why Max Bupa is a good choice for YOUNG PEOPLE too..

                    *GURARANTEED LIFE LONG RENEWALS – If a young man of 24 takes this policy, he is assured of mediclaim for as long as he lives..Most of the MEDICLAIMs in the market cover at the max 75..With average indian age (URBAN) going up to 75 & beyond..i think its the best bet..I dont know any company, except Apollo Munich, providing life long coverage…

                    *UNDERWRITING AT THE POINT OF SALE – Max Bupa is doing underwriting at the point of sale, that is checking the correctness of the case since inception..Unlike other companies who do underwriting at the point of claim..So we can provide clear idea to the policyholder from the begaining what is covered and what is not…

                    * NO LOADING – Most of the companies provided coverage till the age 75 charge LOADING..that is they will charge extra amount once you made any claim…We are making no such exceptions…

                    *PREGNANCY COVERAGE – In addition to maternity expenses for upto 2 deliveries, with additional feature of 1 year vaccination for child FREE from MAX BUPA..

                    You tell me are these points not in favor of young people?? i dont think so…Manish, you become referre, and decide the merits of Max Bupa for young people…

                    • Kapil

                      I agree Dhawal that these points looks good and definitely holds merit but then you are also charging higher premium rates so now everything boils down to: considering all merits and demerits, whether this policy is worth purchasing at this premium rates.
                      Its a difficult question to answer and I leave to forum members to come to a put forward their comments based on their knowledge and understanding.

                      Kapil

                    • dhawal sharma

                      @Kapil – No dear, certainly i didn’t took your comments personally..Infact, i put those facts only because i am associated with Max Bupa and i know these information. Nothing personal brother :-)

                      Now to your concerns on EXCLUSIONS..But before taking them in depth, i would like to make something clear to every body which i believe most of the people dont have idea about..is that MEDICLAIM is used when somebody is HOSPITALIZED and if someone is inpatient (Admitted) only then MEDICLAIM comes into being..So if someone is seeking treatment by going to a doctor or specialist, MEDICLAIM will not hold any meaning, whether it is from Max Bupa or from any other company..and i dont think someone gets hospitalized just because he is suffering from some illness/disease due to old age or any other reason…

                      Now going back to exclusions, lets again discuss them one by one (Sorry, complete explanation to these exclusions is not on the site, there is just a list of exclusions 😉 I have literature on this but that is for internal circulation only)..
                      ARTIFICIAL LIFE SUPPORT – The explanation says that if use of these means result in restoration of health as previous to admission to hospital, then these expenses will be covered..means if these ARTIFICAL LIFE SUPPORT systems proved to be of no help, expenses on them will be not reimbursed..but yes, if they prove useful or help to bring patient up from his deteriorated health, then these expenses will be reimbursed..

                      AGEING RELATED PROBLEMS – No this list is not limited to only those 2 complications which i have earlier mentioned..Infact ALZHEIMER’s disease is not covered by Max Bupa from the very onset under the EXCLUSIONS heading NEUROLOGICAL & PSYCHIATRIC CONDITIONS and it includes PARKINSONIAN DISEASE..It includes every type of RUN-DOWN CONDITIONS..Please see the following link for meaning of RUN-DOWN conditions..
                      http://en.wikipedia.org/wiki/Introspection_Rundown

                      and yes, SLEEP DISORDERS not covered under this policy are TREATMENT FOR SLEEP APNEA, SNORING, or ANY OTHER SLEEP-RELATED BREATHING PROBLEM..

                      ..yes, we do cover ALL DAY CARE TREATMENTS..Apollo Munich has come up with 143 DAYCARE procedures which will be covered by them..We have gone a step ahead and states that no such list, EACH & EVERY DAYCARE PROCEDURE will be covered :-)

                      & yes brother, i dont mind about all these queries/questions..In fact, i handle them day in & day out in my real life, as an agent, from real life client who are much more subtle and in-your-face…No problem at all..i like this forum for this thing only that people come up with GENUINE QUERIES, for which they really want to know..Cheers…

                      And yes, we are quite expensive if compared to the rest but if you take a collective package, the kind of and number of benefits which an individual can have in Heartbeat, i bet no other mediclaim can offer collectively as of today..One or two features here and there can be better than us but collectively, NO..

                      Aur waise bhi kehte hain naa, MEHNGA ROEY EK BAAR AUR SASTA ROEY BAAR-BAAR 😉

                    • Nitin

                      Hello Dhawal,

                      Nice answers that you are providing for every query raised and that tempted me to raise one more query.
                      in the policy wordings, it says, list of exclusion includes heredity conditions. So does it mean, if one of my parents has succumbed to the death due to heart problem – heart attack, I won’t be covered in your policy? immediate reply is appreciated, as i am finalising either of the two: MaxBupa Heartbeat Gold and Apollo Munich Easy Health Exclusive. Also, kindly let me know the advantages of Heartbeat Gold over Easy Health Exclusive for 5 Lacs cover.
                      Thank you
                      Nitin

                  • chandna

                    NOT COVER AGING

                    They have not explained the meaning of AGEING. They can reject any claim in the name of aging. Its highly confusing and risky. You are admitted in a hospital and MAX says Your claim is rejected because at the age of 25 there was no problem and now you are 30 , this problem is due your age which has been increased by 5 years.. Avoid the companies who are not specific and use vague terms like AGING

                    • Dhawal Sharma

                      @Chandna – As i have mentioned above in the same thread, explaination for age related issue is as follows:

                      NOT COVER AGEING & PUBERTY – the complete explanation is “TREATMENT TO RELIEVE SYMPTOMS CAUSED BY AGEING SUCH AS MENOPAUSE & HEARING LOSS CAUSED BY MATURING OR AGING..i dont think its a vague definition..Company is making clear that something a policyholder has developed due to old age will not be covered..But if same complication, like hearing loss has occured due to an accident, will be COVERED

                      Dhawal Sharma
                      URJA WEALTH CREATORS

      • vishal

        Hi
        As you said that apolo is providing with the same benefits but you know that they do have a sublimits for hospital room rent, emergency ambulance etc, and one more thing that they are not covering critical illness complately, however max bupa is covering maximum desies in their policy.

      • KRANTIVIR RAJPUT

        @ MANISH
        What is your personal financial portfolio….means what Instruments you have in your kitty….so that we may also select some of them.
        PPF, MFs, TermPlan, Mediclaim, Health Plans etc.

        (Please don’t get offended…..I am geniunly asking for guidance) :-)

        • Krantivir
          Choosing the products from others portfolio will be of no help .. its totally based on your risk appetite and how you look at it .. I have a kind of traders personality , so i love options trading .. which can be dangerous for a person who does not like risk . I have got few MF and some money in Bank .. thats all

          Manish

      • Mangesh Magar

        Abhishek,
        Apollo Munich is leading the race in health insurance, however, there is a deadly clause of “Premium Loading” , which means if you lodge a claim with them.. the next year onwards your premium is hiked by directly 150%. So, beware !!

    • dhawal sharma

      the only difference is APOLLO MUNICH start covering pregnancy after 4 years whereas we people at MAX BUPA are covering it after 2 years…Moreover, the maximum entry age for APOLLO MUNICH policy is 60 years where as MAX BUPA has no such limitations..

      • chandna

        Max has no limitations for age for renewals

        Because they are going to reject your claims :

        Claim rejected due to AGING

        Nowhere they have explained the meaning of AGING

        • vishal vaid

          Hi
          first of all i would like to ask a very simple question from you that do you realy understand the meaning of aging? so kindly learn first about that then only post a comment about any company, max bupa is a very transperent company because they do underwrite the the customer before issuing the policy, then after they issue, unlike other company will issue a policy first then at the time of claim they do ask about the medical report, so that means you are completely cover against anything(except permanent exclusions/pre exixting condition) after taking a policy through max bupa.

      • Mangesh Magar

        Ramiz,
        The fact reamins that no health insurance company mention about capping of treatment covered. Wheher it is Maternity or in regards to treatment of any inclusive disease, we need to probe them and seek the printed document if the capping clause exist with them or not.

  2. Madhu Babu

    What happens in the below cases:
    a. If I take a Health Policy which covers 3 lakhs and premium say 10,000/-. And later after 10 years (paying premium regularly), If I want to increase the Policy Coverage from 3 lakhs to 8 lakhs, where the premium is 35,000/-(for 8 lakhs). Does the Health Insurance company allow me to renewal for the higher coverage maintaining the same policy(instead of new policy).
    As at present 3 lakhs is good enough for health coverage(I already have Health policy taken by my employer), but after 10 years, 3 lakhs is not enough.

    b. And for the same Health policy, say preminum is 10,000/- for 3 lakhs coverage. The premium can be increased by the HealthInsurance Company though we don’t claim it. Is there any restriction that the premium can’t be increased more than certain limit.

    Thanks
    Madhu

    • Madhu

      A) I think this is allowed in some companies , it is advised that you ask your insurer about this rule , Is this mentioned in your policy document ?

      B) Yes , it can be increased , it would depend on rising cost of health care, the claim they get every year and the projection for same in coming years .

      Manish

  3. Asif

    not having TPA’s involved does not seems to be a good move as we do not have any claim processing history of it so can not figure out how it would be handled.
    what’s your opinion?

    • Asif

      Can we get claim processing History if we have TPA , Company’s who do not have TPA , do the processing in house , so its not that the claim history is not maintained . Having TPA just means that company’s delegate the “client interaction while claim” part to 3rd party .

      Are you clear now ?

      Manish

  4. ManishJ

    I compared it with other insurance policies on apnainsurance dt com

    Looks like the premiums are very high compared to others – no doubt some points are better than other policies. In my case (2adults+1child) 5L coverage : Rs17K for MaxBupa-Gold v/s Rs 9K for National Insurance – Parivar for Family (Floater).

    Maternity benefit is not available within first 3 yrs…
    If this is the case, how much useful this clause would be and for what % of people looking for health insurance.

    • smitha

      Premiums are obviously way high, atleast when I compare with what I get here in this part of south -east asia.

      The more people opt for health insurance the less they would pay in premiums as risk spread increases. Do you any idea about what percentage of population is taking insurance?

      PS: I pay a premium of 4290 INR per annum for self, for a basic coverage of about 50 lakhs INR in this part of world outside India, no caps on room charges or per day limits, but no TPA here.

    • ManishJ

      Yep

      Its almost half the premium , I think the reasons there premium is high is

      1. The provide renewal for whole life , which National gives upto 65
      2. Covered for medical expenses incurred 30 days prior to hospitalisation. (National for 15)
      3. Covered for medical expenses incurred upto 60 days after hospitalisation. (National for 30)

      the point 2 and 3 are pretty heavy if you think in deep . They might be asking for that reason , apart from that I am not sure about the claim settlement part and their service .

      Manish

    • JayaprakashReddy

      I’m not very much inclined with a policy with maternity benefit. If a policy is good because it provides maternity benefit then I think this is not good reason.

      Just for example: There is a cap on maternity benefit payment in these policies, which is 25k. Now, a normal delivery will easily go up to 25k in small private hospital local to your area and if you go for a big corporate hospital it will be anywhere between 30-40k. If it is cesarean then it will cost you 35k in small local area private hospital and in corporate (Apollo) it will be 50k around.

      In this case you pay hefty premium because of maternity benefits and you get less than you pay. As maternity is considered as regular medical condition hence lets not look for it in a mediclaim policy and get policies for cheaper with some other benefits like life long renewal. This is my opinion after getting some information on health insurance policies with various benefits. Comments are welcome.

  5. Jitendra Solanki

    If one look at Apollo Munich Health insurance Plan then all features are available.May be something more than Bhupa.
    Theprime reason is that you cannot have more features now.So any company which will come in the market will tinker already existing plans -+10%.So what Bhupa has done is add some features on Apollo Plans (also its their competitor in hospitality) .But due to this the premium has increased to a great extent.
    In comparison features are same in both the companies. Advantage with Apollo is Low Premiums and an early starter.

    • Jitendra

      Yup .. looks same to me , Do you know if Bupa is targetting a higher middle class customers ? Looks like those extra benefits will lure only people who need more than Basic ?

      What do you say ?

      Manish

    • Mangesh Magar

      The regulating authority IRDA must intervene without any further delay and arrest the rising premium graph of companies by issuing a directive to that effect. The present rates are unacceptable vis-a-vis the earning capacity of an average customer.

  6. Nilesh Panchal

    I have recently come across about Aditya Birla Money IHO Health Plan Card which offers coverage at discounted rates and have following advantages.

    1. No Age Limits: No exclusions made on the basis of age
    2. All Pre-existing Diseases Covered: No exclusion for pre-existing diseases
    3. Dentistry Included: All dental and cosmetic treatments are covered
    4. No Waiting Period: Avail of benefits instantly!
    5. All Specialists Included: Virtually all doctor specializations are included
    6. No Limits on Visits/ Services: Visit IHO medical practitioners as often as required
    7. High Quality of Doctors: Only high quality doctors are part of the IHO network
    8. No Deductibles: All treatments/ conditions are covered
    9. No Claim Forms: No complicated procedures to avail of benefits

    Is anyone have come across this?

    • Gaurav Raina

      Nilesh,

      IHO is not a Health Insurance Org. They are providing the facility to provide dicounts on Medical Chk ups, Buying Medicines and consullations from doctors under their network by issuing the IHO card.

      They are not an insurance company and will not provide you any cover. They are just to provide the discount on any Pre- hospitalization treatments like regular chk ups and if you buying medicines from their approved pharmacies their will provide discount.

      • Mangesh Magar

        Nilesh,
        I think you should introspect before putting up any misleading information like the one you posted. The motive must be to guide and not to misguide.

    • Trinath

      Hi,

      I am very happy to see this blog… I am worried about my parents who are 60+ years. Do you think this plan as it says will provide equal coverage for them also?

      Anyone has any comments on 60+ years and pre existing conditions?

    • aditya

      IHO is fraud. I have already suffered. I will not go in more explanation, but kindly do not go for IHO. i have already done a lot of reserch on this, so plz plz u do not waist ur time on this.

  7. dhawal sharma

    @ Nilesh – IHO is only covering OPD..Its no substitue for MEDICLAIM.

    @ Jitender – I’ll give you at least 5 plus points of BUPA over Apollo Munich
    1. Health check up every year from BUPA where as Apollo Munich is giving it after every 2 years.
    2. Max Bupa will be giving 10% loyalty bonus every year (Claim or no claim) where as Apollo will be giving only No-claim bonus.
    3. Newborn baby is covered after 2 years by BUPA where as Apollo will be covering after 4 years.
    4. Baby will be covered from day one as well as vaccinations for first year will be provided free by BUPA where as no such scope from Apollo.
    5. No limit on maximum entry age by BUPA where as its 60 years from Apollo.

    There are number of other positives in favor of Max Bupa for which i believe public can shell out 2k to 3k more

    • Rahul Bajaj

      Last time i checked with them , the 10% bonus every year was only on some purchase of health or medical products like B.P checking machine or blood tester etc. I find the no claim bonus to be better, which other companies are offering ! if this would have been an added feature then it would have been welcome, but as i see it its there only to fill the gap of no NCB with something which sounds similar. Please check this again !

    • Mangesh Magar

      Yes, on lodging claim with Apollo Munich, they are charging 150% loading on premium which I think is criminal. So what if one is lodging a claim ..its not for fun..they must realise this and shed their profit-loss leveraging attitude and become customer centric.

  8. srikanth

    I had taken family floater for 3 lakhs from United India Insurance, premium is 5400 per year.

    Its the cheapest that i know of and from a govt organization.

    can someone dig the finer print for this please.

    • Srikanth

      You should look at the finer prints and see if the benefits and limits suit your requirement , how come you didnt look at it first and then choose the policy ?

      Were you sold the policy in hurry ?

      Manish

      • srikanth

        No, i was not sold into it. I bought it myself.

        2 reasons.

        1. person selling the policy in Andhra bank didnt have a clue about the policy.

        2. I was preoccupied with the thought that medical insurance finer print it too complex to understand.

        finally i was delaying it for so long that i bought it out of frustration than thought. It was cheapest insurance that i had found and was from a reputed bank and insurance company. I fell for those 2 points.

        • Srikanth

          Even if fine prints are tough to understand you should read it , its actually not that tough , you take any ULIP plan policy document, its actually very easy , people are lazy to read actually , that too for investments :)

          Manish

        • Mangesh Magar

          Srikanth…same happened to me and finaly chose Bank of India National Swasthya Bima Policy for my parents. There is no point in bragging our brain as we are not in a bargaining position on this matter. Its a subject matter of solicitation as rightly said !!

    • Mangesh Magar

      The clause of Capping is very bad in govt. insurance companies. One cannot pre-judge the treatment cost and issue conditions about same. This defeats teh purpose of insurance.

  9. mukul

    Hi Manish,

    thanks for bringing this up. I am watching this space for more comments.yes, i agree, premiums are little higher than other providers like royal sundaram, united india, andhra bank’s health plan.but what i like was renewal. also i think it is not having any caps/sub-limits(like 1% or 1.5% of SI). only condition is it should have shared room for silver plan.for gold plan, private single rooms are covered.also there are some added benefits over silver plan.vaccinations are covered for kids.

    • Mukul

      yep , some benefits are there which are generally not there in other plans, but from others comments i came to know that there is no much difference compared to Appolo Munich P0licy , so you might want to explore that too .. also think a lot about the benefits , see if its your actual requirement , we just dont buy Audi or Mercedes because it is better than other , we also have to be comfortable with the pricing and see if it fits us .

      Manish

  10. chakrapani

    There is a similar policy from ICICI Prudential called Health Saver. this is also a whole life plan and is in existence for over a year now. I don;t see much difference between the two plans (i.e. MAX and ICICI). Whatz ur opinion?

    BTW the premium for 5L coverage (2 adults + children) in ICICI is 15K. Thus MAX looks costlier.

    • chakrapani

      BTW in ICICI health saver, your money (premium) is invested as in ULIP. Thus a corpus is always available for your use and later withdrawal after 5 yrs of policy continuance. Hear you can claim all your medical bills apart from hospitalization (like purchase of medicines at the local chemist etc) on producing receipts. Thus the vaccinations are taken care here but in a different format. I mean all day care charges like visits to the doc can be claimed including dental services.

      • Chakrapani

        Health Saver is a ULHP , which means that its a unit linked product, Just like a ULIP , it can get complicated later even though it promises much , I am not saying its features are not exciting , if one understands the products he should go with it , but Unit linked products in general are a no to retail investors who like simple things .

        Manish

    • Yes, if you are long term investor, you can go for this kind of ULIP Medical policies.
      Especially, this policy works best for salaried people as they will be paying premium when they are earning, and when their earning has stopped, their corpus in this Policy would be enough to take care of their future premiums.

      However, the best option would be to go for a Regular Health Plan and invest the difference in Diversified Equity fund and treat the Fund as your Health Expenses Back up.

      Regards,
      Srikanth Matrubai

  11. Mukul

    hi Manish,
    In respect to taking ulip health plans,I am no authority to talk on these things. However I get a feeling that health insurance should be a simple. it
    Simply avoid me to pay from my pocket when I am hospitalized.I think that one should break his/her health insurance into (mediclaim + critical care).mediclaim for cashless purposes.and critical care which will cater to major surgeries. why it should be different, single critical care plan like from bajaj allianz comes at less price.taking group schemes reduces the premium even further.

    • Mukul

      Yup .. agreed . I would say if one has got Term insurance , he can also include critical illness rider and then take a stand alone policy for health insurance.

      Manish

  12. pattu

    Manish,

    I am amazed at how informed the comments are! I think the comments valuable to someone choosing a policy for the first time. Great contributions from readers!
    I have one from United India. As you know I am always skeptical of private insurers. Two (trivial?) things I don’t like about Max Bupa:
    1. Their website has an irritating flash intro with a clock ringing.
    2. Their ad campaign asks us to keep fit! So that we don’t get sick and they don’t have to pay!? :)

    • Pattu

      haha , I will take that as a pinch of humour :)

      How does that clock ringing is related to their health insurance policies ? Also if they are saying keep fit , it can also show they care for their health :) , but again i take it as emotional attyachar . Can you give more review about the health policy you have from United India ?

      Manish

    • Dhawal Sharma

      Hi Pattu,

      Cuz me an advisor for Max Bupa, would like to add that ad campaign says, FOR US, YOUR HEALTH COMES FIRST..that is, we are more concerned about your well being – as for claims, we are with you for life…What about ICICI LOMBARD’s MEDICLAIM FAMILY FLOATER which says that they will charge loading of upto 75% once you make claim..which indirectly means take our policy but dont ask for claims otherwise we will penalise you 😉

      • Dhawal

        What does off loading mean ? I think what you are talking about is called the concept of “excess” . In which company do not bear a certain percentage , but the customer has to bear it , it helps in reducing fraud .

        Let me know if I am not correct .

        Manish

        • dhawal sharma

          hi manish,

          for once, i caught you off guard 😉

          LOADING, as specificially mentionedin ICICI LOMBARD broucher means the excess amount they will charge from the client..For eg: their clause shows that if claim is made for 2 lakh, they will make a loading of 75%..that is, if someone is paying a premium of Rs 10k, after loading he will be required to pay 17500..Isn’t it blatent loot and fleecing the customer..check for yourself

          http://www.icicilombard.com/Content/ilom-en/Downloads/Product-Brochures/floater.html

            • dhawal sharma

              loading, in terms of mediclaim policies, means the extra amount charge by the company in light of client/policy holder being prone to disease-ailement-illness after he has claimed from the company due to any of these problems..The basic understanding according to these companies is that once a policyholder has made a claim for any problem, he is going to make claim again for such issues in the future for sure..To safeguard against this recurring expenditure on the part of the company, what they do is CHARGE EXTRA AMOUNT from the policyholder by way of LOADING (as you must have seen in the broucher of ICICI LOMBARD)..Which is something like daylight robbery..On one hand, they are selling MEDICLAIM policies and on the other than, they are charging extra amount once someone made a claim through this policy..Very-very wrong but sadly, 99% of the people are not aware of this fact or its resultant repercussions while taking this type of mediclaim policies..

        • dhawal sharma

          what you are talking about here manish is called “CO-PAY” clause that upto a certain percentage of claim is paid by the company and rest is to be borne by the policy holder..This type of CO-PAY clause is levid mostly in case of senior citizen policyholders because in their case, company’s risk for mediclaim is high as well as expenses at their age, even for minor ailments would be high..This is very different from LOADING

  13. SHAILENDRA

    when i read the the ARTICLE..i think i found the best MEDICLAIM POLICY,..
    but after reading comments..i got confused..people like me who does not understand such technicalities gets confused and their decision to take a policy got a reason to delay their plan .
    MANISH … if possible, can we have some formulas to choose a best mediclaim policy …. one more thing policy should be a (pvt or govt.) one? ..

    overall …jagoinvester really leaving a impression on me….i am cursing my self that i came to know about this site so late (31 yr.)..u r doing a wonderful job… in every fin. disscussion i mention about you… and asked them to follow ur article…
    thanks

    • SHAILENDRA

      Nice to know that you are liking Jagoinvestor and having so much confidence :)

      Health Insurance is a tough game and there are so many policies that its tough to decide , one of the ways of selecting a good policy , is first remove the policies which does not look good to you . So have a list and then see which one have features which will not work for you , its always better to first de-select the companies or policies as you need just 1-2 things to say NO .

      Now once you have some policies , now you need to research on them and find out which works best for you . If you have found some good one’s but its too tough to decide the best among, them I would say toss the coin and take one or just go for any of one , because if you dont do this , you will never choose them and keep on postponing the decision , atleast with this method you know that you are getting into something which is good , if not BAD .

      Manish

      • Dattatrey

        Dear Manish

        I found your comments extreemly useful…and they do gave much needed insight into the finer print. I need your expertise in selecting a health isurance for my father. His age is 62. He has no previous medical conditions by grace of God.
        Plz suggest on what Sum Assured Amount I should take the policy. I was confused between Star Health’s Red Carpet and Max Bupa. I am Govt Servant with 3 lacs per anum salary. Plz share your openion on Red carpet plan.

        • Dattatrey

          You can go with Max Bupa , its a bit higher on premium , but their features are better . You need to do your own study on it . Which city do you belong to ?

          The only problem is your father is now 62 yrs , his premium would be really on the higher side . with 3 lacs of annual salary , it would be a bit on higher side .

          Manish

  14. Gopal Gidwani

    Hi Manish,

    I went through all the comments on the policy. It is amazing to see the points that people have highlighted about different types of policies available in the market. I myself got to learn a lot from the comments of other people. Thanks for posting my article. It did a world of good for my understanding of health insurance policies available in the market.

    A lot of people are skewed in favour of health policies issued by the 4 Public Sector Insurance Companies as they are cheaper. But here I would like to highlight one major point which is making lot of news recently. The public sector health insurance companies have recently removed 150 major private hospitals from their list of cashless facility. These hospitals inclued the likes of Fortis, Apollo Hospitals and other big private hospitals. Now if a person is denied cashless facility and has to pay the bills first from his pocket and then claim it from the insurance company the person will face lot of hardship. The reason given by insurance companies for removing the cashless facility is that these companies inflate the bills and because of this the insurance companies are bleeding losses. So individuals should take notice of this before deciding the policy to go for. Because even if the policy is coming at a cheap premium if it does not help in the time of emergency it serves no purpose at all. The companies along with their TPAs are working with the hospitals to resolve this deadlock. I hope they come up with a solution soon to this problem. But at the moment the ban on these hospitals remains. But whenever a solution comes up there will be a cap on the room rents for a basic premium. And if the customer wants to avail semi-private and private room facility and luxury treatement he/she will have to fork out a higher premium in the range of 25-50% above the base premium. Then the private health insurance policies premium wise will be at par with the policies of national insurance companies or the private companies may appear cheaper compared to national companies. So lets wait and watch this space for future developments and see what is the outcome.

    Best Regards
    Gopal Gidwani

    • Mukul

      Hi Gopal,
      Thanks for this informative article and thanks Manish for including it. The comments on Jagoinvestor are very informative. They throw more information to the readers. It is upto the readers to dig out more info and turn this into knowledge and use it to their benefit.

      Thank you duo for this article.

      • Arudra Kumar

        Hi Manish,

        I have been reading all the posts since some time now and I find this site to be fantastic. You are really doing a great job. Keep up the good work.

        Coming to the current topic, I have a Health insurance plan from Star health insurance. Its a family floater. This is one of the good and cheap plans I found out. However, not really sure about their claim process as I have not done any claims so far.

        Regards,
        Arudra.

        • Dhawal Sharma

          Please check out the capping levid on the claims to be made..1% of sum assured on room rent and 2% for ICU expenses..That is, if someone is having a cover of Rs 2 lakhs, he is entitled to a room of Rs 2000..if by chance, he is taken a room of higher denomination (Which is the case is most of the top end hospitals like Max, Fortis, Apollo) then you have to shell out remaining amount from your pocket..that is the sad part..Cheap plan, yes but Good plan, NO…

  15. Kshitij

    Hi Manish,
    Its very nice to read your post. I would like to thanks to you and all other users for thier comments. I would like if you write a detail post on Apollo Munich and National Insurance – Varistha policy. Most of the users like to know about them. Young generation as well as elder generation can take benefit of above mentioned policies and secured there future.

  16. vivek

    well nice discussion.but i m amazed to see that nobody talked about star health insurance.it is one of the cheapest health insurance. i personally have star health family floater for two adults and a child of 5 lakh and the premium is just 7100/- and of course no TPA along with all the benefits(i mean the useful benefits). what u guys say ….please compare

  17. KKR

    Hi Manish,

    Excellent page / comments. I am in the market for a good health insurance plan. Premium is not an issue – but I am looking at a hassle free and quick claim process – I have faced problems previously from New India and Bajaj Allianz and keen to avoid dealing with loopholes in the policy.

    Some of the points I am keen are – getting a cover for maternity benefit for my wife (at the earliest), life long renewal, cover for my aged parents (60+), premium room facility, no capping on bills i.e. cashless should mean cashless – not have exclusions at the time of billing. I will study Max Bupa Gold and Apollo Munich mentioned here further. The slideshare link was very helpful.

    Will keep you posted on how the search goes. Keep up the good work.

    Cheers,
    KKR

    • Karthik

      Wonderful :). Great to have you hear and feels good that you have your expectations very clear , I am sure you will get some good policy , share your learnings with everyone .

      Manish

  18. TS GNANADEV

    Hi Manish!!!
    Good work!very useful and informative comments!!!
    i have been thinking to take a family health insurance for more than 6 months….
    after becoming Jagoinvestor reader thinking twice before doing any financial decision.
    Thanks for giving this!for kind information after reading the Term plan Aegon religare i have taken term plan for 2500000.credit goes to you!
    For this topic, the same Aegon religare comes with interesting health plan called silver,gold,diamond and platinum.
    just planning to go either ApolloMunich family floater exclusive or Aegonreligare silver…..
    if possible please compare these two,will be helpfull.

    Thanks again for your support…

    cheers!!!
    ts gnanadev

      • sandeep

        one thing to notice about AR iterm is from 25lk to 50 lk the premium gets costlier and at 50lk it drops again. So if someone is looking at taking cover for 25lk to 49.9lk in iterm, he/she should go for 50lk directly as premium will be lesser actually. i did this analysis about 5 months back, may hv changed now. use the sliding calculator to do some scenario analysis.

  19. TS GNANADEV

    Manish!

    planning to get one more term insurance for another 25L…….instead of one with 50L want to divide into two.
    Thanks…
    cheers!!!
    ts

  20. JInsure

    Nice to read some useful info and comments. Here are my few cents:

    Though Max Bupa charges highest premuim, the following factors still go in its favor.

    1) Max Sum insured is upto 50 Lakhs. Most insurers offer only upto 5 Lakhs.

    2) No loading charges. That is the premium dont increase on renewal just because a claim was made in the previous year.

    3) Renewal for Life. There is no max age limit after which renewal is disallowed.

    4) Premuim can be increased on renewal (max upto 50 Lakhs).

    What this means is that someone who has paid premium for 20 years for sum insured of say 2 lakhs can increase the sum insured to 50 Lakhs in the 21st year by paying the corresponding premium. This is very significant because the insured person finds a need for higher cover only in the 21 year in this example. Note: this will not be possible with any current policy other than Max Bupa. Either they have a upper cap on sum insured and/or they have loading charges.

    If any of you feel that even Max Bupa will not support the case in the example then please write in. Because i spoke to their sales person and he confirmed this is possible but i wd only have this in writing from the company to be sure that this policy is indeed one useful one for long term at the cost of higher premiums.

  21. Aseem

    I have ICICI family floater-3 lac- for 2 adults and 1 kid and now that thier is an addition in the family does it make sense to go a new policy for the new born or include her on our existing policy. But then i lose my no claim bonus of 10%-30K.

    Secondly if you can advise it its possible to use two policies for the same surgery (incase one card limit is crossed) and a bill is more
    thanks

  22. RAM

    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?

      • VENKATESH

        Thanks for excellent review of Max Bupa policies.

        Max Bupa clearly states that pre-existing conditions are not covered for 48 months. My question is, my mother has health insurance from National Insurance Company (varistha mediclaim- for senior citizens) from March 2008. We have not filed any claims.

        If we shift to Max Bupa in March 2011, it will be 3 years without filing any claims. So if we go with Max Bupa, will this 3 year-block period carried over? Is there a policy from IRDA?

        Please address this issue-portability of time/period. With regards, Venkat.

        • Venkatesh

          Depends on the company where you are moving . You have to let Max Bupa about this , and it would depend on their underwriters to consider your situation , It might be allowed , depends on company to company , its not a general rule

          Manish

        • Pradeep Sharma

          Dear Mr. Venkatesh,

          It is nice hear that by the grace of God you havn’t filed a single claim from the last 3 years.
          If you want to switch over to Max Bupa then it will be treated as new policy not the existing one, as till today portability Max Bupa is not supporting portability.
          You can wait for the right time.

          Regards

          Pradeep Sharma

  23. neha

    please take this seriously..i had a bad experience with the agents of max bupa selling the policies..they say all kinds of lies..in my case i had asked the agent who visited my house a written prospectus with all clauses mentioned including a set of their network hospitals..to which he said ” sorry mam i forgot to get it” and he gave me wrong info about network hospitals they have.i trusted him and took the policy
    and later when i recieved my policy i realised my family doctor hospital[a famous hospital] was not included in thier network which means il never get cashless in that hospital..so my choice is either i select hospital in their network or i always apply for re-imbursement incase i want to stick to my family doc and his hospital.
    nanawati in parle,bombay is also not covered in thier network pls note.

    • Neha

      Thats bad . You should have taken the policy only after its confirmed somewhere that those hospitals are covered . What was the rush behind your action ? Why didnt you wait for some more days .

      Manish

      • neha

        hey
        i didn’t wait for a few days as my dad wanted to take the claim and he was totaly convinced by the agent who convinced him.i asked the agent a few medical teminologies and he was unable to answer which means these agents employed don’t have complete information about their company policies and even gave me the excuse that he fogot the prospectus..he assured us that there would be no problem.we asked him thrice if that particular hospital was under their network panel and he said yes.i wonder why this company has employed agents which don’t even have enough knowledge .anyways that agent’s name is UTKARSH MAURYA for all those people who should not be cheated in the future..thanks

          • neha

            oh yes.il surely learn.it’s just that these kind of incidednts refrain you from trusting people in today’s world.anyways i still feel not all people are the same…coming back to the incident.it was my father who trusted the agent and immediately took the policy but its ok i guess..no choice now.i just want others to be careful.

            • dhawal sharma

              @Neha – Hi, i am Max Bupa agent in New delhi and apologies from me for someone who apparently told you lies and broken your trust..After reading your comments, i can suggest you a simple solution which might be of interest to you..Max Bupa has a provision that you can cancel your policy any time during the tenure of the policy, even after 15-day freelook period. Return amount will be as follows:

              LENGTH OF TIME OF POLICY REFUND PREMIUM
              Upto 30 days 75%
              Upto 90 days 50%
              Upto 180 days 25%

              If you are not satified with the agent, product, or company; you can avail this facility :-)

  24. Ashish

    Hi Everyone

    I really appreciate all the comments posted, very informative with different perspectives.

    Now to the point. I am looking for a health Insurance for my parents. My dad is 62 yrs and Mom is 56 yrs. As my dad has crossed 60, the co’s offering insurance policy to senior citizens as per my research are:
    o Max Bupa Heartbeat
    o National Insurance – Varistha Policy
    o United India Insurance – Mediclaim Policy Senior Citizen (Individual
    o Future Generali – Health Suraksha Basic (Individual) Health Insurance
    o HDFC Ergo – Health Suraksha (Floater) Health Insurance
    o ICICI Lombard – Health Advantage Plus
    o Reliance General – Healthwise Standard(Floater)
    o Bajaj Allianz – Silver Health(Individual)
    o Oriental Insurance – Health Insurance(Individual)
    o Apollo Munich – Maxima(Floater)

    Appreciate your suggestions/views for me to narrow down and choose one for my parents at the earliest.

  25. Jitendra Solanki

    Hi Manish,

    I feel comparison are not made in the right way.There are companies which are providing life long renewal,no loading,No sublimits and other features too.
    If you compare very minutely then with same features MaxBhupa is a costly product.Someone with age 24-25 would not mind waiting period for maternity expenses.Similarly Life Long renewals and No sublimits are there in Apollo also.So why to pay a high premium.Then who will go for 10-15 lakh mediclaim cover.Not a young executive who just started earning.
    So every Health insurance policy in the market has its advantage and disadvantage.I know a policy form National Insurance sold only through Bajaj Capital where they are not taking medical test till age 65 and all preexisting disease covered for day one. But the Cashless network is only 1500 pan india.

    So if we really want to compare then look at all features ,match it with your requireents and then see if at the same price you are getting a good deal.

  26. dhawal sharma

    Wanted to bring a new development to your knowledge Manish as well as everybody who is a regular on this site..Max Bupa has come up with a new variant of its MEDICLAIM policy named HEARTBEAT, called FAMILY FIRST where in a single policy, every member of the family is covered..So now a joint family can get a single policy for all of them which covers HUSBAND & WIFE, their KIDs, Husband’s GRANDPARENTS, Husband’s GRANDCHILDRENs, Husband’s FATHER-IN-LAW & MOTHER-IN-LAW…Can be a very usuful product for indian environment where joint families still thrive..

      • dhawal sharma

        you are right manish, price of this product will be high..on an average if 8 family members are falling in this catagory and if i take price of 8 individuals then pricing would be high..But my experience with HEARBEAT sales says that if people are shown a better product with better features or benefits which no other is offering, public at large is willing to shell out 2k to 3 k more…This plan is launched with keep in mind the fact that in effect, there are 3 to 4 mediclaim policies in a single house for a single joint family..So just to add up every member in a single policy, MAX BUPA has come up with this plan…

  27. VENKATESH

    I really appreciate the discussion on health insurance policy.

    Here is a reply from Max Bupa. In our situation, my mother has pre-existing condition and has Varishta policy (National Insurance). We have not filed any claim from last 3 years. Because of poor customer service, wanted to move to Max Bupa. So, contacted Max Bupa and explained our situation.

    Based on the following reply, we need to wait for another 48 months for pre-existing conditions. So, pay a higher premium compared to National Insurance and get no benefit. Where is portability? I feel that these insurance companies are running a pyramid scheme. Collect money from new policy holders for 48 months and pay those who have crossed 48 months limit.

    “Also, once you sign up with Max Bupa it will be a fresh policy & the benefits will start from the year 1. In case there is a pre-existing condition for your mother then it will be excluded from the cover for the first 48 months”.

    Please provide your suggestions and comments about United India Insurance policy for senior citizens. Thanks, Venkat.

    • dhawal sharma

      @Venkatesh – Let me inform you that POLICY PORTABILITY has not been officially sanctioned by IRDA..There are a few MEDICLAIM COMPANIES which are providing policy portability but with TERMS & CONDITIONS attached..IRDA is in the process of drafting such a bill for PORTABILITY but as of date, its not there…

      As in your case where you have taken a policy for your mother from NATIONAL INSURANCE and now wants to move to MAX BUPA, the hitch is that the product you earlier had does not comply with the product you want to take now..That is VARISHTHA POLICY (National Insurance) does not have all the features of HEART BEAT (Max Bupa) and that is why you are not getting benefits by switching from other company..LIFE LONG COVERAGE – NO CAPPING ON CHARGES – NO LOADING are benefits just to name a few which are not there in NATIONAL INSURANCE..So to move from VARISHTHA POLICY to HEART BEAT is like asking to be accommodadted/shifted/transferred from MARUTI 800 to MARUTI SUZUKI SX4…And this is the basis of the PORTABILITY DRAFT..IRDA wants a base plan with common features across the industry so that policyholder of A company can move to B company without deriving extra benefits…

      Please study and compare the Max Bupa policy with any of other policy in the market and you will realize the BIG DIFFERENCE..

      • Venkatesh

        Thanks for your replies. Just focus on 48 months clock not any other benefits.

        I understand that portability is a complex issue. But, on the other hand IRDA or any agency has to say, if the policy holder has not filed any claims for 48 months with their previous company for pre-existing conditions or any conditions, if they move policy to another company, the clock need not start again. In our case, we have not filed any claims for 3 years=36 months.

        I agree that there is no free lunch. On the other hand, we will pay more premium for the benefits offered by Max.

        Insurance companies argument will be, there is no central database to check whether or not claims were filed. Insurance lobby is powerful in India as in USA.

        As we say, what you pay what you get. That is capitalism and consumers understand that.

        Starting 48 months clock again doesn’t make any sense. With this clock issue, senior citizens will forever stay with one company or if they buy a new policy, they are stuck again with their new 48 months clock. Thanks, Venkat.

  28. vikram singh

    Hi Manish,

    i need to buy a medi claim policy for my parents who are 63 and 61 yrs old.

    my mother has pre-existing conditions and father has no history,

    i hav shortlisted 3 policies :-

    1. MAX BUPA’s Heartbeat Silver
    2. ICICI LOMBARD’s Health advantage plus, and
    3. APOLLO DKV’s Maxima.

    all three of them hav their advantages and disadvantages. like, Max Bupa’s 4 yrs waiting period and hospital network in Lucknow (my place of residence) really is an annoyer. similarly Lombard covers only till 70 yrs… Apollo is extremely high on the premium side but have the best network coverage in lucknow. Maxbupa’s premium is lowest but then there is also a CO-pay of 20 % in Bupa.

    Therefore, i have become really confused as to which policy should i go for. could you please advice me on the issue. others are welcum too.

    And i must also inform you that i intend keeping the max cover to 2-3 lakhs only. In fact i am an army officer and my parents are well covered under army medical facilities; i am buying these medi claim policies jus for the emergency and unforeseen situations.

    thank u in advance…

    VIK..

    • Vikram

      You have to ask yourself do you really need our help ? Are you going to take a decision based on what we tell you is important for YOU ? You should look yourself what is more important for you in policy , good coverage , less premium or coverage even after 70 , I would consider your situation as a if you are confused and are not ready to go forward with your decision . Please take into consideration again what is most important criteria and which company is the best on that .

      Manish

  29. Akshat

    Hi,

    I did the analysis myself for the requirement of medical health policy for my parrents (age 56 and 61) and came to conclusion that both Max Bupa and Appollo Munich Maxima offers what I want.

    However, I dont have clarity on below two points.
    a. Max Bupa – list of exclusion includes heredity conditions. My doubt is how do you judge if a particular ailment is heredity or not. Is this exclusion common across policies from other insurers as well or it is specifically in Max Bupa.

    b. Appollo Munich – They are silent on how the premiums will increase every year. They say it depends on age slab but they dont give any specific details. Max Bupa says they will increase premium by Rs 400 max every year. I dont see this in writing but this is the information I got from the executive!

    Can you please help me with this.
    Thanks.

    • Akshat

      Health Insurance is a 1 yr contract only , so even if they have not mentioned in the policy that they will increase it , still they can increase it as it will be a new renewed policy next year , what you are signing today is valid for 1 yr only .

      Its not upto you to judge it , doctors will tell you if its heridetery or not . Ask your doubts on http://www.jagoinvestor.com/forum/

      Manish

  30. pokermaster

    Hello All,

    I read various feedbacks above and would like suggestion from you great people.

    I need help to buy a health policy..My comparsion is for Max Bupa and Apollo Munich…Could anyone suggest which one would be best for Individual in terms of pricing, service,easy to settle claims , renewals and benefits…Sum issured to be between 2 lac to 5lac

    –Pokermaster

    • Pradeep Sharma

      Hi Mr. Poker master,

      No doubt Apollo Munich is better however Max Bupa is the best, no problems for claims because no TPA with the company, everything is inhouse! However premium is bit high compared to other companies.

      Regards

      Pradeep Sharma

  31. Hi all,
    I have taken Max Bupa 2lack silver with 3333/-pa. I would recommend for the yongers who race on bikes atleat they can cover the benefit.

    I want to know your opinon as agent said these words.
    1. 1/2 hr hospitalize
    2. even fever also comes under
    3. non-alopathy treatment not covers
    4. No document to fill at time of hospitalization just hadover you card or id no to the executive who is availble at there.
    5. No maternity benifit covereage upto 1.5yrs

    so what is your comments.

  32. udit

    Hi

    I am Udit( age-30) looking up for a good medi claim policy for me and my wife( age-27),
    i want a reviw on Apollo Munich Maxima( which cover most of the medical needs)

    Regards
    udit

  33. Gaurav

    Hi,

    Do Max Bupa covers Catract also? If yes, from when???
    Also as i can see, there are no network hospitals in Delhi/Haryana under MX BUPA so i am curious to know what does Cashless would mean in this scenario. Let us assume i take a family floater plan of Rs. 5 Lac or more, then in case of any emergency from where i should collect the money first on my behalf and then apply for the reimbursement or is there any other way out?

    I would like to know from existing customers as well that how they are finding their relations with Max Bupa.

    Regards:
    Gaurav Arora

    • Tanmoy

      Dear Mr. Arora,

      Cataract is in the list of exclusion of Max Bupa for 2 years if the client enrolls in the policy at or after 60. However it is not excluded for people who enroll into the policy within 59 and they can take the claim even at 60.
      Max Bupa is adding hospitals on a monthly basis and clients are updated on a quaterly basis with the list of new hospitals added through a post that is rolled out.
      For the out of network hospital the best thing in Max Bupa is that there is no clause of Co Payment for reimbursement upto the age of 65. So the company pays 100% of the claim as reimbursement.

      Tanmoy Mukherjee

    • Pradeep Sharma

      Hi Mr. Arora,

      Yes, Max Bupa covers cataract also, if it is not pre-existing condition then right from the first year for the persons who are less than 60 years of age at the inception date of the policy but who are more than 60 years of age then it will be covered after 2 years of waiting period.
      Max Bupa don’t have waiting period for any disease if person is less than 60 years of age at the commencement of the first policy period!

      And about hospitals please click on http://www.maxbupa.com/contactus/hospitallocator.aspx they have tie up with hospitals in PAN india!

      egards

      Pradeep Sharma

  34. Dr. Ashok Mittal

    Dear Sir, Me & my wife both 56 yrs & son 27 yrs have Mediclaim Policy from Reliance Gen. Ins. it is continue with No claims last 3 yrs. Premiums (Gold plan) for me & wife were Rs5805/ & for son (silver plan) was 1680/- Now this year they demand Rs24273/- less 15% = 20632/- each from individual of us & Rs4716/-10% = 4244/- from my son. Its almost 5 TIMES. I cant imagine how it can be ? My renewal date is nearing 15 Feb. If I change the company, the preexisting disease & other diseases etc will probably not be covered. Plz advise me what is best & also tell me is it fair on part of companies taking 5 times more even when no claims.

  35. Insurance Seeker

    Can someone pass on to me Dhawal Sharma’s e-mail id or any other contact information. I am in dire need of insurance for my parents and would love to buy from someone who provides clear answers.

      • Merwyn

        Hello Manish,

        Could you kindly forward me the details of Dhawal Sharma as well.

        Will be very kind of you.

        Am looking for an helath insurance for my parents and myself. Preferably a family floater.

        Any suggestions from you to, as to which insurance company would be the best?
        I have narrowed down two.
        1> Apollo Munich or
        2> Max Bupa

        Which do you think would be better?

        Thanks,
        Merwyn.

  36. debatosh Roy

    Hi ,
    great to see so much info being exchanged across on family health plans.
    I am 44 , and looking for a 10 L health cover for self , wife and kid under family floater. Have zero-ed down to ICICI Prudential health saver , Max Bupa gold , Appllo Munich.
    1. Some agents are advising against health saver with the logic that mediclaim and investments are not to be clubbed. Don’t understand why. Where is the catch? At least the premium remains steady, helps in the planning.
    2. Max Bupa premiums seems to get real high when the age increases specially after 70 .
    Some suggestions will really help to decide
    many thanks in advance
    Debatosh

    • Debatosh

      generally people dont advice for mixing the two , because there are high charges in these products and for a common investors it becomes pain to understand the product and make the best out of it . So if you feel it works for you , take the responsibility and go ahead, but make sure you dont come back and say that you were missold , You buy it , dont get missold :)

      Max bupa is good btw

      Manish

      • Manish L

        Manish,

        Have you found any further details on the Health Saver plan? It seems like a very good plan. I met the branch Manager of ICICIdirect. It seems you pay 25K premium for a a period of 5 years and you are covered for your entire life for 10 lacs hospitalisation expenses. You are also covered for opd and medicines until there is amount in the fund. I don’t see any catch unless I am not aware of something here. There is also no issue in terms of renewing the policy or anything of that sort.
        In mediclaim policies, are there no issues while you renew the policy in case you claim for a serious illness the previous year?

        Pls. provide your comments.

        Thanks,
        Manish

        • Hello Manish L,

          From what I understand, the product would entail charges related to Hospitalization Benefit and the Health Saver benefit for the entire policy term, even after 5 year of premium payment.

          It is questionable, how Rs. 25000 paid for 5 years, would take care of such charges for 40-50 years + Allocation charges + Fund management charges. I am sure you are aware, the product will exist only till there is fund value to deduct charges from.

  37. Hitesh

    Hi Manish,
    After reading all the articles on health insurance from Jago Investor, I have zeroed on two companies Apollo and Max. Currently my Health Insurance is with Oriental Health Insurance as follows
    1. Father – 150000 – Individual – 64yrs
    2. Mother – 150000 – individual – 61 yrs
    3. Self – 100000 – Individual – 30yrs
    4. Spouse – 100000 – Individual – 28yrs
    5. Son – No policy – 1 yr.
    I have decided to continue with father and mother’s individual policy with Oriental for 2.5 lacs each and need to take a floater with Apollo or Max Bupa for 3 lacs
    I am very much confused between the two insurance viz Max and Apollo.
    Which one is better ? Also can i get one to one comparison of the Max Bupa and Apollo policies ?
    2 differences which i know is Apollo has lower premium but in case of Max Bupa the premium increases every year.

    Thanks
    Hitesh

    • Comment from Santosh

      major differerence between apollo and Max bupa is maternity cover, in apollo munich you have option of taking maternity cover and secondly the minimum limit is as low as 100000/- where as max bupa, maternity cover is compulsory you use it or not and minimum limit is 200000/-

      • Dhawal Sharma

        @HITESH/MANISH/SANTOSH – Didn’t get your point that MATERNITY COVER is compulsory??? MATERNITY COVER is a benefit avilable to a FAMILY FLOATER policyholder after 2 years..Its a built-in feature where as in APOLLO, its OPTIONAL..which means if you want to avail it, you have to pay extra premium..

        Let me tell you the real differences between the two..
        A) ANY AGE ENROLLMENT – An individual of age 70 can also take up MAX BUPA where as APOLLO has an entry age restriction of upto age 60 years.
        B) DAY CARE PROCEDURES – Procedures which require hospitalization for less then 24 hours are known as DAY CARE..APOLLO has a list of 143 day care procedures where as MAX BUPA covers ALL DAY CARE PROCEDURES…
        C) MATERNITY COVER – Pregnancy benefits are avilable after 2 years in MAX BUPA whereas APOLLO gives this facility after 4 years..

        there are many more points to distinguish but these are some of the major ones to put MAX BUPA ahead of everybody, including APOLLO or any PSU..

        Regarding the last point raised by Mr HITESH that premium increases every year in MAX BUPA..Yes, it does but so does APOLLO MUNICH..They have made slabs for age-wise premium..For eg: your premium would be Rs 5000 for age 35 – 40..But when you move to age 41-50 your premium would be 7500..They would spike the premium with Rs 2500 in one go whereas we at MAX BUPA will increase it somewhat every year..I think it would be same if you pay increased premium of Rs 2500 at one given year after 5 years or pay 400 every year for next 5 years..

        Dhawal Sharma
        URJA WEALTH CREATORS

        • Nilesh K

          Like others, I’m also thinking over apollo and max bupa (individual health cover) and I just had a word with Max representative. he told me that the premium will increase by 15-20 rs every year. So he was not sure about the % increase in premium every year.
          With regards to apollo, I did not see anything on loading/co pay on theyr website/wordings. Can anyone throw some light on it?

          • in apollo munich, age slab is there, according to that the premium they will collect. if you check in apollo website clear picture you get.upto 35 yrs one premium and from 36-44 one fixed premium which is more reliable and affordable than other insurance cos.

        • Vijay

          Hi Dhawal,

          Just wanted to ask about copayment clause with MAx-Bupa. 20% co-payment clause is present for people after age of 65. Is it that way?
          -Vijay

          • Dhawal Sharma

            @VIJAY – Yes, there is a clause of 20% CO-PAY after the age of 65..It means that policyholder who is above the age of 65 is required to pay 20% of the total HOSPITALIZATION EXPENSES out of his own pocket even if the HOSPITAL BILL is within the COVER limit of the policy..

            Dhawal Sharma
            URJA WEALTH CREATORS

  38. Ankur Srivastava

    Hi I want to get my parents insured and after read few forum threads I am kind of confused b/w Max, Apollo Munich and Star. My only concern is which one will provide me hassle free claims. I mostly read bad feedback about Apollo Munich, mixed for Star but no feedback for Max. Can any one here help me? Is any one using the policy for Sr citizens and how is the claim process? Also do they only cover treatment in theri n/w hospitals as is the case with Apollo Munich.

    Thanks for help!!

  39. Jaishri

    What are the pros and cons of max-pupa not using a TPA? Also, how can I find out about their record in awarding claims? Thank you.

  40. raj

    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

  41. sunil

    Hi Mr Dhawal Sharma,

    i have opted for Maxbupa Gold family floater for myself and my wife for 5 lakhs. As we are planning for a baby, will the new born baby be included as third member in policy. will i have to shell out more premium?
    Is there anyfacility that i can increase coverage amount later in life? /kindly clarify

    with regards

    • Dhawal Sharma

      Dear SUNIL JI,

      Great to know that you have decided to cover your family for any MEDICAL EMERGENCY through Max Bupa policy..

      Yes sir, you have the option of UPGRADING your policy from your existing cover of 5 lakh under GOLD VARIANT to 7.5 lakh or 10 lakh..Or you can move to 15 lakh/20 lakh/50 lakh under PLATINUM VARIANT at any point of RENEWAL of the policy..You have the facility of UPGRADING but you CANNOT move down from existing cover of 5 lakh to lesser cover amount of 2 lakhs or 3 lakhs..

      Congratulations for expected arrival of new member in the family :-)

      New-born baby will be covered FROM DAY 1, if the baby is born under MATERNITY BENEFIT programme which comes into being after 2 years of the policy..As in your case, if your wife is expected to deliver the baby in the near future, the baby will not be covered from day 1. You can either take a seperate policy for the baby (An individual policy) or add the baby into your policy by paying extra premium..Extra premium, because your policy will be turning from 2 ADULTS to 2 ADULTS + 1 KID..

      Dhawal Sharma
      URJA WEALTH CREATORs

  42. Jawaid

    Dear Mr Manish
    this is for “atmmanthan”
    Can you negotiate with Apollo Hospital?
    Can you negotiate with Sir Ganga Ram Hospital?
    Can you negotiate with Max Hospital?
    Can you negotiateb with Fortis Hospital?
    or
    Can you negotiate with a small nursing home in you neigbourhood?
    if you or your family member falls ill
    You can’t do that
    Your full pocket of rupees will do the needful
    You should have either full cash in your home because ATM withdrawal is maximum one lac
    or a Health Insurance Policy which has cover of maximum of atleast one critical illness because nobody knows the risk of disease
    Professional Health Insurance Planning is necessary to ascertain the Optimum Sum Insured.
    Just taking the 1, 2 ,3, …5,10, 15 lac of sum insured without planning is waste of money,
    You have a health Policy and also contributing in health care expenses if you are under insured
    Health Insurance Companies often declining claim because insured persons taking policy when health risk becomes certain assuming they can conceal the fact of illness.
    I am citing one live example I faced as Insurance Agent one gentleman enquired about maternity cover when his wife get pregnant.
    So always plan for future probable risk not future confirm risk.
    Health Insurance Premium amount is just a donation from the persons who does not fall ill for the person who got the illness within the Insured group, so please dont negotiate on premium.
    Just calculate appropriate health insurance cover you needed for yourself and your family
    I have read all the comments in one go
    Jawaid

      • Jawaid

        Dear Mr Manish
        Sum Insured is approx thousand times the premium
        one has to pay maximum premium or maximum treatment cost.
        Conclusion is that Sum Insured should be highest which can cover any possible disease that can be treated in India

        • Jawaid

          But a person has to decide how much he wants and he can afford , what if a person thinks that he needs just 2 lacs cover ? then can we force him to take a larger one ? I dont think its realistic

          Manish

  43. Jawaid

    Dear Mr Manish
    we cant force anybody to take a larger Sum Insured or even cant force to take a health Insurance policy
    But can can guide the people to take a health insurance policy (as you are doing now) by highlighting the medical risk and cost of treatment of the modern diseases.
    for example bypass sergery costs aprox. 150000-400000 rupees in a quality hospital today a Health Insurance Policy of Rs 2 lac SI has any use?? After illness can he inhance the Sum Insured without exclusions? Is the person will be in the same position to buy another health insurance plan??
    As I stated earlier every person has probable risk of illness even critical illness and that must be covered by a appropriate Sum Insured and person of your stature must understand who enfluance others to take right decision..
    thanks
    jawaid

  44. Anand

    I calculated the premium on maxbupa site, and I got automated email from them about premium quote. In that email, it was mentioned that
    “In case of any clarifications, feel free to write to us at insurance24x7@maxbupa.com“.

    When I sent an email to insurance24x7@maxbupa.com asking some clarification, what I got was “email failure delivery” with ‘user unknown’ error.

    Disappointed with the first interaction with the company!

  45. Amit Tank

    Sear Sir, I want a Mediclaim policy for my Family. I want a floating cover of around 3 to 5Lacs, please advice best policy. The people who will be covered are.
    Father – Age 62
    Mother – Age 58
    Wife – Age 27
    Me – Age 32

    Mother has high Blood Pressure. Father, wife and me do not have any pre existing diseases

  46. Suryaneel

    Recently I bought Heartbeat Gold policy from Maxbupa. My first experience was pretty good with the call agent and he had patiently resoved all my queries over the phone.Hopefully in future too when the need arises, my experience would be good enogh to share with you all

  47. Monika Chandra

    Dear Manish

    I am 25 yrs old n still studying but sooner I will be earning. These days I have been listening a lot about Max Bupa…probably because of my habit of listening radio. It has made me think about Health Insurance for my family as well as for myself. With zero previous knowledge about all this things…..n having a preconceived notion of too much complexity of this topic I kinda afraid that if I ever be able to take decisions about such responsibilities. But truly speaking that though its a long way to go before deciding about any health insurance plan but after reading this post…..things seems a bit clear and interesting enough to dig more to get more clarity.

    A nice post for people like me :)

    Best regards
    Monika

  48. Ankur Srivastava

    After contemplating a lot I had bought Apollo Munich insurance policy for my parents but unfortunately I had to submit a claim for my father and then I saw the real colors of these people.
    We have submitted all the bills, reports in original with them but now they are asking us to resubmit the documents which we have already submitted. So we have already decided not to continue with this policy next year but which one to take now is something we are looking at now. I am thinking of going with Max Bupa.

      • Ankur Srivastava

        Hi Manish,

        they have just called me and asked to submit some of the documents and when I checked with my father he mentioned we had already submitted the document. We went to their office in Lucknow where we had submitted the documents with the receipts and they said now they can not do anything as the documents have been sent to Delhi and when we call their call center they have no proper response to our queries.

  49. Utkarsh

    With due respect to Mr. Manish, Dhawal and all those who contributed here. I really appreciate this forum, Its a nice place to know everything about health insurance policies.
    I’m Utkarsh (age-28) working with an IT firm and like others i’m also looking to buy a good health insurance policy with hassle free claim settlement. (It would be my first investment wrt securing my future).
    I want to cover myself, my would be wife(getting married soon) and my dad (age-55).

    I’m in discussion with Max Bupa people, and soon i’ll post all my experience in here. Till now i have had a really good experience with these Max Bupa guys. And i’m finding no reason to deny them.

    Today I have sent them an email to their customer care dept. regarding the queries about claim settlement, coz i feel thats the ultimate thing that we are getting this insurance done for.

    Following are the queries that i have asked to them through an email today, and i’m waiting for their response. I’m doing this b’coz this is what i feel would be the communication medium throughout, once i purchase the policy. And if their customer care department responds in a good way, everything else will go smoothly. Hence, ill be able to take the decision. Hoping a quick and satisfactory response from them. Will update in here once i get the response from them.

    Email:


    I need some assistance. Your early response would be highly appreciated.

    1. What all documents do i need to submit to get my claim (if expenditure is 1.5 lakh, and i’m covered for 1 lakh individual and 2 lakh floating)?
    2. Where do i need to submit them? Do i need to contact any TPO? or you will send some representative to my home to collect those documents?
    3. What is the process you follow to dispatch and settle the claims? You send it through a cheque or demand draft?
    4. And by what date/days (approximately) can i expect the claim amount if i submit the documents today (when i have gone through a treatment in non-network hospital)?

    Please answer these queries in detail as early as possible since its urgent.

    [PS: I’m sending these queries to you b’coz i was not able to connect to your customer care number 1800-3010-3333 through my bsnl mobile, it said this number does not exist, and when i called up on the number available on your website then your automatic answering machine says that i have called in ‘out of office’ hours and your office hours are from Monday to Friday 8:30 AM to 6:30 PM and today is Sunday, I had no other option left.]

    Keeping my fingers crossed. :)

  50. Shashank

    Sir, all the posts are very interesting and enlightened me about health insurance. My doubt is if we cover critical illness rider in Life insurance term policy, will it not be sufficient?why health insurance? Is taking CI rider in life insurance policy applies to once in life time or can be used for any no. of times?plz clarify.
    Thanks.

    /

    • Shashank

      CI rider can be just used once and then your contract expires . Also CI as rider with term insurance might not cover as many things as a stand alone policy will cover

      Manish

  51. ROHIT

    Dear All,

    1. Maxbupa has covered new born babies, but incase if the baby is detected to have a congenital heart defect, is the baby still covered for the surgery performed for repair of the defect.

    2. Is there any insurance policy that covers a congenital heart defect in new born babies.?

    Thanks in anticipation.

    • Dhawal Sharma

      Dear Rohit,

      CONGENITAL DISEASES (Birth Defects) are not covered by ANY of the MEDICLAIM POLICY in the market, including MAX BUPA as of now..

      Dhawal Sharma
      URJA WEALTH CREATORS

      • LICAgentJaved

        In LIC we have a policy for lady policyholder which covers congenital disease, if holder of that particular policy delivers a baby with congenital disease a Sum Insure is payable and policy continues

  52. ANil K

    Thanks guys for the wonderful info and guidance. it was really difficult to zero on the actual health insurance. I though it would take atleast a month to finalize my health insurance product after research. It almost took me 2 hours to read through this entire post. But i feel its enough .

    I am planning to go with maxBupa with below two options: I am 31 now – wife 27 – daughter 1

    These are the positives i am looking at .

    1) No LOADING. I dont want to be shocked at the next year premium once i submit a claim.

    2) No sub-caps. This was a shocker for me when i have submitted my wife’s maternity bills to a group policy of my employer. With raising hospital expenses i think sub-caps will be again a shocker.

    3) no-claim bonus : This should take care atleast part of the comparatively-extra-premium that i will pay to max-bupa

    4) ability to increase the SI: If anyone has not realized it yet, get it now. At 31 years 5 lakhs seem very good. But at 35 years ( 5 years from now) its not that much. with age, one definitely needs to increase the SI. With a new policy everytime you will lose the benefits of continuity.

    I think the extra premium that one will pay to max-bupa will be nullified by the benefits you accrue over a period of time.

    thanks
    Anil

  53. Hello Anil,

    Great, that you are taking a decision and buying Health Insurance in an early age. Appreciate you taking the pain to research and buy. Most people do not research, and go by hearsay. Max Bupa is definitely a good product.

    Another 2 points you need to take care:
    1. Copay of 20% from the age after you reach 65 years.
    2. Go for Gold Plan, as only Gold plan offers a Private Room. If you buy a Silver plan and go for a Private Room, there will be several deductions on expenses linked to type of room, like Doctor Fees, Diagnostic tests etc. , than the difference between Cost of Shared and Private Room

    We have observed, these points are generally not explained by some Agents and the Call center of Max Bupa.

    Good Luck!

    Mahavir

    Cheers!

  54. ANil K

    thanks for the suggestions mahavir. I will take those things into consideration.

    LicAgentJaved,

    I didnt understand why you have asked me to take the cover for 30lacs .
    Because maxbupa gives an option to increase the cover at a later stage, isnt it wise to take the required cover ( 5 lacs) now and then probably after 5 years increase it to 10 lacs ?

    Why pay premium for 30lacs cover for this year ?

    Or, is there any other point that i am missing ?

  55. LICAgentJaved

    Hi Manish
    Points for 30 lacs SI
    1.You cannot guarantee same medical condition you have now
    2. You are taking cover for future illness cost of heart attack treatment is aprox 5 lacs for one person, Cost of organ transplant 15 to 25 lacs for one person etc etc what cover you are taking for each person of your family
    3. premium for 5 lac SI of Heart Beat Family Floater is Rs 17109.00 for your family and premium for 30 lac family First in Silver Plan Rs 15223.00 and in Gold Plan is Rs 21462.00
    is it enough??
    Javed

  56. ANil K

    Thanks Javed. The information you have given about the Premiums is really a point that everyone needs to consider. Why there is such a difference ??

  57. Vijay

    Features Max Bupa

    Waiting period – 90 days
    1 & 2 year limitations – no
    Preexisting diseases from 5th year
    Loading charges – no
    Co-payment – no
    Capping (sub limits)- no
    2 year term discount – 20%
    Limited region coverage discount – yes
    Shared room – yes
    TPA – no
    Rider – Critical illness – no

    • LICAgentJaved

      Hi Vijay
      Feature of Max Bupa read as

      Waiting period – 90 days for normal illness treatment of which can be delayed,
      otherwise from day one.
      1 & 2 year limitations – no upto 60 years
      Pre existing diseases from 5th year
      Loading charges – no for claim
      Loyalty Discount Coupon every year upto 10% of last premium
      Co-payment – no upto 65 years of age thereafter 20%
      Capping (sub limits)- no
      2 year term discount – 20% (No 2 year term is available)
      Limited region coverage discount – yes (Max Bupa Policy has all India Coverage, Premium rate is for 3 regions Delhi NCR/Begaluru, Mumbai and Rest of India
      Shared room – yes for Silver Plan
      Single Private Room for Gold and Platunum Plan
      TPA – no
      Rider – Critical illness – no
      Maternity Cover – From 3rd year for females
      Javed

  58. Pravjot Verma

    Dear Dhawal
    I am working in merchant navy (Oil tankers).I will be out for more than 6 months out of India on board oil tanker.My Employer will be covering for the tenure out of India.
    Do Max Bupa cover for my stay in India if I take the Silver Plan.

    Regds
    Pravjot

  59. vikasluthra

    Dear All

    Firstly i would like to congraluate all concerned with the healthy discussion which obviously feel benefit the readers giving better insight of the pro’s and con’s of different health policies and at the same platform enabling sharing their views on each of them.I am also one looking for a health policy but also have a situation in hand for which need some guidance.

    I am 31 year old presently covered for 3 lacs with ICICI HEALTH SAVER POLICY along with my wife and 2 year kid. I will complete 3 year of the policy in end jan and it has been claim free periods under this policy.Now i want to change it over to another company since i realise this policy is not sufficient for all of us at 3 lacs.

    As what is stated in the policy document and as per my understanding of the policy terms listed, i can stop paying after 3 years and still the policy will remain in force till the value of my units is above 110% of the premium value.If this happens they will intimate me and if i still dont make any efforts to pay it will result in foreclosure.However same cannot be verified by any agent or icici executive and i have been asked to visit icici pru life branch.

    The present value of the NAV is around 23000 rupees which is sufficient to cover my premium amount which is arnd 11-12000 rupees.

    Alternatively I am planning to look at MAX BUPA or APOLLO MUNICH however same is possible if i manage get rid of present policy without any liability or loss.

    Pleased to have your valuable inputs/suggestions or any experience to be shared.

    • Vikas,

      This product is no good to cover your long term healthcare expenses. Regret to say this, but please forget the money you have paid, and correct this mistake, now. If I were you I would let this product lapse, and not further invest even a rupee into it.
      Go for a indemnity based health insurance from a general insurance company or health insurance company. Max Bupa, Apollo Munich both have some very good products.
      Finally, humbly request you to learn from this error and choose your advisor well this time.. Don’t fall in the trap of sales-pressured relatives, neighbors, friends. Look for a health insurance professional who is experienced and qualified.

  60. Hello Vikas,

    The product is no good to cover your long term healthcare expenses. Regret to say this, but please forget the money you have paid, and correct this mistake, now. If I were you I would let this product lapse, and not further invest even a rupee into it.

    Go for a indemnity based health insurance from a general insurance company or health insurance company. Max Bupa, Apollo Munich both have some very good products.

    Finally, humbly request you to learn from this error and choose your advisor well this time.. Don’t fall in the trap of sales-pressured relatives, neighbors, friends. Look for a health insurance professional who is experienced and qualified.

    Regards,

    • vikas luthra

      Dear Mr Mahavir

      Many thank your suggestion which well noted.

      Please also advise what is more beneficial in terms of taking critical illness cover…taking it through medical insurance or including it within term plan since many companies now cover it with term plans.

      I feel its better to do it through medical insurance since its deal directly and would be cheaper option,however suggestions are always welcome.

  61. vikasluthra

    Dear all

    Well after much study into these medical policies i somehow feel inclined towards MAX BUPA FAMILY FIRST SILVER PLAN for myself/my wife and my son (31/28/2)which seems to be reasonable compared to APOLLO in following aspects:

    1)PREMIUM AMOUNT

    FOR MAX BUPA WITH 3 LACS EACH + 9 LACS – TOTAL – 18 LACS SI – ANNUAL PREMIUM – 13800
    FOR MAX BUPA WITH 1 LACS EACH + 3 LACS – TOTAL – 6 LACS SI – ANNUAL PREMIUM – 11800

    FOR APOLLO FOR FAMILY FLOATER PLAN 2+1 UPTO 7.5 LACS – 13500 INR + IF WE GO FOR CRTITICAL ILLNESS OPTION WITH 10 LACS COVER
    -APPROX 3000 INR,THUS TOTAL FOR 17.5 LACS SI – ANNUAL PREMIUM IS 16500

    2)NO LOADING CHARGES WHICH OBVIOUSLY IS VER VALID REASON

    3)NO AGENTS INVOLVED

    4)NO CAP TO ROOM TARIFFS ALTHOUGH IN SILVER PLAN ONLY SHARED ACCOMODATION IS PAID FOR.
    (UNDERSTAND APOLLO HAS 1.5% OF THE SUM INSURED WHICH PLS ADVISE IF CORRECT)

    ABOVE HAS BEEN TABULATED ON THE BASIS OF WHAT I HAVE READ THROUGH VARIOUS BROCHERS/TALKING TO CUSTOMER EXECUTIVES/READING THROUGH DIFFERNT WEBSITES SO MIGHT NOT BE 100% CORRECT.MOST WELCOME FOR ANY COMMENTS/VIEWS/FEEDBACKS/OBSERAVTIONS ETC.FURTHER ALSO ADVISE IF ANY ADDITIONAL CRITICAL ILLNESS PLAN NEEDS TO BE TAKEN INCASE OF MAX BUPA OR IT COVERS ALL EXPCT THE EXCLUSIONS.

    • Hello Vikas,

      Max Bupa is a good product, you can go for it.

      – Apollo does not have Room Rent Limits, neither does it have loadings. It’s Optima Restore product is worth considering, as an option.
      – Agents or Brokers are required in a complex product and service like Health Insurance, since it requires good amount of service as well as advise. One needs to have an expert on his/her side for the long term. Believe me, taking service through call centers and coordination on your own takes a toll on your daily affairs. I am part of a Broking Organization, but this is more from a personal experience.

      If you are going for Max Bupa, please go for the Gold Plan. The Silver with Shared rooms is not cost-effective, in my opinion.
      Also, remember, there is a copay of 20% after the age of 65 years in Max Bupa.

  62. JMP

    I am 57 having no pre existing disease. I am insearch of mediclaim policy which has no waiting priod or very less waiting period for (1) Cataract, (2) Knee replacment (3) Spinal/orthopedic/spondolysis type age related disease (4) heart disease (5) Kidney related disease (6) B.P./diabeatis
    Max Bupa has 90 days waiting period but for above disease also 90 days ?

  63. M deviraju

    Hi
    I am planning to buy health insurance for my Parents (57yrs & 46yrs). Pl suggest. Max Bupa heartbeat and Apollo Munich optima Restore are on my mind. They both have High BP but under control now (with medication).

  64. Antara Kundu

    I’ve been tremendously benefited by this thread! A day back my idea about the Indian health insurance policies for senior citizens was vague – and now I have quite some opinions of my own!

  65. praveen

    NEVER EVER FALL INTO THE TRAP OF MAX BUPA HEALTH INSURANCE.

    PLEASE GIVE WIDE PUBLICITY AND GIVE ME A CALL FOR MORE DETAILS OF GENUINITY ( 09388934690)

    COMPLAINT REF ID – 135432
    I HAVE PURCHASED A POLICY ON 21 MAY 2012 THROUGH TELE LINK WITH THE HELP OF THE REPS OF SALES MR KANIYA AND MOHIT KUMAR.
    WEB REFERENCE ID – 196209
    REF ID – 0000122552.

    BEFORE TAKING THE POLICY AND MAKING THE PAYMENT, I HAVE BEEN TOLD THAT NO DOCUMENTS, MEDICAL CHECKUP ETC ARE REQUIRED.

    AFTER MAKING PAYMENT STARTED ASKING ID PROOF
    THEN I HAVE BEEN TOLD TO GIVE A MEDICAL CHECKUP. I HAVE BEEN TOLD THAT HOME VISIT IS ARRANGED. LATER I GOT A CALL THAT I HAVE TO GO AND DO CHECKUP.

    AFTER MEDICAL, NO INFORMATION ABOUT MY POLICY.
    ON 28 MAY 12 I MADE A CALL AND EMAIL TO KNOW THE STATUS OF POLICY
    I HAVE BEEN TOLD THAT THE POLICY IS DECLINED ON MEDICAL GROUNDS ON 23 MAY. I REQUESTED TO REFUND MY FULL AMOUNT AS I HAVE BEEN CHEATED AND MISGUIDED.

    I HAVE MADE COMPLAINTS TO CUTOMERCARE 8 TIMES AND IT IS PRETINENT TO MENTION THAT I GOT ONLY REPLY ONE TIME

    AGAIN I MADE COMPLAINTS THROUGH GREVENCES THROUGH THE PROPER LINKS GIVEN IN THE SITE OF http://WWW.MAXBUPA.COM. BUT AGAIN THERE WAS NO REPLY.

    I CALLED UP CUSTOMER CARE ON 02 JUN AND MR KANIYA. Mr. KANIYA HAS PROMISED ME THAT THE AMOUNT WILL BE CREDITED TO MY ACCOUNT WITH IN 2 DAYS.

    AFTER 2 DAYS, I HAVE NOT RECEIVED THE MONEY, I CALLED UP CUSTOMER CARE. I HAVE BEEN TOLD THAT I WILL RECEIVE THE AMOUNT BY LAST FRIDAY.

    BUT I HAVE NOT RECEIVED THE MONEY. AGAIN TODAY I CALLED UP CUSTOMER CARE. NOW THEY ARE TELLING THAT I WILL RECEIVE THE AMOUNT BY CHEQUE

    I AM GETTING CHEATED UP
    TODAY IS THE 20 TH DAY

    NEVER EVER GET CHEATED BY MAX BUPA

    GRIEVANCE REDRESSAL POLICIES ARE ALSO FAKE. NO RESPONSIBILTY AT ALL.
    MAKING ME RUN AROUND FOR MY OWN MONEY. FIRST TOLD ME DIRECT TO BANK, NOW BY CHEQUE ? WHEN ? GOD KNOWS …………………………….

  66. abdul

    Great website this..

    May be you can do some keyword modification so that it appears in Google earlier like in the 1st or 2nd page :)

  67. Manu

    Dear Manish,

    Thanks for helping society with your experienced and prfessional advice.

    I need your help in healthe insurance product- I am 35 years & my wifeis 31 years old.

    1, Whcih Comapny is Best in health insurance product?
    2, What should be our coverage amount for each individual?
    3, Which HI is ahving best service records?

    Thanks in Advance.

    Reagrds,
    Manu

  68. Sethu

    Thanks Manish

    Can the contact details for dhawal sharma be passed to my email-id please?I have a few questions and i would like to clear them off with absolute confidence before i take a decision on MaxBupa.

    completely irrelevant to this post but still Manish – i have submitted the PPF documents today and hopefully it should be completed tomorrow.I have read and implemented atleast 4 items in this blog during the last 30-40 days(since i started reading Jago Investor)

    Salute you Sir ! :)

    Thanks
    Sethu

      • sethu

        Thanks Manish! I have opted for MaxBupa Silver 3L – Family Floater which comes around to 9016 INR/Year.I made the payment today and had a discussion with their Doctor over a phone call for a basic set of questions asked from a template.

        I told them that i’m not comfortable doing this over the phone and requested them to do a Medicals personally so that there will not be any surprises when a Claim is actually made down the line.

        They are reluctant to arrange for a medicals and still waiting for their official stand on this…

        MaxBupa Clients/Agents(Dhawal),

        Is this the normal way of recording patients medical history over the phone when we opt for a Max-Bupa Policy?

        Or is it just because i opted for a SILVER plan?

        Thanks
        Sethu

        • If the sum assured is small like 3 lacs , it might be the case that there are no medicals. I think its ok , whatever is the medical history you know, better just disclose it over phone .

    • Sagar

      Your understanding is not correct. Life insurance business is always a long term plan , initial years goes more into making the base and acquiring the business , the loss has nothing to do with the claim

  69. vinay

    Hello Manish ,

    Please help us out on a issue ,Max bupa employees are making us to see stars in morning , my close friend have taken a insurance , his dad got admitted and nearly 2.5 lakhs bill has been taken place , when I tried to show the max bupa insurance card the concern admin team in hospital informed us that it would take nearly 4 days to follow this insurance procedures so we went with direct cash by taking loans . It’s been 5 months we have sent all the original documents to the team , they are neglecting it by saying some documents have missed and stuff , though I have the confirmation from them that they received all the documents …so I am his close friend and working in deccan chronicle firm (DC paper), planning to screw them by raising the complain in paper and also will try to spread the same news over media as we few friends our there and they are ready to help us out , we are not bothered about of money its their duty and work as they need to complete the work in time ….so what you suggest ? but we follow in this way i am sure from now on no one will try to take the max bupa insurance and also same time we also forget our money too …which is not a an big issue as of now but is there any other way ? …

    • Hello Vinay,

      There is a better way to resolve this.

      Would need some information, to understand the issue better, before we can help you resolve it.

      1. Cashless process takes maximum 6-8 hours. Did you speak to the Max Bupa call center, to check?
      2. Do you have an official acknowledgement of receipt of the documents you submitted to Max Bupa?
      3. Have you been provided any claim reference no.?
      4. Have you received any written communication from Max Bupa?
      5. Have you made any official complaint on this to Max Bupa. Any reference no.?

  70. SavenKumar

    I purchased a family health insurance policy from MAX BUPA

    Date 25 April 2012.

    Paid INR 5649/

    Reference id is 0000115626.

    1st June 2012 my wife was suffering from Tified Fever doctor advised her to admit in hospital. Hospital’s TPA sent the insurance details to MAX pupa but the denied the claim saying that ……. (Please read below line)

    “Any treatment taken during the first 30 days since date of commencement of the policy, unless the treatment needed is the result of an Accident or Emergency, is not covered. Hence cashless cannot be approved.”

    Problem:

    It was more then 30 days and Tified Fever comes under emergency treatment.

    Before going to hospital I confirmed with them that I will get the cashless treatment but later on they just denied.

    MY policy documents sent to me after 3 months.

    Wrong and fake hospital list been shared with me while buying the policy (I have the mail record from them)

    They don’t have any document which explains that in which circumstance claim will approve/denial.
    Please raise my voice against Max bupa as they cheating innocent customer.
    Thanks,
    Sarven Kumar

    • Hello Sarven,

      We would first require some preliminary information to help you.
      Can you let us know the
      1. Start date of the health policy.
      2. Date of admission in Hospital.

      There have been cases where Insurance companies misinterpret cashless requests, and then these are settled in Reimbursement. So put up your case for reimbursement, if you are convinced about the tenability of the claim.

  71. Ankur W

    Hello Manish,
    Thanks for the Good Article.
    I am planning to buy health policy for my parents.I really dont have any knowledge about the health policies.Please help me out to choose the best one as i am thinking of poilicy for long term.
    Mother (age-52) and Father (age-56).
    I have contacted by Max-Bupa persons.They have quoted me different plans as below:

    1.Mother + Father (Total 5 lacs)
    Premium : 13857/-

    2. Mother (5 lacs) + Father (5 lacs) + 15 lacs (addon cover by company)
    Silver premium : 26975/-
    Gold premium : 42474/-

    They have also told me there is an option to include me and my would me better half for which they hav quoted me :

    1. Mother + Father +Self + Spouse(5 lacs each + 15 lacs(addon cover from company))

    Silver Premium : 37378/-
    Gold Premium : 57444/-

    Here, the first confusion i am facing that
    * should i go for only parents plan or to include me and spuse in it.
    * if i am going for parents only plan then which plan will be better for me.

    what i am thinking that i should have seperate plans for parents and my individual family.

    Please guide me here.I know many of us have the same problems of choosing the right one.

    THANKS IN ADVANCE!!!
    Regards,
    Ankur W.

  72. RANATA D

    hi.
    Manish Chauhan i wnt to take a policy for my self and my hubby ,i was cmpring with many insuranes ,so me in taking a good plan ,even i am cmpring with icici lombard ,even they have good benfts . to tell u i realy like they policy.lots of differents .i dnt matter the Premium is high .i am ready to pay.
    NOW I JUST WNT TO NOW WHAT ARE THE DIFFERENTS IN UR POLICY
    AND ICICI LOMBARD.I WNT TO NOW EACH AND EVERTHING.
    KINDLY HELP ME IN TAKING IT.

    PLLLLL REPLY

  73. RANATA D

    thanku for u reply.can u tell me pll .i realy dnt undersatnd .wich policy to take.
    i wnts to now what are the differents are there.

  74. Pradeep Borah

    Following are permanently excluded from your MAX BUPA health insurance policy.

    http://www.maxbupa.com/productvariantpages/health-insurance-plan-HBIndividual.aspx

    Permanent Exclusions
    • Addictive conditions and disorders
    • Ageing and puberty
    • Artificial life maintenance
    • Circumcision
    • Dental/oral treatment
    • Conflict and disaster
    • Congenital conditions
    • Convalescence and Rehabilitation
    • Cosmetic surgery
    • Drugs and dressings for Out-patient or take-home use
    • Eyesight
    • Experimental treatment
    • Health hydros, nature cure, wellness clinics etc.
    • HIV and AIDS

    What I found disgusting is there are no details mentioned about following exclusions either on the MAX BUPA website or in their brochure .

    However, same exclusions are listed in detail at BUPA International website.
    http://www.bupa-intl.com/for-you/bwho/exclusions

    It clearly shows the laxity of IRDA, India and difference between IRDA and Regulatory body in abroad.

    This might be the case with other insurance company too. Why they need to hide the facts and information and can’t be proactive to be transparent to the customers?

    • Hello Pradeep,
      Brochure, by definition is a advertising/marketing document.

      Policy wordings are the underlying contract of the health insurance cover you buy. All good articles you would read on health insurance would ask you to read the policy wordings carefully before signing up for the policy.

      Max Bupa has clearly provided all the conditions you have mentioned in their website on all products under the Exclusions tab. They also provide downloads of the policy wordings.

      Having said that, I agree and am aware, not all conditions are always available on the website. There is always a thin line between maintaining brevity, and hiding a material fact on the website/brochure.

      Bottom-line: Marketers (across industries) will always blow up the benefits, and distract you from the fine print. We need to open our eyes – “Jago” :)

  75. Vinay Rawat

    Few major points called Diffrentiater of Max Bupa Heartbeat Policy

    1. No TPA (Applicable for all products)

    2. Assured Renewability Of Life – If something happens in the future where the cust claims for a Disease so for that you can claim again if you require in the future and we will renew your policy to lifetime.

    3. Health Check Up Every Year (Once in two years in Silver Policy & Every year in Gold Policy)

    4. No Capping For Room Rent

    5. Health Relationship Programe 10% Of Your Premium, Next Year At The Time Of Renewal You Will Get Opd Voucher, Dental Voucher Etc ,Irrespectively If You Make A Claim Or Not.

    6. Emergency Ambulance Charges Free In Network Hospital, Emergency Ambulance Charges Upto Rs. 2000 per visit In Non Network Hospital.

    7. No List Of Exclusions Like In The 1st Year & 2nd Year, coverage from the 91st day of the policy. (If we issue a Fresh Policy upto the age of 59)

    8. No Age Restriction For Enrollment/ For Renewability.

    9. We Don’t Do Under Writing (Medical Test) At The Time Of Claim ( We Do Underwriting (Medical Test) At The Time of Application Stage)

    10. Maternity & Child Care Benefits.

    11. Relationship Manager – We May Assign A Relationship Manager Who Will Personally Help You At The Time Of Hospitalization, Attend To Your Claims Settlement, Leaving You Free To Concentrate On Getting yourself Or Your Loved Ones Better.

    12. Covering All Day Care Procedures. (Less Than 24 Hours Treatments Or Operations)

    13. Covering All CRITICAL ILLNESSES From the 91st day Of The Policy(Emergencies from Day 1).

    14. No Loading of premium. (If a Person claims in any year)

    15. No Limitations In terms of Room Rent, Medicines, Operation theatre Charges, Pathology, X-Rays, Therapies and Prosthetic Implants(All Expenses will be covered upto Sum Insured)

    16. In every Plan / Policy we cover All Critical Illnesses.

    17. Pre-Existing Diseases are getting covered after the completion of first initial 48 months.

  76. Atul Singh

    Hello Expert,

    I have a few queries regarding health insurance, which are as below:

    1. I need a health insurance plan for my family and details of my family members are as under:

    A. Father : DOB is 5.07.1962 (50 years)
    B. Mother : DOB is 15.07.1962 (50 years)
    C. Spouse : DOB is 6.08.1962 (26 years)
    D. Self : DOB is 27.08.1987 (26 Years)

    2. My parents lives in Firozabad city near Agra (U.P) and I with my wife is in Pune.
    3. Should I go for a single plan for all four of us or split it into two between parents and me & spouse ???
    4. Which health insurance plan should I opt for, rather which are the most promising plans available today (Higher premium can also be considered if the benefits are good enough).
    5. Few plans which I’m looking at are : Max Bupa Family First, ICICI Lombard’s complete health plan.

    Kindly advice….

    Thanks
    Atul Singh

  77. upendra pandey

    i am confuse bet two plan one is max bupa individual and apolo Munich easy excursive plan i am 34 year old which plan is better for me

  78. Ravi

    HI

    I am a diabetic and take medicine for diabetics and hypertension. I am of age 40. I have taken insurance for my family with Appllo munich. I wish to have medical insurance for myself. I am thinking of Max bupa. Platinum since paying premium is not an issue for me but I need good service. I am thinking for 15 Lacs cover. I am not sure when appllo will lauch the insurance for diabetics as they have not got the approval from Govt. Please give your opinion for the same.

  79. Gaurav

    Hi Manish
    Thank you for your sterling services, I’ve recommended your website to friends.

    Now, my situation is
    I’m a 45 year old IT worker, my wife is 39 years old. My parents and I, as well as my parents are covered by my employer’s health Insurance Plan, which happens to be under Apollo Munich. Having recently paid off my home loan, I have virtually no savings left.

    Now, given the uncertain economy and state of the IT services business, I’ve decided to take another health insurance plan, along with critical illness cover (which may be a rider, or a separate plan from the same or a different insurer) for my wife and myself. Please note that we’re trying to have a baby so coverage for possible pregnancy would be required, should that happen. I also wish to have coverage for any critical illness (about Rs 5L, min). This may come as a rider to a general health insurance policy that I’ll buy, or as a separate policy from the general health insurer or a different insurer. I hope I’ve explained adequately.

    Now in this scenario, which Insurance plan would you recommend? I’ve heard of Apollo’s Optima Restore Policy, but this doesn’t cover pregnancy or doesn’t have a critical illness cover. What If I buy this policy for us (my wife and I) as well as a separate Critical Illness Policy (say from Max Bupa) for additional cover? Or would you suggest a different policy / combination?

    I’m sure there are many other people in the same situation as I and your suggestion would be greatly helpful.

    • Gaurav

      OK, let’s forget pregnancy. Can you please offer your suggestions regarding the other points? I’ll contact medimanage, but I value your opinions as well.

      • A lot of things are not covered in first 2 yrs . Some major illness also have waiting period of 4 yrs . Same with pre-existing illnesses. I suggest you get hold of some policies brochure online , and have a look at them

        Manish

  80. Arun

    Hi Manish,

    First off let me say you have an awesome blog going on here. I have also started reading your books (currently on the second one). Excellent books too. Highly recommended to everyone!!

    I had a question on medical insurance. From your book, i understand that the idea of taking medical insurance early is that premium increases with age and can be costly if taken at later stages of life. Now, I had few months back got Max Bupa family first policy for myself and my wife. But i can’t clearly understand the renewal charges for the future from their policy document. Tried calling the customer care but couldn’t really connect to the renewal department. So i am wondering if the renewal charge next year, will be lesser or will it be about the same if i had started a fresh policy next year?

    Thanks in advance!

      • KALPESH

        Dear Manish / Mahavir Chopra / Dhawal / Javed,

        Very good discussion to understand thoroughly the loopholes to consider while selecting Mediclaim Policy and not to just rely on what agent sells (perhaps he have less knowledge @ what he sells)… Thanks to u guys…

        It takes me 4-5 hrs to read each comment its respective link and make complete understand…

        Now I have question :

        1) If I take the policy(floater/ individual) for particular SA say 5L at some age bracket say at my age 34 (i.e. Below 35 age bracket) and continues policy with no-claim uptil next bracket say upto my age of 42 yrs in particular company. { Pls note that some companies have 36 – 45 age bracket for prm while some has 36 – 40 & 41 – 45 as age brackets for prm table for various ages So in earlier case one bracket while later case second bracket is to be consider for today’s age example} Now my question is : Will there be Renewal Premium for my existing policy will be different than that of as if I am taking same policy with same company for same basic SA at my current age (i.e. 42 yr for our eg) Please forget @ Waiting period, No-claim added SA loyalty benefit, cover of disease that may cover as on today which arise due to increased age etc.

        2) Have the prm table that shows by agent for particular age bracket is valid only at entry time and renewal prm totally depends on company if there is no prm renewal as whole that what happens in previous 3 yrs back where all companies suddenly increased their mediclaim policy prms? (Thanks God !!! Now there is IRDA Of course still many steps to go ahead & can be improved in this field) If there is no loading with claim, we can at least have idea right when we take the policy that what we have to bear over next 10-15 yrs So that in early age we take lesser SA and lateron increases SA as family size, Need as per older age, increased expenses, inflation etc.

        Please comment… Sincere thanks for all contribution.. -Kalpesh

        • Hi Kalpesh

          Truly speaking your question looks a bit complicated for me to understand :( . All I can say to you is that the premium will keep changing as per the slabs irrespective of your old history with them . So if you are a old customer and I am a new one . and we both will be paying the same premium at 40 (suppose i plan to take at 40) . Now the only advantage you have is that your illnesses are covered with them because you are an old customer !

          Manish

          • KALPESH

            Dear Manish,

            Thanks for the reply that clears my doubt.
            So now we can predict on what amount we are going to pay towards mediclaim if family size is same if we choose no loading mediclaim policy – Of course provided there is no market change in basic age bracket premiums – which definitely in coming years may change due to inflation, increased medical treatment cost and % of increasing life mortality. But at least we can have rough idea + 15% here n there…

            God bless you for sharing such nice info…

            Kalpesh

  81. Nisha

    Hi Manish,

    Just wanted to let you know that your blog has been extremely helpful in deciding on the insurance policies to take – be it term plans, CI plan, personal accident plan. Iam in the process of deciding on health insurance. Have read through the entire comments on this page :) and have decided to get in touch with Medimanage as an expert adviser for the same.

    Thanks.

  82. ishita

    hi, am looking for a health insurance policy for mysekf where i can include my mother as well, my age is 27 and my mothers age is 57. am looking for accidental as well as hospitalisation and also which will cover major disease. can u suggest which is the best company to go for?

  83. Suresh aD

    I want to go for health insurance pplicy fro my parent aged about 58 and 63.

    Please suggest best policy and best insurance company…

    Thank you
    Suresh

  84. Abhi

    Friends,

    Do not trust Max Bupa.They apparently seem to be very well versed but in reality do not follow the best practises and is total waste for money when you are in need !
    They bluff things.

  85. upender

    Hi
    I am planning to take health insurance for my parents , My father age is 58 and mother age is 48 please suggest good health insurance plan and company as well

    Appreciate your response

  86. Salil Save

    Sir,
    I need help in choosing best health insurance policy.(For family)
    I ma diabetic since last 7 years. My age is 43 years, My spouse age:39 yrs, My kids age is 12 years.
    I am looking for sum assured 5 lakhs which would grow upto 10 lakhs in view of no claim
    as my family is insured by my office… and the claim if any would be only after my retirement i.e. after 15 years.
    I need lifelong renewal policy.
    I have heard some companies increase their yearly premium.
    I need guidance from you,
    Thanks

    • Hi Salil

      Every company increase their premium over the years (not every year , but on age slab) . So let us first understand your exact requirement and then you can identify the right policy . I am putting an email to you on this

      Manish

  87. Vipul Aghera

    BEWARE BEWARE BEWARE from MaxBupa
    Dear friends,
    Please DON’T buy Maxbupa Heartbeat policy. I am regret my decision to buy it.
    I have buy it 2 year ago keeping mind that I may be need maternity benefit after 2 years. Today I don’t need that. So I ask Maxbupa to change my Heartbeat Family Floater Plan to SAME COMPANY’S Health Companion Plan. (Reason : Heartbeat premium = 11500apx. And Health companion premium = 5700apx. Its almost HALF) Now Maxbupa told that if I change plan I have to serve another 2 years waiting period (which they covered for last 2 years).
    Now Mr. Manish and all Maxbupa agents and their well wishers, plz give answers this:
    1. Why another waiting period? I have same company policy and I already serve 2years
    2. When I ask @ health insurance portability from one plan to other plan, they said you have ask to change plan. If u come from another company then its OK. They don’t give me benefit of portability because I am with them for 2 years?
    3. I am asking to change from their Premium/Higher Plan to Lower plan i.e. I am not asking for more benefit, instead I am asking for fewer benefits like no maternity, no bonus, room capping etc. Then why why why? Its India, yaha sab kuchh chalta hai. ** IRDA’s Health Insurance Portability Rules ki 1 2 3?
    If they don’t allow me from lower to higher benefit, its understandable. But in my case only fool can understand…….
    Now for new policy buyers:
    Plz check this things, if you are buying MaxBupa Heartbeat plan,
    1. In maternity benefit policy wording, they said that: THEY WILL COVER PRE AND POST HOSPITALISATION MEDICAL EXPENSES ONLY WHERE SUM INSURED IS MORE THAN Rs. 10 LACS. (so for SI of 2L, 3L, 5L, 7.5L can’t ask for pre and post hospitalization which in general, you may required)
    2. If they charge high premium for service is OK, but why should I pay for benefits which I don’t want like MATERNITY BENEFIT. After certain period you don’t need that, but you pay premium for that whole life.
    3. If they give life long renewal benefit, then ask for very high premium for that as per your age. So why high premium for young age?
    4. Please google for health insurance claim rejection ratio, its 13% with top three. Which said all things.

  88. Prosenjit Das

    Fake Cashless Insurance Policy

    It was big mistake for us to select Max-Bupa Insurance. At the time of taking Insurance , they promise for cashless and reimbursement. But, after full filling all conditions, they have denied pre-approval for my mom’s treatment. They can’t even provide proper reason. It is all about advertisement and fake Insurance company. Please get back to me for any evidence, what I am talking.

  89. Dr. Sudhanshu Kumar Sarangi

    Hi Friends,
    I’ve Max Bupa- Individual Gold Policy. When I took the policy I had no pre-existing medical conditions which was established by Max Bupa Medical Tests and by God’s grace I’ve always been in pink of my health. Few weeks back I was diagnosed with intestinal obstruction- I was not able to pass stool or gas for more than 24 hours, severe to moderate pain in my abdomen, vomiting tendency and restlessness. Local doctors tried treating it with medicines when it didn’t resolve permanently I visited a specialty hospital in Patna the doctor there sensing the emergency asked me to get admitted and started me on IV fluids, Parental Antibiotics and few other medications and advised for a battery of diagnostic tests- CECT full abdomen, XRAY Chest & Abdomen, Ultrasound Full Abdomen, Blood Work, Stool Test, TB Tests and few others. Slowly my condition improved and I was diagnosed with obstruction in my Jejunum. Reason could be TB, Infections, Ulcer, Crones Disease, Cancer of Jejunum, Cancer of Lymph Node, etc. I was referred to higher center in New Delhi for further evaluation as appropriate equipment’s are not available in Bihar.
    I went to Gangaram Hospital in N.Delhi as it is excellent for Gastro, while in train same problems started again- At Gangaram Hospital doctors sensed the emergency and admitted me and again started me on IV fluids, Parental Antibiotics and few other medications and advised for a battery of other diagnostic tests- Double Balloon Interoscopy, Colonoscopy, CECT Thorax, Blood Work, Biopsy etc. Slowly my condition improved and I was diagnosed with non-specific stomach ulcer from biopsy sample. The doctors were still confused and they presented my case in a conference so that other doctors could discuss and give their opinion- finally they agreed on the diagnosis and gave me medications for ulcer and I’m recovering now.
    I myself is a doctor and specialize in Gastro- Most of the doctors who treated me are DM Gastro and are considered to be best in the country in Gastro- Both the hospitals where I was treated are network hospitals of MaxBupa. Paras HMRI is the most reputed Hospital of Bihar & Sir Gargaram Hospital is the most respected Gastro Hospital in N.Delhi. But ironically Max Bupa internal team disagree with all of them and they rejected both my Patna & New Delhi claims. Different reasons given:
    1) Excuse 1: First 90 days only accidental claims: Though the policy states Emergency or accidents
    2) Excuse 2: It’s not an emergency- All DM Gastro doctors are wrongs, without seeing the patient MaxBupa team came to this conclusion.
    3) Excuse 3: It’s a chronic condition: Though it has never happened before and the tests reports suggest otherwise.
    4) Excuse 4: Waiting for it!!
    I’ve taken legal counsel they have asked to follow these steps:
    1) Step 1: MaxBupa- Grievance Redressal for Senior Citizen
    2) Step 2: MaxBupa- Grievance Redressal- Gargi Sahu- General Manager – Customer Services
    3) Step 3: MaxBupa- Grievance Redressal- Saurabh Tripathi- Head – Customer Services
    4) Step 4: Insurance Ombudsmen- Bihar- Shri. K. B. Saha
    5) Step 5: IRDA- Grievance Redressal
    6) Legal Notice to MaxBupa
    7) Move to Court

    So, choice is simple, Pay heavy premium to Max-Bupa & get treated like me & run from pillar to post for appropriate compensation or select an honest insurance company!! You know the worst part is how the field & customer representatives treat the patients and their attendants- I bought this policy which is supposedly one of the most expensive policy in the market for just one reason that if anything happens to my health then the insurance company will fulfill its obligation and help me financially in my treatment.
    The customer service rep treats me like an uneducated individual and try to educate me on what is medial emergency, chronic condition and when I asked him/her to connect me to the manager- I was being told that he/she doesn’t see a reason for doing so as what he/she is telling is full & final- It feels like I’m living in a banana republic and MaxBupa is the Judge, Jury & Prosecutor.
    When I was taking treatment in Gangaram hospital, one of MaxBupa Field Rep made a surprise visit to my room which I initially appreciated it, as he could view the documents and resolve the payment issues. But on the contrary instead of helping me out since I was only on IV fluids and medication for quite some time and feeling quite weak with on & off pain and on top of it the mental agony of going through relentless and painful tests with cancer doubts hanging over my head- he was more interested in taking my pictures and asking me twisted questions which could give him reasons to reject my claim. They should have some sensitivity training in Max Bupa- You are selling health insurance not mobiles phones, when people need you then they are in pain so at least have an ounce of humanity.
    As Warren Buffet once said “Price is what you pay & Value is what you get”- I paid an excellent price (38 K PA for 5.0 L Individual Policy) to MaxBupa Health Insurance and in terms of value…. Worst financial decision in the last 35 years of my life.
    Best,
    Unsatisfied MaxBupa Policy Holder

  90. Dr. Sudhanshu Kumar Sarangi

    PART: II
    Hi Friends,
    Following up on my previous engagement with you all- I received a call from Geetanjali (Gurgaon Office) at 12:37 AM on 12th May, 2015 (today) regarding my email, Facebook & other posts. I was unable to speak with her as there were strong aftershocks in Muzaffarpur area today around the same time. So, I’ve requested her to email me the details. I’ve not received any email response (except the auto emails) since I’ve started writing to Max Bupa from yesterday.
    The reason for the denial cited in the letter and told to me today telephonically today is that the Admission date is within 90 days waiting period. As per policy terms & conditions clause No. 4(b)-90 days initial waiting period since the date of commencement of the policy, unless the treatment needed is the result of an accident.
    In the 38 pages policy kit provided to me after I bought the policy, it’s mentioned on Page No. – 16, Clause B- 90 Days Waiting Period: We will not cover any treatment taken during the first 90 days since the date of commencement of the Policy, unless the treatment needed is the result of an Accident or Emergency. This waiting period does not apply for any subsequent and continuous renewals of Your Policy.
    I myself is a doctor and specialize in Gastro- Most of the doctors who treated me are DM Gastro and are considered to be the best in the country in Gastro- Both the hospitals where I was treated are network hospitals of MaxBupa. Paras HMRI is the most reputed Hospital of Bihar & Sir Gargaram Hospital is the most respected Gastro Hospital in N.Delhi. So, in the treating doctor’s opinion it was an emergency that’s why they admitted me and treated me…… And Emergency is covered in the first 90 days too according to the policy I bought!! So, what’s the problem- I’ll tell you- Selecting Max Bupa as an insurance provider was a mistake. I hope you guys could learn from my mistake and select an honest health insurance provider.
    I hope the wise guys of Max Bapa could wake up from their self-imposed slumber and for a change do what they promise.
    Best,
    Unsatisfied MaxBupa Policy Holder

  91. Mathew B

    Can someone please throw some light on the 59% claim settlement ratio and very bad reviews written in mouth shut. com.
    I do not find max bupa is expensive if you consider cost per lakh, if you consider…it’s a whole sale cover not retail! :)
    But some reviews are like they are literally operating to reject the claims. ..

  92. Dr. Sudhanshu Kumar Sarangi

    PART: VI

    Good Afternoon Ms. Sapkota,
    Good to hear from you. As I’ve been emphasizing upon it in my previous emails too, I would like to discuss the first denial only now (ID: 71541), I bought this policy and paid a hefty premium because I liked what’s been promised in the policy as a whole- I was assured cashless facility in case of an emergency. Unfortunately there was a medical emergency but the commitment was not fulfilled by Max Bupa. So, first I want to establish if I was eligible or not in accordance to the policy. So, I would like to ask again-
    If my case was not an emergency as per definition 16 due to which I was not authorized for cashless payment and in the first 90 days only Accidental or Emergency claims can be considered so according to which clause you are asking me to apply for reimbursement?
    Money is a matter of consideration so is honestly hence I don’t want to beat around the bush and expect a straight forward answer. If it was an Emergency or not- If not then why in writing? Until and unless I get a straight answer I’ll keep on asking the same question again and again!!

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