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Health Insurance is Wealth Insurance

by Manish Chauhan · 118 comments

Does Health insurance or Mediclaim Insurance really protect your health ? Ask yourself this question and deep down in your heart you will hear someone shouting , No Idiot ! , There is no policy which can protect your health ! . Health can only be protected by right diet , right exercise and right lifestyle (download this ebook). Unless you are doing any of these your health can’t be insured. So what is Health/Mediclaim Insurance, when it does not protect your health ?

In reality, what we all fail to realise is that Health Insurance is actually “Wealth Insurance” . When you buy a health insurance policy, all you are doing is protecting your wealth from those scenarios which would ask for a lot of money from your wealth. So you have to understand the importance of buying a health insurance policy.

I was talking to some one few days back in Goa (Yes, I go on vacations too) who rejected to take a mediclaim policy because of higher premium due to his diabetes. I told him that I hear something out of his decision of not buying a health insurance plan. He was surprised to hear this because he didn’t say anything else other than “I will not take health insurance” . So I told him what I heard.

I told him that I hear from him that he is ready to lose a big part of his wealth in few years if he is detected with any further illness . I told him that I hear that he didn’t want insurance company to pay for his medical bills , but was ready to bear the cost on his own. If he has to spend 5 lacs , he will pay it . If its 15 lacs , he will pay it ! and even if its 30 lacs (after 12-15 yrs) , he will still pay it .

Protecting Wealth is much easier than Protecting Health

I told him that by choosing not to buy a health insurance plan, he is accepting that he is ready to bear a big cost in future incase the situation demands . A lot of people do not think about health insurance like this. While this is the internal truth that the job of health insurance is to protect your wealth and not your health, a lot of people just fail to look at it this way .

So if you love your Wealth , buy health insurance.

For health , you can take other routes like eating right food, physical exercise daily , having a positive and a good life style (see this post from subra)  .. But the sad thing is protecting your wealth is much easier than protecting your health :)

What are your views on this ? What have you done to protect your health and wealth ?



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{ 118 comments… read them below or add one }

1 Rashmi November 21, 2011 at 2:28 pm

Nice one :)

I have been in the same Co for past 11 years and have utilized the mediclaim policy a number of times. Should I still have a health insurance policy? I am in my early 30′s. Whats the best time to go for a health insurance and what things should I look out for?

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2 Vikas November 21, 2011 at 3:02 pm

Manish,
Another good one :)

Rashmi,
I have been with the same organization for close to 6 years.
My organization has changed the policy terms twice in these 6 years. Earlier, everybody in family was covered and there was no concept of co-pay. Now, the employee, spouse and kids (max 2) are covered as earlier but if parents make use of the policy (make a claim), they have to pay 20 % of the claimed amount. Also, from last 2 years, I am paying around Rs. 1900 as part of my annual premium.
Health insurance, as I understand, is an annual contract at least for the corporates. What happens, if because of any reason your organization changes its policy or even the Health Insurance company changes the insurance policy or you leave the organization or some other reason.
So, I think that you must have at least a minimum 2 lakhs insurance for yourself. If you keep renewing the policy, there is no way the Health Insurance company can change it’s policies and terms.

Reply

3 Manish Chauhan November 22, 2011 at 1:18 pm

Vikas

thanks , with companies changing their terms and conditions and coverage for parents and benefits , it has become more important to be self reliant now

Manish

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4 Manish Chauhan November 22, 2011 at 1:29 pm

Rashmi

Good to hear .. You said you already have a policy and using it , then why do you want other policyu ?

Manish

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5 Dr. Pradeep Khedkar September 18, 2012 at 4:47 pm

Manish I want to buy Tata AIG Wellsurance Executive Mediclaim policy and Tata AIG Individual_Accident_and_Sickness_Hospital_Cash Policies. What is your opinion about these 2 policies. Should I proceed?

Reply

6 Manish Chauhan September 19, 2012 at 5:46 pm

Pradeep

You should discuss it here http://www.jagoinvestor.com/forum/

Reply

7 MK November 21, 2011 at 2:38 pm

This is what I did:
Took health insurance and renew it without fail. Do not jump the provider that often.
Planning to up the insured amount next year by a few lacs as I think medical costs are rising and my current amount will be less.
MK

Reply

8 Manish Chauhan November 22, 2011 at 1:21 pm

Mukul

good to see you being responsible in your financial life

Manish

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9 Carlos May 2, 2012 at 3:33 pm

MK,
Have you ever put in a claim ? If yes, was your claim cleared in full and without any undue delay/hassle ?
Since my experience has been terrible with both the insurer and the TPA both doing their best to avoid paying, I thought I had better sound you off.
Regards,
Carlos.

Reply

10 Deepthy November 21, 2011 at 4:36 pm

Hi,

Suppose i take an insurance of 5 lakhs today, and next year I want to increase the coverage taking inflation to account. Will that be possible? If so, will the premium will be increased since my age has increased? and what about the waiting period for pre-exsisting disease, will i again have to wait another 4 years instead of 3?

And could you please provide a comparison of medical insurance available in India now.

Also, How much should an individual go for Critical illness cover, are there any calculations on that?

Regards
Deepthy

Reply

11 Manish Chauhan November 22, 2011 at 1:14 pm

Deepthy

I am not aware if companies are allowing increasing of cover later today . So its better to take a higher cover today itself

Manish

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12 MK November 23, 2011 at 10:44 am

Manish,

I spoke to Max bupa guys. They allow to increase the coverage. The premium is calculated as per the year when you want to increase the coverage.It is the same policy they say.I did not try it as I was not sure.

MK

Reply

13 Manish Chauhan November 23, 2011 at 1:38 pm

MK

some policies might allow to increase it later, but its very rare

Manish

Reply

14 LICAgentJaved November 28, 2011 at 9:45 pm

Hi Deepthy
If you have Apollo Munich Health Policy you can increase you SI to next SI i.e. 7.5 lac.
Apollo Munich Health Insurance Company has option of Critical Illness Rider (CIR) in adition to all CIR covering in health policy itself you can take CIR Sum Insured either 100% or 50% of Original SI ( CIR benefit is available for 8 Critical Illness and SI is payable if Policyholder get diagnose for critical illness and survives for 30 days)
Waiting Period of 3 years for enhanced SI
======
If you have Max Bupa Health Insurance Policy you can go for any SI at one go upto 50 lac SI
Max Bupa has no individual critical illness cover
Max Bupa has 90 day waiting period except Accident and EMERGENCY in new policy and no other waiting period upro age of 60
Enhanced Sum Insured is subject to 4 years of waiting
I have comparison Chart but of 12 companies doing Health Insurance but cant disclose here.
Javed

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15 Aditya April 20, 2012 at 11:07 pm

The exclusions are applicable to the increased sum insured.
For eg, if u had a 5 year old policy of 2 lakhs si, and u renew the same policy with 3 lakhs si. incase u lodge a claim of 3 lakhs for a preexisting disease which usually would have got covered after 4 years of continuous renewals, your claim will get settled for only 2 lakhs.

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16 Sambaran Mitra November 21, 2011 at 5:01 pm

I have taken personal medical insurance(United India) on top of company-scheme.
However, I am not sure whether it is sufficient. I am listing my doubts in no
particular order:

1. The max coverage is 5lakhs. At time of my retirement, 5 lakhs will be peanuts. Since 5 lakh is maximum for United India right now, I cannot increase the coverage even if I want to.
2. If United India increases its maximum coverage with inflation, I am not sure how I am going to ride that? Will they allow me to move to the higher coverage without pre-existing disease clauses?
3. Family floater gives higher coverage. I have seen amount like 15 lakhs coverage. However, I have read some articles about disadvantages of family-floater vis-a-vis individual-policies. So I am confused here.
4. I have read about top-up/super-top-up with high coverage. However, the facts about these policies are not clear to me. Internet has got minimal discussions on this indicating that it is not a popular product. This tells me that it is risky to trust this product to stay till 20-30 years more.
5. Technically, health insurance is per year contract. Legally, the insurance company is free to renege on renewing my health insurance. So I wonder whether getting the personal insurance is of any use at all.
6. Sometimes I believe the only way to meet hospitalization expenses of old age is to build enormous wealth. One can keep the health insurance with the hope that insurance companies MIGHT help but it does not look like a fool proof strategy.

I am really confused without satisfactory answer to above doubts. I have erred on the side of caution and continuing with my personal insurance. However I do not feel secured at all whether I have insured my health (or as Manish says, wealth) for post-retirement phase.

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17 Manish Chauhan November 22, 2011 at 1:11 pm

Sambaran

Let me get expert to answer this

Manish

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18 Ram November 22, 2011 at 1:36 pm

Great questions! I have very same questions.

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19 Mahavir Chopra November 22, 2011 at 4:30 pm

A1. Yes, you are right, with medical inflation zooming, Rs. 5 Lakhs will be a very low sum insured even 10 years from now. You should plan for a higher coverage.
A2. Any upgrade, would require a declaration of health, and yes, an existing ailment will result in restrictions. No doubt.
A3. Family Floater is a good long term option in your approach, when you want to take a higher coverage (Above 5 Lakhs), and cover for the rising inflation.
A4. Only Internet discussions cannot be a parameter to trust a product. You need to shortlist a good health insurance advisor who can help you through this confusion. It pays to have an advisor.
A5. Yes, this is a reality. Health Insurance is free to change every year. However, IRDA does protect to an extent. Every change has to go through IRDA, and IRDA is putting norms in place regularly to avoid unfair practices.
A6. You need to build savings for healthcare parallely, no doubt. But no calculation of savings can match what a right Insurance cover can pay.

Buying a Health Insurance without restrictions is almost gold today for old people who have purchased policies when they were young and healthy. We see numerous claims settled everyday, believe me you will never regret buying a Health Insurance in the long term.

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20 Sambaran Mitra November 22, 2011 at 9:14 pm

Mahaveer, thanks for your excellent, lucid and to-the-point reply. Going through your reply was sheer joy.
I do realize the role of an expert insurance advisor. In fact I have opened communication with one of them and their answers are coming quite satisfactory. It will be quite a few iterations though before I can fire all my questions at them. Coincidentally Manish’s blog came at the same time and I fired few of my questions.
Finally Manish! What a blog are you maintaining! Sometimes it feels like a crime to get such high quality information free-of-cost.

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21 geo thomas November 21, 2011 at 5:38 pm

Health insurance is the most important thing, i have got a 5lac floater from a pvt company and over that i have bought a top up of 10lac, which comes to be cheap, also considered the feature and claim settlement of this company.
Small sum assured mediclaim will finish all ur savings in a short time. So better change with time.

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22 Manish Chauhan November 22, 2011 at 1:01 pm

Geo

Which policy you have bought ? Looks like a good cover of 15 lacs at an affordable premium

Manish

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23 Dharmesh November 21, 2011 at 7:00 pm

Manish,
Very nice article… and very true…
Health insurance for most of us is just buying a mediclaim policy… we seldom think about keeping ourself fit. I know the importance of regular exercise but, I just cannot follow that due to the current lifestyle & work hours.
Your article focuses on the often-forgotten part of health insurance; which is regular exercise.

Thanks for sharing this.

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24 Manish Chauhan November 22, 2011 at 12:59 pm

Dharmesh

Thanks for the appreciation .

Manish

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25 Kartheek November 22, 2011 at 1:53 pm

Hi,

This products always concerns me because I and my wife both are mutually covered under company health insurance policies which includes dependents as well. I have to pay separate premiums for my parents which is fine (anyway I would have paid) and 80:20 co-pay for all of us. Though company policies/health insurance policies keep chaining still I see a large benefit compare to external ones.

Do I still need to purchase at additional policy? please advise.

Regards,
Kartheek

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26 Sambaran Mitra November 22, 2011 at 2:12 pm

Personal medical insurance is required under two circumstances:
1. During job life: In case you have to quit/change job, or the company lays off, you need personal mediclaim. In your case it is unlikely that you and your wife get laid off at the same time. So I will leave it to your judgement whether you need personal medical insurance at all. It is a game of probability with odds in your favour because of your working spouse.

2. During retirement: You get into medical insurance cover to reap the goodness of it once you retire. I myself have a lot of doubts whether taking medicalim keeping retirement in mind is worthwhile. See my comment above. I have still taken a personal mediclaim to err on the side of caution. If I get convinced in future that mediclaim-for-retirement is worthwhile, Iwill retain my policy. Otherwise I shall drop it (resulting in a loss of 4-5 years of premium, but that is acceptable).

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27 AMIT DOSHI November 22, 2011 at 2:10 pm

Hi Manish,

I am 38 yrs old & my wife is 35 yrs old. We have a son who is 2 & 1/2 yrs old. At present each of us have a separate mediclaim cover of Rs 5Lacs each with Oriental Insurance. I wanted to enhance this cover to Rs 10 Lacs each and so approached Oriental Insurance but they did n’t enhance it citing the reasons that beyond Rs 5 Lac individual cover wont be enhanced.
Manish, I would like to continue with this individual mediclaim policy and side by side I am planning to buy Floater Policy. As end number of floater policies are available in the market but I have zeroed down on Oriental Floater Policy as my base policy is with them . As you must be aware that an article was written in your blog on Oriental Floater Policy so just wanted to check from you is this a right decision and would appreciate in case you update me at what max age this floater policy from Oriental Insurance could be renewed?

Pls share your esteemed views.

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28 Manish Chauhan November 23, 2011 at 2:14 pm

Amit

Why do you want to go with Oritental only , What do you mean by BASE policy ? There wont be any added advantage just because of this reason . For family floter , you can look at other options like Max Bupa or Appolo

Manish

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29 AMIT DOSHI November 23, 2011 at 5:55 pm

Hi Manish,

Thanx for your feedback. By Base Policy what I mean is that my individual mediclaim cover is with Oriental so I think it makes sense to be with them in case of any claim in future as unnecessarily I do not have to knock the doors of two insurers if I approach any insurer other than Oriental for floater policy. Keeping this in mind, I thought of Oriental Floater.

What do you say?

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30 LICAgentJaved November 28, 2011 at 8:56 pm

Hi Amit
Do you know Oriental Policy upto 5L SI has 10% Co- Pay concept?
Javed

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31 LICAgentJaved November 28, 2011 at 9:13 pm

Hi Amit
If all of you have 5lacs SI each that means you are paying Rs 17584.oo p.a.with 10% Co -Pay and lots of other sublimits. Just pay 17584.00 for MaxBupa policy for Rs 30 lacs SI and any one can use 20 lacs maximum (Khuda na Kare ) in case of any claim.
javed

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32 Mahavir Chopra November 29, 2011 at 4:38 pm

Javed,

Can you please mention which product and variant you are talking about, when you are quoting premium. This will help customers understand better. The premium seems to be for for Silver variant, which restricts you to shared room facility only, which, in my opinion, is a big constraint, for the kind of premium it charges.

Also, Max Bupa has a copay of 20% after the age of 65 years. Not many agents, representatives talk about this.

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33 LICAgentJaved November 29, 2011 at 9:19 pm

Mahavir Chopra
Please compare policy on the basis of age of Insured person e.g. 18 years to 60 years No other companies giving you 50 lacs SI. Thus Max Bupa is beyond comparison. Max Bupa has no 1 year, 2 years exclusions and 4 years exclusions but all other companies I knows has exclusions, here also Max Bupa beyond comparison.
Age group 60 and above No other company is giving big SI even with co-pay. In this group specific waiting period of 2 years for certain disease also applies if any body enters Max Bupa after 60.
Premium given above is for Silver Plan for DelhiNCR and Bangaluru this will change for Mumbai and Rest of India.
Which option is better Single room of maximum 5000.00 per day or Shared room without LIMIT?
Can you mention Room Rent of Shared Accommodation in Apollo Hospital?
Javed

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34 Mahavir Chopra November 30, 2011 at 12:54 pm

LICAgentJaved,

IMHO,
1. Max Bupa has good products, but it is not beyond comparison of cost-benefits on a whole.
2. Shared room is not a good option, when you pay such a high premium. I would not go for a shared room, even if I am paying from my own pocket.
3. Its better to know the amount per day I am entitled to in a product service, rather than restrict the category of room.
For instance, If i am a good customer, someone who does not want to misuse Insurance, and I prudently choose an affordable but good Hospital for a small treatment, i could actually take a private room (where there is an amount capping) in this hospital and enjoy the convenience and privacy it gives with rent lower than shared room in a Large Tertiary Care Hospital. In Max Bupa, I would still be forced to take a Shared Room everywhere.

Please understand, we have nothing “against” or “for” any product, as we don’t represent any Insurance company, what I requested to you is to mention the product or variant name, and not only the price and sum insured, as it could be misleading.

When we are giving details about negatives about a product, it is to give a better perspective of the product suggested.

Finally, all of us are eligible to our own opinion.

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35 LICAgentJaved November 30, 2011 at 9:19 pm

Mahavir Chopra
Heading of this discussion is “health insurance is wealth insurance’ which I understand is how much wealth you can insure for what cost (premium) . Basis of discussion must be premium and Sum Insured, here we are discussing health insurance not health insurance product.
In this forum I am not selling any Health Insurance Product but sharing my knowledge I gained as a Health Insurance Advisor and as an Individual.
Health Insurance Policy or Mediclaim is not only for planned Hospitalisation but also for Accident and Emergency Hospitalisation. Nobody can predict he or she will be admitted in particular Hospital or Nursing Home because after illness accident he cannot take or not able to take decisions.
It is wrong to say all those claiming Hospitalisation in Apollo, Medicity, Fortis or Max Hospital are bad customer and those who are taking treatment in lower grade hospitals are good customer as you said. All those taking treatment in these hospitals are paying through Health Insurance Policy or they are only rich people.
If you can afford to pay after illness why not now? (pay extra Premium and take Gold or Platinum Plan)
Health Insurance/ Mediclaim or any Insurance Policy is for worst case scenario, at the time of accident or medical emergency no one can control the situation as per his or her choice but aim of everyone will be to take the Patient to nearest hospital first. Selection of hospital and any immediate help from family members depends on situation.
I would like to share part of World Health Organisation (WHO) Report 2010 which says:
(a) 40% of people who are hospitalized either borrow money or sell assets to cover medical expenses
(b) India is the Diabetic and Cardiac capital of the World. 9 crore diabetics in India by 2025.
(c) Over 8 lacs people die of Cancer every year in India. More than 7 lacs new cancer cases diagnosed in India every year.
CII Health Care Sector Report 2010 says 30 % people suffers health attack are affected before the age of 40.
I would also mention a report from Times of India dated 16 may 2011 which says “ In India Health Care Expenses are rising at a rate of 22% ( i.e. Medical Inflation year on year).
Estimated minimum treatment cost in good Hospital for Heart Attack Rs 5 lac, Cancer Rs 10 lac, Kidney Replacement 15 lac.
Anybody finalizing for Health Insurance he should keep in mind cover for disease first then type of cover etc. etc
If a person can predict that his health will be as he has today then why he should take a mediclaim at all?

As a Health Insurance Advisors we are selling Mediclaim as Fire Fighting Equipment which is suitable only when fire broke out. A Fire Ladder suitable to douse the fire of say 15th floor can also douse the fire of 10th floor but can you imagine ladder suitable for 10 floor can douse the fire at 15th floor?
Please buy that Health Insurance Plan which afford medical bill instead of buying affordable health insurance plan.
Kindly elaborate IMHO
Javed

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36 mukesh November 22, 2011 at 2:59 pm

manish sir,
may u kindly disclose ur insurance portfolio i.e. which co. u have term insurance and health insurance

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37 Muthu Krishnan V November 22, 2011 at 5:28 pm

to protect my health, I have reduced my weight from 89 kgs to 74kgs over the past 1-1/2 years and very close to ideal BMI of 23 :). This is a result of walking 5kms a day in 45 minutes and dieting (less oil, minimum sweets, sugar-less coffee, less rice, no pickles).

to protect my wealth, I am dependent on company health insurance. parents have independent health cover from NIA of 3lakhs + bonus each. am thinking of going for the high value family policies like 25L or 50L to take care of retirement as well.

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38 Manish Chauhan November 23, 2011 at 2:10 pm

Muthu

Thats great to hear .. I am inspired :) . I am going to decrease my oil and sweets intake :)

Manish

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39 LICAgentJaved November 28, 2011 at 8:53 pm

Hi Muthu
Give your family details I can help to find a suitable Mediclaim Policy.
Javed

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40 Sidharth November 23, 2011 at 8:27 am

Nice post!
Is it required to have separate health insurance other than offered by employers ?
In case an employee change his job,
What will be the implication of the existing health insurance’s validity.

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41 Manish Chauhan November 23, 2011 at 1:39 pm

Sidharth

When you leave the job , the existing cover from employer vanishes and you have to restart all over again . So better take a new one

Manish

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42 Aditya April 20, 2012 at 11:12 pm

the employee can get for himself a individual mediclaim from the same insurance company which provided insurance to the company. he should bring to notice of the insurance company while buying individual policy that he was covered under group mediclaim with them. you will get all the exclusions waived.

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43 Sarath November 23, 2011 at 1:03 pm

I understood that we need health insurance policy apart from the company provided mediclaim policy.

But I am confused between family floater or individual policies.
I am 26 years old and newly married. I want to buy health insurance(Coverage ~10lakh) which covers my entire family including my parents.

I read somewhere that parents are not included in family floater policies. Is it true?

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44 Manish Chauhan November 23, 2011 at 1:08 pm

Sarath

Parents are generally not included in family floater plans , but now a days there are some plans which does , like Max Bupa Family First , but the premiums would be higher , and if you thought that just becuase parents are covered , the premium would be low , its not true .. also there are few reasons why you might want to exclude parents from family floater and let them go for a seperate plan , read htis : http://www.jagoinvestor.com/forum/request-for-a-suggestion-for-a-suitable-health-insurance-policy/2253/

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45 LICAgentJaved November 28, 2011 at 8:49 pm

Hi Sarath
If you mention age of you wife and parents I will suggest you a suitable Policy Sum Insured and Premium.
Javed

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46 Sarath November 28, 2011 at 9:53 pm

My wife is 21 year old. my mom is 45 yrs old dad is 59yrs.
I am about to finalize the mediclaim policy. Let me know your opinion.

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47 LICAgentJaved November 28, 2011 at 10:19 pm

Hi Sarath
You may go for 50 lacs SI with maximum 20 lac cover for any one member
with maternity cover after 2 yaers
Premium for Silver Plan is Rs 37435.00
Premium for Gold Plan is Rs 55312.00
if you are from Delhi NCR or Bangaluru
Please dont waste your money in small SI Health Policy.
Javed

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48 Aditya April 20, 2012 at 11:17 pm

floater policies cover only husband wife and two children. although family floater plans are cheaper, there are many disadvantages over individual mediclaim:
1) NO no claim bonus is provided.
2) if any claim is lodged on the policy by any member, the remaining members also have to wait for 4 claim free years to get p-e-d cover.

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49 Krishna November 30, 2011 at 2:44 am

Hi Javed/Manish,

I have shortlisted Oriental Individual Mediclaim with cover of 5 lakhs each,as the family floater is expensive even for 6 lakhs the premium amount is more or less equal to Individual one. Hence I decided to choose Oriental Individual policy.My Family Details are Self:32 male, Spouse:28 and Daugther 2 yrs.

Krishna

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50 LICAgentJaved November 30, 2011 at 9:23 pm

Hi Krishna
if you already shortlisted Oriental then what opinion required now?
before shortlisting a company must go for product.
Javed

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51 AMIT November 30, 2011 at 9:41 pm

Hi Manish,
It seems that this platform has become a platform to pitch in selling of products rather than providing right guidance. As I can see that Mr Krishna has provided his view and opinion on Oriental and the kind of the answer provided by Mr Javed shows that he is basically interested to speak all good about Max Bupa and being a professional he should have provided reasons why Oriental is not a good product as compared to Max. And I think this is the real test of an advisor to advise a person correctly even if he has choosen a wrong product. I don’t have personal gruge with anyone but not satisfies with the reply of Mr Javed.

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52 LICAgentJaved December 1, 2011 at 9:38 pm

Hi Amit
Do you know patients with empty pocket are not allowed in Private Hospitals?
Do you kmow any person opting for second grade health facility even if he has liberty to choose best ?
I am not selling here any product here .
I am trying to convince the reader of this blog is take bigger SI in lowest cost with many other benefits, if you have knowledge of any product kindly share with us.
Javed

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53 Krishna November 30, 2011 at 9:45 pm

Sorry, I meant to say Max Bupa and Oriental are been shortlisted. Max premium is on higher side also new entrant,but Oriental is Public Sector,hence i am confused whether to go for Oriental or Max

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54 LICAgentJaved November 30, 2011 at 11:47 pm

Hi Krishna
You should first decide for Sum Insured, here is limit:
Oriental Individual 5 lacs each total cover for family Rs 15 lacs maximum cover for each 5 lacs premium 14826.00 upto 5lacs policy is silver
Floater cover total SI 5 lacs premium Rs 7920.00 maximum cover 5 lac
Max Bupa Silver Plan Total Cover 30 lacs for family maximum for any one 20 lacs premium 15486.00 if you are from Delhi NCR
In Oriental upto 5 lacs SI only 90% of admissible claim is payable i.e 10% co-pay
Max Bupa has no co-pay upto 65 years of insued age.
Javed
javed

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55 readtoawake com December 4, 2011 at 11:29 pm

Health Insurance and Life Insurance are very Important especially if you have family members who depend on your Income. I totally agree with Manish that If you want to preserve your wealth, you should get a Health Insurance.

I just want to add one thing that you should not buy insurance policies for the investment purposes. If you invest your money in the traditional life insurance or health insurance policies that give your money back after a certain period of time, you end up loosing your money due to inflation and taxes.

So I think if you are young, instead of paying premium for health insurance, you should invest that money in safe investments where you can get above average returns.

If you have a financial portfolio that can cover your family’s expenses for ten years, you don’t need an insurance.

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56 Manish Chauhan December 5, 2011 at 9:42 am

Thanks for the comment

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57 LICAgentJaved December 6, 2011 at 8:33 pm

readtoawake.com
I think you are assuming illness as fever or temprory hospitalisation.
Imagine a person get infected with critical illness in which all his saving driedup then ?
For small treatment in big Hospitals big amount is required so you have to keep big amount in home (because you cannot withdraw big amount in the night) or have a best mediclaim policy.
Every person required a mediclaim Policy if he think Financial Planning.
Javed

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58 Kuldeep Singh Rathod December 14, 2011 at 1:57 pm

Hi Manish,
I am having two query :
(1) Can you Suggest Best Family Floater plan from PSU Company
or Comparative chart only for PSU Insurance Company only.
I shortlisted Oriental Ins Family Floater plan so please advise me if you have other good PSU floater plan
(2) Which one is better Family Floater plan or Individual?

Regards,
Kuldeep

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59 Manish Chauhan December 14, 2011 at 8:51 pm

Kuldeep

Ask this on our forum : http://www.jagoinvestor.com/forum/

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60 Monika December 17, 2011 at 4:10 pm

Hi,

Can someone help me understand how would potability work in health insurance. Let us say I am covered with the organisation I work for. Now if I wish to take another health insurance on my own then what are the possibilities of potability ?

Can I change the health insurance cover from my group cover (provided by my organisation) to Individual or family floater cover with another or same organisaiton.

Monika

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61 Manish Chauhan December 17, 2011 at 7:19 pm

MOnika

I think converting from group cover under employer to individual cover is not possible ,you can only transfer from those policies which you bought on your own .

What exactly is that point whch you want to clarify

Manish

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62 Monika December 17, 2011 at 9:03 pm

Thanks Manish. Would want something more conrete on it. Someone is telling me that the group medical policy that i am insured for through my organisation is something that can be changed to Individual policy if and when I leave the organisation and that this happens due to Potability facility.

My understanding is – Group policies are bought by the organisation and has nothing to do with individual when he is not with that organisation.
Only those policies which i buy on my own are allowed to be transfered to other company in case i wish to access potability for any reason.

I am looking for a complete clause of health insurance potability !

Can you help Manish ?

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63 Mahavir Chopra December 17, 2011 at 10:36 pm

Hello Monika,

You can port your cover under the Corporate Policy (irrespective of who has paid the premium) to an individual policy with the same Insurance Company in the first year. You will be able to port into another Insurance Company in the second year.

The complete clause of portability is as follows:

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64 Manish Chauhan December 18, 2011 at 9:06 am

Mahavir

THanks for Info .. i was not aware of this

Manish

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65 Sambaran Mitra December 18, 2011 at 7:51 pm

Hi Mahavir,
The link is not working (at least at the time I am posting this message).

This portability provision from corporate to individual was a surprise to me. If it is without any killer clause/rider, this is a very pleasant surprise indeed. One of the reasons I have taken personal mediclaim (over and above the company provided one) is keeping post-retirement scenario in mind. With the kind of portability you indicated, I see no reason to continue personal mediclaim for post-retirement purpose. Any comments?

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66 LICAgentJaved December 19, 2011 at 12:33 am

Hi Sambaran Mitra
If you have personal Mediclaim over and above the company provided Mediclaim is always a good option, it increases your SUM INURED.
Portability is the option you can use to transfer your policy but you cannot compel a mediclaim company to accept your portability proposal. If anybody has taken claim or has critical illness new company will not accept the proposal. Nobody can compell to a Health Insurance Company to accept a bad risk.
New proposal or portability is for those who are medically insurable, but if you have life time renewable policy the HI company cannot refuse to renew the policy because of illness.
Javed

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67 Mahavir Chopra December 19, 2011 at 9:53 am

Hello Sambaran,

Portability is an option, except for the the following conditions:
1. Young Members, that is all members are below the age of 45.
2. You have a claim in your existing policy.
3. You have a new ailment contracted during the continuation of the existing policy
4. You have a pre-existing ailment mentioned in your existing policy.

The catch in Portability is that it would always be subject to underwriting guidelines of the Insurance Co. The proposal for portability can be rejected or additional conditions added before acceptance.

Portability from Corporate is not the answer for coverage post retirement.

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68 Sambaran Mitra December 19, 2011 at 9:56 am

Javed and Mahavir,
Thanks a lot for your replies. It helps.

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69 Manish Chauhan December 21, 2011 at 11:22 pm

Kanchan

Yea .. correct .. This health insurance will really help her incaes of some mishap

Manish

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70 Shiva December 24, 2011 at 6:59 pm

Hi, I’m self employed and looking to take health insurance for my family. I’m single and my parents 54 & 49 are both diabetic and my father has hypertension. They use oral medication only and looking to take an insurance plan that would cover any ailments in future. We are looking for a good plan, where i could add my wife in future. Kindly advice.

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71 Manish Chauhan December 24, 2011 at 8:27 pm

Shiva

There is a new plan in market called Appolo Munich Optima Restore . Then you have options like Oriental Happy Family Floater and Max Bupa

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72 LICAgentJaved December 24, 2011 at 8:46 pm

Hi Manish
Apollo Munich Health Insurance Company is not accepting proposal from diabetic.
And
The Oriental Insurance Company Ltd is also not issuing a mediclaim policy to diabetic persons.
Only option left for Shiva is Max Bupa Health Insurance Company in which he can take Silver, Gold and Platinum Plan and Sum Insured upto 50 lacs.

Javed

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73 Manish Chauhan December 24, 2011 at 9:14 pm

Javed

I was not aware about that .. Does Max Bupa cover any diabetic person ? Wont they deny the policy ?

Manish

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74 LICAgentJaved December 24, 2011 at 9:52 pm

Manish
They will underwrite the proposal with following 3 options:
1 pass as normal policy,
2 pass with certain exclusion written on the policy or
3 reject the proposal

javed

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75 Shiva December 24, 2011 at 10:08 pm

Thank you Manish for such a wonderful portal and alos thanks to javed for helping me.

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76 Mahavir Chopra December 26, 2011 at 11:11 am

It’s true that Apollo Munich does not accept Diabetic cases, but Oriental does accepted ALL cases for Diabetes with us.

We have a very recent case with Max Bupa, where customer had Diabetes and Hypertension, went through Medical Test, and the proposal was denied.

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77 Rahul Srivastava December 25, 2011 at 7:10 pm

Hi,

I am 28, married & 1 kid; I am looking for 2 things:

1) Health Insurance policy i.e. Cashless Hospitalization Mediclaim(Family Floater)
2) Critical Illness Policy for myself

Like everyone else, I am covered under a Corporate Health Insurance Plan ( from my employer ).

Which is the best insurer in terms of claim acceptance & convenience & overall performance, so far ?

Second, should I buy this policy from PSU, Private, General Insurer, Heath Insurer, LIC or whom ]

Finally, are the policies like LIC Health Plus / Jeevan Arogya, good enough ? What’s you take on them ? Please suggest.

Thanks in advance.

Regards,
Rahul

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78 LICAgentJaved December 25, 2011 at 7:39 pm

Hi Rahul
Write your spouse age ans your city.
Javed

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79 Rahul December 26, 2011 at 10:47 am

Hi Javed,

Spouse is 29 years, kid is 1 year & city is Bangalore.
I have shortlisted Apollo-Munich Standard, Star Family Optima, HDFC Ergo, United India & Oriental ( all Family Floaters ).
However, I have seen contradictory info regarding Apollo Munich & Star Allied.
Some say, Star Allied has highest Claim Acceptance ratio ( HT-Mars Survey ) & hassle-free service & Apollo has lower Claim Acceptance ratio, while some like i-save mention the reverse of it. Which one is actually better ?

Second, what is your view of HDFC Ergo, who as per i-save, have the best Claim Acceptance Ratio & Best Service, albeit higher cost ? Is this reliable enough ?
Can you clarify these things ?

Please suggest. Thanks in advance.

Regards,
Rahul

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80 Mahavir Chopra December 26, 2011 at 11:19 am

Rahul,

Claim Acceptance ratio, cannot be a core criteria to buy a policy. A PSU company like New India or Oriental will have a low claim settlement ratio, since it could be attracting many fraud claims or claims where facts have been misrepresented.

An Insurance Company which has a 100% claim settlement ratio, is not necessarily a good company, it could be a case, where they don’t have a good investigation mechanism to catch claims with misrepresentation or fraud.

A Survey can again be misleading, depending on how composite the survey participants are, and whether they represent the experience of a large population like India.

You need to talk to a good Neutral/Unbiased Health Insurance Advisor, understand and depend on his real experiences, to get a good understanding.

Mahavir Chopra – http://www.MediManage.com

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81 Mahavir Chopra December 26, 2011 at 11:21 am

In my personal experience, I would rate Bajaj Allianz, as the best, solely based on claims experience.

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82 Manish Chauhan December 26, 2011 at 9:06 am

Rahul

It would be better to ask directly to medimanage.com site on this or our forum : http://www.jagoinvestor.com/forum/

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83 Rahul December 26, 2011 at 11:28 am

Thanks for your reply Mr. Mahavir.

So, in keeping with my family profile, do you suggest me to go for Bajaj Allainz family floater ? Not with Apollo, or Oriental, or Star, or HDFC, or United etc. ?
Beacuse HDFC & United have a good Claim Acceptance Ratio ( as per i-save: dont know how reliable their rating is ), & so is Star ( as per HT-Mars survey ).

Could you please elaborate a bit, if possible ?

Need to finalise & close this by tomorrow EoD.

Thanks & Regards,
Rahul

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84 Mahavir Chopra December 26, 2011 at 11:45 am

Hello Rahul,

Most Insurance Companies settle genuine claims, as per policy wordings. The rejection of claims, we experience are purely due to non compliance with policy wordings, misrepresentation of facts in proposal form OR due to explicit exclusion in the policy.

Bajaj, Apollo, Max, Oriental, HDFC, Star are all good companies, which will not reject a genuine claim. You need to be educated about exclusions, so that you know what to expect.

Discuss your requirement, with an expert advisor in detail, explain him your needs, and then decide.

Good luck!

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85 LICAgentJaved December 26, 2011 at 9:57 pm

Hi Rahul
I do agree with Mahavir (Most Insurance Companies settle genuine claims, as per policy wordings. The rejection of claims, we experience are purely due to non compliance with policy wordings, misrepresentation of facts in proposal form OR due to explicit exclusion in the policy.) BUT imagine a situation Mr A has taken a mediclaim policy for example 5 lacs Sum Insured and he after 5 days or 10 days hospitalised for Dengu and remain in hospital for 10 days. In this situation do you know mediclaim company will pay the claim?
before taking final decision you should know the WAITING PERIOD, Temporary Exclusions, Permanent Exclusions, Coverage, Sub Limits, Co-pay, No claim Bonus/No claim Discount.
Have you decided about Sum Insured ? ( or what is your Annual Income?)

Javed

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86 Veena January 30, 2012 at 1:16 pm

Hi,
I am very new to this Health Insurance world. As many of us, i too was under the impression that Corporate cover would suffice. Thanks to this blog that changed my opinion.
I would like to take an insurance for me(32) and my husband(34). I have the following questions
1. What are the various aspects I should keep in mind?
2. I do not understand the these jargons – CO-Pay, Family Floater, etc
3. Would I be covered for Maternity in a year’s time if I buy the plan by May?
4. Can I claim for any tax benefits?
5. Also, if I dont claim, would my premium change?
6. What are the various riders that I shud be considering?
7. Can I split the coverage and take 2 policies instead so that I an share the premium with my husband?
Any other details that can better my understanding would be appreciated. Reading my questions, you would know that i am a novice in this field and trying to gain knowledge to save my wealth!

Thanks
Veena

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87 Mahavir Chopra January 30, 2012 at 2:35 pm

Veena,

Good to hear that you have realized the importance of owning your own mediclaim policy.

Your questions are very long and broad. We would suggest you find a neutral health insurance adviser to answer your questions.

If you want, we can help answer these and many more queries you may have (**with no obligation to buy the policy from us, whatsoever**) – You can write to us at expert@medimanage.com

Regards,
Mahavir Chopra – Medimanage.com

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88 Rishikesh Ratnaparkhi February 7, 2012 at 5:39 pm

My Query is with reference to Medclaim for individuals with pre-existing Critical Illeness & in particular to Medimanage.
While i as planning to take medclaim for my family & i also have pre-existing health hazard, i posted a query on medimanage mentioning the health hazard .
The response which i got is with mentioned health hazard ,no PSU /Private Sector insurance company will give me mediclaim which is quite surprising and shocking . I was under impression for any existing illness there will be a waiting period by the company usually 4 yrs.& probably they may charge a higher premium but denying a mediclaim altogether is nowhere on my mind.
Is that correct company refusing proposal based on existing health condition,also is there a universal list of critical illness ( ??) which all the companies follow for refusal .
Also isnt this should be a basic right of every individual to go for medical cover

While i appreciate the due dilligence and long term approach of Medimanage team & also when i communicated to medimanage rep. that even though my disesase come under your category of critical illeness but the same is not true as per my doctor & medical reports , he suggested to send him , my medical reports ( Which i sent to them right away) based on which he will go and check with insurance companies and come back to me. This again shows there customer centricity.Hoping for a positive response from there side.

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89 Mahavir Chopra February 8, 2012 at 10:45 am

Hello Rishikesh,

Insurance Companies are for-profit organizations and have the full right to deny coverage, as per their underwriting guidelines. There is no universal list, but proposals with existing critical ailments including ones related to Heart, Renal, Paralysis, Cancer etc. are denied coverage by nearly all insurers.

We are in the business of health insurance, and we would never want to refuse a customer, but the fact of the matter is that in 99% cases, people with existing critical ailments are denied cover by Insurance companies, and that’s what we mentioned to you.

This is precisely the reason, why we continuously recommend, in all forums, regarding, taking covers at the youngest age possible, at-least once you start earning.

We would suggest you to help us with logging a complete proposal including payment of premium to the Insurance company, for us to try and get a cover for you. Remember, there are just 1-2% chances of acceptance.

Regards,
Mahavir Chopra

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90 Rishikesh Ratnaparkhi February 8, 2012 at 11:11 am

Hi Mahavir,

Thanks for the reply , so should i log the proposal or wait for your representative ( To whom i have sent me medical reports) to come back .

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91 Mahavir Chopra February 8, 2012 at 7:39 pm

Our representative will call you. Thanks.

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92 Abhishek Maheshwari February 20, 2012 at 4:56 pm

Hi Manish

I generally reads blogs at this website. I came to know about this post while searching for any good mediclaim policy. Fantastic article. thanks for this!!!

I want to take mediclaim policy (Family floater) option for me (33 years) and my wife (31years). I am confused which one to take as lot of options are available. Reading above comments but could not take decision. I shortlisted 2 finally after reading much.

1. United India insurence
2. Apollo Munich

Could you please suggest, with which I should go for. UII has a limit for daily expenses but Apollo doesn’t but it has bit larger premium. As generally people suggest that should not go with private options (Apollo). is this correct..?

What should I do please from the above. Need to have your valuable advise on this..

Thanks
Abhishek

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93 Mahavir Chopra February 20, 2012 at 6:40 pm

Hello Abhishek,

Presuming, you do not have any ailments, or medical history, you have multiple choices, some of the good ones are Apollo Munich Optima Restore, Max Bupa Family First, Bajaj Health Guard and Oriental Happy Family.

Do go through the following article for steps towards buying the policy: http://www.jagoinvestor.com/2011/05/health-insurance-buying-steps.html

Also: http://www.jagoinvestor.com/2011/08/health-insurance-myths-india.html

Look for a Good advisor, who provides unbiased advise and claims support.

Mahavir Chopra
http://www.medimanage.com

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94 Manish Chauhan February 21, 2012 at 11:26 am

Abhishek

There is no problem with Apollo , you can go with them and they have recently came up with a good plan called Apollo Optima Restore . Its a good one and recommended. Read the policy document to get insights in detail

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95 Abhishek Maheshwari February 22, 2012 at 4:02 pm

Hi Manish,

Thank you for your advise. As per your suggestion I assume, there should not be any problem in claim settlement from Apollo, if we are the genuine in asking claim. I get bit afraid in private option as we hear that private company ‘A’ has been overtaken by company ‘B’. should there be any such thing with apollo in future :-)..?

Yes Apollo Optima Restore is good option but creating very high premium. I want to take simple family floater option for around 3L per year. What you suggest please.

Thanks in advance.

Abhishek

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96 Manish Chauhan February 23, 2012 at 3:11 pm

Abhishek

Note that claim is never rejected if its within the rules , most of the rejections happens when things are not in rules and regulation . Most of the times buyers misunderstand the things and expect something which is not covered at all and then later say bad things .

Manish

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97 Sandeep March 18, 2012 at 8:13 pm

Manish , I am a 44 years old MNC employee & my organisation provides the cover of around 2.5 Lacs (for general hospitalisation) & critical illness cover of around Rs, 8 Lacs for my entrire family (my wife & daughter) . My wife is a Govt employee & she has the facility of free treatment for entire family in selected hospitals for any illness .This facility of hers will continue even after her retirement being the govt employee
Although we are properly life insured , but have not taken any extra Health insurance . Should we go for more Health Insurance , seeing our existing stable health insurance policies from our respective employers

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98 Mahavir Chopra March 19, 2012 at 10:23 am

Hi Sandeep,

It is high time you go for your own independent cover. Depending on CGHS or any other Govt. health scheme is not a sound financial planning.

From my experience, these are the drawbacks of depending on Govt. Schemes:

1. Many hospitals do not have all the medical facilities (mostly the advanced facilities) and there are major deductions, when treatment is carried out of the network of listed hospitals
2. There are limits. A CGHS scheme allows a maximum of Rs. 65000 for a stent for cardiac operations, whereas a really good one, costs around a lakh. Many hospitals are opting out of treating CGHS employees.

Chances of suffering an ailment rises after 40 years, it becomes more and more difficult after 45 to get a good mediclaim. We would therefore suggest you buy a mediclaim immediately.

Regards,

Mahavir Chopra | http://www.medimanage.com

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99 Manish Chauhan March 19, 2012 at 8:12 pm

Sandeep

Good to see that you have got some good facilities, if you are going to get everything covered, then I think you can skip it

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100 mahesh April 30, 2012 at 12:44 pm

Hi Manish, thanks for the good information posted on the net.

Please note that am an NRI and my company provides the health insurance for myself and myself. In india i dont have any health insurance. In addition to the the HI which my company has provided, do i need to take private health insurance in india. I visit india once a 6 months. Please advice. Regards, mahesh

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101 Manish Chauhan May 1, 2012 at 11:20 am

Mahesh

Only you can decide if you need extra health insurance or not . Just see how much health insurance you have and ask yourself if thats enough . Think about it

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102 maneesh May 19, 2012 at 8:52 pm

Dear manish

please give your views on
1) critical illness cover in mediclaim policy
2) critical illness as a rider, in term plan
3) stand-alone critical illness insurance policy

which is better in long term and benefits of taking any two of these simultaneously
regards
maneesh

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103 Manish Chauhan May 19, 2012 at 11:37 pm

This question is best suited for : http://www.jagoinvestor.com/forum or enquire at medimanage.com

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104 Dr M Chandrashekhar June 6, 2012 at 9:42 am

Dear Manish,

Is it true that nationalised banks have group medical insurance for their employees in which they allow some customers ( good customers as per bank) also to participate ? The premium is not very high & being bankers they manage to wrangle good services from Insurance Companies.

I cannot recollect where I read about this.

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105 Manish Chauhan June 6, 2012 at 6:20 pm

I dont think this is true , ask it on forum to confirm : http://www.jagoinvestor.com/forum

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106 Ashok Gupta September 27, 2012 at 4:54 pm

I recommend AVIVA online insurance to everyone.

My wife got breast cancer and had to be operated. Aviva paid the entire fees for the operations. Aviva’s health care plan is definitely one of the safest and the best.

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107 Manish Chauhan September 29, 2012 at 10:55 am

Are you not too biased because you had a good experience ? I am not doubting it , but the point is there are many cases where it gets declined too !

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108 Ashok Gupta October 12, 2012 at 9:28 pm

Maybe ! It’s always good to read the terms and conditions properly. For example, I checked the hospitals covered under Aviva.

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109 Manish Chauhan October 16, 2012 at 2:42 pm

Thats great !

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110 Ashok Gupta October 12, 2012 at 9:23 pm

Health insurance is wealth insurance indeed ! I recommend Aviva’s health insurance plan to everyone. After being a customer of Aviva for three years, I can say that it is definitely one of the safest and best health plans in the market.

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111 Sai November 21, 2012 at 1:41 pm

Hi Manish,

i took maxbupa health insurance for my father aged 59 ,charged me almost 8500/- only for 2 lak cover. after taking this policy i got call from New india assurance company through citi bank credit cards. actually i dont require it since i have already taken it from max-bupa, but the insurance premium is almost 60% less and there is no co-pay kind of thing in this policy. premium amounts are really tempting. i spent only 2000 for 1lak for my father aged 59, next year his age would be 60, so they may ask him to go for medical tests before approving the health insurance. thats again a big headache. in my case i took at the age of 59, so they dont need any tests for renew of same policy.
so next year i am going to renew this New india assurance policy for 3laks only for 4800/- and going to stop renew of Maxbupa.. that sounds good to me..

What you suggest? Please help me if i am wrong.

Regards,
Sai.

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112 Manish Chauhan November 25, 2012 at 12:03 pm

But did you check other aspects like till what age they allow the renewal , the sub limits, kind of coverage they have ?

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113 Sai November 27, 2012 at 6:05 pm

till 100 yrs, they have full coverage, no co-pay kind of thing.

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114 kahnu January 3, 2013 at 1:57 pm

Dear Manish,

My grand ma age is around 70 yrs . can you please suggest me some good health insurance for her.

Thanks

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115 Rahul August 23, 2013 at 5:06 pm

Dear Manish Ji,

I have a query related to Pregnancy related expenses in Mediclaim Policy

I work in a big private organisation. I got married around 2 years back and unfortunately we couldn’t go along well and got divorced

Now I am again planning to get married. I want to go for an early child and start a family. In my Company’s Mediclaim policy, in my family details, the details of my old wife are mentioned from last 2 years.

I have two questions

1) Will they change the details if I tell them that i have got married for second time. Is there a provision in Group Mediclaim policies to change the name of wife ?

2) Will I be able to claim the pregnancy related expenses or is there a minimum time period after marriage date that we can claim such expenses

Thanks & Regards
Rahul

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116 Manish Chauhan August 29, 2013 at 2:25 pm

1. Yes, they should be able to change it

2. I think it will apply the time limit . It cant happen that the child is due next year and its covered !

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117 Anand December 9, 2013 at 9:56 pm

Hi All,

I am working in a pvt company which gave me mandatory medicliam policy at the time of joining. My wife works in a govt sector and she will get all the medical facililties for the family. Now I have to provide a letter stating I am not getting any medical facility from my current company to avail the medical benefits from my spouse’s firm. But here my HR is not willing to give me the letter. Is there any option t to discontinue the medicliam provided by my company. Please let me know.

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118 Manish Chauhan December 12, 2013 at 2:00 pm

HI Anand

You shoudl discuss this with other members on our forum http://www.jagoinvestor.com/forum

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