Beware of Loading and Co-pay in Mediclaim Policies

POSTED BY manish ON October 3, 2010 COMMENTS (149)

Today we discuss two concepts in Health Insurance, generally present in the policy document, which policyholders are not normally aware about, because they don’t care to look at those clauses. We are talking about concept of Loading and Co-Pay . Let’s talk about both the concepts one by one.

Copay and loading in health insurance and mediclaim policies

What is Loading in Health Insurance ?

Loading, in terms of Mediclaim Insurance means the Insurer (Company) will charge more amount than the regular premium from the policy holder after a claim has been made. Suppose, for eg., you have an Insurance policy and you pay Rs 8,000 each year in premium, and now suppose in 3rd year you make a claim, then from the 4th year onwards, your premium increases by a certain amount which can range from 5% to even 300%. The increase depends on the company terms and the rules. If the loading is 50%, your premium will increase by 50%, which is Rs 12,000. Loading can apply with every claim you make. Please check the brochure off loading is 50% , your permium will increase by 50% , which is Rs 12,000. Loading can apply with every claim you make.

Please check the broucher of ICICI Lombard mediclaim policy stating different slabs for different amounts of claim made. One more product, I would strictly advice all the readers to stay away from, is Star Health’s Red Carpet policy for Senior citizens. This is one of the most fictitious policy, I have ever come to known. Not only is this policy, making an option of Co-pay up to 30% but also has Loading as well. So, a senior citizen, who is normally retired and must also be suffering from one ailment or the other, will be forced to shell out a huge amount of expenses for hospitalization in addition to the premium paid. According to me, it is of prime importance, for the prospective client to look for the clause of Loading in the policy document of said company.

But it doesn’t mean that all Mediclaim Policies in the market come with the Loading clause. There are a few companies in the market without such Hidden Riders like United India(Gold and Platinum only) and Max Bupa. This concept of Loading defeats the very purpose of Mediclaim. An individual takes a Mediclaim Policy, just so that he won’t pay anything extra, out of pocket but ultimately, he is spends more by way of Loading after the claim has been made..

Why Loading concept is there from Insurance Companies ?

Generally, the insurance company is of the view, that once a policyholder has made a claim due to any illness or some major illness, he might make the claim again in future (if not near then in the distant future), so just to be prepared to face those recurring claims, the company tries to safeguard itself, by procuring a larger premium by way of Loading. Sometimes, it make sense but most times, it does not! The only justification on the company’s part, is that they make this loading thing clear, at the very inception of the policy, in its brochure as well as its policy documents and they do take, a declaration from client that they knows about it with his/her signatures. If the client doesn’t read/go through these details and is later on required to shell out more from his pocket, then it is his mistake not the company’s.

So my advice for all the readers out there; Dear friends, don’t get fleeced! By the sheer laziness of not reading/going through the policy brochure or documents, we will be facing heavy Loading, both of money and of tension.

Is loading acceptable ?

On the brighter side, companies can not just have any kind of unreasonable loading in policies. These have been challenged by consumers, and often the consumer forums have taken decisions in favor of consumers. Here’s a case in point –

Amina Sheikh, an octogenarian, was insured for Rs 1.5 lakh for a decade by the National Insurance Co. Ltd. under its Mediclaim Policy. When her policy was due for renewal in 2007, the company increased the premium from Rs 5,305 to Rs 32,787. This was done to make it financially unviable to continue with the policy. Her daughter protested, so the premium was brought down to Rs 23,845, which too was very high. She was forced to pay this premium and renew the policy to avoid a break in insurance. Her daughter wrote to the company demanding an explanation for the arbitrary increase. The divisional manager replied that the policy now stood cancelled as Amina did not seem happy with the firm. He also clarified that the premium doubles immediately when a person crosses 80 years of age and for her, the premium had been loaded by another 100% in anticipation of claims arising due to advanced age.

CWA then filed a consumer complaint. Rendering the judgment on behalf of the bench, the forum president observed: “Managers of public sector undertakings are duty-bound to take decisions based on facts and not in an arbitrary and irresponsible manner based on their emotions.”

The Forum held that the loading of the premium was arbitrary, unjustified, and contradicted the terms of the policy, which is deficiency in service and unfair trade practice. The forum directed the firm to continue the policy by charging Rs 13,112 and to refund the excess premium collected. It also directed the company to continue renewals without loading as long as the insured paid regular premium in time. Also, compensation of Rs 15,000 for mental agony and Rs 2,500 as costs were granted.  Source : TOI

[DDET Click to Read 2 more cases]

Case Study 2: In Dr Rupali Shirke’s case, the insurance company loaded her premium by 50%, increasing it from Rs 7,727 to Rs 11,824 and decreased the sum insured from Rs 5 lakh to Rs 2.5 lakh. This was done because of two claims lodged by her, which were genuine and settled by the company. This was considered as an “adverse claims ratio” by the firm. When she protested, the insurance firm ignored it.

CWA filed a complaint challenging loading of premium and reduction of the sum insured by United India Insurance Co. Ltd. The Forum held that the firm was bound to renew the policy on the same terms and conditions. It directed the firm to restore the sum insured and charge regular premium without loading. A compensation of Rs 5,000 and costs of Rs 5,000 were also awarded.

Case Study 3: In the case of Hoshang Khan, after a claim was lodged, the insurance firm imposed a loading of 400%, increasing the premium from Rs 10,558 to Rs 55,952. Khan could not afford the high premium, so he sent the premium cheque without the loading, but the insurance company returned it. CWA filed a complaint against United India Insurance Co. Ltd. The Forum held that loading of premium was arbitrary and unjustified. It directed the company to accept the premium without loading. On receipt of the basic premium, the firm was directed renew the policy with retrospective effect from 2006 onwards to maintain the policy’s continuity.

[/DDET]

What is Co-Pay in Health Insurance Policies ?

Co-pay, as the name signifies is the payment made by two parties, even if that is not in equal proportions This is another important factor to be kept in mind while selecting the Mediclaim policy for oneself. Under this clause, the insured is also required to bear a certain percentage of expenses incurred on illness/disease while hospitalized, either conditionally or under certain conditions..

Usually, in our country, the concept of Co-Pay only comes into picture after a certain age. Most of the companies levy this clause once the policyholder enters the Senior citizen category, that is after the age of 60. Mostly this percentage is mentioned as 20% pay – i.e., policyholder is required to pay 20% of the expenses out of his own pocket. For eg, if Mr X, who is 63 years old falls sick and has to be admitted to the hospital for 5 days, for which hospital bills come out to be Rs 80,000 and his Mediclaim Policy mentions 20% co-pay, then Mr X has to pay Rs 16,000 and rest Rs 64,000 will be borne by the company. The basic understanding behind this clause, is that the company is expecting an increase in claims from this particular section of the policyholders, – the senior citizens. The company’s thinking is that as the age progresses, the chances of policyholders getting sick increases. The expenses on his treatment for a given complication will also be higher as compared to the same treatment for someone who is much younger, say age 38 or 40. Looking at it from the prospective of the company, this clause seems logical but as an individual policyholder, I believe this is one of the main thorns in the flesh of the policyholder who is entering the age bracket of 60s. I believe this percentage has to go down, or associated to some very major complications/illnesses, or senior citizens should given some rebate on premium year on year just to balance out this Co-Pay clause.

Some other companies, preferably PSUs, charge this co-pay clause if the policyholder is taking treatment in out of network hospitals. Earlier, they would apply this co-pay concept, in case the policyholder chooses a higher-end hospital with air-conditioned services or someone from smaller city getting treatment in costly cities like Delhi, Mumbai, Chandigarh, Bangalore etc. At that time, co-pay clause was built in to ensure that the policyholder choose the appropriate hospital/doctor/room level relevant to his economical status as well as the premium paid by him to ensure there is no overspend just because of the existence of the mediclaim policy.

So dear all, please keep an eye for co-pay clause in the policy which you are thinking of buying for yourself as later on, it may negate the very concept of cashless or reimbursement later on as later on! And in the 60s when people have mostly retired with no real source of income, to pay even 20% of the total expenses out of own pocket would be a considerably big amount.

So should you choose a company without co-pay and Loading clause ?

No, not always , you should not make co-pay and other clause as the sole criteria for choosing the policy because even if a company does not have co-pay and loading clauses today , it can include them at later stage . As per Medimanage company

“Again in our opinion, a clear loading policy is better than those policies where there is no explicit loading clause. This is because every policy wording has a term where it clearly mentions that “all terms including premium are subject to change on renewal, based on claims or otherwise.” – this makes you exposed to an unlimited extent, when you grow older. Bajaj Allianz implemented a new loading clause in August 2010. The most scientific loading policy is that of ICICI Lombard, which has classified claims into Chronic and Non Chronic. Non-chronic claims like an accident or Malaria etc. would have a loading only above a certain threshold claim amount, which is not carried forward in the subsequent year. Whereas chronic ailments will have a loading of 75% and carried forward upto 200%.

Finally remember, even if you are buying a policy without loading this year, nothing stops the Insurance Company to add a loading clause at the time of renewal. Dont choose a company only because it does not have loading, choose a company which is stable in its services, and does not make frequent and big changes in their policy conditions.”

Please let me know your comments on this topic . Do you feel its ethical to just mention in the document and not make customers aware about it from their own side ? Do you think if companies disclose about it while selling the product face to face, it would create more respect for companies ?

The inputs are provided by Dhawal Sharma, who is an agent for Kotak and Max Bupa .

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149 replies on this article “Beware of Loading and Co-pay in Mediclaim Policies”

  1. Nitin Agrawal says:

    Hi Manish,

    I found your blog very helpful. Earlier also I had asked some queries related to LIC term plan.

    I have a corporate insurance for my parents. Please let me know “is co-pay part of total sum assured”? For e.g. suppose if sum assured is 300000 (3 lakhs) and co-pay is 10% then will the maximum amount which I can get after claim reimbursement be 300000 – 30000 = 270000?

    I am asking this as recently I claimed my mother’s hospitalization as reimbursement (not cashless). The total expenses occurred were 420,822. But they approved only 270000 and 30000 as co-payment.

    1. Yes, what you said is correct. Whatever is the claim amount (max : upto sum assured) , you need to bear 10% of it yourself and only 90% will be paid by company !

  2. Deepak says:

    My personal accident policy of sum insured 2 lacs says that in case of hospitalization due to accident 40% of admissible total claim amount or 10% of sum insured or actual expenses is payable. My question is please clarify 40% of total claim amount. Request please explain this with an example.

  3. Sachin says:

    I have Mediclaim and topup from same insurer 3L & 10L(deduction3L). So Far never used any claim and policy being 4Y&1Y old. Both has loading in premium due to overweight and some Hypothyroid disease. Currently paying premium of 7.5K & 6k respectively @age 34years. Now I want to include my newborn baby in the insurance and after talking to insurer the premium is going to be increased by approximately 2000/- for each policy. So my queries are.
    1. Wouldn’t it be better to buy separate policy for newborn as the total cost is increasing significantly approximately 4000/-
    2. Are there any policy providers who do not charge loading for being obese.
    3. Is there a rule where proposer me should be in same plan as baby if I buy separate. As my insurere said I can buy different policy but it has to be same plan as me.

    1. Sachin

      Dont over think on this, you are getting good deal . Add the kid name in the existing policy !

      1. Sachin says:

        Whats the advantage going in existing when I can get separate sum insured with similar premium ? Please suggest. Also I didn’t mention earilier but I have cover from employer where kid is already cover with suffecient sum insured. So I have no urgency in adding kid to personal policy. But I will be glad If you can help me understand the advantage of goin with existing policy with shared sum insured.

        1. DO one thing Sachin.

          Please share your details here http://bit.ly/1LLdyFc . You will get a expert calling you from our trusted partner network and help you complete this action

  4. Ranjana says:

    I bought Medicalim Policy from Universal Sompo Gen Ins. Co. (Alongwith Indian Overseas Bank) few years ago and the policy did not contain the Copay Clause till 2012.
    The renewal policy for the last 3-4 years contain this clause and the Co. says it is approved by IRDA.
    Please let me know if the Co. is right in inserting the Copay clause in the last 3-4 years.
    I believe that there are cases holding that the mediclaim policy is a contract and the terms of the original oolicy cannot be varied at the time of renewal.
    Please reply to kelkarjuhu@gmail.com

    1. I think it can happen at the time of renewal . Renewal is a new contract !

  5. Ankur says:

    i had my corporate medical policy along with my father. Sum insured remaining was Rs. 350000 and he got major heart attack. The bill of hospital comes out to be 400000 and my policy has 20% copay. The TPA is saying i shall get maximum of 350000-20% of 350000, means 280000. According to me it should me 400000-20% of 400000 i.e. 320000, please guide me in this respect

    1. No , your TPA is correct

      Your claim amount itself is capped at 3.5 lacs. So if your bill is higher than that, as per policy it would be considered 3.5 lacs. and then there after 20% copay !

      1. Ankur says:

        But this will decrease my sum insured. I am stating definition of co-pay from IRDA document, please guide me accordingly:-

        2. Co-Payment
        A co-payment is a cost-sharing requirement under a health insurance policy that
        provides that the policyholder/insured will bear a specified percentage o f the
        admissible costs. A co-payment does not reduce the sum insured.

        1. Hi Ankur

          I will have to check this with experts now. I am contact someone from COverfox.com to comment on this.

          Manish

        2. Hi Ankur,

          Copay is always applied on the “admissible claim” amount – Since the admissible claim amount (lower of remaining sum insured and payable claim amount) in this case is Rs. 3.50 Lakhs the copay will be applied on this amount. Since Copay is applied to the Admissible claim it never reduces your sum insured. Your remaining sum insured will be Rs. 70000 (3.50 Lakhs – 2.80 Lakhs)

          1. ankur says:

            Thanks Manish & Mahavir, also please let me know whether I can use this 70000 for post medicines etc?

            1. I guess if your policy covers it, only in that case you can use it

  6. KISHOREBASU says:

    IS THERE IS ANY HARD AND FAST IRDA RULES OF CO-PAYMENT FOR SENIOR CITIZEN? I MEAN IS THIS MANDATORY FOR EVERY MEDICLAIM COMPANY?

    1. No , copayment is not mandatory . Its a decision which is taken at company level

  7. Raja says:

    Is there claim based loading in ICICI Lombard complete health policy now? I had read that they have loading upto 200%

    1. AS per the recent IRDA guidelines, now claim based loading has been abolished totally . No company can do that !

      1. Shoma says:

        I have Oriental Happy Family Floater policy. I was going through the policy wordings and looks like it has still has the claim based loading. Could you please confirm is it valid and legal?

        Source: http://www.medimanage.com/insurance/oreintal/wording/happy-family-floater-policy.aspx?page_no=2

        “In case any claim is admitted under the policy, where No Claim Discount has not accrued or the earned No Claim Discount has been forfeited, a Loading SHALL be levied on the renewal premium @5% for each claim occurred year subject to a maximum of 20%.”

        1. That might be an old document. Claim based loading does not exist now as per IRDA rule changed.

  8. Suresh says:

    On my policy, now, since more than 13 years, I claimed in 2008-2009. on renewal co put excess clause of 25%. Can a company put excess mark (I think it is co-pay)? if yes upto what period it will remain in policy? Now when i submitted claim in 2013-14, company deducted 25% of claim settled amount. Is there any guidelines from IRDA of Competent authorities?

    Can any one have idea??? Please share.
    Thnaks
    Suresh

    1. If its as per terms and conditions , then any company will surely do that!

  9. shankar_iyer83 says:

    Hi Manish,

    Hows is ICICI Lombard mediclaim policy , I plan to buy a basic (Rs 4 lacs) and topup(Rs 8 lac) for self with premium of Rs 16000(approx)(tax benefit under sec 80d) , any better policies than this?

    Shankar

    1. One cant just make a conclusion like this, every policy is very different at times from another features wise. you need to read the full brochure !

  10. Mayur says:

    Dear Manish,

    This is with reference to Viren’s query about Apollo Optima Restore policy. This is the same query which forces me to surf the web and ultimately leads to this page.

    The last sentence of the clause written in section 5 b) is “These loadings are applied from Commencement Date of the Policy including subsequent renewal(s)
    with Us or on the receipt of the request of increase in Sum Insured (for the
    increased Sum Insured)”. It clearly mentions about loading on premium at the commencement as well as at renewal(s).

    This contradicts (indirectly) with the clause mentioned in section 5 p) about renewal “We will not apply any additional loading on your premium at renewal based on claim experience”.

    Please clarify me if i have interpreted it wrongly. On one side they are mentioning that “no premium loading on account of claim”. But, claim is made against diagnosis / medical condition. And, as per section 5 b) “The maximum risk loading applicable for an individual will not exceed above 100% per diagnosis / medical condition and an overall risk loading of over 150% per person. Hence the claim indirectly leads to premium loading.

    Please help me to resolve the query, Thanking you, Mayur

    1. Hi Mayur

      How old is your policy document ? With recent regulations, now there is no CLAIM BASED LOADING in subsequent years! . So if you have taken the policy and paying a premium of Rs X per year, then because of claims there will not be loading in premiums, there can be some other reason like slab change, but not claim, I am going to do an article on this !

      Manish

  11. Viren says:

    Hi Fellow memebers / Manish,

    I am planning to buy Apolla Optima Restore for me and my spouse.
    They have not mentioned anything specific regarding LOADING in the ‘Policy Wording Document’ However it is wriiten in section 5 b) that -“We may apply a risk loading on the premium payable (based upon the
    declarations made in the proposal form and the health status of the persons
    proposed for insurance). The maximum risk loading applicable for an
    individual will not exceed above 100% per diagnosis / medical condition and
    an overall risk loading of over 150% per person. These loadings are applied
    from Commencement Date of the Policy including subsequent renewal(s)
    with Us or on the receipt of the request of increase in Sum Insured (for the
    increased Sum Insured).”
    I am not sure what do they mean by this ? Can they increase my premiums later on (may be at the time of renewals) if I am diagnosed with any medical condition in the previous year ?
    Please clarify.

    Thanks,
    Viren

    1. This point of loading is all about increasing the premium at the time of taking the policy . Later on, they can only increase the premium based on age slabs which must be there on the websites . You can see those slabs on their websites where you calculate the premiums !

  12. Arijit Mukherjee says:

    Hi

    I am working in out of India and recently have got my job and financial stability. My family is very othodox and financial matters have always been kept away from children. I just recently realised my family is not insured.

    My father aged 59 (Blood Sugar problem)
    My mother aged 57 (Arthritis)
    My bother aged 27

    If my father is buying an insurance policy, is there any policy you would perticularly suggest please?

    Thanks,
    Arijit

    1. But do they need one now ? Is someone financially dependent on your father at this age ?

  13. amarkprem says:

    Hi Manish,
    Pl. advise best Health Insurance plan (Family floater) available and suitable as per one of my relative’s status:
    Elder member’s age=41 yrs, spouse 34yrs, 2 sons (11 &6)
    No history of critical disease
    Financially good from business
    Living in rural area (Nearest City is at 28 km distance & Capital city is 150kms)
    No depth knowledge of Policy matter, terms & conditions of insurance company
    none have never insured
    Pl. suggest best with pros & cons.

    Thanks!

    1. I think Religare would be a good choice .

  14. Pingback: IRDA Health Insurance Regulations 2013 - Simplified
  15. vijay says:

    Nice article. Quick question though – what is cwa in “CWA then filed a consumer complaint?” Seems like if we ever have some legitimate run-in with the insurance company, there could be some respite.

    Although I am familiar with the concepts of loading and co-pay, some of the comments were thought provoking. I am now beginning to re-evaluate Religare. They have no loading, at least as of now. They have no co-pay if the policy has been one of renewal before 61yr age. Their premiums are among the lowest. Over all, their policy sounds very consumer friendly – almost a sweet bait! Does any one have some experience with their claim process? Does it bring along unpleasant surprises? Will be nice to hear other’s views on this.

    Thanks.

    1. Religare is a good company overall and a strong top level management team. I would recommend going ahead with it .

      Manish

  16. Jignesh Desai says:

    After a claim has been made & settled , for how many years does New India Assurance charge Premium on it’s (i) Mediclaim Policy 2007 & (ii) Family Floater Mediclaim Policy ?

  17. Jignesh Desai says:

    After a claim has been made & settled on a Policy , till how many years does New India Assurance charge Loading on Premium in case of it’s :- (i) Mediclaim 2007 Policy & (ii) Family Floater Mediclaim Policy ?

  18. neeraj says:

    now i am having apollo munich easy health exclusive family floater from last 2 year.

    now it is time to renew it again…. we are a young family of 2 members. eldest person age is 32 years.

    Please tell me which health policy is best. and there would be no loading and co pay changes.

    i do not know apollo munich has loading or copay….

    1. There is nothing like best here . If there is no copay and loading, then premium will be very very high , because those things are all included in the premium

  19. Vipin Chauhan says:

    Dear Sir
    I read the full article and still not able to decide to choose the best policy for
    my family – Me , My wife and 04 mths kid.
    Since my wife is suffering from Rheumatic Heart Disease (RHD) which is not a serious threat even in coming years, I am confused between to take a Family Flotter or Individual policies for every one and one Critical Illness Disease cover for wife.
    Your expert advice will be highly helpful.

  20. observer says:

    All insurance (life, motor, general, medical ) works on the principle of probability. In a group of 100 people , if all pay premium of 10,000 , then total amount collected is 10,00,000 . If 20 people put a claim of 50000 , entire collection is gone . In case of medical insurance , 1 person in a family ( middle aged , elderly ) will certainly claim this amount . Hence almost all families will make a claim every year. Insurance company pays out more than the total premium collected and hence all this loading , increase in premium is done . Whereas , in motor , life , general the claim probability is very very less

    1. Your concept is correct, but numbers might not be

  21. Gautam says:

    Optima Restore from appolo Munich

    1. What is your comment ?

  22. Gautam says:

    Please confirm if the Appolo Munich Policies have Loading & Copay provisions

    1. Which policy are you talking about , give the exact name

  23. Vinay Joshi says:

    Hi Manish & Team,

    I appreciate you n your team for sharing this article on forum. After reading the comments and reviews i have decided to go with Max Bupa family first policy for my family.

  24. Jyoti says:

    My brother (Age now- 39) have suffered a stroke 4 years back (admitted – 10 days) now recovered completely, at that time he was covered by Reliance gen. mediclaim.
    after it no claim and policy is continuing. Now, they have raised premium & clause of no renewal after 45 years. Which policy should he take now ?

    1. Jyoti

      there are policies from Appolo and Max Bupa which are good one’s

  25. Akshat Agrawal says:

    Hi, Appreciate if anyone can please explain me if the co-payment amount has to be on total hospital bill or on the amount which is after removing TDS from the total bill. My understanding is that the copayment is applicable on total amount minus TDS but hospital is charging me the copayment amount on total hospital bill. Please help!

    1. Akshat

      What is TDS cut from hospital bill ? Why will there be any TDS ? Its not a income for you ! .

      And the co-pay should be on the total bill only .

      Manish

  26. Vijay says:

    Hi,
    I am looking for a family floater policy which will cover my wife, me and my mother. After some search, i am thinking of oriental’s happy family floater policy which has defined loading and still at lower price.
    Any suggestions?

    1. Vijay

      You should take suggestions from our forum members : https://www.jagoinvestor.com/forum/

  27. Dharmesh says:

    Manish,

    Really nice info regarding loading & co-pay.
    Recently, i came across an article in a leading newspaper related to loading in Mediclaim Policies, thought I should share. Heres the link. http://www.dnaindia.com/money/report_buying-a-health-cover-see-what-it-loads_1451778-all

    Dharmesh G

    1. Dharmesh

      Thanks for the link 🙂

      Manish

  28. S S says:

    I was not aware of it will take care of these things now onwards. I think this unwareness is because we dont read policy document. Not only mediclaim document we have stopped reading any document. An agent come home and we sign it wherever he puts a mark. Everyone is so happy about it.

    1. SS

      yes , unless we take responsibility of reading docs on our own , things wont change

      Manish

      1. geo thomas says:

        Hi manish, a small survey done by me on max bupa, i just want to share.
        eg; If i take a policy from max bupa at age 40 and continue it, at age 65 there will be a co-payment of 15% there on, there was no explanation given to me from max bupa.
        2. if i get hospitilised in a hospital , where there are double room with ac and with out ac, and i get admitted in ac double room, i would be paid for non ac room, as the policy wording says reasonable room rent charge. again they have confirmed the same.
        and when it comes to senior citizen with pre existing disease, they normally reject the policy after medical.
        Today clients does not buy mediclaim, they have to be sold, or they come to know abt any disease, thats when they go for mediclaim, such people dont read the wordings, and trust the agent blindly.

        1. Geo

          Thanks for sharing that , I agree that just like Life Insurance, even health insurance is sold . But dont you think what you said was right for almost all the insurers ?

          Manish

  29. Sonia Advani says:

    Hello all,

    50 comments, truly means Manish is jagaaoing the investors and consumers. 🙂 Great job! This was really helpful.

    1. Sonia

      Thanks a lot 🙂

      Manish

  30. Arudra Kumar says:

    @ Manish,

    Thanks a lot for sharing this article. Till date, I never knew about the loading clause. I need to check my insurance docs immediately. by the way, I have a family floater insurance from Star Health.

    Regards,
    Arudra.

    1. Arudra

      If you see the article , Star Health Red carpet has loading , check which one you have ?

      Manish

      1. Arudra Kumar says:

        Manish,

        i think, Red Carpet is only for senior citizens. I have Star – Family Health Optima. Its a family floater.

        Arudra.

        1. Arudra

          ok , so did you check if it had those clauses or not ?

          Manish

  31. Vinaya H S says:

    Not sure if my first attempt at leaving this comment worked.

    @Ankur:

    Quite a risky move — unless you’re absolutely sure of NOT receiving a pink slip. While I strongly advocate building a fallback health portfolio (see: http://www.vinayahs.com/archives/2010/09/21/whats-your-fallback-when-your-health-insurance-provider-refuses-to-pay-cashless/), I will recommend that you buy an independent health insurance cover.

    Consider this scenario: You’ve only recently started accumulating your health portfolio, you loose your job (guaranteed in this day and age!), you (or your dependents) fall ill. What would be your fallback here?

    You can read more about my thoughts on health insurance @ http://www.vinayahs.com/archives/tag/health-insurance.

    1. Ankur says:

      @ Vinay,

      Thanks for your response. I understand that it is risky move. I am thinking loud on various options available.

      As I understand from your response, you consider that risk is between now and the time when I have good enough amount in health portfolio and, that too, during period I lose job. Basically, this risk materialises if three conditions occur together. One, I get medical emergency in family, Second, I lose job, Third, my health portfolio is not adequate.

      So, I need to basically take judgment on my losing job and remaining jobless for long period of time. While nobody can predict this, I guess one can say with reasonable judgment, considering current job market, whether there is likely scenario of losing job in next two or three years. (This can be further evaluated periodically). I think it is bet worth taking.

      Even if one takes independent cover being conservative, I think one needs to utilise this time for building a health portfolio for old age. I think, to be dependent on health insurance in old age is very expensive and not a reliable way. Having a robust dedicated portfolio is much better.

      Your views are welcome!!

      1. Ankur

        I understand that its bet worth taking , but then is it not worth to take insurance for next 2-3 yrs while you are busy building that corpus which you would call your “health insurance corpus” . Just saying that its worth taking the bet wont help .

        Are you sure if things really go wrong , in that case the regret of discarding the option of health insurance will not be more than taking it .

        Manish

        1. Vinaya H S says:

          Second this thought.

          And why does this need to be an either-or decision? If you can afford to, I’d highly recommend that you have both: independent health insurance and an independent health portfolio. In this day and age, every financial fallback that you can afford to have is honestly worth having.

          1. Ankur says:

            @ Manish & Vinay,

            Yes. I need not think in either / or mode. It makes sense to pursue both options. I need to think over it on how to proceed.

  32. Ankur says:

    Manish,

    Really great article, atleast for me as I was not aware of such things before. I am covered by my employer for health insurance. However, I was recently thinking about taking independent health insurance myself. After reading this article, I am rethinking whether it is really worth taking this trouble. I would rather build a portfolio dedicated for health related matters, just same as retirement portfolio, rather than keep paying all the money to insurance company.

    Yes, it will take time and I need to contribute every month and ensure that I have lot of cushion. But, it is doable and I will have peace of mind knowing that I am on my own. Mean time, my employer’s insurance is continuing to cover me.

    Any views?

    1. Ankur

      you can do that , just make sure till the time you are busy building that corpus for health issues, you are covered till that time .

      Manish

  33. Rakesh says:

    Manish,

    Very good post, quite an eye-opener on the loading point. I was not aware of it, will have to go back and check the minute points in my policy.
    Btw.. i have health insurance from National Insurance.

    Rakesh

    1. Rakesh

      There is co-pay and loading in some forms in this VARISTHA policy

      “Insured has to bear 10% of all the admissible claims(Compulsory Excess). However, 20% co-payment will be considered if the insured opt for the same. In such cases 10% additional discount in premium will be allowed.

      Insured has to bear additional 10% of all admissible claims if the claim arises out of pre-existing diseases for which the insured opted cover and paid additional premium. This provision is in addition to the compulsory excess stated herein above and applicable only for claims arising out of Pre-existing Diseases.”

      http://www.healthinsuranceindia.org/national_senior_citizen_insurance_4.asp

      Manish

  34. Karthik says:

    Hi Manish,
    I’m looking for a policy that covers only dental insurance (including root canal treatment). My employer already covers for other cases through group mediclaim insurance. Have any good choice to make?

    thanks
    Karthik

    1. Karthik

      I have not come across insurers which cover dental insurance.

      Anyone else has any idea ?

      Manish

      1. Karthik says:

        Interesting. I have to recently shell out for three root canal treatments and that cost me around 18K! and I’ve been searching for a dental insurance policy since then….in case anyone figure it out, please do let me know.

        thanks!

        1. Karthik

          I found out that there is something called ICICI Lombard Dental Insurance , find more yourself now : http://www.indiahousing.com/icici-bank/icici-lombard-dental-insurance.html

  35. Chetan Deshmukh says:

    Thanks for insights Manish. Really helpfull

    1. Chetan

      Welcome .. do share your learnings and experiences .

      Manish

  36. Pavan Kulkarni says:

    Thanks for the info Manish; i never knew such a thing (Loading) existed!!!

    1. Pavan

      Good to hear that . I had something for you then 🙂 . Go and look at your document now and see if its there 🙂

      Manish

  37. Vinaya H S says:

    I can share my experience with Star Health’s Red Carpet policy for Senior Citizens. I’d taken this policy for my mother when she was 62. Coverage was 2 lacs. When she was hospitalized (1.5 years after taking the policy), we had to bear 40% co-pay for that specific surgery. Star Health settled 1.2 lacs through cashless facility. Don’t know if the premiums would have increased.

    There aren’t too many options for Senior Citizens — especially without medical tests. And it honestly isn’t easy to convince them to undergo one. So, in my opinion, one should still take this particular policy since it will be very helpful at least during the first claim.

    I don’t think you should advocate a blanket ban on this policy.

    1. Vinaya

      Thanks for your review . It would depend on person if they would like to consider being comfortable with co-pay upto 40% , Lot of people have too much expectations and hence they are never satisfied.

      What do you think is better ? Taking a policy with high co-pay and less premium in start OR taking a policy with high premium in start but no co-pay .

      Manish

      1. Vinaya H S says:

        Here’s another angle.

        http://www.vinayahs.com/archives/2010/09/21/whats-your-fallback-when-your-health-insurance-provider-refuses-to-pay-cashless/

        I strongly believe it’s a good idea to save up for medical emergencies. When you do that, it makes sense to opt for lower premiums but with a co-pay.

        1. Vinaya

          Thats good . I agree with you , but for creating that emergency fund it would take some time and by that time one has to take insurance any ways .

          The other point is that people who do not create these emergency funds for health related issues anyways end up paying the money from their pocket by liquidating some of their assets/investments . .just that we can be more planned by created the emergency funds

          Manish

  38. Mahavir

    Wonderful info from you , I have added your inputs in the article with a link back to your website . Good one . please contribute more in coming days , we all need experts like you on this forum .

    I was not aware that companies can change that policy later 🙁 . Keep in touch

    Manish

    1. prabeesh says:

      doesn’t these policies which already have loading in place also have the fine prints stating “all terms including premium are subject to change on renewal, based on claims or otherwise”. Then what makes us think these policies will not change in later stage?
      say icici lombard from max 200% to 600%.

      As the year progresses on i think the premium will increase based on the claim and in some cases its fare to increase it. But is there a policy which is fairly priced in all sectors? i dont think there is any

      1. Prabeesh

        Its said that MAX BUPA is one of them , which causes their premium to be high from start . What do you say ? But that high premium is a reason no one would like to get into that .

        Manish

  39. really a good read and valuable insight

    1. Kashyap

      Do you want to add some inputs from your side on these clauses ?

      Manish

  40. Yogesh Tiwari says:

    Awesome, good to know info..thanks a ton.

    Regards
    Yogesh Tiwari

    1. Yogesh

      Thanks , do you already have a policy or you are going to buy one now ? I am sure you will now be more cautious to choose the one .

      Manish

      1. geo thomas says:

        Hi manish, i agree to some point, but i disagree to some , like co payment, when you mentioned star health, senior citizen policy has co- payment, now tell me which company covers senior citizen with pre existing disease, most of the old clients dont have mediclaim, now if star is giving them cover for even pre existing disease for 50% co payment, what is the problem, he would atleast get 50% , as we know the hospitalisation is high after 60. so when you say beware, the people who read it feels it is words of bible, i dont know if he does not have a policy at this age and if it is a necessary, should i not give him the policy, more ever max bupa is promising a lot, i would certainly wait for 2 years , and most of the mediclaim companies are at loss and does not want to sell mediclaim as the claim ratio is high compared to the premium received, but they have to sell because of irda regulation.
        note: i dont sell star senior citizen policy.

        1. geo thomas says:

          i have a policy from star health for the last 3 years, and in the brouchers it s clearly mentioned about co-pay and loading, i am going through the brochure of red carpet , it clearly mentions in exclusion that 50% co-payment applicable for pre existing and 30 % co payment applicable for all other claims. also clearly in bold letters about loading, i want all of you to read the brochure carefully, i am not marketing star health, but i was told of all the exclusion and loading before i bought it.

          1. Geo Thomas

            Thats not my point , My point is just that it should not be the surprise to you at the time of claim , the point was awareness as primary thing and if possible search for a policy which you agree with their terms and conditions 🙂 , like in your case .

            Manish

        2. Dr Adesh says:

          Hi Geo thomas,
          u r right when u say star senior citizen policy is giving cover to senior citizens who may have pre-existing health issues but u know Max-bupa is also giving it ..may b premium is more but after proper examinations by panel of doctors cover is valid after 4 years for pre-existing health issues( time period may be decreased depending on severity)..may seem a long period but in the mean time take cover with above policy and after Incubation period, stop it and continue Max bupa.
          i hope u got d point.

  41. pattu says:

    A correction:

    United India has no loading for gold and platinum individual polices but has a reasonable loading scheme for family medicare:

    —————————————————————
    Claims Loading – If three or more claims are lodged during the two immediately preceding policy periods–
    Upto 25% of Sum Insured – 25% loading on applicable premium
    26 to 50% of Sum Insured – 50% loading on applicable premium
    51 to 75% of Sum Insured – 75% loading on applicable premium
    Above 75% ` – 100% loading on applicable premium
    This loading will be removed after three continuous claim free years. The No Claim Discount will apply only after completion
    of four claim free years in such cases.
    —————————————————————————-

    1. Pattu

      Which one you have ? Did you happen to read all fine prints at the time of taking the policy ?

      Manish

      1. pattu says:

        I have individual policies for myself, wife, child and mother. They don’t have any loading. I got a claim of 2.75 lakhs for my wife and the premium did not change. Of course I did not get the ‘no-claims’ discount for the following year premium.

        I didn’t know about loading when I got the policy! So I guess I was luck not to take the family floater of United India which has loading.

        I increase the sum assured for everyone by Rs. 25,000 min every year and still the total premium changes by about Rs. 1000. If you consider family discount+ no claims discount then its even less.

        With regard to my earlier comment this sentence:
        “There are a few companies in the market without such Hidden Riders, primarily Max Bupa.” sounds biased.

        Max Bupa is only one of the few insurers who offers this.

        Its a business for everyone. Lets not naively think (or claim!?) that one company alone cares for the clients health!

        1. Pattu

          Just came to know from Mahavir that co-pay and loading clauses can be included by the insurer any time as per the fine prints of the policies .

          Let me include United India along with Max Bupa .. lets also find more companies which does not have it , I guess the number is very small

          Manish

          1. pattu says:

            I suppose loading clauses can be included if you have fragile health and get 1/2 claims every year.
            Even so I would trust state run insurers to introduce loading in a more transparent way than private players.

            1. hmm .. have to verify that in coming days

              Manish

            2. dhawal sharma says:

              @pattu – Please check the policy broucher for PLATINUM/GOLD version of this UNITED INDIA MEDICLAIM policy..

              I guess why thy wont’ be levying LOADING is because they are not GIVING any facility at all…1% of COVER as room rent and 2% of COVER as ICU charges are just not acceptable at all..in your case (As you mentioned cover of 2.5 lakhs) room rent in this case would be Rs 2500 and ICU charges would be Rs 5000..Dont you thing if something untowards happen (A major accident or major illness) to this policyholder and hypothetically he gets his treatment for about 10 days in MAX/APOLLO/FORTIS hospital, he would be paying practically everything from his pocket (Because room rent in these hospitals is at least Rs 8000 and ICU is way too high)..I think this INDIRECTLY is LOADING..What say???

            3. pattu says:

              Yes I am aware of these restrictions. At that time my wifes admissible cover was Rs. 3 lakhs. She was in a super deluxe room with a room rent of 2700 per day which is okay but ICU was Rs. 8000 a day. These were reimbursed in full!! She spent 27 days battling for her with 15 days in ICU.
              I still don’t know why I got ICU charges reimbursed!

              As I mentioned earlier when I got the policy I didnt anything about insurance of any kind. However it came to my aid when I wanted it and I am reasonably happy with it. I see no reason to shift to Max Bu(r)pa! (Burp after eating premiums!) Thank you. No loading in Burpa but yearly increase as you once wrote in this blog. Wonder which is better!!

            4. pattu says:

              Although room rent is set @ 1% there is a following flexibility
              In case Insured opts for a room with rent higher than the entitled category as in 1.2 A above, the
              charges payable under 1.2 C & D shall be limited to the charges applicable to the entitled category.

              Refer to A,B,C,D here:

              I wonder if they extended it to ICU as well. Not sure. Was plain lucky I guess! Poetic justice in my wifes case since her illness was caused by doctors mistake.
              She is fine now BTW

            5. pattu says:

              One final comment:
              Take a look here:
              http://www.moneylife.in/article/7735.html
              “If you were to buy a health insurance policy from Max Bupa, your premium would depend on your age as well as the city you live in. For example, a 60-year-old living in Mumbai would have to pay a premium of Rs18,841 and it will increase each year. At age 62, for example, the premium will increase to Rs21,632”.

              This is for the same sum assured!!

              Consider the premium charges for my mother in United India
              age 62, SA Rs. 2.5 L premium Rs. 8322 (upto Oct. 2010)
              age 63, SA, Rs. 2.75 L, premium Rs. 9061 (upto Nov. 2011)
              I voluntarily increase premium every year by 0.25 L
              I think it is easy to see that MAX BU(R)PA “loads” by another means and United India despite its limitations of room rent and ICU rent has reasonable premium rates.

              DID you know BuPa has for people above 65, a 80% co-pay policy? This should be mentioned in the article.

              Final word:
              1). I am not for United nor am I against Bupa. I am merely pointing out I am happy with the product I chose (without researching!)

              2). Beware of policies which say no loading. Doesn’t mean the premium will not increase every year. In max bupa it looks like it will increase with or without claim! Source: (1) above article (2) Dhawal made this comment in an earlier article.

              Manish: I am very uncomfortable about articles from agents/advisors. The conflict of interest tag is unfortunately unshakable.

              Forgive this long series of intrusions from a jobless idiot!

            6. dhawal sharma says:

              @Pattu – Great to know that your wife is doing fine..God bless..Also, great to see someone getting fortunate with PSU to an extent that getting reimbursed for entire ICU expenses whereas limit was only for 2% of the SUM ASSURE..[Always doubted, these PSUs never honor their ceilings 😉 ]

              Now to the point of discussion, the co-pay factor is actually 20% and NOT 80% as you mentioned, and that too after 65 years..

              Max BUPA increasing its premium with age is just one half side of the story..Second part is that Comany is giving LOYALTY BONUS (Different from NO CLAIM BONUS in a way that policyholder will get this bonus even if he has taken claim) which is 10% of the RENEWAL PREMIUM, which further can be used to avail host of other benefits like CONSULTATIONS/DENTAL TREATMENT/EYE CARE/VACCINATIONS etc…So this increased premium not only giving cover facility of OPD but also returning 10% as well as health check up every year on renewal (Unlike PSUs where its once in every consecutive block of 3 claim-free years)…

              Premium high??? AGREED…But kind of features and facility??? YES, only avilable through MAX BUPA…

              Just a last point to make: me being an agent of max BUPA has nothing to do with writing this article..I myself has disclosed that i am an agent of Max Bupa/Kotak..Could have conceled my identity and still written such an article with all good things about Heartbeat product..CONFLICT of INTEREST will be there only when i will be sitting face-to-face with some prospective client..I just feel the need to bring these things to the knowledge of public at large (99% of my clients never knew that CO-PAY or LOADING exist, in their previous policies with PSUs)..You have good experience with them, and you say good things about them because you feel that way and in the same way, i feel strongly towards this product from max bupa; and me being an agent for the same company is just an ancillary thing..

              and yes, sometimes i too feel little awkward and irritated being pricked as an agent, writing comments and articles, for my personal gains..Dear Manish, please clarify to everyone that you are not paying me anything to do the stuff 🙂

            7. Pattu/Dhawal

              Guys calm down and lets make sure we take only what makes sense for us and ignore what we dont want .

              We are all matured enough to know what part we take from the article and ignore if we dont like it . Anyways this is all some knowledge or information and we are free to extract things for our needs .

              Lets move on and not get stuck in negative discussions , lets give info and solve queries .. thats all

              Manish

  42. pattu says:

    “There are a few companies in the market without such Hidden Riders, primarily Max Bupa.” !!
    Was inputs for this article given by Dhawal?!

    I know United India doesn’t have loading. I thinks we should compile such a list in the comments section.

    1. Pattu

      Yes, the article is contributed by Dhawal .

      1. dhawal sharma says:

        @PATTU & MANISH – Please check this broucher from UNITED INDIA ASSURANCE (Clause 7 – page 6) where the loading slabs are VERY CLEARLY mentioned…Sorry PATTU, but UNITED INDIA did have LOADING concept…

        1. pattu says:

          yes loading for family medicare for first 3 years

  43. Srividhya says:

    Thanks for a good article Manish. My father aged 70 owns a senior citizen policy from Star health and I was not aware that he would be loaded if there is a claim until I read this article. We bought the plan in a hurry as he was not insured and was also hospitalized due to a fracture.

    Are there any good policies that a senior citizen can avail in the market?Most of the companies do not give fresh policies for person aged over 60 or 65.

    1. Srividya

      I think you have red-carpet policy 🙂 . Incase thats the case then there would be CO-PAY applicable as follows

      # 50% co-payment applicable for pre-existing diseases conditions
      # 30% co-paument applicable for all other claims

      I can not see clause of loading in the policy , please dig deeper .

      Manish

      1. geo thomas says:

        Hi mahavir, plz go through the broucher, it clearly mentions about co-payment and loading and also in bigger font, most of us dont read the broucher, and are ready to jump to conclusion, but in star it is clearly mentioned.

        1. Dsouza says:

          Hi All, I am insurance agent representing different companies and all mentioned here. We represent many companies because all policies in any one company are not good, there is at least one to rip off the public. If people could take the time to read and understand and ask those who know, the confusion would be less.

          Manish is right, in the Star policy Red Carpet there is no loading like what peopel are wrongly understanding. What all of you are talking about is the increase in premium if claims are made.
          What the Star policy says is general increase if claims go up.
          Don’t think Max bupa is holy, but i say’l say no more, you guys have to check their policy wordings. I doubt even then if most of you excited people will understand or read what you what you want to know.

          Anyway Star is a very big company, so they can absorb claims with a increase of just a few hundred rupees, not what happened to the xxxx Anil ambani Reliance.
          Give a customer good advise – no no, I deal with everything Medical, Life and General and have stopped selling to individuals as people expect a lot and want what they want. Tell them lies and they buy it – yuk, and then shout they were cheated.
          So i prefer business people, they understand profits and loss.

      2. Vishnu says:

        Hello Mahavir,

        I have bought this policy for my father

        This policy Red Carpet” was very much recommended by experts.

        Let me be honest. I wanted a policy for my father (above 65) with 2-3 Lac Coverage within 15,000 Premium. There were not many options available that time.

        I was recommended for this policy for 3 reasons.

        1. No medical checkup
        2. Reasonable Premium 9600 for 2 lacs coverage.
        3. No change in premium for life time

        I was very much aware of the 30-50% co-pay. But, somehow, I MISSED to notice the LOADING, which is as high as 50% which I realized only during second renewal. And, I could do nothing by that time.

        Now, I have completed 3 years without any claim. But, I am disappointed with the LOADING as well as so many sub-limits.

        And, I see two new senior citizen policies available which are better (Religare and Apollo Munich). But, neither of them agree for Portability for some one who has pre-existing disease (Hyper Tension).

        What are my options if I want to port my policy to a better policy with higher sum assured without loosing the waiting period benefits from my previous policy.

    2. Karsudha says:

      Apollo Munich Maxima plan and Max Bupa are two bet policies for senior citizens.

      Oriental has a senior citizen policy but they have too many sub limits.

      1. Dsouza says:

        Most comments here are indeed hilarious and not yours Karsudha, it’s better than others. A slight error corrected is…….
        It’s only Apollo my dear who does not have co-payment in the Maxima individual and family policies. max Bupa has 20% and Star at very cheap premiums for those who can’t pay have 30%.
        While Bupa takes 4 yrs to cover pre-existing diseases, Star covers from start if they are more than a year, even those are covered in the 2nd year.
        While Star and Bupa give to those who have Diabetes under control, Apollo Does Not do so.
        So it all depends on a particular person, nothing to do that one company is good. Find yourself a good agent who also represents different companies and not your friend or relative who may have no idea and only wants to earn money.

  44. Dhiraj Bahroos says:

    Thanks Manish for sharing this informative article with all of us 🙂 !

    Indeed it is unethical to not disclose these hidden costs at the time of selling the policy. But I guess this is also due to our Indian mentality wherein we completely trust the agents/banks and don’ t make our effort to read the policy document.

    You are correct to say that if the company disclose about all these hidden costs while selling the product, they would do more to their respect, but frankly I don’t think companies care abt the respect so much at this stage as they are busy trying to tap more customers to increase their premium capitalisation.

    I just think the consumers should be more aware and spare time in reading the terms and conditions.As the consumers become more selective, and as the mediclaim industry matures, these hidden costs would probably die out.

    Btw, I was looking to buy a new mediclaim policy (family floater(myself, spouse and 1 kid), eldest is 33 years age, 5 lakhs, gud network for cashless in Mumbai).Do you have any recommendations?

    1. Dhiraj

      Good points from you and I agree . Customer is the king but at the same time he cant expect to be treated like a king and should do all the dirty bits himself .

      I do not have any recommendations for you , you can check apnainsurance.com for comparisions

      Manish

  45. Sachin says:

    @gkdoda – You can approach consumer forums on why premium was increased arbitrary. Same thing Manish conveyed above in two examples.

    @ Manish – Even in big IT companies (MNC), co-pay has come. I have to co-pay 20% for parents and 10% for spouse. This is because “claim/premium” is coming above 1 for insurance companies.
    This is also party due to fake bills (excess bills) submitted by few peoples.

    Some understanding is going between hospitals-insurance companies on the claims amount. Hope once the maximum cap is introduced for any illness, mediclaim premiums will also come down.

    1. Sachin

      You mean co-pay has come in health insurance provided by company ? It would be depending on which insurer your company has choosen . And also the reason provided by you which are “fake bills” is one of the reasons why its there .

      Manish

      1. Sachin says:

        Manish,
        Yes, co-pay has come in health insurance provided by company.
        In year 2008 , company was paying premium of Rs 5200 [ it was included in CTC 🙁 ]. At that time their was no co-pay clause. Insurance provider was Reliance. They exited due to high claim ratio, more than 140% of the premium received. That’s why I mentioned regarding fake/excess bills.

        After three years in 2010 now the medical insurance component has shifted from company to employees salary.
        Now , we have to pay Rs 13,000+ per year for health insurance. Also co-pay of 20% for parents and 10% for spouse is added.
        Now Insurance company in United Health Insurance.

        1. Sachin

          Companies apply loading because of high claim ratio also .. So I think in your case , same was the case .

          Manish

    2. Dsouza says:

      Ha ha ha, has it really, what you say “Even in big IT companies (MNC), co-pay has come”
      It was there ever since but more after TPA’s came into market, which is why you have it in companies.
      You really want to know why, cause in the private IT companies the admins are corrupt, yes sir. Why else do they want to tie up with TPA’s like TTK instead of directly signing up with the insurance companies.

      I’ll only tell you this and no more as I am an agent too, a few of insurance companies too are ready to pay the admins et al now to grab the business -all at your cost.
      Until Anna Hazare’s bill starts actually working, you guys will have to wait for a really good medical health policy cause there are more things going on in the companies that can shock you, they need profits you see even if declaring losses!!!!!!!

      1. Sachin says:

        Dsouza ,
        I agree that their may be corruption at admin level in private IT companies. But do you think Anna Hazare’s bill will tackle corruption in private companies also ?
        Its upto company CEO or top management to fire those corrupt admin folks. But what if top mgmt is also involved in this (earning commission from TPA) ?
        I have even discussed in our company about why we need TPA. Cant we deal directly with company ? Ans the response i get is that is required for hassle free claims. BULLSHIT !!!

        1. Dsouza says:

          yes Sachin, Anna Hazare’s bill will tackle corruption in private companies too in stage too, it was publicly announced in Bangalore when he was here.
          And what makes anyone think private companies are better than govt. or think senior management will fire them. These guys too have something to hide or too busy or lazy to fire them. Sachin check it out, a 3-4,000 bill is passed at 50,000 even in the best companies like Hsbc or you name it – collusion sweetheart, everyone gets a bit of the honey.

          1. Dsouza says:

            2nd line above should read as stage two

  46. saurabh kumar says:

    Hi,
    Have you come across any recent article/website which has a comparison of existing mediclaim packages with their loading/co-pay clause?
    I am trying to decide between Apollo Munich Easy health and Max Bupa, but Bupa is very expensive 🙁

    1. Saurabh

      You have to decide if you want immidiate expensive product , or a product which is cheaper now and becomes expensive later and gives you surprises 😉 . Which one suits you ?

      Manish

      1. Dr Adesh says:

        hi Manish,
        nice article.
        What do u suggest because these two, Apollo Munich Easy health and Max Bupa are best in field in terms of comparison of various points given at various sites.
        Please suggest in line with ur comment ‘if you want immidiate expensive product or a product which is cheaper now and becomes expensive later ”
        ur suggestion is highly regarded.
        Thanks…God bless u.
        Adesh.

        1. Dr Adesh

          I am not saying that these two companies policy would be best always , there are other companies which have good plans ,the only thing is these companies take care of those small things which other companies dont and it irritates the investors a lot . So i would still recommened finding more info on all the policies and then going for it

          Manish

          1. Dr Adesh says:

            Manish

            thanks manish for ur prompt response…I am still finding out the best policy out there for me. I have 2 to 3 policies in mind and contacting their customer services and askng my doubts.
            i hope i will get the good one.
            thanks again for ur insight into areas we are likely to miss.
            adesh.

            1. Adesh

              Make sure you also take actions soon enough . Because just finding the “best” policy will take so much time that you might never go beyond finding things . Take action

              Manish

            2. Dr Adesh says:

              hello Manish,

              I have finally taken Max Bupa health insurance for my parents..
              ..thanks for ur guidance.

              Adesh.

            3. Good to know that 🙂

              Manish

      2. Dsouza says:

        Hello,
        In the above comparison between Max Bupa and Apollo, it is not necessary that expensive product is better, if that’s true please buy icici – it’s taking people for a ride, as much better options given by Star at half the rate.
        This is not true in insurance itself and the imagination of customers who have no time to spend is truly defying. I am agent and find people with vague thoughts from someone, as they say the blind leading the blind and many have immense greed.
        As an agent i have found in most cases, tell customers the truth they don’t believe you except what they want to hear, nice things and they buy and then complain.

  47. gkdoda says:

    It’s really strange & unfortunate that inspite of so many companies & millions of customers, these insurance company can not offer a single mediclaim policy without such hidden terms & conditions. Generally, customers do not read so-small printed pages in policy bond.

    Senior citizens have to suffer more because of HUGE increase in premium every year or so.

    I share my own experience here. My health policy was with Reliance General Insurance from the last 3 years. Even without any claim in these 3 years & still young (age 34 yrs), the company has increased my premium by around 440%. So I this year I shifted to Apollo Munich.

    I wish IRDA management should see at General insurance sector and make changes favorable to customers as they’ve done something in life-insurance sector recently.

    Good work, Manish. Keep it up.

    1. gkdoda

      What reason did Reliance gave to you for increase , was it mentioned in the policy that it can be increased later without any reason ?

      Some companies like Max Bupa are now coming up with policies without those clauses

      Manish

      1. gopal says:

        There was no reason given by Reliance on increase in premium. As far as I know the wordings of these general insurance companies, they keep all terms in their own favour. They are least bothered for the customers. I’m sure every company reserves this right to increase the premium when they wish to; after all, all these policies comes under legal contract for 1 year only.

        GKDoda

        1. Yea .. that makes sense ..

          Manish

          1. dhawal sharma says:

            IRDA has laid down the provision that any company carrying GENERAL INSURANCE business , cannot change its premium slabs before completing at least 3 years of operation..So what RELIANCE GENERAL INSURANCE did was right according to this clause..But what was suspecious even at the time of launch of the RELIANCE MEDICLAIM was ridiculously low premium..RELIANCE MEDICLAIM was launched as FAMILY FLOATER with cover of Rs 2 lakhs for premium of 599 which is now converted to 5999..So the very first thing to check is how come this company or any company is charging such lowely premium for such high cover..

            1. Dhawal

              Lol ! .. that was a nice way of looting people . Trap them first and drink blood later 🙂

              Manish

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