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Old 31st March 2009, 17:57   #16
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Just what the doctor ordered. Sorry for the pun.

I'm 31, don't have any health insurance, and would like to get one done. Here are my doubts:

1. How does it work? Is there like a fixed amount per year that you can avail? If you don't use it for a few years, will that accumulate, and can it be used all at once?

2. How many people in my family will the insurance cover? I'm single now, but in case I get lucky, will the policy cover my wife and children too?

3. Is it valid at all hospitals? Let's say I want to go to Lilavati or Breach Candy every time I fall sick.

4. Does it cover all illnesses/ procedures?

5. Is it valid all my life?

6. Let's say, at some point of time in my life, I have to undergo one of the common, expensive procedures, what would it typically cost? And if I want to cover the cost of a such a procedure 100% with health insurance, what sort of annual premium am I looking at?

Thanks in advance.
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Old 31st March 2009, 19:49   #17
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OK. Here is one question for which i could not get any clear answer from any insurance agent.

What is a pre-existing desease? Suppose, a person was diagnosed with a critical illness (say Heart desease/Cancer/) but was subsequently declared disease free (remission) by the doctors, could he still avail the Health insurance without the pre-existing disease clause?

An friend's mother was treated for squamous cell cancer ( a type of skin cancer i think), 4 years back but was declared disease free after treatment for 1 year. But even today, insurance companies reject her application for Health insurance saying that she has to first declare this as a pre-existing disease and undergo medical tests. And that this pre-existing disease will be covered after 4 subsequent renewals only.
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Old 31st March 2009, 20:21   #18
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Quote:
Originally Posted by Bass&Trouble View Post
1. How does it work? Is there like a fixed amount per year that you can avail? If you don't use it for a few years, will that accumulate, and can it be used all at once?
Yes there is a max limit on claims that can be made in a year.

lets say you buy a policy of 5 lakh. Then policy will cover claims up to 5 lakh in a year.

And if you do not claim anything in a year, then nothing gets passed on to next year. Next year, cover again starts from 5 lakh.

Things like Dental / Cosmetic treatments are not covered at all.

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2. How many people in my family will the insurance cover? I'm single now, but in case I get lucky, will the policy cover my wife and children too?
It depends on you. You can either buy it for yourself or include your family.

If it costs 5 k per year to get cover for yourself, cost would be slightly lesser for family. E.g. it might cost 17k to cover 4 persons.

However, since you are single then you might or might not be able to "Add" others to policy (in future). Depends on policy.


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Originally Posted by Bass&Trouble View Post
3. Is it valid at all hospitals? Let's say I want to go to Lilavati or Breach Candy every time I fall sick.
Dafinetly at hospitals like Lilavati /Asian Hearts and other star hospitals.

In such hospitals you wont have to pay upfront and things would be cashless.

However, some Govt companies do not cover costly hospitals for cashless.

E.g. Oriental DOES NOT cover Lilavati.

So you will have to pay comple cost from your pocket and then claim it from company.

Usually takes 3 - 6 months if claim is more then 1.5 lakh.

Otherwise things are settled in 2 - 3 weeks.


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4. Does it cover all illnesses/ procedures?
BIG NO

Only "serious" things are covered. (I am simplifying things here)

E.g.

Lasik eye surgery might not be covered.
Root canal definetly not covered.
Mostly if you need be admitted in hospital for more then a day then procedure is covered.

There are exceptions though. Some operations can be done in few hours but will be covered.

If you get sick with Maleria and are in Lilavati for 5 days, you are coverd 100%.

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5. Is it valid all my life?
NO. Depends on you.

If you buy a policy for age up to 50 it might cost 5k per year.

Same policy might cost 6k if you choose to get it till age 60.

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Originally Posted by Bass&Trouble View Post
6. Let's say, at some point of time in my life, I have to undergo one of the common, expensive procedures, what would it typically cost? And if I want to cover the cost of a such a procedure 100% with health insurance, what sort of annual premium am I looking at?

Looking at your age, and the fact that you stay in Mumbai you would need to sepnd approx 10 - 15k per year.

You would get ~10 lakh coverage.

These things are based on my own experience. Will post that later.
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Old 31st March 2009, 20:30   #19
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Originally Posted by DCEite View Post
An friend's mother was treated for squamous cell cancer ( a type of skin cancer i think), 4 years back but was declared disease free after treatment for 1 year. But even today, insurance companies reject her application for Health insurance saying that she has to first declare this as a pre-existing disease and undergo medical tests. And that this pre-existing disease will be covered after 4 subsequent renewals only.
I understand that declaration of all pre-existing diseases is mandatory as per law. But the Insurers restriction that they will not cover this disease is a clause which they ask the insured to sign . So, is there no clear law stating that they can't deny insurance for pre-existing but cured disease? Damn this medico-legal jargon , its so confusing.
Similar case with my mother too. She had diabetes but its fully undercontrol now.Am in a fix as to what policy I should choose.
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Old 31st March 2009, 21:37   #20
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I understand that declaration of all pre-existing diseases is mandatory as per law. But the Insurers restriction that they will not cover this disease is a clause which they ask the insured to sign
That is illegal.

Policy has to cover ALL pre - existing disease after certain number of years. I think that is 3 0r 5 years.
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Old 31st March 2009, 22:31   #21
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hmm, nice timing.. I'm looking for buying health insurance for my family and am confused because of the large difference in premium from different insurance companies - for the same insurance amount ? Am I missing something here?

Can you share a comparison of different providers and common pitfalls.

thanks in advance
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Old 31st March 2009, 22:49   #22
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Quote:
Originally Posted by NetfreakBombay View Post
BIG NO

Only "serious" things are covered. (I am simplifying things here)

E.g.
I really didn't expect to cover root canals etc on that. Whats the point of paying 5-10k per year for such petty things? Thanks for explaining that though. I just meant to ask - are there any serious illnesses/ procedures that are not included for any reason? Like, let's say there's something in there that says that they won't pay if they realize that the policy holder is terminally ill. OR that they won't pay for say, treatment of complications that have been caused due to some negligence at the hospital, OR the Big C.

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Originally Posted by NetfreakBombay View Post
Looking at your age, and the fact that you stay in Mumbai you would need to sepnd approx 10 - 15k per year.

You would get ~10 lakh coverage.
Hmm, should have thought about this earlier. Anyway, anyone have any idea what something like a bypass would currently cost at a reputed hospital?

Last edited by Bass&Trouble : 31st March 2009 at 22:50.
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Old 31st March 2009, 23:26   #23
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Originally Posted by Bass&Trouble View Post
they won't pay if they realize that the policy holder is terminally ill. OR that they won't pay for say, treatment of complications that have been caused due to some negligence at the hospital, OR the Big C.
No idea if they can deny based on actual or alleged negligence.

For terminal illness like Cancer and other horrifying things, there is a different policy.

Its called "Critical Illness Cover". You can add it to your current life insurance as Rider.

If someone is diagnosed with such illness, company pays the whole amount upfront.



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Originally Posted by Bass&Trouble View Post
Hmm, should have thought about this earlier. Anyway, anyone have any idea what something like a bypass would currently cost at a reputed hospital?
Bypass costs 3 lakh to 10 lakh depending on:

1. Planned or emergency procedure. In case of emergency charges are 2 times.
2. Type of Room. Procedure that costs 2 lakh for "Single room AC" will cost 6 lakh in "Deluxe" room and lesser in "Shared" room.
3. Complications

Someone in family had to go Bypass in Feb. It was done at Liavati, cost was 4 lakh (Procedure + Medicines + Follow ups). Insurance covered everything except 1800 Rs for Misc items.

But still following up for payment since Lilavati was not covered in cashless.

OTOH : Same procedure would have costed 1.8 lakh (all inclusive) at Bombay Hospital Indore.

Same doctors charge more then twice at Bombay Hospital, Bombay (as compared to Indore).
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Old 1st April 2009, 08:45   #24
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Originally Posted by NetfreakBombay View Post
That is illegal.

Policy has to cover ALL pre - existing disease after certain number of years. I think that is 3 0r 5 years.
Irda is thinking to bring in a law where in all the pre-existing disease in all the health insurance policy will be covered after a some period.
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Old 1st April 2009, 08:55   #25
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Quote:
Originally Posted by Shankyz View Post
hmm, nice timing.. I'm looking for buying health insurance for my family and am confused because of the large difference in premium from different insurance companies - for the same insurance amount ? Am I missing something here?

Can you share a comparison of different providers and common pitfalls.

thanks in advance
Well in my opinion all the company have a different rating and different product to offer. If you are comparing only rates then let me tell you Icici and reliance are the two company which has the cheapest in rating. but at the same time there is a capping in reliance policy that insurance is covered till the age of 75 only!! - That's bad according to me.

Don't look only at the rates, look at the coverage part also. Lot of companies are offering lot of different product please see that also.
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Old 1st April 2009, 10:15   #26
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Hi..Thanks for opening this thread. I'm planning to take a family floater plan for me and my spouse. I also want pregnancy and critical illnesses to be covered.

Any suggestions on what I should look out for in the policy? I also want to know your opinion on Reliance Health insurance schemes as they seem cheapest in the market right now.
Normally pregnancy and related problems are not covered in the insurance policy but still there are some produce which will cove that also look out for them.

All the critical illness is covered in health insurance policy.
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Old 1st April 2009, 10:28   #27
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I have company funded family Medi-claim at present but I am thinking for getting ICICI Medi-claim.

I planning to have 5 Lakh limit policy and might upgrade later to 7 Lakh limit
Quote:
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Normally pregnancy and related problems are not covered in the insurance policy but still there are some produce which will cove that also look out for them.

All the critical illness is covered in health insurance policy.
BTW Delivery is covered in my current policy provided by company, andI claimed that for my daughter's delivery and even post delivery medicinse for one month
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Old 1st April 2009, 10:36   #28
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BTW Delivery is covered in my current policy provided by company
Thats usually the case.

Delivery and pre-existing illness is NOT covered if you buy the policy yourself.

But if the policy is bought as a group policy by employer then these things are covered.

Usually Delivery would be covered up to 50k (again depends on negotiated rated between employer and Insurance provider).
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Old 1st April 2009, 11:31   #29
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Normally pregnancy and related problems are not covered in the insurance policy but still there are some produce which will cove that also look out for them.

All the critical illness is covered in health insurance policy.
Thanks. I did some research on the topic and could not find any policy were delivery was covered.

Guys, any feedback on Reliance general insurance. Their policy seems to the cheapest and most comprehensive.

Also I found a site insurancepandit.com where you can get the policy terms and conditions documents which you normally get after signing up for the policy. This way you can look at the fineprint before buying the policy.
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Old 1st April 2009, 12:06   #30
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Quote:
Originally Posted by rkbharat View Post
I have company funded family Medi-claim at present but I am thinking for getting ICICI Medi-claim.

I planning to have 5 Lakh limit policy and might upgrade later to 7 Lakh limit

BTW Delivery is covered in my current policy provided by company, andI claimed that for my daughter's delivery and even post delivery medicinse for one month
What product you have currently is a group health insurance. (From the employer)

Now what you are going for is a individual health policy. where in no pre-existing will be covered for first 3 to 5 year's and secondly no pregnancy or related dieses will be covered.
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