Team-BHP - Health insurance queries? Ask me!

I have bought Religare Care Health Insurance in Jan 2015 after giving a lot of thought. The decision was made when one of my friends who works as a Health Insurance agent endorsed it. Few observations from my end:
1) Buying online policy was super smooth.
2) The NCB collected from previous Health Insurer i.e Apollo Munich would be applicable when it comes to claims. I had Insured value of 4.2L and bought a 10L policy with religare which means in the first year 4.2L worth claim would be processed without any issues. For the rest of the amount, the general rules would apply.
3) Their free health check up is a big joke.
4) Not many hospitals in the city I live are tied up but the process of the same is ongoing as per Religare.
5) Which other Insurance co do provide almost 120% increase in the Insured amount over 5 yr no claim period?

I work for an online insurance aggregator in the health insurance space. Without taking any sides, here's my review on the Religare Care product with other competitors -

1. The product is too new, hence claim settlement ratios are not known - as a consumer if you face hassles with claim settlements then what's the use of the policy. In the industry apart from PSU's, Max Bupa has a great claim settlement ratio (more than 95%), Tata AIG is one of lowest. Religare is at about 85%-87% (early days)

2. Cashless claims within network hospitals, they've a comprehensive and evergrowing list of 4100+ hospitals, need not worry on that. Star Health has one of the biggest list of more than 6500+ hospitals

3. Product wise - in case you are not concerned about maternity (which in itself is a sham) - there's no competition in sight.

The product provides you -

a. No claim bonus going upto 150% of base sum insured
b. Restore/Recharge feature
c. Single pvt. room facilities (SI > 5 Lacs)
d. Annual health check up's

For the price point, Optima Restore from Apollo gives you a similar set of features but roughly costs about 15-20% higher.

Quote:

Originally Posted by varun.ppl (Post 3730903)

I work for an online insurance aggregator in the health insurance space. ....
For the price point, Optima Restore from Apollo gives you a similar set of features but roughly costs about 15-20% higher.

Hello Varun! I have an urgent query.
Currently my family (me-23, dad-61 and mom-58) has Indus Health Plus Gold Card policy. We pay an yearly premium of around 14-15K.

My query is is it any good? If not then going by what you have replied above can you recommend me a good policy for my family from Max Bupa?
I am finding a new job and hence my family income is around 18-20K per month.

Is 'Health policy' the only one I need? or something else too?

Please help me choose from these: http://health.accuratequotes.in/quot...iryid=ODY0MDc1
please:

Quote:

Originally Posted by RavSam (Post 3731904)

Hi Sam,

Indus Health is technically not a health policy, they're more of a wellness service provider, i.e. they provide health check up's, body screenings, discount on consultations etc. (what I know, as we were dealing with them earlier). To summarize, it's a Preventive Healthcare Package

Basis your query, we are talking about a comprehensive health coverage, which would primarily cover -

Inpatient Hospitalization - i.e. taking care of medical treatments, room rent etc.
Health Check Up's - Annual or once in a block of 2 years
Day Care Procedures - Treatments which take less than 24 hours (mind you, these don't cover fractures etc, i.e OPD expenses)
No Claim Bonus or Cumulative bonus - Pretty similar to NCB we get in motor policy, but here rather than premium reduction, there's enhancement in sum insured.

Coming back to your query, there are 3 different methods to procure a policy -

1. A floater policy which would cover all 3 members in a single policy (a single option available to you by Max Bupa Family First)
2. An individual cover for you, and a floater cover for parents (whole lot of options)
3. Individual cover for all three

Ideally, would recommend choosing the 2nd option, reason being - would lead to a better coverage, better premium savings.

For parents, go for L&T Mediclassic, good claim settlement and good value for the kind of features.

For self, go for Religare Care NCB, reason being, you might not make a claim soon, in 5 years, your sum insured would be 150% of original (NCB kicking in).

If you wish to go for the first option, that is all in one group, Max Bupa FF Silver is the best plan, choose 2 or 3 lac individual cover for each and go for as high floater sum insured as possible, because in Max Bupa, the premium factor is hugely dependent on individual sum insured rather than floater.

Would explain how this works. There's a 200ml glass in front of all 3 of you which is filled and then there's a jug which has 2000ml of water. Now, if one of the users consumes his/her 200ml, he/she can use the water available in the jug too.

So, be rest assured, that if you're choosing Max Bupa you aren't making any mistakes.

P.S. - the link that you've shared, I work for the same company, we have added a lot of intelligence in the platform and hope it would've helped. But, the views I have expressed here are not in any direct co-relation to the line of business, this is separate from the business line and an honest and fair assessment of your needs.

Best,
Varun

Varun - Need recommendations on Health Plan for myself (45), Wife(41), Son (12). Parent are covered under CGHS so dont need to consider them
I currently have Company provided Health Insurance with a 5L floater.

In the last 20 years thanks to God, I have not had to use the Insurance but would now want to consider a personal plan over and above the company plan.
I have the following queries

- What is the right insured amount for my situation ? Do I have flexibility to Increase/ Decrease it later without the premiums going thru the roof ?
- Would prefer providers with high settlement %
- Day Care procedures coverage
- Any options where OPD/ Dental is covered as well
- Any options to pay 1 time premium of 10-15 years in one go
- I have seen companies jack up premiums later so that they dont have to continue with the subscriber. How can I ensure that they dont play this game ?

Quote:

Originally Posted by LonelyPlanet (Post 3732900)

Sir, it's great that you're in the best of health. Hope it stays this way.

Ideally, a good sum insured for you would be 10 Lacs (floater) for the three of you, reason being doesn't require any Pre Policy Medical Check Up's and would be an appropriate cover atleast for the next 10-15 years (keeping in mind the inflation index).

1. Yes, you can either increase of decrease your sum insured during your policy renewal. Usually, it's either 1 step up or down, i.e. you can go from 10 Lacs to 15 Lacs or 7.5 Lacs, you can't jump to 20 Lacs straight away.

2. Everyone has decent claim settlements, prefer to go with the insurers where they've a direct settlements rather than TPA's - Max Bupa, Religare have direct settlements.

3. Day Care procedures - Religare covers 170, Max Bupa 300 odd, everyone covers anywhere between 100 - 300 day care procedures.

4. OPD/Dental - Good to have, but only if you're buying a sum insured greater than 15 Lacs, it's like a Value added service, caller tune on mobile phone.

5. One time payment - not really possible - Religare has maximum term of 3 years, rest others 2 years at best. Your premium would change at an interval of every 5 years (as you're 45, good to go for 2 or 3 year premium), you save atleast for the next 3 year change in premium and additionally get a 10% discount. But, savings under Section 80 D, would be applicable only for this year (just talk to insurance company, they would provide a certificate every year).

6. Usually, happens with customer who make frequent claims, ICICI known for doing this quite often, Apollo also does the same.

Basis, the above pointers, would like to recommend - Religare Care NCB or Max Bupa Heart beat Gold for you.

Both, would have no sublimits on room rent.

Religare would provide a 150% NCB over 5 years (i.e your 10 Lacs would be 25 Lacs, post 5 years). In Max, it's 50% over 5 years.

Max would additionally provide maternity (I don't think so, you might be requiring the same)

OPD not covered by any of them - Max Bupa would cover it from Platinum plan category and Religare above 25 Lacs sum insured.

Do let me know in case of any further queries.

Regards,
Varun

Quote:

Originally Posted by varun.ppl (Post 3731934)

Hi Sam,

Coming back to your query, there are 3 different methods to procure a policy -

1. A floater policy which would cover all 3 members in a single policy (a single option available to you by Max Bupa Family First)
2. An individual cover for you, and a floater cover for parents (whole lot of options)
3. Individual cover for all three
...

For parents, go for L&T Mediclassic, good claim settlement and good value for the kind of features.

Hello Varun, I really appreciate the efforts you are taking to help us choose the right product. A big thank you for the help you are providing.
My parents (Dad 63, Mom 59) have been insured with Star Health Optima floater plan for the last 9 years. No claims have been made in those years and there is some NCB ~1L added to the policy. Since my Mom will be turning 60 next year and renewal is coming up in a few months, I am thinking of changing the Insurer to one better suited for senior citizens.

Pros of current Insurer:
Life time renewability. (That's what they claim, I do not know the hidden clauses.)
400+ Day Care procedures covered.
6000+ Network hospitals.
Automatic Restoration of Sum Insured. (I still do not understand how this works and what are the clauses. The agent always give vague answers)

Cons:
20% Co payment for 60+ age

1. I am looking for a Insurance provider who provides least co-payment, maximum renewability, good network hospitals in Trivandrum, Kerala and Bangalore. I am also planning for a Top-Up insurance and hence I think automatic restore option will become insignificant.

2. Health Checkups atleast once in 2 years.

3. What is Critical Illness coverage? Do we have to take separate coverage for Critical Illness along with normal insurance? Normal insurance brochures are silent on this, but they talk about it too much on the brochures of Critical Illness plans, hence the confusion.

I checked LnT Medisure Classic and looks good. Not sure if it is same as MediClassic you have mentioned in your post.

4. LnT brochure states "Cataract, benign prostatic .....will not be covered during the first 2 years of the policy." Will clauses like these be waived off when you use portability option since we are moving from 9Yrs continuous claim free coverage of Star Health?

5. Do you recommend going for 3L floater + 4L Super Topup (United India) for them? What are disadvantages of these Topup/ Super Topup plans?

Thanks in advance.
SF