Team-BHP - Health insurance queries? Ask me!

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Originally Posted by nowwhat? (Post 3871225)

Based on a web recommendation, I got in touch with Coverfox (www.coverfox.com) and not only did they attend to my queries patiently, but I was also able to obtain a Family Floater medical insurance policy of Rs. 6 lakhs with no medical checkup whatsoever. The insurance contract clearly has an endorsement for my diabetes as a pre-existing disease and they also mention that all pre-existing diseases would be covered after 4 years.

Coverfox seems like an insurance broker? How ethical are they - do they advise based on our requirements or based on their commissions? Would going through them increase our premiums?

My sister and her husband need coverage in Bombay - they are thinking Mediclaim/Healthinsurance + a Critical illness policy. Both are above 45. Any company which offers a policy without extensive range of tests. They both have pre-existing illness they will declare & are OK with some time lag before those get covered.

Also, what happens with mixed hospitalization for multiple reasons. For e.g. let's say one has a pre-existing disease (say diabetes) which is currently not covered by your insurance. Now you have a road accident which leads to hospitalization. Now because of this trauma, your pre-existing illness exacerbates. So when you are in the hospital - you are also treated for diabetes - so in this case what does the insurance company do - do they pay for everything, nothing or part of the stuff?

Also, what happens if due to an emergency you get admitted in a hospital which is part of the insurance company's network?

What company is good with claims? Is there anywhere where we can get claims %age for health insurance companies?

How easy or difficult is to work with the Govt insurance companies - National, Oriental etc?

Quote:

Originally Posted by carboy (Post 4017057)

Coverfox seems like an insurance broker? How ethical are they - do they advise based on our requirements or based on their commissions? Would going through them increase our premiums?

Of course they are an insurance broker. They mention the companies they are dealing with right there on their website.

Regarding ethics, etc. I have no idea, but as I said they came highly recommended from another forum.

No, going through them or anyone else will not raise your premiums because the commissions are paid to the broker by the company as a percentage of your premium which is usually the same for others in that age group. As in the case of direct term plans and agent-based term plans, insurers who use agents will have more overheads and therefore charge more for their insurance. As a result, there is no way that a government insurer's quote will match that of someone like Star Health, the same way LIC cannot beat Aegon Religare.

Quote:

Originally Posted by carboy (Post 4017057)

My sister and her husband need coverage in Bombay - they are thinking Mediclaim/Healthinsurance + a Critical illness policy. Both are above 45. Any company which offers a policy without extensive range of tests. They both have pre-existing illness they will declare & are OK with some time lag before those get covered.

First thing to note is that beggars can't be choosers. I tried getting medical insurance on my own last year but quickly realized that private insurers do not want anyone with even minimal risk. Any pre-existing disease means that private insurers will put one through a medical test, then increase your premium or deny insurance altogether. Of course if coverage is denied, not only do you have to pay for the tests from your own pocket, but other insurers may also deny you as almost everyone asks in their application form if you have been denied coverage before. There are enough stories of those with a kidney stone receiving coverage, but those who took the effort to remove it being denied.

So I am pretty grateful to Coverfox that I got medical cover in the general pool with no medical test despite having diabetes for over 10 years. The medical insurance I have now puts me in the general pool which was what I was looking for, plans that specialize in diabetes usually have high premium, co-pay and a host of other restrictions. My medical insurance clearly states that I have the pre-existing disease of diabetes.

Last year I had bypass surgery, this year I tried to increase the sum assured but Coverfox told me that there is no way the insurer will even accept my application now. Instead I simply renewed my existing medical insurance which covers me for any complications from diabetes (including cardiac problems) after 4 years.

Quote:

Originally Posted by carboy (Post 4017057)

Also, what happens with mixed hospitalization for multiple reasons. For e.g. let's say one has a pre-existing disease (say diabetes) which is currently not covered by your insurance. Now you have a road accident which leads to hospitalization. Now because of this trauma, your pre-existing illness exacerbates. So when you are in the hospital - you are also treated for diabetes - so in this case what does the insurance company do - do they pay for everything, nothing or part of the stuff?

I have no idea. Bear in mind I am not an insurance agent or in any way connected with this industry.

I am relying on my employer-based insurance to take me through the next few years until my pre-existing diseases are covered.

Quote:

Originally Posted by carboy (Post 4017057)

How easy or difficult is to work with the Govt insurance companies - National, Oriental etc?

They seem to have banded together to form their own TPA called Raksha. I have used Raksha in the past and they are quite good. In fact much better than MediAssist which I had used once.

Its that time of the year when you have to submit the investment proofs to the company and Medical insurance is one of them. I have a heath insurance from Religare health and received the renewal premium mail. Found the premium to be jacked up by 13k rs. When I called up the customer care, I was told I moved the age group and new age group results in higher premiums. Paying 13k extra for the same insured does not make any sense. Hence started looking out for alternatives. Checked out Cover fox, Policy bazaar and the quotes were almost matching the Insurance co website quotes.

The thing that stumped me the most was the portability conditions. Presently I have an accumulated no claim bonus of rs 12L over and above the Sum insured of 10L. If I were to port to a different insurance co, I would have to buy an Insurance for more than 22L. If I choose not to opt for a higher Insurance amount, I would only get 35% of Sum Insured as accumulated bonus carry forward (i.e 3.5L). This would mean my coverage amount at the start of the policy would be 10L + 3.5L. One of my Insurance friend suggested me to keep the same sum Insured (10L) and opt for a Top up health Insurance (15L). The cost of top up insurance would be around 5K only. This would take my total coverage to above 25L which mean I could use the accumulated bonus fully. But the premium cost of this Health insurance + top up insurance is again comes in the same range as my existing renewal premium.

Hence confused, any advice what should be the way forward?
Presently looking at Star Family Health optima insurance + Apollo Munich top up.

Dear members,

My parents, both aged 67; have their medical insurance initiated through my company since 2013. Owing to increased amount of claims, this year they charged me 43,000/- INR for coverage of 5 lakhs, payable by me in equal installments. The policy pays 100% during hospitalization, barring a few non-medical items that comes to 300-500/- on case by case basis, no questions asked. The policy even has coverage for homeopathic and Ayurveda treatments.

The insurance coverage will cease to exist if I leave my company. Now this leads to me few problems, in future if I move to another firm and the new firm doesn’t have this option, I will be putting my aged parents at risk. Also beyond 70, it won’t be possible to take fresh insurance from outside.

I have been taking offline quotes and would appreciate your help here on choosing a good insurance provider.

1.) My concern being the waiting period for pre-exiting illness. Is there a way to circumvent this limitation by paying extra premium?
2.) My dad underwent open heart surgery in 2014, would this be a ground for rejection when applying for new outside insurance?
3.) Does pre-existing illness apply for outside insurance in my case? My company initiated policy is active since 2013, would this hold good?

Thanks in advance.

Rgds,
Vinod

Quote:

Originally Posted by Mr_Bean (Post 4198694)

1.) My concern being the waiting period for pre-exiting illness. Is there a way to circumvent this limitation by paying extra premium?
2.) My dad underwent open heart surgery in 2014, would this be a ground for rejection when applying for new outside insurance?
3.) Does pre-existing illness apply for outside insurance in my case? My company initiated policy is active since 2013, would this hold good?

Thanks in advance.

Rgds,
Vinod

You can try the Star senior citizen Red Carpet policy. I got one for my parents who are in a similar age category. Since my brother went over the details and got the policy done, some of the details escape me, but from what I remember, they have a waiting period of only a year for the pre-ex diseases instead of the 3-4 years that others insurers impose. Also, there is a sizeable co payment clause (upto 20% IIRC) While this is a bummer, you are at least getting a policy for senior citizens which is anyways difficult to get. I do not think you will get the benefit of continuity from your company insurance though, since those are group policies. But no harm in checking

Check the details online and call them, we found them to be customer friendly.

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Originally Posted by quickdraw (Post 4194010)

Hello gentlemen,

I have health insurance from office for Rs 5 lakh of medical expenses a year, but I am thinking of buying my own insurance for me and my wife. So far Apollo Munich seems the best, but Bharti AXA has OPD coverage also, and which Apollo doesn't.

My requirement is complete peace of mind, I am not looking at insurance as an investment. I feel a cover for 1-2cr is good enough considering that we are exposed to a very unhealthy urban lifestyle. Any tips/pointers are appreciated since its the first time I'm buying insurance.

Hi,
Any specific reason you shortlisted Apollo Munich? I am in the process to buy Family floater health insurance. Though I and my wife are covered by health insurance supplied by our employer, I think having an external health insurance is a must now a days.

I have shortlisted ICICI Lombard / Apollo Muinch / Max Bupa. And find Max Bupa better than others. Reasons being

NCB benefit is not deducted from total cover for subsequent years having a claim. Unique to Max Bupa

Restoration benefit is given in case of a shortfall. Whereas Apollo Munich requires you to exhaust full cover then only restoration benefit is extended. ICICI Lombard as well offers this.

Max Bupa and Apollo Munich NCB benefit is 100% of base cover in subsequent years. ICICI has capped it to only 50%

Max Bupa and Apollo Munich are better in settling claim as you deal directly with insurance company. Whereas ICICI is TPA administered.

Hope this helps.

Quote:

Originally Posted by StepUP! (Post 4203467)

NCB benefit is not deducted from total cover for subsequent years having a claim. Unique to Max Bupa

Restoration benefit is given in case of a shortfall. Whereas Apollo Munich requires you to exhaust full cover then only restoration benefit is extended. ICICI Lombard as well offers this.

Max Bupa and Apollo Munich NCB benefit is 100% of base cover in subsequent years. ICICI has capped it to only 50%

Max Bupa and Apollo Munich are better in settling claim as you deal directly with insurance company. Whereas ICICI is TPA administered.

Hope this helps.

Thank you for your reply. I shortlisted Apollo Munich because I had made a claim earlier for 5 lakhs (surgery) and they covered it without any fuss and got it done at Apollo hospital which is decent. This insurance was through my employer.

Instead of the restoration benefit doesn't it make more sense to have a higher cover since the restoration only works in the case of unrelated illness?

I actually don't understand what you mean by "NCB benefit is not deducted from total cover for subsequent years having a claim."

Not even considering ICICI, every product from them is a mess. Car insurance, bike insurance I've had a very bad experience. Don't want to give them another chance.

Quote:

Originally Posted by quickdraw (Post 4204835)

I am not sure what you meant by unrelated illness. I think restoration benefit can be taken for the same illness claim under Max Bupa. Only condition being it should not be the first claim in the year, which is same for every policy. Agree, having higher cover is better but it is always good to have restoration benefit particularly for family floater as, when two or more members have a claim in the same year and first member has exhausted the base amount, restoration is triggered with no additional burden of premium.

"NCB benefit is not deducted from total cover for subsequent years having a claim." Let's take an example, suppose you have a base cover of 5L and policy says NCB bonus of 20% of base cover would be added to base cover for each claim free year. At the end of two claim free years, your total cover would be 5+2 = 7L. In the third year, if you have a claim, other companies reduce 20% NCB bonus cover for the next year. So your cover would be down to 6L in the thrid year after claim settlement. Whereas Max Bupa does not do this. It will continue to offer you 7L cover in the third year even after settling a claim.