[ani_meher]

Thanks for your replies, guys. Star comprehensive policy looks good. Premium comes around 20k for 10L.

If I buy 10L coverage, then with 100% bonus it will become 20L from next year onward. Then do I need to buy additional 20L critical illness coverage? Wouldn't the diseases from CI be covered in the basic policy? What is the incremental benefit of this Critical Illness policy? Sorry if this question is too naive.

[ani_meher]

Originally Posted by ani_meher

What is the incremental benefit of this Critical Illness policy

Got it. CI gives a lumpsome payment as against health insurance which pays at cost.

[ani_meher]

In Star health insurance, in one product there is a co-payment of 10% beyond age 60, and in other it is 20%.

As I understand, co-pay is the amount the patient must pay before insurer pays his dues. Is the co-pay calculated on bill amount or insurance amount? Suppose a 65year old insured person gets a medical bill of 4 lakh on a policy of 5 lakhs. Does he have to pay 10% of 4 Lakh = 40,000 and insurer pays remaining 3.6 lakh, or does the insured person pay 10% of 5 lakh (policy amount) = 50,000 and insurer pays balance 3.5 lakhs? I hope its the former!

Any policy where there is no co-payment with lifetime renewals?

[hothatchaway]

^^^Co payment is on the bill and not the coverage. E.g. if one is handed a bill of Rs 40k with copayment of 10%, then one's liability is 4k or a capped amount. If co payment was on the coverage then lets say, in this case, if the coverage is 5l, one would then be liable for the entire bill.

[mercedised]

Hi guys, Recently my grand mother went through hip replacement surgery. She has health insurance with National Insurance (govt. owned), it has been 3 months since the surgery, we had submitted all the documents and the claim was accepted by them at that time (some 40-50k Rs total). Since then they have not reimbursed our bills, whenever I call the customer care they say that the amount will be paid to you in next 2 days, this has been the story since start. What do I do? Where should I approach to get the amount.

[hillsnrains]

BHPians, I need help/suggestion in choosing health insurance

I have gone through last few pages of this thread and not able to zero in on my health insurance.Here is brief background and requirements
1. My employer group medical policy is 5L (covers me 37yrs , spouse 36 yrs and son 7yrs).
2. Spouse works for PSU Bank and they have some coverage as well, but ignoring it for time being.
3. I am looking for top-up group policy for >5L to <30L expenses. Is my thinking is right? The intent of this policy is to cover rear expensive illness treatments. Should I take Base plan with coverage from Zero?
4. I searched through internet and realized max coverage I can get is 25L that to with Royal Sundaram and HDFC Ergo (both are not pure health insurance co's). I am inclined to go either Star health, Apollo or Cigna TTK.

Please help me in choosing right policy.

[The Rationalist]

Originally Posted by hillsnrains

I am looking for top-up group policy for >5L to <30L expenses. Is my thinking is right? The intent of this policy is to cover rear expensive illness treatments. Should I take Base plan with coverage from Zero?

You only need a Top up policy for 10 - 15 lakhs. A Comprehensive plan is not needed for you as both of you have a base coverage from the institutions you work for. The chance of a rare illness is rare, so don’t worry too much. And an extremely rare illness won’t be treatable how much money you have also. Once you reach retirement, start a Comprehensive health cover. Till that time invest the difference amount between Comprehensive and top up in a mutual fund.
If Comprehensive costs 20,000 and Top Up 5000, invest 15,000. At retirement you can take a good plan by yearly taking out a small amount from the mutual fund.

[hrman]

Originally Posted by mercedised

Hi guys, Recently my grand mother went through hip replacement surgery. She has health insurance with National Insurance (govt. owned), it has been 3 months since the surgery, we had submitted all the documents and the claim was accepted by them at that time (some 40-50k Rs total). Since then they have not reimbursed our bills, whenever I call the customer care they say that the amount will be paid to you in next 2 days, this has been the story since start. What do I do? Where should I approach to get the amount.

Have you tried calling the TPA? For my dad's policy with National Insurance, it is Emeditek.
For my dad's claim last year, they took over two months. Within a month, when I didn't hear from them and enquired, they said it has been rejected since there is no time of discharge time on the Discharge summary. Then I wrote to them asking them to refer to the final bill which has the time of discharge. They processed it and I got the amount after a month. They are not as efficient as the others. Constant followup is needed.

[hillsnrains]

Originally Posted by The Rationalist

You only need a Top up policy for 10 - 15 lakhs.....
At retirement you can take a good plan by yearly taking out a small amount from the mutual fund.

Thanks for quick reply. Now I know what to look for.
Start Health Super Surplus (Super Top-up) policy with 15L (with 5L deductible) cover costs 8K/year. Where as ICICI Lombard is charging 8.8K for similar policy.

Any other better alternatives I should consider?

[The Rationalist]

Originally Posted by hillsnrains

Start Health Super Surplus (Super Top-up) policy with 15L (with 5L deductible) cover costs 8K/year. Where as ICICI Lombard is charging 8.8K for similar policy.

Both are good quotes. Take whichever you like.

[ghodlur]

Originally Posted by hillsnrains

3. I am looking for top-up group policy for >5L to <30L expenses. Is my thinking is right? The intent of this policy is to cover rear expensive illness treatments. Should I take Base plan with coverage from Zero?

Request you to go through this article related to Top up policy. Some key things to be noted are mentioned in the article.

https://www.businesstoday.in/moneyto...ry/185705.html

Originally Posted by The Rationalist

At retirement you can take a good plan by yearly taking out a small amount from the mutual fund.

Wouldn't a comprehensive plan be expensive at the time of retirement. God forbid, if any insured ends up with an illness Insurance co would straightaway refuse providing any health insurance at all. I have seen cases with a few of my friends who unfortunately had to undergo angioplasty and many Insurance co simply refused to provide any health cover at all.

[The Rationalist]

Originally Posted by ghodlur

Wouldn't a comprehensive plan be expensive at the time of retirement. God forbid, if any insured ends up with an illness Insurance co would straightaway refuse providing any health insurance at all.

Ofcourse at time of retirement a Comprehensive plan would be expensive. But if hillsnrains invests the savings into a mutual fund, he could easily afford any plan. If we start worrying too much about all the permutations and combinations then there is no end to it. I have seen patients ending up with bills of above 40 lakhs. How much coverage should we take for such rare scenarios? Right now in India the percentage of insured is too less. Going forward the percentage would increase and the rates would become less. Till retirement he has the safety net of his company and his wife’s policy. A stand alone policy for 25 lakh will cost ₹ 37000. He can easily save ₹ 30000 a year. That if invested in a Mutual fund can be around ₹ 80 lakh- ₹ 1 crore by retirement. He could easily get about ₹ 4-5 lakh yearly from that amount and the best insurance at that point wont cost more than ₹ 2 lakh a year.

[mercedised]

Originally Posted by hrman

Have you tried calling the TPA? For my dad's policy with National Insurance, it is Emeditek.
For my dad's claim last year, they took over two months. Within a month, when I didn't hear from them and enquired, they said it has been rejected since there is no time of discharge time on the Discharge summary. Then I wrote to them asking them to refer to the final bill which has the time of discharge. They processed it and I got the amount after a month. They are not as efficient as the others. Constant followup is needed.

Thanks for the reply. Emeditek is the TPA for them and I am also dealing with them. They are very lazy indeed, the only reason we are continuing with them is because nobody else will insure my grand mother as she is of 83 now. I am regularly following the, tweeted today to Health min., IRDA, National Insurance & Emidetek too, but no reply from them.

[hillsnrains]

Originally Posted by hillsnrains

Start Health Super Surplus (Super Top-up) policy with 15L (with 5L deductible) cover costs 8K/year. Where as ICICI Lombard is charging 8.8K for similar policy.

Apollo Munich Optima Super plan for the same sum insured costing ~8K. The interesting aspect is that the deductible becomes zero after 5 years of continuous coverage. This feature looks very interesting. Any views or prior experience with this feature?

Originally Posted by ghodlur

Request you to go through this article related to Top up policy...

Wouldn't a comprehensive plan be expensive at the time of retirement.

Thanks for the link, which is very informative. This is where I got the fair understanding of Star health insurance Silver and Gold plans. Gold plan aggregates all expenses of multiple hospitalizations, where as Silver plan does not.
I already have critical illness cover through life insurance policy. Hence I am inclined to go head with super top-up policy.

Originally Posted by The Rationalist

Ofcourse at time of retirement a Comprehensive plan would be expensive.

Thanks for the detailed explanation.

[hillsnrains]

Originally Posted by hillsnrains

Apollo Munich Optima Super plan for the same sum insured costing ~8K. The interesting aspect is that the deductible becomes zero after 5 years of continuous coverage. This feature looks very interesting. Any views or prior experience with this feature?

Small correction to my above post.
Deductible will not become zero as mentioned in the website, but one have an option to convert this top-up policy in to comprehensive policy (premium will increase significantly due to coverage from zero rupees).

I have decided to go with start health super surplus policy.
Thanks for all the inputs and support. You guys made my life easy.