[varun.ppl]

Originally Posted by Deep Blue

A noob question. Why such complicated terms of base & top up etc? Why cant the health insurance companies offer a straight forward policy of 1 crore instead of 5 lakhs base + 95 lakhs top up etc? And then there are so many riders. Why can't a single comprehensive policy cover everything?

Sharing my two cents, since I have spent (still spending) a considerable time in the Indian Insurance ecosystem (and ex-Policybazaar too) -

1. Sum insured offers are typically defined by the usage (medical expenditure). Till about half a decade back the median sum insured being bought was 3.4 Lacs, as the average/mean cost of hospitalisation used to be 65K. Now, you would hardly see sum insured options of 1 or 2 Lacs as hospitalisation expenses (per claim) have gone by ~60% in the last 5 years; hence 5 Lacs has more or less become the new base sum insured option (at least in Metros and Tier-1 cities)

2. The higher the sum insured in your base policy, the higher the premium. Hence, comes the concept of deductible and top-up's vs super top-up's (Yes, there's a difference here too). Also, deriving from Point 1, since 85-87% of the claims would be still under 1-1.25 Lacs, hence offering a straight-off 1 Crore sum insured would have an insignificant take up rate. Why go through the entire hassle of creating a product, filing with IRDA, building it in the core systems and developing digital buying journeys (and even spending on marketing) if you're going to sell <500 policies a year.

2.1 - Yes, such products do exist and they're targeted towards HNIs offering Value added jazzy features like Global Health coverage, Air Ambulance, Priority Doctor, Priority room in hospital etc to name a few

3. Top Up's vs Super Top-Up's (Do read the fine print before purchase) - There's just one inherent difference between the two. Top Up's allow only covers the specific claim amount which is above the threshold/deductible limit, while super top-up covers it on cumulative claim amounts for that policy year. An illustration to make things simple -

Top Up - (Base Personal Cover/Employee Cover/GMC) - 3 Lacs + (Top Up) 10 Lacs (with a deductible/threshold of 3 Lacs) = Effective cover amount = 13 Lacs

Claim 1 - 2 Lacs --- 2 Lacs from base cover
Claim 2 - 2 Lacs --- 1 Lac from base cover & 1 Lac from pocket
Claim 3 - 5 Lacs --- 3 Lacs from pocket & 2 Lacs from Top Up (as threshold limit is 3 Lacs)
Claim 4 - 1 Lac --- 1 Lac from pocket
Claim 5 - 4 Lacs --- 3 Lacs from pocket & 1 Lac from Top Up

Similar scenario in Super Top case with same consideration set -

Claim 1 - 2 Lacs --- 2 Lacs from base cover
Claim 2 - 2 Lacs --- 1 Lac from base cover & 1 Lac from Super Top Up (Total claim amount in year @ 4 Lacs)
Claim 3 - 5 Lacs --- 5 Lacs from Super Top Up (Total Claim amount in year 9 Lacs)
Claim 4 - 1 Lac --- 1 Lac from Super Top Up (Total Claim amount - 10 Lacs)
Claim 5 - 4 Lacs --- 3 Lacs from Super Top Up (Exhausted 10 Lacs of super top up) and 1 Lac from Pocket

So, while choosing your base sum insured, do keep in consideration variables like No claim bonus (whether it is fixed or does it reduce on claims), restoration/recharge/reinstatement of sum insured in a policy year (all three are very different), room rent capping, room type, zone coverage (Delhi, Mumbai have higher premiums).

If anyone wishes, I can write a detailed one on NCB and sum insured restore concepts as well.

Not promoting Corona Kavach (which IRDA has mandated to all insurers), but ideally if you do have a private indemnity policy - you should go for pocket insurance products like Dengue Cover & Corona Kavach as if you make a claim in your existing health policy (for Dengue) you would lose out on the no claim bonus for that year or it might even reduce in some scenarios. Wouldn't it be better to spend 400 Rs for a 50K dedicated cover for Dengue. Riders is a different story altogether.

I would leave it here, don't want too much information overload. Stay Healthy!

[Gansan]

Can someone provide insights in to the specific Covid 19 covers being offered? How do they work? If someone already has health insurance, can he or she claim for Covid 19 treatment exclusively from this policy without touching the existing health policy? If not, then what is the purpose of this policy?

[varun.ppl]

Originally Posted by Gansan

Can someone provide insights in to the specific Covid 19 covers being offered? How do they work? If someone already has health insurance, can he or she claim for Covid 19 treatment exclusively from this policy without touching the existing health policy? If not, then what is the purpose of this policy?

The Corona Kavach policy is a short term policy (and not renewable like regular Indemnity/Health product). The maximum tenure for which you can buy the policy is 9.5 months. It resulted primarily as a mandate by GoI to IRDAI which mandated insurance companies to launch a specific Covid cover, as <5% of Indian population has a dedicated personal medical insurance.

The waiting period for this cover is 15 days, i.e. in case a person buying this policy contracts Covid in that 15 day period wouldn't be covered. Beyond that, it would be covered till the next 9 months (maximum tenure).

It does cover hospitalisation expenses and also covers treatment at home for upto 14 days per incident which would've required a hospitalisation. Also, is covered the cost of PPE and other consumables (need to refer to Policy wordings for details) - PPE kits aren't covered in normal health policies.
The most important aspect is that these policies cover comorbidity. For eg, if someone already has a heart condition and they test positive for Covid, the positive factor acts as a trigger for this policy to kick in. During hospitalisation if the person witnesses any specific heart condition, the same would also be covered/treated till the maximum sum insured.

I believe till here I have explained the purpose of this policy.

If someone already has a health cover and they end up buying Corona Kavach then in case that person tests positive for Covid, they can use only this policy to cover the expenses till sum insured (but maximum sum insured option right now is limited to 5 Lacs).

[Deep Blue]

Originally Posted by varun.ppl

Sharing my two cents, since I have spent (still spending) a considerable time in the Indian Insurance ecosystem (and ex-Policybazaar too) -

If anyone wishes, I can write a detailed one on NCB and sum insured restore concepts as well.

Thank you very much for the lucid explanation. It made things very clear. Whenever you have time, please do the NCB and sum insured restore concept as well. Thanks in advance.

[vharihar]

I'm considering buying another health insurance for me and my family and my parents, besides the one that I already have thru my employer.

Questions:

How exactly does claim submission work if a covered medical expense exceeds the employer-provided insurer's limits? Can a bill be split across insurers? I have trouble figuring this out because as far as I know normally all "claim submission" processes have you submit original receipts. And clearly there can only be one original receipt for a bill. So how exactly does this work?

Or is it that we need to live with the limitation that one bill cannot be shared across insurers, but if there are 5 bills for a particular medical expense/procedure, then some bills can be claimed from insurer#1 while the rest from #2 (subject to limits of course)?

[sunilch]

Originally Posted by vharihar

I'm considering buying another health insurance for me and my family and my parents, besides the one that I already have thru my employer.

Questions:

How exactly does claim submission work if a covered medical expense exceeds the employer-provided insurer's limits? Can a bill be split across insurers? I have trouble figuring this out because as far as I know normally all "claim submission" processes have you submit original receipts. And clearly there can only be one original receipt for a bill. So how exactly does this work?

Or is it that we need to live with the limitation that one bill cannot be shared across insurers, but if there are 5 bills for a particular medical expense/procedure, then some bills can be claimed from insurer#1 while the rest from #2 (subject to limits of course)?

I have limited experience with this but here is how it goes:

1) If the first claim is cash-less, you don't have to submit any originals for the hospitalization. You get the originals and you can use those for the second claim/policy.

2) If both are not cash-less, then you submit originals to the optimum claim value to company 1 and also get an ack from them stating that these are with them now in original. Submit the ack to the second company along with details of how much you have claimed and which bill corresponds to what, and so on. This will be a bit painful to manage but that is how it works. Xerox of those bills work work in this case.

They can't deny the claim if you don't have the originals due to above reason. But you need to submit some proof of the same. The ack works 99% of the time.

[Swapnil4585]

I have few queries regarding the pregnancy mediclaim policies being offered.

1. Who is the best provider of Maternity Insurance Plan?

2. What is a waiting period in this type of mediclaim? (I believe that a waiting period is the one, after the passing of which, the benefits of the policy starts accruing to the insured. So if I get one such policy today, and my wife gets pregnant in say 1-2 months, she won't get the benefits of the policy.)

3. With regards to the waiting period, most insurers have policies with a waiting period of minimum one year. I think only Reliance Insurance is the one where there is no waiting period. Are there any others?

4. What types of expenses are covered in a Maternity Insurance Plan?

5. Has anyone opted this route? If yes, how was the experience?

[diyguy]

I have a personal insurance policy for my wife and kids for a base of 25L. I pay about 38k annually. Is there any form of NCB to expect from this? Attaching the renewal notice.
Through my work policy and a topup, we have an additional 30L cover as well, so i am not opting for 50L cover that is recommended in the letter.

[whitewing]

Originally Posted by varun.ppl

Sharing my two cents, since I have spent (still spending) a considerable time in the Indian Insurance ecosystem (and ex-Policybazaar too) ...

Thank you for the detailed explanation.
I was looking for a top up plan for my existing family floater. The current policy expires in Nov, but I am looking at taking a topup instead of increasing the cover. A policy bazaar agent I interacted with, hinted that post Oct some major changes will be done and that it probably is better to wait for the same. But he refused to divulge details.
Any idea on what's coming up?

[raksrules]

Is there absolutely any reason to go with a middle man / agent for buying heath insurance if I can get same product at bit less premium online directly from the company's website?
I am looking at a max bupa reassure policy which costs ₹28.3K as per what the agent quoted me and when I try to purchase myself online, I get price of around ₹26.5K.

[Ananthang]

Originally Posted by raksrules

I am looking at a max bupa reassure policy which costs ₹28.3K as per what the agent quoted me and when I try to purchase myself online, I get price of around ₹26.5K.

Sometimes the agents have given lesser rate than Online, especially with LIC.

Since it is a question of common interest, requesting you to ask the same question the agent and see what he is responding and let the group know. Maybe ask him to do a price match also.

If he is talking about extended service etc, then would be better to buy directly from whom ever it is cheaper.

[raksrules]

Originally Posted by Ananthang

Sometimes the agents have given lesser rate than Online, especially with LIC.

Since it is a question of common interest, requesting you to ask the same question the agent and see what he is responding and let the group know. Maybe ask him to do a price match also.

If he is talking about extended service etc, then would be better to buy directly from whom ever it is cheaper.

As far as I know there is nothing special she is offering. She explained me everything yesterday when I had expected that policy premium would be 24K but she sent me screenshot of 28.2K (using her app which I think is some agent app). She selected couple of extra features that max bupa offers like "Safeguard" which is something like your bonus is not decreased or so and another is hospital cash. If i dont take these, my premium would be under 24K if done online.

[Ananthang]

Originally Posted by raksrules

As far as I know there is nothing special she is offering. She explained me everything yesterday when I had expected that policy premium would be 24K but she sent me screenshot of 28.2K (using her app which I think is some agent app). She selected couple of extra features that mx bupa offers like "Safeguard" which is something like your bonus is not decreased or so and another is hospital cash. If i dont take these, my premium would be under 24K if done online.

Then I think it makes sense to buy directly in online. If you have time, you can call Max Bupa and ask the reason. Obviously it is loaded with agent commission added to Premium amount.

[varun.ppl]

Originally Posted by whitewing

Thank you for the detailed explanation.
I was looking for a top up plan for my existing family floater. The current policy expires in Nov, but I am looking at taking a topup instead of increasing the cover. A policy bazaar agent I interacted with, hinted that post Oct some major changes will be done and that it probably is better to wait for the same. But he refused to divulge details.
Any idea on what's coming up?

Frankly, apart from revised product pricing (higher pricing) by a few Private health insurers, I don't think there's a major revision happening.

In this year's IRDA sandbox, a private insurer has submitted a proposal of a referral based health insurance product akin to Referral & Multi level Marketing....you can read the original concept on Friendssurance, a German insure tech. But, I don't see the concept coming through in October.

Since your current policy is due for renewal in November, I would suggest wait it out to see if some major development does happen.

[varun.ppl]

Originally Posted by Ananthang

Sometimes the agents have given lesser rate than Online, especially with LIC.

Since it is a question of common interest, requesting you to ask the same question the agent and see what he is responding and let the group know. Maybe ask him to do a price match also.

If he is talking about extended service etc, then would be better to buy directly from whom ever it is cheaper.

As per IRDA's mandate for Life/Term & Health insurance plans, insurance companies cannot charge differential premium across channels. So, if anyone is offering you a higher/lower premium, tread it with caution. Higher is simply unacceptable as an agent can't charge for their service (already being paid Salary & Incentive). Lower, well the beauty of Term/Health insurance is that once it's sold, a customer would continue to renew it throughout their lifetime. So, even if the agent forgoes their commission for the first instance, they would be getting an incentive every time you renew.

Some insurance companies (actually only Star Health) offer a 5% online discount - as online policies reduce the Cost of Acquisition for an insurance company. A few insurance companies have/are re-filing their existing products with zero commission and/or online only products so that they can pass on the cost benefit to the end user.