[varun.ppl]

Originally Posted by 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.

From the renewal notice, it's evident that you have an Apollo Munich Policy (now HDFC Ergo Health), if I'm not wrong, the cover is "Optima Restore". The policy offers 50% NCB for each claim free year (max 100%) and if you check you've 25 Lacs as an additional Sum insured. In effectiveness, you've 50 Lacs cover from your personal health insurance (which is optimum) plus another 30 Lacs from your Corporate cover.

The only aspect is that the HDFC Ergo policy's NCB reduces with claim. For eg, in case you make a claim this year, your next CB would be back to 50%. And post another claim free year back again to 100%.

[diyguy]

Originally Posted by varun.ppl

In effectiveness, you've 50 Lacs cover from your personal health insurance (which is optimum) plus another 30 Lacs from your Corporate cover.

Thank you for the response Varun. I am confused on the multiplier 25L as at the bottom they are urging me to upgrade to the 50L cover. If I already have the desired amount why would I shell out the extra bucks, unless there was some catch with the multiplier claim?

[varun.ppl]

Originally Posted by diyguy

Thank you for the response Varun. I am confused on the multiplier 25L as at the bottom they are urging me to upgrade to the 50L cover. If I already have the desired amount why would I shell out the extra bucks, unless there was some catch with the multiplier claim?

It's just a premise with the insurance company to have a better book with a low risk customer like you. As I believe that you and your family do not have any chronic conditions (cause if you've had, you wouldn't have been offered an upgrade in the first place), secondly you haven't made a claim and thirdly, the future propensity to make a claim is also low.

So, the insurance company knows you're a low risk customer and more of a cash cow (Kotler's marketing influence) and hence the offer/push.

You've an adequate cover of (25+25+30) Lacs which is more than sufficient in a metro city.

[raksrules]

Is there any benefit of the hospital cash which some companies provide? I am seeing Max Bupa and they charge around 1700 Rupees additional for that but the caveat is that only if one is hospitalized for more than 48 Hours, the cash kicks in and it is not clear but seems only applicable for twin sharing room, does it mean if one gets a single occupancy room, they cannot get this benefit?


Coming back to topic of agent, I asked the "relative" who is also agent as why her quote is 2K higher than website quote, she told me website gives discount since they have "targets" which I feel is absurd as I personally think, website gives discount due to no agent in between. Am I wrong?
She also tell me in time of claim, I will have to do everything myself, implying that she will do work for us if claim arises. Are their services worth it for the additional charges they ask for?

[csnanjappa]

Hi Varun,
My Mother is 72 years with regular underlying conditions such has diabetes and BP. Do you suggest any kind of health insurance for her?

[varun.ppl]

Originally Posted by raksrules

Is there any benefit of the hospital cash which some companies provide? I am seeing Max Bupa and they charge around 1700 Rupees additional for that but the caveat is that only if one is hospitalized for more than 48 Hours, the cash kicks in and it is not clear but seems only applicable for twin sharing room, does it mean if one gets a single occupancy room, they cannot get this benefit?


Coming back to topic of agent, I asked the "relative" who is also agent as why her quote is 2K higher than website quote, she told me website gives discount since they have "targets" which I feel is absurd as I personally think, website gives discount due to no agent in between. Am I wrong?
She also tell me in time of claim, I will have to do everything myself, implying that she will do work for us if claim arises. Are their services worth it for the additional charges they ask for?

Frankly, I would never go for a specific Hospital Cash cover considering my present age and medical history. Paying an additional premium for an event which might happen once in a decade doesn't make a strong enough case for me.

Though, just so as to touch upon Hospi Cash, this amount primarily covers expenses which are beyond the purview of your in-patient hospitalisation or room rent coverage. If you've gone through the policy wordings, you would come to know that surgical instruments, X-rays, anaesthesia etc aren't covered under your room rent coverage. Your policy primarily covers your stay and treatment cost (dedicated doctor/surgeon). All these other expenses can be covered under the Hospital Cash benefit and as you stated most of the insurance companies require a minimum of 48 hours of hospitalisation. Also, it does depend on room type as well. In case you've opted for the topmost variant of the health plan - your package (decided by the hospital) would cover more items in the purview and it would be significantly expensive vis-a-vis someone who has opted for a lower room category/lower variant plan.

Second part - Most of the insurance companies typically have a dedicated TPA desk or they've a dedicated toll free number for Claim intimation. Even if you reach out to your agent, they would be registering a claim with the insurance company primarily a facilitation job.

The problem that I see (sitting within the insurance company) is that claim is a major touchpoint for a customer and hospitalisation is a major life event as well (even for a regular surgery). It's an emotionally straining event and at that time the customer doesn't want an additional worry of managing their claim processing (on a web portal or someone calling them for additional details/documents) and hence, we rely on agents to sort that process out for us.

From a technology lens (not trying to downplay claims), it's yet another transactional event (an important one at that) and a lot of insurance companies are trying to make it as simple and straightforward as possible by building AI bots and dedicated toll free numbers to strengthen their claim processes.

I would say an additional 2K is certainly not justified.

[varun.ppl]

Originally Posted by csnanjappa

Hi Varun,
My Mother is 72 years with regular underlying conditions such has diabetes and BP. Do you suggest any kind of health insurance for her?

Sir,

There are only a select few private insurance companies which allow entry post 60-65 years viz. Star Health, Max Bupa, Aditya Birla, Cigna & Religare. I would discount the last two because of their reputation and the constant revision in ownership. None of the PSU insurance companies would be covering your mother as well due to her age.

Now, since you've spoken about co-morbidities like Diabetes & BP - a little more clarity would be required whether it's Type 1 or Type 2 Diabetes. A quick comparo of the three insurers -

Star -
(Positives) Waiting period for coverage of PED's is 1 year, better cashless network in Bengaluru, Health Check-up's for every claim free year.
(Negatives) Exorbitant Co-Pay of 30% per hospitalisation & 50% in case of PED's, No No-Claim Bonus, No Restoration benefit*

Max Bupa
(Positives) No capping in terms of room rent (except for Suite and above), 10% Cumulative Bonus for every claim free year (need to check 10% number though...max upto 50%) and also it doesn't reduce in the event of a claim, No Co-pay (but do check the policy wordings please), Does cover alternate medicine upto sum insured (like Ayurveda etc), Does cover Hospitalisation at home, annual health check-up's

Negatives Waiting period to cover Pre existing conditions is 3 years

Aditya Birla
(Positives) 10% Cumulative Bonus max. upto 50% but it does reduce by the same amount in case of a claim year, Covers alternate medicine for upto 10% of Sum insured, Covers hospitalisation at home, annual health check-up's, covers Pre existing conditions after 2 years

(Negatives) Co-Pay of 20% for every claim.


In terms of annual premium - Star (21K), Max (44K) & ABHI (48K) for a 5 Lac sum insured, doing a cost benefit analysis Max > ABHI make more sense than Star cause you would be paying at least 30% of claim amount every time and that 20K difference in annual premium wouldn't be justified in case the claim amount is 60K and above.

In case you're salaried and your company has a GMC, ideally, add your mother as a dependent parent as there are no waiting periods in Group Mediclaim covers, till the time your private health insurance starts covering your mother' pre existing conditions.

P.S. *(Restoration is primarily in case the sum insured is exhausted in a policy year, it's fully restored (there are terms like Restoration, Recharge, Refill - all three are different)) but the restored sum insured cannot be used for the same hospitalisation in that policy year.

For example - If I have a 5 Lac cover, and end up consuming 3 Lacs for a claim in case of BP related hospitalisation, my left over sum insured of 2 Lacs would be restored to 5 Lacs but I cannot use it again in that year for another BP related claim, I can use it for any other event though.

[raksrules]

Originally Posted by Ram_BMWTravel

I have a Max Bupa group policy for similar family profile - 37,34,5,1 . I have a base policy of 5 Lakhs and a super top-up of 95 Lakhs. I bought this directly from Max Bupa for a total price of INR 22000.

I suggest to purchase this directly from Max Bupa website.
The base policy is Health Companion.
The Super Top-Up is called Health Recharge.

Ram

How do you know that the 95L is a super top up? Asking since I believe there is difference between top up and super top up where, if we have top up then the top up kicks in only if base is met but with super top up, it can be cumulative across multiple claims.


One question, do I need to see how many network hospitals does the company have? Because from what I see, Max Bupa has 5K while companies like HDFC ERGO have 10K+. I see some hospitals near my home not showing on Max Bupa (their site is broken while showing network hospitals so I got list from coverfox.com) but see them in HDFC ERGO.

Is the network hospital only important to seek cashless treatment? And if hospital is not in network that means I can still get admitted there but I have to bear costs first and the claim with insurance?

[Ram_BMWTravel]

@ raksrules

The policy i am talking is 'Health Recharge – Family Health Insurance Plan'. In the Max BUPA site it is mentioned clearly that is a Super-Topup plan. Please search for this plan and combine this with 'Health Companion' to get a quote for 1 Crore.You can see the details and they are fairly clear. What i noticed is that for Chennai they have a good list of hospitals.

[raksrules]

Originally Posted by Ram_BMWTravel

@ raksrules

The policy i am talking is 'Health Recharge – Family Health Insurance Plan'. In the Max BUPA site it is mentioned clearly that is a Super-Topup plan. Please search for this plan and combine this with 'Health Companion' to get a quote for 1 Crore.You can see the details and they are fairly clear. What i noticed is that for Chennai they have a good list of hospitals.

Thanks for the information. So if I want to buy this, on max bupa website, do I need to so two separate transactions for the base 5L and then 95L super top up or I can buy the combined policy in one shot.

Also about the network hospital question, the use of network hospital is only if I need to avail cashless hospitalization right? If someone gets treated in a non network hospital, they can still claim from insurance right?

[Ram_BMWTravel]

Yes that's what i did. Picked up a health companion for 5 Lakhs, waited for a day to get the policy generated and then bought a Recharge for 95 Lakhs.

Yes in a non-network hospital you can always pay first and then claim. There might be some time delay and extra review for approval. The reason being that in a network hospital the rates are already approved with the insurer.

[hondafanboy]

Can someone please advise whether we have adequate health cover based on the following details ? The polices are due to renewal and I am wondering whether to increase the SI.

Employer- 10L floater - self-wife-kid-parents

Personal- from Religare Care from last 5 years and no claims made

Father- 62
Sum insured- 5 L
Accumulated NCB- 2.5L
Premium- 28950

Mother-54
SI - 5L
Accumulated NCB- 2.5L
Premium- 18790

Self- 10L
Accumulated NCB- 4L

Floater for wife and kid
SI- 20L
Accumulated NCB- 8L

[Haste]

Looking to purchase super top-up insurance to supplement my employer insurance for any medical contingencies. Has any body have experience with HDFC Ergo health insurance. Looking at the premium table, there super topup plan seems good. I'm getting floater plan for family of 3 for 4290+GST for 5L deductible and 20L coverage.

Is there any pointers or t&c i should be aware of before purchasing this plan or any better policies worth checking out?

BTW I had also checked out details for Max Bupa health recharge plan which many people are buying here it seems. On first glance their t&c seem more relaxed as well huge cover of 95L. However, I saw premium is increasing hugely with age. At current age of 35Y, I get only a premium with 4.8k + GST for family of 3. If I increase my age to 46Y ( just to get feel of premium increase) I got quote of 27K. I also checked premium quote at age 44, it was also 20k+.
Compared to HDFC ergo which has defined slab from 36-45Y and have same premium. It increases at 46Y however it is just nominal 2.4K (6600) which seems justified. Probably that's why they don't give premium table in the product brochure.

[Ram_BMWTravel]

Thats a premium only for entry into the insurance. Year on year based on the claim and medical history it will vary. So in my view the premium table does not matter much for future years. Please choose a policy which covers your specific needs and also hospital coverage.

[pandey.jai]

My spouse and I are in the IT industry and we have company provided insurance. Both our floater plans cover 5 and 6 lacs respectively.

We’re expecting a baby in a couple of months time. I checked the hospital that the OBGYN has a tie up with and it appears that the hospital is not in the networks hospital list of one of our insurance companies.

The one where we can get the cashless option has a paltry 30k upper limit for maternity, while the other insurance has 50k.

What are my options in this situation? Do I opt for cashless (Insurance 1, with 30k limit) or do I pay cash and try the reimbursement route (insurance 2, 50k maternity limit)? Or is there another better option?