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Individual Health Insurance Policy Queries

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 Posted 16-02-2012 13:14:56
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Hi,

I am 39 years old. I want to buy a new individual health insurance policy. I have few questions:

1. Say for Sum Insured of Rs.600000 what are the advantages and disadvantages of buying a single policy vs 2 policies of Rs.300000 each apart from premium? In such a case if there is claim for 2 lac do I need to inform both the insurers? Can I claim it from one single policy?

2. I just went through a list of network hospital for a couple of policies but some of good hospital are not part of the same e.g. Breach Candy, Fortis, KEM, Lilavati or JJ Hospital. What if we need to go to a non-network hospital? Do insurance company enter such claims?

3. How do you rate Apollo Munich Optima Restore and United Insurance Top Up Policy?

4. Why are critical illnesses not covered in general by health policies? So does that mean I will have to buy separate critical illness policy as well to have a complete coverage? Which are the decent critical illness policies available and what is a good sum insured for this considering that I may take health insurance separately? Basically from lifelong coverage, covered illnesses, claim ratio and larger network hospitals.

6. What happens when you exhaust all of the sum insured for a normal health insurance policy not like Optima Restore? Do we have to go through the hassle of buying a new policy with all waiting period etc and new rating and premium calculations?

7. Do you buy a policy from an agent or online? What are disadvantages of buying online?
Post #198
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 Posted 20-02-2012 17:52:18
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Hello Jaideep,

Congratulations on finally deciding to buy your own health insurance policy.

1. The advantage of having 2 policies of Rs. 3 Lakhs each is that you can make small claims from one of the 2 policies, and grow the No Claim Bonus (and save on loading) on the other. The disadvantage is the inconvenience, it can cause to renew and moreover claim from 2 policies. It is somewhat painful.

2. You have a choice to claim from any of the policies. As per the policy wordings of all Insurance products, in India, you are supposed to claim proportionately from all the policies you have, however, this is not practiced in reality. An Insurer can insist on proportionate claims.

2. Hospital Network depends on the Insurance Company. There are good products which cover all the hospitals you have mentioned. Contact us at expert@medimanage.com, in case you would like to know more. In case, the hospital is not covered, you can still claim by making the payment to the hospital and submitting the bills (within stipulated time) to your TPA/Insurance company.

3. My Review of Apollo Optima Restore: http://www.medimanage.com/health-insurance-experts-blog/post/2011/12/19/Apollo-Munich-Optima-Restore-Health-Insurance-Review.aspx

4. United India Super Top up is a good product, but painful to buy. The policy requires regional approval, and hence, has to much of bureaucracy. United India offices are reluctant to offer the policy. At medimanage, we have stopped providing this product.

5. Hospitalization for Critical Illnesses are covered in all Mediclaims in India, as per policy conditions. The specialized critical illness policies, are benefit policies, which provide a lumpsum benefit, on diagnosis of a critical illness. Bharti Axa General's Critical Illness policy is a good option.

6. When the Sum Insured is exhausted, you cannot claim in the policy upto renewal. On Renewal, the sum insured is reinstated. The cover continues like before.

7. Thats an important question. We would recommend you buy policy from anywhere, provided the adviser, provides UNBIASED ADVISE, and is experienced enough to support you at the time of claims.

Regards,

Mahavir Chopra


Mahavir Chopra from www.medimanage.com

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 Posted 21-02-2012 23:31:02
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There is one more differance regarding point number 1, Most of the policies provide room rent eligibility as per the sum insured that is normally 1% and 2% of si in case of normal and ICU respectively. if you are taking 600000 policy eligibility will be 6000 per day and if you are taking 300000 cover eligibility will be Rs. 3000

further if you exceed this limit while hospitaized there will be incremental charges applicable in whole bill , but again it varies from policy to policy, UIIC , NIA AND BHARTI AXA applies incremental charges and deduct proportionately.
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 Posted 21-02-2012 23:46:45
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Iamtum39,

That's an excellent point. I agree the Room Rent restriction is a big difference, when you buy 2 policies, for products where there are such limits.

Regarding proportionate deduction, by far, all companies are deducting charges proportionately on all expenses, once you are paying more than the Room Rent Limit.


Mahavir Chopra from www.medimanage.com

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Edited: 21-02-2012 23:47:10 by Mahavir Chopra
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 Posted 29-02-2012 14:29:58
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Thanks! That helps.
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 Posted 29-02-2012 14:53:18
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Mahavir Chopra from www.medimanage.com

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 Posted 02-03-2012 15:29:29
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Hi Mahavir,

I was about to buy a policy on-line, and onone of the pages I saw this disclaimer:

"Due to recent regulatory changes on portability norms, portability benefits cannotbe provided for policies bought online due to procedural formalities. In case you wish to avail portability benefits please apply through our local office."

This is rather disappointing. I mean, we should tag this for all prospective on-line buyers. Afterall, today an insurer may have better rating and be a top-notch service provider, however in future such a status could cease to exist, that is where portability should be a useful tool for the insured.

I have a query with regards to one of your replies:

As per the policy wordings of all Insurance products, in India, you are supposed to claim proportionately from all the policies you have, however, this is not practiced in reality. An Insurer can insist on proportionate claims.

Why do we have such a rule? I mean it is rather skewed towards the insurer. My point is apart from the limit factor which is not there for some of the policies, I would rather look it this way:

1.    Usually, whenever there is a claim insurer tend to bump-up the premium sooner or later. I wouldn’t want that to happen to both of policies(say I have 2 policies). I would rather keep one claim free.

2.    If premium becomes disproportionately higher, portability will be of little use to me at that point in time. I could very well discard this policy and continue with the claim free one. With this rule (which you have quoted) in place I will not be able to do that. Also, buying a policy at that point in time would mean go through a lot (if I had one policy only).

3.    I can best of both world. Basically, I might like some features of one policy and some of the other.

4.    Buying one single large SI is rather cumbersome to buy and maintain. I have my doubt on portability itself in long run, I think insurer in general would rather be reluctant.

Cheers,

Jaideep




Edited: 03-03-2012 16:10:44 by jaideep
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 Posted 05-03-2012 21:32:54
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Hello Jaideep,

The rule of proportionate claims is as per the principles of Insurance called "Contribution". As per this principle, when risk for a particular subject matter/person has been insured against various Insurance Companies, the claim is required to be settled proportionately. An Insurance Company has a right to pay proportionate to its share of risk.

In reality, most Insurance companies are not practicing it, may be as it is cumbersome, and technical.

Yes, having 2 policies has its benefits, as enlisted by you. But you need to be aware, that such a principle is applicable, and can be implemented.

The reason premiums are increased on claims, is due to the "insured risk" becoming degrees more riskier. This risk is applicable to all Insurance Companies, one has bought the policy from, and not only the one you claim from.

In case you need help on portability you can contact Medimanage Advisory Team, at expert@medimanage.com

Regards,

Mahavir Chopra, Medimanage.com


Mahavir Chopra from www.medimanage.com

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