That important ‘Catch’ in Top Health Insurance policies.

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Top Health Insurance policies India

That classic state of mind, where you have shortlisted a good product to buy, you are about to sign up, and you wonder “Am I missing something….Is there is a catch in this product I am missing”. With Health Insurance, a complex, sometimes expensive, long term paying premium product/service, this happens all the more. This post is an attempt to answer this classic question. We have picked up top 8 best Medical Insurance plans in the Indian market today, and explained the important fine print you should be aware of.

Note, what we call a “catch” here may not necessarily be an intentional fine print always. In most cases, these are conditions clearly mentioned on product documents easily accessible like the brochure or the policy wordings of the product, which have been lost in interpretation, or missed due to the ignorance of the reader.  

And yes, most certainly, this is not an exhaustive list. There are some products I would have missed. There would be that important feature, which in my opinion was not important to take a call on these products. Please feel free to let me know your opinion, feedback in the comments section below. Would be more than happy to interact with you and take your inputs.

We start in Descending Alphabetical order.

United India Family Medicare

United India is a popular Government Insurer in the market, making their standard family floater mediclaim policy equally popular.

The Catch in the Policy: “Surgery Limits”

A Surgery limit is a capping on a list of Surgeries. In this policy, it is as a percentage of sum insured. For instance for major surgeries like Cardiac, Knee Replacement etc. it has a limit of 70% of Sum Insured or Rs. 4 Lakhs, whichever is lower. So someone who has a sum insured of Rs. 2 Lakhs would be able to claim only Rs. 1.40 Lakhs for such surgeries, even if the cost of surgery is more.

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Implications: The implications are obvious. For surgeries whose limits are mentioned, you would be able to claim an amount only upto the capping. A cardiac or a hip replacement surgery can cost close to Rs. 4-6 Lakhs, depending on the complications, a capping can be a big surprise hole in your savings, in case you are not aware of this clause.   

Star Health Senior Citizen’s Red Carpet:

The Catch # 1: “Surgery Limits”

This is a great product for senior citizens at its price point. It being a declaration based policy, not requiring any complicated medical tests; it offers great convenience to senior citizens, specially for people who have their kids in a different city or country.

The Clause: Surgery Limit of 75% for Cardiac, Kidney Failure, Breakage of Bones and 60% for all Major Surgeries for the Rs. 1 Lakh and 2 Lakh plans.

Similar to United India, this limit will also cap you claims to this amount. At a time when most Insurers are running away from Senior Citizens, at the price point at which this is sold, such cappings are fair, which one needs to know these before signing up for the plan.

The Catch # 2 Copay of 10% from age 60.

Oriental Happy Family Floater:

Again, this is a very good product, one of the only products offering cover for parents under the family floater, at very reasonable premiums.

The Catch: Waiting period of 2 years for Diabetes and Hypertension.

The Clause: The clause implies that even if you or your family members do not have Diabetes or Hypertension before the inception of the cover, all treatments directly related to Diabetes and Hypertension would not be payable in the first 2 years. So, if one buys a policy, and faces a heart attack in the first 2 years, this would not be payable as per the policy conditions.

Again, this is clearly mentioned in the Prospectus as well as the  Policy Wordings. We find this condition fair, given the premium charged by the policy.

Max Bupa – Heartbeat and Family First:

The most recent entrant in the Health Insurance space, Max Bupa came in India, with many innovative features in its products. Some being, no waiting periods, no entry age limits, all day care procedures covered. Other than the glaring high premium compared to other products in the market, here are the other important fine prints you could have missed:

The Catch #1: The concept of Shared & Private Room:

Unlike PSUs which have a capping on Room Rent and most private players which have no capping, Max Bupa has introduced a unique concept of restricting the type of room you can claim for.

Silver Plans in Max Bupa Heartbeat as well as Family First, will allow you to claim only expenses billable under the shared room category. Similarly, in case of Gold, you can go for a Private Room, but not a Deluxe or a luxurious Suite (which you can, in case there are no cappings).

It is important to note, that this capping is not restricted only to the room expenses, but also other expenses like Doctor Fees, Diagnostic Tests etc. which are linked to the category of the room. If you have paid bills at hospitals you would know, that Hospitals charge differentially for services they rended, based on the category of room, one has chosen.  So Doctor visit fees billed for a general ward, would be different from a shared room, would be different in a private room. When your eligibility is say a Shared Room, and you go for a Private Room, other than the deduction of excess charges for Private Room, there would also be deductions on other expenses like Doctor Fees, Diagnostic tests which are linked to the Room Category.

The Catch #2:  20% copay from the age of 65 years.

This clause implies that the health  Insurance Company would pay 80 % of the admissible while you will have to bear the deductions, as well as 20% of the admissible claim from your pocket. In our discussions with many prospects/customers who were considering this plan, we found, that most missed this point. At the age of 65 years or more, you certainly wouldn’t want a deduction in your claim, unless you have taken a very large sum insured of more than 8-10 Lakhs. Set your expectations right, if you are going for this plan.

Star Health Family Optima:

The Catch: Renewal ceases at Age 60.

The brochure clearly mentions that the maximum renewal age of this policy would be till 60 years of age.

This policy leaves you, when you need it the most. Though, the officials at Star Health assure that the policy will be converted into Star Red Carpet, it is not a great idea to get into surgery limits and co-pays after paying premium for so many years.

IRDA is working towards making all Health Insurance products lifetime renewable. Hopefully, Insurers will toe the line soon.

ICICI Family Floater:

The Catch #1: Renewal ceases at Age 70

With mortality age going up, and advancement of medical science, most of us are expected to live more than 70 years. The maximum renewal age of 70 years is therefore a dampener to this otherwise good product.

The Catch #2: Cataract Limit of Rs. 20000 per eye. With the northern movement of healthcare expenses, the limit is tad too low for a metropolitan cities and for treatment in large/branded hospitals.

Bajaj Allianz Health Guard:

The Catch: 10% Copay at Non-network Hospitals.

The product has a copay of 10% at non-network hospitals. This means you need to pay 10% of the claim admissible under the policy, in cases you are hospitalized in a hospital out of the Bajaj Allianz network. Though, Bajaj is most popular for its claims settlement. Given, the high premium that Bajaj charges, this is a point you need to know before sign up. Note, there is an option of paying 10% higher premium, and getting a waiver on the 10% Copay.

Apollo Munich Easy Health Policy:

The Catch #1: Permanent Exclusions

Though, the policy wordings mention the waiting period as 4 years, we have observed (in all cases processed) that Apollo Munich puts a Permanent Exclusion on every ailment declared/detected during proposal stage. So, if you or your family has a Pre-existing ailment, this is definitely the last option you should be considering.

Finally, remember, most of these are great products, which we recommend to our customers. We nowhere mention that these products are not worth buying. Our only intent here was to make you aware of that important point.

Did we miss a product you were considering? Do you have something to say? Let us know your feedback in the comments below.

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