GUIDE into buying your Health insurance

[Chacha_vidhayak]

any experience with niva bupa/ ICICI lombard/ care/ bajaj, etc? How good is the service during claims?

also, in the thread if anyone can share their experience of various insurance company, it will be great.

I've hdfc ergo policy and I can confirm their service is really good, all things are digital as well which adds convenience and they responds to mails for any doubt.

I purchased niva bupa recently and got to know they provide claim relationship manager to you from the very 1st day … the guy told me that’s the benefit of buying directly from niva bupa , which i wouldn’t have got if purchased from policybazar or any xyz medium … This info is new for me … correct me if I’m late in knowing this 🙂

 

[Sudip]

I purchased niva bupa recently and got to know they provide claim relationship manager to you from the very 1st day

this is new for me, thanks for sharing.

my concern is claims experience, usually marketing is done very nicely but when claim comes, that's when the service is looked upon and want to know how the company delivers it.

 

[prashu]

Can a person take Health Insurance ? if he has term insurance along with critical illness rider plan ? Is it beneficial ?

 

[V G]

It's not final edited because on laptop u can only see things in dark.
Will edit tomorrow asthetic

Will be making thread on most common reason for health insurance rejection/ partial rejection


Buying a health insurance has become a hectic task , because there is too many sub clause and sub limits added and as much as we are vulnerable while availing the health emergency , these company leach on those moments and save their money .

so before buying health insurance like any other thing you buy ,
make a list what do you need in your health insurance

questions like
is 5 lakh cover sufficient ?
do you think hospital you would admit having 5-6k per day budget good ?
are you ok with double wing sharing ? or you need single private room ?

but bigger question is we will buy policy based on features but there is always some conditions hidden .


now question is who need health insurance ? anyone who doesnt have corpus in multiple crores should take health insurance


there are two types of health insurance
1 individual
2 family\flotter - cheaper but let say u take 10 lakh insurance for 5 member but if one uses 8 lakh then 4 can only use remaining 2 lakhs

take individual plan for person with more risk ( like elders like one with alcohol or smoking ) as adding them in flooter would increase premium for everyone , flotter for childrens and less risk individual



now lets talk about devil in the show

1 room rent fasade - lets say you took 5 lakh policy , it has 1% policy for room rent cap so 5000 and you took 10k room and thinking u only have to pay 5k extra of room but in some policy company would only give 50% of the surgery amount too as room rent was also 50 % reimbursed
even for other post surgery expenses

so ideally take higher value policy or dont take policy with such clause


2 CO PAY - avoid this at all cost


3 sub limit - some insurance have sub limit on type of surgery like heart attack etc has 2 lakh sub limit , avoid these policy too


4 zonal vs pan india policy - sometimes policy premium depends on area , ideally take insurance on pincode you live dont take at rular address to save money . sometimes due to this you might have to do 20 % co pay .
not a deal breaker but ask your policy agent .

5 top up and super top up - these are stand alone policy you can take from same company or other . take same company for cashless experience
top up --- say u have 5 lakh insurance and 5 lakh top up
surgey 8 lakh so 5 lakh from base 3 from top up

but same year u got another 2 lakh bill u can't claim from top up as top up only will activate after 5 lakh base in same year

but in super top up - u can claim that 2 lakh standalone in next surgey same year

take super top up



6 pre and post hospitalization - ideally every company is providing this 60 day pre op and 180 day post op . some have 30 and 60 respectively so check according to your need . more for old people , less for young guns

7 day care coverage - some surgey dont need 24 hour admit , and to claim any health claim u have to be admitted 24 hour minimum so take day care coverage if you live in city as medicine is getting smarter

8 extended coverage - ayush treatment should be there , if you want to go that way , cosmetic is very much optionallllll


9 - waiting period - 30 day is minimum waiting period for any claim this is standard waiting
critical illness - has 90 day waiting period
maternity claims - 9 to 36 months (depends on policy )

10 pre existing disease -3 or 4 year depending on company but there are few diseases which would be there in policy paper has 2-3 year waiting period even though u dont have that disease


11 no claim bonus - ideally they increase the base cover in next 3-4 year for no claim bonus . say 5 lakh insurnce can go upto 7.5 with 3 year no claim bonus ( must have )

12 ambulance charges - check if this is covered or not

13 cashless hospital - check for hospital link up for cashless in city its not a prob , for tier 3 town etc you must know your hospital

14 free health checkup - a big stress reliever as having free check up from company linked checkup would be , your health condition would be updated yerly so no chance of denial for pre existing diseases

15 restoration of sum assured - lets say u took 5 lakh policy but it has restoration benifit once a year , then u can claim 10 lakh in total . but there can be clause u cant use restoration for same disease etc

16 - exclusions --- there is list of exclusion like reg fees ,some diseases which will never be covered no matter what etc so keep eye on it

17 - you should anyday choose cashless +reimbursement policy as in case of accident , no one will care for your only cashless network hospital , reimbursement is best for any planned surgery as cashless claims are being used as scam to loot money from insurance from hospital . i know many clinic doing this fake admit and earns 10k daily being fake admit patient

most important thing dont lie about your health problem like drinking & smoking


these were some of the question you should check . ideally if you would choose all you might not get any policy ticking all boxes so you have to prioritise which one most important to you

Can you suggest a policy which also covers critical diseases without sub limit? In many cases, either critical disease is an add on or have sub limit if covered. Also the premium becomes very high in case critical disease is included in policy.

In my view (I may be wrong), for an average person, generally (most of the cases, not all) super top up is useless as the expenses for non critical diseases are not much.

 

[VasukiVasuki is verified member.]

Can you suggest a policy which also covers critical diseases without sub limit? In many cases, either critical disease is an add on or have sub limit if covered. Also the premium becomes very high in case critical disease is included in policy.

In my view (I may be wrong), for an average person, generally (most of the cases, not all) super top up is useless as the expenses for non critical diseases are not much.

You should be checking your family history for diseases and what u think u might be exposed to

 

[Sudip]

anyone has any claims process experience with aditya birla health insurance? are they good and do timely cashless approval or timely reimbursement claim settlement?
thanks.

 

[SMS91]

What is the best platform for buying health insurance?

 

[CCFinvest]

TECHNOFINO
C

• Health Insurance

Claim settlement ratio and Claims paid ratio for Health insurance​

• Thread starterreal_name_hidden
• Start dateNov 28, 2024
• TagsNone

Ignore threadJump to newWatch
R

real_name_hidden​

TF Select​

• Nov 28, 2024
• New
• 
  
• Add bookmark
• #1

Although most of us look into csr and icr while purchasing health insurance, should claims paid ratio should also be considered?

Ditto recommends hdfc, care and Aditya birla for health insurance but their claims paid ratio seems very low.

Public sector insurers seems to be better on that but they've generally cap on room rent limits.

Would like to know opinion of community members who've taken claims from insurer.

Article link

https://www.moneycontrol.com/news/b...th-insurance-claim-payout-chart-12875757.html

Attachments​

• 
  Screenshot_2024-11-28-12-51-45-334_com.divum.MoneyControl.webp
  109.5 KB · Views: 20

Like Quote Reply
Report

[IMG alt="sunit123"]https://www.technofino.in/community/data/avatars/m/38/38218.jpg?1723526643[/IMG]

sunit123​

TF Premier​

• Nov 28, 2024
• New
• 
  
• Add bookmark
• #2

3rd party apps like ditto and policy bazaar always recommend those policies where they get maximum commission.

1. Declare complete details in proposal form and be transparent about health status
2. Fix your requirement based on your need
3. Health insurance claim cannot be rejected after 8 years

Like Quote Reply
Report
[IMG alt="sunit123"]https://www.technofino.in/community/data/avatars/m/38/38218.jpg?1723526643[/IMG]

sunit123​

TF Premier​

• Nov 28, 2024
• New
• 
  
• Add bookmark
• #3

Although most of us look into csr and icr while purchasing health insurance, should claims paid ratio should also be considered?

Ditto recommends hdfc, care and Aditya birla for health insurance but their claims paid ratio seems very low.

Public sector insurers seems to be better on that but they've generally cap on room rent limits.

Would like to know opinion of community members who've taken claims from insurer.

Article link

https://www.moneycontrol.com/news/b...th-insurance-claim-payout-chart-12875757.html
Click to expand...

Check claim settlement ratio on IRDA website...This list seems to be incorrect...Also check reliance general insurance which is missing in the list


Like Quote Reply
Report


A

_ayush​

TF Ace​

VIP Lounge

• Nov 28, 2024
• New
• 
  
• Add bookmark
• #4

3. Health insurance claim cannot be rejected after 8 years

I read that IRDA reduced moratorium period to 5 years. Isn't that applicable anymore?

Like Quote Reply
Report
[IMG alt="sunit123"]https://www.technofino.in/community/data/avatars/m/38/38218.jpg?1723526643[/IMG]

sunit123​

TF Premier​

• Nov 28, 2024
• New
• 
  
• Add bookmark
• #5

I read that IRDA reduced moratorium period to 5 years. Isn't that applicable anymore?

It will be applicable only at the time of renewal of existing policies...For new policy, it will be 5 years

Like Quote Reply
Report
Reactions:_ayush
A

_ayush​

TF Ace​

VIP Lounge

• Nov 28, 2024
• New
• 
  
• Add bookmark
• #6

I purchased a policy in july 2024. So hopefully it will be 5 years right?

Like Quote Reply
Report
R

real_name_hidden​

TF Select​

• Nov 28, 2024
• New
• 
  
• Add bookmark
• #7

Yes these seems old data as per reference from the article

Like Quote Reply
Report
C

CCFinvest​

TF Neo​

• 1 minute ago
• New
• 
  
• #7

This message is awaiting moderator approval, and is invisible to normal visitors.
Key reasons for reduced payouts :

Policies have several exclusions and limitations. If the policyholder does not take these into account at the time of purchase, it can result in a lesser claim settlement amount and an unpleasant claims experience.
Sub-limits and caps: Some policies impose sub-limits on room rent, surgeries, and treatments. Older policies, for instance, offered room rent coverage for a fixed amount or up to 1 per cent of the sum insured. If a policyholder opts for a higher-cost room than allowed, the insurer may make a lower claim payout.

Staying in a higher-category room can lead to a proportionately lower payout on the entire bill.

Copayment and deductible:Many policies, especially for senior citizens, include copayments. If the copayment is 20 per cent, the insurer will pay 80 per cent of the bill, and the insured must cover 20 per cent out of his pocket.

For policies with a deductible, such as Rs 1 lakh, the insured must pay bills up to this amount. The insurer covers only bills above that threshold.

Exclusions: Certain conditions or treatments, such as cosmetic procedures, are not covered by policies. A claim for these exclusions will not be paid.

Consumables: Items like PPE (personal protection equipment) kits, gloves, and masks used during treatment are often excluded. Consumables can account for 7-10 per cent of the total bill. Traditionally, many policies did not cover consumables.
In order to get the full coverage, you need to choose the right product according to age and your health condition. Health insurance is a very person specific product now a days with so many features and options accross many insurers.TECHNOFINO
C

• Health Insurance

Claim settlement ratio and Claims paid ratio for Health insurance​

• Thread starterreal_name_hidden
• Start dateNov 28, 2024
• Tags
  None

Ignore threadJump to newWatch
[COLOR=rgb(230, 153, 230)]R[/COLOR]

real_name_hidden​

TF Select​

• Nov 28, 2024

• New
• Add bookmark
• #1

Although most of us look into csr and icr while purchasing health insurance, should claims paid ratio should also be considered?

Ditto recommends hdfc, care and Aditya birla for health insurance but their claims paid ratio seems very low.

Public sector insurers seems to be better on that but they've generally cap on room rent limits.

Would like to know opinion of community members who've taken claims from insurer.

Article link

https://www.moneycontrol.com/news/b...th-insurance-claim-payout-chart-12875757.html

Attachments​

• 
  Screenshot_2024-11-28-12-51-45-334_com.divum.MoneyControl.webp
  109.5 KB · Views: 20

Like Quote Reply
Report
[IMG width="48px" height="48px" alt="sunit123"]https://www.technofino.in/community/data/avatars/m/38/38218.jpg?1723526643[/IMG]

sunit123​

TF Premier​

• Nov 28, 2024

• New
• Add bookmark
• #2

3rd party apps like ditto and policy bazaar always recommend those policies where they get maximum commission.

1. Declare complete details in proposal form and be transparent about health status
2. Fix your requirement based on your need
3. Health insurance claim cannot be rejected after 8 years
Like Quote Reply
Report
[IMG width="48px" height="48px" alt="sunit123"]https://www.technofino.in/community/data/avatars/m/38/38218.jpg?1723526643[/IMG]

sunit123​

TF Premier​

• Nov 28, 2024

• New
• Add bookmark
• #3

real_name_hidden said:
Although most of us look into csr and icr while purchasing health insurance, should claims paid ratio should also be considered?

Ditto recommends hdfc, care and Aditya birla for health insurance but their claims paid ratio seems very low.

Public sector insurers seems to be better on that but they've generally cap on room rent limits.

Would like to know opinion of community members who've taken claims from insurer.

Article link

https://www.moneycontrol.com/news/b...th-insurance-claim-payout-chart-12875757.html
Click to expand...

Check claim settlement ratio on IRDA website...This list seems to be incorrect...Also check reliance general insurance which is missing in the list

Like Quote Reply
Report

[COLOR=rgb(46, 184, 184)]A[/COLOR]

_ayush​

TF Ace​

VIP Lounge

• Nov 28, 2024

• New
• Add bookmark
• #4

sunit123 said:
3. Health insurance claim cannot be rejected after 8 years

I read that IRDA reduced moratorium period to 5 years. Isn't that applicable anymore?
Like Quote Reply
Report
[IMG width="48px" height="48px" alt="sunit123"]https://www.technofino.in/community/data/avatars/m/38/38218.jpg?1723526643[/IMG]

sunit123​

TF Premier​

• Nov 28, 2024

• New
• Add bookmark
• #5

_ayush said:
I read that IRDA reduced moratorium period to 5 years. Isn't that applicable anymore?

It will be applicable only at the time of renewal of existing policies...For new policy, it will be 5 years
Like Quote Reply
Report
Reactions:_ayush
[COLOR=rgb(46, 184, 184)]A[/COLOR]

_ayush​

TF Ace​

VIP Lounge

• Nov 28, 2024

• New
• Add bookmark
• #6

I purchased a policy in july 2024. So hopefully it will be 5 years right?
Like Quote Reply
Report
[COLOR=rgb(230, 153, 230)]R[/COLOR]

real_name_hidden​

TF Select​

• Nov 28, 2024

• New
• Add bookmark
• #7

Yes these seems old data as per reference from the article
Like Quote Reply
Report
[COLOR=rgb(6, 19, 13)]C[/COLOR]

CCFinvest​

TF Neo​

• 1 minute ago

• New
• #7

This message is awaiting moderator approval, and is invisible to normal visitors.
Key reasons for reduced payouts :

Policies have several exclusions and limitations. If the policyholder does not take these into account at the time of purchase, it can result in a lesser claim settlement amount and an unpleasant claims experience.
Sub-limits and caps: Some policies impose sub-limits on room rent, surgeries, and treatments. Older policies, for instance, offered room rent coverage for a fixed amount or up to 1 per cent of the sum insured. If a policyholder opts for a higher-cost room than allowed, the insurer may make a lower claim payout.

Staying in a higher-category room can lead to a proportionately lower payout on the entire bill.

Copayment and deductible:Many policies, especially for senior citizens, include copayments. If the copayment is 20 per cent, the insurer will pay 80 per cent of the bill, and the insured must cover 20 per cent out of his pocket.

For policies with a deductible, such as Rs 1 lakh, the insured must pay bills up to this amount. The insurer covers only bills above that threshold.

Exclusions: Certain conditions or treatments, such as cosmetic procedures, are not covered by policies. A claim for these exclusions will not be paid.

Consumables: Items like PPE (personal protection equipment) kits, gloves, and masks used during treatment are often excluded. Consumables can account for 7-10 per cent of the total bill. Traditionally, many policies did not cover consumables.
In order to get the full coverage, you need to choose the right product according to age and your health condition. Health insurance is a very person specific product now a days with so many features and options accross many insurers.

 

[Vinay13]

I have employee health insurance of 15L and HDFC ergo SI 5L both covers whole family . I was thinking is there need to take cancer insurance also separately? Premium are very less 3k for 50L SI per person and premium fixed for 3 years . Because i am under 30 my premium is less

 

[CCFinvest]

Employee health insurance is a group policy where you won't have lifelong coverage (unless your company specifically provides that).
Porting is not possible and after your retirement (when we need it mostly), you will have to buy expensive individual policies with loadings or waiting period.
But group health insurance is cheap.
It is suggested to take seperate comprehensive coverage for lifelong renewal and no waiting period after your retirement. If you do not want to do it now, must cover yourself with critical illness insurance.
For Cancer cover or Critical illness cover there are many options available. You may contact us to customise best available options specific to your need.