Need Advice on Managing My Health Insurance Without an Agent

[Ekavya]

Hi everyone,
I’m a complete newbie when it comes to health insurance and need some advice.

Four years ago, my mother purchased two health insurance policies ( Star Health)—one for herself and one for me—through a local agent. He also sells LIC and Star Health policies and is a well respected doctor with a chamber (No Degree) in our area. She simply went with the policy he recommended as people do in my place.

I never paid much attention since she was handling the payments. However, issues arose when she repeatedly asked me to open a joint account with her, saying the agent had advised it for the insurance. I refused multiple times, and eventually, she stopped asking. Now, she’s asking for my PAN, Aadhaar, and a photo—again, because the agent requested them. It frustrates me that I’m not given a proper explanation, as if I don’t deserve to know the reason. Maybe the agent is right, but I don’t want to rely on a third party for something as important as my health insurance.

I have a few questions for those experienced in this field:

1. Can I manage my policy and renewals myself, completely bypassing the agent? Is it possible to do this online?
2. Will I lose any benefits if I stop dealing with this agent?
3. Do agents play a role in claims, or can I handle the process on my own?
4. If I ignore the agent completely, will there be any consequences?

Side Note: One of my aunts had a policy from this same agent, but when she was hospitalized, she never received her claim. The agent couldn’t help her either. But still this agent is considered God as most of the people are either semi literate or illiterate.


Would appreciate any insights!

 

[MANAV28]

Check Ditto app…They will clear all your doubts, service is also good. Free consulting over phone.

 

[Ekavya]

Check Ditto app…They will clear all your doubts, service is also good. Free consulting over phone.

It seems they aren't providing Health Insurance related topics

 

[Thomas244]

Please go through a good agent for health insurance. The insurance company employs a team whose only role is to find faults reject and minimise payout. So u need an agent to fight on ur behalf and get a good amount and ur coverage sublimits also needs to be adequate. It seems this agent cudnt get payout for ur aunt. Goto him find out the reason. If he can explain why she didnt get showing u the clauses he knows his stuff

 

[viznu99]

Hi everyone,
I’m a complete newbie when it comes to health insurance and need some advice.

Four years ago, my mother purchased two health insurance policies ( Star Health)—one for herself and one for me—through a local agent. He also sells LIC and Star Health policies and is a well respected doctor with a chamber (No Degree) in our area. She simply went with the policy he recommended as people do in my place.

I never paid much attention since she was handling the payments. However, issues arose when she repeatedly asked me to open a joint account with her, saying the agent had advised it for the insurance. I refused multiple times, and eventually, she stopped asking. Now, she’s asking for my PAN, Aadhaar, and a photo—again, because the agent requested them. It frustrates me that I’m not given a proper explanation, as if I don’t deserve to know the reason. Maybe the agent is right, but I don’t want to rely on a third party for something as important as my health insurance.

I have a few questions for those experienced in this field:

1. Can I manage my policy and renewals myself, completely bypassing the agent? Is it possible to do this online?
2. Will I lose any benefits if I stop dealing with this agent?
3. Do agents play a role in claims, or can I handle the process on my own?
4. If I ignore the agent completely, will there be any consequences?

Side Note: One of my aunts had a policy from this same agent, but when she was hospitalized, she never received her claim. The agent couldn’t help her either. But still this agent is considered God as most of the people are either semi literate or illiterate.


Would appreciate any insights!

1. Yes. Yes.
2. No.
3. Agents assist rarely. Mostly OYO
4. No.

 

[Thomas244]

If he cant assist u now in understanding why aunt claim rejected how can he help u later. Better go via other option. U can always do direct but having an agent with experience helps.

 

[Ekavya]

Please go through a good agent for health insurance. The insurance company employs a team whose only role is to find faults reject and minimise payout. So u need an agent to fight on ur behalf and get a good amount and ur coverage sublimits also needs to be adequate. It seems this agent cudnt get payout for ur aunt. Goto him find out the reason. If he can explain why she didnt get showing u the clauses he knows his stuff

My opinion is he dopesn't know his stuff much. Even though I belive his intentions aren't bad.
Even if he isn't good at his stuff is it still wise to stick to him rather than managing the policy myself?

 

[Ekavya]

1. Yes. Yes.
2. No.
3. Agents assist rarely. Mostly OYO
4. No.

OYO? I didn't get it.

 

[nemesis23]

OYO? I didn't get it.

On your own. Ditto do give health insurance consultant. everyone can manage their health and life insurance with little bit of research, (btw local adviser take a lot of cut hence increase your insurance price)if you are not comfortable then go through ditto.

 

[sunit123]

1. YES
2. NO
3. NO. You can manage
4. NO.

 

[sjmajumder]

Hi everyone,
I’m a complete newbie when it comes to health insurance and need some advice.

Four years ago, my mother purchased two health insurance policies ( Star Health)—one for herself and one for me—through a local agent. He also sells LIC and Star Health policies and is a well respected doctor with a chamber (No Degree) in our area. She simply went with the policy he recommended as people do in my place.

I never paid much attention since she was handling the payments. However, issues arose when she repeatedly asked me to open a joint account with her, saying the agent had advised it for the insurance. I refused multiple times, and eventually, she stopped asking. Now, she’s asking for my PAN, Aadhaar, and a photo—again, because the agent requested them. It frustrates me that I’m not given a proper explanation, as if I don’t deserve to know the reason. Maybe the agent is right, but I don’t want to rely on a third party for something as important as my health insurance.

I have a few questions for those experienced in this field:

1. Can I manage my policy and renewals myself, completely bypassing the agent? Is it possible to do this online?
2. Will I lose any benefits if I stop dealing with this agent?
3. Do agents play a role in claims, or can I handle the process on my own?
4. If I ignore the agent completely, will there be any consequences?

Side Note: One of my aunts had a policy from this same agent, but when she was hospitalized, she never received her claim. The agent couldn’t help her either. But still this agent is considered God as most of the people are either semi literate or illiterate.


Would appreciate any insights!

@Ekavya Star Health is one of the worst insurers. You have yourself given an example (your aunt). Just get rid of it.

You don't need an agent. They will hardly ever help you with claim settlement.

Buy online without agent. It will have lower premium.

You should buy a new policy from the likes of HDFC Ergo, ICICI Lombard, etc. Check policy features, claim settlement ratio and declare everything honestly. You can also buy from one of the 4 Govt insurance companies but the features of their policies are not good.

Update:
Another good option - port it to HDFC/ICICI or the insurer of your choice. You need to approach new insurer 30-60 days before expiry/renewal date of current policy. This way you will retain the benefits of covering existing disease (if any).

 

[Ekavya]

On your own. Ditto do give health insurance consultant. everyone can manage their health and life insurance with little bit of research, (btw local adviser take a lot of cut hence increase your insurance price)if you are not comfortable then go through ditto.

I am planning to do : OYO. It seems the best thing to do.

 

[sheru]

Hi everyone,
I’m a complete newbie when it comes to health insurance and need some advice.

Four years ago, my mother purchased two health insurance policies ( Star Health)—one for herself and one for me—through a local agent. He also sells LIC and Star Health policies and is a well respected doctor with a chamber (No Degree) in our area. She simply went with the policy he recommended as people do in my place.

I never paid much attention since she was handling the payments. However, issues arose when she repeatedly asked me to open a joint account with her, saying the agent had advised it for the insurance. I refused multiple times, and eventually, she stopped asking. Now, she’s asking for my PAN, Aadhaar, and a photo—again, because the agent requested them. It frustrates me that I’m not given a proper explanation, as if I don’t deserve to know the reason. Maybe the agent is right, but I don’t want to rely on a third party for something as important as my health insurance.

I have a few questions for those experienced in this field:

1. Can I manage my policy and renewals myself, completely bypassing the agent? Is it possible to do this online?
2. Will I lose any benefits if I stop dealing with this agent?
3. Do agents play a role in claims, or can I handle the process on my own?
4. If I ignore the agent completely, will there be any consequences?

Side Note: One of my aunts had a policy from this same agent, but when she was hospitalized, she never received her claim. The agent couldn’t help her either. But still this agent is considered God as most of the people are either semi literate or illiterate.


Would appreciate any insights!

Finding a good agent is difficult I agree.
But having a single point of contact for any kind of insurance claim, renewal is better than dealing with different agents on tollfree every time you want help.

P.S. - I am an agent myself and deal in multiple companies.
Let me know if I can help you. DM me.

 

[sjmajumder]

I am planning to do : OYO. It seems the best thing to do.

Good choice. Trust me agents are useless (there may be few exceptions). They only eat heavy commission which increases your premium.

If you need help with claim there is an Insurance Ombudsman 🙂

 

[Pradumya]

Can I manage my policy and renewals myself, completely bypassing the agent? Is it possible to do this online?

Yes you can. You will have gotten the policy number, add that to any payment apps like GPay. You will get renewal reminders and due notification from GPay itself. You can make that payment also via insurers webs

Will I lose any benefits if I stop dealing with this agent?

Nope. Agents are just intermediaries. Your policy and benefits are provided by insurer and doesn't matter if it is via agent or not.

Do agents play a role in claims, or can I handle the process on my own?

In most cases agents play the role of handling paperwork and followup. In a scenario where someone is admitted, you may be stressed and you may make mistakes. But if you think you can handle everything then surely you don't need agents.

If I ignore the agent completely, will there be any consequences?

No financial consequences as such.. social consequences, I dont know. Remember PK movie scene of Boman Irani saying Trishul ghusa diya tha.. that you have to take care of

 

[sjmajumder]

In most cases agents play the role of handling paperwork and followup. In a scenario where someone is admitted, you may be stressed and you may make mistakes.

If you go to a network hospital (which is fairly large for any reputed insurance/TPA) you really don't need to worry about this. The hospital TPA takes care of everything, right from intimation to answering queries and uploading claims and gets you cashless settlement.