Finally on a health policy hunt (steps included). Shortlisted one, advice needed.

[highonluna]

Hi all,

A regular reader on this sub here finally makes his first post. This post might be helpful for anyone who wants to buy a health policy but doesn't know where to start. This is my attempt to help anyone get started.

I'm in my early twenties, started working two years back. I'm covered with a Group Health Policy of 3L from my employer already, which includes my parents as well. Thanks to all the discussions on this forum already, I learned I should also have a separate HP apart from my employer.

I started looking about two days back (better late than never), first by going through all the posts on r/IndiaInvestments and r/india, which had any kind of discussions regarding the subject. Owing to which, I learned about the crucial points to look for while looking for a policy (I'll list the steps below based upon which I decided my final contender).

• There were some very informative articles on this sub that you must go through before starting on your hunt. The most important criteria that you must look for are:
  • 0% Co-pay ( you won't be paying anything in your claim and all the eligible expenses would be borne by the insurer )
  • No room rent limit (detailed related article here), avoided single private standard A/C too (article)
  • No maternity cover, dental/vision cover. It can be handled by yourself.
  • Least waiting period for pre-existing disease (for parents). Waiting period weightage could be less for you if you're young and looking for yourself.
• I used coverfox.com (I personally loved this platform), policybazaar.com, and insurancedekho.com to compare and shortlist policies. Coverfox doesn't have updated network hospitals in my hometown for each policy, so-referred individual companies for the same.
• I also referred MSMR (Mint SecureNow Mediclaim Ratings) on Livemint which rates different HPs from different companies based upon some criteria they've mentioned in detail.
  
  MSMR (2019) edition
  
  MSMR (2018) edition
• For past data of the insurers for CSR (Claims Settlement Ratio), Claims Settlement Efficiency Ratio, etc I referred a MoneyControl article here.
• Then after steps 1, 2, 3, and 4. I looked at the different network hospitals in my hometown. The hospitals that I looked for were the prominent ones in my hometown.
• Then I went through each shortlisted policy's detailed brochure directly from their website.

My dad (55 years) has mild hypertension (controls it by taking pills)Mom (48 years) has thyroid and slip-disc

Since we're already covered with 3L health insurance, thinking of starting with a health cover of 5L and maybe increasing the premium later on either in GHP or this one (also they're residing in a tier-2 city). I also have a younger brother of 19 years, who'll be operated for hernia this year probably. I read that premium in a family floater plan depends upon the maximum age of the insured and that this operation can't be claimed if we get a policy now, made sense to get him a different HP altogether, maybe a student one if it exists. Also, opting for a policy with OPD cover also didn't make any sense, taking into consideration the value for money and the fact that my dad gets free consultations in railway hospitals (officer in Indian Railways).

After taking all of these things into consideration and 2 sleepless nights (pats on the back), I selected HDFC Ergo my:health Suraksha Insurance - Silver Smart Plan. Policy brochure

Here are it's salient features:

• Copay : 0%
• Room rent: No limit on room rent (preferred with a higher premium on no limit rather than going with single standard A/C for peace of mind)
• Waiting period: 3 years
• Restore benefit
• Free Health Check-up every year
• Renewal Bonus: 10.0%
• Pre/Post-hospitalisation Cover
• In-house Ayurveda/Homeopathy: up to 5L

Annual premium (including taxes) checked on the HDFC website (tier-2 city): Rs. 23709

Annual premium next year onwards (got from Coverfox): Rs. 27666

I haven't made the final payments yet, will go through the documents again, talk to their customer care to cross-check if I missed out on anything, and take this subs' valuable opinion. Please let me know about your thoughts, willing to hear from you guys!

P.S. A couple of reasons I didn't go with some insurers:

• Star Comprehensive: Extra things which I didn't require and more waiting period, also a limit on room rent to single standard A/C
• Max Bupa: Unavailability of prominent network hospitals
• ICICI Lombard: Higher premium and less number of network hospitals as compared to HDFC
• Royal Sundaram: Unable to find network hospitals in my hometown, left out of frustration
• Bajaj Allianz Health Ensure: No room rent limit with maternity (no need) - only in the Gold plan
• ManipalCigna Health Insurance: Didn't check in detail, it said about a limit on a room to single standard A/C

After this is sorted, need to figure out health as well as term insurance for myself as well. xD

 

[resjudicata]

@highonluna Have you tried Digit insurance? Two weeks ago I took their health insurance policy for self and spouse. 1 crore each. Rs 30k per annum.

 

[highonluna]

@resjudicata Hi, I didn't come across them on any platform. I like their selection of hospitals - included only important ones. Is it 30k p.a. for both of you combined wherein both have a cover of 1cr each?

Though I feel health insurance of 1 crore is an overkill (comparison). The premium for my parents would go through the roof then (65K p.a).

Will look for other sums assured. Thanks for the info!

 

[resjudicata]

@highonluna 30k for both combined. Would have been 25k if I was not overweight and parents did not have medical history.

I wouldn't consider 1 crore overkill. The medical expenses these days are insane. My friend's father had a stroke - it cost them 85 lakhs over 6 months.

I also like the fact that digit offers critical illness cover.

Overall, if you are considering for your parents, a higher cover is extremely important.

 

[highonluna]

@resjudicata 85 lakhs? Damn, I think I was in the dark till now! "Critical illness cover" - need to look this up now in more detail.

Another reason why I was skeptical of GoDigit is the fact that it just a startup that entered the health insurance segment just 1.5 years ago. I understand they're backed by a big insurer based in Canada, but it's just what Farhan said in 3 Idiots, "Abba nahi maanenge."

 

[keepingsteady]

@highonluna Its owned by Fairfax who were initial investors in ICICI Lombard. They have good experience in setting up and running an Insurance company in India.

 

[heliumskylark]

@keepingsteady Don't you think there is a catch somewhere when some company is offering a 1 crore health policy at 30k for 2 person? There is no free lunch. Others are offering nowhere near that high a coverage for 30k. If it was really possible to underwrite such policies and remain profitable, other companies would have also offered it. Insurance is cut throat business and underwriting practices are fairly competitive due to high competition.

Since health insurers can indiscriminately increase policy premium every year, I feel this may just be an introductory offer to lure in customers.

 

[keepingsteady]

@heliumskylark Ofcourse its intro offer of sorts. Such low premiums are not sustainable in long run.

 

[sadie_the_cat66]

@keepingsteady What's the plan of they hike up later??

 

[nicholasuk40]

@sadie_the_cat66 You can always reduce the coverage to 50 L and still be fine

 

[wylted]

@resjudicata Are you sure that this 85 lakhs isn't so high a number because the insurance was covering it? Often private hospitals swindle rich people and hand them bills > 50L. Stating upfront that you don't have insurance helps reduce the expenses considerably

 

[nicholasuk40]

@wylted That is not true. You can might a discount on the final bill, but the charges are linked to your room ( private AC room or shared room or suite). I mean if you go to a small town hospital, you can negotiate but this won't work with big hospitals in metro cities

 

[jpag]

@resjudicata I was looking at them as well, but they don't cover above 60.

 

[annson]

@highonluna Why arent u considering govt owned insurance companies?
u can also check with your bank for a group health policy. You can saves loads of money on your parent health insurance.

 

[highonluna]

@annson I was also wondering the same while going through the posts in this subreddit. Despite those guys having a good track record why didn't people go for them. I'm assuming due to fewer features and slightly more premium as you go for more cover. Also, neither were they included in the aggregator platforms nor in the A-rated category HPs in the MSMR list by LiveMint. Also, my lazy ass didn't even search once; thank you for reminding me!

I wasn't aware of the second point; I will enquire with my bank's relationship manager for the same.

Update: Found this article, might clear some doubts regarding point 1.

 

[heliumskylark]

@highonluna

Despite those guys having a good track record why didn't people go for them.

Actually most people go for government insurers. Look how high their customer base is compared to private insurers. I have a New India Assurance policy and I purchased it after researching for many days.

I'm assuming due to fewer features and slightly more premium as you go for more cover.

Yes, they offer fewer features but what's important is that they offer the basics that you need and not the bells and whistles which are just gimmicks offered by private companies to hike your premium.

Premium for gov insurers are always the lowest in the industry. They have ICR above 100%. So if any private company is offering even lower premium, you should be very wary of them.

Gov Insurers impose room rent capping and other sub-limits and that is the reason why many people don't prefer them. I think room rent capping may not be a bad thing as nearly all other expenses are tied to your room rent. If you go for a higher priced room, all other expenses are also hiked in proportion. So the trick is to decide in advance what kind of room you are comfortable staying in and the rent for that room in hospitals near you. Then you can go for a cover that is minimum 100x your chosen room rent. That way your entire bill gets covered by the policy.

 

[nina723]

@heliumskylark Thanks for the insights. Few queries if you don't mind sharing your experience
1. Did you visit their office to get the formalities done?
2. I already have a coverage through my employer which discounts any pre existing illness, I would probably go for partial reimbursement for any extra bill incurred. If you have already made a claim, how was your experience?

 

[heliumskylark]

@nina723 I purchased online and also pay my yearly premiums online. No need to visit office or contact any agent.

I never made a claim but my father has and he has the same policy. Experience was good but he purchased his policy through agent. But I doubt agent makes a difference since hospital's insurance desk will help you process cashless claims anyway. If reimbursement is needed, then you will have to fill up claim form and send in all required documents within 7 days of discharge.

 

[trthetrny]

@annson Doesn't govt owned have a room rent cap ?

 

[kcool]

@highonluna Commenting for future reference.
Ps. A very detailed search mate. Good job