Health Insurance Process and Review

[favoursaks]

Update: There are 5 edits in this post with updated or corrected information. Please go through them if you have missed something. I am NOT expecting this post to be edited in future. Thank You all for the updates, correction and participation.

Recently, I was searching for Health Insurance plans for my parents (both 55+) for ₹10-lakh Sum Assured (SA). I stumbled upon this excellent post by @tail0rmade22 and used it as my initial template. Because that post was a year ago, I want to collate /update /reiterate the information. My post will be long and some advice will be repeated but I am hoping for your comments, corrections and personal experiences, if possible.

Basics

• "Health Insurance" section of Sub wiki i.e. Insurance is woefully inadequate and old. However, it covers the basics. Before diving deep into the subject, understanding of basic terms is essential.
• Personally, I found this PDF a decent read. Suggested by @sisterdonna in this comment

I decided on following points –

• Family Floater Plan – Because both are in similar risk profile.
• No Co-Pay
• No Room Rent Limit (sub-limit)

With these minimal conditions, both CoverFox and BankBazaar effectively bound me to choose between HDFC Ergo and MaxBupa.

• Care & Birla were out because of "Single Private AC" on Room limit and 4Y for pre-existing conditions

Edit 3: I want to clarify here that "Single Private AC" and 4Y for pre-existing conditions are NOT bad, as such. But, in same class, HDFC and Max are providing ALL Rooms and 3Y for pre-existing.

• My notes are missing the reason for exclusion of Royal Sundaram but I guess, it was probably its premium and Hospital coverage in my area.
• ICICI Lombard – Both Coverfox and BankBazaar does not offer any product from ICICI. Its premium (on its website) turned out to be costly. See Below for details.

"HDFC Ergo Optima Restore" vs. "Max Bupa Health ReAssure"

• Premium – HDFC premium is much higher than Max. For my parents, HDFC Yearly premium was 46% higher than Max Bupa (Yes, it is NOT a typo).
• Pre-existing diseases - Both cover them after 3Y
• Both provide no-claim bonus of 50% for 2Y i.e. 100% cumulative and both deduct it by 50% after claim. (sidenote: Max Health Companion plan will NOT reduce it after claim. However, it charges higher premium)
• Hospital Coverage – HDFC has much wider coverage compared to Max.
• Reviews – HDFC has better reviews than MaxBupa about their claim settlement process.
• Decision – HDFC (Higher premium but better chance of support.)
• Edit 5: Decision – I have purchased Max Bupa despite their bad reviews. Originally, my Parents mistakenly identified a key hospital unavailable with Max. However, it was available in its network. With this change, the difference in premium between Max and HDFC became too much to handle.
• Originally, I was going with 5-lakh SA with Super Top-Up. But, after more consideration about the total cost and headache involved for the parents, I decided to increase SA to 10-lakh without Super Top-Up. See Below for details.
• "Critical Illness Rider" is supposed to open to interpretation by the company, so I decided against it for now.

Coverfox:

Coverfox sales person was good and tried to find out actual answers if required. However, Coverfox site has not been updated with latest plan (MaxBupa Health ReAssure) due to Covid-19. Further, their site also does not show correct list of hospital coverage. Personally, this was a deal breaker. If they can't be bothered to update their product listing, I am doubtful of their claim about great support during claim settlement process.

BankBazaar:

• BankBazaar site is good but their salesperson kept giving me misleading or inaccurate information.
• He told me that if I buy the policy from them using Credit Card, they will give me 0% interest rate on EMI and that offer was available only for that day.

I checked, the policy site itself is offering same reward even today.

Edit 4: The website of insurance company didn't offer 0%EMI on credit card, so I bought my policy with Policybazaar. They gave me discount on total premium. Thus, although bank will charge EMI interest on my card, effectively I am NOT paying anything extra.

Others:

• InsuranceDekho does not have good plans or enough plans
• Myinsuranceclub was so bad that after 30min, I was not able to see any plans on the site
• PolicyX – See This Comment

Claim Settlement Ratio:

The document to check this is called "NL25". Every Insurance provider has this uploaded on their site. Although, this is cumulative information for all their policies but still it provides a base to compare.

ICICI Lombard:

As stated above, it is not a partner to either Coverfox or BankBazaar. Its premium was higher than even HDFC. However, it also offers coverage of pre-existing diseases after 2Y (compared to 3Y by HDFC). (As stated by both Coverfox and BankBazaar) Problem with ICICI is that when its premium band changes, after 4 or 5Y, the premium shoots up significantly.

One thing to add vis-a-vis ICICI Lombard. Purchasing it via Amex will give you a dedicated Amex team to handle your queries and claims.

This Comment by @lbeebe48

Exclusions:

Earlier, there were a list of consumables (Syringe, Gloves etc.) and administrative expenses (Application fees etc.) which had to be paid by the policy holder but Oct-2020 onwards, IRDAI has disallowed these exclusions. If someone has any experience regarding this, I would be grateful.

OPD Coverage:

Be aware that, unlike in some other countries, HEALTH insurance in India is actually HOSPITALIZATION insurance (with some exceptions). If you get expensively ill but do not require hospitalization, you get nothing.

this comment

I really wanted a policy with OPD Coverage but their premium or the rider are very high. I would have paid additional ~3,000 yearly for OPD coverage limited to ~5,000 yearly. If anyone is interested, it is covered in HDFC ERGO Health Wallet.

Super Top-Up:

Yes, Super top up is another policy on it's own. You even get a separate insurance card.

Top-Up is effectively a separate policy and if I port the base policy, Top-Up is NOT ported.
Please see This Comment by @joneshomes

Critical Illness Rider:

It is supposed to open to interpretation by the company, so I decided against it for now.

References:

• Buying Health Insurance (plus a review request)
• Is health insurance worth it in India ?
• Monthly Thread for Insurance Products - Please go through at least 1Y of posts and comments. Some of the advice is Great.

EDIT

Privacy:

Both CoverFox and BankBazaar had kept all medical and conversation information of mine for 2Y atleast. In 2018 also, I tried to convince my parents to buy Health Insurance but they were not interested then. Hence, I didn't buy any product from either site at that time (2018). Please remember this when you talk to anyone.

Edit 2:

More References:

• Health Insurance vs. Corona Kavach by @brightflame
• Process similar to mine but got different opinion by @highonluna

Incurred Claim Ratio:

It can be found Here provided by @danviking03.
It is NOT extremely relevant for established companies but it is better to have an idea about this.

Disclaimer: I am NOT a professional in financial field. Feel free to discard my advice at your convenience.

Who/why need Health insurance in India?

YES, Everyone needs to have Health Insurance.

If someone can't afford Health Insurance, He/She definitely can't afford Hospitalisation.

Health Inflation in India is much higher than normal inflation and we need to be on this band wagon.
Further, You can account for your Food, Shelter, Education and other living expenses but Health Expenses are extremely high and sudden. Health Insurance reduce their impact on your lifestyle to a certain extant. I want to add many more sentences here but I don't want to repeat the linked posts above. Many smart people have given much better reasons, please read them.

Edit 3:

PSU Insurance Companies vs. Private

I want to clarify that Government Companies may turn out better or more reliable. My personal preference is more towards 'Ease of Doing Business' and the perception is that private companies are much better in this regard. After some suggestions here, I looked at 2 of them. One had high premium with lower benefits and the other (SBI) told me that they can't take my money online (!) and I need to contact their office if I want to give them money.

I believe that in 2020 this sort of headache is not worth the effort (for me). But, please look at the policies if you are interested and feel free to share your thoughts /experiences.

• This Comment by @slandley provides his relevant experience.
• This Comment by @elon has some interesting opinions. I don't agree with them but his/her experience is relevant.

Edit 4: See Above

Edit 5: Co-pay & Deductible (Also See Above)

• Why Co-Pay is bad for health Insurance by @sirjude asks this question.
• This Link talks about Co-pay vs. Deductibles. I am NOT going into details because the difference is clear.
• This Link discuss this in some detail. It advocates my thoughts on this matter.

Personally, I do not want to concern or limit myself to the question of cost of the medical care at the time of Health Emergency. If their is a co-pay clause, my parents will look for cheaper hospitals too whereas I want them to go for the best possible option (within my limited means).

Tl;dr: Health Insurance purchase turned out to be a 1 week involved exercise for me and even then I made some mistakes. Please read thoroughly and decide wisely.

 

[curiousstudent]

@favoursaks Great work mate.

 

[favoursaks]

@curiousstudent Thank you for the praise and award

Actually I had to leave out a lot of policies specific info and common info also because the post was already long enough.

But, it was fun

 

[jakob1997]

@favoursaks Did you consider Icici Lombard group Insurance? It is available for all ICICI account and CC holders. Can be applied via netbanking. PE disease allowed after 12 months. Premium is comparatively less. Good coverage of cashless hospitals.

https://www.icicibank.com/terms-condition/rib-tnc/health-insurance-product.page

 

[favoursaks]

@jakob1997 No, because I am not interested in any type of Group Insurance. I know these policies have some advantages. But, I have replied to some other user about "Kuvera Group Insurance" and same concern will be applicable on ICICI also.

However, I agree that it may suit your purpose. I am recommending neither for nor against them. This is just my personal preference.

 

[malvikaadhikari]

@curiousstudent Found this checklist really helpful, while doing some research on health insurance

https://simplify.healthcare/#about

 

[joneshomes]

@favoursaks Good write up. I will add the difference between top up and super top up for anyone reading in the future.

Top-up will pay a single bill above the deductible, limited to the coverage amount.
Super Top-up will pay any number of bills above the deductible, limited to the coverage amount.

As I understand this, top up policy is not really a great choice, so one should look for super top up.

I personally have individual insurance for me and my mother and a single super top up for both. All from HDFC Ergo, but I have no experience of taking advantage of the insurance yet.

I have seen some 1-3 crore health insurance with global coverage option from MaxLife and Aditya Birla that I am considering for myself. Would appreciate any reviews for these 2 companies.

 

[keepitsimple144]

@joneshomes I thought there aren't much options for senior citizens when it comes to Super Top-up.

Do you mind sharing base policy provider ,SA and super top-up policy provider, SA you considered for your mother?

My mother(68) has one health insurance of 2.5 Lacs and another 5 Lacs from Royal Sundaram

 

[joneshomes]

@keepitsimple144 HDFC Ergo my:health Medisure Super Top-up does not cover everything, like organ donation, but it was cheaper and looked good enough to extend the base policy. I will recommend reading the policy document carefully if you're considering only buying the super top up.

You can get the super top up policy for senior citizen (without existing conditions) but you will have to get a medical checkup done for anyone above 55 as per HDFC Ergo website. I didn't have to because my mother was 51 when I took the policy.

Base policy is "my:health Suraksha" with 5 la and super top is 20 la with 5 la as the deductible.

 

[danviking03]

@joneshomes @joneshomes

all companies do not cover pre/ post hospitalization, screening cost of uninsured donor or any other payment made to the donor and only the hospitalization part for organ extraction only ( complications might not be covered, not sure here) . Not sure about organ transportation.

Apart from that companies have sub limits on organ donor expenses. what is it with your policy or is it upto sum insured?

 

[keepitsimple144]

@joneshomes Thanks for sharing the details, I guess I missed the bus. One should be less than 67 at the time of applying HDFC Ergo Medisure Super Top-up

 

[favoursaks]

@joneshomes

I personally have individual insurance for me and my mother and a single super top up for both

I want to confirm the following: Super top-up term is also yearly (or 2 /3 years) i.e. effectively it is another Health Insurance which has its own T&C.

Because, I decided this will be too much for my parents to handle.

 

[joneshomes]

@favoursaks Yes, Super top up is another policy on it's own. You even get a separate insurance card which you can print and give to your parents. In a networked cashless hospital your parents wouldn't have to deal with a lot of details, just gotta keep both cards/policy number with them. But take it with a grain of salt since I haven't tried making a claim yet.

 

[favoursaks]

@joneshomes Thank You for the clarification.

This is the main reason because of which I decided to go with higher SI but no Super Top-Up.

 

[danviking03]

@favoursaks Higher SI may not be sufficient for complications in older age but 10 lakhs is good enough doubling up as 20 within two years anyway. If you can afford it is good to have but yes this is optional. I agree with the other commentator as it may not be an issue in cashless situation at all. Also it may not be available if anything happens.

Simple procedures are about 3 to 5 lacs these days in Bangalore and 20 lacs is good enough to cover most complications in a single hospitalization.

You have enough time to decide to buy super top up later. Perfectly fine choice otherwise.

For higher SI , I thought of care advantage from Religare but the policy was costly and had less features and a 4 year waiting period.

 

[sgraves76]

@favoursaks Thanks mate. Good read, I'm currently without a proper job and never had to buy one for myself or my parents. But gearing up the future. Have a great year ahead!

 

[slandley]

@favoursaks my relative works in insurance and he advised me to go with govt insurance companies. reason: initial premiums and other facilities are good for private players (eg: hdfc ergo, which i own) however, when one reaches 45 years of age the private players hike the premium like anything. I am with hdfc ergo from past 3 years and 4th year they increased the premium by 27% (I have not touched 35 years of age), when enquired what they told is they even cover in house treatment which when i enquired is tricky and understood one can never claim for that.

 

[markpote69]

@slandley

govt insurance companies

Any Govt company which he recommended?

 

[megusta]

@slandley I didn't know health insurance premiums could go up without any reason or agreement. Is this the norm?

 

[danviking03]

@favoursaks Hi I am going through the same, and this is helpful, thanks

1. I, too , am confused between Max Bupa and HDFC as plan offering was cheaper and had more features I guess. I liked your decision to go with HDFC. Have not heard good things about Max Bupa. Also there ICR is one of the least in top insurers.
2. Have you considered TATA AIG and IIFCO Tokio ? they are costly too and deal through TPA but have features similar to Reassure of Max Bupa
3. Any confirmation or link about OCT 2020 IRDAI order? does it apply to existing policies?
4. Is there any private or stand alone health insurer whose Incurred claim ratio is between 70-90%? I could see HDFC, star having 63 percent and Edelweiss having more than 100 percent?
5. I understand your reason to not buy a super top up now but at older age, it is better to have. I have heard it is usually okay if base policy is with the same insurer. Even if it is not , it can be thought of as having multiple policies option while going cashless. It is also really hard to port between insurers if there are any diseases or hospitalization before porting. Migration is okay.
   
6. General question to all, can we have a mega thread or pinned thread for listing of experience with underwriter with existing medicines and ongoing treatment of diseases. How and when proposals are rejected. I have heard proposals being rejected for Sinusitis , allergic rhinitis, asthma, bronchitis, deviated septum, GERD and related symptoms, constipation, benign prostate, prostatitis, varicose veins. Even if doctor mentioned it is only suspected and not confirmed.
7. Does anyone have any experience with policy issuance after declaring general issues of that of sinus , indigestion or constipation?
8. Anyone denied claim because of delayed treatment clause even after declaring pre existing diseases ?