Health Insurance Process and Review

[favoursaks]

@danviking03 Where did you find the ICR for Insurance companies? Please share the link, I will add that in the Post.

1. Yes, Max Bupa lost me because of their reviews and lower hospital coverage in my area.
2. No, for AIG and IIFCO. My requirements of No Co-pay and No Room limit filtered them out.

Any confirmation or link about OCT 2020 IRDAI order? does it apply to existing policies?

It is applicable. Max ReAssure Plan is based on Max Health Companion Plan with these new guidelines in mind.

1. I could not find ICR documents. Share the link, I would also look into that.
2. Please see my comments HERE .
3. +1 for mega-thread.

 

[danviking03]

@favoursaks

AIG and IIFCO both have no room rent or type capping , almost good as reassure but costlier. I contacted them directly, so not aware what policies aggregators are selling.

I contacted and liked RoyalSundaram and liked it as it was cheap and deals with TPA. All discussion based on minimum 5 lac SI or more. TPA network and experience is fine in my area (Bangalore)

 

[danviking03]

@favoursaks Here is one report

https://www.comparepolicy.com/blogs/irda-incurred-claims-ratio-for-year-2018-19/

but it does not have specific ICR for health policies served by general insurers.

 

[favoursaks]

@danviking03 Thank You, My limited search didn't turn up anything useful about this earlier. I would also look into this.

 

[danviking03]

@favoursaks found even better
https://www.moneycontrol.com/news/b...rs-incurred-claim-ratio-improves-5060391.html

 

[favoursaks]

@danviking03 This article was updated on 26-Mar-2020. Lockdown was started on 23rd. Next Update of this article will include impact of Corona. It will be interesting. Thanks for sharing

 

[danviking03]

@favoursaks Max Reassure have a safeguard rider to cover consumables. AIG new policies cover it by default but cost more compared to reassure with rider

 

[pilgrimparson]

@favoursaks Thank you for the post. Very informative and helpful!

One question:
If I buy an individual health insurance plan, will it be possible for me to port to a group health insurance plan later when I get a job?
I believe group health insurance is better but currently i'm not employed.

 

[favoursaks]

@pilgrimparson Sorry, I think you have misunderstood something.

An individual can buy 2 types of plans - Individual or Family Floater.

However, companies offer "group" health insurance for employees of other companies. You can think about it as a Family Floater where your family has thousand members.

It is always better to have your own (individual or family floater) health insurance. Otherwise, If you change your job or you are not employed you may lose the cover and you will have to restart the clock on pre-existing diseases.

 

[thimbleberry]

@favoursaks Just to add to this , the insurance product provided by Kuvera ( in partnership with AXA) is a group insurance one but you can still purchase it as individual.

 

[pilgrimparson]

@favoursaks Yes, I'm talking about the group insurance that is provided by the employer. I know that porting the employer given health insurance into individual health insurance is possible.

If we transfer it before we lose/quit the job, we don't have to restart the clock on pre-existing diseases:
https://economictimes.indiatimes.co...ance-policy/articleshow/65967413.cms?from=mdr

However, I don't know if it's possible to do it the other way, i.e. start with individual then port to group.

I'm aware that we can have both individual and group insurance. However, group insurance provided by the employer is paid for by the employer and normally has better/faster settlement process (i've heard).

 

[favoursaks]

@pilgrimparson It was not my intention to offend you.

In addition to the group cover, having an individual policy always helps. Even though the migration is allowed, there could be health concerns and the fresh medical underwriting may pose problem.

The link itself argues in favour of keeping an individual policy (in addition to group policy)

I also am not sure if it is possible to port individual policy to the group. Maybe someone better informed can help.

However, group insurance provided by the employer is paid for by the employer and normally has better/faster settlement process (i've heard)

Anecdotal point, I had group insurance policy with my employer. Employees brought their parents into the policy, (ab)used it and the next year premium overshot even the best plan available in the market

 

[keepitsimple144]

@favoursaks Thanks for posting this

But, why do you want the super top policy to be ported wherever you port your base policy?

 

[favoursaks]

@keepitsimple144

why do you want the super top policy to be ported wherever you port your base policy?

If, in future, I port the base policy of my parents then there will be effectively two separate policies with different companies and I don't want this sort of headache for my parents.

This is totally personal preference.

 

[keepitsimple144]

@favoursaks ok, got the context now. Thanks.

 

[wylted]

@favoursaks HDFC has different premiums for each city, how does this work? Is treatment limited to the city that you choose? I guess other insurers would have something similar too.

HDFC OR has an exclusion "Abuse of intoxicant or hallucinogenic substance like drugs and alcohol", does this mean anyone who drinks might face issues with claims or that they'll not reimburse fatty liver or such diseases arising out of excessive drinking?

Family plans are discounted, so how to deal with death of the insured person? Is the plan transferable to the dependent?

Incidentally how much was the difference in premiums between HDFC and Max Bupa? I checked, and at first glance it seemed HDFC was around 11k and MB said "starts at 9k". Were you referring to 2k, or is there something else that I'm missing?

 

[joneshomes]

@wylted

HDFC has different premiums for each city, how does this work? Is treatment limited to the city that you choose? I guess other insurers would have something similar too.

Yes, HDFC Ergo has 3 tiers of cities.

Tier 1A comprising of Delhi & NCR

Tier 1B comprising of Mumbai including (Navi Mumbai, Thane and Kalyan), Pune, Ahmedabad, Vadodara and Surat

Tier 2 comprising of Rest of India excluding those in 1A & 1B.

If you have the lower tier policy, then you will be paying 20% Co-Pay if you get treated in a higher tier city.

Source:

https://www.hdfcergo.com/OnlineProducts/HealthSurakshaOnline/FAQ PDF/HealthSuraksha.pdf

 

[favoursaks]

@wylted

HDFC has different premiums for each city, how does this work? Is treatment limited to the city that you choose?

Yes, it is different depending upon the Pin Code. I looked for all-India coverage in both CoverFox and BankBazaar as well as on the site of HDFC Ergo.

HDFC OR has an exclusion "Abuse of intoxicant or hallucinogenic substance like drugs and alcohol"...

If you are talking about list of exclusions given then that is now common to all policies under IRDAI guidelines.

If you mean that HDFC is asking about drinking/smoking habits then it means insurance companies calculate your premium based on your habits and likelihood of relevant probability of hospitalisation. Some companies discount premium for non-drinkers /non-smokers. I don't know if HDFC or Max Bupa does that.

Family plans are discounted, so how to deal with death of the insured person? Is the plan transferable to the dependent?

In the policy, there is a provision for nominee. I am unsure about what that entails. Maybe someone better informed can tell.

Incidentally how much was the difference in premiums between HDFC and Max Bupa?

HDFC Yearly premium is 46% higher than Max. Effectively, I can purchase double SI from SI for the price of what am I getting from HDFC. You can definitely question my judgement but I am going for HDFC because of better reviews and Coverage of key hospitals in my area.

 

[vtachy]

@favoursaks Kuvera is now offering a group health insurance plan. Have you had the chance to take a look at their terms?

 

[favoursaks]

@vtachy Relevant Thread has information about it and Kuvera CEO himself clarifying some points.

My personal concern about the group health policies is this:

What happens when Kuvera decides to go with different policy provider 5Y down the line?

May be your nearest /best hospital is covered now but there is no guarantee in future.

With your individual policy also there is a chance of exclusion of your favourite hospital from the cashless system. But that probability is low and you have more control over it (i.e. you can move away from that policy if this happens).

I am noone to recommend for or against an insurance plan. Please go through the T&C and find the best option for you.