Health insurance & YOU

GR asked, is it ok to take the health policy online or it is advisable to take it through some agent? will the agent be helpful in settlement of claims in future?

Harsh Roongta answers, If the pricing is same (sometimes a particular policy that you like may be available only online) and your agent is an active broker/agent then there is no harm in buying through an agent/broker as an active agent/broker does assist in the claim process. But take care that Insurance is a serious business for teh concerned broker/agent so that s/he has the infratsructure and the motivation to assist you in your need.

UMESH asked, HELLO I AM 38 MY WIFE 37 AND 2 KIDS 8 AND 2 YEARS AGE MY ANNUAL INCOME IS 2 LAKHS AND MY WIF 1.5AKHS I WANT GOOD FAMILY FLOATER PLAN SINCE IAM KEEPING ILL HEALTH.

Harsh Roongta answers, You have not specified the nature of the ill health that you are keeping. All policies will normally exclude existing illnesses (except for diabetes and blood pressure which some insurance companies allow to be covered at an extra cost). As long as you have correct expectation from what the mediclaim kind of policy will give you you should go for a relevant health plan. In fact covering your family immeidately is critical while they are still healthy. You can use this link to see some of the mediclaim kind of helath plans on offer. http://www.apnainsurance.com/health-insurance-india/compare.html. You can also talk to your insurance broker/agent for advise on this.

mahee asked, Do we get money back incase of maturity of health policies? ( Critical illness, mediclaim, accidental)

Harsh Roongta answers, No and i think you should not expect it also. All money back plans (whether endowment type or ULIP type) give you back your own money. So if you go in for such policy the premium you will be substantially higher than what you pay for pure risk cover policy. Also it is a cardinal principle of financial planning that you must first cover risks adequately before you begin investing. If you are insistent on getting health plans with money back then your choice is limited to LIC health plus and a similiar policy from Reliance Life Insurance company. But please remember neither of them are a substitute for mediclaim kind of policy which you must take beforfe you consider buying these health plans from these Life Insurance companies.

Manoj asked, Sir, I am having a family Health Insurance policy with National Insurance. My self and wife is insured with Rs. 1 lacs each and one daughter with Rs. 0.50 lacs. On my policy I am availing Bonus of 25% as on date. I would like to convert this policy in January 2009 when it become due for renewal in to the family floater. My question is weather the policy can be transferred into the family floater and bonus will be be continued. The benefit of the family floater as old policy holder will be available to me or not.

Harsh Roongta answers, I am assuming that you are thinking of taking a floater for Rs. 1 lakh. You shoud think twice about doing this as the premium that you save by moving to a Floater plan (inlcuding premium rebate for no claim in the year 2008-09) may be very small as compared to the additional risk of hospitalisatioin expenses exceeding Rs. 1 lac if all 3 of you are exposed to hospitalisation (say due to an accident). Please consult your personal finance advisor but our advise would be to stay covered on an individual basis and to increse the sum assured, if you can afford to do so.

AKC asked, I am having Mediclaim insurance for the last 10 years without break from national insurance. Last year in Oct 2007, I rolled over to reliance general insurance. I was admitted in July 2008 for spinal injury. Reliance denied claim as pre-existing desease. Is pre-exisisting desease is not covered in rolled over policy?

Harsh Roongta answers, I am assuming that the Spinal injury is not a result of an accident but arose from an existing illness. If it was an accident than it should have been covered even in the first year. All Insurance companies have certain exclusions which are not covered in the First year of coverage. For reliance you are a new client and hence may not be reimbursible. This brings out the importance of sticking to one insurance company if you have built a track record already. That is more important than any savings you might make by moving to another company. If at all you want to experience the product of another company you should take the polciy for an additional amount with them as and when you decide tro increase the sum assured on your policy.

arunk asked, i am 44 years hni with no health insurance & no current illness what kind of health ins should i go, I need money only in case of a very major illness

Harsh Roongta answers, Even though you are an HNI would advise mediclaim kind of coverage. Off course you should also look at a critcal illness plan from Life insurance companies. See this article for why you should take critica illness cover from Life insurance companies rather than non life companies. http://www.apnainsurance.com/articles/health-insurance-india/Health-insurance-life-insurer-or-non-life-insurer.html. Off course if you have sufficent assets and savings your life insurance requirements might be low to nil.

skalra asked, Dear Mr Roongta I am a senior citizen (65 years old) and my wife is 61. I have had a Mediclaim Policy for Rs 5 lakhs each for myself and my wife since 2000 (when I retired) with Oriental and have never claimed a Rupee. By the grace of god we both enjoy excellent health....but one never knows! I am told by everyone that When the time comes Oriental never pays, and if they do you have to give heavy bribes. And once you make a claim they discontinue the cover. I would seriously like to switch over to a private insurer while our health is good. We don't mind a medical check up...and in fact we have a comprehensive one each year. And I'd like to raise the amount of cover since Rs 5 lakhs doesn't get you much these days. your advice will be greatly appreciated. Thanks and regards

Harsh Roongta answers, Dear Mr. Kalra - All insurance companies including PSU insurance companies are governed by strict regulations of IRDA. Also claim process is handled by the third party Administrators. Your no claim track record is extremely important and would strongly urge you not to switch your insurance comapny under any corcumstances. Please remember that any claim dipute is adjudicated by Insurance ombudsman and a valid claim (especially given your long no claim track record) will be paid.

Piyush asked, Self 35, Wife 34, Child 4 , Daddy 68, Mummy 66, I have got the policy for all of us from our company floater of Rs.3 Lacs with annual premium 13,700, what if I change my Job want to get the personal mediclaim which can continue even I change my Job , pls advise

Harsh Roongta answers, Good question. Fisrt check if the company group policy allows you to take it along with you when you leave your job (some group policies do allow it). If so then there is no need to take any additinal policy if you think the coverage is adequate. If this is not allowed then consider taking an additional smaller mediclaim policy to build your no claim tarck record. When you leave your job you can increase the coverage at a later date by paying higher premium.

BSS asked, Roongta sir, I am sorry but are you typing so slow that you can answer few questions only here and later on if people need help then they should buy your services?

Harsh Roongta answers, Sorry for the limitations of my typing speed. will try and spill over for some time. After that you can put in your questions at http://www.apnainsurance.com/health-insurance-query/query.html and we will try and respond to each and every query as far as possible.

ajay1234 asked, I have taken a mediclaim of Rs. 2 lakhs per person from national insurance in 2008 for me, my wife and both my parents. Both my parents are 56 years old. Since I have joined a new job, the both are also covered in the policy of my company. Should I surrender the policy taken personally as the policy of my company covers all four of us?

Harsh Roongta answers, If you can afford it i would suggest that you continue to hold your existing policy. You can aslo consider reducing the coverage amount but keeping your policy alive as it helps in building your no claim track record.

mahee asked, Where do we file case against insurance companies in case of any issue in settling claims?

Harsh Roongta answers, Please use the services of the Insurance ombudsman which is very effective. You can file complaints even online. Please use this link www.irdaindia.org/ and go to the ombudsman tab on the left hand side of the website.

rakesh asked, Is there any disadvantage if we buy health insurance as part of group insurance (for e.g linked to account holders of banks) if the right cover amount is taken.

Harsh Roongta answers, Please confirm that the no claim track record is available to you even if you stop having that specific relationship and that you can convert it into an individual polciy from the same insuance company (maybe at a higher cost) but with your no claim track record carried forward from your group policy. If so then it is useful as they are normally cheaper.

asdfg asked, insurance in india as in any other sector is equally corrupt if not more, do u agree?

Harsh Roongta answers, I do not agree. With all regulations in place this is clearly not true. In some cases the problem is with mis-selling where a consumer has been sold an inappropriate policy or the polciy details ahve not been explained to him. The Insurance sector under teh guidance of the regulator (IRDA) is doing a great job in bringing insurance to the door step of the common man and we should refrain from making such generalisations.

Sameer asked, Hi.How is the equity linked health plus plan of LIC? what are your views?

Harsh Roongta answers, At Apnainsurance our advise to consumers is very clear. Separate your insurance requirements from your investment requirements. So generally speaking we do not recommend any combined plans (like ULIP or endowment).

boobo asked, Sir, Insurance companies can reject by simply saying any disease as pre-existing one? Is there any company which covers the insurance for any pre-existing diseases also?

Harsh Roongta answers, The Insurance council has recently agreed on a standardised definition of 'pre-existing disease' which should be implemented soon in all mediclaim policies. This also covers from when the coverage will start for such pre-existing diseases. Some insuarnce companies are willing to cover specific pre-existing diseases (say diabetes and blood pressure) if you pay an additional premium. Some insurance companies cover pre-existing diseases faster than the 4 years that is standard under specific circumstances.

ks asked, I and my wife have diabetes. Which policy you suggest which covers diabetes?

Harsh Roongta answers, Some of the public sector insurance companies cover this at an additional premium. Star health also has a specific cover for this (Type II diabetes only). There could be additional companies who cover this as well. request you to put your queries at www.apnainsurance.com and our research team will find out a comprehensive list.

SANTOSH asked, good afternoon ! sir, iam 27, married n working in pvt firm. I do not have any health insurance plan. i would prefer the plan in which the expenses in the form of Hospital Bills are borne by insurance company and also they should offer major hospitals in their panels. Pls. suggest.Also the annual premium should be 10k to 20k.

Harsh Roongta answers, Almost any mediclaim kind of plan would satisfy the crietrion laid down by you. For a partial list of such plans please click on his link. http://www.apnainsurance.com/health-insurance-india/compare.html

Vinoth asked, Sir, Self 27, mother 54, father 55, sister 23. Mom is a Chronic Kidney Disease patient. Dad has arthritis. Is there any coverage available which will cover any forthcoming diseases other than existing?? I'm getting married by Decemeber. Please advice. I own a company and we're in the process of talking to agents for employee health insurance coverage. should I go for individual policy or is it better to get the coverage under company's name? please advice.
Harsh Roongta answers, You have very specific requirements and it would be better for you to talk to an Insuarnce broker who will understand your requirements and propose options from various insurance companies.

Harsh Roongta says, Thank you everyone and bye till next time. If you still have any queries you can login into www.apnainsurance.com and we will try and answer all of them. Thanks and take care.