Faking NCB to save insurance premium

Faking NCB to save insurance premium–: There is no point!

RAJ PRADHAN | 

No-claim-bonus for mediclaim or car insurance is given as an incentive for not making a claim. Car insurance NCB can be transferred to the new insurer. Resist the temptation to save on premium by faking the NCB while moving to a new insurer, else you will face problems when a genuine claim is filed

Amit Kumar (name changed) had a car insurance with Royal Sundaram in 2009-10 and 2010-11. There was one claim in each year. He says, “When I renewed it with HDFC ERGO in the third year (2011-12), I was told by the insurance agent, that he will give No-Claim-Bonus (NCB) and bring the insurance premium amount down. 

When I told him that I had made an insurance claim that year, he said, nothing to worry as I am switching the insurance company and he will manage it. So, I was offered a 20% NCB by the new insurer. Fortunately there was no accident in the third year. In the fourth year (2012-13), I purchased online insurance from Royal Sundaram. I was offered 25% NCB as there was no accident or claim in that year and also there was 20% NCB mentioned in my HDFC ERGO policy.”

Kumar met with a small accident in last week of Nov 2012 and was in for a shock. TheRoyal Sundaram executive called up after a good 5 days and told him that he had wrongly claimed NCB, for which he was not eligible from HDFC ERGO in his third year. HDFC ERGO had gone back and checked the claims made in prior years and unilaterally reduced his insurance tenure from 12 months to 10 months to adjust for the NCB claim. In effect, says Kumar, “My insurance with HDFC ERGO ended in August 2012 itself. After I made claim in December 2012, I was told by the Royal Sundaram executive that I had misrepresented the facts when buying online policy in October 2012.”

Clearly, Amit Kumar fell for a glib-talking sales agent who said he could fix the problem. However, on the face of it the fact is simple—Kumar knew he had claimed insurance and was still claiming a NCB. Remember, buying car insurance with fake NCB is as good as not having any insurance. You may be tempted to ask for NCB when changing your insurance company in the hope that the new insurer will not find out and that you get a clean slate going forward. After all, NCB can give up to 50% discount on Own Damage premium. But someone who is in the habit of claiming insurance almost every year ought to be even more careful.

Faking NCB is like washing away the sin of being involved in an accident. Today, insurers share far more data than they did in the past and it is easy to get caught. This is supposed to happen at the time of underwriting and not really when a claim is made, but don’t be surprised if insurance companies share data only when there is a claim.

The NCB rule is clear—“You can avail of the NCB facility if you change the insurer on renewal. 

You would have to produce proof of the NCB earned by way of renewal notice from the current insurer. 

Alternately, you can produce your original, expiring policy along with a certification that you have lodged no claims on the expiring policy. 

For this, the proof can be in the form of a letter confirming the NCB entitlement from the previous insurer.”

Manipulation of NCB is a major cause of claims denial. Don’t get lured by agent to ‘fix’ your NCB and give good premium rates. The insurance company may just play dumb until there is a claim even though they should validate the NCB claimed by customer at underwriting. It is as though the insurance company is underwriting with understanding that they don’t have to pay the claim. Giving any amount of discounts in this case is still profitable for company. There cannot be anything more risk-free for the insurance company!

The customer is supposed to have signed the insurance contract in utmost good faith. Amit Kumar is clearly at fault, but does it completely absolve HDFC ERGO and Royal Sundaram? Did they do the necessary due diligence?

There are five points worth pondering –

•     Do insurance companies really do underwriting or accept the NCB desired by the customer to make a quick sale?

•      How did the HDFC ERGO agent manipulate the system? Did HDFC ERGO also mis-sell the policy?

•    Did HDFC ERGO realise the misrepresentation and reduce the policy term from 12 to 10 months?

•     If Amit Kumar (policyholder) knowingly misrepresented facts, what happens to the pending claim with Royal Sundaram and the status of existing insurance cover (2012-13)?

•    Was Royal Sundaram aware that Amit Kumar availing 25% NCB (2012-13) was already insured by it in 2009-10 and 2010-11 and had claims in both the years?

Agents represent insurance company while brokers represent you. Brokers have more responsibility than agents in case of mis-selling. What are the steps taken by some brokers to ensure that NCB is not manipulated by their client? 

If No-Claim-Bonus (NCB) is wrongly claimed, your claim will be rejected and your policy cancelled. The agent is contractually not liable to you. Don’t fall into the agent’s trap of a false NCB lure. The company will wake up at the time of claim and uncover your wrongdoings

Brokers have more responsibility than agents in case of mis-selling. According to Avadhoot Mavlankar, principal officer, Shinrai Insurance Broking Services, “We take the renewal notice from the client, but we also insist on a NCB confirmation letter duly signed by the client, especially from unknown clients. This is because the renewal notice is generated one to two months before the policy expiry. A claim can occur after renewalnotice issuance and prior to the expiry of the policy.”

He added, “An agent represents the insurance company, so contractually the agent is not liable to the insured. In my opinion, this is purely Mr Kumar’s fault. Insurance contracts are contracts of utmost good faith. Let alone the good faith, Mr Kumar has purposely declared wrong NCB entitlement. So his case is weak.”

Sure, Mr Kumar is at fault by blindly agreeing to HDFC ERGO’s agent, but how did Royal Sundaram not know that Mr Kumar was their customer for two previous years with the same car and had made a claim in each year? In era of computerisation, it is almost certain that the insurance company knows or should know more at time of underwriting. Once the claim is filed, the insurance company goes in overdrive mode to scrutinize your NCB and it is indeed a perfect trap to proclaim that policyholder erred with NCB while buying the policy and hence no claim is payable.

When contacted by Moneylife, Royal Sundaram claims that HDFC ERGO had unearthed the fake 20% NCB and hence reduced policy term from 12 to 10 months. Interestingly, Royal Sundaram is unwilling to give that in writing to the policyholder. The only reason given for claims rejection is that the customer misrepresented the facts while buying policy with Royal Sundaram.

HDFC ERGO has maintained stoic silence when asked by Moneylife. If Royal Sundaram is true about its assertion, did HDFC ERGO take any action against its own agent who lured Mr Kumar to go for 20% NCB even though the agent was told by the customer that he has one claim in each of the previous years? The agent claims that he does not remember as he had sold the policy more than one year ago. How true, considering that it may be routine for this agent to bait a prospect with NCB manipulation! 

According to Mr Kumar, “I tried to check with HDFC ERGO executives if they had intimated to me about the shortfall in the policy. They are saying that they are unable to retrieve the details and that they would have informed me by phone or letter. I am sure that I have not received any letter or phone or mail from them about the shortfall. I have not changed my address.”

Avahoot Mavlankar, says, “In normal course HDFC ERGO (new insurer) would confirm the NCB entitlement from the old insurer (Royal Sundaram), till this time the policy is already issued with NCB declared by the client. Now, HDFC ERGO would have got the reply from Royal Sundaram that client has made a claim and hence there is no NCB entitlement. So, there is NCB recovery amount due from the client. In normal course, HDFC ERGO would have sent the notice for the same on the policy address (which may be different from communication address). The insurer might not have received any reply from the client within the stipulated period, so the only option available to it is short binding of the policy i.e. adjust the recovery amount by curtailing the period of insurance. HDFC ERGO must have also issued endorsement to that effect.”

After the claims rejection by Royal Sundaram due to misrepresentation, the insurance policy is technically no longer valid. Mr Kumar did not get any response from the company about the status of the policy. He was kept in a limbo for few days until Royal Sundaram agreed with Moneylife that the issue needs to be closed to ensure that Mr Kumar is covered going forward.

Royal Sundaram agreed that they will make a decision on underwriting fresh policy or recover the NCB amount to continue with existing policy. If not, then Mr Kumar will not have any cover during the interim, which can be huge liability for him considering that he has been having accident almost every year! Mr Kumar, if your car driving is so bad, how dare you to go for NCB considering that you are financially well-to-do working in the IT field?

On 18 January 2013, Mr Kumar received email response from Royal Sundaram that the OD (Own Damage) portion of the policy stands cancelled with effect from 15 January 2013. Looks like the insurance company decided to cut-off business from Mr Kumar.

source : http://www.moneylife.in/article/faking-ncb-to-save-insurance-premiumndashii-there-is-no-point/30835.html?utm_source=PoweRelayEDM&utm_medium=Email&utm_content=Subscriber%23111138&utm_campaign=Today%27s%20Exclusives

Can I take Mediclaim Policies from two different companies?

1. Claiming mediclaim from two different insurance companies

A mediclaim policy is a reimbursement policy which means you can get back the money that you spend. Obviously, you cannot profit from such a policy. So the total amount you can receive on a valid claim will be restricted to the amount you have actually incurred.

Since you are maintaining two different policies from two insurance companies, they will pay the claim to you on pro-rata basis of the sum assured you have from both the insurance companies.

For example, if you have a mediclaim policy of Rs 1 lakh from company A and Rs 2 lakh from company B and the amount of claim is say Rs 90,000, then according to the 'Principle of Indemnity' company A will pay you Rs 30,000 and company B will pay Rs 60,000.

http://getahead.rediff.com/slide-show/2010/sep/14/slide-show-1-money-making-profits-from-health-insurance.htm

2. Can I take Mediclaim Policies from two different companies? What is the maximum health insurance cover a person can take? Is the waiting period covered under a health insurance policy for pre-existing diseases,etc., will also be applicable/admissible on another/additional mediclaim policy taken from another company? What will be the claim procedures for health insurance taken frm 02 cos?

Answer

You can always choose to avail 2 health insurance policies and if the limit of one gets exhausted, then you can claim the remaining amount from the other plan.

There is no maximum limit on the health coverage that one can avail. If the insurance company offers a Rs 10 lacs of individual coverage, then you can opt for the same as well. It entirely depends on the underwriter's decision whether you will get the policy or not.

There is usually a waiting periof of 3-4 years for all pre-existing diseases but other illnesses would be covered from day 1.

If you need 2 health insurance plans, it would be a better deal if you opt for one Health Insurance Plan and then a Top Up Plan, where there would be a deductible for the amount of your first plan. In this case, the prmeium would also be much lower than 2 individual policies.

A Top Up Plan provides for coverage of expenses arising from a single illness or disease in one year but only after the intial cover has been exhausted and the premium is usually much less than normal plans. A Super Top Up Plan provides coverafe of expenses for all illnesses in one year after the certain threshold level has been exhausted. This limit is called Threshold Limit.

The premium for a Top Up Plan or a Super Top Up Plan is usually much less than a full fledged Health Insurance Plan.

Bajaj Allianz Top Up Plan, Star Health Super Surplus Plan, United India Top Up Plan and United India Super Top Up Plan are some of the common Top Up and Super Top Up Plans that are available in the industry.

http://www.myinsuranceclub.com/ask-an-expert/can-i-take-mediclaim-policies-from-2-different-cos

3. My wife has taken a group mediclaim life policy of Rs 5 lakh from Oriental Insurance. She wants to take another group mediclaim policy for Rs 5 lakh. Can her cashless hospitalisation bill of Rs 4 lakh be settled under the second policy without affecting the first policy? — A DUTTA

If you have two health insurance policies from two different companies, the claim will be settled by both the companies in a rate proportion of the sum insured with each company. Instead of buying additional basic health policies you can consider a top-up policy like Star Health — Super Surplus Plan. Top-up plans cover the additional expenses over and above the sum insured in the basic policy.

http://articles.economictimes.indiatimes.com/2011-02-02/news/28427665_1_insurance-plan-insurance-policies-health-insurance

Room Rent Sub Limit : why it is very important for health insurance claims

This is a very nice article - one must  read it:

Watch out – Room Rent Sub Limit can really limit your health insurance claims

April 2, 2012 by Harsh Roongta

A lot of health insurance policies are being issued with a specific limit on room rents. For example the health insurance policies of all the 4 public sector companies have a clause that restricts room rents to 1% of the sum insured or Rs. 5,000/- whichever is lower. On the face of it this sounds like an innocuous little restriction that will, at worst, shave off a few thousand rupees of your claim for hospitalization expenses.  But this is actually not so. Here is an example that will illustrate the huge impact of this clause. 

Let’s say you have a mediclaim policy of Rs. 3, 00,000 from an insurance company that has this clause restricting room rents to 1% of the sum insured. That means the room rent limit applicable to you is Rs. 3,000/- per day. Now if you have to undergo a 2 days stay in a hospital for a procedure (let’s assume an angioplasty) that has the following costs: 

1)      General Ward : Room rent Rs. 1,000/- per day  plus all other eligible expenses – Rs. 73,000/- (Total expenses are Rs. 75,000 – room rent Rs. 2,000 plus Rs. 73,000/-) 

2)      Twin sharing room  : Room rent Rs. 3,500/- per day plus all other eligible expenses – Rs. 2,43,000/- (Total expenses are Rs. 2,50,000 – room rent Rs. 7,000 plus Rs. 2,43,000/-) 

3)      Single room  : Room rent Rs. 6,000/- per day plus all other eligible expenses – Rs. 3,88,000/- (Total expenses are Rs. 4,00,000 – room rent Rs. 12,000 plus Rs. 3,88,000/-) 

Now can you tell me what will be the amount you will be reimbursed if you decide to get the procedure done in a twin sharing room? It will cost you Rs. 2, 50,000 (which is well within the policy limit of Rs. 3 lakhs) but how much will the insurance company reimburse you? 

If you are like most people you would have answered Rs. 2,49,000/- i.e. Costs of Rs. 2,43,000/- incurred in the twin room combined with maximum room rent of Rs. 6,000/-. If this answer had been correct then this restriction may not have such significant impact. Unfortunately the correct answer is Rs. 79,000/- only.  

A small fine print tucked away in the insurance policy states that the room rent restriction means that all other expenses other than room rent will also be restricted based on what you would have incurred had you stayed in a room that you were entitled to. In this specific example the room rent sub-limit means that you are not eligible for staying in a twin sharing room. The expenses in the next lower category are only Rs. 73,000/- which is what you are entitled to plus the room rent incurred subject to the maximum limit which makes it Rs. 6,000/= (making it a total of Rs. 79,000/-). 

Very few people actually understand this particular implication of the room rent sub limit and discover it only when they actually make a claim. The pernicious practice of hospitals to charge widely differing costs for the same procedure and exactly the same treatment combined with this fine print in the mediclaim policy makes this restriction a very major restriction.  I mean please remember this limit will remain fixed for years to come even as room rents will keep rising. 

I have no idea how this restriction will work when even the general ward room rates will become higher than the maximum limit of Rs. 3,000/- mentioned in the above example. What can you do now?

 If you are out looking to buy a mediclaim policy, avoid any policy that has such a restriction. If you already have such a policy, then use the recent portability guidelines to shift to any insurance company that does not have any such restriction.  

Of course if you are older than 45 years the new companies who do not have such restrictions may not be willing to provide you this cover. In such cases you will have no option but to plan a contingency fund to deal with these extra expenses that are not reimbursable.

source : http://india.apnapaisa.com/blog/

Hassle free claim on your mediclaim policy

Posted on 21 February 2011 by Harsh Vardhan Roongta

A large number of mediclaim policyholders have to claim re-imbursement from their insurancecompanies for hospitalisation expenses as a large number of hospitals have been removed from the list of network hospitals by the public sector Insurance companies. Most PSU Insurance companies (and some private Insurance companies as well) require you to deal with a Third Party Administrator (TPA) for your claim adding one more layer in the claim process.  At the best of times it takes at least 2-4 weeks for the claim to be settled. Here is a list of 8 things that you must remember to do to make sure your claim re-imbursement process is relatively quicker.

1) Inform the company about the impending claim via email to the TPA (or the Insurance company) as soon as you are hospitalised. The said email is  available on the policy documents as well as the booklet that comes along with the card that you get for each policyholder. The email sent by you must provide full details of the policy number, date of insurance policy, date from which the policy was first taken from the insurance company, name of the policy holder, brief details of the reason for hospitalisation as well as the details of the concerned hospital. Make sure that you take a print out of the same email and forward it by hand or courier and get the stamped acknowledgement on the physical copy as well. If you are using your agent to do this, don’t just depend on him to verbally inform the TPA. Make sure you get the acknowledged copy of the claim intimation email.
2) Get the FIR copy - If hospitalisation is due to an accident then you will need the certified copy of the First Information report filed with the police. If the accident was at home not involving the police (say you slipped and fell in the bathroom at home) get your treating doctor to certify in another letter that the injuries are consistent with your claim that they were incurred in a domestic accident.
3) Get all original bills and reports and discharge certificates and submit them along with the claim (you need to make copies for yourself). Most TPAs nowadays demand copies of the indoor case papers of the Hospital. The hospital will supply you with a certified copy of the indoor case papers on payment of a small fee. Also get copies of any X-ray or MRI films (again available on payment of a small fee to the hospital) since some TPAs have started demanding the X-ray/MRI films as well.

4) Make sure that any bills for diagnostic tests or medicines are supported by a prescription contained in the indoor cases papers or a separate prescription from the treating Doctor. Number all the documents/pages in the claim file. If possible cross reference all expenses and reports with the relevant prescription and bills.

5) Keep copies of all documents submitted to the TPA and get acknowledgement from them in writing for any documents submitted.

6) Make sure that the claim is submitted within 1-2 days of discharge from the hospital to avoid the chances of the claim being denied on grounds of delayed submission. If you have post discharge claim amounts (such as medicines prescribed on discharge to be taken for a few weeks or months after the hospitalisation) you can submit a supplementary claim later.

7) Watch your claim status on the online website: Most TPAs have online claim status on their websites though for obvious reasons they do not publicise it too much (their website address can be divined from their email address e.g. Claim@xyztpa.com means the TPAs website iswww.xyztpa.com). The TPAs have a disconcerting habit of posting fresh requirements regarding your claim on their website without ever actually sending the letter to you.  You will need your policy number to be able to find out the status of your claim.

8)  Every second follow up should only be by email or by acknowledged letter.  This helps build up your case in case any future action is required.

If you follow all these steps hopefully you will get your claim amount relatively quicker and will not need to use the grievance redressal forums provided by IRDA as well as consumer legislation and the regular courts. 

http://blog.apnapaisa.com/tag/mediclaim/

How to Choose Best Health Insurance in India

May 24, 2011 

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Today we will find out how to Choose Best Health Insurance in India . With so many Insurance companies , so many health insurance policies with different names and complex features, it becomes an impossible task for a common man to pick a policy and be confident about it . So I requestedMahavir Chopra from medimanage.com, a vetern in the Health Insurance sector having a vast experience to give some insights to readers on how to choose health insurance product and explain the think step wise. Medimanage is a health insurance broker, which blends unbiased Health Insurance Expertise, Technology Powered Delivery and Professional Claims Management into one integrated service model.  Over to Mahavir from here on -

Health Insurance, as its’ known worldwide is the only effective mechanism known and available that can ensure you to get the best healthcare at affordable price. Whereas, the healthcare industry being more organized abroad, has resulted in insurance companies offering more comprehensive range of products overseas. Comparing this to the Indian Healthcare system, in its current form, can be actually be called by ‘Hospitalization Insurance’. The products that are available in country, only covers for the expenses related to hospitalization charges for accidents as well as sickness. This benefit of course is subject to a looooong list of term and conditions.

Manish asked me to be very specific, and give the readers (of JagoInvestor.com, a blog I admire for its simplicity and rich content) a clear take away on how they can zero in the best product in the market. With more than 25 General Insurance Companies marketing more than 40 Health Insurance products, comparing multiple terms of such policies looks like a daunting task (see a common man complaint to a health insurance company) . It’s not, if you first come to terms with the following 2 things:

1. Settle to the fact that there is no Exact-match, no Perfect Product available.
2. You only compare the crucial features/benefits/terms that will affect your coverage in the long run.

Here are the most important things you must follow when you compare products. Of course, there are other features you can compare, which have been left out in this article. These features (like 1, 2 year waiting periods, Pre and Post Hospitalization Expenses, Loading, No Claim Discounts have been left out, looking at Health Insurance as a long-term product)

1. Cut out the frills. Go Basic

Most frilled products in India are not at all cost-effective. They are the products which take almost double the median premium and offers unnecessary frills is a strict no no. We have all traditionally lived with and survived the cost of routine medical expenses like Consultation expenses, Dentists bills, Medicine bills, and such costs are therefore manageable by most of us, unlike a huge hospitalization bill which could eat way more than a couple of months’ salary or savings.

Bottom-line : You should first look at covering ALL members of your family for the larger “unmanageable” costs, which could burn a hole in your overall financial planning before signing for any fancy product. (see two policies which are cost effective)

2. Don’t Compare Premiums

Never start by comparing premiums. Health Insurance is long-term purchase and it is more than a Mumbai-Delhi Air Ticket, which you can compare and buy from comparison/aggregator websites. Health Insurance is a long-term complex contract coupled with complex services. Comparison of premiums could be largely misleading and could result in a disaster. Comparing Health Insurance requires deeper insights into the overall insurance contract (called policy wordings) over and above price comparison. Either you need to get yourself into comparing the features in detail, or take help of an unbiased health insurance advisor.

Bottom-line: Understanding the benefits and terms is more important than the cost you are paying.

3. Look for Maximum Renewal Age

Maximum Renewal age is the age on which the coverage on your health insurance would discontinue. This could be for all members or for a specific proposer/member, depending on product to product. Remember, your core goal, when you buy Health Insurance is to save yourself from mounting healthcare costs right through your life. A product, which ceases renewal, while you are still alive and when you need it more than any time before, is a BAD product. Shift through all products and find out the maximum renewal age. Better, look for Lifetime products. Rule out all products, which do not cover your family members for a reasonable lifetime. As medical science progresses and becomes more accessible to the common man, life expectancy in India will move higher from the current average of around 70 years. A product with a lower renewal ceasing age than 70 years is a complete no no.

Bottom-line: An insurance product which does not work, when you most need it, is not insurance.

4. Look for Limits (Treatment wise limits & Copay)

Look for treatment wise limits in the products. Treatment wise limits basically cap the amount you can claim for a particular surgery under the policy. Say, there could be limits for Cardiac treatments of Rs. 1.50 Lakhs or for Cataract for Rs. 20000 per eye. Such limits would cap your claim, even n when you have a large sum insured under the policy. You need to weigh this in, before you sign up. Some products I remember are United India’s Family Medicare, Star Health’s Red Carpet have such limits. Bajaj Allianz General and ICICI Lombard have a limit only for Cataract. (Max Bupa Review)

Another condition is the COPAY – it is basically the share of admissible claim that the customer would have to pay from their own pocket. For instance, with copay option of 10%, the claim amount is of Rs. 50,000, and the admissible claim is Rs. 48,000 then the copay amount would be Rs. 4800. The Total amount you would have to pay is Rs. 6800/- (Rs. 2000 deduction in the policy + Rs. 4800 of Copay) .

Couple of products which have Copay

• Oriental Happy Family Floater at 10% of the Sum Insured upto Rs. 5 Lakhs Sum Insured.
• Bajaj Allianz has a copay of 10% for treatment at Non-Network Hospitals in their Health Guard products, and 20% in Silver Health.
• Star Senior Citizen Red Carpet has a copay of 30%. For Pre-existing the copay is 50%.

Bottom-line: Know what you will not get paid.

5. Understand Day wise Cash limit Health Products

There are some products marketed and sold as Health Insurance (Aegon Religare Life, Tata AIG General are the popular ones) which provide a daily cash benefit for the no. of days one is hospitalization. Most surgeries require an average of 6-10 days, so at the Rs. 5000 per day limit multiplied by 10 Days would pay Rs. 50000 per hospitalization, irrespective of the actual charges incurred. An Angioplasty in this will unknowingly burn a big hole in your pocket. Please avoid this product for your core healthcare expenditure risks or as an alternative to a Standard Health Insurance product. This product is more like an add-on cover, than the bigger solution.

Important Note : Do not confuse the above with products that have specific limits on Room Rent. Room Rent Limits, to an extent, make sense both for the customer, as well as the Insurance Company, as they categorize people paying a higher premium in the higher eligibility bracket. This has been further discussed in detail below in this article.

Bottom-line: All plans which are called Health Insurance may not be what you are looking for.

6. Zero in on a Coverage amount/Sum Insured

Sum Insured is the total annual liability under the policy. Since this is a long-term product, you should look at the maximum available cover you can afford.  Remember, a sum insured of Rs. 2 to 3 Lakhs will have no value, by the time you start using it. As per a very recent report on Healthcare in India by Tower Watson, the medical inflation in India is rocketing anywhere between 17 to 20% annual

Option of Upgrading Sum Insured: The option of upgrading the cover at a later stage when you are older is dicey and complicated. There could be a requirement for a medical test. Moreover, if you or any of the family members contact a new disease in the interim, the ailment would be excluded for the upgraded amount. Upgrade would be almost like taking a new policy at that age, which I would not recommend.

Bottom-line: Look for the highest cover affordable. An I-will-upgrade-it-later option may not work.

7. Compare Premiums for age bands higher than 45 years

Premium in Health Insurance increases as per increase in your age, but, there’s something about the no. 45. Insurance Companies dislike this no. Have a look at the rate charts, and you will be surprised to see good jump in premiums after one cross the age of 45 yrs. In some cases, the increase in premium is as high as 50%. You need to factor this, before you sign up. Ensure premium remains affordable in your retirement days, and does not kill your hard-earned retirement savings.

Note: You need to factor in that these premium charts can change even tomorrow, like they have changed earlier, but looking at the current charts for older brackets would get you a flavour of the company’s pricing philosophy for older age bands.

Bottom-line: Know how the premiums change in the long run.

8. Credibility, Check. Look at the history of the company

If it is a new company, you could look at the history of the promoters and their businesses. Generally, a company or set of promoters known for their ethics and excellent governance, venturing out into Insurance would be a decent bet. Get information from your advisor, on the overall claims experience, on responsiveness, about changes and number of changes in the product, since it was launched. Too many or too large changes, indicates there could be more tomorrow.

Bottom-line: History in the best teacher.

9. Products for older age/Senior Citizen family members.

Most Insurers, including the ones ‘specialized’ in Health Insurance resist covering members above 45 years. Remember, you need to somewhere take the responsibility of not covering your parents, earlier in their life, and not completely blame Insurance Companies for not covering them, now.

There is no perfect product available for Senior Citizens. All products for senior citizens are restrictive. You need to settle for a product, best affordable to you, even if it has co-pay, exclusions and other restrictions. Again, if your parents have existing ailments, then this becomes more complicated.

Bottom-line: There is no Perfect Product. Definitely not, if you are a Senior Citizen.

10. TPA V/s Non TPA Insurance Companies

TPAs have unnecessary got caught in the blame game of high claims burning the health insurance industry. The point is, TPAs are just BPOs of Insurance Companies, and are therefore as good as the Insurance Company itself. Remember, India is the world’s processing house, and there are Indian BPOs which handle more complex health claims for large Insurance companies, the world over. Insurance Companies that have engaged TPAs better and insisted on execution of hardbound contractual agreements have not faltered on their service.

11. Government V/s Private Insurance Companies

Some consider Private Insurers better due to their modern infrastructure, their responsiveness. Some consider Public Sector to be more reliable. Private Sector would run for business and hence would be very responsive. Public Sector, are the Government’s mechanism to ensure a great healthcare infrastructure, and hence somewhat have a social angle, changes in the policy are not driven only by profits but also need to socially acceptable. You need to understand the pros and cons diligently and hence set your own expectations right for your choice.

12. Finally, Ensure you have a Good Advisor

I have always said this, ensure you spend good time in deciding, who is your intermediary. Once you have taken pain to finalize a good advisor, you are more than half way done. A good advisor is one who would provide -

a) Unbiased advice, without any special affiliation to any Insurance Company.
b) Provides Routine services like Pickups, Renewals etc.
c) Assists and Guides you at the time of Claims.

Health Insurance industry is witnessing huge changes both in products, price as well as processes, being an insider, it is sensible to have an expert on your side, who updates you on changes, their impact on your coverage and suggest change in course, in case necessary.

Bottom-line: Insurance Companies will always have their own vested interests. Have someone on your side.

Note: The other terms & benefits comparable are Pre and Post Hospitalization, Benefits like No Claim Bonus/Discount, Loading of Premium, 1-2 or 4 year waiting Period for Specified Ailments have not been considered as they do not make a very big impact on the decision to purchase Health Insurance.

http://www.jagoinvestor.com/2010/10/17-most-asked-questions-in-health-insurance.html

HEALTH POLICY FOR SENIOR CITIZENS

I want to buy a health insurance policy for my parents for major critical illnesses with a cover of Rs 3-5 lakh individually. Which plans should I go for? — PRAGATI

You can consider National Insurance — Varistha Mediclaim for Senior Citizens Policy for your parents. It covers hospitalisation expenses up to Rs 1 lakh and expenses for treatment of critical illnesses, if opted for, up to Rs 2 lakh. You can also consider Star Health- Senior Citizen Red Carpet Policy which offers a cover up to Rs 5 lakh.

http://articles.economictimes.indiatimes.com/2011-02-02/news/28427665_1_insurance-plan-insurance-policies-health-insurance