- Better Sum Insured Value

- Lowered Policy Premiums

- Get an insurer with a better Claim Settlement ratio

- Better service provider

- No Loss in previous policy benefit

I suggest you to kindly declare the said ailment to the insurer. The premium will not increase considering this factor as the said ailment occurred after the policy issuance.

1. What's the meaning of 5 lakh coverage? Will I get a full 4.95 lakh for both knees transplant (my hospital package is costing 4.95 lakh from entry to exit)?

2. When the hospital sent the proposal to TPA, only 2.47 lakh were provisional sanction. What's the meaning of provisional? I was told that the final amount will be settled once final bill is produced by the hospital. Does it mean that 4.9-2.47=2.43 lakh or so, will be settled and remitted to the hospital by Oriental insurance? 

3. When I sought clarification from TPA, I was verbally told that now the final amount cannot be decided. Only after the final bill it can be. Nothing said on email. No replies from Oriental insurance of my email query.

4. Hospital insists that I deposit 50% (2.5 lakh) cash from pocket before admission.

5. If I have to pay cash, then where is the cashless scheme?

If you have started smoking after the purchase of the policy, then at the time of renewal you should declare it to the insurer. In fact, any material change in activities between renewals should be declared to the insurer; it is then up to them to either adjust your premium accordingly or accept it without a change in the premium amount.

Health insurance is a safety net for the financial well-being of an individual or a family. With medical inflation close to 15 per cent year on year, it has become imperative to opt for a comprehensive health insurance plan for the entire family so that the hospitalisation expenses are taken care of.

A comprehensive health insurance plan is an indemnity plan and hence pays for all expenses incurred during hospitalisation. It typically covers all hospitalisation expenses related to an illness, injury or an accident.

So, from the time of hospitalisation, the cost of an ambulance, room rent, medicines, diagnostic tests, surgery/ implant or any other treatment procedures, etc. would be covered under in-patient hospitalisation. Additionally, pre- and post-hospitalisation expenses for diagnosis and follow up treatments, AYUSH treatment, domiciliary, organ donation, etc. treatments and procedures are usually included.

There are other value-added benefits of comprehensive health insurance plans as well; such as free annual medical check-ups, sum insured restoration benefits, maternity and other covers. You can further enhance the base coverage by purchasing optional add-ons like personal accident and critical illness coverage.

Yes, your premiums would increase over time and it depends on age brackets, claim experience and other factors. So, even if you opt for a health insurance plan earlier in life, your premium would go up almost every year or every 5 years, depending on your age, health conditions and other factors.

So, the natural question everyone would have is, why opt for a health insurance plan early? In any case, younger people need to claim their health insurance lesser than older people, right? So, should the younger ones wait to grow old before opting for a good HI plan?

In my opinion, the answer is NO and there are multiple reasons for the same.

a. Is there a guarantee that the young will not fall ill?

With COVID-19 second wave, we have seen that the young needed more hospitalisation than the old.

b. With the rise of lifestyle ailments, diabetes, obesity, digestive concerns and hypertension has taken a leap in the youth of India. Fitness and a healthy lifestyle, which have taken a backseat, need to be focused along with a large comprehensive health plan to tackle the issue.

c. The earlier you opt for a health insurance plan, the lesser likely it would be that you would have any pre-existing ailments. So, your coverage quantum would be higher than if you have any of the pre-existing lifestyle ailments.

d. Since the young usually need lesser hospitalisation than the old, your mandatory and specific waiting periods would be over before you actually need them.

The moral of the story is that you need to opt for a high health insurance plan as early as possible. You can always top it up later.

Yes. If you have any major health ailments in India -- whether it's Thyroid, BP or Diabetes -- you can still avail of your hospital and medical expenses. There are policies available for patients with the common complications of prevalent conditions like diabetes and thyroid. There is health insurance coverage accessible for everyone, but make sure you notify your insurance provider of any illnesses and understand your policy's coverage.

Thus, when you fill up your proposal form for a health insurance plan, you need to disclose all material facts; else your claim might be rejected on the basis of non-disclosure or misrepresentation of material facts. So, if you have high blood pressure or diabetes, just remember to mention it along with the list of medications prescribed to you. Then, the underwriter will assess your risk and quote the premium accordingly. Also, there could be a waiting period, or, an exclusion attached.

Once the health insurance plan is accepted with the specified risks, all expenses associated with your pre-existing ailment would be covered by your insurer.

Certain conditions are not covered by health insurance policies. These conditions will land in an ‘Exclusion' in your health insurance policy.

The exclusion list includes unless specifically mentioned in your policy document:

1. Pre-existing health conditions which are not declared from the time of policy inception

2. Lifestyle-related conditions

3. Maternity related complications, including treatments and childbirth, etc,

4. Cosmetic Treatments unless necessary for survival

5. Suicide Attempt Injuries

6. Congenital Diseases

7. War Injuries

8. Dental and eye expenses, unless specifically covered under OPD

9. Diagnostic tests without any proper line of treatment which needs hospitalisation

10. Therapies such as naturopathy, magnetic or acupressure, etc.

11. Waiting Period Illnesses

The insurance provider will not accept any claims in these instances. However, you can purchase add-on coverage to include any exclusion to your base coverage.

Yes. Personal plan is a great alternative to corporate policies -- even if you work for large companies. Corporate policies come with limited coverage with limited or no option to customise it. In fact, your coverage can even decrease over time.

Plus, there's no lifelong renewability once you exit the group. Thus, when you actually need the plan, that is, in your post-retirement phase, you would have to opt for limited coverage available in senior citizen plans.

Also, individual health insurance plans give the flexibility to choose the right kind of protection and better coverage. You can customise your policy, such as selecting the cover according to your needs. It ensures lifelong renewability and additional coverage options, such as hospital cash benefits, pre-existing conditions coverage, etc.

Proper health insurance planning includes high coverage of personal health insurance plans with lifelong renewability over and above group plans!

Super top up policies do not offer cashless claims but only provide reimbursements.

The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.   

Any medical condition which arises after the waiting period of the policy will be covered in the health policies. Which is why check for the waiting periods associated with different ailments in your policy document.

As our age increases, the chances of health deterioration increase which makes the premiums higher and in some cases a lot of diseases and ailments come with a longer waiting period and PED exclusion lists. During the time of issuance, each insurer analysis the risk via proposal form, medical reports and take decisions accordingly.

Age is an important factor in risk determination by the insurers and considers old age applicants as very high-risk profiles and hence doesn’t provide health policy. Few of the heart policies as said will provide coverage but will exclude the PEDs (pre-existing diseases).

This is why the Govt. of India, IRDAI, Insurers and broking companies like Coverfox Insurance are trying to educate the masses to purchase health insurance policies at a younger age and are constantly trying to inform people of the benefits of Health Insurance and how to choose the correct plan for oneself.

For other ailments, at the time of issuance an insurer analyses the risks, given the ailment of the insured. Accordingly, the insurer takes a decision whether the policy can be issued or not, there are few insurers in the market that will keep the pre-existing diseases excluded or will have a waiting period for it. However, if your ailments have developed after the policy issuance then you can avail insurance facilities for those ailments.

Answering your third question, yes you can prefer ECHS for this specific issues and the remaining expenditure can be claimed from other insurers.