I am 32 years old male, working in a government organisation (institute). Where i get free health check-up, medicines and consultation in our institute dispensary. If anything they cannot cure then dispensary will give referral to other hospitals in the city (expenses borne by our organisation) for health related issues and get treatment at CGHS rates for all health issues. After retirement i will get a CGHS card if we go to other hospitals without referral still I will get reimbursement at CGHS rates. Now please suggest me whether I should buy a health insurance apart from this? I already have a HDFC ergo optima restore for 5 lakh sum assured to cover my family (wife, child and myself) which i did not use so far in 4 years and feel it's waste. Yearly I pay 24k for this hdfc health insurance. Please clarify. It's premium is increasing @10% every year.

Ans: Any insurance company is good provided you have a good advisor

Ans: HDFC ERGO Health Insurance is one of the reputable health insurance providers in India, offering a range of policies catering to various needs. However, whether a policy claim will be rejected after 8 years of continuous renewals depends on several factors, including the terms and conditions of the specific policy you've opted for, the nature of the claim, and adherence to policy guidelines.

It's essential to carefully read the policy documents, including the fine print and terms and conditions, to understand the coverage, exclusions, claim process, and renewal provisions. Additionally, maintaining continuous renewal without any breaks is generally advisable to ensure uninterrupted coverage and avail benefits like waiting period waivers and no-claim bonuses.

While insurance companies typically have provisions to minimize claim rejection risks after a certain period of continuous renewals, it's crucial to stay informed about any policy updates, changes, or exclusions that may affect your coverage.

To ensure clarity and peace of mind regarding your health insurance coverage, consider reaching out to HDFC ERGO's customer service or consulting with an insurance advisor for personalized guidance tailored to your specific policy and circumstances.

Ans: Choosing the right health insurance plan for your family is crucial. A good plan ensures that you are financially protected in case of medical emergencies. You have shortlisted HDFC Ergo Optima Secure, which is a great start. Let’s discuss the factors you should consider when choosing the best health insurance plan for your family, covering you, your wife, and your two kids with at least a Rs 15 lakh cover.

Coverage and Benefits
Sum Insured
Adequate Coverage: Ensure the plan offers a minimum cover of Rs 15 lakh. Higher coverage provides better financial protection.
Hospital Network
Cashless Treatment: Look for a plan with a wide network of hospitals offering cashless treatment. This ensures ease during emergencies.
Room Rent Limits
Room Rent Capping: Choose a plan with higher room rent limits or no capping. This prevents out-of-pocket expenses during hospitalization.
Pre and Post-Hospitalization
Extended Coverage: Ensure the plan covers pre and post-hospitalization expenses. This covers expenses incurred before and after hospitalization.
Daycare Procedures
Comprehensive Cover: The plan should cover various daycare procedures. Many treatments don’t require 24-hour hospitalization.
No Claim Bonus (NCB)
Incremental Benefits: Look for plans offering a No Claim Bonus. This increases your sum insured for every claim-free year.
Inclusions and Exclusions
Maternity and Newborn Cover
Family Planning: If you are planning for more children, ensure maternity and newborn cover is included.
Critical Illness Cover
Serious Conditions: Consider a plan that covers critical illnesses. This ensures coverage for life-threatening conditions.
Disease Waiting Period
Waiting Period: Check the waiting period for pre-existing diseases. A shorter waiting period is preferable.
Specific Exclusions
Understand Exclusions: Read the policy document to understand specific exclusions. This helps avoid surprises during claim time.
Additional Benefits
Annual Health Check-Up
Preventive Care: Plans offering annual health check-ups help in early detection of health issues.
Wellness Programs
Healthy Lifestyle: Some plans offer wellness programs and discounts for maintaining a healthy lifestyle.
Ambulance Cover
Emergency Services: Ensure the plan covers ambulance charges. This is crucial during medical emergencies.
Restore Benefits
Reinstatement of Sum Insured: Look for plans that offer restore benefits. This reinstates your sum insured if exhausted within a policy year.
Premiums and Co-Payments
Affordable Premiums
Cost-Effectiveness: Ensure the premium is affordable for the benefits offered. Compare different plans for cost-effectiveness.
Co-Payment Clause
Co-Payment: Be aware of the co-payment clause. Lower co-payment means less out-of-pocket expenses.
Claim Process and Customer Service
Easy Claim Process
Smooth Claims: Choose a plan with a hassle-free claim process. Online claim settlement options are preferable.
Customer Support
Support System: Good customer service is essential. Ensure the insurer has a robust support system for queries and claims.
Claim Settlement Ratio
Reliability: Check the insurer’s claim settlement ratio. A higher ratio indicates reliability and trustworthiness.
Recommendations
Balanced Plan
Comprehensive Coverage: Choose a plan that balances coverage, benefits, and premiums. Ensure it meets your family’s healthcare needs.
Customizable Plans
Tailored Options: Opt for plans that allow customization. Add-ons and riders enhance the basic plan as per your requirements.
Renewability
Lifelong Renewability: Ensure the plan offers lifelong renewability. This is crucial for continuous coverage in old age.
Portability
Switching Plans: Check if the plan allows portability. This helps in switching insurers without losing benefits.
Final Insights
Choosing the right health insurance involves evaluating coverage, benefits, and costs. Ensure the plan meets your family’s healthcare needs and offers adequate financial protection. Regularly review your policy and update it as per changing requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Hello;

Before signing up for a healthcare insurance cover you need to understand the permanent and time bound exclusions mentioned in the policy

Also check the black listed hospitals on insurers website and avoid them as far as possible.

Better is to select network hospital and go for cashless facility.

Also before signing up, you need to honestly disclose pre-existing diseases, hereditary history of you near blood relatives in good faith.

This will reduce chances of claim rejection.

For your reference I am sharing names of some health insurers whose incurred claims ratio(ICR) was above 80% in FY-24:

HDFC Ergo
ICICI Lombard
SBI General
Bajaj Allianz
National Insurance

Request you to do your due diligence and seek help from an investment advisor or insurance advisor for further help.

Best wishes;