I am 73 (DOB 10-07-1949). I had an open heart surgery in Sept., 1999. I am taking blood thinner otherwise ok. My wife is 66 (DOB 13-09-1956). She has no problems. I have a 5L Family Floater health insurance from Oriental Insurance - Bank Saathi Policy at an annual premium of about Rs. 35,000 for self and wife.

Since in these days this is not sufficient, I want another policy for 5L or Top Up for 5 / 10 L for self and wife. Please advise an honest suitable minimum cost affordable policy since I have limited capacity to pay because my life time savings in Punjab & Maharashtra co-op Bank Ltd., Mumbai, has been looted by bank Management, Senior Employees, HDIL Construction Co. (Wadwhans), RBI, Politicians and Govt.

Another point. Earlier I had policies with National Insurance, New India Insurance and Oriental Insurance from my Bank tie-up but one after the other they broke the tie up with Banks and offered their direct policy raising annual premium from 11,000 to 43,000 (National Insurance) and others also on same lines because they follow dishonest business policy and just want to loot the common man. How anybody can afford such increase after 8 years with Govt. co. insurance Policy? IRDA is also on their side being dishonest. Not only private but Govt. cos. are also dishonest, corrupt and want to kill the common man.

Ans: Hi Sunil, there are policies in the market who will provide you with the said coverage within the said premium grid. You can contact us at 02248971018 to explore the plan details or connect directly with an insurer of your choice to know of the various policies and plan as per your requirement.

Ans: Unfortunately, finding a new health insurance policy with pre-existing conditions like open-heart surgery can be challenging, especially at the age of 69. Here's why:

• Pre-existing Conditions: Most insurers are hesitant to cover pre-existing conditions, and open-heart surgery falls under that category.
• Age: As you age, premiums tend to rise, and insurers might be more cautious about taking on new senior citizens.

However, there are still some options to explore:

1. Renew Existing Policy with Oriental:

Check with Oriental Insurance Co. again regarding renewal. While they might not increase the sum insured to 15 lakh, they might still offer renewal on the existing 10 lakh plan.

2. Senior Citizen Mediclaim Plans:

Many insurers offer senior citizen health insurance plans designed for people above 60. These plans may have limitations on pre-existing conditions, but they could offer some coverage. You can explore options from reputable companies like Max Bupa, Care Health Insurance, or Cholamandalam MS. Research these companies online or consult an insurance broker for plan details.

3. Top-up Plans:
These plans work alongside your existing policy and provide additional coverage in case your existing sum insured gets exhausted. However, pre-existing condition exclusions might still apply. Explore top-up plans offered by your existing insurer or other companies.

4. Finding the Right Plan:

• Use online insurance comparison platforms or consult an insurance broker to compare different senior citizen mediclaim or top-up plans.
• Carefully review the policy documents, especially exclusions related to pre-existing conditions.
• Consider factors like network hospitals, co-pay clauses, and claim settlement ratio before finalising a plan.

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;