75 Years Old with Expensive Med Insurance - What's a Better Option?

Ans: Hi Mr RN Mitra, sorry to hear about your condition, wish you good health and recovery.

As far as the top up plan is considered, given your age and pre-existing diseases, your risk profile is high and most insurers may not be able to offer Super top up plans.

The best option is to apply for a new base plan with a higher sum insured, however the premium will be on the higher side.

Ans: Hi Subhas, instead of buying a new policy for 2 lakh each to increase sum insured you can buy a super top up on your current policy which will cover more sum insured on a lesser premium.

If you purchase a new policy, it will not cover your pre-existing diseases. Moreover, waiting period associated with the new policy will be there because of which you will not be able to claim your sum insured.

Ans: I understand you're looking for a good health insurance plan for you and your wife. That's a smart decision, especially considering your health conditions. Let's break it down to help you choose the best option:

Understanding Pre-existing Conditions:

Your existing health conditions (BP, spondylitis, etc.) are called pre-existing conditions. These might affect your policy options and premiums.
Individual vs. Family Plan:

Family plan: Covers you and your wife together under one plan. It can be cheaper, but coverage limits get shared.
Individual plans: Separate plans for each of you. More flexibility, but might cost slightly more overall.
Considering Your Needs:

Pre-existing condition coverage: Look for plans that cover pre-existing conditions after a waiting period (if any).
Hospitalization coverage: Choose a plan with sufficient coverage for hospitalization expenses.
Medicines: Check if the plan covers medicines you take regularly.
Finding the Right Plan:

Talk to a CFP professional: A Certified Financial Planner can assess your needs and recommend suitable plans from different insurers.
Compare plans online: Many insurance companies offer online plan comparisons. Look for plans that cover pre-existing conditions and have good network hospitals in your area.
Here's a quick tip: Since your wife is younger and has a different health profile, individual plans might be better. This allows you to get customized coverage based on your specific needs.

Remember: Don't hesitate to ask questions! Choosing the right health insurance is important, and a CFP professional can guide you through the process.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Sanjib, I understand your concern about the significant increase in the health insurance premium for your parents. A 40% hike is substantial, especially when managing finances for retired or aging parents. Your father, aged 64, has diabetes, and your mother, aged 61, has been managing high blood pressure for a decade. Health insurance is crucial for them, and choosing the right provider is essential.

Evaluating Your Current Health Insurance

Long-term Relationship

You have maintained the current health insurance for six years, which is commendable. This continuity provides benefits like reduced waiting periods for pre-existing conditions.

Health Conditions

Considering your parents' medical history, including diabetes and hypertension, it's crucial to have a comprehensive policy that covers these conditions without excessive restrictions or exclusions.

Increased Premium

The 40% increase in premium can strain your budget. Evaluating the reasons behind this hike is necessary. Insurers often raise premiums due to increased claims or changes in their underwriting policy.

Exploring the Option to Port Insurance

Portability Rules

Health insurance portability allows you to switch insurers without losing benefits like waiting periods for pre-existing conditions. This is regulated by the Insurance Regulatory and Development Authority of India (IRDAI).

Comparing New Providers

While other insurers offer lower premiums, it's essential to compare the coverage, benefits, and exclusions. A lower premium might come with reduced benefits or higher co-payments.

Pre-existing Conditions

Ensure the new provider covers diabetes and hypertension without new waiting periods. Confirm this before making any switch.

Benefits of Staying with the Current Provider

Accumulated Benefits

Staying with the current insurer means continuing to benefit from the accumulated waiting period, which might be fully exhausted for some conditions by now.

Policy Continuity

Continuity ensures your parents do not face new waiting periods or exclusions, which can be a risk when switching insurers.

Trusted Provider

If you are satisfied with the current insurer’s claim settlement process and customer service, it might be worth staying despite the higher premium.

Benefits of Porting to a New Provider

Cost Savings

Lower premiums with a new provider can offer immediate financial relief. This is particularly important if the premium hike strains your budget.

Potential Better Benefits

Some new policies might offer better or more comprehensive coverage, even at a lower premium. Evaluate the policy details carefully.

Healthy Competition

Porting can help you take advantage of competitive offers in the market. New insurers might offer attractive features to gain new customers.

Important Factors to Consider

Coverage and Benefits

Compare the coverage limits, room rent caps, and critical illness coverage of the current and new policies. Ensure the new policy matches or exceeds your current coverage.

Exclusions and Waiting Periods

Check the exclusions and waiting periods for pre-existing conditions with the new insurer. Ensure there are no hidden clauses that can affect future claims.

Network Hospitals

Ensure the new insurer has a robust network of hospitals in your area. Cashless treatment at preferred hospitals is a significant advantage.

Claim Settlement Ratio

Evaluate the claim settlement ratio of the new insurer. A higher ratio indicates better reliability and a smoother claims process.

Steps to Port Health Insurance

Research and Compare

Use online comparison tools to evaluate different health insurance policies. Look for reviews and ratings from existing policyholders.

Apply for Portability

Initiate the portability process at least 45 days before your current policy renewal date. This gives enough time to complete the process without a coverage lapse.

Submit Documents

Provide the necessary documents, including the previous policy details, claim history, and medical records. Complete all required forms accurately.

Wait for Approval

The new insurer will review your application and may request a medical check-up. Approval can take a few weeks, so plan accordingly.

Renew and Pay Premium

Once approved, pay the premium for the new policy. Ensure there is no coverage gap during the transition period.

Case Study: Porting vs. Staying

Let's consider a hypothetical example to illustrate the decision-making process.

Case Study: Staying with the Current Provider

Mr. Kumar, aged 65, with diabetes, and Mrs. Kumar, aged 62, with hypertension, have been with their current insurer for eight years. Their annual premium increased by 35%. They decided to stay because:

The current insurer covers their pre-existing conditions with no waiting period.
Claim settlements have been smooth, with timely reimbursements.
They value the peace of mind and continuity of coverage.
Case Study: Porting to a New Provider

Mr. Reddy, aged 63, with heart disease, and Mrs. Reddy, aged 60, with diabetes, faced a 40% premium hike. They decided to port because:

The new insurer offered a 25% lower premium with similar coverage.
The new policy had a lower co-payment for chronic conditions.
The new provider had a better hospital network in their city.
Long-term Considerations

Health Deterioration

As your parents age, their health may decline, leading to more frequent claims. Ensure the insurer has a good track record with senior citizens.

Financial Planning

Consider the long-term affordability of the premium. Opt for a policy that provides sustainable coverage without becoming a financial burden.

Emergency Coverage

Ensure the policy covers emergencies and offers cashless hospitalization in reputed hospitals. This reduces out-of-pocket expenses during critical times.

Conclusion

Porting your health insurance can offer financial benefits, but it requires careful evaluation. Compare the benefits, exclusions, and waiting periods of both current and new policies. Consider the long-term implications for your parents' health coverage. Staying with a trusted provider has its advantages, especially with pre-existing conditions. However, porting can provide cost savings and better benefits if chosen wisely. Regularly reviewing your policy and staying informed about market options ensures the best coverage for your parents.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in