This is Bobby here and have a few questions related to your article (enclosed), Mediclaim: What You Must Know

Would like to know, with your experience in this field, as to:

1. Which mediclaim policy or policies, currently in INDIA and especially Mumbai has all the required coverage as mentioned in your article

2. We are a family of 3 with a school going child and both of us are aged 45

3. Have acquired diabetes a few months ago and have hepatitis B and kidney stones 

4. What should be the approximate premium, per annum to cover all that is mentioned in your article and keep us safe from the issues arising out if and when we really require hospitalisation and save us from rejected claims.
 
5. Presently we are covered under Mediclaim policy from Star Health

Would be highly obliged should you guide us on the above to make our lives easier.

Ans: Hi Vilas, in order to understand the difference in the estimated costs, you should ask the hospital on what parameters they have estimated the two costs. Questions on treatment protocol, room charges and type, doctor’s fee etc., should be asked.

When choosing cashless treatment, the patients often opt for the best facilities that they may not have opted for otherwise. Sometimes hospitals may run some additional tests as well in order to avoid back and forth on your claim settlements, when it is a direct transaction between insurer and the hospital.

However, if you feel that you are being overcharged, then you should report any discrepancy in what you are being charged for, to the insurer. Insurance companies take such cases very seriously, which is why insurers have preferred network hospitals that agree on a certain pricing for various treatments and other tariffs.

In case it is observed that there is any abuse of cost or sum insured then there is a chance of being de-paneled and hence a check is in place.

Ans: Hi, the coverage amount should be an estimate of the treatment you may be expecting in the near future in case you have any pre existing diseases. Else, due to the age being on higher end, you may have to pay higher premiums. Do not delay and purchase as soon as possible.

Ans: I'm glad to hear your surgery went well, and you're on the road to recovery. Considering your situation, it’s important to secure your health insurance needs for the future. Let’s break down your questions and concerns regarding taking an additional health insurance policy.

Can You Take Another Health Insurance Policy?
Yes, you can take another health insurance policy from a different company. However, your recent medical history, including the renal transplant surgery, will impact your new policy's terms and premiums.

Impact of Renal Transplant on New Policy
Pre-Existing Conditions: Your kidney surgery will be considered a pre-existing condition. Most insurers have a waiting period for covering pre-existing conditions, ranging from two to four years. It’s crucial to check the specifics with any new insurer.

Medical Underwriting: Given your recent medical history, the insurer may require detailed medical underwriting. They may request your medical records and possibly a medical examination to assess your current health status.

Premium Considerations
Increased Premiums: Due to your pre-existing condition, new health insurance policies are likely to come with increased premiums. The exact amount will depend on the insurer's assessment of your health risk.

Loading Charges: Some insurers might add a loading charge to your premium, which is an additional cost to cover the higher risk associated with your medical history.

Types of Policies to Consider
Individual Health Plans: These provide coverage for a single person. Given your situation, ensure the plan offers extensive coverage, including post-operative care and critical illness coverage.

Family Floater Plans: These plans cover multiple family members under a single sum insured. They might be a good option if you plan to get married and start a family in the near future.

Critical Illness Plans: These plans provide a lump sum amount upon diagnosis of specified critical illnesses, including kidney-related issues. It can be a supplementary policy to your primary health insurance.

Steps to Take
Research and Compare: Compare policies from different insurers. Look for policies with comprehensive coverage and a reasonable waiting period for pre-existing conditions.

Consult Insurers: Speak directly with insurance representatives. Explain your medical history and get clear information on how it will affect your premiums and coverage.

Read Policy Documents: Carefully read the policy documents, especially the sections on pre-existing conditions, waiting periods, exclusions, and premium loading.

Consider Riders: Look for riders or add-ons that can enhance your coverage, such as critical illness riders, hospital cash, and personal accident covers.

Consulting a Certified Financial Planner
Given the complexities of your medical history and future health needs, consulting with a Certified Financial Planner (CFP) can be very beneficial. A CFP can help you understand the nuances of different policies, assess your long-term financial needs, and recommend the best health insurance options tailored to your situation.


You’ve shown great foresight in considering additional health insurance despite your recent surgery. Ensuring your future medical needs are covered demonstrates a strong commitment to your long-term well-being. Your proactive approach to securing your health is commendable and shows a responsible attitude towards managing potential future risks.

Final Insights
Securing an additional health insurance policy is a wise move, especially considering your recent medical history and future plans. While premiums might be higher due to your pre-existing condition, thorough research and consulting with professionals can help you find the best policy for your needs. Remember to compare different plans, understand the terms, and choose a policy that offers comprehensive coverage and aligns with your financial goals.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Getting health insurance for your family is very important. Since you have pre-existing conditions (BP, GERD, diabetes, schizophrenia), some insurers may have waiting periods or exclusions. But you can still get coverage with the right approach.

 

Key Factors to Consider
Pre-existing Diseases (PEDs): Most insurers have a waiting period of 2-4 years for existing illnesses. Some plans may offer waivers with extra cost.

Mental Illness Coverage: Schizophrenia and depression must be covered under IRDAI guidelines, but insurers may still have conditions.

Family Coverage: Choose individual or floater policies based on needs.

Senior Citizen Coverage: Your mother may need a separate senior citizen plan due to age and BP history.

Cashless Hospital Network: Ensure the policy covers hospitals near you.

 

Best Approach for Your Family
1. Individual Health Policies for Each Family Member
Since your sister has serious pre-existing conditions, a separate policy for her is better.

Your mother should get a senior citizen plan with day-care and domiciliary coverage.

You, your wife, and daughter can take a family floater policy.

 

2. Super Top-up Plans for Extra Coverage
Base policies may not be enough for major treatments.

A super top-up plan can give extra coverage at a lower cost.

This helps in reducing premium costs while increasing coverage.

 

3. Critical Illness Rider
You should consider a critical illness policy.

Covers major diseases like heart attack, stroke, and kidney failure.

Provides lump sum payout in case of critical illness diagnosis.

 

How to Get Insurance for Your Sister?
Mental illness coverage is now mandatory, but many insurers still hesitate.

Some insurers may exclude pre-existing mental conditions.

If regular insurance denies coverage, look for state-sponsored health schemes.

 

Final Steps
Check waiting periods for pre-existing conditions.

Get cashless policies for easier hospitalisation.

Choose a Certified Financial Planner (CFP) or health insurance expert for the right selection.

 

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner

www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment