Sir I have echs coverage for myself and family and child . Presently I am reemployed at bank and they have corporate insurance plan for their employees and dependent with ceiling limit of 3.0 lakh. Under mediassist. Can I take this for my treatment .

Ans: Hi Thangavelu, good to know that your wife is doing better. Coming to your questions, yes you can avail the insurance facilities for the same ailment in future from your existing insurance companies. However, if you purchase a new insurance policy from another company, then whether you get the coverage or not will depend on the ailment and the insurer.

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.

Ans: Here's how you can potentially minimize your out-of-pocket expense for cataract surgery with ECHS and your insurance:
1. Understand Your ECHS Coverage:

ECHS has pre-defined package rates for cataract surgery. These rates may cover a specific type of lens (likely monofocal).
Check the ECHS policy documents or contact your local ECHS office for details on their coverage for cataract surgery, including the type of IOL (Intraocular Lens) covered.
2. Explore Options with the Hospital:

Discuss your situation with the empaneled hospital performing the surgery.
Explain your ECHS coverage and the additional insurance benefit for a better lens.
Hospitals might be able to provide a breakdown of costs for surgery with a monofocal lens (covered by ECHS) and the additional cost for the better lens you desire.
3. Leverage Your Insurance:

If the chosen lens falls under the Rs. 30,000 limit of your insurance plan and isn't covered by ECHS, you can likely claim the additional cost through your insurance.
Contact your insurance provider and understand their claim process for cataract surgery with a specific lens type.
Here's a possible scenario:

Let's say the ECHS covers surgery with a monofocal lens costing Rs. 20,000.
The better lens you desire costs Rs. 10,000 extra (total cost Rs. 30,000).
Since it falls under your insurance coverage limit, you can potentially:
Pay Rs. 20,000 to the hospital, covered by ECHS.
Claim Rs. 10,000 for the lens upgrade from your insurance company.
Important Note:

This is a simplified scenario. Actual costs and claim processes may vary.
Recommendations:

Get a written cost breakdown from the hospital for surgery with different lens options.
Contact your insurance company and understand their claim process for cataract surgery with a specific lens type.
Once you have this information, you can calculate the potential out-of-pocket expense for each scenario (monofocal vs. preferred lens).
By following these steps, you can make an informed decision about the lens and minimize your out-of-pocket expense for cataract surgery.
Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Having both Ex-Servicemen Contributory Health Scheme (ECHS) and a bank insurance plan gives you flexibility and additional options for healthcare. Here’s a detailed look at how you can navigate using both:

Understanding Your Options
ECHS (Ex-Servicemen Contributory Health Scheme):

Eligibility: Available to ex-servicemen and their dependents.
Coverage: Provides comprehensive medical care including outpatient care, hospitalization, and medication at ECHS empaneled hospitals and clinics.
Costs: Generally, there are minimal or no out-of-pocket costs when using ECHS facilities.
Bank Insurance Plan:

Eligibility: Typically provided by your employer or purchased individually.
Coverage: Can vary widely based on the policy but usually includes outpatient care, hospitalization, surgeries, and sometimes dental and vision care.
Costs: Usually involves premiums, co-pays, and deductibles.
Choosing the Right Option
Cost Efficiency:

ECHS is usually more cost-effective since it often has no or very minimal costs compared to private insurance plans which may have deductibles and co-pays.
Availability of Services:

ECHS has a network of empaneled hospitals. If a particular treatment or specialist is not available within this network, you might opt for your bank insurance which could provide access to a broader range of hospitals and services.
Geographical Convenience:

Consider the location and convenience of the healthcare providers. If the ECHS facilities are far or not easily accessible, you might prefer using your bank insurance.
Quality of Care:

Both ECHS and private insurance plans generally offer good quality care, but sometimes private hospitals may offer additional amenities or shorter wait times.
Specific Conditions and Treatments:

For some specialized treatments or conditions, one plan might offer better coverage than the other. Check both policies for specific exclusions and benefits.
Practical Approach
Consultation and Minor Treatments:

For routine check-ups, minor ailments, and consultations, using ECHS can be beneficial due to minimal costs.
Major Treatments and Hospitalization:

Evaluate the facilities and specialists available under both plans. If ECHS provides adequate care, it would be the economical choice. However, if your bank insurance offers better facilities or faster service for major treatments, you might prefer using it.
Emergency Situations:

In emergencies, the closest and most suitable healthcare provider should be prioritized, whether it falls under ECHS or your bank insurance.
Coordination Between Plans
Check if Coordination of Benefits is Available: Some insurance plans allow for coordination of benefits where costs are shared between two plans. This can reduce out-of-pocket expenses.
Final Recommendation
Primary Use of ECHS: Given its comprehensive coverage and low cost, ECHS should be your primary option for healthcare needs.
Supplement with Bank Insurance: Use your bank insurance for situations where ECHS services are not accessible, or the bank insurance offers significantly better or faster care.
Always review the specific terms and coverage details of both your ECHS and bank insurance plans to make informed decisions.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Understanding Your Health Insurance Coverage
You are in a situation where making informed decisions about your healthcare is crucial. Having both ECHS and a corporate insurance plan gives you options, but understanding the specifics of your coverage is essential. Let's evaluate your options for ACL surgery in Delhi.

Evaluating Your Insurance Plans
You have ECHS and a corporate insurance plan with a Rs 3 lakh ceiling and an additional top-up of Rs 7 lakh. Knowing what each plan covers will help you decide the best course of action.

Corporate Insurance Plan
Coverage Limits: Your corporate plan covers up to Rs 3 lakh with an additional top-up of Rs 7 lakh.
Network Hospitals: Confirm if Apollo Delhi is a network hospital under your corporate plan.
Pre-authorization: Ensure you get pre-authorization for your surgery to avoid claim rejection.
Specific Coverage: Check if ACL surgery is explicitly covered under your policy.
ECHS (Ex-Servicemen Contributory Health Scheme)
Network Hospitals: ECHS has a list of empaneled hospitals. Check if any in Delhi perform ACL surgery.
Approval Process: ECHS may require approval for surgeries; ensure you follow the correct procedure.
Cost Coverage: Understand the extent to which ECHS covers surgery costs and related expenses.
Assessing the Costs and Benefits
Understanding the costs and benefits associated with each insurance plan will help you decide which hospital to choose for your surgery.

Apollo Delhi under Corporate Insurance
Cost Consideration: The surgery costs Rs 2.9 lakh, which is within your corporate insurance limit.
Quality of Care: Apollo Delhi is known for quality medical care, ensuring you receive top-notch treatment.
Convenience: Being a network hospital under your corporate plan simplifies the claim process.
Reimbursement vs. Cashless: Ensure Apollo offers cashless treatment to avoid out-of-pocket expenses.
ECHS-empaneled Hospitals
Cost Efficiency: ECHS typically covers a significant portion of the costs, reducing your financial burden.
Quality of Care: ECHS hospitals also offer quality care but ensure the chosen hospital is well-reputed for ACL surgery.
Approval and Process: ECHS may have a more complex approval process, which you need to navigate efficiently.
Practical Steps to Ensure Coverage
To ensure your surgery is covered, follow these practical steps:

Verify Network Hospitals
Corporate Insurance: Contact your insurer to confirm if Apollo Delhi is in their network.
ECHS: Check the list of empaneled hospitals in Delhi and their specializations.
Pre-authorization
Corporate Insurance: Get pre-authorization from your insurer for the ACL surgery at Apollo.
ECHS: Follow the necessary approval procedures for surgery under ECHS.
Detailed Cost Estimates
Apollo Delhi: Request a detailed cost estimate from Apollo Delhi to ensure it aligns with your coverage.
ECHS Hospital: Get a cost estimate from the ECHS-empaneled hospital for comparison.
Claim Process
Corporate Insurance: Understand the claim process, whether it's cashless or reimbursement, to avoid surprises.
ECHS: Familiarize yourself with the ECHS claim process, including necessary documentation.
Weighing the Pros and Cons
Making an informed decision involves weighing the pros and cons of using corporate insurance versus ECHS for your surgery.

Pros of Using Corporate Insurance at Apollo Delhi
Quality of Care: Apollo Delhi is known for excellent medical care.
Cashless Facility: If Apollo offers cashless treatment, it reduces your financial stress.
Simpler Process: Corporate insurance might offer a streamlined approval and claim process.
Cons of Using Corporate Insurance
Coverage Limits: Ensure the entire cost of surgery and any additional expenses are covered.
Documentation: Prepare for extensive documentation and follow-ups with the insurer.
Pros of Using ECHS-empaneled Hospital
Cost Savings: ECHS covers most costs, minimizing out-of-pocket expenses.
Comprehensive Coverage: ECHS provides extensive coverage, including post-surgery care.
Cons of Using ECHS
Approval Process: The approval process can be cumbersome and time-consuming.
Hospital Choices: Limited to ECHS-empaneled hospitals, which may not have the same reputation as Apollo.
Emotional and Practical Considerations
Your decision also involves emotional and practical considerations beyond financial aspects.

Emotional Factors
Trust and Comfort: You might feel more comfortable and confident with the care at Apollo Delhi.
Peace of Mind: Knowing your surgery is in the hands of reputed specialists can provide peace of mind.
Practical Aspects
Logistics: Consider the convenience of hospital location, travel, and stay arrangements for your recovery.
Post-Surgery Care: Evaluate the quality and convenience of follow-up care and rehabilitation services.
Final Insights
Making an informed decision about your ACL surgery involves careful evaluation of your insurance options, hospital choices, and personal preferences. Whether you choose Apollo Delhi under your corporate insurance or an ECHS-empaneled hospital, ensure you follow the necessary procedures to get the coverage you need. Your health and well-being are paramount, and choosing the right path will ensure a smooth and stress-free recovery.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in