My family (aged 54 years) is covered under ECHS (Ex-servicemen Contributory Health Service) for the last thirty years. I have family floater health hospitalisation policy in two different insurance companies. Three years back, she had some issues related to her blood disorders. During the blood transfusions, we have made claims in the insurance cover.

It took few months to diagnose the issue. Finally it was diagnosed as 'a type of blood disorder'. I have availed the hospitalisation and treatment facilities from ECHS.

Now she has recovered (and under medication) for the last two years. She is leading normal life. My query is:

Can I declare and have Critical illness included coverage in the health insurance? (Earlier I was denied as permanent exclusion -IRDA).

Can I continue the existing health coverage from the insurance from other than Critical illness? (I can get ECHS facility, but there are limitations). Since she is alright, will the insurance companies accept? We are ready for relevant medical tests as required.

We seek your advice.

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: In a family floater policy, the daughter will normally be covered till the age of 21 or 25 years old irrespective of her marital status, of course, depending on the terms & conditions of the specific policy purchased by you. All the benefits remain as it is till the permissible age.

Post the age limit the daughter can be part of a new individual plan and can avail all continuity benefits or part of her husband’s floater plan with terms and conditions applicable to that policy.

Ans: Hi Pradeep, yours is a legit concern. It would be best if you take advice from a professional person or company – having the necessary qualifications -- after discussing your issue with them.

Insurance is each to its own. Depending on your concerns and requirements a professional service provider will be able to give you the best advice, whether to tweak policy amount or switch to top up.

Ans: Hi Ritu! Having a separate critical illness policy could indeed provide an added layer of financial security. While a family floater health insurance plan typically covers hospitalization and medical expenses, a critical illness policy focuses specifically on major illnesses (like cancer, heart disease, or kidney failure), providing a lump-sum payout upon diagnosis. Here’s a look at the pros and cons:

Pros:

1. Lump-Sum Payout: Critical illness insurance provides a lump-sum amount on diagnosis, which can be used for treatment, lifestyle adjustments, or even household expenses if you or a family member cannot work due to the illness.
2. Income Replacement: If you or your spouse were unable to work due to a critical illness, this payout could cover lost income and help maintain your family’s lifestyle.
3. Flexible Usage: Unlike regular health insurance, the payout is not restricted to hospital bills. You can use it for any need, like home modification, recovery aids, or even travel for treatment.
4. Additional Coverage: It covers illnesses that often have high treatment costs that regular health insurance may not cover fully, especially if there are co-payments, sub-limits, or high deductibles.

Cons:

1. Limited Coverage: It only covers specified critical illnesses listed in the policy. If you’re diagnosed with a condition not on that list, you won’t receive a payout.
2. Waiting Periods and Survival Clauses: Many policies come with a waiting period (30 to 90 days), and you may need to survive for a certain period after diagnosis (usually 30 days) to claim the payout.
3. Premiums Increase with Age: Critical illness premiums can be higher as you age, so it’s usually more cost-effective if purchased early.
4. Can Overlap with Health Insurance: If your family floater policy has a large sum insured, it might cover most hospitalization costs even for serious illnesses, making a critical illness policy seem redundant in some cases.

Given that you have a young family and if your current health coverage isn’t very high, adding critical illness insurance could be a good idea. It’s worth discussing options with your insurer to tailor coverage to your family’s needs, ensuring a balance between adequate protection and affordability.