Ex-serviceman seeking additional health insurance: Can I have both ECHS and a private Mediclaim policy?

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: Hi Thangavelu, good to know that your wife is doing well. To answer your first query, yes you can declare your critical illness and avail the rider for it. Another option is to purchase a new plan for critical illness from an insurer of your choice. The insurer will ask a set of questions and based on that the coverage will be provided. However, most of the insurers will keep the PED in the Permanent exclusion list. As far as your query on continuation of policy is considered, you can continue with the existing health policies you have.

Any medical condition which arises after the waiting period of the policy will be covered in the health policies. Which is why check for the waiting periods associated with different ailments in your policy document.

Ans: Understanding Your Health Insurance Options
You have three health insurance coverages: ECHS, corporate insurance from your bank, and MediAssist. Let's explore how you can effectively use these for your treatment.

ECHS Coverage
The Ex-Servicemen Contributory Health Scheme (ECHS) provides comprehensive healthcare to ex-servicemen and their dependents. It covers a wide range of treatments and has a broad network of empanelled hospitals.

Advantages:

Comprehensive coverage for various treatments.
Wide network of empanelled hospitals across India.
No upper limit on coverage, providing financial security for significant medical expenses.
Considerations:

May require referrals for certain treatments.
Limited to empanelled hospitals and clinics.
Corporate Insurance Plan
Your bank's corporate insurance plan provides coverage up to Rs. 3 lakh. It covers employees and their dependents under MediAssist, a third-party administrator (TPA).

Advantages:

Covers immediate family members, offering additional security.
Can be used at network hospitals and clinics under MediAssist.
Quick processing of claims through the TPA.
Considerations:

Coverage limit of Rs. 3 lakh, which may not be sufficient for major treatments.
Possible restrictions on certain treatments or hospitals.
MediAssist Coverage
MediAssist, as a TPA, facilitates smooth processing of insurance claims. It offers a network of hospitals where cashless treatment can be availed.

Advantages:

Facilitates cashless treatment at network hospitals.
Efficient claims processing and support.
Reduces the financial burden at the time of hospitalization.
Considerations:

Limited to the network hospitals under MediAssist.
Requires pre-authorization for cashless treatment.
Using Your Insurance Effectively
To optimize your health coverage, consider the following strategies:

Primary Coverage:

Use your corporate insurance plan as primary coverage for regular treatments.
The Rs. 3 lakh limit can cover most routine medical expenses and minor procedures.
Secondary Coverage:

Use ECHS coverage for more significant medical treatments and hospitalizations.
ECHS can act as secondary coverage if your corporate insurance limit is exhausted.
Cashless Treatment:

Use MediAssist for cashless treatment at network hospitals.
This reduces the need for upfront payments and eases the claims process.
Planning for Major Medical Expenses
For significant medical treatments, you may need to plan strategically. Here's how:

Initial Expenses:

Use your corporate insurance plan to cover initial hospitalization and treatment costs up to Rs. 3 lakh.
Follow-Up Treatment:

Switch to ECHS for follow-up treatments and additional medical needs beyond the Rs. 3 lakh limit.
Documentation:

Ensure all medical documentation is accurate and complete.
Proper documentation helps in smooth claim processing with both ECHS and MediAssist.

Balancing multiple health insurance coverages can be confusing. However, with careful planning, you can ensure comprehensive coverage for yourself and your family.

Your effort to understand and utilize these coverages shows your commitment to securing your family's health.


You are proactive in managing your health insurance. This approach ensures financial security and peace of mind for your family.

Final Insights
To utilize your health insurance effectively:

Use your corporate insurance for routine treatments up to Rs. 3 lakh.
Employ ECHS for major treatments and additional coverage.
Take advantage of MediAssist's cashless treatment facilities.
This strategy ensures comprehensive coverage and reduces financial strain during medical emergencies.

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: I think the coverage is sufficient for you. Hence no need to buy additional insurance