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

Ramalingam Kalirajan |7847 Answers |Ask -Follow

Mutual Funds, Financial Planning Expert - Answered on Aug 23, 2024

Ramalingam Kalirajan has over 23 years of experience in mutual funds and financial planning.
He has an MBA in finance from the University of Madras and is a certified financial planner.
He is the director and chief financial planner at Holistic Investment, a Chennai-based firm that offers financial planning and wealth management advice.... more

Asked by Anonymous - Aug 18, 2024Hindi

My father is an ex service man and he and his dependent s are covered under echs if he wants, can go for private mediclaim policies along with echs card?

Ans: Your father, being an ex-serviceman, and his dependents are covered under the Ex-Servicemen Contributory Health Scheme (ECHS). ECHS offers comprehensive healthcare benefits, including cashless treatment at empaneled hospitals. However, there are situations where a private mediclaim policy might complement the ECHS coverage.

Benefits of Having Both ECHS and Private Mediclaim Policies
Extended Coverage
While ECHS provides good coverage, it may not cover all hospitals or specific treatments, particularly in non-empaneled hospitals or for certain advanced procedures. A private mediclaim policy can bridge this gap, ensuring broader coverage.

Additional Sum Insured
With healthcare costs rising, the sum insured under ECHS might not be sufficient for all situations. A private mediclaim policy can provide additional financial security, covering expenses beyond the ECHS limits.

Faster Reimbursement
ECHS reimbursement processes can sometimes take longer. A private mediclaim policy could provide quicker claims processing, reducing the financial burden on your family during emergencies.

Coverage of Non-Dependents
ECHS primarily covers dependents, which may exclude certain family members. A private mediclaim policy can ensure that those not covered under ECHS are still insured.

Cashless Treatment at Private Hospitals
If your father prefers treatment at a non-ECHS empaneled hospital, a private mediclaim policy offering cashless treatment at a wider network of hospitals can be beneficial.

Points to Consider Before Opting for Private Mediclaim
Premium Costs
Private mediclaim policies come with a premium. Ensure that the additional coverage is worth the cost, considering your father's healthcare needs and financial situation.

Policy Exclusions
Review the exclusions in the private mediclaim policy. Some policies might have waiting periods for pre-existing conditions or specific illnesses, which ECHS might cover.

Coordination of Benefits
When having both ECHS and a private mediclaim, it’s essential to understand how claims will be coordinated. Usually, ECHS would be the primary insurer, and the private mediclaim would cover any remaining costs.

Age and Health Condition
Depending on your father's age and current health status, the availability and cost of private mediclaim policies may vary. Some insurers may impose higher premiums or limit coverage for older individuals.

Final Insights
Your father can certainly opt for a private mediclaim policy alongside the ECHS card. This dual coverage offers an extra layer of security, especially for treatments outside the ECHS network or for large medical expenses. However, it’s important to carefully assess the benefits against the cost and ensure that the policy aligns with your family's healthcare needs.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.

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My family is covered under Ex-serviceman Contributory Health Services (ECHS). She is having health insurance coverage from three other insurance entities. Still continuing. So, there was no pre-existing conditions. Two and half years back, we have opted for claim re-imbursement only for blood transfusions during the pre-diagnosis period. Later, her medical condition was diagnosed and the same was falling under IRDA exclusions. She was treated once in-patient and afterwards as outpatient. All claims for admission and medicine re-imbursement were availed from ECHS. (Once I have opted for enhancement of insurance coverage from one insurer and the TPA has refused under these clauses). Now, after two and half years, she has recovered better (Even Doctor's perception). But she is continuing medicine with lessor dosage. Presently, her condition is fine. My questions are: 1. Can I avail insurance facilities from insurance companies for the same issue in future? 2. Can I avail insurance facilities from the insurance companies, for other issues than the specifically excluded? 3. Can I prefer ECHS for any eventualities for the specified issue to the extent admitted, and remaining expenditure from other insurance companies? Please guide.

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.

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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 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.

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