i am having happy family floater policy from oriental insurance company for medical insurance.The policy amount is Rs.8,00,000/-This policy covers my family .In my family,myself(AGE 66years),my wife (Age 51 years) And my son (AGE 21 years).Since 8 lakhs is not sufficient amount now a days for health coverage,I want to enhance the mediclaim policy amount.Since I am 66 years old,including my self in the same policy may increase premium amount.Please suggest me a good policy giving direction whether I should take 3 different policies individually for each one of us,or shall I make my wife and son a separate group.suggest me if I have take any separate policy for any type of critical illness like cancer?I was a smoke from my 22nd year to 50th year,i.e. from 1982 t0 2010.Since then I stopped smoking.But I was a heavy smoker smoking on average 20 cigarettes a day.If Iincrease our coverages to 15 lakhs rupees,is it sufficient.or any other suggestion.Similarly suggest a good policy and from whom I should take these policies.I can not enhance the existing policy as oriental insurance is not interested to enhance the policy amount because of certain claims which were there in this year and previous year. Thanks and Regards.

Ans: Unfortunately, finding a new health insurance policy with pre-existing conditions like open-heart surgery can be challenging, especially at the age of 69. Here's why:

• Pre-existing Conditions: Most insurers are hesitant to cover pre-existing conditions, and open-heart surgery falls under that category.
• Age: As you age, premiums tend to rise, and insurers might be more cautious about taking on new senior citizens.

However, there are still some options to explore:

1. Renew Existing Policy with Oriental:

Check with Oriental Insurance Co. again regarding renewal. While they might not increase the sum insured to 15 lakh, they might still offer renewal on the existing 10 lakh plan.

2. Senior Citizen Mediclaim Plans:

Many insurers offer senior citizen health insurance plans designed for people above 60. These plans may have limitations on pre-existing conditions, but they could offer some coverage. You can explore options from reputable companies like Max Bupa, Care Health Insurance, or Cholamandalam MS. Research these companies online or consult an insurance broker for plan details.

3. Top-up Plans:
These plans work alongside your existing policy and provide additional coverage in case your existing sum insured gets exhausted. However, pre-existing condition exclusions might still apply. Explore top-up plans offered by your existing insurer or other companies.

4. Finding the Right Plan:

• Use online insurance comparison platforms or consult an insurance broker to compare different senior citizen mediclaim or top-up plans.
• Carefully review the policy documents, especially exclusions related to pre-existing conditions.
• Consider factors like network hospitals, co-pay clauses, and claim settlement ratio before finalising a plan.

Ans: Taking the right health insurance coverage is crucial, especially given the rising medical costs. With your current family floater policy of Rs. 22.5 lakhs and considering your wife's family history, it’s essential to evaluate your needs. Here’s a comprehensive guide to help you decide on additional coverage and whether a critical illness or cancer policy is necessary.

Current Health Insurance Coverage
Your existing policy has served you well, accumulating a bonus of Rs. 7.5 lakhs, increasing your coverage to Rs. 22.5 lakhs. This is a good base, especially since you’ve prioritized a public sector insurer due to concerns over private insurers.

Public sector insurers have a reputation for reliability and fewer complaints. Your choice is wise, given your specific concerns.

Assessing Your Coverage Needs
Health insurance needs can vary based on several factors, including age, family medical history, and lifestyle. Considering these factors, let's analyze your situation:

Age: At 49 and 44, you and your wife are approaching an age where medical issues become more common. Your daughter, at 16, still has a relatively low risk.

Medical History: Your wife’s family history of heart problems and cancer is a significant factor. This history increases the likelihood of needing substantial medical care in the future.

Rising Medical Costs: Medical inflation in India is high. Treatments for severe illnesses can easily exceed Rs. 20 lakhs, especially in metropolitan areas.

Given these points, it might be wise to consider additional coverage. A coverage of Rs. 30-50 lakhs could be more appropriate.

Evaluating the Need for Additional Coverage
To determine if you need more coverage, consider these aspects:

Hospitalization Costs: Major treatments and surgeries can be very expensive. Even with Rs. 22.5 lakhs coverage, a few hospitalizations could exhaust your policy limits quickly.

Treatment Advances: Medical technology is advancing, leading to higher costs for newer treatments and procedures.

Geographical Location: If you live in a metro city, medical costs are generally higher compared to smaller towns.

A top-up or super top-up policy could be a cost-effective way to increase your coverage without significantly increasing premiums. These policies kick in after a certain threshold is met, offering higher coverage at a lower cost.

Critical Illness and Cancer Policies
Given your wife's family history, a critical illness policy or a specific cancer policy could be beneficial. These policies provide a lump-sum payment on diagnosis of specific illnesses, which can be used for treatment, recovery, or even daily expenses.

Critical Illness Policy: Covers a range of severe illnesses like heart attack, stroke, kidney failure, and more. It provides financial support at a crucial time, helping to cover costs that may not be included in a regular health policy.

Cancer Policy: Specifically designed for cancer treatment. Cancer treatment can be prolonged and expensive. This policy ensures that financial constraints do not hinder the treatment process.

Benefits of Critical Illness Policies
Lump-Sum Payment: On diagnosis, you receive a lump-sum amount which can be used for any purpose, giving you flexibility.

Wide Coverage: Covers several major illnesses which can be financially draining if not insured.

Peace of Mind: Knowing you have coverage for major illnesses can reduce stress and allow you to focus on recovery.

Benefits of Cancer Policies
Specialized Coverage: Tailored specifically for cancer, ensuring comprehensive coverage for all stages of the disease.

Enhanced Support: Provides financial support for expensive treatments, ensuring quality care without worrying about costs.

Flexibility: The payout can be used for treatment or other related expenses, providing financial flexibility during tough times.

Premium Considerations
Health insurance premiums do rise with age and medical inflation. To manage premium costs while ensuring adequate coverage, consider the following strategies:

Top-Up Plans: As mentioned, these can provide high coverage at lower premiums compared to base policies.

Family Floater Plans: These can sometimes be more economical than individual plans, especially when covering multiple family members.

Regular Review: Periodically review and adjust your coverage to match your current needs and financial situation.

Practical Steps to Enhance Coverage
Assess Your Needs Regularly: Health needs change over time. Regularly assess your insurance coverage to ensure it aligns with your current and future needs.

Consider Top-Up Policies: If you find your current coverage inadequate, a top-up policy can provide additional coverage at a reasonable cost.

Evaluate Critical Illness and Cancer Policies: Given your wife's family history, these policies can provide financial security in case of serious illnesses.

Consult a Certified Financial Planner: They can provide personalized advice, ensuring your insurance strategy fits within your broader financial plan.


You’ve taken commendable steps to ensure your family's health and financial security. Your proactive approach to health insurance is admirable. It’s evident that you care deeply about your family's well-being, and you're making informed decisions to protect them.

Final Insights
Ensuring adequate health insurance coverage is crucial, especially with rising medical costs and potential health risks. Your current coverage of Rs. 22.5 lakhs is a good start, but considering additional coverage could provide more security.

A top-up policy could enhance your coverage cost-effectively. Given your wife's family history, a critical illness or cancer policy could offer additional peace of mind and financial support.

Health insurance is not just about covering hospital bills; it's about securing your financial future against unforeseen medical expenses. By carefully evaluating your needs and considering additional coverage options, you can ensure comprehensive protection for your family.

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner

www.holisticinvestment.in

Ans: Hi Biswadeep,
Its good for you to think about increasing Health Insurance cover as it is one of the basic requirement these days.
For your family of 3, cover of 15 lakhs is a good amount to decide.

Things for you to consider while choosing policy:
- Select your insurer which has wide hospital network.
- Check the claim settlement ratio. More the ratio, better is the insurer.
- Check online reviews regarding claim process.
- Check room rent limits.
- Check co-pay and deductible clause.
- Check waiting period of any pre-existing diseases. It is usually between 3 to 5 years for different policies.
- Ensure the policy also cover day care procedures.

Also make sure to avoid the one with lower premiums. Lower premiums usually comes with extra cost and hidden T&C's.
And avoid mixing insurance with investments such as LIC policy or ULIPs.

Working with a Certified Financial Planner - a CFP can guide you with exact insurance and investments keeping in mind your age and risk profile.

Best Regards,
Reetika Sharma, Certified Financial Planner
https://www.instagram.com/cfpreetika/

Ans: You have taken a very sensible step by reviewing your health insurance at age 66. Medical inflation in India is rising rapidly, and an Rs. 8 lakh family floater that was adequate a few years ago may not be sufficient today, especially when one family member is already in the senior citizen age bracket.

» Assessment of Your Current Cover

– Existing family floater cover of Rs. 8 lakh for four members is on the lower side today.

– A single major hospitalization such as cancer, cardiac surgery, organ-related illness or prolonged ICU stay can consume a large portion of the sum insured.

– Since you have already crossed age 65, health insurance planning should now focus on preserving coverage and increasing protection rather than looking only at premium costs.

» Family Floater or Separate Policies

– In your case, keeping all four members under one policy may not be the most efficient arrangement.

– Your age of 66 significantly influences the premium for the entire family.

– A better structure may be:

One separate senior citizen health policy for yourself.
One separate family floater policy for your wife and son.

– Since your son is already 21 years old, many insurers may eventually require him to move to an independent policy depending on policy conditions.

– This structure often provides better flexibility and may help optimise premium costs.

» How Much Coverage Should You Target?

– In my view, Rs. 15 lakh total coverage is better than Rs. 8 lakh, but may still be modest considering your age and medical inflation.

– Ideally, think in terms of a combination of:

A base health insurance policy.
A super top-up health insurance policy.

– This approach often provides significantly higher protection at a reasonable cost.

– For a family in your situation, total protection of Rs. 20 lakh to Rs. 30 lakh would provide greater comfort.

» Critical Illness Cover

– Critical illness insurance can be useful, but it should not replace health insurance.

– Health insurance pays hospital bills.

– Critical illness cover provides a lump sum amount after diagnosis of specified illnesses.

– At age 66, availability and premium will depend on underwriting and medical history.

– If available at a reasonable cost, a critical illness cover can be considered as an additional layer of protection.

– However, strengthening core health insurance should be the first priority.

» Impact of Past Smoking History

– You stopped smoking around 15 years ago, which is a positive factor.

– However, insurers will still ask about your smoking history.

– Always disclose your past smoking habit honestly.

– Non-disclosure can create claim-related complications later.

– Since you have remained tobacco-free for many years, some insurers may view the risk more favourably than an active smoker.

» What Features to Look For

When evaluating a new policy, pay attention to:

– High claim settlement service quality.

– Lifelong renewability.

– Reasonable waiting period conditions.

– Coverage for modern treatments and advanced procedures.

– Good network hospital availability in your city.

– Restoration or refill benefits.

– Super top-up options.

– No restrictive room rent limits.

» Before Moving From Existing Policy

– Since you already have a running policy with claim history, be careful before surrendering or discontinuing it.

– Check whether portability to another insurer is possible.

– Portability may help carry forward certain accumulated benefits and waiting period credits.

– Compare the terms carefully before taking a final decision.

» Finally

– I would not recommend keeping all four members under a single family floater at this stage.

– A separate senior citizen policy for yourself and a separate arrangement for your wife and son deserves serious consideration.

– Instead of looking only at Rs. 15 lakh cover, explore a combination of base cover plus super top-up cover so that total protection reaches a much more comfortable level.

– Your biggest objective should be ensuring that one major medical event does not disturb your retirement corpus and family finances.

– Health insurance at this stage is less about saving premium and more about protecting wealth accumulated over a lifetime.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

https://www.linkedin.com/in/ramalingamcfp/