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Health Insurance Premium Increase after Diagnosis: A 30-Year-Old's Concern

Ramalingam

Ramalingam Kalirajan  |7012 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Aug 13, 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
Dilip Question by Dilip on Aug 11, 2024Hindi
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I have health insurance for almost continues 5 year, sixth running. If during this year I am diagnosed with any kind of terminal or non communicable disease, will my premium increase? Or it will be same as it should be due?? Further I would like to clarify in last 5 year I have no claims

Ans: Health insurance is essential for safeguarding your financial well-being. As you have maintained your health insurance for almost six years without any claims, it's important to understand how your premiums might be affected if you are diagnosed with a terminal or non-communicable disease.

No Claim History and Its Impact
First, your consistent history without claims is positive. Typically, insurers reward this with benefits like No Claim Bonus (NCB). This bonus often results in increased coverage without a corresponding rise in premium. However, let's address your specific concerns regarding premium adjustments.

Diagnosis of Terminal or Non-Communicable Disease
If you're diagnosed with a terminal or non-communicable disease during your current policy year, here’s what usually happens:

Premium Stability: In most cases, your premium will remain the same until the end of the current policy year. Insurers cannot increase your premium mid-policy due to a change in health status.

Renewal Considerations: Upon renewal, the insurance company may reassess your health status. However, given the regulations and consumer protections, insurers typically do not increase premiums solely due to a new diagnosis during the policy term. Your existing premium structure is likely to continue unless there is a broader industry-wide change.

Understanding the Insurance Regulatory Framework
The Insurance Regulatory and Development Authority of India (IRDAI) plays a crucial role in safeguarding policyholders. As per IRDAI regulations:

No Mid-Term Premium Hike: Insurers cannot arbitrarily increase your premium within the policy term due to new health conditions.

Renewal Terms: At the time of renewal, your premium may be reviewed. However, this review is generally based on age-related factors rather than health status changes during the existing policy.

Impact of No Claim Bonus (NCB)
Your five-year claim-free history has likely earned you a No Claim Bonus. Here’s how it benefits you:

Increased Sum Insured: Typically, the NCB adds to your sum insured, giving you higher coverage at the same premium.

Stable Premiums: The NCB often helps in maintaining stable premiums, even at the time of renewal, as long as the NCB rules of your insurer are favorable.

Preparing for Policy Renewal
When your policy renewal is due, consider the following:

Review the Terms: Check if your insurer has made any changes to the policy terms, especially regarding premium calculation.

Consider Portability: If you feel the premium is unjustifiably high or the terms have become unfavorable, you can consider porting your policy to another insurer without losing your accrued benefits like NCB.

Addressing Future Health Concerns
Given the unpredictable nature of health, it’s wise to consider how your insurance will protect you in the event of a terminal or non-communicable disease diagnosis.

Comprehensive Coverage: Ensure your policy offers comprehensive coverage for a wide range of illnesses, including critical illnesses. This provides you with financial security during challenging times.

Top-Up Plans: Consider purchasing a top-up plan if you feel your current coverage might not be sufficient in case of a major health crisis. This plan can supplement your existing coverage at a relatively low cost.

Importance of Regular Health Insurance Reviews
Maintaining your health insurance policy without any claims is commendable. However, regular reviews are essential to ensure your policy continues to meet your needs.

Policy Updates: Stay informed about any updates or changes your insurer may implement. This includes changes to premiums, coverage, and terms at renewal time.

Evaluate Coverage Needs: As you age, your health insurance needs may change. Periodically assess whether your current coverage is adequate, especially in light of potential future health risks.

Final Insights
Your careful management of health insurance over the last five years has set you on a solid path. While a new diagnosis during the current policy year should not affect your premiums immediately, it's wise to stay informed about your options at renewal. Keep in mind the importance of comprehensive coverage, the benefits of No Claim Bonus, and the possibility of adding top-up plans to safeguard against future uncertainties.

By staying proactive and reviewing your policy regularly, you can ensure that your health insurance remains a strong pillar of your financial security.

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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Hi team, I have a health insurance since 2011. No claims as of now. I don't have BP or Diabetes as of now. the insurance company is NIA. What if in due course of time i develop some lifestyle ailment like BP or diabetes and it goes unchecked. will it affect my claims after that?
Ans: That's a great question! It's fantastic that you've been proactive with your health and maintained good health so far. Let's break down how pre-existing conditions and health insurance claims work:

No Claims and Pre-existing Conditions:

Good news! Having no claims history generally looks good to insurance companies. It shows you've been responsible with your health.
Pre-existing conditions are medical conditions you have before buying health insurance. These might affect your coverage or premiums in the future.
Lifestyle Ailments and Claims:

Lifestyle diseases like BP and diabetes can develop over time. If they go unchecked, they might become pre-existing conditions.
The impact on claims depends on your specific policy and when the condition developed. Some plans have waiting periods for pre-existing conditions. This means you might have to wait a certain time before coverage kicks in for those conditions.
Here's what you can do:

Maintain a Healthy Lifestyle: This is key! Keep up the good work by eating healthy, exercising, and getting regular checkups.
Review your Policy Wording: Look at the section on pre-existing conditions and waiting periods. If unsure, call your NIA customer service for clarification.
Talk to a CFP Professional: A Certified Financial Planner can help you review your health insurance coverage and see if it aligns with your future health needs.
Remember: Early detection and management of lifestyle diseases can make a big difference. Taking care of your health now can benefit you in the long run, both physically and financially.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Ramalingam

Ramalingam Kalirajan  |7012 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 11, 2024

Asked by Anonymous - Jun 24, 2024Hindi
Money
Hello sir, my age is 40 yrs currently unmarried. Recently, I had to undergo a renal transplant surgery since I was suffering from AKD (Acute Kidney Disorder) in Bangalore. I was on dialysis for last one and half yrs and moved to bangalore just for the surgery. It went well and now I am on the road to recovery.We had a health insurance policy by manipal cigna company (medi-assist) which ensured that every expenses was met through reimbursement like dialysis expenses, OPD chgs, pharmacy bills etc. We were satisfied with the services of the health insurance provider. My question here is that can I take any more health insurance policy now (may be from a different company) for my future medical expenses which might occur in future (considering I am pretty young right now and single too). What premium do I need to pay for that? Will it be increased premium or the same normal premium. I might not use the health cover for my renal disease now but as a safeguard for the future diseases which may come up.(considering I will get married and have a family too in future). Will my kidney surgery have any impact on the future health cover or not? Kindly advise.
Ans: I'm glad to hear your surgery went well, and you're on the road to recovery. Considering your situation, it’s important to secure your health insurance needs for the future. Let’s break down your questions and concerns regarding taking an additional health insurance policy.

Can You Take Another Health Insurance Policy?
Yes, you can take another health insurance policy from a different company. However, your recent medical history, including the renal transplant surgery, will impact your new policy's terms and premiums.

Impact of Renal Transplant on New Policy
Pre-Existing Conditions: Your kidney surgery will be considered a pre-existing condition. Most insurers have a waiting period for covering pre-existing conditions, ranging from two to four years. It’s crucial to check the specifics with any new insurer.

Medical Underwriting: Given your recent medical history, the insurer may require detailed medical underwriting. They may request your medical records and possibly a medical examination to assess your current health status.

Premium Considerations
Increased Premiums: Due to your pre-existing condition, new health insurance policies are likely to come with increased premiums. The exact amount will depend on the insurer's assessment of your health risk.

Loading Charges: Some insurers might add a loading charge to your premium, which is an additional cost to cover the higher risk associated with your medical history.

Types of Policies to Consider
Individual Health Plans: These provide coverage for a single person. Given your situation, ensure the plan offers extensive coverage, including post-operative care and critical illness coverage.

Family Floater Plans: These plans cover multiple family members under a single sum insured. They might be a good option if you plan to get married and start a family in the near future.

Critical Illness Plans: These plans provide a lump sum amount upon diagnosis of specified critical illnesses, including kidney-related issues. It can be a supplementary policy to your primary health insurance.

Steps to Take
Research and Compare: Compare policies from different insurers. Look for policies with comprehensive coverage and a reasonable waiting period for pre-existing conditions.

Consult Insurers: Speak directly with insurance representatives. Explain your medical history and get clear information on how it will affect your premiums and coverage.

Read Policy Documents: Carefully read the policy documents, especially the sections on pre-existing conditions, waiting periods, exclusions, and premium loading.

Consider Riders: Look for riders or add-ons that can enhance your coverage, such as critical illness riders, hospital cash, and personal accident covers.

Consulting a Certified Financial Planner
Given the complexities of your medical history and future health needs, consulting with a Certified Financial Planner (CFP) can be very beneficial. A CFP can help you understand the nuances of different policies, assess your long-term financial needs, and recommend the best health insurance options tailored to your situation.


You’ve shown great foresight in considering additional health insurance despite your recent surgery. Ensuring your future medical needs are covered demonstrates a strong commitment to your long-term well-being. Your proactive approach to securing your health is commendable and shows a responsible attitude towards managing potential future risks.

Final Insights
Securing an additional health insurance policy is a wise move, especially considering your recent medical history and future plans. While premiums might be higher due to your pre-existing condition, thorough research and consulting with professionals can help you find the best policy for your needs. Remember to compare different plans, understand the terms, and choose a policy that offers comprehensive coverage and aligns with your financial goals.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

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