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Milind

Milind Vadjikar  |1238 Answers  |Ask -

Insurance, Stocks, MF, PF Expert - Answered on May 08, 2025

Milind Vadjikar is an independent MF distributor registered with Association of Mutual Funds in India (AMFI) and a retirement financial planning advisor registered with Pension Fund Regulatory and Development Authority (PFRDA).
He has a mechanical engineering degree from Government Engineering College, Sambhajinagar, and an MBA in international business from the Symbiosis Institute of Business Management, Pune.
With over 16 years of experience in stock investments, and over six year experience in investment guidance and support, he believes that balanced asset allocation and goal-focused disciplined investing is the key to achieving investor goals.... more
Badrinath Question by Badrinath on May 06, 2025
Money

HOW TO CHOOSE HEALTH INSURANCE

Ans: Hello;

You may shortlist health insurers based on following factors:

1. Incurred claims settlement ratio for 3 years atleast, preferable if available for 5 years.

2. List of network hospitals across the country and around the places that you generally operate. The more the better.

3. List of black listed hospitals so as to avoid them.

4. Low waiting period for pre-existing illnesses.

5. Claim settlement through TPA or directly the insurer(better). Also cashless claim settlement feature is desirable.

6. Reputation in the market.(Capital adequacy)

7. List of permanent exclusions

8. No sub limit on daily room rent.

9. Alternative therapies covered(Ayurveda, homeopathy etc).

10. Psychiatric treatments coverage.

Key is to disclose all existing conditions and conduct medical tests as requested by the insurer.

This way the chances of claim rejection are reduced.

You may also consult an insurance advisor if required, for further clarity.

Best wishes
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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What factors should I consider while buying life insurance or health insurance?
Ans: When buying health insurance, it's essential to consider several factors to ensure that the policies meet your specific needs and provide adequate coverage. Here are key factors to consider for each type of insurance:

Health Insurance:

Coverage and Benefits:

• Hospitalisation Coverage: Ensure the policy covers hospitalization expenses, including room charges, doctor's fees, and surgical expenses.

• Preventive Care: Check if the policy includes coverage for preventive care, vaccinations, and health check-ups.

• Network Hospitals: Verify the list of network hospitals where you can avail cashless treatments. A robust network ensures accessibility to quality healthcare.

• Coverage Limits and Sub-limits: Be aware of the overall coverage limit as well as sub-limits for specific expenses, such as room rent, doctor's fees, and specific treatments.

• Waiting Periods and Exclusions: Understand any waiting periods for specific conditions and the list of exclusions. Some policies have waiting periods for pre-existing conditions.

• Renewal Age and Continuity: Check the maximum renewal age and continuity benefits. A policy that allows lifetime renewals can be beneficial in the long run.

• Premiums and Deductibles: Compare premium costs and consider the impact of deductibles on your out-of-pocket expenses.

• Claim Process: Look for a health insurance policy with a straightforward and efficient claims settlement process.

• Family Coverage: If you are considering a family health insurance plan, ensure it covers all family members adequately.

Both life insurance and health insurance are crucial components of a comprehensive financial plan. It's advisable to assess your specific requirements, compare policies from different insurers, and seek advice from insurance professionals to make informed decisions based on your unique circumstances.

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Asked by Anonymous - Apr 04, 2024Hindi
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Hi I want a health insurance for my family but unable to decide which one to choose. What are things need to know before taking Health insurance. I want total cashless insurance. I have heard some insurance company do not cover all in claim. How to know about that. Thankyou in advance
Ans: key things to consider before choosing a family health insurance plan with cashless coverage:

Family Coverage:

Member inclusions: Ensure the plan covers all your immediate family members (spouse, dependent children, and potentially parents depending on the plan).
Sum Insured: Choose a sufficient sum insured per person considering potential medical inflation and future healthcare costs. Opt for a joint sum insured or individual sum insured per family member based on your needs.
Cashless Network Hospitals:

Network breadth: Research the insurance company's network hospitals in your area. Accessibility and quality of hospitals within the network are crucial factors.
Cashless claim settlement ratio: Check the company's cashless claim settlement ratio, indicating the percentage of cashless claims approved. A higher ratio indicates smoother claim processing.
Policy Coverage:

Hospitalization expenses: Ensure the plan covers hospitalization bills, including room rent, surgeon fees, medications, and other related costs.
Pre-existing conditions: Look for a plan that covers pre-existing conditions if any family member has one. However, there might be waiting periods for coverage.
Daycare expenses: Some plans offer coverage for daycare expenses incurred during hospitalization.
Co-pay/Deductible: Some plans involve co-pays (fixed amount paid for specific services) or deductibles (amount you pay before insurance kicks in). Understand these clauses and choose a plan with terms that suit you.
Claim Settlement Process:

Claim settlement turnaround time: Research the average time the insurance company takes to settle claims.
Claim intimation process: Understand the claim intimation procedure and required documentation to ensure a smooth process.
Company Reputation:

Financial stability: Choose a health insurance company with a strong financial track record for claim settlements.
Customer service: Look for a company known for good customer service, especially regarding claim processing assistance.
Ways to Research Plans & Claim Coverage:

Company Websites: Most insurance companies have detailed information about their health insurance plans on their websites.
Insurance Comparison Websites: Websites like Policybazaar (https://www.policybazaar.com/), CompareRaja (https://health-plan-compare.com/), or Fincare (https://www.insurancedekho.com/health-insurance/news/religare-health-insurance-partners-with-fincare-small-finance-bank-7) allow plan comparisons and provide valuable insights.
Insurance Agents: A licensed insurance agent can help you compare plans, understand exclusions, and choose the one that best suits your family's needs.
Understanding Exclusions:

Most health insurance plans have exclusions, which are medical expenses the plan doesn't cover. Here's how to learn about them:

Policy Wording: Read the policy wording carefully, focusing on the exclusions section. This will clearly outline what isn't covered by the plan.
Speak to the Insurance Provider: Contact the insurance company directly and ask about any exclusions related to specific procedures or pre-existing conditions.
Choosing the Right Plan:

Don't just focus on premiums: While cost is important, prioritize comprehensive coverage over just the lowest premium.
Get quotes from multiple companies: Compare quotes from different providers to find a plan that offers the best value for your needs.
Ask questions: Don't hesitate to ask questions and clarify any doubts you have about the plan details or claim settlement process.
By considering these factors and thoroughly researching your options, you can choose a family health insurance plan with cashless coverage that provides peace of mind and financial protection for your loved ones.

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Financial Planner - Answered on May 23, 2024

Asked by Anonymous - May 09, 2024Hindi
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I am totally confused as to which health insurance plan to buy for my family. What are the most important pointers I must know before buying a mediclaim? I want total cashless insurance. My friends tell me that many insurance companies don’t cover all the claims. How will I know about that?
Ans: Choosing the right health insurance plan for your family is crucial, and it's understandable to feel overwhelmed by the options. Here are some important pointers to consider before buying a mediclaim policy:

1. Coverage and Benefits:

• Inpatient Hospitalisation: Ensure the plan covers hospitalisation expenses, including room charges, doctor's fees, surgery, and nursing.
• Pre and Post-Hospitalisation: Look for coverage of medical expenses incurred before and after hospitalisation.
• Daycare Procedures: Check if the policy covers treatments that don't require 24-hour hospitalisation.
• Domiciliary Treatment: Verify if home treatment is covered if hospitalisation is not possible.
• Maternity and Newborn Benefits: If relevant, look for plans that cover maternity expenses and newborn care.

2. Network Hospitals:

• Cashless Facility: Ensure the insurer has a wide network of hospitals offering cashless treatment. This means the insurer pays the hospital directly, reducing your out-of-pocket expenses.
• Hospital Network Size: The larger the network, the better your chances of finding a network hospital near you.

3. Claim Settlement Ratio:

• Research: Check the insurer's claim settlement ratio, which indicates the percentage of claims settled against the total claims received. A higher ratio is preferable.
• Customer Reviews: Look for reviews and testimonials regarding the insurer's claim settlement process.

4. Exclusions and Waiting Periods:

• Pre-existing Diseases: Understand the waiting period for pre-existing conditions.
• Specific Treatments: Check for exclusions related to specific treatments or conditions.
• Waiting Periods: Be aware of initial waiting periods, disease-specific waiting periods, and maternity waiting periods.

5. Sum Insured and Sub-limits:

• Adequate Coverage: Choose a sum insured that adequately covers potential medical expenses.
• Sub-limits: Be cautious of sub-limits on room rent, specific treatments, or diseases, which can limit your claim amount.

6. Premiums and Deductibles:

• Affordable Premiums: Ensure the premiums fit your budget without compromising on coverage.
• Deductibles and Co-payment: Understand any deductibles or co-payment clauses which require you to pay a portion of the expenses.

7. Additional Benefits:

• No Claim Bonus: Some policies offer a bonus for each claim-free year, which can increase your sum insured.
• Free Health Check-ups: Look for plans offering periodic health check-ups.
• Restoration Benefits: Check if the policy offers sum insured restoration in case it gets exhausted during a policy year.

8. Portability and Renewability:

• Policy Portability: Ensure the policy is portable, allowing you to switch insurers without losing benefits.
• Lifetime Renewability: Opt for plans offering lifetime renewability to ensure coverage in older age.

9. Customer Service:

• 24/7 Support: Check if the insurer provides round-the-clock customer support.
• Ease of Process: Evaluate the ease of buying, renewing, and claiming processes.

10. Regulatory Compliance:

• IRDAI Approval: Ensure the insurer and the plan is approved by the Insurance Regulatory and Development Authority of India (IRDAI).

11. Steps to Verify Coverage and Claims:

• Policy Document: Read the policy document thoroughly for detailed coverage, exclusions, and terms.
• Brochures and Websites: Check the insurer’s official website and brochures for detailed information.
• Customer Service: Contact the insurer’s customer service for any specific queries.
• Independent Reviews: Look for independent reviews and ratings on insurance comparison websites.
• Friends and Family: Gather feedback from friends and family who have experience with the insurer.

By carefully evaluating these factors, you can make an informed decision about the best health insurance plan for your family that meets your needs and offers comprehensive coverage.

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DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Investment in securities market are subject to market risks. Read all the related document carefully before investing. The securities quoted are for illustration only and are not recommendatory. Users are advised to pursue the information provided by the rediffGURU only as a source of information and as a point of reference and to rely on their own judgement when making a decision. RediffGURUS is an intermediary as per India's Information Technology Act.

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