Im 62 year old and retired person. I am looking for health insurance policy for me and my wife who is 52 year old and housewife. I am suffering from high BP, Cervical and Lumber spondylitis, knee osteoarthritis, IBS and taking medicines for last 10-12 years. My wife has hypothyroidism, spondylitis and diabetes Please suggest better health insurance policy. Also suggest whether individual or family policy will be better Regards

Ans: It's great that you're considering a health insurance plan to secure your family's well-being. When selecting a health insurance plan, several factors come into play, including coverage, premiums, network hospitals, and additional benefits. Here are some tips to help you choose the best one:

Assess your family's healthcare needs: Consider factors like existing medical conditions, expected healthcare expenses, and any specific requirements related to treatments or procedures.

Comprehensive coverage: Look for a health insurance plan that offers comprehensive coverage for a wide range of medical expenses, including hospitalization, daycare procedures, pre and post-hospitalization expenses, and critical illnesses.

Network hospitals: Check the list of network hospitals associated with the insurance provider to ensure accessibility to quality healthcare facilities in your area.

No claim bonus (NCB) and benefits: Evaluate if the plan offers incentives like no claim bonus for claim-free years, health check-up benefits, and wellness programs to promote preventive healthcare.

Claim settlement ratio: Review the insurer's claim settlement ratio, which reflects their track record of processing and settling claims efficiently.

Affordability: While opting for a comprehensive plan is essential, ensure that the premium fits within your budget and offers value for money in terms of coverage and benefits.

Based on these considerations, you can explore health insurance plans offered by reputed insurers like HDFC ERGO Health, ICICI Lombard, Apollo Munich, or Max Bupa. Compare their features, coverage limits, exclusions, and premiums to select the one that best meets your family's needs.

Before finalizing the plan, read the policy documents carefully, including terms and conditions, exclusions, and claim procedures, to have a clear understanding of what is covered and any limitations.

Additionally, consider consulting with a licensed insurance advisor or Certified Financial Planner to receive personalized recommendations based on your specific requirements and financial situation.

Best Regards,

K. Ramalingam, MBA, CFP,
Chief Financial Planner,
www.holisticinvestment.in

Ans: Hello;

Before signing up for a healthcare insurance cover you need to understand the permanent and time bound exclusions mentioned in the policy

Also check the black listed hospitals on insurers website and avoid them as far as possible.

Better is to select network hospital and go for cashless facility.

Also before signing up, you need to honestly disclose pre-existing diseases, hereditary history of you near blood relatives in good faith.

This will reduce chances of claim rejection.

For your reference I am sharing names of some health insurers whose incurred claims ratio(ICR) was above 80% in FY-24:

HDFC Ergo
ICICI Lombard
SBI General
Bajaj Allianz
National Insurance

Request you to do your due diligence and seek help from an investment advisor or insurance advisor for further help.

Best wishes;

Ans: Hello;

If you have a known illness of the heart unfortunately hardly any general insurance company will come forward to cover you despite other positives.

Because insurance works on probability and when they reckon that probability of claim, in future based on current information, may be high they refuse to underwrite such risks.

Since you are an employee of a public sector company, I suppose your employer may have some group mediclaim plan or coverage for the retirees as well.

Take that coverage even if you have to pay and undergo a waiting period.

Alternatively you may earmark some fixed sum 8-10 L as medical contingency fund for yourself.

For your spouse you should opt for a minimum 25 L healthcare cover from companies such as HDFC Ergo, ICICI Lombard, Bajaj Allianz, SBI General etc which do not entirely depend on healthcare insurance as the only business segment.

Best wishes;