My salary is 60k pm and I am reaching 50 years of age, I am planning to take a mediclaim policy. Can you please help, which policy and how much cover should I look for me and my wife?

Ans: At the age of 73, it's still possible to obtain medical health insurance coverage, although it may come with certain limitations and higher premiums due to your age. Here are some options you can explore:

Senior Citizen Health Insurance Policies: Many insurance companies offer specialized health insurance plans specifically designed for senior citizens. These policies typically provide coverage for hospitalization expenses, pre-existing diseases, and other medical expenses incurred due to illnesses or accidents. While premiums may be higher compared to regular health insurance plans, senior citizen policies offer comprehensive coverage tailored to the healthcare needs of older individuals.

Government Health Insurance Schemes: Some government-sponsored health insurance schemes cater to senior citizens and provide affordable healthcare coverage. For example, in India, schemes like the Pradhan Mantri Jan Arogya Yojana (PMJAY) or state-specific health insurance schemes may offer coverage for hospitalization expenses and treatment for certain illnesses.

Group Health Insurance: If you have any affiliation with professional or social organizations, you may be eligible to join group health insurance schemes offered by these organizations. Group insurance plans often provide coverage at a lower cost compared to individual policies and may have less stringent eligibility criteria.

Family Floater Plans: If you have family members who are younger and in good health, consider opting for a family floater health insurance plan that covers you along with your family members. Family floater plans offer shared coverage for the entire family at a relatively lower premium compared to individual policies.

Pre-existing Disease Coverage: Since you may have pre-existing medical conditions at the age of 73, it's essential to choose a health insurance policy that offers coverage for pre-existing diseases. Look for policies that provide coverage for pre-existing conditions after a waiting period, as this can help manage your healthcare expenses effectively.

Before purchasing a health insurance policy, carefully review the coverage features, exclusions, waiting periods, premium costs, and claim settlement process. Consider consulting with an insurance advisor or agent who can help you compare different policies and choose the one that best suits your healthcare needs and budget.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Choosing the right health insurance for your family is a crucial decision. I understand that this process can be overwhelming, especially with the numerous options available in the market. Let’s explore this step-by-step to ensure that you select the best health insurance plan tailored to your family’s needs.

Understanding Health Insurance
Health insurance is essential to safeguard against unexpected medical expenses. It covers hospitalization, treatments, surgeries, and sometimes even preventive care.

Having health insurance gives you peace of mind, knowing that you won't have to bear the entire financial burden in case of medical emergencies.

Assessing Your Family’s Health Needs
To choose the right health insurance, you need to assess the specific health needs of your family.

Consider Your Age and Health Status
At 62 years old, your health needs may be different from those of your wife, who is 56, and your children, who are 25 and 20 years old. Older individuals typically require more frequent medical attention and might have pre-existing conditions.

Pre-existing Conditions
If any family member has pre-existing conditions, ensure the policy covers these after a waiting period. This is crucial for avoiding out-of-pocket expenses.

Coverage for Hospitalization and Surgeries
Ensure that the policy covers hospitalization and surgeries. Medical costs can be very high, and comprehensive coverage will protect you from significant financial strain.

Comparing Different Policies
When comparing health insurance policies, consider the following factors:

Sum Insured
Choose a sum insured that is sufficient to cover the potential medical expenses for the entire family. In metropolitan cities, medical costs can be higher, so opt for a higher sum insured if you reside in such areas.

Network Hospitals
Check if the insurance provider has a wide network of hospitals. Cashless hospitalization in network hospitals simplifies the process and reduces financial stress during emergencies.

Sub-limits and Co-payments
Some policies have sub-limits on room rent or specific treatments and co-payment clauses. Understand these limitations to avoid unexpected expenses.

Waiting Periods
Understand the waiting periods for pre-existing diseases, maternity benefits, and other specific treatments. Shorter waiting periods are more advantageous.

Family Floater Plans vs. Individual Plans
A family floater plan covers all family members under a single sum insured, while individual plans provide separate coverage for each member.

Family Floater Plans
Family floater plans are usually more cost-effective and simpler to manage. The sum insured is shared among all members, which is beneficial if no major health issues are anticipated simultaneously.

Individual Plans
Individual plans can be more suitable if family members have varying health needs or if older members need higher coverage. Separate policies ensure that one member’s high medical expenses do not exhaust the entire sum insured.

Critical Illness Coverage
Consider adding critical illness coverage to your health insurance. This provides a lump sum payment upon diagnosis of severe illnesses such as cancer, heart attack, or stroke.

Maternity Benefits and Newborn Coverage
If there’s a possibility of expanding your family, check if the policy includes maternity benefits and coverage for newborns.

Premiums and Affordability
While choosing a policy, balance between comprehensive coverage and affordability. Higher premiums usually mean better coverage, but ensure it fits within your budget.

Additional Benefits and Riders
Explore additional benefits like wellness programs, free health check-ups, and disease-specific riders. These add value to your policy.

Evaluating Insurance Providers
Choosing a reliable insurance provider is as important as selecting the right policy.

Claim Settlement Ratio
The claim settlement ratio indicates the percentage of claims settled by the insurer. A higher ratio reflects reliability.

Customer Service
Evaluate the insurer’s customer service. Prompt and efficient service is crucial during medical emergencies.

Reviews and Recommendations
Read reviews and seek recommendations from friends, family, or a Certified Financial Planner to make an informed decision.

Portability Options
If you’re not satisfied with your current insurance provider, check the portability options. This allows you to switch insurers without losing benefits.

Government Schemes and Tax Benefits
Explore government health schemes for additional coverage. Also, health insurance premiums offer tax benefits under Section 80D of the Income Tax Act.

Conclusion
Choosing the right health insurance involves thorough research and understanding your family’s specific needs. Consider the factors mentioned above to make an informed decision.

Remember, investing time in selecting the right policy can save you from financial stress during medical emergencies.

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;