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: Hi, the coverage amount should be an estimate of the treatment you may be expecting in the near future in case you have any pre existing diseases. Else, due to the age being on higher end, you may have to pay higher premiums. Do not delay and purchase as soon as possible.

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.

Ans: I am sorry for your loss. I understand this is a tough time financially and you're juggling multiple priorities. Here's why a mediclaim policy for your family might be a good idea:

• Peace of mind: Medical emergencies are unpredictable. A mediclaim policy would provide financial cover beyond your company insurance, especially if the hospitalisation costs exceed 10 lakh.
• Security for children's future: Medical bills can derail your savings plan for their education. A mediclaim would ensure their education funds remain untouched.

Finding the right mediclaim policy:

• Family floater plan: Consider a family floater plan where the sum insured is shared amongst you and your children. This is usually cheaper than individual plans.
• Start with a reasonable sum insured: You can start with a sum insured of 5-7 lakhs on the family floater plan. This can be increased later.
• Check for exclusions: Carefully review the policy document for exclusions pre-existing conditions, specific procedures etc.

Balancing cost and coverage:

• Compare quotes online: Use online insurance aggregators to compare quotes from different insurers. They can help you find plans that fit your budget.
• Company vs Individual plan: While your company plan offers some coverage, a personal mediclaim can provide wider coverage and may not be tied to your employment.

Don't forget:

• Disclose pre-existing conditions: Be upfront about any pre-existing conditions to avoid claim rejections.
• Renew on time: Timely renewal ensures uninterrupted coverage.

Remember, a mediclaim policy is an investment in your family's well-being. Weigh the cost of the premium against the potential financial burden of medical bills.

Ans: Choosing the right health insurance plan for your family is crucial. A good plan ensures that you are financially protected in case of medical emergencies. You have shortlisted HDFC Ergo Optima Secure, which is a great start. Let’s discuss the factors you should consider when choosing the best health insurance plan for your family, covering you, your wife, and your two kids with at least a Rs 15 lakh cover.

Coverage and Benefits
Sum Insured
Adequate Coverage: Ensure the plan offers a minimum cover of Rs 15 lakh. Higher coverage provides better financial protection.
Hospital Network
Cashless Treatment: Look for a plan with a wide network of hospitals offering cashless treatment. This ensures ease during emergencies.
Room Rent Limits
Room Rent Capping: Choose a plan with higher room rent limits or no capping. This prevents out-of-pocket expenses during hospitalization.
Pre and Post-Hospitalization
Extended Coverage: Ensure the plan covers pre and post-hospitalization expenses. This covers expenses incurred before and after hospitalization.
Daycare Procedures
Comprehensive Cover: The plan should cover various daycare procedures. Many treatments don’t require 24-hour hospitalization.
No Claim Bonus (NCB)
Incremental Benefits: Look for plans offering a No Claim Bonus. This increases your sum insured for every claim-free year.
Inclusions and Exclusions
Maternity and Newborn Cover
Family Planning: If you are planning for more children, ensure maternity and newborn cover is included.
Critical Illness Cover
Serious Conditions: Consider a plan that covers critical illnesses. This ensures coverage for life-threatening conditions.
Disease Waiting Period
Waiting Period: Check the waiting period for pre-existing diseases. A shorter waiting period is preferable.
Specific Exclusions
Understand Exclusions: Read the policy document to understand specific exclusions. This helps avoid surprises during claim time.
Additional Benefits
Annual Health Check-Up
Preventive Care: Plans offering annual health check-ups help in early detection of health issues.
Wellness Programs
Healthy Lifestyle: Some plans offer wellness programs and discounts for maintaining a healthy lifestyle.
Ambulance Cover
Emergency Services: Ensure the plan covers ambulance charges. This is crucial during medical emergencies.
Restore Benefits
Reinstatement of Sum Insured: Look for plans that offer restore benefits. This reinstates your sum insured if exhausted within a policy year.
Premiums and Co-Payments
Affordable Premiums
Cost-Effectiveness: Ensure the premium is affordable for the benefits offered. Compare different plans for cost-effectiveness.
Co-Payment Clause
Co-Payment: Be aware of the co-payment clause. Lower co-payment means less out-of-pocket expenses.
Claim Process and Customer Service
Easy Claim Process
Smooth Claims: Choose a plan with a hassle-free claim process. Online claim settlement options are preferable.
Customer Support
Support System: Good customer service is essential. Ensure the insurer has a robust support system for queries and claims.
Claim Settlement Ratio
Reliability: Check the insurer’s claim settlement ratio. A higher ratio indicates reliability and trustworthiness.
Recommendations
Balanced Plan
Comprehensive Coverage: Choose a plan that balances coverage, benefits, and premiums. Ensure it meets your family’s healthcare needs.
Customizable Plans
Tailored Options: Opt for plans that allow customization. Add-ons and riders enhance the basic plan as per your requirements.
Renewability
Lifelong Renewability: Ensure the plan offers lifelong renewability. This is crucial for continuous coverage in old age.
Portability
Switching Plans: Check if the plan allows portability. This helps in switching insurers without losing benefits.
Final Insights
Choosing the right health insurance involves evaluating coverage, benefits, and costs. Ensure the plan meets your family’s healthcare needs and offers adequate financial protection. Regularly review your policy and update it as per changing requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in