Which is the best health insurance policy in india? Self -39yrs, Spouse -38yrs,Son-13yrs, son-7yrs. I have thyroid.

Ans: Hi Kumar, every insurance policy has its own benefits and one will have to pick according to their requirements. However, check for waiting period, any exclusions, network hospitals etc., while deciding.

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;

Ans: Getting health insurance for your family is very important. Since you have pre-existing conditions (BP, GERD, diabetes, schizophrenia), some insurers may have waiting periods or exclusions. But you can still get coverage with the right approach.

 

Key Factors to Consider
Pre-existing Diseases (PEDs): Most insurers have a waiting period of 2-4 years for existing illnesses. Some plans may offer waivers with extra cost.

Mental Illness Coverage: Schizophrenia and depression must be covered under IRDAI guidelines, but insurers may still have conditions.

Family Coverage: Choose individual or floater policies based on needs.

Senior Citizen Coverage: Your mother may need a separate senior citizen plan due to age and BP history.

Cashless Hospital Network: Ensure the policy covers hospitals near you.

 

Best Approach for Your Family
1. Individual Health Policies for Each Family Member
Since your sister has serious pre-existing conditions, a separate policy for her is better.

Your mother should get a senior citizen plan with day-care and domiciliary coverage.

You, your wife, and daughter can take a family floater policy.

 

2. Super Top-up Plans for Extra Coverage
Base policies may not be enough for major treatments.

A super top-up plan can give extra coverage at a lower cost.

This helps in reducing premium costs while increasing coverage.

 

3. Critical Illness Rider
You should consider a critical illness policy.

Covers major diseases like heart attack, stroke, and kidney failure.

Provides lump sum payout in case of critical illness diagnosis.

 

How to Get Insurance for Your Sister?
Mental illness coverage is now mandatory, but many insurers still hesitate.

Some insurers may exclude pre-existing mental conditions.

If regular insurance denies coverage, look for state-sponsored health schemes.

 

Final Steps
Check waiting periods for pre-existing conditions.

Get cashless policies for easier hospitalisation.

Choose a Certified Financial Planner (CFP) or health insurance expert for the right selection.

 

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner

www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment