Month: October 2016

As part of routine annual health checkup from his company, Vikas went to a well-known hospital for the same. He was quite surprised to know that his blood pressure or BP was high. He was diagnosed with hypertension. Hypertension indicates a high risk factor for cardiovascular or heart ailments. Vikas was worried as he did not have any individual health insurance plan. This led him to investigate health plans which cover critical illnesses related to the heart.

Research shows that in India over 320 lakh people are cardiac patients in 2015. Medical Inflation is almost 20% per annum. It can thus make a large hole in one’s pocket.

Vikas comes across a Cardiac Care Plan and wonders if he should opt for that! To understand a Cardiac Special Plan, you need to know who can opt for the same.

Who can opt for Cardiac Special Health Plans?

Star Health has a cardiac special health plan called Cardiac Care Plan. Star Health Cardiac Care Plan has been especially designed for people who have undergone heart surgeries for the first time or had an angiogram. Heart surgeries include PTCA (Stenting) through Angioplasty or CABG (By Pass Surgery).

Therefore, the basic question is answered here. Vikas has been diagnosed with hypertension. He, however, has not undergone any of the heart related surgeries. Thus, he needs to apply for a regular health plan immediately. Along with basic lifestyle changes to keep the high BP under control. If the medications start, it becomes difficult to get the regular health plan issued, even with additionalpremium.

Now, you may have an ischemic heart or other heart related disease in the family. Even then, you need to apply for a regular health insurance plan. This should however be done after making the necessary declarations. Heart related ailments would then be considered as a “pre-existing” illness and might have a waiting period. Cardiac Care Health Plans can be bought ONLY if you have undergone any heart related surgeries. Not otherwise.

Uniqueness of Star Health Cardiac Care Plan.

Eligibility.

It can be taken by anyone till 65 years of age and can be renewed lifelong. This policy can be taken by anyone who has undergone Angioplasty or Bypass surgery. However it needs to be within 6 months to 3 years prior to applying for such plan.

Small Waiting Period.

This plan has 2 variants, Gold and Silver. The benefits can be summarized as under.

In both Silver and Gold Plan, all Hospitalization and Accidental expenses are covered from day 1. Even out patient expenses upto the specified limit are covered. Pre-existing non-cardiac ailments are covered after 4 years of continuous renewal. This is similar to many plans in the industry. The Gold variant covers medical management treatment as well where surgery is not mandatory.

The uniqueness of this plan is the small waiting period of only 3 months from commencement for all Cardiac Related Pre-Existing Ailments. Thus, all heart related treatments are covered from the 91^st day onwards. As long as the treatment requires at least 24 hours of hospitalization.

Other Exclusions.

• Dental treatments, other than any damage due to an accident.
• Any ailment or costs related to hearing/visual impairment, spectacles, contact lenses, wheelchair, etc.
• Pregnancy and other maternity expenses.
• There is a 2 year waiting period for treatment of certain illnesses. The illnesses under this category would be cataract, tonsillitis, piles, fistula, gall bladder, etc.
• Unconventional treatment.

Is the Star Health Cardiac Care Plan very expensive?

Let us take an example of a 40-year old man with heart surgery. If he opts for a coverage of Rs 4 lacs in the Silver Variant, he needs to pay a premium of Rs 25,300.

If he did not have any heart surgery, he would require to take a regular health plan. Star Health Medi Classic Policy would cost him Rs 5992 only. Star Health Comprehensive Insurance Plan would cost him Rs 9286 for a comprehensive coverage of Rs 5 Lacs.

So, yes this plan is quite expensive. That is the cost you need to pay if you have had a heart surgery and yet do not have any health plan!

Moral of the story is take your health insurance coverage ASAP. It should be taken much before you are even diagnosed with any serious ailment. Else be prepared to pay more premium!

Read more about how to lower your insurance premiums

Read more about Dejargonizing health insurance plans

The healthcare costs in India are very high. And if you decide to start a family, there is no denying the fact that your expenses are about to double. Child birth is an expensive affair. To ease the burden many young couples are opting for health insurance plans with maternity benefit.

Occurrence of maternity in a person’s life is almost certain. It is unlike any other unforeseen medical emergency. This is one cost which the insurance companies would surely have to pay for. Thus, when you add maternity benefit to your health plan your premium will be much higher.

For most of the employees, maternity cover is provided under the group insurance plan of their employers. However as mentioned there are certain exceptions and an individual may look at buying maternity insurance in the health plan.

As of now maternity benefit offered by various companies comes as an add-on in the comprehensive health plan.

Adding maternity benefit for such individuals in their health plan will depend upon various factors. These factors include age of the person, marital status, and number of deliveries covered (usually 2) and waiting period for the benefit to be claimed.

Having said that, let us look at the premium calculations of some the most popular insurance plans which offer maternity benefit.  Let us see the impact on the premium amount on the policy if you add maternity benefit. For example, let us consider the premium for a 30 year old woman with and without maternity cover for a sum assured of Rs. 5 lacs. This is with the assumption of  no group insurance.

Now, if we look at the above calculations the premium difference with and without maternity benefit mostly increases for policies with lower waiting period. And that is the reason one really needs to be certain about the time horizon to evaluate the actual benefit of such a plan.

Here, if we look at the Apollo Munich plan the difference in premium is Rs 3,000 roughly per annum with a waiting period of 6 years. So, if you have a normal delivery after 6 years, you are effectively paying a premium more than the cover benefit. Even worse if you get pregnant before the completion of waiting period then this excess premium is just a wasted expense for you. However, this comparison is valid only till a sum assured of Rs 5,00,000. Because beyond that only the Exclusive and the Premium variant is available wherein the maternity benefit is built in!

The Religare Joy Today has the lowest waiting period in the industry. But this policy needs to be purchased for 3 years and the cap for maternity is only Rs 50,000. Thus all this must be very carefully evaluated before adding maternity benefit to the plan as the premium is too high.

The entire difference in premium is not solely attributed to maternity benefit as there are other criteria like room rent sub-limit and waiting period. However, on an average, if you add maternity benefit to your policy the cost can go up anywhere between Rs2,500 to Rs. 5,000 per annum.

However if you have recently gotten married and have 3 to 4 years to plan a family, you can look at L&T Medisure Classic , which has a waiting period of 4 years. This is a cost effective plan with loads of other benefits as well, other than only maternity.

Thus, when you wish to purchase a Health Insurance Policy, you need to opt for a comprehensive plan where maternity can also be a part of the plan. However, maternity benefit should not be the sole cause for selecting a particular health plan. A comprehensive plan should be taken by weighing the overall benefits and premiums accordingly. Also, opting for a family health plan reduces premium per person. So, what are you waiting for? Opt for the best health plan with the overall benefits for you and your family.

Read more Does it makes sense to by a maternity insurance benefit plan?

Read also An anatomy of an health insurance plan

Read more about Dejargonizing health insurance terms

A health insurance policy is a very important requirement in today’s age. Modern day lifestyle has made an average individual more prone to illnesses. Coupled with this, the rate of medical inflation has increased tremendously to almost 20% according to HDFC ERGO. Here is the graph showing the increase in hospitalization costs as surveyed by the National Sample Survey Office in 2014:

Both these reasons mandate a health insurance policy for your whole family, an important requirement. Insurers have designed family floater health insurance plans to fulfill this requirement. These plans cover all the family members under a single umbrella and are also affordable. Even your parents can be covered under such plans. But, is covering your parents under the same floater plan prudent?

Before advising you on the right course of action, let’s understand the concept of family floater plans.

What are family floater plans?

Family floater plans cover family members in one plan under a single Sum Assured. The members covered include self, spouse, dependent children and dependent parents. Some health plans also cover parents-in-law. These plans are cheaper than individual health plans for each family member.

Read more about family floater plans

Should parents be involved in a floater plan?

Though family floater plans allow the inclusion of parents, it is not prudent. There are several reasons why parents should not be included in a floater health plan. Such reasons include the following:

1. Entry age restrictions. Floater plans have a restriction on the maximum entry age. Usually the age of the eldest member is considered and is limited to 65 years. If your parents are above this maximum age limit, they cannot avail a floater plan. Individual senior citizen plans, on the other hand, are designed for individuals above 65 years of age. Thus, they fit better for your parents’ cover.
2. Higher rates of premiums. Under a family floater plan, premium is calculated using the age of the eldest member. If you include your parents, the premium rate would depend on their age and would be high.
3. Disadvantage of frequent claims. When you do not make any claim in your health plan, you are entitled to a No Claim Bonus (NCB) in the subsequent year. This NCB is cumulative in nature and accumulates for every consecutive claim-free year. If your parents share your floater cover, being aged, they might require frequent medical assistance. As such, the probability of making a claim in your plan increases and you lose out on the accumulation of NCB.
4. Pre-existing waiting period. Every health insurance plan has a waiting period for pre-existing illnesses. The waiting period ranges from 2-4 years depending on the plan chosen. Since your parents might be suffering from such illnesses, their illnesses would be excluded from the scope of your plan. Consequently, despite having a health plan, you would have to bear the medical costs of such pre-existing illnesses.

What should you do?

From the above discussions, it is clear that parents should not be covered under your floater health plan. However, they should not be left out from the scope of a health plan either. You should buy a separate floater plan for your parents. Below are the arguments in favor of such separate plans:

1. Customized coverage. Senior citizen plans are designed especially for older individuals. As such, they provide an exhaustive coverage for ailments found commonly in the older population. Under these plans, your parents can enjoy all-inclusive coverage for their ailments which were excluded from your regular floater plan.
2. Lower waiting period. If your parents are more than 60 years of age, then you should opt for Senior Citizen Plans for them without a second though since they might have pre-existing ailments. Plans for Senior Citizens generaly cover pre-existing illnesses after a smaller waiting period compared to regular health plans. Thus, you would be spared the expenses of such ailments.
   However, for parents less than 60 years of age you need to avail regular health plans as they may not qualify for senior citizen plans.
3. Savings in premiums. Premiums for your floater plans would come down when you segregate your parents’ coverage. For example:

Case 1. Mr. A, aged 35 years buys Apollo Munich Easy Health Plan covering his family – parents (60 and 58 years), himself (35 years), wife (33 years) and two kids (4 and 2 years). He chooses the Sum Assured of Rs.5 lakhs and the premium required comes to Rs.84, 386 for a 1-year policy.

Case 2. He buys a separate family floater for his family (self + wife + kids) and another one for his parents. He pays Rs.23, 781 for his floater cover and Rs.48, 237 for his parents’ floater cover bringing the total outgo of Rs.72, 018. This is significantly lower than the earlier figure.

All in all, though you might be tempted to include your parents in your floater plan itself, you should avoid doing so. Covering your parents in a separate health plan makes more sense. We, at Turtlemint, believe in this and provide a separate health plan for your parents at the outset. If you wish to buy a health plan online for your family visit us at www.turtlemint.com. We would fulfill your health plan requirement and also suggest a separate plan for your parents.

Read also An anatomy of an health insurance plan

Read more about Dejargonizing health insurance terms