Tag: mediclaim

Is HDFC Ergo Optima Secure value for money?

Personal Finance

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The outbreak of the pandemic along with the rising incidence of lifestyle-related illness has not only highlighted the importance of having health insurance but also having sufficient cover (amount).

Additionally, a health policy should not only cover hospitalisation expenses but also offer other benefits including OPD, daily cash benefit in case of hospitalisation, restoration of sum insured (SI) in case of claim and no claim bonus (NCB).

HDFC Ergo has recently introduced one such product, Optima Secure. Here is a review of the product features.

What’s on offer

The SI under the Optima Secure policy starts from ₹5 lakh and goes up to ₹2 crore. It provides all basic covers like other health policies such as hospitalisation expenses including day care treatment expenses, AYUSH treatment, home healthcare (domiciliary hospitalisation), organ donor expenses, pre and post hospitalisation expenses, and cumulative bonus benefit.

The policy also covers the cost of preventive health check-up on each continuous renewal of the policy.

The highlight of Optima Secure is that it offers a cover of more than the base SI (cover amount) to all policyholders.

The ‘Secure’ benefit of the plan offers additional coverage amount equivalent to 100 per cent of the SI.It also offers a ‘Plus’ benefit, where on policy renewal, the policyholder receives 50 per cent of the base SI, irrespective of the number of claims made.

It also provides Cumulative Bonus benefit, where the base SI increases by 10 per cent for every claim-free year subject to a maximum of 100 per cent of the base SI.

Then there is an automatic Restore benefit. Under this, in the event of complete or partial utilisation of the base SI, the plan offers to restore it fully. This is irrespective of whether the secure or plus benefit or the cumulative bonus SI is utilised.

Let’s understand this with an example. Say Joe’s base SI is ₹10 lakh. As soon as he purchase the policy, he gets the Secure benefit. So his SI stands at ₹20 lakh (10 + 10). If the restore benefit is considered, then his total SI stands at ₹30 lakh during a policy year.

Additionally, Optima Secure also offers daily cash benefit for shared room (₹800 per day, maximum of ₹4,800), air ambulance service, and e-opinion for critical illness.

The policy also offers two add-on covers (riders) for additional premium – my: health critical illness cover up to ₹5 crore and my: health hospital cash benefit .

Our take

HDFC Ergo’s Optima Secure offers more than sufficient health cover for a policyholder and one can consider this plan only if you are looking for additional cover (amount) over and above the base SI.

The benefit of additional SI comes handy during medical emergencies and for those with existing medical conditions in the family.

Also, the plan doesn’t have any sub-limits or SI capping including for day care procedures, ICU or intensive cardiac care unit, road ambulance services and on modern treatments such as oral chemotherapy and stem cell therapy, unlike some health policies. For instance, HDFC Ergo’s Optima Restore plan has a sub-limit on road ambulance service of up to ₹2000 per hospitalisation.

But keep in mind a few points. One this Secure benefit is available only once in a policy year and does not carry forward to the next policy year. Even the automatic SI Restore feature is available only once during the policy year.

Two, though in most cases, the hospitalisation expense requirements are often met with the additional SI offered under Optima Secure, there are products in the market such as Max Bupa’s ReAssure plan and Care Plus plan from Care Health Insurance that offer restore benefit multiple times in a year.

Three, under Optima Secure, the NCB (cumulative bonus) benefit increases 10 per cent each claim-free year but there are products in the market which double the NCB or increase it 50 per cent for each claim-free year up to a maximum of 100 per cent of base SI.

The ReAssure plan from Max Bupa increases the same by 50 per cent for each claim-free year. Manipal Cigna’s Pro Health plan offers guaranteed increase in SI by 10 per cent up to 200 per cent (of base SI ) every year irrespective of the claims

And lastly, while Optima Secure offers comprehensive coverage, it may appear slightly expensive compared to other products in the market.

For instance, under Optima Secure, for a ₹10 lakh cover for a family (husband and wife; 30 years), the premium works out to ₹19,106 (including GST) per year.

Under Max Bupa’s ReAssure, the premium is around ₹11,321 (including GST) per year.

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How to claim from multiple health plans

Personal Finance

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Since the outbreak of pandemic last year, many individuals have considered purchasing a health policy for self as well as for family. While having one health policy with sufficient cover based on individual or family needs is adequate, many end up having multiple health policies. Usually, as policyholder you will have a group cover from your employer and an individual health cover (as the group cover offered may not be sufficient) or in some cases, it can be two separate policies from different insurers. At the time of claim, if you are among those individuals with two or more health policies, here is how you should go about the claim.

One by one

Almost all insurers have wide hospitals under their network to make cashless facility hassle free for the policyholders. Barring a few scenarios, including certain treatment or diseases not covered by the policy and treatment taken in a non-network hospital, your health policy should be able to meet the hospitalisation expenses for you (cashless). But irrespective of the number of policies, you can make one claim at a time only, be it cashless or reimbursement. This is because insurers require policyholders to submit the original bills while filing a claim.

Suppose you have two health policies and you want to have cashless under both, then you must indicate to the hospital or the TPA about this. Many insurance experts suggest that it is better to exhaust the sum insured of one policy before claiming from another. Priya Deshmukh Gilbile, Chief Operating Officer, ManipalCigna Health Insurance, says “In case of a cashless claim, with the same TPA, the co-ordination for two or more policies become easier. Even if the TPAs are different for the policies held by policyholder, cashless can be done. The approval letter from the first insurer has to be submitted to the second insurer for the remaining claim amount”

However, there could be practical difficulties when it comes to cashless claims from multiple insurers. According to Indraneel Chetterjee, Co-Founder, RenewBuy “While cashless facility from multiple policies is doable by TPA/insurer, there could be a little struggle in terms of co-ordination between the TPA, insurer and the hospital due to incremental operational work.”

Hence you can also plan your claim (medical expenses) part cashless and part reimbursement. Suppose you have two policies of ₹5 lakh each and your expenses work out to ₹6 lakh. In this scenario, up to ₹5 lakh, the hospital/TPA will co-ordinate with the insurer. For the balance amount of ₹1 lakh, you as policyholder need to submit the bills given by the hospital along with discharge summary (which will mention the claim covered) to the other insurer for reimbursement. It could help you have a smooth claim procedure and avoid unnecessary delay at the time of discharge or while starting a treatment.

Keep in mind

While having multiple health policies has its advantages, there are a few points to keep in mind, when making a claim, in order to reap the maximum benefits.

One, you should go for the policy which has minimum or no co-payment (where policyholder agrees to pay a certain percentage of medical expenses and the balance paid by the insurer) or sub-limits (refers to the limits for a certain medical treatments or diseases in a policy) clauses. This is so that the difference between medical bills and claim amount (settled by insurer) is low. If you have to choose between a group cover and an individual health cover, then go for group health insurance first. This is because, the benefits of no-claim bonus remains intact.

Two, it is important to disclose to each insurer about the multiple policies you hold, if specifically asked in the proposal form at the time of purchase of health policy. The non-disclosure of the other policies may affect at the time of claim as it is a breach of (insurance) contract and insurer have the right to reject or not settle your claim. However, not many insurers ask for this disclosure these days.

Lastly, while there is no cap on the number of health policies that you can buy, the premium amount you shell out for every renewal could be high for all the policies. Amit Chhabra, Head Health Insurance, Policybazaar.com says “For policyholders it is better to have a base policy and then have top-up plans from the same insurer, as it will work out to be affordable and for easier claim, instead of having separate policies from different insurer. ”

Exhaust sum insured of one policy before claiming from another

Divide claim into cashless, reimbursement

Have base policy and top-up plan from the same insurer

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Should you opt for family floater plan to lower premium?

Personal Finance

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A health insurance policy is a must-have even before you plan your investments. But before you buy one, give a thought to whether you want to buy an individual or a family floater insurance policy. In case of the latter, a single policy takes care of the medical expenses of the entire family. While both variants of the policy help ease your financial burden at the time of a medical emergency, a family floater policy is not always recommended. So, when does it make sense to take a family floater policy and when not? Here are a few points to keep in mind while deciding.

Make a choice

While the coverage, benefits including restore and no-claim bonus, and features such as waiting period, deductible remain the same between individual plans and family floater plans, the premiums can be different.

The age of the oldest member in a family is an important factor to keep in mind while considering a family floater policy. This is because the premium is calculated based on that. That is, higher the age, higher will be the premium, as the chances of medical complication go up as you age. So if you are aged 30 years, and you include your father and mother in a floater plan, then then premium will be calculated based on your father’s age (being the oldest), say, 50 or 60 years.

If you do have dependent parents or in-laws, who are say over 50, it is better to take separate health policies for them instead of adding them to yours.

However, a young family which includes husband, wife (with or without children), can consider a floater plan.

Do note that children beyond certain age (usually 21 or 25 years, the maximum entry age varies across insurers) are treated as adults and are not covered under floater plans. So it is better to have them moved to a separate individual health policy. However, they will be provided the continuity benefit, that is, there will be no separate waiting period for them when they move to an individual policy.

While the premium may go up in case one of the family members has a pre-existing medical condition, the waiting period, deductibles and other exclusions will be applicable only to that member.

For instance, if the husband has a pre-existing medical condition then only he has to undergo about 2-4 years of waiting period, while the wife will be covered after 30 days.

Benefits

Before you decide to go for a floater policy, understand how it works. Family floater insurance covers the entire family under a single premium. The sum insured (SI) covers the entire family and can be used in case of multiple hospitalizations in the family during the policy term. Family here includes spouse, maximum two children (up to the age of 21 or 25 years, depending on the maximum age of entry as per the insurer).

Let’s consider an example. Joe and his wife have a family floater health insurance for ₹25 lakh. His wife gets hospitalised and the claim amount comes to ₹25 lakh. Here, the entire cover can be utilised for Joe’s wife. This is the single most important advantage of a floater plan. That is, one SI is available to everyone in the family. Though on the downside, the SI available for the family as a whole reduces. However, most policies in the market offer to restore the SI used.

According to Amit Chhabra, Head, Health Insurance, Policybazaar.com “It is always better to go for floater policy for a family. Even if the sum insured is exhausted, most policies in the market offer restore or refill of sum insured in case of partial or full exhaustion of the cover during the policy term.”

On the other hand, if both had a separate insurance cover for say ₹10 lakh each, then ₹15 lakh would have to come out of Joe’s pocket.

Also, a floater policy that covers all the family members, may result in a lower premium outgo than 2-3 individual policies would. Let’s consider HDFC Ergo’s Health Suraksha plan. For a 30-year old married individual, the premium works out to be ₹15,802 per year. On the other hand, for two individual policies with ₹7.5 lakh cover each, the premium works out to be ₹8,025 per year (totals to ₹16,050 per year).

However, keep in mind that the premium difference between individual and floater plans varies with insurers and taking a floater policy may not always reduce your premium outgo.

In case of Max Bupa’s ReAssure plan – Family floater, for a 30-year old married individual, the premium works out to ₹16,896 per year (including GST) for a ₹20 lakh cover.

Now, if the individuals opt for a separate cover of ₹10 lakh each then the premium works out to be lower at ₹15,510 (including GST).

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Who needs an insurance cover against vector-borne disease

Personal Finance

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Recently, the insurance regulator, IRDAI, came out with a standalone standardised health cover for vector-borne diseases – Mashak Rakshak. Insurers are being encouraged to introduce this product from April 1, 2021.

Vector-borne diseases are transmitted through carriers such as mosquitoes, fleas and bugs. Malaria, dengue and chikungunya are some common vector-borne diseases. According to the World Health Organisation, over seven lakh people die every year globally on account of such diseases. So, this cover can address specific disease-related needs of people, particularly during the monsoon season when the infections rate is high.

While there are already a few players in the market offering a standalone vector-borne diseases cover, IRDAI’s standardised product can make policy selection easier for people. But should you go for the standardised plan, given that vector-borne diseases are also covered by regular health insurance policies? Here is a look at product features and its suitability.

About Mashak Rakshak

IRDAI’s standardised policy, Mashak Rakshak, like the other standalone products in the markets is a fixed benefit policy. That is, 100 per cent sum insured (SI) will be paid to the policyholder on positive diagnosis of any one of the vector-borne diseases. The policy provides coverage against seven vector-borne diseases – dengue, malaria, filaria, kala-azar, chickungunya, Japanese encephalitis and zika virus. If an individual is diagnosed with any one of these infectious diseases, as confirmed by a doctor, then the complete sum insured will be payable, provided, the individual is hospitalised for a minimum continuous period of 72 hours. Upon the payment of SI, the policy terminates.

Also, if a policyholder is diagnosed with filaria (commonly known as elephantiasis), the benefit is payable only once in a lifetime. Even if you renew the policy, you will not be covered for the same disease. Whereas, in the case of other vector-borne diseases, the policyholder will be covered after the renewal as well. In other words, you can get the benefit under this policy more than once in a lifetime.

Further, the policy will pay two per cent of the SI on positive diagnosis through laboratory examination and confirmation by a doctor on first diagnosis during the cover period. Do note that, this diagnosis cover is applicable only once a year for each disease.

Mashak Rakshak provides an individual as well as a family floater option. Family includes self, spouse, dependent children and dependent parents. The minimum SI is ₹10,000 and goes up to₹2 lakh. The policy provides coverage only within India while existing policies like Bajaj Allianz’s M-Care provides coverage both within and outside India. Mashak Rakshak is an annual policy with lifetime renewability. The minimum entry age is 18 years and maximum is 65 years.

The minimum waiting period in case of Mashak Rakshak is 15 days. However, if you benefit from the standard cover and renew it, a cooling off period of 30 days will be applicable from the date of previous admission of claim. The plan offers the option to port also.

Other standalone products

There are a few insurers who offer a standalone vector-borne disease cover in the market currently. These includes Bajaj Allianz General Insurance (M-Care plan), HDFC Ergo Health’s Dengue Care (also offers Mosquito Disease Protection plan but it is offered as group policy) and Future Generali’s Future Vector Care. These are benefit policies and the coverages is more or less similar to that under Mashak Rakshak. However, there are differences in SI offered and the premium. For instance, Bajaj Allianz’s M-Care provides five SI options — ₹10,000, ₹15,000, ₹25,000, ₹50,000 and ₹75,000. The premium ranges between ₹160 and ₹1,200 for an individual policy.

Similarly, the waiting period also differs. While the initial waiting period remains the same (15 days) as Mashak Rakshak, in case of recurring occurrence of the disease, the waiting period could change. For instance, in Future Generali’s Future Vector Care, an individual is subject to 60 days’ waiting period in case the insured person is suffering from any one vector borne disease at the time of taking the policy or within 60 days prior to applying for the policy. Similarly, in case of M-Care, a waiting period of 60 days is applicable for that particular ailment and 15 days for other diseases, if the policyholder opts for the policy after the occurrence of and cure from, one of the seven vector borne diseases.

Our take

A vector-borne disease policy is most suitable for those living in proximity to canals or where there is stagnant water ( breeding ground for mosquitoes and fleas). However, your regular health policy will also provide cover for vector-borne infections — OPD (treatment in the outpatient department, if included in the policy) as well as hospitalisation. So, having a comprehensive health plan is always better.

While standalone vector covers including M-Care, Dengue Care and Future Vector Care can be taken by anyone, even those with pre-existing disease conditions, IRDAI’s standardised cover is silent on this. According to Amit Chhabra, Head-Health Insurance, the regulator has not specified on the policy issuance to those with pre-existing conditions and it depends on the underwriting guidelines of the insurers.

But having a standalone vector-borne disease cover can be advantageous too. When you are hospitalised for one of the seven vector borne diseases, you will get the benefit from the policy and can also claim hospital expenses (if any) under your regular health policy.

A standalone vector-borne disease cover is not a must-have. But if you don’t have a regular health insurance plan and are at risk of catching a vector-borne disease, you can consider buying a policy.

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