Insurer: Aviva Life Insurance

Objective: Health insurance and return on investment

Accidental Death & Disability: In case of death due to accident, base death cover amount along with additional Sum Assured becomes payable. In case of disability, a fixed % of Sum Assured becomes payable.

Sickness Only-Total Permanent Disability (STPD): In the event of permanent total disability due to illness, Sum Assured will become payable in lump sum amount.

Critical illness benefit: On diagnosis of critical illness, Sum Assured will be payable after the survival period has passed. A total of 18 critical illnesses are covered in this benefit.

Surgical Cash Benefit: Depending on the surgery required, fixed % of Sum Assured becomes payable.

Hospital Cash Benefit: If insured undergoes hospitalization, this benefit provides fixed sum for each full day.

Maturity Benefit: Depending on age at entry, a guaranteed amount will be paid on maturity.

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Surrender Value: The policy acquires guaranteed surrender value after 2 policy years. The final surrender value will be higher of special surrender value or guaranteed surrender value.

Reinstatement: If your policy has lapsed, you can revive within 90 days from the due date of unpaid premium.

Grace period: You can pay due premium within 15 days from renewal date.

Free Look Period: HealthPlus plan can be cancelled within 15 days of receiving the policy contract. A written application can be submitted to any branch for the same. The premium will be paid back minus some charges like stamp duty, medical reports.

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Insurer: Apollo Munich Health Insurance

Category: Health Insurance

Objective: Ensure good healthcare services of your preference

Major USP of Optima Restore: A health insurance plan which restores the Sum Assured if the base Sum Assured gets exhausted during the policy year.

No Claim Benefit: Your Sum Assured will be increased by 50% if no claims are made. This Sum Assured will be increased to 100% if no claim is made in the next year also.

Discount: If you buy individual plan for 2 or more members, you can avail 10% discount. And if you take 2 year plan, you get additional 7.5% discount.

Tax benefits: You can avail tax benefits under Section 80D to maximum amount of Rs 15,000. For senior citizens, the maximum amount is Rs 20,000.

Waiting Period

- Any illness diagnosed within 30 days of inception of policy is not covered, however accidental injuries will be covered

- There is 2 year waiting period for particular diseases like cataract, hernia, joint replacement, hydrocele etc

- The pre existing diseases will be covered from 4th year of policy.

Permanent Exclusions

- Treatment for HIV, genetic disorders and related diseases

- Treatment for internal and external congenital diseases

- Non allopathic treatments

- Cosmetic treatments or plastic surgery

- Abuse of intoxicant things like alcohol or drugs

- Self inflicted injuries

- Mental Disorders

- Act of war, nuclear war or radiation

There are few more exclusion’s which can be verified from the policy document

For family floater plans, a person aged 30 covering his wife and 2 children with Sum Assured of Rs 500,000, the premium would be approx Rs 12,522. The premium is exclusive of service tax and applicable cess.

How can I buy Optima Restore?

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Policybazaar representatives will assist you in buying Optima Restore. The plan can also be purchased online.

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Health Insurance Portability- The Blindside 

After health insurance portability came into effect from October 1, 2011 there has been much debate about the pro and cons of the same. Health insurance portability lets you shift to the new insurer without losing the credits gained with the previous insurer. The credits are the time bound benefits which you become entitled to after the waiting period is over. For example- there is 2 year waiting period for medical ailments like cataract. If you have health insurance policy for continous period (without break) and you want to shift to new insurer using health insurance portability, the two year period will be considered by new insurer. Thus health insurance portability has been hailed as excellent initiative by many industry experts.

However, there are many issues which are as of now remain unresolved. There are many complex things involved and before you jump on health insurance portability bandwagon, keep the following things in mind:

• Pre exisiting diseases are the medical conditions which insurer has before taking health insurance. There is standard waiting period of 2-4 years before these are covered. The new insurer will consider the waiting period with your old insurer. However the complexity involved here is that if the insured contracts medical ailment after getting health insurance, he will be covered by insurer. But when he shifts to new insurer, that medical condition will be considered as pre-existing with the new insurer and waiting period will apply.
• Also there is always a possibility that insurer will not risky cases. If a person has claim history or belong to higher age group, it is possible that new insurer might not accept the portability case.
• Even if insurer accepts the case, there could be loadings and co-pay clause with the new insurer. So before migrating to new insurer, find out about these.
• If you do not make claims, many insurers offer no claim bonus which results in increase in base Sum Assured. When you shift to new insurer, the premium amount will be charged on the basis of increased Sum Assured.

Health Insurance- Claim Settlement Ratio

There are many health insurance plans in the market. Most of the health plans are very comprehensive with many benefits including no sub limits on room rent, maternity benefits, lifelong renewal etc. There are very few things which sets them apart. The basic premise of health insurance is to provide financial assistance in times of need. It could be cashless or reimbursement  and as smooth as possible. However there has been regular complaints about the delay in services on the part of TPA or health insurer.

Therefore before randomly choosing a health insurance plan, one should always check the claims data. The claims data will apprise you of total number of claims, how many claims have been settled and rejected. Some claims remain outstanding as well.

The health settlement ratio determines the % of claims solved by the insurer. For instance- claim settlement of 80% implies that out of total of 100 claims, 80 claims have been accepted by the insurer. The rest 20 claims have been denied or remain outstanding.

Health insurance claim settlement has been calculated as the following formula-

Health insurance claim settlement ratio = claims settled/ (total claims-claims rejected)%

The health insurance claim settlement ratio of the insurers for the Quarter 2,  2011 is given below:

Along with health settlement ratio, you should keep in consideration number of claims outstanding and claims rejected. If your claim is always stuck in paperwork, it would not make much sense. Hence try to find out the time taken by the insurer to solve the claim as well.

Health Insurance Portability Frequently Asked Questions (FAQ)

Question 1: What is health insurance portability?

Answer: Health insurance portability lets you shift from your current insurer to any other insurer of your choice. Instead of cancelling your policy and losing out time bound benefits (waiting period), you can just switch. When you switch to new insurer, the waiting period will be accepted by the new insurer.

Question 2: What is portable? How does it benefit me?

Answer: Earlier, if you were unsatisfied with the existing insurer, the only option was to buy health insurance policy from other insurer which would have resulted in serving waiting periods again. However with health insurance portability, you can switch to new insurer and the waiting period will be considered. For example- There is 30 days waiting period for health insurance policy and if you have health policy for 2 years, the 30 day period will not apply with the new insurer since that waiting period has already been served by you.

Question3: What is not portable?

Answer: The benefits within a health insurance plan cannot be transferred. For instance, disease covered under health insurance plan, sub limits on room rent etc.

Question 4:  What is the process for health insurance portability?

Answer: You have to approach the new insurer at least 45 days prior to renewal of the existing health insurance policy. You can get the portability form from the new insurer.  The new insurer will notify the customer about accepting or rejecting the portability within 15 working days. Accordingly, the fresh policy will be issued.

Question 5: What happens to no claim bonus?

Answer:  No claim results in increase of base Sum Assured (health cover). When you apply for portability, the increased Sum Assured (with bonus) is considered as base Sum Assured with the new insurer and premium is charged accordingly. So advantage of no claim is lost.

Question 6: What documents are required?

Answer: The following documents are required when you will apply for portability:

• Proposal Form, Portability Form
• Previous Health Insurance Policies
• Self-declaration by customer in case of no claims
• If claims have been made, additional documents like discharge summary, investigation report etc could be required.

Question 7: Is increase or decrease in health cover allowed?

Answer: You can request for revision for health cover. However increase in health cover will be subject to insurer’s underwriter acceptance. Also, for the additional health cover, the complete waiting period will apply.

Question 8: Are medical tests necessary for portability?

Answer: It will depend on the insurer.

Question 9: Can portability be rejected?

Answer: Yes, health insurance portability can be denied.

Question 10: What are the things to consider before opting for health insurance portability?

Answer: Before applying for health insurance portability with the new insurer, you should take into consideration the benefits you might lose like disease coverage, sub limits, lifelong renewal, loading, co-pay etc. You should also find out about the claim process and hospital network.

Insurer: L&T Health Insurance Company Limited

Category: Health Insurance

Objective: Ensure good healthcare services of your preference

Major USP of my: health Medisure Prime Insurance

-Zone based Premium

-3 lacs to 10 lacs cover can be opted

-No medicals below 45 years

-Lifelong Renewal of policy

Critical Illness Cover: If the insured is diagnosed with critical illness, additional amount equal to Sum Assured will be available in addition to base Sum Assured.

Accidental Cover: If the Sum Assured has been utilized and insured is hospitalized as a result of accident, then the Sum Assured is reinstated to the maximum of base Sum Assured.

Hospital Cash: If insured is hospitalized for more than 3 days, amount equal to INR 1000 is paid from 4^th to 10^th day. Amount up to Rs 500 per day is available to family members from 4^th to 8^th day is paid.

If hospitalization is for more than 10 days, INR 10,000 is paid.

Maternity Expenses: After 48 months of continuous coverage, maternity expenses and new born expenses will be covered.

Health check-up: After two consecutive renewals and the age of insured is above 45 years, health check-up will be covered by the insurer.

Cumulative Bonus: If no claim is made, Sum Assured will be increased by 5% on every renewal subject to maximum of 50%.

Zone based premium: The premium will depend on the residence of the insured. If the treatment costs are lower in your zone, premium will be lower too compared to urban cities.

Co-pay: For people aged above 70, 25% of the claim amount has to be borne by the insurer.

Tax benefits: You can avail tax benefits under Section 80D to maximum amount of Rs 15,000. For senior citizens, the maximum amount is Rs 20,000.

Discounts on My: health Medisure Prime Insurance

Family discount of 10% if two or more people are included under same policy

What is not covered in L&T My: health Medisure Prime Insurance?

- Any illness diagnosed within 30 days of inception of policy is not covered, however accidental injuries will be covered

- Pre existing conditions will not be covered for the first two years.

- There is 2 year waiting period for particular diseases like cataract, hernia, joint replacement, hydrocele etc

- War or related activities

- Any epidemic recognized by World Health Organization (WHO)

- Self inflicted injuries

- Abuse of intoxicant things like alcohol or drugs

- HIV, genetic disorders and related diseases

- Cosmetic treatments or plastic surgery

- Non allopathic treatments

- Dental treatments

- Mental Disorders

There are few more exclusion’s which can be verified from the policy document

Max Bupa Health Companion Review 

Plan Name: Health Companion

Insurer: Max Bupa Health Insurance

Category: Health Insurance

Objective: Ensure good healthcare services of your preference

Major USP of Health Companion 

Three variants – Silver, Gold, Platinum offer flexibility to customers.

Health Companion has Sum assured as high as Rs 50 lacs.

Out-patient benefits with Health Companion Platinum

Anyone can buy and Health Companion can be renewed lifelong

What benefits does Health Companion offer?

In-patient: Health Companion provides medical expenses incurred during hospitalization including pre and post hospitalization expenses, day care procedures, and domiciliary treatment. The Sum insured is dependent upon the plan type opted.

Tax benefits: You can avail tax benefits under Section 80D to maximum amount of Rs 15,000. For senior citizens, the maximum amount is Rs 20,000.

Lifelong Renewal: Health Companion can be renewed lifelong subject to specified conditions.

Day Care Procedures: All day care procedures are covered.

Hospital Cash: This is an optional benefit which will pay lump sum amount when you are hospitalized. This benefit is additional and does not affect the base policy Sum Assured.

Max Bupa Health Companion Variants

There are few differences among the variants to offer customer variety of options. The premium does increment if you opt for more comprehensive coverage.

Health Companion Silver: This is the basic plan that fulfills necessities. The Sum insured in Health Companion Standard are Rs 2, 3 and 4lacs. The inpatient treatment is covered up to the Sum Assured. Depending on the Sum Assured opted; there is sub limit on hospital accommodation, pre and post hospitalization expenses, domiciliary treatment. You can opt for hospital cash of Rs 1000/day with the plan.

Health Companion Gold: This is the plan which provides more benefits to customer. The Sum insured in Health Companion Exclusive is Rs 5, 7.5, 10 and 12 lacs. The inpatient treatment is covered up to the Sum Assured. Depending on the Sum Assured opted; there is sub limit on hospital accommodation, pre and post hospitalization expenses, domiciliary treatment. You can opt for hospital cash of Rs 2000/day with the plan.

Health Companion Platinum: This is the plan with comprehensive coverage. The Sum insured in Health Companion Premium for individual and family floater is Rs 15, 20, 20 and 50 lacs. The inpatient treatment is covered up to the Sum Assured. Depending on the Sum Assured opted; there is sub limit on hospital accommodation, pre and post hospitalization expenses, domiciliary treatment. You can opt for hospital cash of Rs 2000/day with the plan.

OPD benefits are covered in the plan.

What is not covered in Max Bupa Health Companion?

Even though Health Companion is comprehensive in nature, there are some exclusions which are:

Waiting Period

- Any illness diagnosed within 90 days of inception of policy is not covered, however accidental injuries will be covered

- The pre existing diseases will be covered after waiting period of 4 years

- For people aged above 60, two years waiting period on some conditions will apply

- For people aged above 65 years, 80% of expenses will be borned by Max Bupa (copay)

Permanent Exclusions

- Treatment for HIV, genetic disorders and related diseases

- Treatment for internal and external congenital diseases

- Non allopathic treatments

- Cosmetic treatments or plastic surgery

- Abuse of intoxicant things like alcohol or drugs

- Self inflicted injuries

- Mental Disorders

- Act of war, nuclear war or radiation

There are few more exclusion’s which can be verified from the policy document

Who can buy Health Companion?

Health Companion can be bought by anyone and can be renewed lifelong provided it’s renewed without break.

Health Companion is available for both individual and as family floater plan. You can cover as many as 4 children along with adults.

Insurer: IndiaFirst Life Insurance

Category: Unit Linked Health Plan

Objective: Health insurance and return on investment

Day Care Procedures: There are a number of treatments which do not require hospitalization like radiotherapy, dialysis etc which are also covered with the plan.

Pre & Post Hospitalization: Medical expenses incurred 30 days before hospitalization and 60 days post hospitalization are covered.

Maturity Benefit: The fund value will be provided on maturity

Adding Members: You can add new members like spouse or child within a set time frame.

Loans: Loans are available before the completion of five years of the policy.

Portability: After completion of five policy years, you can switch to any other IndiaFirst unit linked

plans.

Tax benefits: You can avail tax benefits under Section 80D to maximum amount of Rs 15,000. For senior citizens, the maximum amount is Rs 20,000. You are also eligible for tax deduction under Section 80C.

Returns in IndiaFirst Money Back health Insurance

There are a total of six funds ranging from high risk to low risk wherein you can invest your amount. If you have higher risk appetite and are for long term you can opt for aggressive fund. On the other hand, if you have limited investment period, you should go for conservative fund.

In a typical scenario, you will be able to get at least 10% return on investment. The investment risk is borne by the policyholder.

- War or related activities

- Self inflicted injuries

- Abuse of intoxicant things like alcohol or drugs

- HIV, genetic disorders and related diseases

- Cosmetic treatments or plastic surgery

- Non allopathic treatments

- Dental treatments

- Mental Disorders

There are few more exclusion’s which can be verified from the policy document

Fund Management Charge: Charge is 1.35% for all funds which is deducted from the units for fund management.

Policy Administration Charge: These are monthly deductions which start from first month and are for maintaining the policy- paperwork, work force etc.  The policy administration charge is 1.8% for the first year inflating at 5% per annum thereafter.

Morbidity Charge: These are charges deducted as a part of health cover provided and are recovered through cancellation of units.

Both individual and family floater plans are available in Money Back Health Insurance

Insurer: SBI Life Insurance Company Limited

Category: Health Insurance

Objective: Financial payouts in case of hospitalization

Major USP of SBI Life Hospital Cash

Daily Cash Benefit

Multiple Discounts

Available Online

Intensive Care Unit (ICU) Benefit: In case the insured is admitted into an ICU for more than 24 hours, then intensive care benefit would be equivalent to twice the daily hospitalization cash benefit. The maximum numbers of days of hospitalization are 50.

Family Care Benefit: In case two or more insured members are hospitalized simultaneously for more than 5 days, separate INR 10,000 will be payable once in a policy year.

No Claim Benefit: If no claim is made, Sum Assured would be increased by 5% on each policy anniversary. The maximum increase allowed is 40% of the basic Sum Assured. If a claim is made, then Sum Assured will be decreased by 10%. However Sum Assured will not be decreased beyond the basic.

Discount: 2.5% discount will be applicable on renewal of policy.

Family Rebate: Depending upon the number of family members covered under the policy, additional discount on premium amount is provided.

Tax benefits: You can avail tax benefits under Section 80D to maximum amount of Rs 15,000. For senior citizens, the maximum amount is Rs 20,000.

- There is 2 year waiting period for pre-existing injuries and particular diseases like cataract, hernia, hydrocele etc

- War or related activities

- Any epidemic recognized by World Health Organization (WHO)

- Self inflicted injuries

- Abuse of intoxicant things like alcohol or drugs

- HIV, genetic disorders and related diseases

- Cosmetic treatments or plastic surgery

- Non allopathic treatments

- Dental treatments

- Mental Disorders

There are few more exclusion’s which can be verified from the policy document

Health Insurance Portability Guidelines

Health insurance portability to be launched from October 1, 2011 allows customer to switch from one health insurer to another without losing out many benefits. IRDA, the regulatory body for life and general insurers has issued guidelines for health insurance portability.

IRDA has stipulated few guidelines which will apply to time specific waiting period. Presently, if the insured switches to new insurer, he has to begin anew with the time specific waiting periods for particular diseases. But when health portability comes into effect, the waiting period would be considered by the new insurer and customer has to complete only the additional waiting period if any.

The Process

Customer looking for portability has to apply 45 days before the premium renewal date. There is no liability on the part of insurer if the customer does not approach new insurer within the time frame.

A customer can submit the application for portability and the insurance company will furnish the customer with portability form, proposal form and the relevant product literature. The customer will submit the same to the insurance company. The new insurer within 7 days will then seek the medical records and claim history of the customer from the previous insurer through IRDA web portal. The previous insurer will apprise the new insurer all the required details within 7 days. After getting the details, the proposal form will be sent for underwriter’s approval. If there is no response regarding acceptance of proposal form with 15 days from the insurer, the proposal will be considered accepted by default.

In the interim period when the customer has applied for health insurance with the new insurer, the customer can extend existing health insurance for minimum period of 1 month (short period) and premium will be charged accordingly. The customer should not cancel the policy until he has obtained health policy from the new insurer. The policy cover of new insurer will begin from date of expiry of short period. The insurer has the right to continue with the existing insurer and no penalty will be imposed.

Health portability will apply to both individual and family floater policies.