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Got a health insurance query?

Antony Jacob, CEO, Apollo Munich replies Health Insurance queries of Apnapaisa readers.

Antony Jacob

07 May 2010

1. What are the advantages of group insurance over individual insurance?

Group Health insurance covers are extended by the employer to an employee as well as their immediate family for emergency and routine medical procedures. These policies are valid till an employee is employed and the employer is extending the cover. In many a situation, when an individual change his job, retires or there is a amendment in corporate policy, the cover ceases to exist and the person gets exposed to high financial risk pertaining to healthcare costs.

It should be noted that at the time of retirement, an employee is much more prone to illness as he or she is at a higher age. On the other hand it gets tough to find a comprehensive cover that suits fine for an individual, as all plans would come with certain amount of waiting periods for pre-existing and specified diseases.

Hence, it is advisable to have an additional individual plan, even if someone is insured with a group cover.

2. What is the better option...Health insurance or ULHP? Which schemes would you recommends at present time especially in ULHP plan?

We believe insurance and investment tools are completely different things. An efficient health insurance plan requires holistic understanding of the entire healthcare value chain starting from a provider to an administrator to tertiary support mechanisms. At Apollo Munich, we are inclined to develop innovative products and services which help in bringing better customer satisfaction through the utilisation of our experience and expertise in healthcare and insurance rather than developing unit linked investment health plans.

It is advisable to keep the two separate, as that would bring in optimal utilization of your investment amount.

3. What will determine my health insurance premium? What factors should I be aware of in selecting coverage?

Health Insurance premium primarily depends upon the chosen sum insured option, person's age and any adverse health risk identified at the initiation of a cover. To choose a particular sum insured level, one must look into the age and perceived need for cover.

We believe that a person in the middle to young age group should have an indemnity cover of at least Rs. 3 lakhs. In case of a married individual, it would be wise to choose a family floater plan for the entire family (two adults and two children). The ideal cover in that case should be of at least Rs. 5 lakhs.

You should always read the policy wording. Once a customer takes an informed decision and receives cover by an insurer, we firmly suggest the person to read through the policy schedule and policy wordings document. Like we do at Apollo Munich, many other insurers have also started to give a synopsis document (Customer Information Sheet) along with the policy wordings which would help the insured (customer) to quickly understand all the coverage and exclusions.
4. My father is 65 years old and recently undergone a heart bypass operation. My mother is 58 years old. Is it possible for me to take a health insurance policy for them. For your kind info., I am employed in Dubai, married & 32 years old.

Yes, you can opt to enter into a new health plan till the age of 65 years for most of the existing health plans offered in India. Please note that every insurer is governed by its underwriting principle and you have to abide by the same while choosing a cover. It is always advisable to choose a health insurance company that underwrites (asks medical history questions and understands you better) when you join, rather than when you claim or at renewal.

All major insurers including us would offer you a 100% secure online transaction environment for an easy payment mechanism. This could be helpful for you to manage the payment part as you reside outside India.

5. Is there a Dental Insurance in India, if so please let me know the name.

The newer plans being introduced in the market have started to offer dental and optical covers, but yet they very few in number. Our health insurance policies like MAXIMA offer dental and optical covers - both for inpatient and outpatient treatment within specified limits.

6. What can I do if my health insurance claim is denied?

You should check with your insurer on the exact policy schedule, and if dissatisfied, approach their grievance cell or the Ombudsman for assistance.

It is advisable to choose a plan that provides transparent benefits and also take the effort to understand what you have purchased.  It is always advisable to choose a health insurance plan that has no disease specific or expenditure specific sub-limits to avoid situations where claims get denied for sub-limits.

This may be marginally expensive in some cases, but you will hedge larger financial risk and have greater freedom for efficient treatment at the best healthcare provider.

7. Is it true that some mediclaim policies gives benefit only at 1% of the policy amount with regards to Hospital room charges and similar Limits to Doctor, etc.?

Every insurance product is different from another in some way. Hence, it needs to be noted that the policy will govern limits.  Unfortunately, some health insurance plans in India are more complicated than they need to be, causing confusion and dissatisfaction at the time when we need claims.

It is advisable to always opt for those plans with no disease specific and expenditure specific sub-limits even if they are marginally expensive compared to others.