A Competition in the market is a boon for consumers. Health insurance companies vying for market share has allowed a flurry of features and riders to enter the marketplace that cater to most healthcare needs. This can also prove counter productive if the policyholder zeroes in on the wrong customised plan.
The optimal method would be to identify the crucial need as a policyholder and then to filter the available options for the right fit. As otherwise, to scan through the multiple combinations and features within insurance companies would overwhelm policyholders into making a sub-optimal purchase. Here we choose a central need to be served and filter options that provide the most bang for the buck.
Maternity Cover
Maternity covers are a work in progress. The options are fewer in number but are better compared to a few years ago. Because of the higher likelihood of occurrence, maternity expenses are generally not covered in health insurance as insurance aims to mitigate unknown risks.
The policies that include them do so at a significant waiting period or as an expensive rider or both. Tata AIG-Medicare Premier includes maternity cover of Rs. 60,000 in the base policy and with a four-year waiting period. The policy itself costs Rs. 12,000 for a Rs. 10 lakh cover for a 25-year-old female.
Niva Bupa Health Premia offers a comprehensive package. The base policy provides a Rs. 40,000 maternity cover after a 2-year waiting period. Even the newborn is covered for the same amount for 90 days after delivery after which the child will have to be included in the plan at a cost. It costs as much as the Tata AIG plan.
Disease-specific
For policyholders who have a pre-existing condition such as high BP, heart ailments, cancer or diabetes, the chances of policy issuance are slim. But there are policies that claim a ‘high chance of policy issuance’ for such customers, with or without medical tests.
While Star Health’s Comprehensive plan targets patients with high BP, another such variant targets diabetes. The Care Health insurance plan Care Heart targets policyholders with heart conditions. The policies are priced nominally at Rs. 10,000 to Rs. 12,500 for a 40year-old male. Manipal Cigna- Lifetime policy targets cancer care that can be received Worldwide including US and Canada. This comes as a rider that costs Rs. 9,500 on top of a premium that costs Rs. 14,253 per year for a cover of Rs. 50 lakh. The plan has a waiting period of two years.
Consumables and OPD
Consumables are used once in the course of medical care and then discarded. These are charged by hospitals but not honoured by insurance companies. These charges can size up to 12 per cent of medical bills especially post-Covid. Out patient consultation charges have similarly ballooned in the recent years but not fully reimbursed by insurers and can impact policyholders.
Both are addressed but as add-on riders in many insurance policies. Aditya Birla’s Activ One Max covers consumables in the base policy itself. The rider for consumables costs Rs. 383 with
ICICI Pru Health Advantage or Rs. 774 with Manipal Cigna Lifetime. Considering the small increase in premium, all policyholders should consider the add-on as the costs can be recouped in a single claim paid by the insurer including the consumables.
The cost vs cover for most OPD riders is sub-optimal. By purchasing a rider that costs Rs. 2,000 on top of the base policy, the OPD covers are a meagre Rs. 5,000 or so per year. Niva Bupa and Manipal Cigna have a better proposition in this regard. Niva Bupa’s Aspire Gold includes a OPD rider that costs Rs. 5,730 and covers an overall Rs. 22,500 OPD cover that is split over the three: consultations, diagnostics and pharmacy. Similarly, Health 360-OPD rider from Manipal Cigna costs Rs. 1,760 but covers a similar amount across any of the three.
Expanded Covers
Health insurance covers have expanded and have done so without substantially increasing the cost for the policyholders; Rs. 1 crore covers are on offer from most insurers. Compared to Rs. 9,000-11,000 per year for a Rs. 5 lakh cover, the most inexpensive Rs. 1 crore cover options can start from Rs. 12,000 for Aditya Birla’s Activ One. ICICI Pru’s Elevate Combo policy even offers Rs. 5 crore covers at a cost of Rs. 15,000 for a 40-year-old male. Another way of increasing cover is by opting for Star Health’s Super Star policy (Rs. 8,300 for a Rs. 5 lakh cover) that allows to claim an unlimited amount for a single claim in the policy lifetime. This should cover the critical healthcare needs once.
Apart from these, restoration of covers and renewal bonuses allow for the sum insured to increase to seven times over five years (Care Supreme Direct).
Manipal Cigna Lifetime with a cover of Rs. 50 lakh (Rs. 14,250) allows unlimited restorations and Rs. 7.5 lakh per year renewal of bonus without prescribing a maximum limit.
The health insurance market place offers many other options to cover healthcare. Prospective policyholders should identify their primary need and filter options.
One can add adjacencies to improve the use-case but without diluting the primary need or being overwhelmed by the available options. For a holistic cover, Tata AIG Medicare or ICICI Pru Elevatae are comprehensive offerings. (Source: BusinessLine)
