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A health insurance policy is a must for anyone today, even if the employer provides a health cover for the entire family, considering how medical costs have gone up. Health insurance companies too have been coming up with interesting products to meet the varied health needs of individuals and families.
One such product, which many health insurers offer now, is the double sum insured health insurance product where the insured, after exhausting the original sum insured can avail a higher cover at no additional cost, in case of a sudden medical need.
For instance, an individual takes a double sum insured product, with a basic sum insured of Rs 3,00,000, which gets used up, say for a heart ailment. Subsequently, he gets an arm fractured in an accident. He would still be able to get insurance cover for the accident although, he has already exhausted his sum insured. The additional coverage is for a maximum of Rs 3,00,000.
Star Health Insurance’s ‘Family Health Optima,’ Apollo Munich Health Insurance’s ‘Optima Restore Health’ and L&T General Insurance’s ‘Medisure Prime Insurance’ are such double sum insured products. Here are what the buyer has to know before going for such products:
These policies are more expensive:
The premium to be paid for a restoration policy with a basic sum insured of Rs 3,00,000 and the option of doubling it, would be at least a few thousand rupees higher than a policy with just a basic sum insured of Rs 3,00,000. “The risk of a possible additional coverage has been factored in while pricing the premium for these products,” says Joydeep Roy, CEO, L&T General Insurance.
Additional cover only unrelated conditions:
Most of these policies provide the additional cover only when the condition is different than the one for which claim was made. For instance, if a diabetic with a Rs 2,00,000 sum insured policy exhausts it, following the amputation of a toe and then later develops diabetic retinopathy during the tenure of the policy, it will not be covered. In fact, only a few of these policies offer additional cover only in cases of accidents that require hospitalisation, after the original sum insured is exhausted.Minimum amount for additional cover:
Since the risk is high in such insurance covers, the minimum sum insured for such products is also high. The minimum cover for such double sum insured products is Rs 3,00,000 and most of these products are family products rather than for individuals.
Coverage only for a different family member:
In a family restoration policy, if one member exhausts the entire sum insured, he cannot avail the additional coverage. It will only be available for another member of the family who is covered by the policy.
Who can buy such products?
“There are no clear rules on who can take these policies and who cannot. It depends on the health risk that one perceives for himself and his family. A basic policy is a must for anyone. If someone already has a policy but feels that the coverage is inadequate, he can go in for a top-up policy with a lower premium, which will be of use if the first policy is exhausted,” says Sanjay Datta, head of underwriting and claims, ICICI Lombard.
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