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Naseem Akhter (64 years) is a worried woman these days. As a retired pensioner, she is shocked and upset that the premium of her health insurance policy has gone up by 460 per cent post a cataract operation. Four years ago, she was one of the many people who bought Reliance Healthwise policy, only because it was the cheapest policy on offer. Reliance General Insurance had launched the policy in three variants namely gold, silver and standard. The standard variant was priced attractively at Rs 999 for Rs 1,00,000 cover.
Akhter bought a standard variant of Reliance Healthwise for Rs 3,00,000 cover insuring her and husband in 2008. She paid a premium of Rs 4,051 for 2009-10, which surprisingly reduced to Rs 3,848 in 2010-11. However, post a cataract operation in 2010, the premium increased to a whopping Rs 21,921 for the year 2011-12. Akhter has a pending cataract operation in the second eye and wonders how much the premium would increase to in the next renewal.
Insurance companies revise the premium rates of their products depending on their loss ratios and rising medical costs. Therefore, besides the premium amount, one should look at the following key factors in deciding the right cover.
Is higher sum insured available? A person may be in his 30s and may find a Rs 2,00,000 cover adequate, but as age progresses and with medical costs rising, he may require a much higher sum insured after a few years which may not be available in the policy. If he switches to another insurer, he may lose out all the portability benefits and pre-existing diseases coverage. Do check if the policy has a higher sum insured.
How much of the sum insured can be enhanced? Choose a cover that permits you to enhance your sum insured. Policies offered by some private insurers allow a person to increase his sum insured from 10 per cent to 50 per cent of his current sum insured. Choose a cover that allows you to enhance your sum insured to the maximum.
Limits and sub-limits: With rising losses in health insurance, a few insurance companies have introduced co-payment for claims made by insured over 60 years. Co-payment in insurance parlance is making the policyholder pay a portion of the claim amount. Does your policy have co-payment in the higher age bracket? Also avoid a cover that has sub-limits on doctor's fees and procedures.
Says Satkam Divya, director of Rupeetalk.com, "A person buying a health insurance cover should consider the number of day care procedures, critical illnesses that will be covered in the policy besides the limits on daily expenses."
Time excesses for different diseases: Insurance companies do not cover certain diseases such as heart ailments, cataract, hernia, fistula, piles, fibroids in the initial years of the policy. Also, certain diseases are completely excluded from the policy. "A person should check the waiting period of the diseases that are hereditary or he may be susceptible to," said Rahul Aggarwal chief executive officer of Optima Insurance Brokers.
Renewability: Ensure that the cover has high renewability. Most public sector insurers allow policyholders to renew their cover till 70-75 years. Also, some standalone health insurers have introduced products that offer lifetime renewability.
Age for undergoing medical tests: Most insurers do not ask a prospective policyholder to undergo medical tests if he is below 45 years of age. The higher the exemption age, the better it is.
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