NiveshKarBefikar With Amit Chhabra Do You Have Sufficient Health Insurance For Covid-19 Treatment Cost

In life, there is nothing which can be guaranteed. So, you must not take your health for granted too. Covid-19 is a testimony to the fact that healthiest people can also get infected. One must take health insurance for monetary protection against any disease or illness.

The health insurance industry has quickly adapted to these difficult times and is making claims processes simpler and easier for the consumers. Every insurance company has a specific team which works on only Covid-19 related claims and ensures that they are approved within minutes. PPE kits and consumables are generally not covered in health insurance but companies have said that customers can claim for those as well.

In continuation of its consumer awareness initiatives, Policybazaar organized a health insurance-special webinar, under its Nivesh Kar Befikar series. The webinar was hosted by Apeksha Mishra, Corporate Communications Manager at Policybazaar, who spoke to Amit Chhabra, Head, Health insurance, Policybazaar. Here are the edited excerpts from the Q&A session:

Q. Would a group health insurance policy be sufficient to cover medical emergencies?
— From Ankit Verma
Group policies are given by your employer or you can buy them from banks, apps like Ola or websites like Amazon. Disadvantages of buying a group policy are that they can be discontinued at any point in time. For example, a lot of customers had group policies with Syndicate Bank. My parents were also among them. Now, Syndicate Bank has been merged with another bank. So, customers who had group policies in the bank are now left helpless because their policies have been discontinued by the insurance company and the banks. They are left with no choice but to buy a new health insurance policy. My father has thyroid and my mother is suffering from hypertension. It was difficult to get a new comprehensive health insurance policy for them because both have pre-existing diseases. Though they got one, there is a waiting period of four years for their existing illnesses.

Similarly, if you want to leave your job and start a business, your health insurance policy will be discontinued by the employer. If you join a new organization and it doesn’t have health insurance or doesn’t provide adequate coverage, then you are left helpless. Group health policies don’t give comprehensive coverage too. Therefore, one should buy a comprehensive health cover.

Q. I have HDFC Ergo Optima Restore policy for myself and my wife who is 28 years old for a Rs 10 lac cover. Should I take a top-up especially due to high expenses of Covid-19 treatment? If yes, which one would you suggest?
— From Narayan Pandey
The ideal way of increasing coverage is top up. You can upgrade your cover to a Rs 1 crore plan. It has become very affordable. You can buy health recharge top-up from Max Bupa. This will cost probably Rs 2000-3000. Last year, the maximum amount of claim for health insurance was Rs 65 lacs. So, Rs 1 crore health insurance means that you are covered for everything that can ever happen to you.

Q. Do all health insurance policies cover Covid-19? If yes, please tell me about Covid-19 specific plans which have been launched recently.
— From Mamta
Every health insurance policy covers Covid-19. A normal health insurance policy covers for everything that may happen like cancer, heart diabetes etc. A Covid-19 specific policy will only cover for Covid-19. You need to decide whether you want to get covered for only Covid-19, then that policy would cost Rs 200 per month or you want coverage for all diseases including Covid-19 which costs Rs 800 per month.

Q. I have a family health insurance of Rs 10 lacs cover for two adults and one kid. Is it sufficient to cover Covid-19 and other illnesses?
— From Raghu
Rs 10 lacs cover used to be a decent amount 3-4 years back. However, you need to consider that the cost of health-care is increasing by 15% every year. Also, new medical treatments like robotic surgeries have been introduced in India. All of us want to be treated in the best hospital in case of a medical condition. So, a Rs 10 lacs health cover won’t be sufficient to avail the best facilities. I would recommend the same sum insured that I mentioned in the question asked before.

Q. What is the key difference between critical illness along with term insurance vs a comprehensive health insurance plan?
— From Johnthan Kumar
Critical illness plan is a fixed benefit plan for coverage of a specific illness along with term insurance. It generally includes coverage for cancer, brain tumour or heart ailments. Unfortunately, if the policyholder gets a critical illness during the policy term, the amount is paid out and the critical illness policy ends. Whereas in comprehensive health insurance, it covers all treatment costs and has a wider sum insured. A comprehensive health insurance policy doesn’t end after its usage, unlike a critical illness policy. A health insurance policy is a lifelong renewable.

Q.If I have Covid-19 symptoms and take a test, will the insurer cover the expenses if I turn negative?
-From Neeraj
No, it doesn’t if someone turns negative. In case someone tests positive, if there are any expenses of your health care up to 30 days before hospitalisation, they are covered.

Q. My dad is an alcoholic and eats a lot of tobacco. He is suffering from diabetes and Asthma. Is there any health insurance policy which will cover him?
-From Vishal Kapraval
Insurers have a lot of plans available for people who have diseases as well. I will need more details as to the severity of their illness, intake of alcohol and tobacco. If you have had a heart attack in the past, diabetic for the last 20 years, you can still get a health insurance policy.

Q. In case of a senior citizen aged 70 years, can we top up beyond existing coverage? Can I port out of my existing policy along with the additional top-up?
-From Tushar
At the age of 70, you will have limited options but you will still have options. Religare has a top-up which one can buy beyond the age of 65 years as well.

Q. I am a soldier and my medical expenses are borne by the defence. Is there still a need for Covid-19 insurance in my case?
-From Hitesh
Ideally no. The policy provided by the defence is comprehensive and gives you access to the best of places. It’s just important to ensure that your family is also covered.

Q.How does Max Bupa give a Rs 1 crore cover for the price which health insurance companies are giving for Rs 10 lacs cover? Isn’t this too good to be true?
-From Alex
You have to understand the economies of scale. Whenever you buy a health insurance policy, the agent also takes a commission, insurance company earns money and there is a risk cost which is the cost of the claim paid out whenever the customer needs. The cost of the agent’s commission has reduced, expenses are lesser and benefits to the customer are more. So, the price is affordable. Not just Max Bupa, Aditya Birla and Religare are also offering rs 1 crore cover and two more companies are soon going to offer this coverage.

Q. What are the major things in top-up health insurance that a customer should look for before buying one?
-From Johnthan
One of the most important things you need to consider when buying a top-up is the deductible amount. Example, I have a Rs 10 lacs health cover and want to top it up to Rs 1 crore, I would buy a Rs 90 lacs top up with a Rs 10 lacs deductible. A deductible is an amount which isn’t paid by the insurance company. So, in this case, if I buy a Rs 90 lacs top up, the first Rs 10 lacs won’t be paid by the insurance company. However, the rest Rs 90 lacs will be paid by the insurer. For example, if the first claim comes for Rs 5 lacs in a year, it will be paid by my base policy.

If there is a claim of Rs 50 lacs, the first Rs 5 lacs will again be paid by my base health insurance policy. Since I have used Rs 10 lacs of my base policy, now top-up will get activated and the next Rs 45 lacs will be paid by my top up. So, keep in mind that the deductible amount won’t be paid by the insurance company. After that, it is paid by the top-up policy. Make sure you have coverage of a deductible amount from somewhere else.

Q. I have taken a comprehensive health insurance policy from Star Health for my family, myself and wife who are diabetic. We took riders and paid an additional premium for them. Waiting period for critical illness was one month including Covid-19. If I have taken a policy with riders, am I not eligible for treatment with a waiting period of one month or do I have to wait for more time?
-From Binod
Star Health Comprehensive policy has a PED waiting period buyback rider. It means that PED (in your case, diabetes) starts to get covered after the first year itself. Whereas Covid-19 and all critical illnesses like Cancer are covered after 30 days.

Q. I have a Rs 5 lacs Corona Kavach and my corporate policy is of Rs 3 lacs. Is it possible to combine both if the hospital bill happens to be Rs 7 lacs?
-From Pramod
Assuming this hospitalization is due to Covid-19, you can combine both.

Q. If I have a base cover from a particular company and top up from another company. Will my top-up claim be cashless and what will be the procedure?
-From Sandeep Gupta
A top-up claim is like any other health insurance policy’s claim and it will be cashless. Try and buy both the policies from the same company. Let’s say you have a base plan from Religare or Star Health, make sure that the top-up is also from the same company. If two policies are from the same company, the cashless facility is never an issue. In case they are from two different companies, one of the claims has to be in reimbursement mode. God forbid if there’s a huge claim and you have to use both the policies, make sure that the policy which is paying a larger amount is being used as cashless. The policy which pays a smaller amount is reimbursed.

Q. I and my wife have a health insurance policy from New India Insurance. We are planning to enhance the coverage. Please suggest how to go about it?
-From Hardeep
There are three ways to do it. It is important to check the terms and conditions of the policy. Does it have room rent capping? A lot of policies from PSUs have room rent capping which means you are eligible for only 1% of the sum insured for room rent. So, you can go to a room which costs only Rs 5000 per night but the problem is that most of the top hospitals have rooms starting Rs 10,000 and above. Single rooms cost Rs 15,000 and above. Make sure that your policy has at least a single private room coverage. If it’s not there, you can port to a new policy which provides it. Secondly, you can ask your insurer to increase the sum insured at the time of renewal. The third option is buying a top-up policy at any time of the year. You can buy from New India or any other company. Though, I would recommend you to buy from New India because the claim will be completely cashless in case of buying from the same insurer. So, you should take a Rs 10 lacs deductible in the top-up policy and buy a top-up of the highest sum insured.

Q. I have coverage from Religare of Rs 20 lacs for four family members. Is there a need to increase the cover through top-up?
-From Dimple
Rs 20 lacs would have been enough but times are uncertain especially in today’s environment. If someone gets infected by Covid-19, it could also happen to the entire family and the hospitalization cost of Covid-19 is high. I would suggest you increase your sum insured up to Rs 1 crore by buying a top-up. It will cost only Rs 2000 for your entire family.

Q. I am having Aditya Birla Diamond Assure individual policy of sum insured Rs 5 lacs. Does it cover Covid-19?
-From Mukesh
Yes, it covers. Covid-19 is like any other disease when it comes to health insurance.

Q. Can you please elaborate on porting of policies? Is there a waiting period on Pre-existing diseases (PED)?
-From Alex
There was a time when porting was a complex process with a lot of paperwork. However, its a very simple process and completely digital now. You can fill up a form online and your policy will be instantly ported. If there isn’t any PED, it will be ported on the same day itself. In case there are some PEDs, insurance companies take 2-3 days to issue a policy. If you have already served the waiting period for a pre-existing disease in your previous policy, then there isn’t any waiting period. It will be covered from day 1 in this policy as well. If a certain number of years of your waiting period is left from your previous policy, they will be carried over in your new policy.

We have seen a lot of demand growth for health insurance, especially during these circumstances. What do you think is the future of health insurance in India? How do you see the customer trend changing from here on? A lot of people used to think that nothing will happen to them, so there isn’t any need to buy health insurance. With Covid-19 coming in, people have started to realize that things can happen to healthy people too. Not just Covid-19, we have seen people having cancer or a heart attack at a very young age. This is making people more aware. With health insurance, we are assured that we are financially secured.

Q. Does Star Health Insurance or any other general insurance company cover PPE kit or not?
-From Saurabh
Star health insurance doesn’t cover the PPE kit. You can check which companies cover PPE kit on our website. Max Bupa, HDFC Ergo, Aditya Birla, Manipal Cigna cover PPE kit. Every company has also defined how much cost they will bear for the PPE kit.