health insurance policy for my mother aged 59 years

Hello Rakesh,

Here's our quick take.

1. First thing - in our view - a 5 Lakh cover could be inadequate for your mother in the mid to long term. Would recommend a higher sum assured at least 10 Lakhs for your mother - with no pre-existing disease and her entering her 60s soon, it makes sense to take a higher cover immediately - as it can get trickier as she turns older.
2. Between Care NCB Super and HDFC Ergo Health Optima Restore - Optima Restore wins purely on the benefits. It has no room rent limit, no limitation on day care procedures, the restoration benefit is also way superior compared to Care NCB Super, so between the two choices - based on product benefits Optima Restore is a better choice.
3. Do also have a look at Max Bupa Reassure, which is comparable to Optima Restore, before finalizing the plan.

Cheers!

Team Beshak

Hey Rakesh,

Read through both your postings, you're right. 10L is sufficient. And your plan is correct too. With 50% NCB, 5L cover will become 10L in 3rd year itself. Very very cost-efficient.

My suggestion - Look at Optima Restore from HDFC Ergo, Health Companion from Max Bupa or Lifeline Supreme from Royal Sundaram. All 3 are comparable plans and inflation-neutral, meaning the medical inflation over the future years will not depreciate the structure of the plan. With age-related premium hikes, in the long run, Health Companion comes out to be cheaper than the rest 2 plans as their premium jumps are higher over the years.

But keep in mind that NCB is deducted at the time of claim. It works both ways. It accumulates when no claims, and it's deducted when claimed.

A superior alternative, if you're willing to spend 20% additional on premium, would be Max Bupa ReAssure with Safeguard addon. What Safeguard does is that it locks the accumulated NCB and it cannot be deducted due to claims, so doubling of your SI is guaranteed with safeguard option. ReAssure plan give you unlimited restoration of sum insured within the same policy year unlimited number of times even for the treatment of same illness. So in the extreme event at the 10L turns out to be short and there are a few month remaining for the policy to be renewed, ReAssure with Safeguard protects your extreme downside risk.

Happy to answer if you have any followup questions.

Now, regarding pre-existing diseases (PEDs) for your mother, let's be double sure. Could you review these 5 questions below and confirm answer is No for all of them.

(a) How many times has your mother been admitted in hospital for minor or major reasons since their birth

(b) What are the allergies that she has now or had ever in the past, which may or may not have needed treatment

(c) Did she have had any accidents ever, minor or major

(d) Is she taking any medicines currently or have consulted doctor in the past. For what ailments were those consultations done.

(e) Is she having now, or has suffered in the past, with any body pain such as joint pains, headaches, back-pains etc.

Since this is medical history, you can mention here or can send privately to me on anuj@sureclaim.in for my comments.

Anuj Jindal

Co-founder

SureClaim

Hello Rakesh,

5 Lakhs is adequate today. The health insurance coverage you buy should be adequate enough, inflation proof for a lifetime. With double digit healthcare inflation, a Rs. 5 Lakh cover will be of 2.5 Lakh value in less than 10 years, when your mother will be 69 years of age. We strongly feel Rs. 10 Lakhs is the minimum cover you should buy for someone at age 59. As mentioned earlier, in case any health issue arises after crossing the age of 60 years, it would be very difficult to get approval for an upgrade in your base cover, and you may be stuck at a small cover later.

Secondly, we advise you to not consider No Claim Bonus as part of your base coverage. Let bonus be like a buffer for really unforeseen situations. It is always beneficial to invest in an adequate base coverage and not depend on no claim bonus that can be lost in the same number of years you accumulate it. With the kind of inflation we are seeing in the country thanks to the scarcity of good doctors and hospitals, believe me no cover is an overkill.

 Also if i may ask in your experience do claims get settled of 10 lacs in realistic?

Why would a valid claim of any amount not be settled - if it is within the sum insured limits? There are no reasons for you to worry about this. Again remember the value of 10 Lakhs will keep deteriorating due to inflation.