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Is a health insurance top-up better choice than upgrading existing plan limit? Coulf new diseases declaration result in rejection of top-up?

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21 Sep, 2020 by  Adarsh M

My current health insurance is a family floater for 4 lacs and have been active for 9 years. I'm 41 years, and now feel need for increased cover with diseases onset after policy commencement. Apprehensive about very high spike in premium or cancellation of existing policy. Is top-up better choice than upgrade?

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21 Sep, 2020

Hey Adarsh,


I completely understand your dilemma. There are several questions in your post, so I will try to isolate them and deal individually, and then we'll strategize. Also, there are some more details I'd require to be able to give a more informed opinion.


Apprehensive about very high spike in premium or cancellation of existing policy (due to diseases onset after policy commencement)

Health policy premiums do not change due to onset of a disease or claims made since the policy commencement. Health premiums only increase when you move to higher age bands or there is premium revision periodically due to medical inflation / product upgrade / regulatory changes.

The purpose of policy is to pay your future claims as many number of times as needed for your treatment till your policy continues. Your policy is lifelong renewable unless you decide not to renew.


Is top-up better choice than upgrade (for a 4 lakh sum insured family floater bought 9 years back, current age 41 years)

This is tough to answer in the absence of full understanding of your scenario, need answers to several questions - (a) How big is the family covered in policy, with individual age of all members (b) What is the product name, because if you are getting, say, 100% no-claim bonus, then your current cover would be 8 lakhs (c) Has there been onset of a disease for any member, if yes, which are these diseases (d) What was the medical history of members before policy was started 9 years back (e) Which city do you live in and what is nature of your profession?

I look forward to your reply Adarsh.


Anuj Jindal

Co-founder

SureClaim

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22 Sep, 2020
Adarsh M
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22 Sep, 2020

Thanks Adarsh, the information is super useful.


With CKD as PED, even your current insurer will not allow you to increase your sum insured. I think HDFC Ergo is pushing Easy Health customers to upgrade to Optima Restore at the time of renewal, so you have a good upgrade coming your way as it will provide you with restoration benefit which your current plan doesn't offer.

My suggestion would be for you to port out your wife and children to a different floater policy and keep the entire sum insured of your current easy health policy for yourself.

You can port your family itself to a floater optima restore, so that switch should be seamless for you, and upgrade the sum insured for your family at the time of renewal to 5/10 lakhs, whatever suits you. If you're family is opting to port to optima restore plan floater, I am hoping that your family's accumulated no-claim bonus will not be lost.

A lot will depend on how you have purchased your policy. Is it through agent, online from a comparison website or directly from insurance company?

Happy to answer if you have any followup questions.

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23 Sep, 2020
Adarsh M
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06 Oct, 2020

Hello Adarsh,


Answering your questions:


I'm actually not sure about CKD, as it is entirely based on creatinine levels and in connection with my BP investigations done 5 years back.

When you say you are not sure about CKD, are you saying that it has been cured? As far as we know, there is no cure for CKD. Please do clarify. You have Diabetes, Hypertension and CKD - hence what Anuj has mentioned does make sense, it will be really difficult for you to get an upgrade in the current policy or through a topup. If you want to try you may like to try with a government insurance company - like New India, Oriental, United India, National


Not sure how to opt for Optima Restore, also my NCB is accumulatiled to 7.11 L.


You need to simply inform your insurer about the shift to Optima Restore at the time of renewal. They may actually offer it to you. However, please note there is a good chance that given your health history, they may like you to continue in your existing plan with the existing coverage only. We would recommend you to however give it a shot.

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09 Oct, 2020
Adarsh M
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