Choosing the right health insurance plan when porting
My father-in-law is looking to port their current floater to a private provider from United ins. Age 55 and 54 yrs.
He zeroed down on Religare's Care comprehensive plan, Star's family comprehensive policy, HDFC ergo's heath suraksha gold, Bajaj's health guard gold.
Product features wise he likes almost all four. All are more or less similar, decently "feature" rich products.
He is diabetic, but under very decent control. So shouldn't sound a lot of alarm bells with the insurer (he hopes). We Have confirmed with Religare, they had a look at the health papers prima facie and sounded favourable.
Wanted advise on how to finalise and zero down on maybe one or two insurers.
Saw a recent video of Mahavir's, where her spoke about finding insurers with strong systems, teams in place.
Wanted help on those parameters with the above four players :)
Much appreciated !
- We would need you to elaborate on your requirement - What is their current coverage, reasons he is looking to migrate to a different plan, their current health condition and their past medical history, apart from the information regarding Diabetes you provided in your question.
- My views on the most important benefits in health insurance that you should look for are mentioned in my answer here: https://www.beshak.org/forum/post/health-insurance-rlyyzkpjl - Beyond these benefits, almost everything else are frills. Any plan that meets these requirements well should be shortlisted.
- Don't know honestly which video you are referring to - but it is not possible to get insights into an insurer's inner working today - This information is not publicly available.
- In the current situation, the best thing I could suggest with respect to health insurance is to look for an insurance intermediary who will take ownership of your claim experience. Agents/Intermediaries who have a track record in your locality or extended family to handhold customers right through the claims experience. Since these intermediaries take ownership of the experience, they ensure a) you are aware of all the terms and conditions before you buy the policy and b) you buy the right insurance plan that will have least friction during claims.
- On the portability front, please ensure you start the process well in advance - around 45 days before the renewal of the policy and follow up diligently to ensure the migration happens before the expiry of your existing policy.
Thanks, here is what you might further need:
Their current coverage is 5 lakhs, he wants to migrate to a different plan because he thinks there are much better plans at around the same price in the market currently. Besides diabetes, he had undergone a angiography, which turned out to be normal in all ways, his wife had dengue some 5-7 years ago and two c sections some 20-25 years ago. Nothing else currently, NO CLAIM DONE EVER ON THE POLICY.
I went through the article you referred, makes sense. But one thing I wanted to understand - A lot of private only health players like Care insurance, HDFC ergo, Star health, cigna etc. have flooded the mkt in these recent 5-7 odd years. While they might have well rounded products and networks, how many of them, in your experience, would be welcoming to a 55 yr old with diabetes (although excellently controlled). I doubt most of them are in the mkt for the younger slice of the population. For one, HDFC ergo (erstwhile Apollo), directly said no for porting his case. Said we won't be able to accept.
Was referring to your webinar that is put up on the website, titled - "Insurance disputes/glitches webinar | LawSikho". 26th minute precisely :)
Mahavir has asked some key questions that will help understand the scenario and then suggest the strategy for way forward.
Apart from the question Mahavir has posted, I would like to ask a few more:
- For how long has he been covered in existing policy and what has been claim history in the policy? Which is the TPA assigned in the policy?
- Where is he currently based in?
- What is the sum insured (SI) in current policy and what SI he wants to move to, because policy comparison varies based on SI.
My initial comments based on the limited information available are:
- All these companies process claims in-house. So that is a plus and good enough reason to move away from United as the claims are managed by the 3rd party.
- One gap I see in selection of all these plans is that they all have a room limit of single private ward. In the same or lower premium, you may even get plans with no room rent capping. Has he explored such plans? Happy to answer any specific doubts regarding them.
- One Mahavir's 4th point, I can add that if you choose to buy the policy by porting directly from the insurance company's website, you will get atleast 5-10% rebate on annual premiums compared to all other channels of buying, and for your claims, you can always use an independent platform like SureClaim to take advice and services during claim. So you can save on paying 15% annual commission to agents (translates to average Rs 1.5 lakhs in commissions in 20 years & no guarantee of service) versus when you buy directly from insurer's website (0% commission) and benefit from expert platforms like SureClaim for claims only when there is a need.
Disclosure: I am co-founder of SureClaim, an independent claim advisory platform
He has been with this insurer for around 5 years. No claim history in the policy.
His SI currently is 5 lacs. He is looking at 5-7 lacs max, when he shifts. That's what he can afford, it seems.
He is based in PUNE.
You mentioned plans with no room rent capping, in the similar premium category. Do you mind naming a couple, I'll check them too.
one thing I wanted to understand - A lot of private only health players like Care insurance, HDFC ergo, Star health, cigna etc. have flooded the mkt in these recent 5-7 odd years. While they might have well rounded products and networks, how many of them, in your experience, would be welcoming to a 55 yr old with diabetes (although excellently controlled). I doubt most of them are in the mkt for the younger slice of the population. For one, HDFC ergo (erstwhile Apollo), directly said no for porting his case. Said we won't be able to accept.
Thank you Jeet for providing more information.
Here's my advice on strategy to follow:
1. From your list of 4 insurers, Bajaj is a no go because they have a room limit of 5k for 5 lakh cover. Rest 3 are fine to begin with. All 3 are ditto similar plans with max 50% no claim bonus allowed and room rent limit of single Pvt ward.
2. You can look at ICICI Lombard, Royal Sundaram & Max Bupa as they have no room rent capping. Given medical history, Royal and Max may reject the proposals, only ICICI Lombard (IL) seems to be possible. Just to warn you - IL is one of the most expensive insurer in market, but claim experience is one of the best.
3. If companies in point 2 are not feasible, then try out Religare or Star. Within Star, you have option for Family Health Optima or Comprehensive plan. Chances of cracking Comprehensive may be high as it's a premium product.
With Star Comprehensive, you get 100% no claim bonus, so with same premium, you can doubt the cover.
Let me know if you have any pending doubts.
Just make sure you disclose every pre existing medical condition (PED) in the proposal form while porting. Things like past hospital admissions, accidents, injuries, doctor consults, any body pains, allergies etc must be declared with vivid details while porting. Fill form yourself, don't leave it in the hand of agents. Ensure you check policy certificate once it's issued so that it has all PEDs mentioned in certificate.
Do share your porting experience, or verify info with us if you find any info received from agents doubtful.
Btw if you buy directly from insurer's website, you get discount of 5-10% compared to buying from everywhere else.