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Medical insurance: See what's on offer

Smita Tripathi | September 20, 2003

For decades there was MediClaim and there was MediClaim.

Anyone who wanted medical insurance had to be satisfied with it because there simply wasn't a choice.

But medical expenses are shooting through the roof and if you are not medically insured, it may take years to pay for, say, a heart surgery or a kidney transplant.

The upside is that the state insurance companies don't have a monopoly any longer on medical insurance and there's more variety both in terms of policies and premium rates.

The latest to join the medical insurance bandwagon is Tata AIG. It has launched its HealthFirst policy which, besides covering medical expenses, also provides life insurance.

The policy provides a complete cover for prolonged hospitalisation, including a major surgery or critical illness.

HealthFirst is different from the policies that were on offer till very recently.

Its unique feature is that, in case of a surgery, it does not reimburse actual medical expenses but instead gives you up to Rs 125,000 (depending on how many units you purchase). The complete allowance is paid even if the operation cost much less.

In addition, the policy gives an allowance of up to Rs 2,500 per day during hospitalisation. However, this allowance is available only after the first three days of hospitalisation up to a maximum of 90 days. That means if you are admitted for five days, you'll receive the benefit for only two days.

Moreover, the insurance company will not pay hospital expenses in the first 90 days after the policy has been taken out. During this period only claims from accidents are covered.

Then there is the critical illness cover. The plan provides treatment for up to Rs 12.5 lakh (Rs 1.25 million) for 12 critical illnesses including cancer, stroke, heart attack, organ transplant, Alzheimer's and paralysis.

However, critical illnesses are covered only if diagnosed after 180 days of having taken the policy.

A post-hospitalisation benefit is also given. But this is restricted to up to Rs 1,250 per day for a maximum of only three days.

If a person covered by the policy dies without claiming any of the above benefits the family will be given up to Rs 10,000.

You can make multiple claims of up to Rs 25 lakh (Rs 2.5 million) during the tenure of the policy. Thus, if you claim for two illnesses of Rs 12.5 lakh each, your lifetime cover will be exhausted and your policy will terminate.

Another unusual feature of this policy is that it is bought in units (between one and ten). The benefits given depend on the number of units that have been bought.

For instance, if you buy one unit you will get hospital cash allowance of Rs 250 per day as opposed to five units or ten where it will be five and ten times, respectively.

Thus, your coverage increases with the number of units purchased. However, your premium also increases. The premium depends on your age, gender and the number of units.

For example, if you are a 35-year-old male, the annual premium will be Rs 1,844 for one unit and Rs 9,219 for five units.

On the other hand, if you are a 35-year-old woman, the premium will be Rs 1,881 for one unit and Rs 9,405 for five units. The policy is available to people between 18 years and 60 years.

Royal Sundaram's Health Shield Gold policy has one unique feature that sets it apart from the others.

It's the only medical insurance policy which covers maternity treatment charges of up to Rs 20,000.

All other medical insurance policies including those offered by the state insurance companies do not cover maternity treatment.

The policy is available for anyone between the ages of 91 days to 75 years.

However, persons above 55 years are covered as part of the family and not as individuals. The policy covers pre-hospitalisation expenses for up to 30 days and post-hospitalisation expenses up to 60 days.

The minimum sum insured is Rs 75,000 while the maximum is Rs 500,000. The premium depends on your age and the sum insured. For instance, if you are between 19 years and 45 years and the sum insured is Rs 5 lakh, the annual premium is Rs 6,775.

Pre-existing illnesses and injuries are covered only after five claim-free years. Thus, if you had a stone in your kidney, and were treated for it five years ago and have had no medical treatment for it since then, it will be covered if you suffer from it again.

Bajaj Allianz's Health Guard policy covers pre-existing diseases from the fifth year onwards, provided you have continuously renewed the policy with the company for four years.

Moreover, it provides cover for pre-hospitalisation expenses for up to 60 days and post-hospitalisation up to 90 days.

The policy can be bought by people between five years and 55 years, though children below five years can be insured if either of the parents is concurrently insured with the company.

The minimum sum insured is Rs 1 lakh (Rs 100,000) and the maximum is Rs 5 lakh. If you are between 26 years and 40 years, and the sum insured is Rs 5 lakh, the annual premium will be Rs 5,130.

In all the above policies, the person has to be hospitalised for more than 24 hours in a hospital which has at least 15 beds and an operation theatre.

None of these policies cover dental treatment unless it is a result of an accident and requires hospitalisation. Also, all these policies only cover allopathic treatment.

That's where the state insurance companies differ. Their MediClaim policy covers not only allopathic but also ayurvedic and unanipathy medicine.

However, the patient must be hospitalised for over 24 hours in a hospital that has at least 15 beds and an operation theatre.

Nearly all private players as well as the state insurance companies have tie-ups with third party administrators and so treatment is almost cashless. If you are admitted to a hospital which is not part of the network, bills are reimbursed within 14 days.

Premiums paid for medical insurance are eligible for tax deductions under Section 80 D up to Rs 10,000.

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Number of User Comments: 2

Sub: medical Insurance for the poor

Is there any medical insurance for the poorest of the poor either initiated by the Tata's or the LIC ,If yes then kindly give details. ...

Posted by madhok

Sub: Deshis are adamantly refusing to improve.

All the deshi insurance companies are adamant and are refusing to improve their ways of delays, fraudulent rejections of the claims, and undue harassment of ...

Posted by chanakya


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