Which health insurance?

Santy

Well-Known Member
Joined
Aug 23, 2010
Messages
2,391
Points
113
Location
Bengaluru
Hi Friends
I have been ignoring this for a long time. Call it as my arrogance, I have not learnt the lesson from a tragedy (coughed up ~Rs. 4L a couple of years back from my pocket).

I always wanted to do a thorough study before I sign up for medical insurance because I want to be sure about the help I would get when I need it the most. That is one reason it keeps getting delayed everytime I initiate a research. I don't want to delay this now.

I have shortlisted a few after some google work, not in any order
-Apollo Munich Optima Restore
-ICICI Complete Health
-Oriental Insurance
-Max Bupa Heartbeat
-Oriental Family Floater

I am quite inclined to Apollo Munich for its NCB and other features. It is rated highest as per this article.
According to this article, ICICI Lombard has a good settlement ratio. Oriental Insurance has lowest rejected claims and also ranks high. But calculating premium on their site seems to be a Himalayan task. Many prime hospitals are not seen in their network (for cashless).

My concern is almost every insurance company has loads of complaints strewn over the web. Not sure who can be trusted. Whose customer service is best. Every company has a complaint by the ones who suffered stating that their claims got rejected on unreasonable grounds. Some are crazy, some are scary.

Do you have any experience of smoothly getting the claims settled- cashless treatment availed without hassles?
 
One of my friend is having HDFC Ergo life insurance and he is quite happy with it, when it comes to claiming refunds and the network of hospitals is also quite large under them.
 
It is the role played by the TPCs of each which makes or breaks the overall reputation of the Insurance Cos.
 
Almost all are good. Just make sure to read and understand the exact terms and conditions. Understand the coverage of various diseases, upper limit or caps on various heads of expenditure in a hospital stay, need for hospitalisation, which treatment protocols and procedures are not included, who all are covered in the policy and upto what limit.
 
A friend of mine works in this field. He says that more than the insurance company, it is the back end company that processes claims that really matters. He used a technical term for the back end company or agency but I forgot what it is called. To put it another way, please double check who will really process the claims. I believe that it gets outsourced.

A couple of other things he said was to go for the best medical insurance possible, and the scary part was when I asked him how much financial reserve one should keep for medical purposes. I asked if 10l is enough (which is what i had planned for) and he said no way, 25l is the bare minimum, and 35+ preferable.
 
A friend of mine works in this field. He says that more than the insurance company, it is the back end company that processes claims that really matters. He used a technical term for the back end company or agency but I forgot what it is called. To put it another way, please double check who will really process the claims. I believe that it gets outsourced.

A couple of other things he said was to go for the best medical insurance possible, and the scary part was when I asked him how much financial reserve one should keep for medical purposes. I asked if 10l is enough (which is what i had planned for) and he said no way, 25l is the bare minimum, and 35+ preferable.



@asliarun , Is "TPA" the technical term you were referring ?

@santy - spend some time on ( if you haven't already ) medimanage.com to review the policies you mentioned and also additional assistance if you need .

I found them very professional . I came to know about them via jagoinvestor.

you can also take a loot at religare care.

I believe if all your ducks are in a row , no company can take you for a ride.
by this I mean , when you apply for a policy :

1. disclose everything about medical history , age, drinking , smoking etc.
2. know your policy i.e. what Is covered and what is not
3 .List of ailments that requires waiting period
4. don't fall for things like NCB , per day allowance etc.
5. make sure the nearest hospital is in their network and has cashless facility
6. lifetime renewability
 
Just a note of caution - NEVER opt for ICICI Lombard. They are worst in response and claims settlement.
 
always ask the insurance company whether reimbursement is possible if u get the treatment in a reputed registered hospital not coming under their cashless service. since if any thing happens outside ur home town this will come handy and also u can choose the right doctor for ur treatment rather than the insurance company , who will bother more about ur money than ur health .
 
The lack of a TPA is the reason I am insured with Bajaj allianz since the last 5+ years. Had one claim in the first year and had zero issues in a cashless transaction. Every other company has a TPA barring these guys who get paid based on how many claims they reject.
 
@asliarun , Is "TPA" the technical term you were referring ?

@santy - spend some time on ( if you haven't already ) medimanage.com to review the policies you mentioned and also additional assistance if you need .

I found them very professional . I came to know about them via jagoinvestor.

you can also take a loot at religare care.

I believe if all your ducks are in a row , no company can take you for a ride.
by this I mean , when you apply for a policy :

1. disclose everything about medical history , age, drinking , smoking etc.
2. know your policy i.e. what Is covered and what is not
3 .List of ailments that requires waiting period
4. don't fall for things like NCB , per day allowance etc.
5. make sure the nearest hospital is in their network and has cashless facility
6. lifetime renewability

Yes, TPA was the term I was looking for! Thanks.
 
Thanks people.

I believe ICICI does not have a TPA- they operate directly while Apollo seems to have a TPA as another company of their own.

I did go through a few articles in medimanage.com; they recommend both the above but they have warned about the loading in ICICI renewal in the event of a claim which is upto 200%. But I confirmed with them that this condition of loading is withdrawn from Oct'13 onwards.

Just a note of caution - NEVER opt for ICICI Lombard. They are worst in response and claims settlement.

But they seem to have least rejection of claims. Can you substantiate your statement, it will be helpful.

always ask the insurance company whether reimbursement is possible if u get the treatment in a reputed registered hospital not coming under their cashless service.

That is what health insurance is all about. Cashless is just another feature. You can take treatment in any registered hospital and get reimbursement upon submitting bills.
 
I would suggest Apollo Munich Optima Restore as i'm a happy customer. The main reason is because it automatically reinstates the basic sum insured in case you exhaust it in a policy year. If one of the family members (in family plan) exhaust the floater sum insured during the year and any other family member falls ill later during the same insured period, Apollo Munich will restore the entire amount at no extra charge. It also rewards you with a multiplier benefit in case you dont claim in the policy.

Here's more info: Here.
 
Also try to go direct (not easy) or through a responsible and proper channel partner-some of them-and I've experienced it- are really useless, and not worth it. All they want is your money and use call centres to hound you and outsourced services to collect the premium. By all accounts Apollo is among the better insurers, though I understand their premia may be at the upper end of the scale..
 
Wharfedale Linton Heritage Speakers in Walnut finish at a Special Offer Price. BUY now before the price increase.
Back
Top