How to buy health insurance in India?

by Manshu on March 22, 2012

in Insurance

This is a guest post by Mahavir Chopra, Head – eBusiness & Retail, http://www.Medimanage.com

Being a part of health insurance services company I have always noticed that there are large number of people, who at first show keen interest in buying Health Insurance services, but after they are recommended some of the best suitable health insurance policies, they suddenly just disappear. Intrigued by this, we did a detailed internal analysis and a customer survey, and we realized that most people, including some of the brightest professionals, delay their decision/action to buy, primarily due to 3 reasons:

a) The product has no instant gratification or compulsion to buy.

b) Expectation of a perfect match to their requirements (and)

c) Due to over exposure to multiple product features, advertisements, and promotions.

 

Our Internal Customer survey done with Medimanage.com customers, revealed that point c) is an important external influence on the decision making process of the health insurance buyer. To-be consumers are confused with multiple products, from various brands, and hence delay their decision on purchase of a health cover, till they can find a recommendation or reference they can depend and rely on. We cannot blame the general customer, as we are aware, and you would agree, that buying Health Insurance is far more long term than buying the latest Widescreen LED Television, and far more complicated than buying a standard term insurance.

 

The over exposure of products has been aptly termed ‘The paradox of choice’ by Barry Schwartz, a social scientist, in his book with the same name. He says, “Unlimited choice results in genuine suffering. The more choices we have to make, the less certainty we seem to have. When we have 285 kinds of cookies to choose from in the grocery store, how can we be sure we’ve picked the right one? And that’s just cookies. When faced with seemingly unlimited choices that have significant consequences like which stocks to invest in, which career to pursue or even which person to marry, many people become ‘maximizers’: people who relentlessly search for the best option. These people spend a great deal of time and energy on choices that will never satisfy them.”

 

Personally, as a buyer, it’s very clear and almost a fact for me, that more product offerings in the market, topped with more promotions, more advertising, are only complicating things, and delaying decisions specially and importantly, when buying products or services, I “need”, but don’t have a strong “want”.

 

So, coming to the million-dollar question, how does one sift through a minimum of 50 health insurance policies and variants and zero in on the best health insurance suitable for his/her family? My answer is quite simple; you need to first, right in the beginning, understand that buying a long-term product like Health Insurance is like getting married. The younger you are, you will have more choice, but there never will be a perfect match for your requirements. You cannot keep waiting for the best product, because there isn’t one.

What you need to look for is the most suitable product, rather than a perfect match, here’s how.

1.    Do a thorough need analysis:

To find a product, which is most suitable to your needs, you need to understand your needs first.

  • The family members you want to cover. The more members, the higher the age, and the higher the coverage you need.
  • The city where you live, and where you are likely to take hospitalization treatment. If these cities are in the northern or western metros (like Delhi, NCR, Mumbai, Ahmedabad etc.) you need more coverage.
  • Your choice of type of hospitals you want. Would you prefer treatment in a neighbouring nursing home, which has a personal touch or would you always prefer a large corporate hospital for the smallest of treatments. If you are expected to use mega hospitals, for all kinds of smallest treatments, you would need a larger sum insured, for sure.
  • Similarly, the choice of room you want, would impact the kind of policy suitable to you. If you are used to private, deluxe AC rooms. The best test for this is, if you had no insurance today, and if any of your family has unfortunately been hospitalized, would you take a private room, or settle for a shared room? This type of room is your real choice, without financing from an insurance policy.
  • Your long-term plans would affect the kind of product, and coverage you would need. For instance, are you/any member in the family planning to migrate abroad etc.?
  • What is the amount of expense on Healthcare you can bear on your own savings?

2.    Recruit a Good Advisor

There are too many general “tips”, “guides”, and other noise about Health Insurance today. If you are looking for unbiased advise to choose the best Health Insurance policy suitable to you, you need to take pain in finding a good health insurance advisor (preferably a broker, who can provide wide spectrum of product options), one who can provide you genuine advise, service the policy, and also has experience in managing health insurance claims. The claims management part is very crucial, as Health Insurance claims can have a lot of back and forth, and get tedious at times, and hence requires professional help. A good advisor plays the role of a linchpin in a complex service and product like Health Insurance, across the life of the policy.

(Full Disclosure: The writer of this blog post works for a Health Insurance Advisory Broker Firm)

 

3.    The younger you are, the more choices you have.

Like marriage, the younger you are, you have larger spectrum of choice, and hence you can get choosy about the most suitable product. The older you get your choices narrow. Once an ailment kicks into the health of any of your family members, the choice can become minimal to one or two products. If you were diligent enough, choosing and buying Health Insurance, when you don’t need it, would provide the widest health cover possible.

4.    There is no Perfect Match

As mentioned earlier, there is no perfect match, and hence, waiting for ever to find the perfect fit to your requirement, may prove hugely futile. After detailed understanding of your needs, and taking sound advise, you need to settle with a good but imperfect product. There is no point waiting for “that important feature” in the product. What’s more, if such product does appear in due course, you can always port the same, with proper planning in place.

5.    The Real thing – look beyond the looks

I am a great movie buff, and after some experience, I observed that today, with strong marketing geniuses around, all films look good, till one week after the release. That’s when the realities and reviews sink :). Health Insurance is no different. Packing old wine in new bottle is an art, many have mastered. Its important to do a core need analysis, and purchase a product/service, that meets these core needs. Anything over and above this is either packaging, or, bonus (if it comes at a similar price.)

6.    Look Long term

Look really long term. Understand that Healthcare inflation in India is rocketing through the roof, and hospital bills are becoming more and more unmanageable without financing solutions like Health Insurance. You need to realize that if you are 30 today, you will most probably need health insurance the most maybe in 15-20 years. You need to factor these inflated costs and then look at an optimum coverage.  Do not settle for a coverage or sum insured, based on current costs of hospitalization.

7.    Understand the *

I know it’s a tad boring to read the fine print, called the policy wordings document. But when you are buying a product, which is a solution, for 20+ years, you need to take that pain. If you cannot understand the legal and medical language, you can always ask a health insurance expert advisor to take you through every part of the policy. The wordings will give you a flavour of how the product actually works, and what problem it solves, and does not solve.

8.    Meet the Parents

It’s important to meet the parents, and understand the background. Knowing the basic reputation of the group and joint venture partner behind the product is critical for a long-term financial product. It reflects how the company will react, specially, in downturns in the industry or its own company.

 

Unarguably, Health Insurance is a critical piece in your financial jigsaw puzzle. Taking the above-suggested points into consideration, apply your own judgement and common sense, take a personal deadline, and take the proverbial “leap” of faith.  Believe me, you will not go wrong, till you act quickly, and take a call.

 

In case you have any questions, or feedback or comments, do share the same in the comments below. I am also available at the email address: expert@medimanage.com

Views: 20192


Get free daily updates in your email:






{ 33 comments… read them below or add one }

bemoneyaware March 22, 2012 at 11:59 am

Very insightful and useful article. You have rightly mentioned the 3 reasons why people don’t buy health insurance. Personally the reason I have not bought health insurance is
a) Employer provides some basic health insurance.
b) Unable to decide right age to buy. Early 30′s , late 30′s, early 40′s. I want to take health insurance when I am able to optimize my health insurance premium.

Reply

Mahavir Chopra March 22, 2012 at 1:44 pm

Hello bemoneyaware,

Thanks for the kind words.

As mentioned in the article, the younger and healthier you are, you have wider choice. You will complete your waiting periods, way before you really need an insurance. Also, you earn no claim bonuses.

In your effort to “maximize” and “optimize”, you are taking a risk of leaving an important part of your financial planning to luck. The right age to buy Health Insurance is NOW!

Reply

Adarsh Thampy March 22, 2012 at 12:39 pm

What would be your suggestion for the following scenario?

Single male. Will be married in 2 years. Will need to cover self (currently) and spouse (later) and later children too. Can invest upto 3000 per month (currently) for health insurance (May increase when married). I’d prefer to go with good established hospitals. Currently I am in Pune and I am originally from Kerala.

Also, do I get any tax benefit or assured returns after X years like when I take LIC policy? Thank you.

Reply

Mahavir Chopra March 24, 2012 at 3:26 pm

Hello Adarsh,

You have not mentioned your age. Assuming it is less than 30, and you have no ailments, and you live a healthy lifestyle. You could start with a Rs. 4 Lakh individual cover, raise it to Rs. 6 Lakhs when you get married, and gradually take it to Rs. 10 Lakh cover.

Apollo Munich, Bajaj Allianz have good quality hospital network.

Regards,

Mahavir Chopra

Reply

lavesh chopra March 26, 2012 at 8:14 am

I am a married person living in delhi and i have my wife, son and a daughter. i have no health insurance policy right now. but planning to buy one..my age is 39yrs, my wife- 32yrs, son is 6 yrs, daughter is 4 yrs now.. i want a cover which can take care of hospitalization cover, opd cover, critical illness cover without causing me much of financial damage( expenses). I have done a lot of analysis and could not find the best one out of the lot. What kind of coverage would u suggest to me and which insurance company can i trust for my need.

Please guide me in this regard and oblige me.

Reply

Mahavir Chopra March 26, 2012 at 11:27 am

Hello Lavesh,

There aren’t any good OPD covering health insurance policies in the market. We would recommend you aim at covering the larger expenses like Hospitalization and Critical Illness cover. If your entire family is healthy, you could go for Apollo, Bajaj, Bharti Axa, Oriental with sum insured of Rs. 10 Lakhs, which would cover maximum of your expenses, including hospitalization expenses related to critical illness.
We would suggest you go for separate standalone policies for Critical Illness (5 Lakhs for each earning member), and Personal Accident (10 to 12 times your annual expenses) which pay in lumpsum, and will cover loss of income.

As mentioned in the article, for customized product analysis, you need to contact a good unbiased health insurance advisor and service provider.

Good luck

Mahavir Chopra from Medimanage.com

Reply

shaky March 31, 2012 at 12:52 am

Hi ,

I am a recently married person , my wife got pregnant and she is 5 months now. Our first marriage anniversary is about to come. Currently my company offers me a health insurance policy for which i have included my wife name. Now i need to know what all expenses i can cover for my pregnant wife (now, during delivery and after delivery). I am not sure whether my company provided group policy can cover it or not , but i want to know all available health insurance providers who can cover this to a maximum . And what about the amount i should invest?

Reply

Mahavir Chopra March 31, 2012 at 1:26 pm

Hello shaky,

Only a group mediclaim policy can cover maternity without waiting periods. You need to check with HR team of your company regarding coverage for maternity. If maternity is covered, it will most probably also cover the baby from day zero. You need to inform the birth of the child ASAP to your HR or whoever manages employee mediclaim in your company.

Regarding independent covers, they have a minimum waiting period of 2 years for claiming maternity. Also, in most cases, they dont prove to be cost efficient.

My recommendation would be to start with an independent health insurance irrespective of maternity cover or not. It is an unavoidable part of long term financial planning.

Regards,

Mahavir Chopra from http://www.medimanage.com

Reply

Manshu April 2, 2012 at 3:55 am

That’s very good info Mahavir – thanks for sharing!

Reply

Mahavir Chopra April 3, 2012 at 11:00 am

Thanks Manshu :)

Reply

Eshwar April 4, 2012 at 12:10 am

Hi,
I am 30 years old by this June, my wife 29 & we have a new born who is 18 days old. I think minimum age at entry should be 3 months. I already have 5 lacs coverage from employer and still want to go for family cover(covering me, my wife & kid) for 5 lacs.

Excuse me if I have provided more information below :(
My current problems:
when I recently gone for a medical check while taking online term insurance from aviva and found my fasting sugar levels are 113 (where as reference ranges from X to 110) which is 3 mg more than the reference, post-fasting sugar levels are normal, 3 month average sugar levels are normal and hepatitis-B infected. With these two problems my premium got loaded with 100% and I still opted for it as I wanted to secure my family.

Questions:
1. With these problems, can I get health insurance policy also? when I asked one of the agent of apollo munich, he said my proposal may get rejected if I am diabetic and I am not sure whether I am diabetic or not based on the above results. And coming to hepatitis-B, it will not be covered for 4 years. Is there any good policy for my case?
2. I am planning to take a critical illness policy as well as I am hepatitis-B carrier(after meeting hepatologist it has been observed that treatment is not required as per WHO guidelines which means virus is inactive and not causing damage to liver and require to go for liver function test & ultrasound every year). please suggest me what this critical illness policy is and any good policies.

Reply

Mahavir Chopra April 4, 2012 at 11:19 am

Hello Eshwar,

1. Please wait till your kid is 3 months old, and buy a health insurance policy.
2. You can get Health Insurance policy, with Hepatitis B and Sugar. There is a good chance of proposal being denied by Apollo, or a permanent exclusion for Hepatitis B and Sugar. There are other companies which you can look at like Bajaj, Max Bupa, Oriental, Tata AIG etc. Given the complications, we suggest you contact a good health insurance broker, who can provide you advice on multiple products.
3. Critical Illness cover would be difficult, with most companies. But can be tried.

Regards,

Mahavir Chopra from http://www.medimanage.com

Reply

Kiran June 18, 2014 at 11:58 am

Hi,
Did u manage to get health policy for you?
I am a hepatitis B carrier. I tried Star, Max, Oriental, Apollo and HDFC and all have rejected my health insurance application.

Reply

Mona April 13, 2012 at 4:51 pm

Nice post..
Which are the best plans in India currently?

Reply

Mahavir Chopra April 14, 2012 at 10:18 am

Hi Mona,

Thanks :)

As discussed in the article, there are no best plans that could be listed. It depends on your requirements, the health of the family members, their age etc.

Reply

Vishal May 29, 2012 at 9:49 am

Is there any group policy available for individual (who are not working with any company) ?

In last episode of Satyamev Jayate, they mentioned about some group policy where people can enroll to avail cost effective treatment.

Thanks in advance.

Reply

Mahavir Chopra May 30, 2012 at 9:24 am

Hello Vishal,

Excellent Health Insurance options are available for everyone. Group policies are generally not recommended unless one cannot afford, or is not entitled (due to ailments or age) to open market policies. Open market policies are better, as it has more flexibility and better covers in the long term.

In case you need any specific product related help, you can write to us at expert@medimanage.com

Regards,

Mahavir Chopra

Reply

akshat July 16, 2012 at 9:01 am

Hi,
I am 24 and planning to buy Max Bupa heartbeat plan for myself.are they in your top list??and how far are they reliable? infact i am the victim of your reason c)over exposure to multiple product features, advertisements, and promotions.

Reply

Mahavir Chopra July 16, 2012 at 5:30 pm

Hello Akshat,

Max Bupa is a good option. It provides good coverages, and better deal in the short term. The drawbacks of this product, that you should know, before you sign up is that
- this plan has a copay of 20% after the age of 65 years
- has room category limit. In case you buy the Silver plan, you can go for only Shared accomodation in the hospital.

There are some other good options like Apollo Munich, Bajaj Allianz, ICICI Complete Health, which you can explore.

You need to catch hold of a good health insurance advisor (one who provides unbiased advice and comparisons + provides claims assistance service)

Regards,

Mahavir Chopra | http://www.medimanage.com

Reply

Amit July 19, 2012 at 11:00 am

Hi,

A very good post indeed!

I am 30 and my wife is 29yrs. My current salary is 18lakhs. I am looking at a comprehensive Health cover plan, one that would not trouble me with “Conditions Apply” and also with a large Hospital Network. Other expectations: Cashless, Spouse cover, Facility to include baby, Speedy reimbursements (if any)

Considering the above:

1. Please suggest if PSU Health companies are better than Private companies
2. What is the ideal cover (Sum Assured) should I opt for?

Thanks in Advance,
Amit

Reply

Mahavir Chopra July 19, 2012 at 7:23 pm

Dear Amit,

While an all-covered health insurance plan is not viable and hence unavailable worldwide. Health Insurance is a contract, and hence there would always be terms and conditions.

Some good options would be Max Bupa, Bajaj Allianz, Apollo Munich, Oriental Happy Family. All have certain pros and cons. You need to discuss your requirements and preferences, with with a good (read unbiased) health insurance advisor, who also services claims. Only then, can he/she recommend you a specific product, based on strong comparisons.

Regarding Govt. Vs Private: Here’s an extract from my another blog:
Some consider Private Insurers better due to their modern infrastructure, their responsiveness. Some consider Public Sector to be more reliable. Private Sector would run for business and hence would be very responsive. Public Sector, are the Government’s mechanism to ensure a great healthcare infrastructure, and hence somewhat have a social angle, changes in the policy are not driven only by profits but also need to socially acceptable. You need to understand the pros and cons diligently and hence set your own expectations right for your choice.

Ideal Cover: Read this article, and my comments below: http://www.jagoinvestor.com/2012/06/how-much-health-insurance-is-good-enough.html#comment-46771

Regards,

Mahavir Chopra | http://www.medimanage.com

Reply

Vijay July 25, 2012 at 11:36 am

Hi,
We are a Ad Agency and we want to run some Ads on your website kindly revert me if you are intrested.

Reagards,
Vijay Chauhan
9015854072

Reply

Manshu July 29, 2012 at 1:59 am

Sorry, not interested.

Reply

Rahul Ingle July 25, 2012 at 5:07 pm

Hi Mahavir,
I am looking to get a Mediclaim as well as a Life Insurance policy for me & my parents. Get in touch with me. My number is +91-9049521235

Reply

Teecee August 6, 2012 at 10:08 am

The most important thing you have forgotten is the TPA !

All medi claims are now processed by the third party administrators which are staffed with under qualified, lowly paid clerks in shanty offices !

Just file a claim & experience for yourself ! They will remind you of “your milk number six” !

Company selling health insurance has no role once you are handed over a policy after collecting the hefty premium!

Reply

Mahavir Chopra October 23, 2012 at 9:45 am

Hi Teecee,

In my personal experience, the problem of a bad quality TPA can be resolved by a good quality adviser/service provider advising you on claims and the way forward – hence the TPA does not matter.

Reply

utkarsh shrimal October 22, 2012 at 1:52 pm

Hi Mahavir,

I want to buy a health insurance for my mother whose age is 56 years. I need to buy a cover of Rs 4 lacs.Pls suggest the best options available in the market.

Utkarsh

Reply

Mahavir Chopra October 23, 2012 at 9:49 am

Hello Utkarsh,

The products you could explore are ICICI Complete, Max Bupa Heartbeat, Religare Care, Oriental Happy Family.

It is very difficult to recommend a specific product on the forum. This would depend on the health condition history, your location, your preferences etc. In case you want Medimanage to recommend you a specific product, you can write to me at expert @ medimanage.com , with your complete details.

Mahavir Chopra from http://www.medimanage.com

Reply

Sujith November 13, 2012 at 2:16 pm

Hi Mahavir … Good article.
Need some advice:
(i) I am planning to buy health insurance (Hospitalization, critical illness & personal accident) for me & my family
(ii) My age: 35 years; wife: 33 years; Dad: 70 years; Mom: 57 years; Mother-in-law: 54 years
(iii) None of us have any existing health/medical concerns/issues and are all in good health
(iv) I’m looking at a coverage of about Rs 10 lac
(v) City: Me & my wife: Delhi. Others: Mangalore (providing this info since you have mentioned that city makes a difference in premium calculation)
(vi) Want a good policy (i.e. in case of hospitalization, would opt for non-shared room; need for coverage of critical illness in the best hospitals etc.)

Kindly advise the following:
(i) Is the coverage adequate?
(ii) When we mean coverage, does it include hospitalization+critical illness or hospitalization only?
(iii) Does the same policy cover both hospitalization+critical illness or are there separate policies for the two?
(iv) What is individual coverage & what is group coverage? What should I go for?
(v) Which is the policy & operator that I should opt for.

Thanks in advance.
Regards,
Sujith

Reply

samantha December 20, 2012 at 6:17 pm

Trust me, people in India always look for the benefits which come at the quick time rather then for a long period so i guess all the policies which come under this way would be sold out soon !

Reply

Ajay February 24, 2013 at 12:35 am

Hi,
I bought an Apollo Munich Health Insurance Optima Restore Plan of 10 Lac coverage directly from company employee his name is also Ajay, after 4 months I suffered from brain hemorrhage and get cashless of Rs. 8.25 Lac cashless claim in Max Devki Devi, Saket, Delhi and more than 1.5 Lac in 6 months as post hospital expenses. I always appreciate who sold me this plan, he helped me on every steps while I need.
Now I would like to have an Accidental Policy. Please suggest how much coverage I must opt and how can I calculate how much coverage would be best for me.

Regds,
Ajay
Call @ 7503607080

Reply

Manshu February 25, 2013 at 5:35 am

Good to hear about your positive experience. I think since you’ve had such a great experience you can tap the expertise of the person who got you the first policy, and take his assistance in getting the new one.

Reply

VENUGOPAL June 29, 2014 at 1:35 pm

hi my son is suffering from a disease called alligile syndrome one of the very rare disease effecting liver & heart mainly a multi organ disorder,at the time of his birth discharge summary all was in normal state after appr 3month we sensed some issue an later after so many dr consultant almost for 2months,the dr concluded he is suffering from the above said,am trying to take a fly health floater or needed some health cover specially for my son future complications like liver transplant etc,needed advice or suggestion is there any policy available in the market to avail,have tried fly floater health cover from Bajaj allianz general insurance but this got rejected even after Dr said my son is fine at the moment,am a bank employee still am struggling a lot to health cover.

Reply

Leave a Comment

{ 1 trackback }

Previous post:

Next post: