How to buy mediclaim for your family

Rakesh Kaul, CDO, Edelweiss General Insurance, answers your health insurance queries.

Do you have health insurance queries? Please mail us at getahead@rediff.co.in with the subject line Ask Rakesh and Rakesh Kaul will answer your health and auto insurance queries.

Maranganti Venkata Ramakrishna: I request your valuable advice on which health insurance policy should I opt for to meet my family’s medical requirements as detailed below:

i. Myself, 50:

Got BP in August 2017 (140 - 190)

Taking BP tablets one each morning & night. Not diabetic.

ii. Wife, 40: 

Suffered with ulcer in stomach in 2009

Taking medicine for acidity

Suffering with difficulty in taking food after delivery in 2013

No BP & not diabetic

iii. Daughter, 9:

Frequently suffering with cold & cough

iv. Mother, 70:

Got BP in 2019 (120-190)

Taking BP tablet one in morning

Not diabetic but on the border

Frequently suffering with cold and cough; previously suffered from bronchitis

v. Sister, 48:

Suffering with depression & schizophrenia

Under medication for the past 30 years

BP & diabetic

Please suggest whether to take a single policy or separate policies, extent of coverage, which company covers pre-existing diseases?

Rakesh Kaul: In a scenario where you have multiple family members with different ages, I would recommend that you opt for an individual policy for the higher-aged members. Considering the age and the existing health conditions, it is advisable to have sum insured cover of at least Rs 5 lakh.

Pre-existing diseases are covered by most insurance companies in the market, but with a waiting period varying from 2 years to 4 years from the start of the policy, and subject to policy terms & conditions and the company’s underwriting guidelines.

Kumaran: I have a query with regard to my two health policies that I have: one is a base policy from Cigna Manipal Pro Health Protect for 3.5 lakh SI and another one is super top up policy from Cigna Manipal for 6 lakh SI with deductible Rs 350,000.

I bought the base policy in 2018 and super top in 2020, and have been paying premium regularly. As per my understanding, the super top up policy kicks in only when the base policy coverage of Rs 350,000 (which is also the deductible amount) is exhausted in a hospitalisation. 

Now my question is:

The base policy has also provided me with cumulative bonus of Rs 70,000 in this last 3 years as NCB. So effectively, the sum insured for base policy will now be Rs 420,000 from original amount of Rs 350,000. So how will super top plan find its place here in case of hospitalisation claim of Rs 400,000 for instance?-

Rakesh Kaul: Your Super top up policy deductible amount is Rs. 3.5 lakhs for which no claim can be made. In case you have Rs. 4 lakhs as hospitalisation claim, you can claim the remaining amount of Rs. 50,000 under the Super top up plan, as per the policy terms and conditions.

Kumaran: As my deductible amount in super top up plus is Rs 350,000 for SI 6 lakh & now that my base policy itself has enhanced coverage with bonus of Rs 70,000 to add to older Rs 350,000. Is super top up worth buying or not? Or, should I have shifted its deductive amount of Rs 35,000 to probably Rs 4-5 lakh as the base policy will keep adding the NCB every year which will enhance the coverage for base policy itself. Please clarify:

Rakesh Kaul: It is always worth buying a Super top up policy with deductibles at least equal to the Sum Insured of your existing base policy, in order to get enhanced coverage. The NCB/ Bonus in your base health insurance policy may get reduced or exhausted depending on the claims made in a particular policy year.

K V Rao: I am 62 years old. I have been reading Rediff for the last 22 years daily. I have a Prudential ICICI Health Saver Plan for last 12 years. Never claimed a single rupee so far. I want a plan which will cover everything. Is it the best one for me or do you recommend to shift to any new or better one?

Rakesh Kaul: You are holding a life insurance cover which offers life cover along with a health component in it. To secure your health related expenses, I suggest you buy a health insurance policy from the various health plans available today. Go for a plan that is specifically designed for senior citizens.

Dipanjan Sarkar: I am 48 years old and staying abroad. I get a health policy for family (spouse and one kid) when I return to India perhaps after 10 years. Kindly suggest whether I should take a health policy now to take advantage of the premium now or wait for me to come back to India. If so, please suggest the best one.

Rakesh Kaul: The premium of a health insurance policy increases with age. Buying a health insurance policy at an early age will help you avail the continuation benefit for the conditions or diseases that have a specific waiting period. You can also explore health insurance policies which offer global health cover.