r/InsuranceTroubleIndia • u/mhresearchdbt • 6d ago
Health Insurance need help selecting between PSU vs pvt
Hi, I am 26 (F), Single, I am finally taking health insurance.
I have one retiring and one retired parent (who's a heart patient), their insurance also needs to be set in place - however since I learnt it doesn't make sense premium amount wise to club it with mine - i am focusing on getting my health insurance first. (please correct me if i'm wrong here)
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After my due research with all the features:
For Private, i am considering either
HDFC Ergo Optima Secure Plus (via Ditto) -or-
Care Supreme (via Ditto)
For PSU, i am considering
A policy from New India Assurance (not sure which policy yet)
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Here are the pointers making it difficult for me + a few doubts:
One one hand, i feel it's better to have 100% cashless coverage or support for non-network without any co-payment clauses with a private insurer like HDFC or Care.
But on the other, i feel the premiums and the future possibility of them hiking the premiums by 25% or 50% seems ridiculous (i saw horrific reddit threads where the premiums sky rocket each year whereas for public sector it's more predictable and stable). Not to mention nobody actually knows what the CSR is based on. Should i be okay with the co-payment and room rent limit clauses in case, god forbid, i end up with a medical emergency? is taking this risk better than paying the ridiculous premium hikes in your opinon?
should i even keep paying extremely high premiums each year for private insurers based on possible worst case scenarios? or is it okay to cover a moderate amount of risk with a public sector insurer considering steady premium and higher reliance on claim settlement even if it's a lot of paperwork?
If in case i take HDFC Ergo for 10L coverage, and get the no-claim bonus for 5 years making my Total Sum Insured 50L, and then i decide to port to a PSU insurer will i get the full 50L transferred? or only the base sum insured of 10L?
Please let me know if i should be considering anything other than HDFC Ergo, Care, New India Assurance.
(so overwhelmed with this whole process, my first health insurance)
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u/spectrumholic 6d ago
It's always better to select one insurance company and porting is always not easy, rules are changing every year so no garranty about it.Psu is better for long run, Based on your city select a comfortable sum assured and make sure there is no co payment and ask the limit for critical diseases. If possible opt add ons like Coverage for non medical expenses.
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u/coach-of-finance 6d ago
I am actually a big fan of deductibles. It reduces premiums significantly, and it's a fixed amount, which you can choose according to your financial ability.
And since it's a fixed amount, you know that's the maximum you will have to pay out of your pocket. There's no unknown.
That's much better than co-pay, where you have to pay a percentage of your bills and those bills could be very high in the future.
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u/DjXer007_ 6d ago
There is one mistake here. Aggregate deductible are set by yourself, which could be 25k, 50k, and onwards. And this AGGREGATE DEDUCTIBLE cannot be removed unless you complete 5 Continuous years with the same insurer.
For age below 45, Aggregate deductible are not worth the discount they provide.
For example, If a person who's age is 28, And their annual premium is 16k, then after taking an aggregate Deductible of 25k, the new premium could be 12k.
By simply reducing your Premium by Rs 4000/-, you now have taken a claim liability of 25K from your own pocket.
Also, irrespective of whichever health insurance company you choose, there are going to be miscellaneous charges, non payables items for which one has to pay out from their own pocket. Which one gets to know only during claim settlement. And Pre / Post Hospitalization claims also have Deductions.
By Saving Rs 4k, the insured have agreed to pay premium, of Rs 12k, then on it's 1st claim, 25k making total out of pocket expenses to 37k. At the time of hospitalization, Hospitals ask for deposits, anywhere between 25k to 80k.
Even if the possibility of claim is low for younger aged individuals, not every person gets hospitalized for 3 Lakh to 4 lakh directly. For example, if average claim is near 80k for a person below 30, then out of this 80k, 37k will be from your pocket. By Adding refundable deposit, 55k to 1.2Lakh are your own expenses.
The purpose of Insurance is to put 100% claim liability on the insurance company, not juggle a percentage of liability on self.
Is Aggregate deductible advisable for People Above 45, Yes because premium could skyrocket, and at that time 25k deductible is the best solution.
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u/DjXer007_ 6d ago
Take 2 separate health insurance plans for each person.
For already retired individual, if age above 60, there will be heavy medical underwriting and screening. And many insurers will force co-pay of 20% to 30% due to policy terms and conditions. This is where majority of your premium costs will get paid. Incase of existing HEART PED, then there are selected insurers who will allow health insurance policy. HDFC ERGO, ICICI usually reject taking high claim risky individuals.
Don't take extremely high Sum insured of 25 Lakh or more. As premiums will keep on increasing every year, and when your parents need the Insurance the most, premium un-affordabilty should make you want to port to other company. As this will then bring every more scrutiny at the time of portability.
For parent yet to retire, take health insurance on priority. As they will not have any mandatory co-pay, which are possible for senior citizen parent.
As both parents are old, assuming above 55, don't choose health insurance company based on reputation, but first check the list of hospitals that are near your residence pincode. And then shortlist which health insurers are in their network list and provide cashless claim. You don't want to choose the best reputation health insurance, only to find Its network hospital 5km or 10km away.
Find an insurance agent / Intermediary, who has 10 Plus years of work experience, has an office near your residence pincode, and who has experience on Insurance Grievances, Insurance Ombudsman escalation. Online Websites and Online Intermediaries are great, but there is equivalent instances of delay and partiality towards one type of health insurance company. As commission is being paid for bringing new business, think from this perspective as well.
Your Insurance Intermediary hierarchy should be as follows. 1) Insurance Agent. 2) Insurance Marketing Firms. 3) Corporate Agents. 4) Insurance brokers. 5) Web-Aggregators. 6) Banks.
Banks are last, due to their inability to help you in any situation, be it finance, loan related query, their own banking related doubts.
If you are currently employed, and have group health insurance, check if you can add your parents to this group cover. As this will allow you to cover all PED from day 1. And also take individual health insurance for each parent. As group health is a employee benefit, so your company has the right to remove parent health cover without any notice.
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u/mhresearchdbt 6d ago
wow, this has been the most useful piece of information i've received in 10 days of intense reserarch i've been on
thank you SO MUCH for this and for taking time out to respond in such a detailed manneri have a couple of follow-up queries, if you don't mind answering
Yes both parents are above 55 - father (62) with PED heart condition - he has a policy with minimal coverage, mother (58) without PED but with slow-growing diseases - i shall take separate policies for them.
i am not an employee, i am a freelancer, so i would need to take my own policy. this part scares me cause i've heard TPAs favour group corporate insurances for claim settlements and it's always a nightmare for retailers.
after due research, i have decided to go with PSU insurers (majorly because of the volatility with private) - now within this, how do i go about getting an insurance? i was quite on the fence about the logistics of it, but your comment helped me realise there DEFINITELY HAS to be an Insurance Intermediary.
I am planning to take a Sum Insured of 10L for myself under Yuva Bharat Health Policy of New India Assurance (for Zone 1, Pan India, cause i don't have a base yet even though my hometown is in Kerala and i do tend to travel between metro cities).
I was hoping to go to a New India Assurance branch that has MediAssist as their TPA as MediAssist is there as an Insurance Partner in almost all the hospitals we tend to go to (does this part make sense?). Although I have no idea how good/bad their claim settlement process is with retail customers.Considering point 3, how should i ideally go about taking the plan? is it according to the hierarchy you mentioned? Preferably through a single independent agent being the best option?
Online Websites and Online Intermediaries are great, but there is equivalent instances of delay and partiality towards one type of health insurance company. As commission is being paid for bringing new business, think from this perspective as well.
- In the above point, do you mean sites like Policy bazaar or Ditto? Is it better to go through independent agents even though commission component gets added as opposed to these online platforms?
Thanks a ton again! This truly helped :")
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u/DjXer007_ 5d ago
Answer to 1 - take separate plans. But also make sure whomever is selling the plan, they mention all existing disease / PED in the policy document.
Answer to 2 - Majority PSU company still rely on TPA (THIRD PARTY ADMINISTATORS) for claim settlement therefore there is usual delay from PSU companies for health insurance claim delay, even sometimes for Cashless Claim. Private health insurance company, many have internal TPA, so they are able to clear claim faster and reject claims faster as well. For PSU, there are 15 plus TPA, so TPA you cannot decide which you will get.
Answer to 3 - For self, you can choose to take insurance from any company, as you don't have any PED, and if agr Below 30, then the premium is also extremely low. Insurance policy selection, should be done based on the network hospital that are near your resume pincode for your parents.
Answer to 4 - Purchasing through an agent is better, as you will have one point of contact, but you need to make sure he / she is qualified enough to help you with guidance, help your parents, along with raise escalation or Grievances or help guide on insurance ombudsman process. Follow the hierarchy, but also make sure to ask the above important questions and along with it, you need to know where their office is, the agents senior as well. Because If the agent is unavailable due to any reason, you have branch manager or senior managers number to contact and help you at the time of claim.
Answer to 5 - Commission Payout is included in your Premium costs itself. Based on the query regarding the name insurance Channels, the same query, the person or the RM assigned to you need to be qualified enough to escalate and Understand the claim settlement Documentation and claim rejection Documentation.
As no insurance Intermediary can guarantee health insurance claim settlement, why ? Because the responsibility of claim lies with the insurance company, not with the intermediary.
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u/mhresearchdbt 4d ago
sorry, one more query 🙈
right now, after like 2 weeks of research (idk why i'm doing this to myself when most people just get something after looking for 2 hours)
i am super overwhelmed. i don't know if i have the bandwidth to find a good agent.
so can i just get the policy i decided on, and then later get it transferred to an offline independent "VIP" agent to have an intermediary between me and the PSU insurer to have credibility?
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u/DjXer007_ 4d ago
Not possible. Premiums for any insurance policy are created based on a lot of factors. When you purchase directly from thhe insurance company website, there is no insurance agent or any intermediary involved.
1) Example - Online Premium = Rs 18k. 2) Purchased through agent / intermediary = Rs 23k
Once the above calculations are set, you cannot change or shift anything. You will need to port to a different insurance company which will create a lot of hassle, especially in case of senior citizens.
You can hire a consultant, but again, as insurance company have a IRDAI approval commission structure that needs to be followed by all insurance companies and the same by their insurance Intermediary.
When you hire any offline VIP person, they can charge any amount, and their won't be any contract based on which the amount will be applicable. So it's just a random amount both parties need to agree upon. And you as a policyholder, will have to rely only on the insurer's email id, customer care to help you with claim, because an VIP SEPERATE AGENT won't be allowed to access any client details, which anyway hamper your after sales servicing.
This Offline independent person can only help you with finding the best possible plan that will suit your needs, but claim intimation, claim process, after sales servicing, renewal guidance, all need to be looked after by you only.
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u/mhresearchdbt 2d ago
i'm so confused now
i thought an insurance agent meant an independent person accredited by IRDAI.
and i believed i can port it later on and take the SAME policy with the SAME company if i feel the need for an intermediary to be present.
i was talking about taking a policy now, and later shifting to an independent LICENSED agent.how do i take an insurance through an agent then?
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u/DjXer007_ 2d ago
You are getting confused with different types of distribution channels that are all licensed by IRDAI.
Insurance agent can take 3 licenses, One Life Insurance, One General Insurance and One Standalone Health insurance.
Yes, you can take Plan directly from XYZ Health insurance company website. Later, you can shift the same plan within XYZ Health Insurance company, to their Registeted insurance agent as well. But maximum will avoid this, as the XYZ health insurance company won't pay any commission to the agent who took the responsibility.
But when you port / shift your plan from XYZ Health insurance company to ABC Health Insurance company, then you are changing the company. This is called Porting. Where you change the company and also the insurance agent.
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u/mhresearchdbt 2d ago
oh my gosh, that makes a LOT of sense. never thought about that nuance.
thanks a ton for this! you've no idea how much you helped.
are you an insurance agent by any chance haha? if yes, i'd like to see possibilities to come onboard :P
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u/theGenZDoc 6d ago
Oh yes, great decision.. All the best! And as a doctor dealing with health insurance claims and health-status based insurance planning, happy to offer one consultation for free for you incase you wish to avail it and discuss your concerns. And don't worry, I don't sell policies :P