Mahavir Chopra / Beshak.org Profile picture
Nov 4, 2020 17 tweets 6 min read Read on X
A thread on the ultra viral thread by @wiredmau5

My take based on reading/learning health insurance policies, helping customers with comparison, claims for 15 years now.

This is right. *However*, most health insurance plans today do not have a room rent limit unless you are buying a cover of Rs. 4 lakhs or less.

Yes, be careful and keep an eye on the room rent limit, but there is more to it, read on.

Some insurers may, however, have a cap on room category - which means they only allow a particular category of room. If you ever opt for a room above this category, u have to bear the difference and proportionate charges for the entire bill.
Never trade coverage for room rent limit. You must have best of both

Room Rent - Never opt for a policy with room limit. A 10L policy with limit of 10K may look adequate today, but the cover will degrade with inflation. (At 8% infln, 10K=2.1K in 20yrs)

Sum Insured/Cover*: 10L cover is not enough.

Health Insurance is a cover for a lifetime of hospitalization expenses. Buy coverage not for today but for your old age.

If 5K looks good today, you need ~ 20L at 8% inflation after 20 yrs.

But I buy a low cover today and upgrade later, someone said?

My take: You should never, I repeat never bet on future upgrades (unless you have genuine budget constraints) - since insurers might decline upgrades based on your age and health condition at the time of your request.
You must worry about the pre-existing disease waiting period - ONLY if you have disease while buying the policy.

If u don't, this waiting period is not applicable for u.

In fact, u must be aware of the 2 yrs waiting period for specified illnesses.

2 yrs waiting period for a list of specified illnesses is applicable despite you not having such diseases when you bought the policy.

Yes, you read it right.

You must be aware of this if you are young and healthy today.

Wrote about it here: beshak.org/insurance/heal…
Always note, that apart from a) existing diseases before buying the policy, and b) specified listed illnesses c) permanently excluded treatments listed in the policy, all diseases that are diagnosed after the policy issuance are covered from day zero.
This is not right.
Most group insurance policies from employers do not have a waiting period for pre-existing diseases. They cover pre-existing diseases from day zero. The problem is different and explained in the next tweet.

Migration from group to individual insurance when you quit your job is never easy - especially for old aged parents, especially if they had claimed.

NEVER depend on employer policy or migration for your parent's health insurance coverage. Please.

Important:
- The policy does not cease to exist when the primary policyholder dies.
- The policy continues with remaining members without any change in cover or waiting periods. You simply have to make another family member the proposer. So chill.

Never buy a Topup, which is what seems to have been bought here.

Always look for a Super Topup. A topup works only on a single instance of hospitalization, while a Super Topup works on an aggregate of multiple hospitalizations during a year.

Yes, buy a topup with a deductible equal to the SI of your base policy.

Pro-tip: try buying the super topup from the same company you bought the base policy - will help during a cashless claim for a major hospitalization.

Apart from this, ensure the following:
1) All Daycare procedures (that take less than 24 hrs are covered)
2) Organ Donor cover without limits
3) Understand each financial limit in the policy.
4) Fill the proposal form, make disclosures like you are making your will :)
Summary
1 Always remain covered
2 Opt for cover u will need at 50+yrs
3 Do not opt for policy with room limit
4 Ensure all Daycare procedures are covered
5 Ensure Organ Donor is covered sans limits
6 Understand limits, exclusions before signing up
7 Fill proposal form diligently.
There is no doubt that insights from real users are extremely valuable. More and more aware buyers who read wordings should share. So not taking away anything from the effort.

The effort here is only to clarify, give a better understanding.

Do RT if you found this valuable.🙏

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More from @themahavir

Apr 24
News going around: "Now people above 65 can buy health insurance."

This is MISLEADING & NOT true.

🧵 Image
EARLIER: Health Insurance regulations had a minimum maximum-entry-age limit of 65 years.

Which meant insurers were required to design all health insurance plans to be open for people at least up to 65 years of age. Image
This age limit has now been removed, with effect from 1st April 2024.
Read 11 tweets
Apr 11
🚨 Good news: Important updates in Health Insurance.

IRDAI made some changes in health insurance, through their recently released regulations.

These come in force from 1st April 2024.

Thread 🧵👇🏻 Image
Change in definition of Pre-existing disease.

Earlier pre-existing disease was any disease, condition that was diagnosed, treated or medical advice seeked in the last 48 months.

It has been changed to 36 months. Image
This means diseases that were diagnosed and completely cured 36 months before commencement of the policy, would not have a waiting period.
Read 15 tweets
Jan 27
💡Interesting benefit launched across all health insurance plans

💎 CASHLESS EVERYWHERE

Get cashless in ALL HOSPITALS in the country.

I cover:
🤔 What is cashless everywhere
🤷🏻 How to avail this
🙄 How does it work
🤨 What should you expect
🧐 What is the catch

Here we go 👇🏻
On January 24 this year, the General Insurance Council (GIC) announced Cashless everywhere.

Who is GIC?
GIC is the apex association of all health and general insurance companies.

So basically, all insurers came together to bring cashless to all the 40K+ hospitals in India.
Earlier we had to check the hospital network before buying a policy. Whether it did cover our preferred hospitals.

This will soon be a thing of the past (if things go right - more below)

You will essentially get cashless in every legit hospital in India.
Read 14 tweets
Dec 14, 2023
🚫 Insurer: "Claim rejected. Hospitalization not necessary"
🧑🏻‍⚕️ Doctor: Hospitalization is necessary

Customer: Confused, annoyed 😡🤬

This has become very very common.

Let's understand:
- Why does this happen?
- How can insurers dispute doctor's advice?
- What should you do?
First, why does this conflict happen:

To make sense of this, we need to understand the incentives of both the parties involved.
Insurers save money when they decline a claim (The type of rejections I am seeing, it looks like there is an incentive to reject)

On the other hand, have heard doctors can have targets to increase billing + they get a referral fee for surgeries.

**Interests are conflicting**
Read 26 tweets
Dec 6, 2023
Agent vs Online - whom do you buy health insurance from?

A debate more complex than Android vs iPhone

I found a reasonable answer to this question through countless interactions with customers over 15+ years of working in insurance distribution.
Here's what I realized.

Online platforms are great for transactional products.
Products where the cognitive load to make decisions is low - where stakes are low, where decisions are reversible.

Simple UX and an efficient call centre do the trick.
But this same thing is not true for complex insurance products like health insurance.

These products have serious nuances that cannot be understood easily.

Personalization, right declarations when buying the policy
Paperwork, follow-up, and dispute management when making claims
Read 19 tweets
May 13, 2023
4 myths regarding parents' health insurance through an employer you must know.

On the face of it, employer parent's health insurance looks like a no-brainer

✅ No medical tests
✅ No waiting periods
✅ Cover all diseases
✅ Faster claims

To problem kya hain? Read on 😅
𝗠𝘆𝘁𝗵 𝟭: I will remain employed for a good time. So I will always have parents cover

Not really

Note, parents' coverage with those lovely benefits causes major losses to insurers The policy is hence prone to:
a) price hikes
b) reductions in benefits
I have witnessed companies that start with fancy benefits for parents, free.

Then renewal comes

When they realize there is a huge premium hike, the CFO walks in, and rest is history

Just check the pricing history of parents insurance in your company for last 5 years.
Read 12 tweets

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