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

Jun 27
🚨 Many buy health insurance - but DON'T KNOW their rights.

Not because they’re careless.
Because no one tells them.

IRDAI has listed 11 rights every policyholder is entitled to.
Check how many you know. Understand the exceptions👇

💾 Save this for future.
🙏 Repost to spread awareness.
1/ Right to lifelong renewability
Your insurer can’t deny renewal just because you aged or made claims or have a new disease.

⚠️ Exception:
Insurers can only refuse renewal if they can prove fraud or intentional misrepresentation.
2/ Right to portability

Unhappy with your insurance plan or insurer?

You can shift to a new one and still keep your waiting period credits.

⚠️ Exception:
Porting is not guaranteed. The new insurer can evaluate and decline your application. Ensure you port while you are young & healthy!
Read 14 tweets
May 10
⚠️ ⚠️ Common tactics hospitals use to inflate bills.

We cover:
1. Different tactics you should know.
2. How it impacts you
3. How it impacts your health insurance

🧵 👇
Imagine booking a buffet dinner.

But when the bill comes, the restaurant has charged you separately for prior booking of the table, using extra cutlery, calling the chef

That’s exactly what many hospitals do to inflate bills.
You could be admitted for a standard treatment, and yet, find your hospital bill packed with surprises.

Some hospitals have a robust system and culture to ensure they inflate bills.

And whether or not you have insurance, this can come back to bite you.
Read 15 tweets
Mar 11
🚨 Why a ₹1 Crore health cover may NOT be enough once you hit 30!

In 1999, my dad was proud owner of a bumper health insurance cover!
Cover of 2 Lakhs. He found it adequate.

In 2010, I felt ₹10L was a decent enough cover.

Today, ₹1Cr still seems a bit of a stretch. But is it?

Let’s break it down. 🧵👇
1. India’s private healthcare is only getting more expensive.

The government spends just 2.1% of GDP on healthcare - one of the lowest in the world. Public hospitals are struggling, and most middle-class families don’t prefer to go there.

That leaves us with private hospitals, and we all know how expensive they are.
Why?

Because the demand for quality healthcare far exceeds supply.

Just look at the top hospitals wherever you live - there’s always a rush.
Beds are perenially unavailable.

(Have seen the MD of a giant company waiting at Hinduja hospital, Mumbai, with their family member, late night, patiently negotiating for a vacant bed. )

India has only
- 1 doctor for every 1,500 people
- 1 hospital bed for every 1,000 people - far below WHO’s recommended standards.
Read 22 tweets
Mar 7
A thread on employer health insurance!

Every year HR sends an "insurance" email most ignore.

You shouldn't.
The email usually has a deck that covers:

• The benefits you are entitled to.
• The process to enrol family members.
• The process to enrol and pay for parents’ covers and top up covers.
• The terms and conditions - which are a lot, believe me (this is ignored the most!)
Employer health insurance benefits are smoooooth!

👉 It is easy to enroll.
👉 It covers maternity benefits.
👉 It covers pre-existing diseases, damn it!
👉 It is even easy to claim.
Read 18 tweets
Mar 1
~70% of health insurance customers I meet are unaware of their rights.

Know your 12 essential rights as a health insurance consumer 👇👇

💾 Save for later.
↗️ Share to spread the word.
🗨️ Let me know how many were you already aware off?
1/ Right to lifelong renewability

Your health insurance cannot be denied renewal due to age or past claims.

An insurer can deny renewal only if:
• You committed fraud or misrepresented fact
• You bought the policy with the intention to make a false claim
2/ Right to portability

You don’t have to remain stuck with an insurer if you’re unhappy.

You can switch to another insurer and carry forward all your waiting period credits.

But note, Porting is not guaranteed. The new insurer can reject your application based on your profile, medical history etc.

Tip: Always disclose your medical history truthfully.
Read 17 tweets
Oct 11, 2024
Patient hospitalized for 6 days
Insurer pays for 2 days - says no "active treatment" after 2nd day.

Doctor shares logic for the 6-day treatment.
Insurer still disagrees.

Should patients consult insurers before taking medical decisions?
Why do patients suffer for lack of medical regulations?Image
First, let's understand why this happens.

So, health insurance as per the contract will pay only in case when the hospitalization is
a) "Necessary" and
b) " requires active treatment"
Ok - so what is "Necessary" treatment?

It is when patient can only be treated at a hospital and not at home or in OPD.

For instance, say I meet with an accident, and break my hand.
Now, the doctor needs to apply plaster on my hand.
But say the doctor asks me to get hospitalized for a day - This won't be covered under health insurance.
Read 9 tweets

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