Nikhil Jha Profile picture
Jul 16 14 tweets 3 min read Read on X
I have corporate health insurance of 5 Lakhs from my Office
Why do I need personal health insurance?

So many people think this way
But who will cover u when u retire?

A thread🧵on the features of a corporate cover & why personal health insurance is necessary?

Let's go👇 Image
What is a corporate cover?

A Corporate Health Insurance Policy is a type of insurance that covers a group of professionals working under an organization against illness, accidents, & other health issues.

Corporate Health Insurance is basically a Group Health Insurance Plan.
Who is covered under a corporate plan?

It is generally the spouse and children of the working member.
Some companies also allow parents to be covered under these policies on payment of some premium
So what is the benefit of a corporate cover?

Senior citizens can be enrolled:-

Senior citizens generally due to the existence of some diseases or others find it difficult to get health insurance.
Group policies are easier to get even for senior citizens
No waiting periods:-

Corporate policies generally come with no waiting periods.

This means that all those who have a pre-existing disease find it easier to enroll and make claims
Waiver of medical checks

One of the most attractive features is these policies generally waive the need for medical citizens

Again this can be beneficial, especially for Senior citizens!
No premium payment:-

The premium is paid by your employer.

Only if you plan to increase the sum assured or top it up with another health plan, you would need to pay the difference.
Problems with a Corporate Cover?

Caps on room rent/copay and other details

Group insurance policies generally have a cap on
🩺Room Rent
🩺Have a co-pay
🩺Sub-limit on the treatment of diseases.

Generally, an individual comprehensive policy will not have these problems.
Underlying terms and conditions can be changed overnight.

In an individual policy, the insurer cannot change the terms of the policy under normal conditions

In a group policy, the employer can change the policy overnight depending on the premium they want to pay
Coverage Amount:-

5L over cover may seem fine today.
But 20 years down the line a 5L cover will be nothing.
So low cover is another problem that is their with corporate policies
Policy Tenure:-

Your corporate health insurance will offer coverage until you are employed with the organization.
The moment your employment ends, the policy will be terminated.

You will be out of insurance cover, till you get employed somewhere else.
Can corporate policies be ported after employment?

Some insurers do allow corporate policies to be ported on the payment of a premium.

But only some insurers allow it and this needs to be checked with the insurer.

The policy conditions are restrictive though
So should u buy a personal health insurance policy?

Yes, u should have a base policy!

Why?
As soon as ur employment is terminated the corporate policy lapses and you will be left without a health insurance cover.
If you develop a serious disease then,
Insurers will not like to cover you.

Therefore you run the risk of not having a cover in a very old age.

In order to cover off this risk,
One must have a personal policy even if you have a corporate cover.

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More from @NIKHILLJHA

Jul 1
Do you know there are certain things which are not coverd in all the policies even if you are holding the policy for last 10 years crossing moratorium period...

What are those lets check below👇 Image
This types of disease, hospitalisation or claims are called as permanent exclusion

What is permanent exclusion ?

These are certain illnesses, treatments, or situations that your health insurance will simply never pay for, no matter what, and not even in the future.
List below are the diseases which are not coverd

Cosmetic treatments ÷

Thinking of a nose job or tummy tuck? If it’s just for looks, insurance won’t pay. (Exception: accidents or medical need.)
Read 12 tweets
Jun 17
🚨Co-payment vs Deductible in Health Insurance

Co-payments and deductibles are both used to lower the health insurance premiums
But which one should u choose?🤔🤔

A thread🧵on copayment vs deductible and which one to choose?

Lets go👇 Image
What is Co-pay in health insurance?

Co-pay (co-payment) in health insurance is the percentage of the claim amount that the policyholder has to pay from their own pocket that is part payment between company and policy holder under a health insurance policy
Generally companies have a co-payment clause of 20%

What does this mean?

If you have a 20% co-pay clause

Out of every Rs 1 lakh claim
You will have to pay Rs 20,000 from your own pocket
The rest Rs 80,000 will be paid by the insurer
Read 13 tweets
Jun 9
🚨Health Insurance Claims Stories

Sum Insured=5L
Claim Amount=90,000 for dehydration

Insurer Rejected Claim:-
"Hospitalization not needed."

Court Slammed the insurer and Ruled:-
"All kinds of sweet talk is done while selling policies
But the insurers find excuses when it comes to paying claims"

Why did the court fine the insurer?
Let's find out in this very important claims stories 👇Image
Background to the case:-

Sanjeev Rana and his family from Chandigarh had bought a 5L policy from a leading private insurer in 2023.

He paid a premium of 35,000 for the policy.
In April 2024,
He experienced severe dehydration and increased creatinine levels,

He went to Max Super Specialty Hospital, Mohali to undergo a thorough medical check-up.

Since some of his parameters were alarmingly abnormal,
He was advised to be admitted to the hospital immediately.
Read 14 tweets
Jun 7
🚨Is Single Private Ac room good enough?

Sum insured=25 lacs
Hospital bill=5 lacs
The insurer only paid 3 lacs

Most people think a Room rent limit of a Single private AC room is good enough!
But the reality is very different

A thread🧵on a room rent limit and is single private ac room good enough?👇Image
What is a room rent limit in a health insurance policy?

The room rent limit in health insurance is the maximum amount that an insurance company will pay for a policyholder's hospital room per day
There are different types of room rent limits that insurers impose based on the policy you’ve bought -

1. Financial Limit
Insurers generally put room rent limit at 1% of the Sum Insured

So for a 5 lakh sum insured the limit is at Rs 5,000/day
Read 16 tweets
Jun 3
🚨Health Insurance Claims Stories
Can an insurer reject a claim due to smoking?

Sum Insured=1cr
Claim Amount = 9.4L for lung cancer,

The PSU insurer rejected the claim:-
"Excessive smoking caused the cancer"

Consumer Court slammed the PSU insurer,
Asked to pay the entire amount and fined the insurer

How was the claim won?
Let's find out in this very important claim story👇Image
Background

A family of four
Mother, father and two children bought a Medical Insurance in 2018 with a Sum insured of 1cr

They were paying a premium of Rs 69,000/year towards this policy.

The father had declared Smoking condition to the insurer,
In April 2023,
The father coughed up blood in the sputum,
This was then accompanied by severe chest pain

Worried by the repeated blood,
They went to the hospital and carried out major tests,

It was confirmed that the father was suffering from lung cancer,

He required immediate surgery
Read 12 tweets
Jun 2
🚨High premiums in health insurance-What to do?

Many people are angry about the premium hikes.
Sometimes the premium rises by as much as 20-50%!🤯🤯

Are there any hacks to reduce your premium?🤔🤔

A thread🧵on 5 ways to lower the premium for ur health insurance?

Lets go👇 Image
Why do health insurance premiums rise?

There are three reasons why health insurance premiums rise
1. Insurer takes company-wide premium increase due to massive increase in claims
2. Your age band changes
3. Rise in medical costs
Here is an in-depth thread on reasons for the premium rise.
Read 17 tweets

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