🚨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👇 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

🚨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 👇 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.

🚨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?👇 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

🚨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👇 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,

🚨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👇 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

🚨Health Insurance Claims stories-Forging incorrect data on the proposal form

Sum Insured=10L
Claim Amount=4L

Insurer rejected the claim stating:-
"Incorrect Date of birth to avoid Medical test"

The policyholder won the case with the ombudsman.

Dramatically,
Courts overturned the decision and ruled in favour of the insurer

How did the insurer win the claim?
Let's find out in this very important claims stories 👇 Background:-

Mrs X and her husband bought a family health optima insurance policy for 10L.

Additionally, they also bought a super top up

The top-up policy covered excess expenditures up to Rs 10 lakh in case of illness.

While filing the proposal form, Mrs X wrongly mentioned his wife's date of birth as 17 December 1960, while her actual date of birth mentioned in her passport was 6 December 1957.

They did this in order to escape from a medical test.

🚨LIC policies- Can you get rid of them?🤔🤔

Most households have traditional Life insurance policies with an "Assured Sum of money" from LIC and other insurers

Most do not know what to do with these policies now

A thread🧵 on what you should do with ur LIC Policies?👇 What is life insurance?

A Life Insurance policy provides financial security to the family of the insured, in case of their death during the policy period, and in some cases a maturity benefit to the insured person, after a set period of time.

🚨Health Insurance Claims Stories-Can drinking lead to claim rejection?🤔🤔

Sum Insured=50L
Cancer Claim=6L

Insurer rejected the claim stating:-
"Frequent Drinking caused cancer."

Even the ombudsman ruled in the insurer's favour,😥😥

However,
The court fined the insurer and passed the claim,😁😁

How was the claim won?
Let's find out in this very important claims stories 👇 Background:-

Mr X(Name hidden for privacy) had taken health insurance coverage for himself and his wife in September 2003 from Insurer A(Name hidden as we don't want any notice)

In 2020, he ported to Insurer B and he increased the cover to 50L

🚨Health Insruance-A checklist to buy

Health Insurance is one of the most complicated insurance!

100s of policies and complex wordings make it worse!🤯🤯
What are the features of the policy u should buy?🤔🤔

A thread🧵explaining the features of a comprehensive policy?👇 What is a comprehensive Policy?

Health insurance policies come with a lot of variations
Some come with
🩺Room Rent Limit
🩺Co-Payment
🩺Sublimits on treatment
🩺High no claim bonus

Which one to choose?

🚨Health Insurance Claims Stories-Hospitalisation not necessary!

Sum Insured=10L
Claim Amount=2.48L

The insurer rejected the claim,
"Saying Hospitalisation was not needed",
The policyholder dragged the insurer to the ombudsman,
Imbodsman instantly ruled in the policyholders' favour

What did he do to win the claim?
Let's find out in this very important claims stories👇 Background to the case:-

Rajesh had a 21-month-old health insurance policy from an Insurer for the Sum Insured of ₹ 10 lakhs with good comprehensive features.

Rajesh had returned from a domestic trip and fell ill with a fever

🚨Room Rent limit and Associated deductions

Policy Amount=25L
Claim Amount-90,000
Room Taken=Deluxe room
Policy Conditions=No room rent limit

The insurer hesitated in paying the claim!🤯🤯

Is no room rent limit a myth or do insurers really offer no room rent limit?
What is the dark reality of room rent limits across insurers?🤔🤔

A thread🧵on if no room rent limit is a reality or not?👇 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

🚨Health Insurance Claims Stories is back

Sum Insured=10L
Claim Amount=Rs 24,497

The insurer rejected the claim, stating
"No need for hospitalisation and can be managed OPD basis"

The customer took the insurer to the consumer court and won the case

What did he do to win the claim?
Let's find out in this very important claims stories 👇 Background

Mr Agarwal bought a family floater policy for his family from Star health in 2018,

The policy also covered his son.

🚨Acko Health Insurance-Is it really good Mamu?😅😅

Acko covers all diseases from day-1(except for pre-existing diseases)
Should u be tempted by the Acko policy?🤔🤔

A thread🧵on features of Acko Platinum Health Insurance and should u buy it?

Lets go👇 Acko Platinum Health Insurance:-

Some diseases such as cataracts etc come with a waiting period of upto 2 years

Acko covers all diseases from Day-1 irrespective of any health condition.

This is a significant deviation from all other policies and is friendly to the customers

🚨Restoration Benefit-One of the most important feature in health insurance?

Sum insured=5L
Claim pased=20L(in multiple claims)

🩺Niva Bupa Aspire
🩺Care supreme
🩺HDFC Ergo Optima Secure
Which policies offer unlimited restoration benefit?

A thread🧵on restoration benefit and which policies offer this benefit?👇 What is restoration benefit?

Restoration benefit is an add-on feature in health insurance policies that provides an additional sum insured amount after the primary sum insured is exhausted in a policy year

This feature may be handy for policyholders likely to use their original sum insured due to recurring illnesses or hospitalisations.

🚨Smoking/Drinking- Detrimental for health and health insurance?

If you drink alcohol or smoke, your health won’t be the only thing at risk—your insurance claim might be too.

Most insurers reject claims if your Liver cirrhosis or lung cancer is linked to smoking/drinking.😱😱(even if you declare smoking/drinking)

A thread🧵on claims due to smoking and drinking in health insurance?👇 How does smoking and drinking affect your health insurance?

Both smoking and drinking are injurious to health

For Smoking:-
If you smoke more than 6 cigettes a day no insurer issues a policy.

For Drinking:-
If you drink regulary or more than 3 days a week insurers may not issue a policy

🚨9x premium rise in 3 years-The reality of group policies,

One of our followers was lured to buy
ICICI Health Shield 360 by ICICI Bank,

The premium he paid:-
2023: 10896, SI 50 Lakh
2024: 32000, SI 15 Lakh
2025: 96000, SI 15 Lakh
9x rise in 3 years!🤯🤯

A thread🧵on group health insurance policies & should u buy them?👇 What is a group insurance policy?

A group insurance policy is a type of insurance that offers cover to a "group" of individuals with a common intent.

Banks or certain communities like Jains offer these policies.

Sum Insured=10L
Claim Amount=3L

Policy Ported in Oct'2024,
Cancer detected in Nov 2024,

Lodged a claim with Niva Bupa,
Niva Bupa rejected the claim and canceled the policy citing non disclosure,😭😭

The ported policy was 5 years old!🤯🤯

A thread🧵on claim rejection due to portability and how to avoid it?👇 How is a health insurance policy issued?

When you approach an insurer to buy a health insurance policy,
Insurer underwrites ur policy,
All existing medical conditions need to be checked whereby insurer decides if he wants to rake the risk and issue a policy or not!

Insurer has the right to reject ur policy if he feels the risk is too high.

🚨Portability Scam-Retail policyholders getting caught out

Random Telecaller asked the customer to port 2 years ago,
Sum Insured=50L
Claim Amount=5L

The new insurer rejected the claim saying pre-existing diseases weren't disclosed!
New insurer cancels the policy!

A thread🧵on scam around portability and checklist to follow while porting?👇 What is health insurance portability?

You bought a health insurance policy.
After some time when u read the policy terms and conditions.

You realize the policy has
🩺Room rent limit
🩺Copay
🩺Isnt a comprehensive policy

Now u want to change the policy!
What do u do?

🚨Super Top up in health insurance

Super top-up is like a mobile recharge!
It increases ur sum assured over and above ur base health insurance policy!

What is this super top-up?🤔🤔

A thread🧵on what is a super top-up plan and its benefits and limitations?👇 What is a super top-up policy?

Super Top Up policy offers you coverage of Mediclaim above your chosen deductible limit

It offers you financial relaxation in the event that your hospitalization claim bill crosses your sum insured under any other Mediclaim policy.

🚨Sum Insured=50L
Claim Amount=5L for heart illness

The insurer found evidence of consumption of hypertension medication,
The insurer rejected the claim saying "Fraud"
Hypertension not declared

A thread🧵on what happens if you dont disclose pre-existing medical conditions and buy a policy?👇 What is the underwriting of a health insurance policy?

Whenever you buy a health insurance?

Medical underwriting is the process of evaluating an application for health insurance coverage by examining the applicant's medical history.

If you disclose any diseases that you have had before buying the insurance.
The insurer can do three things
1. Reject your policy
2. Impose waiting period and exclusions
3. Increase the premium due to higher risk called Loading

🚨Corporate Health insurance-Is it enough or is personal health insurance needed?

At the age of 44,
Ram developed cancer,

All of his expenses were covered by corporate health insurance,
But after a few months,he lost his employment,

No health insurance company was now ready to give him a policy!
This can easily happen to u

A thread🧵on the features of a corporate cover & why u should never rely on a corporate cover? 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.