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? 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"

Health Insurance cos hiking premiums. Again!

Star Health: 10-15%
HDFC Ergo: 9-12%
New India: 10%

🧵 Thread
⦿ Why is the premium rising?
⦿ How do you deal with it?
⦿ Should you drop and invest the money instead? 1st things 1st: Health insurance premiums aren’t fixed.

Insurers can hike premiums whenever they find it necessary — not just for one person, but for an entire portfolio of customers.

And now, for some time, they can do it without regulatory approval 😬.

"What if I skip Health Insurance and build a fund to cover my family’s healthcare."

Fine print + claim hassles have forced all of us to think in this line.

Before you go down that road, here’s a thread on what you need to know
👇🏻👇🏻 Health insurance, despite its flaws, offers some powerful benefits that you should understand before taking such calls.

Let’s break down these powerful benefits of health insurance:

92% health insurance agents don't know basics.

How to find a good agent?

Thread 👇🏻

Will cover:
⦿ Why find a good insurance agent?
⦿ How to find a good insurance agent?
⦿ Where did the 92% number come from?
⦿ Questions to ask Insurance is a complicated product when buying, and more importantly when making a claim.

Not following right processes, making accurate declarations when buying, is one of the biggest reasons why claims get rejected.

🚨🚨 Important changes in Health Insurance.

IRDAI released a master circular today.

Most of the changes are applicable from immediate effect - unless there is a specific target date mentioned for the change.

Thread time 👇🏻 INCLUSIVENESS:
IRDAI has asked insurers to make available products for
1. All age groups
2. People with medical conditions, including chronic.
3. All types of treatment - including OPD!!
4. All occupations, regions, categories.

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

This is MISLEADING & NOT true.

🧵 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.

🚨 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 🧵👇🏻 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.

💡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.

🚫 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.

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.

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

Why are health insurance top-ups so cheap?

👉🏻 What's the catch?
👉🏻 Would they remain cheap forever?
👉🏻 Should you consider buying them or just upgrading your existing cover?

Thread 👇🏻 Let's start with the basics: Health Insurance is an "indemnity" cover

Indemnity-based insurance reimburses you against "actual losses" incurred

Unlike, say a term life policy - which pays a lump sum fixed amount irrespective of the real financial loss incurred.

My parents' health insurance has become super expensive 🚀

Haven't claimed for so many years.
Should I continue or drop?

Here's how to evaluate 🧵 Thanks to crazy hikes in premiums - of around 30-60%, many face this frustrating dilemma during renewals.

Is it really worth paying so much?

Real-life claim

The customer suffered deductions of 48K on a 1 L claim in an employer policy

1.07 L Bill 👉🏻 45K deduction 👉🏻 56K claim received

Reason:
1. Room Rent limit of Rs. 1800 for a hospital in Thane (4Km away from Mumbai limits)
2. 20% Copay

#CompanyCoverNotEnough That's precisely the reason why @BeshakIN we recommend people should never solely depend on employer insurance.

a. You are not in control of the terms.
b. It's linked to your employment.
c. It can become super difficult to get a comprehensive cover once you have an illness.

💡 Quick tip: Never depend on insurers to remind you about renewals

👉🏻 You can lose valuable coverage if you miss a renewal.

🚨 Super important as you grow older, especially for Sr. citizens

Read more 🧵 But aren't insurers held responsible when they miss sending reminders?

As per an IRDAI circular, in the case of health insurance, insurers are liable to remind you before renewal.

No such requirement in Term Insurance or other products.

Real-life claim

A customer suffered deductions of 36K on a health insurance claim (pic below) for:
1. Room Rent Limit (See proportionate deduction)
2. Surgery Limits (See Hernia limit)
3. Non-standard charges (see "Assistant chgs" below)

But what are "non-standard charges"? 🧵 You would have heard of financial limits like room rent & surgery limits, but what are Non-Standard charges?

Non-standard charges are ad-hoc charges applied by hospitals that per insurers should be included under other payable expenses.

🚀 From 10% to 40% share in a life insurer's business.

Guaranteed Plans have never been sold like they are sold today

The pitch:
1. Invest Rs 1 Lakh for 10 yrs
2. Get ~ 2 Lakhs back from Year 12 to 21
3. ROI of ~6% tax-free!
4. 10 Lakh life insurance

So what's the catch? 🤔 There are three things you should be aware of:

1. Minimum years of periodic investment -

You usually need to commit to invest the same premium every year for the next 7-12 years. If you drop out you lose the return promised.

🔜 Coming soon: Demat of Insurance policies

As per news reports, IRDAI has asked insurers to implement mandatory dematerialization of new insurance plans by Dec22

Even existing policies will be dematerialized by Dec23

We analyze
1. Why is this important?
2. What is the impact? Demat of policies did exist all this while.

But it was voluntary for customers, and hence not pushed by insurers.

IRDAI is now enforcing this as mandatory so that all policies are digitally accessible.

A post on a 79% premium hike in 4 yrs has gone viral.

Here's a 🧵 deconstructing health insurance premium hikes for everyone's read:
1. How do premiums rise?
2. Why do premiums rise?
3. What you can do about it?

Please do RT for awareness 🙏🏻

https://twitter.com/panix68/status/1554690085777715200

1. 1st things 1st: Health Insurance is not a fixed-priced product

Insurers can hike premiums for existing products whenever they find them not to be feasible

Not for one customer who has made a claim, but for the entire cohort of customers who have bought this specific product

🚨 Major change (Pls. RT for awareness)

IRDAI recently relaxed product approval norms for select products including Health, Term Life, and ULIP, amongst others.

Insurers can now change products/pricing and launch new products without prior IRDAI approvals.

Implications 👇 When an industry is grown two decades old, it's high time it moves from external regulation into self-regulation.

Heavy regulation beyond a point can lead to bureaucracy, and stifle innovation.

#1

Take care of your health like you take care of your image on social media Take care of your health like you take care of your favorite gadget/vehicle.