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Health Insurance Process and Review

Update: There are 5 edits in this post with updated or corrected information. Please go through them if you have missed something. I am NOT expecting this post to be edited in future. Thank You all for the updates, correction and participation.
Recently, I was searching for Health Insurance plans for my parents (both 55+) for ₹10-lakh Sum Assured (SA). I stumbled upon this excellent post by u/sdhaja and used it as my initial template. Because that post was a year ago, I want to collate /update /reiterate the information. My post will be long and some advice will be repeated but I am hoping for your comments, corrections and personal experiences, if possible.
Basics
  • "Health Insurance" section of Sub wiki i.e. Insurance is woefully inadequate and old. However, it covers the basics. Before diving deep into the subject, understanding of basic terms is essential.
  • Personally, I found this PDF a decent read. Suggested by u/random_desi_guy in this comment
I decided on following points –
  • Family Floater Plan – Because both are in similar risk profile.
  • No Co-Pay
  • No Room Rent Limit (sub-limit)
With these minimal conditions, both CoverFox and BankBazaar effectively bound me to choose between HDFC Ergo and MaxBupa.
  • Care & Birla were out because of "Single Private AC" on Room limit and 4Y for pre-existing conditions
Edit 3: I want to clarify here that "Single Private AC" and 4Y for pre-existing conditions are NOT bad, as such. But, in same class, HDFC and Max are providing ALL Rooms and 3Y for pre-existing.
  • My notes are missing the reason for exclusion of Royal Sundaram but I guess, it was probably its premium and Hospital coverage in my area.
  • ICICI Lombard – Both Coverfox and BankBazaar does not offer any product from ICICI. Its premium (on its website) turned out to be costly. See Below for details.
"HDFC Ergo Optima Restore" vs. "Max Bupa Health ReAssure"
  • Premium – HDFC premium is much higher than Max. For my parents, HDFC Yearly premium was 46% higher than Max Bupa (Yes, it is NOT a typo).
  • Pre-existing diseases - Both cover them after 3Y
  • Both provide no-claim bonus of 50% for 2Y i.e. 100% cumulative and both deduct it by 50% after claim. (sidenote: Max Health Companion plan will NOT reduce it after claim. However, it charges higher premium)
  • Hospital Coverage – HDFC has much wider coverage compared to Max.
  • Reviews – HDFC has better reviews than MaxBupa about their claim settlement process.
  • Decision – HDFC (Higher premium but better chance of support.)
  • Edit 5: Decision – I have purchased Max Bupa despite their bad reviews. Originally, my Parents mistakenly identified a key hospital unavailable with Max. However, it was available in its network. With this change, the difference in premium between Max and HDFC became too much to handle.
  • Originally, I was going with 5-lakh SA with Super Top-Up. But, after more consideration about the total cost and headache involved for the parents, I decided to increase SA to 10-lakh without Super Top-Up. See Below for details.
  • "Critical Illness Rider" is supposed to open to interpretation by the company, so I decided against it for now.
Coverfox:
Coverfox sales person was good and tried to find out actual answers if required. However, Coverfox site has not been updated with latest plan (MaxBupa Health ReAssure) due to Covid-19. Further, their site also does not show correct list of hospital coverage. Personally, this was a deal breaker. If they can't be bothered to update their product listing, I am doubtful of their claim about great support during claim settlement process.
BankBazaar:
  • BankBazaar site is good but their salesperson kept giving me misleading or inaccurate information.
  • He told me that if I buy the policy from them using Credit Card, they will give me 0% interest rate on EMI and that offer was available only for that day.
I checked, the policy site itself is offering same reward even today.
Edit 4: The website of insurance company didn't offer 0%EMI on credit card, so I bought my policy with Policybazaar. They gave me discount on total premium. Thus, although bank will charge EMI interest on my card, effectively I am NOT paying anything extra.
Others:
  • InsuranceDekho does not have good plans or enough plans
  • Myinsuranceclub was so bad that after 30min, I was not able to see any plans on the site
  • PolicyX – See This Comment
Claim Settlement Ratio:
The document to check this is called "NL25". Every Insurance provider has this uploaded on their site. Although, this is cumulative information for all their policies but still it provides a base to compare.
ICICI Lombard:
As stated above, it is not a partner to either Coverfox or BankBazaar. Its premium was higher than even HDFC. However, it also offers coverage of pre-existing diseases after 2Y (compared to 3Y by HDFC). (As stated by both Coverfox and BankBazaar) Problem with ICICI is that when its premium band changes, after 4 or 5Y, the premium shoots up significantly.
One thing to add vis-a-vis ICICI Lombard. Purchasing it via Amex will give you a dedicated Amex team to handle your queries and claims.
This Comment by u/librislibertas
Exclusions:
Earlier, there were a list of consumables (Syringe, Gloves etc.) and administrative expenses (Application fees etc.) which had to be paid by the policy holder but Oct-2020 onwards, IRDAI has disallowed these exclusions. If someone has any experience regarding this, I would be grateful.
OPD Coverage:
Be aware that, unlike in some other countries, HEALTH insurance in India is actually HOSPITALIZATION insurance (with some exceptions). If you get expensively ill but do not require hospitalization, you get nothing.
this comment
I really wanted a policy with OPD Coverage but their premium or the rider are very high. I would have paid additional ~3,000 yearly for OPD coverage limited to ~5,000 yearly. If anyone is interested, it is covered in HDFC ERGO Health Wallet.
Super Top-Up:
Yes, Super top up is another policy on it's own. You even get a separate insurance card.
Top-Up is effectively a separate policy and if I port the base policy, Top-Up is NOT ported. Please see This Comment by u/Prashank_25
Critical Illness Rider:
It is supposed to open to interpretation by the company, so I decided against it for now.
References:
EDIT
Privacy:
Both CoverFox and BankBazaar had kept all medical and conversation information of mine for 2Y atleast. In 2018 also, I tried to convince my parents to buy Health Insurance but they were not interested then. Hence, I didn't buy any product from either site at that time (2018). Please remember this when you talk to anyone.
Edit 2:
More References:
Incurred Claim Ratio:
It can be found Here provided by u/tvijay1. It is NOT extremely relevant for established companies but it is better to have an idea about this.
Disclaimer: I am NOT a professional in financial field. Feel free to discard my advice at your convenience.
Who/why need Health insurance in India?
YES, Everyone needs to have Health Insurance.
If someone can't afford Health Insurance, He/She definitely can't afford Hospitalisation.
Health Inflation in India is much higher than normal inflation and we need to be on this band wagon. Further, You can account for your Food, Shelter, Education and other living expenses but Health Expenses are extremely high and sudden. Health Insurance reduce their impact on your lifestyle to a certain extant. I want to add many more sentences here but I don't want to repeat the linked posts above. Many smart people have given much better reasons, please read them.
Edit 3:
PSU Insurance Companies vs. Private
I want to clarify that Government Companies may turn out better or more reliable. My personal preference is more towards 'Ease of Doing Business' and the perception is that private companies are much better in this regard. After some suggestions here, I looked at 2 of them. One had high premium with lower benefits and the other (SBI) told me that they can't take my money online (!) and I need to contact their office if I want to give them money.
I believe that in 2020 this sort of headache is not worth the effort (for me). But, please look at the policies if you are interested and feel free to share your thoughts /experiences.
Edit 4: See Above
Edit 5: Co-pay & Deductible (Also See Above)
Personally, I do not want to concern or limit myself to the question of cost of the medical care at the time of Health Emergency. If their is a co-pay clause, my parents will look for cheaper hospitals too whereas I want them to go for the best possible option (within my limited means).
Tl;dr: Health Insurance purchase turned out to be a 1 week involved exercise for me and even then I made some mistakes. Please read thoroughly and decide wisely.
submitted by ThisDecade to IndiaInvestments

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