After much debate and hesitation, I finally took the plunge and purchased super top-up health insurance for my family. Since I have written several posts on health insurance, I thought I will share the details here. This is not a recommendation and the purchase I made is truly personal. I am sure there are better products, less expensive products than what I have. So you will take an informed call.
I have plenty of posts that can help you choose either basic health insurance or a super top-up insurance. Check these out:
- How to choose a suitable health insurance policy
- Apollo Munich Optima Restore Benefit vs Max Bupa Re-fill Benefit
- Star Health Comprehensive Insurance vs Religare Care Comprehensive Insurance
- Building a health insurance comparison chart + Cigna TTK vs Royal Sundaram Health Policies
- How to buy a Super Top-up Health Insurance policy
- How I selected a health insurance policy (guest post)
- Why we all need a corpus for medical expenses and how to build it
Let me again reiterate that the following is not a product recommendation. It is based on my personal situation and my personal beliefs. Kindly consider your situation, your budget and your beliefs before taking a call. I do not claim that I have made a good purchase or anything. Like always we need to take the plunge at some point and this is my thinking behind it.
From 2007 onwards, I have held a United India Platinum Health Insurance policy for self, spouse and son (after he was born). I started at probably 2-3 lakhs or so and gradually increased the sum insured each year. See: How my health insurance costs have increased over the years
So I just renewed the base cover and the premium is as follows:
The premium for Self (7 lakh), spouse (7 lakh) and son ( 6 lakh) is Rs. 27,422 (before family and no-claim discount), Rs. 23678 (after discount, before CGST and SGST) and Rs. 27940 (total). Note that the covers are individual and age-dependent (I am 44, the spouse is 42 and son 8).
The premium for my mother (age 71, 5.5 Lakh) is Rs. 23,708 (before tax) and 27,976 (total). United said they will not enhance the cover for her anymore. The no claim discount does not apply to her!!
Now, I purchased this United India policy in a hurry when my late father was admitted to hospital because of cancer and my mother did not have a policy. So I got it my from parents agent and he still services this policy.
I have made three claims with this policy, for self (cashless), wife (reimbursement) and mom (cashless). You can read about those accounts here and here. These claims were all made without the help of the agent as it is a simple matter to read the rules and be aware of how to make a claim. Anyways, the point is that the policy has served me well.
People have asked me, why I have not ported to a less expensive, more feature rich policy (without sub-limits). Why on Earth would I dump a policy that has worked for in my time of need just to save money? My policy has room rent sub-limits, but so far, because I live in Chennai it has worked. Of course, I am lucky that I did not have to go to Apollo or corporate hospitals. I know good doctors who work with reasonable hospitals. Also lucky that I am surrounded by network hospitals at home.
So that brings up to the issue of a super top up. I decided to buy the Super top up from United India for the following reasons:
- I have two pre-existing conditions – an autoimmune condition called Myasthenia Gravis and hypertension. United has had no problem enhancing my cover from 4.75L to 7L over the last 5Y in spite of this. So I took a chance that the premium with full disclosure will not be hiked by too much and it was not loaded/
- My mother has Parkinson’s and hypertension and is 71. Again I figured premium will not be loaded too much and it was not.
- Call me stupid but I do not trust privates. Well, I able to DIY only because I am pig-headed and not get swayed by what everyone has to say. Of course United Indian will soon be a listed company and that will change things. However, I noticed that their premiums have been a bit higher from the start and so far I have been spared of the 300%, 400% increase in premium seen in Oriental Insurance.
- Super top up claims will typically be made in reimbursement mode when combined with a base insurance claim. That is you get admitted and you think the initial cost will be 4L. So you are happy that you have a 5L cover and initiate a cashless cover. Then the costs increase 5L and the super top-up becomes necessary. At this point, you will have to initiate cashless coverage from the super top up. From what little I have seen and heard, the super top-up insurer could (if they accept the claim) ask us to pay and them get it reimbursed. So there is not much point in having a 50L or one crore super top up if I don’t have money to pay upfront!
- It would be a lot easier if the super top-up insurer is the same as the base insurer. This at the very least enhances the chance of getting a cashless super top-up claim.
- United has a 5L deductible and 15 lakh maximum cover. I decided this is “okay” for me. I believe the super top-up amount should be one that an individual can easily pay from their net worth.
- What if the claim is higher than 15L? Well, if it is (and it can), pay from my pocket. Insurance is a game of probability. Insurers play it all the time. So can the insured (as long as they have some insurance!) We cannot worry about getting coverage for every eventuality in life. Please note 15L is probably decent coverage for most South Indian cities (except Bangalore and Hyderabad), unless you get caught in a corporate hospital with an unknown doctor. Getting health insurance is important but becoming friends with doctors is more important!!
So I applied with full disclosure last week for a 15L top-up coverage for my mom (Rs. 8496) and 15L floater coverage for self, wife and son (Rs. 12,272). Now to open a recurring deposit that will mature a month before the premium due date and hope for the best. Alea iacta est.
Again, a reminder that this is only account of my thinking and not a recommendation. I am sure there are better and less expensive products out there. I am sure you need more coverage.