[ethikaSeniorRetailPolicy]
Health Insurance is for Healthy people.
Unfortunately, this is true!
This is why we see Insurance companies avoiding to offer Health Insurance Policies to people who’ve crossed a certain age (usually above 45 yrs., when the metabolism rate of a person slows down). Even if they give, they apply a lot of conditions or sub-limits, and it comes with huge premiums. The Morbidity rate further explains the reason behind this. Morbidity ratio is the likelihood of 1 person falling sick out of every 100 people. As per the insurers’ statistics, the morbidity rate for people under 45yrs of age is usually 3-5%. Whereas the morbidity rate for people more than 45yrs of age can be as high as 10-15%. This is the reason why insurance companies avoid covering people falling under the higher age group.
Most of us have our parents covered under our organisation’s group policies, hence we usually don’t consider taking a separate personal (retail) Health insurance policy for parents. However, it is being seen that most organisations today have started restricting the coverage’s for parents, even in cases where the premium is being collected from the employees. This is because of the high claims ratio that the organisations end up with. Some of the organisations have gone to the extent of discontinuing coverage for employees’ parents.
Even if your current employer covers your parents in the policy, imagine, tomorrow, if you join a new organisation which does not offer coverage for your parents, it is then, when you’ll actually realize how difficult it is to get coverage for your parents.
Unfortunately, the employers who give coverage for parents, usually give it only in the range of 2-5 lacs sum-insured. But to manage our parent’s health expenses, this we know is just not enough. It might be enough to cover minor illnesses like flu, dengue etc., but definitely not enough to cover major illnesses like Cancer, heart ailments, joint replacements etc.,
But do not despair, to suggest you with all the help you need to get the best policy and coverage for your parents, we’ve a team of experts.
You can also opt for the portability benefit which will allow you to waive off the waiting periods in the retail policy.
Not less than 50 lacs!
| Insurance Company | Bajaj Silver Health | National | Sompo | Future Generali | Star Health Red Carpet | Bajaj Supreme | ICICI Lombard | Sompo (top-up) | Future Generalli Topup | Birla Health Standard Active care |
|---|---|---|---|---|---|---|---|---|---|---|
| Sum Insured Options in Lac | 0.5,1,1.5,2,3,4,5 | 1 Lac only | 1,2,3,4,5 | 2,3,4,5,7.5,10 | 1,2,3,4,5,7.5,10,15,20,25 | 5,8,10,15,20,25,30,35,40,45,50 | 3,4,5,7,10,15,20,30,50 | 1,1.5,2,3,5 | 50K, 1,1.5,2,3,5L | 3,4,5,7.5,10,25 |
| Entry age | 46-70 | 60-80 | 60-70 | 60 till any age | 60-75 | 18 years to Any age. | 18 to any age. | 18-80 | Any Age | 55 to 80 |
| Premium increase | Till 70 | Till 85 | Till 90 | Till 80 | Same for all ages | 83 | 80 | 75 | 76 | 80 |
| Pre acceptance health check | Yes | Yes | Yes | No | No | Above 45 years. | Above 45 years. | Above 65 years. | Case to case | yes |
| Pre-existing | 1 Year | 1 Year | 2 Year | 1 Year | 1 Year | 2 Year | 2 Year | 3 Year | 2 Year | 2 Year |
| No Claim bonus | 10% of SI (max 50%) | 5% of SI (max 50%) | No | No | No | 10% of SI (max 50%) | Not Applicable. | 20% of SI (max 100%) | 10% Every year (max 50%) | 10% of SI (max 50%) |
| Pre and Post Hospitalization | 3% of the Claim amount | 30/60 days | 30/60 days respectively | 4K to 10K linked to SI | For pre 30days and for post 5K to 10K linked to SI | 60/90 days respectively. | 30/60 days respectively | 30/60 days | 60/90 days respectively. | 30/60 days |
| Health Check up | once in 4 years | once in 3 years | once in 3 years | No | Once every year for sum insured above 4 lacs | Annual | Annual | Annual | Not Covered | Not Available |
| Co-payment | 20% only for non-network. 15% extra premium if copay is to be waived. | 10% for all the normal Claims. 20% for Pre-existing Claims. | 10% on all claims, 20% on PE, 15% on Day care, No co-pay on packaged charges. | 50% for pre-existing and 25% for all other claims . 20% loading for waiving of 25% copay. | Co-pay for PE Claims 50% for under 10 L Sum Insured. 30% for above 10L Sum Insured. | NIL | Not Applicable | NIL | Not applicable. | 20% |
| Room Rent limit | No Limit | 1% of Sum Insured for Normal Room and 2% of Sum Insured for ICU. Maximum 25% of the Sum Insured. | Room Rent 1% and 2% of SI for normal and ICU respectively. Overall limit 25% of sum insured. | Not Applicable | For Normal Room up to 5 lac SI – 1% of SI per day. 7.5L to 10 L – 6000 per day 15L – 7000 per day, 20L – 8500 per day, 25L – 10000 per day. For ICU Room up to 10L SI – 2% of SI above 10 L SI – Actual | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Sharing |
| Other Sub-limit / Benefits | Cataract limit – 10% of the SI, subject to a minimum of Rs 12,000 and maximum of Rs 25,000/- 50% cap on SI for PE Claims | Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees – 25% of Sum Insured. Other Medical Expenses 50% of Sum Insured. Cataract is up to 10000/-, Benign prostatic hyperplasia is up to 20,000 | Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses overall 25% of sum insured. All other medical expenses 50% of sum insured. | Coronary Artery Bypass Grafting (CABG), Percutaneous Transluminal Coronary Angioplasty (PTCA), Cataract Surgery (per eye), Total Knee Replacement (per knee), Total Hip Replacement (per hip) | -Surgeon, Anaesthetist, Medical Practitioner, Consultants and Specialist’s fees up to 25% of the sum insured per hospitalization. -Anaesthesia, Blood, Oxygen, Operation Theatre charges, Cost of Pacemaker etc up to 50% of the sum insured per hospitalization. Cataract as per table Cerebro vascular Accident, Cardio vascular Diseases, Cancer (Including Chemotherapy / Radiotherapy) Medical Renal Diseases (Including Dialysis) Treatment of Breakage of Long Bones as per table All Other Major Surgery means Intestinal obstruction – acute / sub acute / chronic, Bilo Pancreatic surgery, Gastro-Intestinal surgeries, Total Knee Replacement surgery, Total Hip Replacement surgery, Other major surgeries of joints, Hemi-Orthro Plasty surgeries, Surgeries on Prostrate, Surgery related to Genito-Urinary Tract as per table. | Not Applicable | Applicable only for 3,4,5 Lac Sum Insured. Cataract per eye 20K | 50000 Deductible for each and every Claim. | Organ Donor Covered after 2 years. Ayush Covered after 2 years. HIV/AIDS Waiting period of 4 years. Mental Illness or Psychiatric Illness covered after Waiting Period – 4 years. 50000 Deductible for each and every Claim. | 50% Reload of Sum Insured. |
| Waiting Periods | 30 days for all but accident. One Year Waiting for certain ailments. 1. Surgery for gastric or duodenal ulcers, 2. Benign prostatic hypertrophy 3. Hydrocele 4. Haemorrhoids 5. Dysfunctional uterine bleeding 6. Endometriosis 7. Stones in the urinary and biliary systems 8. Prolapse of genitourinary/intra-abdominal organs 9. Surgery on ears 10. Treatment for prolapsed intervertebral discs 11. Cataracts 12. Hernia of all types 13. Fistulae 14. Fissure in ano 15. Fibromyoma 16. Hysterectomy 17. Surgery on skin/ internal tumours/cysts/nodules/polyps 18. Treatment for benign tumours or malignant conditions or for organomegaly 19. Surgery on joints | 30 days for all but accident. One Year Waiting for certain ailments. Cataract, CSOM (Chronic Suppurative Otitis Media) b. Benign prostatic hypertrophy j. Pilonidal sinus c. Hernia k. Calculus diseases d. Hydrocele l. Benign lumps/growths in any part of the body e. Congenital internal disease m. Surgical treatment of tonsils, adenoids and deviated nasal septum and related disorders f. Fissure/Fistula in anus n. Hysterectomy for menorrhagia or fibromyoma g. Piles (Haemorrhoids) o. Joints replacements of any kind unless arising out of accident h. Sinusitis | 30 days for all but accident. Two Year Waiting for certain ailments. Cataract : Benign Prostatic Hypertrophy : Myomectomy, Hysterectomy unless because of malignancy :All types of Hernia, Hydrocele :Fissures and/or Fistula in anus, haemorrhoids/piles :Arthritis, gout, rheumatism and spinal disorders :Sinusitis and related disorders :Stones in the urinary and biliary systems :Dilatation and curettage, Endometriosis :All types of Skin and internal tumours/ cysts /nodules/ polyps of any kind including breast lumps unless malignant :Dialysis required for chronic renal failure :Surgery on tonsils, adenoids and sinuses :Gastric and Duodenal erosions ulcers :Deviated Nasal Septum :Varicose Veins/ Varicose Ulcers :Joint replacements unless due to accident. | 30 days for all but accident. Two Year Waiting for all diseases of Prostate, all treatments (conservative, interventional, laparoscopic and open) related to all diseases of Uterus, Fallopian Tubes, Cervix and Ovaries, all treatments related to bones and joints except due to an accident, etc., 4 years Waiting Period for any mental illness or psychiatric illness, or in connection with treatment for AIDS and/or infection with HIV. | 30 days for all but accident. Two Year Waiting for chamber of the Eye, Diseases of ENT, Diseases related to Thyroid, Benign diseases of the breast. B. Subcutaneous Benign Lumps, Sebaceous cyst, Dermoid cyst, Mucous cyst lip / cheek, Carpal Tunnel Syndrome, Trigger Finger, Lipoma, Neurofibroma, Fibroadenoma, Ganglion and similar pathology C. All treatments (Conservative, Operative treatment) and all types of intervention for Diseases related to Tendon, Ligament, Fascia, Bones and Joint Including Arthroscopy and Arthroplasty / Joint Replacement [other than caused by accident]. D. All types of treatment for Degenerative disc and Vertebral diseases including Replacement of bones and joints and Degenerative diseases of the Musculoskeletal system, Prolapse of Intervertebral Disc (other than caused by accident), E. All treatments (conservative, interventional, laparoscopic and open) related to Hepato-pancreato-biliary diseases including Gall bladder and Pancreatic calculi. All types of management for Kidney and Genitourinary tract calculi. F. All types of Hernia, G. Desmoid Tumour, Umbilical Granuloma, Umbilical Sinus, Umbilical Fistula, H. All treatments (conservative, interventional, laparoscopic and open) related to all Diseases of Cervix, Uterus, Fallopian tubes, Ovaries, Uterine Bleeding, Pelvic Inflammatory Diseases I. All Diseases of Prostate, Stricture Urethra, all Obstructive Uropathies, J. Benign Tumours of Epididymis, Spermatocele, Varicocele, Hydrocele, K. Fistula, Fissure in Ano, Haemorrhoids, Pilonidal Sinus and Fistula, Rectal Prolapse, Stress Incontinence L. Varicose veins and Varicose ulcers M. All types of transplant and related surgeries. N. Congenital Internal disease / defect | 30 days for all but accident. One year and Two Year Waiting Any types of gastric or duodenal ulcers, 2. Benign prostatic hypertrophy 3. All types of sinuses 4. Haemorrhoids 5. Dysfunctional uterine bleeding 6. Endometriosis 7. Stones in the urinary and biliary systems 8. Surgery on ears /tonsils/ adenoids/ paranasal sinuses 9. Cataracts, 10. H ernia of all types 11. Fistulae, Fissure in ano 12. Hydrocele 13. Fibromyoma 14. Hysterectomy 15. S urgery for any skin ailment 16. S urgery on all internal or external tumours/ cysts/ nodules/polyps of any kind including breast lumps with exception of Malignant tumor or growth. Two Year Waiting for Joint replacement surgery • Surgery for prolapsed inter vertebral disc (unless necessitated due to an accident) • Surgery to correct deviated nasal septum • Hypertrophied turbinate • Congenital internal diseases or anomalies • Laser treatment for correction of eye sight due to refractive error | 30 days for all but accident. Two Year Waiting for Cataract* • Benign Prostatic Hypertrophy • All types of Hernia, Hydrocele • Joint replacements unless due to accident • Arthritis, gout, rheumatism and spinal disorders • Sinusitis and related disorders • Surgery on tonsils, adenoids and sinuses • Stones in the urinary and billiary systems • Dilatation and curettage, Endometriosis • Dialysis required for chronic renal failure • Gastric and Duodenal erosions and ulcers • Deviated Nasal Septum • Varicose Veins / Varicose Ulcers • Fissures / Fistula in anus, hemorrhoids / piles • All types of internal congenital anomalies / illness / defects • Myomectomy, Hysterectomy unless because of malignancy • All types of Skin and internal tumors / cysts / nodules / polyps of any kind including breast lumps unless malignant | 30 days for all but accident. Two Year Waiting for Sinusitis, Deviated Nasal Septum,Fibroids(fibromyoma), Endometriosis, Prolapsed uterus Polycystic ovarian disorder (PCOD), Arthritis, Gout and Rheumatism, Osteoarthritis, Osteoporosis, Spinal or Vertebral Disorders, Calculus Diseases Of Gall, Bladder Including Cholecystitis, Esophageal varices, Pancreatitis, Fissure/fistula In Anus, Hemorrhoids, pilonidal sinus, Piles, Ulcer and erosion, Gastro Esophageal Reflux Disorder (GERD), Perianal abscesses, Urogenital systemExample: Kidney stone, Urinary bladder stone etc., Benign enlargement of Prostate, Chronic Kidney Disease, Cataract, Internal tumours, cysts, Nodules, polyps, skin tumours, Lumps, All types of Internal Congenital Anomalies/illnesses/defects | 30 days for all but accident. Two Year Waiting for Internal Congenital Anomalies, Benign Prostatic Hypertrophy, dysfunctional uterine bleeding, Fibromyoma, Endometriosis, Hysterectomy, all internal or external tumours/ cysts/ nodules/ polyps of any kind including breast lumps with exception of malignant tumour or growth, Surgery for prolapsed inter vertebral disc unless arising from Accident, any types of gastric or duodenal ulcers, stones in the urinary and biliary systems, Surgery on ears. Organ transplant, Rheumatoid Arthritis, Gout, joint replacement Surgery due to degenerative condition, Age related Osteoarthritis and Osteoporosis unless such joint replacement Surgery is medically necessary due to Injury. | 30 days, 2 and 4 years 4 years for Joint Replacement Surgery |