Remain healthy or cough up big bucks for cover

 

Remain healthy or cough up big bucks for cover

 

Buying health cover just got costlier. New India Assurance has joined the three general insurers—Oriental, National and United India—with its new version of the ubiquitous Mediclaim policy (TOI broke the story on July 10). And the new Mediclaim makes it very clear that you will have to shell out more for your cover. In addition, be prepared to pay even more if you live in Mumbai: the new scheme divides the country into three zones to determine the premium, and Mumbai is the most expensive. The only saving grace is that the policy has become a bit more transparent. New India is expected to roll out its new policy soon. Here is a preview of the new Mediclaim.

Differential costs

New India has revised premium rates based on its “geographical area-wise claim experience.” So there are three zones: Zone I (Mumbai), Zone II (Delhi and Bangalore) and Zone III (rest of India). For example, a 35-year-old person would pay a premium of Rs 5,410 for a Rs 5 lakh cover in Mumbai, compared with Rs 5,151 for the old Medicliam policy. The same cover would cost Rs 5,280 in Delhi and Bangalore and Rs 5,150 in rest of India. Additionally, you can claim 100% reimbursement only in your own zone or a cheaper one. If you are in Mumbai (Zone I), you can be treated anywhere in the country and claim 100% reimbursement. However, if you paid a Zone II premium, you can claim 100% reimbursement for treatment only in zones IIand III. If you took treatment in Zone I, you would have to bear 10% of the claim. Likewise, a person in Zone III would have to bear 10% of the claim for treatment in Zone II, and 20% of the claim in Zone I.

Pay more for your child

If you are planning to buy a Mediclaim cover for your child (between three months and five years) be prepared shell out even more. Based on its higher claim experience, New India has carved out a separate category for children. For example, a Rs 1 lakh cover for your child would cost Rs 1,385, compared to Rs 1,300 for a 35-yearold in Mumbai.

Pay more if you claim more

Firstly, here is some bad news for senior citizens. Once you cross the age of 70, be ready to pay
a 2.5% “load” on the premium when you renew each year. The new Mediclaim has some bad news for others, too: customers who make too many claims may find their premium loaded up to 200%. Additionally, they may be expected to bear 15-25% of the claim amount. The loading kicks in the moment you make a claim of 10-20% of the assured sum. That means, if you have a cover of Rs 1 lakh and you make claim of Rs 20,000, your premium will go up by 25%. If your claim is between 50 and 75% of the total cover, you will have to shell out 15% of the claim amount. The loading and bearing a part of the claim amount (co-payment/excess, in insurance parlance) will be applicable only after the completion of two “policy periods.”

Curbed benefits

The new policy has reduced the maximum cumulative bonus you can earn for every claim-free year. It allows a maximum cumulative bonus of only 30%, compared with 50% in the old version. If you have earned cumulative bonus of 30 to 50%, a one-time increase of 5% will be allowed, but you will not earn any more bonus in renewals. If you make a claim of any amount, the cumulative bonus will be withdrawn at the time of renewal. Also, the policy doesn’t allow the domiciliary hospitalisation benefit.

More clarity

The new Mediclaim introduces sublimits to bring more clarity on what you can claim. For example, it sets a maximum of 1% of the assured sum for expenses related to hospital room, boarding and nursing. It also spells out sub-limits for intensive care etc. The new plan covers pre-existing diabetes and hypertension for an extra 20% on the basic premium, but you would not be able to make any claims in the first two years. Partial claims are allowed in the third and fourth years, and full claims from the fifth year. It lists 20 diseases which will not be covered in the first two years, and two others not covered in the first four years. There is a list of diseases that don’t require 24-hour hospitalisation (a must to make a claim).
Lastly, joing a gym may be a good idea. You will qualify for a 2.5% “good health discount” in premium on new cover and renewal of the policy.

 

Source: Times Of India, Mumbai dated 16/07/2007, Page 24.