My wife and I have Rs 8 lakh base and Rs 7 lakh top-up health insurance cover, do I need more?

Economic Times

18 hours ago

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My wife (56) and I (61) are currently covered under a floater policy with Rs 8 lakh base cover and a Rs 7 lakh top-up. Do you suggest any changes in our existing coverage? Is it still possible to revise or enhance the policy at our age? We've had no claims since the policy was first taken over 15 years ago.
Shilpa Arora General Manager, Co-founder and COO, Insurance Samadhan: It's commendable that you have maintained a claim-free health insurance record for over 15 years. It reflects well on your health and strengthens your profile with insurers. You currently have a health insurance coverage of Rs 15 lakh, including your top-up plan. At this stage, you may consider increasing your overall coverage to Rs 25-30 lakh, preferably by enhancing your top-up or opting for a super top-up with an appropriate deductible. That will ensure greater financial protection against high-value medical treatments. Additionally, it's important to review your policy for the following: l Room rent capping: If your policy limits room rent (say, 1% of sum insured), you could face out-of-pocket expenses for a higher category room. l Sub-limits on modern treatments: Check for caps or exclusions on advanced procedures like robotic surgeries, oral chemotherapy, intravitreal injections, or monoclonal antibody therapies. These treatments are becoming quite common, and sublimits can reduce the claimable amount. For instance, robotic-assisted knee replacements are now preferred for precision and recovery benefits. However, if your policy has caps on robotic surgery, you might have to bear a substantial portion of the expense yourself. So, depending on the features of your current plan, you can either continue with the same policy or explore portability within the same insurer to shift to a more comprehensive product. In any case, it is wise to proactively review and upgrade your health insurance, especially in your 60s, to stay prepared for evolving medical needs.
My 26-year-old unmarried daughter wants to purchase medical insurance. She is healthy and has no pre-existing medical conditions. I would like you to suggest some tips so that she can choose the right policy.
Sarbvir Singh Joint Group CEO, PB Fintech: It's great that your daughter is starting health insurance at 26 with no pre-existing conditions. She will get a broad coverage at a low premium. As a baseline, we recommend she consider a sum insured of at least Rs 20-25 lakh. She should opt for a plan that includes pre- and posthospitalisation expenses, daycare procedures, and ideally OPD and mental health coverage, which is now included in most policies. It's also important to choose a plan with no disease-specific or room rent sub-limits, and to avoid co-payment clauses, wherever possible. These often reduce claim payouts and result in unexpected out-of-pocket expenses. A short waiting period for pre-existing conditions is an added bonus, even if she doesn't need it now. She should look at the insurer's claim settlement ratio and ensure a wide network of cashless hospitals for ease during emergencies. A no-claim bonus feature, which increases her coverage each year she doesn't claim, will reward her for staying healthy. A well-chosen plan now can protect her for decades and even allow seamless upgrades later.
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(Disclaimer: The opinions expressed in this column are that of the writer. The facts and opinions expressed here do not reflect the views of www.economictimes.com.)
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