SD- Health Insurance Basics- Part 2 of 3- What all to check before picking the Policy?


Okay, friends We are live Am I audible. My audible guys. Yes, sir Okay. Thank you a little bit brief about what we discussed last time. in the previous session on the health insurance Basics Part one. I’m not going to share the screen for that, but I’ll be just telling in a bit about what I did so that in a couple of minutes when the others join you would be able to get in. They’ll also be able to get in sync with what we are doing now. so we discussed the the basics first of course. With the reasons why a health policy is needed, but most of us because there is too much conclusion about too many policies too many companies available along with that various confusing terms as well.What are the inclusions? What are the exclusions? What are the other factors that actually play a role in this? So then I actually first started with the ten basic questions that you need to ask yourself before buying a health insurance and some of them Some of those questions were what type of health plan you have what does. Health care policy will be covering actually and what is the amount of coverage and what are the exclusions in the policy? What are your routine test, which is covered or not just a basic introduction? Then what is the cost of each plan? usually how much or how which way is the policy premium determined and if we have to avail for the other care factor, what we need to look at and if we want to get the treatment from our doctor hospital, What are the factors involved into that? and what? Number of claims these are the ten questions that we ask then I tell you a bit about it was a terminology predominantly the fourteen term, which I used that I gave you and most and I think those terms were approximately the cashless claim coverage amount critical policy.And disability insurance deductibles. Exclusions. and the floater policies loading charges no claim overseas medical policy personal restoration, and then I gave you a case study of mister mera in which I further discussed the terminology of copay preexisting diseases to hospitalization. The congenital anomalies network hospitals, period period, and of course the portability Part and then I give you a brief. Guidelines by IRDI about the portability factors are the reasons are the things we’ll need to look into when we are putting the policy there are certain norms and principles that we really need to respond to then I detailed you separately about copay, coinsurance and deductible. What exactly it is so why we should be taking the digital and then I’ll tell you about what is the right time to buy health insurance Of course, the young ages because of the lower. Low premium rates. coverage. financial planning durations, and, of course the bonus factors as well. So then there are various factors. I gave it to you in brief about medical history, preexisting a professional body mass index and lifestyle things. further than I tell you about the a few do’s and don’ts that we actually need to keep in mind when buying health insurance in India, there are quite a few the don’ts for less, but that’s were about five to six in number, then what.Which company we should be picking what is the what is the claim settlement ratio? What is the experience in the industry that are award-winning man? What is the need for hospitalist? We all discussed that and then we called it a day for session two. so as I said. or told you about various factors that yes many. terms would be repetitive but. in health insurance or even for other Insurance factors a repetitive. A must usually to get the concept really going because maybe if I have discussed the concept in the first half of the first session, maybe you won’t be remembering it by the end of the third session, especially if it is kept in a mode as we have been keeping it in the past because of the COVID scenario because of the state. personal. request from a few colleagues with discussion that I. had with my local branch members. so. Actually fast tracked this in the session also and also fast tracked this in on Youtube. also so the session that you had do 2 days before this that’s already been scheduled and we’ll go. online tomorrow morning at 830. so and what we are going to take up our we are taking up right now. we’ll be going on Sunday morning, 1030 or 830 again. So this is the way I actually call it my payback to the society call it whatever, but this is the reason I want everyone should be aware of the health insurance and nothing but.In COVID times, so can you allow me to share my screen for the second session? so that we can begin on time. In just about 5 minutes of introduction and then we are almost starting the process So is the screen visible clearly. lifting up these. yes sir. Thank you so today’s session is Basics part two. so instead of a Friday it is on a Thursday. intervening session so as usual, my presentations will begin by thanking the Lord Almighty has given me much more than what I deserve and when it comes to finance, I have to thank my dad as well.He was instrumental in teaching me the clinical power of finance, so this is my people. You all are aware of it by now so we have to understand the basics of the health insurance. The basics are my favorite in any topic because the basics hold the key. you know if you are a cricket player, you don’t go in the ground and directly start hitting the shots you need to understand your poster. you need to understand your feet. you need to understand your back position. you need to understand your crease all those things and then you can go about hitting the shots. you may try it. maybe you can hit a couple as well but otherwise. If you are not adept to the basics, you will not be able to do that. Similarly the basics hold the key in sphere of light. So this is part two of the third part and MPG Webinar number eighteen for the first half of 2021. so we left our conundrum in the session One on this slide followed by this line factors that impact our health insurance premiums. I’ve discussed those in short giving you a brief outlay so let me. With a detailed discussion as I said, some things would be repetitive, but they are in a good taste for all of you and trust me when you search for the factors on health insurance, you will find some will give five 710 912, but I’m going to give you fifteen factors which are going to affect obviously no one policy will have all the fifteen factors, but yes, according to your family history, according to your suitability, according to your coverage, according to your geography. Pollution according to your city, according to your. of the city. and then. considering all those factors that are liable to cause any problem in your city or in your area or in your family, you can pick the maximum possible things for you. There is nothing more than a perfect policy, which will give you all the factors all the factors that I have listed it might be a couple more but there might be an overlap between the two factors, but that is the way I have designed this presentation.So we all know that life. Full of uncertainties and of course, medical emergencies are one of them and. Buying a health insurance is almost inevitable. Those who delayed it last year actually have. 1 year of their life because then they have to pay the premium accordingly. So II hope you and me both of us both of all of us. We’re not expecting the pandemic, especially not in the 2020. Yes, we all had cases of Wuhan virus in November. Of December 2019 the new year and Wuhan China only, but then we have had a history of sassy virus the virus the Ebola virus all those viruses in the first half of 2002000. 2002003 four, but they never affected India in a great day. in fact, not any major part of the world for that to be called it as a pandemic, the pandemic exactly right after 100 years after the Spanish flu in 1920.When Tony Tony began it was supposed to be it was time to be one of the best years of my life of our life and trust me even clinically speaking, it started as one of the best years. Jan Feb March All were very good, even when the lockdown happened, We’re already earned more than what we usually earn in a month in the month of March 2020, but then national don’t happen pandemic fears over and the rest is history. We are still covering and we are in a worst phase that we were exactly a year. I’d like that at that point of time so there is no reason that why you should not be buying a health insurance because whatever it is all said and done Health cover still comes handy. Yes, there are a lot of riders. There are a lot of things that we discussed in this session one but still the amount of coverage and the amount of security that they can provide, especially when it is a cashless at a network hospital. Nothing can replace it. Trust me when the loved one. The one is suffering in the hospital. you don’t look out you don’t look out for other things like filling the documentation or just getting those systems into place You always want to be closer to the loved ones Obviously you never know it might be a mishap. you might lose a loved one, so it might be the last time that you’re talking to someone so you don’t want to lose out on that time. Of course, I don’t wish anyone for that to be going through that phase. but then this is a possibility so if it is. Health insurance at least some part of the documentation at least the hospital and some power and then another factor is the money factor if you’re not having three cars, then you have to rush to the banks maybe get something dipped into your dipping into your retirement savings to be broken off. maybe some investments maybe some emergency funds you might have to take a sudden which you might regret later that may be there.The but then that that those moments are sometimes not the moments to exercise your brain at that. Of time because at that point, it is not important that what you’re dipping into you need the money so the and the cash always makes a big difference in those scenarios and. there there are many multiple factors we we have discussed in brief I’ll be discussing now in depth about this thing so this session today will be comprising a primary the fifteen factors that affect the health insurance and then I’ll be discussing the factors that affect the senior citizen health insurance for our parents and then the. Insurance. the portability of the same and of course group Insurance individuals Insurance, and then one more and then we’ll call it again. so the rest of the comparisons the rest of the data based comparisons the COVID policies and the most important topic the frequent associated myths with Insurance. so I’ll be taking up tomorrow in the Friday evening session, so that is going to be a slightly longest session. So that is the reason I’ve. Time tomorrow at 7:30 PM so. we all should be knowing about the waiting period thing the benefits of the policy the cashless hospitalization the copay limitations and all the other things amongst many so we we we should be aware of these factors when we have to pick up health insurance because when you find too many options sometimes you get confused, which one to pick for and it seems like a lottery to us. Ultima tely, as I mentioned in the day before yesterday’s session that you are someone who’s already bought it, maybe your neighbor a friend colleague and a.Then that goes on to a person who has maybe a sixty acquired a 60% knowledge, and that knowledge will filter from one to another may have about fifteen to 20% or maybe even less than that. And then we blame that person or blame that friend who suggested us, we asked them they didn’t. So we need to remember that we didn’t use our top floor and that is the reason these sessions are there exercise your top floor of the brain so in the normal times so that you’re covered in the abnormal times or the emergency times. So I know the jars are very much intimidating. Many of them are confusing, but those of you who have attended the first session. Many of you are aware of it. I know, but those who attended the last session at least not be not aware of at least got a hang. Things which are you? actually. we’re going to be out in today’s session, so let me give you a few factors. what I believe should be important factors as I said there might be a couple more couple left, but this is the list of the that I actually look at so the number one is the which type of plan individual family plot. We discussed about it a little bit. We’ll discuss more on today’s session so cashless Hospitalization network of hospitals a criteria.Discussed that why it is good to be picking the same the young age and duration of the waiting period. I’ll give you examples of a few policies in this, then a PCR premium to cover. preexisting disease. clause, selecting the right amount claim process maternity benefits pre and post hospitalization lifetime renewal free medical checkup or preventive health checkup daycare procedures very important and no claim bonus again. I’ll be giving wherever possible, I’ve added the data slides along with for the various policies. so let’s. Began discussing each of these factors, one by one. When you are choosing, you first have to know that what plan are you choosing individual or family for as discussed the individual is only for a person one individual in the family, but the family floater plan is for the whole family, For example, some are living in a joint family can have two kids the parents and the two husband and wife covered so you can six of you can be covered in that policy One member can take any number of claims in.Unlimited times in a year up to some insured and if you exhaust the limit you have you can restore the same by paying a nominal amount Of course, you have the option to get individual plans as well. but if you know that always a corporate plan, kind of a thing or a group plan of kind of a thing is going to be always cheaper. So if you buy the same coverage, for example, five coverage for six people in your family and you buy a thirty like family. Photo plan you calculate that. Family plan will ultimately come out to be cheaper even if. even if the. some which is to be insured, is taken by the age of the eldest family member in that so this family photo plan will cover each one of you in the plan and the total sum share is a total sum insured is shared between all of you so as I mentioned the restoration benefit if you exhaust if if you are a god forbid your father or your mother is being hospitalized every second month and You have a good expenditure incurred in that and you maybe you have a family plan and you exhausted by maybe the seventh month of your of the year so the company will give you an option to pay some amount to restore the limit or even the 50% of the limit or whatever you want for the coverage to by paying a nominal amount for the remaining 5 years, and as I mentioned previously, this is not carry forward next year next year.Up for a bigger plan that yes. I can offer this year that you can do at the start of the policy, but not otherwise did that is la. will not be carried forward to the next twenty or twenty like if you have a family plot plan of twenty laps so there are different plans available they work differently. As I mentioned there are fixed benefit plans, Indemnity plans or benefit plans. so indemnity we’ll reimburse the amount of hospital bills in defined benefit plans The lump sum is paid irrespective of the actual hospital. That defined benefit plans we discussed before are the critical illness coverage plans if you have attended the decision previously, you might be aware of that by now so. the critical illness falls in the benefit based plans and the individual family. or me. indemnity plans. so, for example the coverage if you say is a nine and the hospital is 1.8 Lac.So in me you are 1.8 LA will get of course the riders of deductibles and copays and co insurance aside. Those things aside just presuming that this will get covered but in a critical illness plan if you have a nine la plan, you’ll get the nine reimbursed the first day when it is diagnosed and of course when you go through that process the critical. claim process is not very long, of course. so these these two plants are not complementary as we discussed in DCI government’s plan they are actually supplementary nature so can be substituted. They actually help each other as I mentioned you may have. To the agents they don’t have to go through the lengthy physical paperwork process. Everything can be uploaded online. Yes, they might need a physical copy separately, but then that processes the one that can be escaped. You can scan and upload your documents and save on your email and of course, the company has the final say whether they want to select you as a customer or not whether they approve your policy or not so make these medical insurances as a shield and.Against any kind of catastrophe that can strike our family so I always. encourage having a family plan, especially if you are a parent are having some preexisting diseases and you need to make sure that the whole family is covered in one plan because you never know it can strike children as well, It can strike of course, the old people it strikes all people very commonly so always consider their presents and your medical history because these things are very important in that preexisting information is. Very important do not skip them at any cost because it will ultimately lead to your claim being ejected only so you need to make sure so the second factor is cashless hospitalization benefit so we discussed last time the network hospitals will actually settle the bill of the claim themselves. The company representative. and the hospital will do the documentation Part and while you can tend to your loved ones close close. To them, if you are allowed to meet them if they have an ICU or ICU, maybe you may not be having that privilege to meet them for the full period of 24 hours.But then that is a separate thing altogether. so you can actually just submit your policy details and we’ll catch the people cut down a lot of paperwork on your time because that is required. this is mandated the paperwork or even if we do are not doing our clinic. The hospitals are liable to do it they. To maintain it considering the rise in the violence. the rise in the consumer court cases and many other factors, which are there. so the net of the system is a quicker process.So always review your networking list before deciding on the plan and I believe that you should even when you renew the policy next year, Obviously, when you pay the premium, I mean to say, check out the list because the hospital cash network list is revised. Maybe the hospital might have some difference of opinion some difference in charges so they might opt out of the company’s network. paradigm, so it is important that you actually stay put through those lists and be aware of all those things. Always offer a credible company we cover this why you should offer a credible company because everybody would like every hospital would like to be associated with them and why they would also like to be associated with the. well-known renowned hospital and it works both ways the the hospital gets the work and. the insurance company gets the coverage and of course the repetition as well that they are associated with the big hospital and obviously you don’t need to arrange for the funds and then file for reimbursement because that money can be cumbersome because when you dip into your retirement you actually.Break your investment You break your investment Sometimes you lose the compounding advantage. I’ll write a very short story here. II read it in my childhood. like a mango tree so when it starts growing up, it has flowers blooming of those flowers will turn into obviously in fruits as well, but the garden. it cuts down those trees those those flowers so that there are no troops at that time, so it lets it grow. It lets it go so once it grows up and then turn those flowers down into fruits. That is the time you actually can take advantage of the fruit every year, but if the fruits or the flowers are not cut by the gardener at a younger age, then the plant will not grow to the level that it normally does. a plant and then what fruits fruits. So that is the. The three shots have to be spelled over to get long term gains so similarly the compounding advantage has to be dipped into a few break your investments so the cashless is one of the very important factors when it comes to choosing so if out of the fifteen you have to pick any six or seven factors, cashless should be in your list.Surely so take this one factor very very important. I’ll keep on telling you what, according to me are the best six or seven factors of course. then there is. Of course, being younger always helps we discuss this in detail in last year in last session, so obviously in family protocol they actually choose upon your eldest family members age, but then age limit is a good criteria when you’re choosing your health insurance cover and. they’re always check for the entry level as well if you’re if you’re for or if your parents are above the age of sixty they might not the company’s policy might not be there.Some companies have an entry a limit of 90 days means a 3 month old child can have a health insurance. Obviously the young children rarely have a problem apart from the congenital problems if they have any god forbid but the entry level is 91 days and sometimes it is 60 years, But then there are plans that have a age limit from twenty-five to fifty as well. So you have to check the age factor also and obviously no company works for losing out money.They also want to make money and we also want to be held in cases of dias or diarrhea needs when we need the money from the company. We have a medical emergency in our family so then there are some plans which have don’t have any restrictions on there are plans, which are available up to 8082 as well. so choose that option accordingly. so if you’re going in for a family plan, they’ll allow you to cover your two minor children and and you two husband and wife. they might not allow you to cover the grandchildren or grandparents of the kids or your parents for that matter in that. So remember this. Again, one of the important factors, but usually only a few companies come with the age limit Most of them have a age limit of seventy plus usually, but then you have to check the poly What your policy allows you so because health wise a is a critical factor. We know that there are a lot of things which are dependent upon age, especially the premium and the oldest family member will get to be calculated on behalf of the whole family so then.No waiting period This is the second most important thing for me out of the fifteen if you are aware of the waiting period you need to. take a mark on this and obviously no no Health company except for one or two out of the 2526 existing we’ll cover your preexisting illnesses and they will have a coverage from a predefined time only they might cover the same from 24 to 48 months means 2 years to 4 months is the waiting period and then. Diseases that are not covered or maybe which are initially not added. like thyroid blood pressure diabetes or maybe chronic illness like arthritis varicose veins the cataract they also fall into the. waiting period class anything can be twenty-four to forty-eight for. a disease, which is, for example. of related to your intestinal diseases. they are usually 48 months or also related problems also for 8 months, 4 years, so you can. The benefit of the same venue waiting period is over so if you have a surgery lined up in the next 2 months, no policy can help you of course in that case so even for the basic coverage, for example, if you’re hospitalized for a normal thing, it’s not because of any preexisting thing.There is still a waiting period of 30 days before you make the claim for other than preexisting in majority policy. Some have forty-five some have sixty also, but the minimum is usually 30 days, so you cannot make any. any any case. 15 days is the preload so. Days is the waiting period before you claim for a disease or other than preexisting. so then COVID when they were launched, they actually came up with policies, which actually had a writer of 30 days as well but then policies policies kept on happening and there are a lot of relaxation now major policies are coming with a 15 day waiting period. now, let’s discuss the specific policies in the next the ones, which are very famous The SDF ck policy and the reliance coverage policy. and of course, I also one in the PX. I’m sorry, but I don’t remember I guess so it is best to know the waiting period.Clearly so that there are no disputes rather than we blame the company. We use it sometimes in agitation or frustration but again the pinpointing of the finger at one finger at that means three fingers are pointing towards that you don’t know where actually the fort was, We didn’t read only. We didn’t know we just bought it on Esa so choose a plan. The waiting period, which can help you maximally in cases of when you have to die. so as I told you Apollo Apollo Apollo Munich now is SGFC Argo, but still a GFCI is offering the Optima restored planet is one of the very famous plans, which were which had a lot of sales. So what are the waiting periods covered in that so 24 months for ENT procedures? sinusitis reins toss gyn procedures to females cyst polyps polycystic ovarian disease. PCD as we we know, it’s an orthopedic non infected arthritis goats osteoarthritis all these are covered from 24 months after the policy and additionally waiting period means forty-eight is for for midline aviation of the nasal deviation or any prolapse surgery hernia surgeries hernia surgery is a very difficult surgery.Hernia is a very common disease and 48 months for the waiting period. And then some companies come with a writer, even if you spend two like I mentioned last time, some companies will have a limit of 40 thousand for the surgeons then veins varicose ulcers so max. has no riders for 48 months. It only has 24 months and stones and urinary system lump cyst polyps all those cataract and all those things the plan name is Health companion Health insurance plan. So. yes this. Thing needs to be evaluated very, very cautiously obviously. gyn diseases do not usually follow the pattern it mostly follows the lifestyle of the individual, but yes, orthopedic and ENT are sometimes important when we calculate the same. so then the PCR or the premium to cover the ratio and the room we always. try to. The insurance policy with even the TV ads we discussed last time they will promote. so that is the way because India anything, which is not giving you tangible benefits. immediately Of course, we always calculated by the money and we always want to keep up. policy as if we are doing our duty, which is to be done and we are doing it half heartedly so don’t do it that way. Don’t look at the premium premium should be the last thing that should be looked at of course, look out other factors if I have to pick the list of six or seven factors premium would not be out in that list for me, but yes, when I have the seven factors for me covered, I’ll then compare the comparative policies and then I look at. then I look for those factors. Can be good if it is giving you a good coverage at a premium that you can pay but if you if you look at that factor that yes, if there is extensive coverage that a lesser premium, there might be some other cats in it also. The other aspect is lesser at cost of the insurance coverage so usually the difference is because of the lack of awareness.So people will choose a health plan. budget. budget is then the secondary primary thing to them. when they are company that will offer you a monthly premium option or a quarterly option and even a 6 month option. There are a few companies that do that also, but the majority you have to. There are no. if you have a lower premium rate policy your coverage would also be very minimal. Remember that something a policy of you know 7000 for a young 30 year old male non smoker in a city or a ti. city only will not give you about five in any case, and there are a lot of deductibles. There will be a lot of cops and of course there will be supplements also added with it. The only thing is we discussed it in the last session, hire the deductible hire the copay sometimes lower is the premium, so you have to need those factors the room or supplements might not be a criteria in the lower premium, but the and the of the coinsurance might be so the best reason is.It look out for the reasons why they are charging less network hospitals. if the network hospitals compared to the number of hospitals. A colleague of mine actually from a different city ask me thirty-eight this hospital is there. This is a thing of I think in the COVID struck last year, ya. so when I told him the reality he actually dumped the policy on that if it is covering a network with the third grade hospital, I doubt the other good hospital will be there.Then he asked me what are the list of other hospital names then checked out the names all of the big names except one were missing in that list. So you. Look into the number of the hospitals the quantity sometimes is not important The quality definitely is so again we need to check the additional clause of limits and deductibles, of course, but otherwise you need to keep a balance if you’re paying higher deductible and copay nothing wrong with it, but then your premium should be low and your PCR should be high. The premium to cover is the ratio the low low premium but higher amount covered but that is balanced by a higher deductible.A coping up with the and there will be no. BS. everybody will want to earn profits if they’re working so always look out for the right balance between the benefits between the premium, you’re paying between the deductibles between the network Hospital of course Network Hospital over the. facility. Sure. The right balance, as I said, is very important to look for a good premium to cover a ratio so compare the plants or maybe speak to a colleague speak to an expert who knows about it and always.Pay attention to payment structures of course, co payment structures are usually there in the senior citizen policies all in the family plans in individual policies. there are very less structures are on the lesser percentage wise so sometimes as I mentioned last time there might be room limits. Also remember. When we look at the overall scenario your room thing if it is fixed that 1% of your total coverage, for example, if it is a fivek coverage, you’re one person would be somebody’s unmuted. Okay. Thank you if it is fixed at 5000 per day if you file a policy and one person is there. In a policy if the room is on the higher side, remember the doctor visiting fees and other charges and other things will be on the higher limit higher side and they will come with us with a prefix limit also and yes, these are the things which are you’ll be paid only up to this amount so look at those things all those limitations, which is all mentioned in your policy document that what is covered and what is not covered as I mentioned medical treatment expenses also your surgery charges your visit charges your doctor fees your whatever.Are based are also actually on the basis of dominant if you bought in a higher or expensive room in the hospital All these charges will be escalated. so 800 parts. for they are expensive. so remember the same applies logic applies in marketing everywhere as well. So always check the room and allowances what is allowed and. If the room is at 5000, you won’t get a shabby room that is for sure, even if it is a very good hospital or a high-end hospital, you won’t get a shabby room in 5000 so you need to be aware of this factor so always. Hello. and just in here. can I just make one point? No please let me continue. please you can do anything and that you can write it down. you can please make your auditions in there. No problem. Okay. Okay. Okay. Thank you. Thank you. so because it affects sometime my flow and II have to then look out and search for the site which I have made in this of course, you can not this point and we’ll discuss this point. I’ll allow you the time to speak immediately after I finish before I take up the queries so always look. For Long-term, benefits, copay and limitations limits again other than the room limits room. limits are surely another criteria so supplements means even if the doctor fees is allowed for a visit up to 500 the hospital charges to 600. you have to pay that difference of hundred as well so the doctor fees the nursing charges IQ charges they are all linked to the room so accordingly you have to choose those things in most policies. it is capped at 1% and. Are the other hospital expenses accordingly, even if it is a network hospital sometimes you will say that yes, I I’m out of 5000 room.I don’t want it. I want to hire room so, according to your charges will increase as well. so proportionately as I mentioned they will get and your reimbursement would be based on your supplements only and even if your total bill, for example, your total insured is five keys and your total hospital bill comes out to be four PS deductibles and coinsurance aside coinsurance. Aside whatever limits you have and if you have certain limits, let’s suppose those limits calculator come out to 50 thousand so you’ll be reimbursed three and a half out of four Lac and the remaining 50 thousand will be will have to be paid by you and I’m talking of this 50 thousand other than coinsurance copay or deductibles.So this is based on what other expenses that get a boost or proposed, which are increased. so sometimes seem like a very charges but can be exorbitant sometimes so. You need to take that into account, but then this is again one of the factors, which is not in my list of six or seven factors for sure. so then make sure to disclose preexisting diseases a full and honest disclosure is very important and we all know that none of the diseases would be covered in the first. in the from the first day itself, so surely you need to look into those. As well and your coverage of the preexisting would be only after a certain amount of only I mentioned twenty-four 3648 depends upon various policies so yes, if I have a family of a certain disease preexisting coverage of the waiting period would be on my checklist of seven factors if I have to pick. especially if it comes with a start comes into play if I have a positive family history of certain diseases for which I was waiting.This would be under my checklist, but then you have to you have the duty to a full and honest. disclosure so that your claim is not rejected. These things are voluntary, but if you make. a mistake at some place, you’re surely bound to suffer and your claim might be rejected and you might be blacklisted as well to get a further policy from the company. So make a honest disclosure in that regard. So. I gave you an example of the Apollo now compared with the similar I’ll give you the new Insurance so in the same optimal plan that is six waiting. month waiting period from policy for all preexisting conditions declared at the time of application. So if you have a preexisting condition, which is not declared that is not covered on so that means you are not having that and it is very easy for the people to make a diagnosis.The company also has. I have a lot of hospitals and doctors and your statement would not matter at that time. Yes. so that is something very different from that regard. So then new policy the policy 48 months of continuous coverage has elapsed from the date of inception of the policy. so these vary from company to company so then find out if they are co payments use as I said in senior citizen policies. This is a reality and this has to be born for an hour for a normal average policy The copay is about 20% of. You can even offer a higher limit if you are for a higher copay. of course, you’re. either your coverage with the premium to cover the would go high because your premium would be decreased in those cases. so high limit of co payment would stay on premium as well and the PCR a show increases all the coverage increases. so we actually get confused and we ignore such terms. Trust me many of the people who are having health policies in 10 years. Luckily there. Any hospitalization they are still not aware of the laws fully.I gave you the principles of deductible and coinsurance separately, citing a example as well but many people are still not aware of it. so check out those causes what is covered into the people with companies are very smart. they’ll sleep in these closets, Sometimes even we are not aware of it and even the agents play smart. They’ll try to play it smart with a good. Sometimes, if the total bill turns out to be lax, which is a reality in today’s times, you will have to pay six five or six flags from your pocket. Sometimes you might not be able to are very happy to pay that amount. Maybe you might be having some your money in that regard. so always pay attention to these details. so for a national insurance policy, Medicaid plus co payment of 20% of its claim if taken in non network hospital plan a plan. DC they come with the different plants then national insurance company same policy limits limits up to 1% of some insured per day, ICU up to 2% of some insured per day subject to a maximum of 15 thousand even after that 2000 limit, they have a tab at 15 thousand per day Star Health insurance We discussed last time ICU charges 2000 per subject to a maximum of 10 thousand per hospitalization.That means you can stay in ICU for 5 days only. For them at 2000, so again, if this kind of kind of rider is there, we all know no ICU charges are 2000 per day, so obviously and 10 thousand ICU is sometimes a day charged so we need to understand that this kind of a policy which offers such kind of sublime is a total. a big No for me. so don’t ask for that then get a fix on the amount of coverage we discussed about the premium coverage ratio selecting the right insurance amount. Various factors last time I used to tell two to five Las Insurance is medically, but after COVID even I would say. anything from seven to eight Las is a good amount of coverage or up to ten even for an individual should be the one which is opted for and if it is a family plan minimum of I would recommend a light coverage for the whole family. Of course, there is no to decide that your medical history will decide that of course your TFC will decide that and the biggest factors that you. City is linked to the inflation Part You have to factor in inflation also because all those charges that keep on rising and medical inflation rises faster than the normal inflation.So I really enjoy your family members as well. and if you’re having an employer policy either get it converted to an individual plan or maybe you can offer for a separate independent coverage as well even from the same company or from a different company. So. Select the amount wisely and what are the writers involved in conversion of group health to an independent? I’ll be discussing at the end of today’s presentation. so select them wisely as it covers the amount for the whole year. so take your agent into account the higher the younger you are the more some in you would need so always look at your income levels also to analyze the premium affordability as well because sometimes you don’t look into those factors.So. And another aspect is the add on sometimes which we can add separate to the premium amounts for the various factors as well. So then some insured should not be falling short of in case of emergency. so always select a plan which should give you good coverage. So if I say that three la la coverage, this is not suction anymore because surgeries and all those essay hospital admissions are going costly each day.We discussed a lot. Time that even a when it started in April May last year was as high as fifteen to seventeen for some, but yes, a seizure, which is causing two and a half to three laps today, will surely cost in the next seven to eight or 10 years, eight la to ten laps, so we have to factor in the inflation as well when we are buying a SU. for such procedures as we discussed in the SCA plan would be a good one, but yes, if. If you’re not having a family history of. cardiac history, you will not buy a CIA plan for a cardiac usually, but then you need to make sure that this can strike anyone at any age and more so for dentists because most of us have a sedentary lifestyle, we work from one to another chair. We hardly move in the day so again inflation while deciding the amount for that, then the claims this is one.Which I’ll give a marker if I have to say seven factors. yes, the claim settlement ratio is one of the major factors and of course the better customer care if it is a online one the better it is for me and because the policy wards the claims settlement ratio and the claims process all should be smooth. So read about it. Read Customer reviews Also online Everything is available online. Not everything is fake, especially the customer reviews so select a plan, which is known for it. Seamless claims everyone’s services We discussed this fact that she gave his input regarding the claim. settlement Part Yes, the figures are sometimes 90% being shown for many companies, but then there is a writer to it that what was the amount which was covered. What was a mount, which was asked for reimbursement and what was which was not covered. so we need to make sure that if you are in a non network hospital, there will be many many things. Not be covered and accordingly, we have to think about those things then for the females. yes, a very important factor maybe with a star if some of you are already mothers, yes, you might not be but.Needing this, but if some of you are not still enjoying the early years of your marriage or marital bliss, you can actually factor in taking the policy with maternity benefits because. Even bringing a child into the family is a very expensive exercise right from the day you have your LMP your last menstrual period, and of course when you miss it and the. scans or everything that starts and those go up to 3 months, post delivery as well, all those factors the care factor of course, not the scans, but the care factor shortly so again there is a waiting period of two to 4 months before you can. The maternity benefits so if someone of you is unmarried and planning to start a family and maybe a couple of years time have a policy which gives you a 2 years waiting period on maternity benefits and that should work best for you. so also very important is that that should be covering your newborn baby medical expenses apart from the delivery cost of course they don’t cover the pre. or the. Most of them, but yes, right from your admission for delivery or even some some companies cover the complications as well, initially if they are those so don’t forget to check the limitations because there are a lot of writers attached to maternity benefits.So you need to check into the waiting period the supplements if there are any and also check any outpatient expenses or any exclusions, which are related to the policy. Some will not cover a cesarean. Some will cover a cesarean some will cover on they will have a sublime on a cesarean so it’ll it is all dependent upon. Various factors then pre and post hospitalization. we discussed it last time before you encounter a problem, you visited Doctor multiple times and if you don’t get cured, then your advise certain tests, then maybe a few scans, CT MRI all those texts, which are not very cheap these days. so you have to undergo those before you are finally diagnosed with something and then you are admitted of course with your policy, you’ll be covered with the normal medical. Policy you’ll be covered only for the hospitalization part, but before that a pre hospitals and once you’re discharged your post operative care continues a physiotherapy, maybe another thing maybe visiting a doctor, whatever depending upon how ambulatory you are ambulatory, you are so it’ll that will also continue so factor in a policy which gives you a pre and post hospitalization benefit as well for your ambulance charges. Medical tests medicine doctors we don’t look to look into these factors. We discuss the ambulance. Somebody who charged one like 20 thousand for a short visit as well, people actually make Hays it. it is true for many of the professionals not only medical profession, but then we need to make sure that this does not happen with us Then there are only a few policies which will offer a lifetime renewal. They always will have a certain time limit, but then if you are suffering from certain diseases and you’re when you’re old, you are renewable will not be liable so take up a plan which can.Renewed at least seventy-five to 80 years of age, remember entry level of eighteen to sixty or 991 days to sixty or fifty is something else renewal is something else renewal is maybe you started your policy at forty-five and the renewal may be possible to seventy or 75 to 80 years of age. The entry is not possible in policy after fifty or sixty so don’t confuse or mix between the two terms. These are two entirely different terms so. A free medical checkup we need to undergo test, especially those who are heart patients or those who have any families. Do you have any cardiovascular cancer screening or any MRIs if you are doing undergoing that make sure that your policy is covering your preventive health checkups as well. so that your insurance company pays for it and yes, you can definitely save some money there if the same is covered in your policy, but then. Check out the covers check out for if. the company if it is giving you a free medical checkup and obviously it should not be affecting. premium and when the policy undergo renewal so health plan is your best health during such emergencies, then this is one of the most common myths, which has been existing since ever since the policies came into timely that they say. people ask us all the medical leave. You. Hospitalized because I’ll get reimbursement from my company only if I am hospitalized for 24 hours that clause has been done a long long back. they procedures are covered with the event of laparoscopic surgeries. people are sometimes discharged on the same day. and this happens. this is true so there is no longer a twenty-four-hour hospitalization clauses majority of the companies majority would say 90% companies in today’s times they cover the daycare procedures, which are less than 24 hours. And some would mention 24 hours some would mention two nights. There is a difference You went to the hospital at 2 PM or 1 PM in the afternoon. you were admitted and you will discharge the next day at twelve noon. You will see that is because they have to mention that the the amount of the time of. the the time you were discharged from the hospital so they’ll mention to 3 hours of hospitalization Twenty-four kilo. so those. On the internet also for myths, you will not find more than 17, maybe 710 or twelve myths or the myths. you won’t find. but I’ll give you twenty myths of course, those will have at least twenty-five plus points because many will have a double or triple points in that So then the no claim bonus.We discussed the some would offer a straight away Discounting premium Some would offer other benefits some would offer increasing or some insured every year. So this is the claim like a car ins. Like a vehicle insurance that if you don’t make a claim, you have a claim free year, you will actually get. a cash back from the company in a way or a benefit back from the company, not exactly. but yes, that is also an option along with the discussion direction in premium cash back and as I mentioned the increase in some so yes, a couple of you were not there in the last session, you might find a few things confusing but if you are attending today, you can attend the session one tomorrow morning on YouTube many things would be joining together, but yes.Who attended attentively first time they might be getting all the things now positively in their mindset for the future decisions to make in them. so all those claims for some will increase your coverage amount but most companies would specify there. NCB limit so whatever it is increase for example, if you buy a insurance plan of five la. the company will offer you 10% and for every game free you up to a maximum. So it it depends I’ll show you the table how the NCAA is decided by some companies, but these are the fifteen points that you have to consider no company will have all the fifteen points if they have it. the frame would be on the higher side because if any company would have the fifteen points, the PCR goes out of the window the premium to cover the ratio if they have all the points, the premium will be high.For the same. Be very high, so all those factors will not be there. and of course those who are already having the kids. they won’t be needing maternity benefits There are other things that those who are living in a nuclear family only maybe they have disease or maybe the parents live with someone else even they will not need the family plan for the senior citizens. so the variable factors, which will suit a particular individual So if you ask me what is the best policy? do? I really know you do. I really know your. You know your medical history do I need to know your budget? Do I really know your preexisting diseases So how can I tell you the best policy if something is best for me it cannot be best for you. and my answer would be the same your unique situation is best understood by you so whenever someone ask me the best thing and our friend told me. concierge. it is there. Again, no disrespect to other professions or other streams of in India, but yes, we are supposed to be there in the brains, but if you are not ready to use your brain, then it is not my problem. It is surely your problem so look at the NCA claim free here if the first if it is for a policy of five las so first year, you have AA 10% increase of 550, then second year again, six flags 650 We have a proportional increase some would give you a different. kind of. Or a different kind of so you need to make sure that what exactly is there then again Apollo is GFCI optimal plan if no claim has been made and there is no break also again. This is the clause. The Great Spirit is not counted in this of course, as I told you used to many policies used to have a great spirit of 15 days, but now with AIRDI guidelines most have a period of 30 days. It’s not 1 month it is 30 days so remember.There is a difference between the two so a bonus in the next year by increasing some insured by 50% of the basic sum insured and maximum benefit will not exceed 100% of the year and Max Health and Health insurance plan 20% increase in the expiring base up to a maximum of 100% the national insurance 5% of the summit. sir Sir Sir 5% of some is short of expiring policy in sorry, no disrespect, But we all know what how things work so now that you’re. Of all those things. always consider the factors which affect you before you zero in on a policy. so now coming to the senior citizen or when you’re buying it for parents of course, the dynamics remain the same. The facts will remain the same but other factors will actually add to this part, which are more important over here like medicines tests, Periodical checkups ambulance costs Day cares if you’re buying a separate you you feel that. Have a family plan, but you need to buy a separate plan for your parents. sure because you feel that maybe family might not be substance alone.People buy a second policy as well separately for parents, Yes premium would be on the higher side, but there is nothing wrong with it if someone is predisposed or say, is not a very. very friendly with the living conditions and he falls ill very frequently. We obviously have to take care of our loved ones, so we take a second policy so all these factors so for you all these. Out of those fifteen will become very important. you have to look for these factors, which actually can give you benefits and of course provide ease to your pocket as well.So we all know that they can all burn a hole so we need to consider a few things for our senior citizens. so we all want that our parents should get the best because they have made us the best profession possible the doctors so we always want those who actually care for their parents. Would want that their parents get the best because our parents because of commodity because of various reasons fall prey to their fall prey to many diseases, so we need to have a high in short plan so that there are no financial constraints when it comes to hospitalization when it comes to any kind of such issues because they are the ones who are having a major chance of getting infected than us comparatively, of course, so pre. Disclosure is very important the medicines they are taking along with that so that they are covered for a specific period. for some policies in senior citizens the waiting period is less CCP existing disease if it is a separate policy for senior citizens, they will not have a waiting period of 4 years. They will have some a waiting period of eighteen to 24 months old, but then you have to search which policy suits you and which are the conditions Those are which are covered so preexisting and the waiting period play a very important role and this varies from.To each other, especially in cases of senior citizens and it is in in our cases, sometimes it is as high as 48 months some policies for seniors and would also be having for 48 months but many many policies would have a lesser waiting period so check out for the network hospitals again the PCR the premium to cover his ratio and as for the age if you’re a family plan or a separate plan so again, the claim settlement thing, especially if you’re nearby hospital or. Hospital or your Preferred hospital is not in that list. Check out the part as well because for Asian people we always don’t want also that we should be going far off because sometimes if the parents fall ill and you are not home, you are at your workplace. Maybe your spouse can actually take your parents to hospital in case of an emergency, but if it is a far off thing, half of the time would be spent in traffic only so there is a lot riding on the claim settlement Part. Especially if you’re nearby a good hospital is not in the network is not in the list So then a decent factors like maternity benefits, of course, are not needed in senior citizens but free medical checkup.No claim bonus payment option. These are the factors which are very important for senior citizens, especially the co payment option because the co payment option is higher in cases of the senior citizens. so make sure that you check all these factors before you. Zero down on the policy for the senior citizens and then a few factors health history we all should be knowing what exactly is the current problem? What are their symptoms? What are the diseases? What are the medications there that they’re taking so? always keep those histories those files very handy so that you are able to know about the claim if it is there.Somebody’s voice is to yourself. Thank you. some in then again for senior citizens. medical inflation is one criteria you really have to make sure because heart procedures knee replacement hip replacement all those joint procedures. they actually are very expensive procedures and whatever they are today. they’ll be surely rising more than the normal inflation in coming five to 7 years and I believe all the industry. That they will rise eight to ten, but I believe that medical insurance rises by five to 7% at least every year annually, so we have to keep our inflation also in mind for that reason, so then parameters of policies.Where we discussed copay and the timing, especially some plans will have a lower premium, but then the waiting period would be more or maybe other parameters would be accordingly placed differently. So most policies that limit the usage of such things, they will have a lower premium so again the premium should not be the criteria the comfort and the ease should be the criteria and we need to understand that these are the things which come handy because our folks are are are senior citizens are more prone to diseases so on disclosures while disclosing everything again ignorance is not a bliss.I’ll say you need to explain all those things very, very clearly and sometimes. If the senior citizens are the preexisting conditions are on the heavier side, the policy holder of the insurance company will ask them to undergo medical checkup. Also they’re depending upon whether they can choose a client or not the primary thing lies with the the The courts also give this thing that anyone can choose his or her client or patient. nobody can force upon that. Yes, I can do it but once you have chosen, it is your duty to actually give the service if. A patient in our clinic or if it is a senior citizen for the health insurance company, so always disclose in full so that you are not actually rejected by the insurance company whenever the situation for claim arises. so now the this section is for the salary people, especially those who are working with the company or working with the network hospital.They’re working in hospitals. usually they are accorded the employee benefits in various formats and Apart from social security perks bonuses paid vacation, there is one factor, which is usually mandatory by the government of India for every organization and that is the health insurance, Usually all the companies are are safe. It is mandatory for them to provide a medical policy to all their employees and of course when all the employees of the company are under registered under one group Health insurance plan.The group. Will come out to be cheaper for the company and of course, the individuals are insured may not be on the higher side. There are a lot of benefits in the group insurance policies, let’s see a few of them, then, as I said, some in short would be. default if all the employees are called for two las that applies to our except maybe the people might be covered for five laps or so, but then you have the option to increase your sum, especially if you believe you are predisposed to certain considering your family history. Are considering ya and your your own condition or your own lifestyle.So the premiums you shared by the employer and the employee you pay 50% and the employer pays 50%, usually some companies even pay 100% elsewhere, but then if the employer be a complete premium they they are very generous employers. I would say there are certain companies as well. We’re offering this thing. So what are the mandates actually involved in this? so? They actually are very. flexible. in certain matters, but then there are limitations are for coverage amount or maybe duration.So and also once you move out of your job, your group cover will terminate and you can have two options either. You put your group plan to an individual plan. or you buy a separate individual plan as well, group plans and individual. Bands are drastically different group plan sometimes will not have a waiting period. and sometimes they will again those are the policies which are decided by the top management in consultation and obviously the there are various players and all all companies would want a bigger share of the pie. They are so.Employees or employees and guess who won who won who will mind the insurance from such companies so in group they get insured as a fixed amount for every individual and the. You have a public partnership program as they say of the Fifty-fifty Partnership program is there whereas the premium is shared or the employer only pays for individual you can pick and choose as per your choice and individual covers the only usually a single insurance so then waiting period most of the group policies will not have a waiting period for all the diseases and that is very, very strange.You might find it strange but yes, these are the. Writers which companies can do with when they’re offering a group plan to our organization like a hospital like a company like a factory or whatever so there, but then individual will always have a limitations starting from 30 days initially, then 24 to 36 to 48 months. so usually as I mentioned 30 days for the starting twenty-four and forty-eight for the preexisting diseases is the waiting period, but then usually this differs with the group insurance and only a few. Are a few pre existing ones have a waiting period and that on the lesser side, but that is the benefit so if you want to convert your group policy to a individual policy, you can benefit that you can benefit from the waiver of the waiting period. The only thing is that you have to put the policy to the same company the plan can be higher can be seen you can get.Waiver from that and then you’ll be covered of course if you opt for this thing, then your employer won’t be paying the premium you will have to pay the premium of course, but then this is a good risk that you can take if you want to change the hospital or the organization later on you can get the benefit of this waiting period so under the group it is less but otherwise they might not be a group but individual it is surely there so a few things that you need to keep in mind if you are reporting from group to individual. that. The convergence should be done to the same company so and then there is a time clause. Also for that, I’ll be mentioning that so conversion to be done within the same plan so you can convert from a group plan to an individual plan.Of course, you can enhance the limit in company you might be covered for two lacks in individual plan you want to you would want to be covered for five to ten las so whatever benefits you had in that policy, even for two las they will continue to exist. aware of the. Period of the waiting period. or maybe a good coverage ratio in that sense, maybe other benefits, which are associated all those benefits, which are offered to the corporate plan as I say will be transferred to the individual plan, but yes premium does change in that regard, but then if you’re getting such benefits paying a higher premium is absolutely justifiable. so you can’t change to another company and to change to an individual policy then. Conversion should not be more than 45 days later once you are recorded a group Insurance by your employer you need to understand the fine print and you can convert the same within 45 days of the same after 45 days the conversion will not be possible but then the third factor is medical testing may be required in many cases so make sure that you understand these things before you would want to put your group policy to our individual policy in any case any.A salary individual will not keep on working with the hospital or the organization for a limited time. There are only where ultimately you’ll shift to your private practice fully usually usually, but you need to understand these things that. Factor s that will cause you to change your policy to policy should be kept in mind so just compare for a normal policy. It is not a comparison. it is the normal comparison for a group Insurance preexisting usually come from day one in this case after 4 years in in most of the individual policies, the ability to make claim in first 30 days of the loading period. yes only in emergency cases like accidental coverage. so. For diseases waved off covered about 1224 3648 months depending upon the policy maternity benefits, especially female employees offered from day one generally not offered, and they also start after a minimum two to 3 years, sometimes even 4 years as well. so medical checkup before enrollment not required in a group plan, but yes, mandatory for over forty even if you’re going for a renewal of your driving lessons after forty, they will need you to a medical report from eye surgeon. Then co payment for people above sixty not required. because in private organizations the retirement age limit is 65 in some it is seventy as well.So it is not required. It is mostly required copay in an individual policy or even in a family floor plan, it may be required a copay would be required so relationship manager Yes, No. so so are the benefits comparison of group versus the individual plans. Lastly, the section for today is the health insurance for the disabled. Yes, disabled are also a part of our society and it is not about the physical disability. It is about the medical mental disability as well. so people are companies were hesitant a few years back to provide we don’t call them medically disabled anymore.We call them differently. abled, of course the terminology have now changed in India, but there are various myths associated with it. so let’s understand. Exactly are they if you remember the last session I mentioned congenital anomalies that might cause people to be differently abled. They are not actually covered by most of the companies so yes, a specific ad or any congenital disorder is not covered like disabilities from birth.If you are born with certain things like related to heart cerebral spinal bifida cystic fibrosis These are usually not covered by the company then disability. Accidents are surely covered if it is even a partial disability or a total disability. the fractured and impaired limb do fall into this category and they are usually covered a partial or complete blindness is also considered under this category The mental disability means any behavioral issues or psychiatric disorders So do you like this like the congenital diseases. These are also. considered high risk cases, so not all companies will have plans, but yes mental health insurance is a reality in today’s times and many. Companies are covering it if not under critical illness and hospitalization under the medical. they’re covered of course, they might not be considering it under the critical illness coverage so because these are the highest cases, which are known as the red flags to the company, so they are flagged as red, so they are not covered.They’re considered sometimes individual, but then if you have an accident and you sustain God forbid some form of disability those. Those people are actually covered under the health insurance plan and because accidentally disabled people are considered as normal people who because of a mishap landed up into this position so usually they provide them at no additional terms and conditions they would be considered the physically disabled people loss of limb loss of any even eyesight in any accident or due to any hazard or any professional haz. As well, they are considered normal individuals like a normal working individuals other because these are the fact that are no correlation to health. so they are. treated as normal people with no additional riders. to those individuals. So what are the eligibility factors Of course, the health status has to be taken into account for the last couple of months, or maybe a last quarter.So if you are suffering from any chronic illness, even the disabled people by accident have a chance of. Getting the policy claim rejected, then the second important factor is the earning of the family. people will look into the employment factor that where is the premium going to come from if you’re not going to pay your premium. Obviously, you won’t be having the coverage if the person is disabled, there is actually less chances of meeting their ends meet unless the spouse is also working or maybe the family has a any other fixed source of income so then because this is dependent directly to the premium. Capacity so they might ask you what the recent bank accounts or statements or any other ITR so that they can decide that what is your value in that regard? what you can actually pay so Pe as a premium to them. so there are some pointers again. Full disclosure has to be made you need to make sure that you do not fall on that account and non disclosure is that aspect, which you can’t really get away with complete information is mandatory because non disclosure in any. language is where the same is voluntary is. Considered as fraud and reflection IPC 420 so. if even if you see a company your claim is passed by mistake and and in an audit later on it is disclosed that you actually cheated on the company you will actually be liable to be treated under IPC proceedings as well. so then the restrictive clauses the underwriters are the ones who actually approve your policy They might issue you a policy but they issue with. A certain restrictive laws. your supplements they will add or the restrictions they will add accordingly, depending upon your complications so if patients are covered but you’ll find it strange to believe if it is a patient, it shouldn’t have had an attack in the past 10 years to be becoming eligible for epileptic for coverage and health insurance. if he doesn’t have an attack in the last 10 years, why would he be called an epileptic patient? then? Companies have their own rims and fancies for selecting such things, so you should be on regular medication for epilepsy, even if the patient is on regular medication, there are a good amount of chances that the person at least has one or two attacks in the 10 years period. so but then you need to disclose that history as well, The underwriters are the same policy moves will address all those things the medical risk factor and then take a call.That for the disability disabled person or differently, abled person so they allow it, but then a proposal acceptance or rejection is based on the discretion on the policy or the underwriters as they’re called. So if you have the full disclosure to facts they will have full privileges to determine the premium amount. so obviously then the policies come with the ATD tax benefit as well, like any other individual even the differently abled individuals can claim. a TD. Relief under the policies so there are different policies like a offers a good plan for different people even the government schemes like and. we will offer you good plans so check out all those factors and you can be actually these things the medical insurance can be medically and financially rewarding for you in case of a problem so next aspect is OP health insurance and this is.Where I finished today and I’ll be starting from this slide in the last concluding Part tomorrow and tomorrow we start at 730 in the evening for this session so again, it will be slightly longer section. so thank you so much for your patient hearing. so I hope you get the gist of today’s session and this is my YouTube channel health insurance videos will go online very soon as I told you so this is my social media presence you all are aware of it by now so my email address phone number and articles.Again online. for more articles coming to you to send me your feedback in the group and the book is in big welcome. Thank you so much once again and I stopped my shared for questions time and before the questions I would like. to add whatever you want to at that point of time. Here’s our. add whatever you want. I think you mentioned that the rumor and I think something you want to mention that. it is a very common in in every policy. the policy. that. and. exempted. or there is no room your room it. but it will. I’m going to post for example. the 1%. and this one is okay. normally I will. most of the. If the rumor you go to the hospital and you get you your policies, ten las and for, for example, the room rent is 1%. that would mean that you are having a limit of 10 thousand per day, usually for ICU this to the 2% per day Limited to that, For example, we are presuming the scenario so but if you have a certain hospitalization and the hospital is full and they say that the room for 10 thousand or up to 10 thousand is not available, you are having a only the VIP room, which is cost.12 thousand that is only available so you have no choice. you have to pick that room and what it means to say that whenever you. are going for the reimbursement or whatever it is or maybe whatever you have to pay above your cap that is the scenario. That means that you are sixteen to 17% if your bill is 12 thousand, you are being paid 10 thousand per day from the room, and that means approximately sixteen to 17% is being deducted. so and as he said this. To all the services that I actually added in my presentation as well that whenever the room rent is enhanced so obviously all the services associated with the medical charges, the doctor fees the visit fees the medicines and all those things are also added as additional cost in that so number one point he mentioned that number second point, he said that irrespective of however the way I’ve simplified the things it’ll still be very difficult for you to just pick up a policy.Even an agent would not be able to guide you properly because the agents will have a lot of sugary words to use whenever they have to choose a policy. but yes my work is to convey the basics. I could have done that easily in one sitting as well. Why I kept a session of one and a half hours tomorrow would be 2 hours in three periods. I’m I’m spending 5 hours in a session in a particular topic in today’s scenario and again fast.Video to YouTube for the benefit of all there must be some reason for it because I want you to understand and and as much as I can simplify, I’ve done that yes, companies will not find it even if they will not find it to do that. the third thing he mentioned that yes, sir before you jot down on the policy just take a print out of the same, which actually sometime what I believe sometimes might not be possible for you to take out the closets because many of the policies that customized. To your need but depending on your set of diseases, what do you hope for and your content would be the same so he suggested that yes, whatever you do you need it spend half an hour at least on it before you sign on the dotted line and whatever your premium you pay, then keep the print out of that in your record I discussed in the previous session, Yes record keeping for three 4 years is something mandatory. For example, I gave the example of Apollo Munich also last time, which was taken over by SD FCA. When I was taken over by his DC so if they are actually going in for that kind of a thing if the TPA is being changed, the third party administrator is being changed, you need to have the old documents preserved with you. You won’t be searching out your email at that time. you need to have the document and secured place that where you can actually make out. Yes, this is the contract between me and the company and no company can back out from that even if there is a case of a murderer.Hey, guys, DC a merger. FCA take over or acquisition of the Polo Munich in both the cases the IRDI guidelines says the individual contract has to be abided by the third party administrator, who is taking over that. so if you are Apollo Munich, maybe the SD FC is not having the same policy but those customers who were from Apollo Munich if they are getting the renewal done on time, they are.Those things on time they are not indulge in non disclosure of documents they will have to abide by the same contract by the third party administrator in that case. so. as a solution to this, even if you are not allowed to take a print out in the initial state before you sign the policy every policy as per II guidelines comes with a fifteen-day free looking period that I also mentioned in the previous day so you can return the policy without any. You’ll get the full return of the premium, including the GST as well Some some TPS that GST, but IA guideline is the whole amount is to be returned in the free period.So don’t worry about that part. so I hope everything or anything. okay great. So I hope Doctor Kane doctor Megan It is all clear to you whatever was spoken This. This is the thing actually so the room is definitely a writer but rumor. Aside, my take would be to decide the check out for the other supplements if there are associated with it, yes, the other supplements of as I mentioned the increase in the charges would be. that’s what we’re going to do.The comes free with the bride. So this comes free with the bridal of that if the rent is expensive, the other charges would be automatically expensive They might not be mentioned they might be mentioned the product would be there the proposed increase would be there that one line sometimes will not be you will not be able to decipher. So that is the reason I’m spending 5 hours plus I’ve I’ve not yet counted. question answer time to this 5 hours. If you add it is 6 hours so if it it is for your benefit only so if you still you can still at least gain 80% to 90% of the basics from this, yes, there are certain advanced things as well as also mentioned, but yes, if you cover these at least eighty to 90% of the basics Trust me.Will still be at a much better position than what you were a week back even if you have a policy, even if you had a policy so I hope the things should be clear. so I’m taking the question from the first and after that, you can ask me any questions if there are so doctor Bana can there be no payment option? Usually many young policies young individual policies individual policies will not have a co payment clause or have a very miniscule one 2% 5% also sometimes but usually. Clause is there in the senior citizen policies as I as a 20%, rarely twenty-five as you can offer even higher copay. But then as I said, give the example of ten las if it is you pay have the co payment at fifty to 60% out of ten las if you’re paying five to six tax, What is the benefit who’s him? you will get a deduction as their deductibles, then another thing than the limits may be there.Other supplements may be there if you’re getting this. Out of your policy, then what is the benefit of such a clause so keep a balance, but yes, it does exist for a senior citizen and is in a very miniscule thing for the youngsters, but then fifteen factors that is why the co payment was included as a policy. So thank you. Doctor. Thank you.If you need twenty-five coverage is advisable to take five basic coverage and twenty la top of Doctor Kane. The only thing is that sometimes in top up there might be certain diseases, which will not be covered The primary. Would be covered there will be only a $20 cover for the very uncommon ones, which might not be handy for you as well. So if you are hospitalized only the basic limit would be then looked at for those factors, which are covered in the prime day so having a top up might be a good thing.But then it acts as a floater limit only for a few things not for a complete coverage. So remember you have to keep this thing in mind. one more thing besides looking for a top up, it is always please also see. A super top up come in the health insurance, all a very less company provide the support of a type of plan but there is a lot of difference between the top and a topper. so before you go for a top up, always look for the top of what are the inclusion and what are the difference between both of them? Technically there is a difference between both of them in their functionality. so always look at the top of also. I have a brief section of top up and up top up in the third section, so I’ll I was already going to to take up that so don’t worry so is there an advantage of buying through an agent? The agent is a well-informed one Yes, but in today’s times, absolutely no no benefit of buying through an agent you actually buy and policy cheaper.You’re more aware you can make good comparisons and obviously if the agent is from your own family, you sometimes can’t say no also if you don’t like the policy. So that is a big drawback, also sometimes we I gave the example. I think you were not there in the group at that time, one of my uncles used to be in LIC and he got me an dormant plan and trust me one of those endowment plan just finished in 31. March and one will finish in 2026 and the coverage that I had was one lag in this plan and two likes in that plan, which is which was done in 2001 and 2005, respectively.So absolutely no use for those plans so in premium payment. 30 days break different from a month break. Usually a 30 days is a standard thing because the month can be $28 so the month can be twenty-one. also so to remove any kind of disparities to remove any kind of. assumption based thinking. this 30 days. February can be 2829 a month can be 31 January. March May August July. October and December can be thirty-one so to remove that it is a 30 day class to be very specific, Not exactly a month it can be less. Of course, we’re only one last month, but yes to any kind of confusion 30 days 30 days in that regard and whatever is mentioned in the policy it used to be the the company is usually followed their own vision and will I. they had a watchdog as I mentioned their watchdog is IRD they have they actually keep a tab on all these things and all these watchdogs have actually gotten more.In the recent five to 6 years, again, no credit or discredit to any government, but yes, this is the thing that has actually got more powerful in the recent years so that the companies don’t take the customers for a ride that is very important. so if you take the insurance in one city and need to get admitted in another city will there be any in claiming the hell? No absolutely not the network hospitals in India? There is no issue usually in that and if you go. Policy. But then sometimes a tear of city can decide your. that limiting so a minor difference again, 1050 percent of the total coverage would be there, but otherwise there should not be any issue in the claim Part and if it if you if that city which you are opting for does have the network hospital list then there should not be an issue. So how many times can we do portability As of now you can put once a year as of now, but these things can keep on changing how many times we can take a portable we can do at least once a year at the moment and while we in mobile industry and the industry we can put and then we have to be blocked for 6 months I guess in IRA guidelines it is for 1 year presently again.These things are subject to change, but it is 1 year so. Que What is my daughter is already there so he was trying to distract me. anyways. So in situation even the network hospitals are denying cash option. what to do Doctor Kane will be taking up separately in the next issue. Don’t worry next part tomorrow only I’ll be taking a COVID in there is no point in discussing a little bit about that. I’ll discuss everything in detail. Thank you. Thank you. More queries we call it today. So we take a break for today and those who want to attend the casting and the gross profit margin tomorrow be there at 630 in the morning, I’ll be starting half an hour early because tomorrow morning is also going to be slightly longest session. so I’m starting a half an hour early and tomorrow evening Health insurance part three last part again we’ll be starting half an hour early at 7:30 PM. It’s already mentioned in the group so have a good night have a good sleep and surely do put in your feedback in.Whatever you have if there are any learnings from today, surely do it so thank you for your input I really appreciate it. Okay take care Bye See you in the morning? Yes sir.

Related posts

Leave a Reply

Your email address will not be published.