A New Generation Health Plan

Health Insurance Plans in India never witnessed such a wide variety of products as it has been in the last few years. The Health Insurance companies are queuing up in India to tap an unexplored market which has not been exploited especially when the country lacks social security schemes by government. The recent implementation of Ayushman Bharat Health Scheme by PM Narendra Modi caters to BPL category of population. It’s  astonishing to learn that only around 4 % population of India has a Health Insurance cover which means only 5 crore citizens of this huge country which has 2^nd largest population in the world. As per the latest data of National Health Profile (NHP) 35 crore Health policies are active which would mean India’s 135 crore people, 100 crore of PAN nos. are coverless. This is what the Insurance industry is targeting on the potential of the market when the medical cost is increasing by 10 to 15 % p.a. And it is becoming inevitable to have just not a plan but right Health Insurance plan to secure oneself. It is important that one should understand his current health plan, if you have one, and make comparison with the plans available in the market. The old plans especially which were bought over a decade ago are Old Generation Plan. The plans have a major handicap of room rent and ICU room rent capping. This means that as one gets hospitalised the room rent is capped to 1 % of Sum Assured (SA). For example you have SA of Rs. 3lakh , you are entitled for a room costing Rs. 3,000 /-  per day and should you opt a single room in any of South Delhi’s swanky hospitals where room rent is around Rs. 12000/-. You would be entitled to around 1/4^th of the total bill (assuming bill is Rs. 2 Lakh you would be paid Rs.50, 000 approx and rest is borne by you).This actually comes as rude shock as one might not be prepared for such kind of shock while he has been paying premium for his policy for over a decade and was under wrong impression of having a policy of Rs. 3 lakh SA. Thus it’s important to understand your policy which could have limitation built in which you were never aware of, till you put your policy to use in a dire situation. Please see below chart for understanding the comparison between Old and New generation health plans:

Features Comparison:-

Plan Benefits	Old Generation Plan	New Generation Plan
Pre-hospitalization	upto 30 days	upto 60 days
Post-hospitalization	upto 60 days	upto 180 days
Room Rent Capping	Capping on room rent (1% of SI per day) and ICU  Charges (2% of SI per day)	No room rent capping
Domiciliary Treatment	Not Covered	Covered
Organ Donor Expenses	Not Covered	Covered
Daily Cash for choosing shared Accomodation	Not Covered	Minimum upto Rs. 800 / day and Maximum upto Rs. 6000 / day
Health Check-up	Once in every 4 continuous claim free years	Annually for SI 10 lakh and above and once in 2 years for SI 5 lakh
Pre-existing diseases coverage	Covered after a continuous renewal of 4 years	Covered after a continuous renewal of 3 years
E - Opinion	NA	Available in case of Critical Illness
Restore benefit	NA	Equal to 100% of Basic Sum Insured
Cumulative Bonus	NA	10 to 50 % every claim free year upto 100%

Old Generation Plan
Family Size : 2 A + 2 C
Age Band	Sum Insured	Premium (Rs.)
36 - 45 years	5 Lakh	14,533 /-
	10 Lakh	20,400 /-

New Generation Plan
Family Size : 2 A + 2 C
Age Band	Sum Insured	Premium (Rs.)
36 - 45 years	5 Lakh	19,226 /-
	10 Lakh	24,559 /-

                       

                                   
As per new ruling one can get his old policy ported to new policy of any other company. It works similar to your Motor policy as you can exercise portability rights by changing at the renewal of the policy. However, this process has some conditions such as no medical adversity of insured, claim free policy in last 3 years. Need to submit the proposal 45 days before the renewal date to insurance company for underwriting the risk. However once it gets ported i.e. policy gets transferred with all old benefits in the new policy, exercise your right that’s available lest you caught in situation which affects your financial planning.