Buy a health cover with entry level sum assured for planned checkups

Published in Mint on Dec 27 2016, Written by Abhishek Bondia

 

he area that I live in has a few hospitals but none of them are empanelled by the Central Government Health Scheme (CGHS). I am a central government employee. Will it be better for me to buy a health insurance policy?

—Renu Tandon

For a serving central government employee, CGHS allows emergency treatment in any hospital. Expenses could be later filed for reimbursement subject to CGHS rates and entitlements. But the same facility is not available for planned treatments.

I recommend buying a private health insurance policy to cover hospitalisation expenses. Go for an entry level sum assured, say, Rs5 lakh. This will be sufficient to cover minor surgeries and common hospitalisation cases. For complex and advanced treatments, you can travel to a nearby city with CGHS facilities.

The apartment block I live in is insured. The premium is paid regularly. Should I also insure my house separately? Will that serve a purpose or will I end up paying for nothing?

—Mukta

It is now common for resident welfare associations (RWAs) to take a common insurance policy to secure the structure for all apartments. You don’t need to take a separate insurance in such a case. However, RWAs are unable to insure contents inside the apartment. I recommend you take a home insurance policy to secure contents such as furniture and fixtures.

The only other reason you would want to buy a separate home insurance policy is to insure the apartment on agreed value basis. Under this arrangement, if post-damage reconstruction is not possible, you could surrender the title of the property to the insurer and claim full registry value of the house. Typically, RWAs insure apartments only for the reconstruction cost of the structure.

My daughter is autistic. I have been trying to buy some type of health insurance that will provide some cover to her, even if it’s small. I have not been able to find such a policy. Please advice.
—Paresh Seth

Unfortunately, insurers are reluctant to issue individual health insurance policies to persons with autism. You can insure your daughter via group insurance policies. Group policies are guaranteed issue to all members. Employer funded group policies are most common.

A few NGOs also buy health insurance for their members.

What is insured declared value? How does it factor in a car insurance?

—Viji Thomas

Insured declared value (IDV) is the effective sum assured for car insurance. In case of total loss of the car, such as theft, insurer’s liability is limited to the IDV. This value is arrived at by deducting depreciation from the original cost price of the car. Premiums for car insurance are directly linked to IDV.

Which diseases are classified as congenital? Are these covered in health insurance policies?

—Shahir Quli

A congenital disease is a condition, which is present since birth. These are further categorised as internal and external congenital diseases. Anomalies that are in the visible and accessible parts of the body are classified as external, and vice-versa.

Congenital heart defects are common forms of internal congenital diseases. Extra skin is a common form of external congenital anomalies.

Congenital diseases, both external and internal, are part of permanent exclusion list for most individual health insurance policies.

Most group health insurance policies cover internal congenital diseases, but exclude external congenital diseases.

What is AOA limit in a policy?

—Rohan Gandhi

AOA stands for Any One Accident. This is a limit put in the policy to restrict the amount of sum insured that can be claimed out of a single incident.

This limit can be expressed as a ratio to the overall sum assured. For example, AOA:AOY is 1:4, where AOY stands for Any One Year. This will mean that only 25% of the annual sum assured can be used in a single claim. Or, it can be expressed in terms of absolute amount. So, if AOA is 25 lakh, then that is the maximum admissible claim amount for one claim, even if the sum assured is Rs5 crore.

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