For group health insurance you need to cover 10 lives

Published in Mint on, Jun 04 2013, Written by Kapil Mehta

I am 53 years old and self employed. Is it possible to take group health insurance?
—Jagadish CA

There are two requirements that you will need to fulfil to buy group health insurance. First, you need to cover at least 10 lives. Second, the lives covered must be your employees or their families. Generally, the larger the group, lower is the price per person. If you want to cover just yourself or your immediate family through group insurance that is not possible. If you are able to form an eligible group, then make sure you get the full benefit of group insurance by waiving off the waiting period for pre-existing diseases and also removing disease-wise caps or room cost sub-limits.

Could you tell me if excimer laser surgery for cataract is covered in health insurance policies?
—Anil Wilfred

A cataract surgery consists of several steps. In excimer laser surgery a few of the steps are performed using an excimer laser. So, hospitals typically price the entire procedure as the cost of regular cataract surgery plus the cost of using the laser. Laser costs can be high—between Rs.50,000 and Rs.1 lakh—whereas the standard cataract costs less than Rs.50,000. Insurers will pay you for the standard cataract packages but not the additional cost of using the excimer laser. Since cataract is a planned surgery, most insurers prevent the risk of people buying insurance just to pay for surgery by having a two-year or a higher waiting period for cataract. Additionally, since cataract costs vary significantly by hospital and procedure, insurers will often put a maximum limit on cataract costs.

I am 56 years old. I have been diagnosed with diabetes. I have contacted a few private insurers but they have declined to give me a health insurance policy. I need a health policy for about Rs.10-15 lakh. Could you tell me how I should go about it? At the moment I have a health policy of Rs.3 lakh, which I had taken 6-7 years ago and I am yet to take a claim for it.
—J Mukherjee

Over the past one or two years, I have seen insurers becoming more comfortable and sophisticated in insuring diabetics. Generally most insurers will cover non-insulin dependent diabetes with a caveat that diabetes related diseases are excluded from coverage for a certain period. Cover for insulin-dependent diabetics is much harder but not impossible. There are one or two insurers who could offer you Rs.15 lakh insurance even if you are insulin dependent. You could also purchase more than one insurance but of lower value. Insulin-dependent diabetics should work with a good health insurance adviser to understand their options. Do retain your current policy until the waiting periods in your new insurance are completed.
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