It’s hard to get insured for an ailment after it’s diagnosed

Published in Mint on, Apr 23 2013, Written by Kapil Mehta

I am a patient of paralysis. I want to buy a health insurance. Is paralysis covered under pre-existing diseases? If not, what are my options?
—SP

It is hard to buy insurance for an ailment after it is diagnosed. Existing paralysis will be considered a pre-existing disease. Your best option is to be covered by group medical insurance. Waiting periods for pre-existing diseases are routinely waived off in such insurance covers.
The other option is to buy individual health insurance with sub-limits, co-pay and a short exclusion period for pre-existing diseases. Some insurers offer these products where the maximum sum assured is limited to Rs.2-3 lakh, a co-pay of 30% or more is levied and pre-existing diseases are excluded only for a year or so.
Medication, physiotherapy and home care form a large part of the costs in treating paralysis. You may want to consider subscribing to the medical discount cards that many healthcare companies have introduced. These cards give discounts on out-patient department and pharmacy expenses as well as access to specialists or general medicine advice.

I am 38 years old, my wife is 35 and our daughter is 10. My wife suffered an epileptic bout once. How much health cover should I take for my family?
—Arihant

If you live in a metro city, I would suggest a cover of at least Rs.1.5 lakh per person. This means your family should have a Rs.4.5-5 lakh family floater cover, which will cost Rs.10,000-13,000 per year. The rationale for this cover is that serious ailments can cost up to Rs.1 lakh or more. Medical costs are increasing by 15-20% each year and you must factor that into the sum assured that you select.
If you are in a smaller city, then a family floater of Rs.3-4 lakh may be sufficient since healthcare costs are lower there. A few companies offer cheaper rates if you reside in smaller cities.

Will property insurance pay for damage due to seepage?
—Bakshi

Like most things in insurance, the answer is: it depends. The key determinant is what caused the seepage? If the cause was external such as storm, flooding, bursting of pipes then the costs of repair will be covered. However, if seepage occurred because of a design flaw or poor quality of construction or routine wear and tear, then that will not be covered.

I am 52 years old and my wife is 45. We want a cover of Rs.5 lakh. Will family floater be better or an individual policy each?
—Vipin

You may find it more economical to purchase independent health covers rather than a family floater. Insurers normally link the pricing of a family floater plan to the age of the eldest person in the family. If the spouse is relatively younger or children small then individual policies are cheaper for the same amount of cover.

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