Is your Corporate Health Insurance Adequate for you and your Family? A Reality Check. - Dr. Ashok Chandran, [email protected]

Your Company Group Health Insurance Cover may no more be adequate for you and your family’s health and financial protection. Here is a reality check for all employees.

While all Mediclaim policies help you in some way, not having the right and adequate policy cover is as good as not having a cover.

Most youngsters today bank on their company Insurance Policy for taking care of their family’s’ and their own Health Insurance needs. However most employees never go through the policy kit unless there is an emergency; In the current times the Group Mediclaim Policy almost always throws a shocking reality at them when they need it the most. During these tough times you not only need to keep your policy documents handy, but you should also know the exact coverage and wordings of the policy.

Irrespective of whether you work in an office, a factory, for a large multinational company or for a small entrepreneur you need to know what you are covered for, to be prepared and to avoid a last minute crisis.

Check out the points below to understand your reality and ensure that you and your family are covered adequately with the best personal comprehensive health Insurance policy.

1) Health Inflation/costs is almost doubling every 5 years. 5 years back the surgery that cost Rs. 2.5 Lac today costs more than Rs. 5 Lacs. Today's treatment/surgery that costs Rs. 5 Lac will cost more than Rs. 10 Lac after 5 years.

2) The cost of ICU is around Rs. 1 Lac per day in many good hospitals. For a single incident like covid or a major surgery a patient may sometimes require around 5-7 days of ICU care and 3-4 days of normal room; this itself will cost around Rs. 7 to 10 Lacs. And if multiple members of the family get affected then the total cost to the family can be exorbitant and unbearable without a good and adequate Insurance cover.

3) The Pandemic has increased cost of every treatment as the risks of infection is very high. Safety Procedures and compliances in the hospital and need for disposing equipment’s and PPE kits after every treatment has increased costs exponentially.

4) Company Insurance cover in most cases are for their own compliance and legal requirements or part of a limited employee benefit program, and may not fulfill your real Health Insurance requirements.

5) You may not need it now when you are healthy, but with age if your health deteriorates you will never be able to get an Insurance, even by paying more money.

6) You may not be employed with the company forever, it will be difficult to get a policy of a good value at a later part of your life. These are tough times jobs are uncertain, also as we progress in life we will move on to other companies or entrepreneurship. Each company has its own kind of mediclaim policy and many companies irrespective of being big or small do not have any such scheme at all. Many companies also do not cover pre-existing diseases or declined risks from day one of your entry in to an organization.

7) Do not procrastinate once you decide to do something important in life. If you can afford it now and have money now, just do it now, you may not have ready money later and your health situation may also not be in your favor.

8) No increase in Sum Insured will be possible ever, in case of unexpected Critical Illness involving huge costs.

9) Insurance can be difficult and will not be possible atleast for 6 months if you are detected Corona positive and even if you have got treated successfully.

10) Companies normally offer the least cost Group Mediclaim with minimal features with coverage of a few lacs per person. It may sometimes not cover all members of the family especially your parents. The coverage may also put limits to the room rent and a cap on different treatments, limiting your options for treatment.

11) You need to check if your policy covers you in a cashless mode in the hospitals near your office and home and has a good network in India.

12) You need choice of good treatments, doctors and hospitals with all facilities and specialities for your precious family, and not just basic healthcare from a local nursing home.

13) Major surgeries and organ transplants involve huge costs and may be needed any time for anyone.

14) You get your tax benefit under Sec 80D in your Income Tax if you pay for yourself, family and parents directly.

15) Even some of the Government BPL/Subsidy schemes offer more than Rs. 3 Lacs cover and this kind of value is definitely not for all and will not serve your requirements.

16) The flagship product of Star Health, the market leader in this space in India, is the most selling and popular Comprehensive Health Insurance, which covers you for Rs. 1 Crore; High sum insured is the new normal.

17) Your savings and financial goals in life will be jeopardized at one go in case of a medical emergency, if you are not adequately covered, and can cause hardships, lack of good treatment, debts and loss of peace and happiness to the family forever.

18) In case of your own policy you have the choice to increase the sum insured or port it to a new scheme or to port it to a new insurer, and get the best and adequate insurance for yourself and your family, however in case of group mediclaim such flexibility of porting to the best and adequate solution will not be possible.

19) Worldwide there is increase in life expectancy, the need for a good and adequate Health Insurance is highest post retirement. All corporate medical insurance facilities end with your retirement. It is very difficult to get the best medical cover especially when you are over 65 years old as all insurers have an upper limit for entry in to their comprehensive policy; As some or the other ailment/disease comes in due to old age, the insurance is declined in many cases where the senior citizen needs it the most. Also if a new policy is issued to senior citizens the sum insured will be limited and there will be many limits and co-pay applicable under such special insurance products for seniors.

20) Post retirement life is for peace and happy living with spouse, kids and grandchildren. If you have an adequate Health cover of your own, right from your healthy young age, it will continue to serve you; It will take away the financial burden of health emergency not only from your retirement funds/corpus but also from your family’s savings. You will not only be financially independent but will also be able to give yourself and your spouse the best treatment during your old age.   

Wishing you Good Health and Happiness at all times. Stay Safe, Stay Protected, Stay Insured!

Dr. Ashok Chandran is a Health Insurance Specialist and runs his own Wealth Advisory (www.ac.co.in), he can be reached on [email protected]

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