Is a 10 Lakh Health Insurance Adequate in Your City?

An ongoing medical inflation of 14 percent in India (the highest in Asia) requires an all-inclusive health insurance plan to pay for exorbitant hospitalization expenses. The health insurance coverage amount that one needs also depends on the person’s healthcare needs, financial circumstances, and lifestyle.

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      According to financial experts, a sum insured of Rs 10 lakh is the minimum that one needs and it can go as high as Rs. 1 Crore. This article will analyze if medical insurance plans worth Rs 10 lakh can offer adequate protection during medical emergencies.

      Cost of Medical Treatments

      Hospitalization expenses these days are no longer discretionary. For example, an open heart surgery can foot a bill of Rs 10-20 Lakhs in Tier-1 cities, and the treatment for topical diseases such as typhoid, dengue, etc. that require hospital admission can also be expensive. Therefore, finding a health insurance plan that offers adequate coverage without digging into your savings is wiser.

      Estimated Premiums for a Rs 10 Lakh Health Insurance Plan

      The following table is a helpful guide to understanding the estimated premium amount you will need to pay for a health insurance plan worth Rs 10 lakhs. However, the monthly premium amount will also be decided based on the tier of the city. Honestly, there is not much difference in the premium of both.

      The premium for the Care Classic health plan is Rs 4031 per month for a sum insured of Rs 10 lakh to Rs 25 lakh. Whereas the premium for the Care Advantage health plan worth Rs 1 Crore is nearly Rs 6000/month. The premium can also be calculated online using a health insurance premium calculator online:

      Health Insurance Plan Name Monthly Premium Amount (Approx.)
      Aditya Birla Activ One Plan Rs 674
      Bajaj Allianz Individual Health Guard – Gold Rs 925
      Chola MS Flexi Health Rs 663
      HDFC ERGO Optima Secure Rs 1093
      Iffco Tokio Individual Health Protector Rs 785
      New India Assurance Yuva Bharat Gold Rs 705
      Niva Bupa Aspire Gold Rs 799
      Raheja QBE Health QuBe Basic Rs 325
      Reliance General Health Gain Rs 633
      Royal Sundaram Lifeline Supreme Rs 592
      SBI General Arogya Supreme Rs 769
      Star Health Smart Health Pro Rs 557
      Tata AIG Medicare Premier Rs 1139

      *The premium amount is based on the requirements of a 21-year-old with a single health insurance cover of Rs 10 lakh. The premium amount will change depending on the number of add-ons, riders, and top-ups taken along with the health insurance plan.

      Reasons to Purchase a Rs 10 lakh Health Insurance Plan

      1. Coverage for Sudden Ailments/Critical Illnesses

        The hospitalization expenses for critical health issues, like cardiac issues, cancer or stroke, or other chronic conditions, can be paid with a Rs 10 lakh medical insurance plan. However, if you choose a health plan lower than Rs 10 lakh, it is necessary to ensure it covers all the critical illnesses mentioned above.

      2. Coverage for Hereditary Illnesses

        Health conditions like diabetes, anaemia, or cardiac diseases can develop due to your family’s medical history. When choosing a health plan of Rs 10 lakh, it is necessary to consider your family’s medical history. It will help ensure that any sudden expenses due to health emergencies can be covered with the help of the Rs 10 lakh health insurance.

      3. Expensive Medical Treatment Cover

        Health emergencies, such as pneumonia, kidney ailments, and cardiovascular issues can necessitate an expensive procedure like bypass surgery. In such a situation, checking if the health plan worth Rs 10 lakh would provide financial protection becomes crucial. The sum insured should be enough to ensure financial security for expensive medical treatment like bypass surgery at your preferred hospital.

        You may also like to read - Critical Illness Insurance

      4. Healthy Cover for Elderly Family Members

        The family's average age is another crucial reason to purchase a health plan worth Rs 10 lakh. Ensuring that the senior family member is included in the insurance plan will ensure that any undiagnosed illness can be covered. Therefore, before purchasing a health insurance plan worth Rs 10 lakh, it is necessary to ensure that the oldest family member is included in the health plan.

        You may also like to read - Senior Citizen Health Insurance Plan

      5. Option of Multiple Network Hospitals

        Every insurer provides a list of empanelled hospitals in the policy wording. A proper reading of the policy documents will help in getting to know about the empanelled hospitals of the policy provider. The document also provides information regarding any cashless treatments available under the health plan. In addition, the policyholder can also determine the amount required for them to recover from the illness or accident they have faced.

      Enhancing Coverage with Super Top-up and Top-up Health Plans

      It is easy to boost health insurance coverage with Super top-up and top-up health plans without raising the cost of the overall premium. The only difference is how these plans work:

      Most people today buy a health cover of at least Rs 10 lakh, but that also might not suffice in a big emergency.

      To enhance it, you can get a separate health policy, which will roughly cost Rs 15,000 a year, or upgrade the plan by Rs 10 lakh. Both are Expensive options. Meanwhile, a super top-up plan for Rs 10 lakh will cost just Rs 6000 annually.

      Two things that most policyholders get to know at the time of claim –

      1. If you have a super top-up cover of Rs 10 lakh and there is hospitalization twice in a year with bills of Rs 7.5 lakh and Rs 7 lakh, respectively, the super top-up plan will not be triggered.
      2. Simply put, in case of hospitalization, once you have exhausted your limit of Rs 10 lakh, the claim amount over and above will be settled by your super top-up health plan.

      High deductibles can exist, and a super top-up plan usually covers single-incidence hospitalization. Moreover, if your hospital bill exceeds the deductible during a single hospitalization, then only a top-up plan will come into the picture

      So, Super Top-up offers continuous health insurance coverage for multiple hospitalizations, while Top-up covers single hospitalization expense that is over and above the deductible.

      Takeaway

      It is becoming difficult to bear the cost of medical treatments in India amid the increasing cost of healthcare expenses. Is a health insurance cover of Rs 10 lakh enough? As mentioned above, you need to ascertain your requirements based on your income, existing health conditions, and the coverage required for your family. Your medical insurance might suffice today, but in the future, the requirement can increase further. Therefore, it is imperative to have a health insurance plan that caters to both current and future medical needs.

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      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

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      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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