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Why One Needs Health Insurance with High-risk Cover

"There are worst things in life than death." – Woody Allen

Certainly agreed!

When life is a myriad of uncertainties, there is no other option but to be prepared. Due to the rush of our daily lives, we often tend to ignore our health and end up regretting it in the future. Your life insurance policy ensures the financial protection of the family in case of your accidental demise. But what if you are diagnosed with a life-threatening illness? This spine-chilling truth is hard to accept.

Since buying health insurance is difficult and no medical insurance plans offer any coverage for high-risk category ailments, we’ve analysed a few of such complex situations to find the best solution for you.

Smoking Threats

Manoj Kumar, 32, from Mumbai, a cigar addicted, was unaware of the fact that smoking may increase health insurance premium. While looking for the best health insurance India, he chose an online comparison tool to compare plans and simply opted for a health insurance provided by a private insurer.

During the span of his policy, Manoj came to know that the plan he just bought also covers smoking habits. The only condition is that he would be required to undergo a medical check-up for which an extra charge will be levied on him. To avoid this, he can either buy another plan from separate insurers who may not ask for any test even if the smoking option is ticked in the application form or he can go for the test by sticking to his existing insurer. Bear in mind the fact that these insurance plans are highly priced.

It is true that not every health insurance company has stringent terms and conditions regarding smoking or tobacco. The main concern is whether the applicant has any serious health conditions. If the report says ‘NO’, he/she is covered. However, the best health insurance India, offered by companies such as Bajaj Allianz, Apollo Munich, ICICI Lombard etc. have a higher premium for smokers.

Regardless of the insurer, you must speak the truth in case you have any smoking history. This is mandatory, because if you fall sick and the medical report indicates the key reason is smoking, the insurance company may reject your claim based on this solid reason. Also, the insurer will judge the claim based on certain areas such as frequency and amount of tobacco consumption, the means of consumption - chewing tobacco or smoking, - or and how long you were addicted.

If the claimant decides to get rid of the habit, in some cases, the insurance company may not ask for an extra charge and will consider him a non-smoker after a couple of years. But if one intends to quit for a medical reason, then the insurance company will be cautious.

Coming back to Manoj, although he wished to skip it, but the insurer insisted. He was convinced to purchase a critical illness plan that covers ailments related to smoking. Since he was young enough and didn’t have a history of any chronic ailment, getting a health cover was easy for him.

This is why one should undergo a health check-up to avoid complications during a claim; even if the insurer doesn’t require so.

Ill Health

Like most of us, Chennai based civil engineer, Vishwanathan, 42, didn’t consider purchasing a health insurance policy until Vishwanathan was detected with hypertension. By this age, he had limited options left. Insurance companies with affordably priced policies either denied to cover him or offered policies that didn’t cover Vishwanathan's condition. On the other hand, others agreed to give him policies on slightly higher premiums or urged him to serve the waiting period of 3 to 4 years for a pre-existing condition. While the insurance plans that could cover him from the first day had sky-high premium.

Being the breadwinner of his family, Vishwanathan had limited resources. However, he was a member of his employer’s group mediclaim plan of Rs. 2 lakhs. But, it didn’t serve his requirement. His physician advised that if Vishwanathan’s condition wasn’t urgently covered, a health emergency could wipe out all his saving and pose a financial hardship for his family.

While consulting with a private insurance company, the adviser suggested a health plan with a waiting period of three years, to him and also, as an alternate solution, advised Vishwanathan to purchase a critical illness plan. He mentioned while convincing him that hypertension can be the reason for heart damage, kidney, and brain failure and can adversely affect your eyesight. Hence, it is to have a critical illness policy, though, you need to pay a higher premium.

Luckily, Vishwanathan's condition wasn’t very risky or similar to a chronic disease like heart disease or diabetes. There are cases where insurers refuse to cover diabetes and heart patients, and register cases of hypertension with a higher loading. Now-a-days, insurers design health insurance policies dedicated to cardiac or diabetes-related illnesses, which are easily available and affordable as well. For instance, Star Health's Cardiac Care and Diabetes Safe are plans that cover people with a pre-existing medical condition.

Adding Top-up is Wise

With goal of cost-cutting, some employers have either limited the benefits on the coverage for parents, or permanently withdrawn the benefit. If that happens to you as well, consider availing a top-up cover with lifelong renewal.

Top-up cover is a rider for people with an individual health plan or mediclaim policy. While a normal health insurance compensates the medical expenses up to the defined sum insured, a top-up policy covers expenses after a decided threshold is met. The best part is that it is affordable, if compared to an indemnity plan, as the deductibles are higher for similar benefits. It is beneficial to cover the excessive expenditure arising due to a single disease beyond which the existing health plan doesn’t cover you.

Some insurance companies offer coverage for parents under a family floater plan, which costs less than a separate senior citizen plan. In a family floater, all member equally share the kitty, i.e.- the sum insured. But there is a kick! Adding your parents at a younger age make sense. But once you enter the age of 45, and are heading to retirement as well, sharing the sum insured with others is risky. This way one may be left with lesser cover. While healthcare costs are skyrocketing the offered policy cover may not be help you, unless you have a health cover of Rs. 10 lakh or so.

Also, one should not depend only on their employers’ group insurance, under which the terms and conditions keep changing. Also, there is no surety about how long you will be with the same organisation. Hence, get an individual health cover for your parents, regardless of if you buy it at a higher price or with co-pays or sub-limits.

Playing smartly, you can avoid paying a bomb. For instance, your elderly parents need a cover of Rs. 8 lakhs. Now, you should keep the regular health plan’s sum insured low, like at Rs. 2 or Rs. 3 lakhs, where the annual premium will cost you around 15,000. And, add an additional top-up cover of 5 lakh including a deductible same as the agreed sum insured of the regular health plan or simply buy a critical illness plan that covers your parents for high-risk illnesses. Apart from giving coverage for the major listed ailments, it offers lump-sum monetary benefits for surgeries as well. The benefits, however, may vary from insurer to insurer.

Add-ons at an Early Age

It is beneficial to buy add-on covers while you’re still in your youth. Subhansh, 30, realised this only when his existing health cover of Rs 2 lakh, that he’d bought seemed insufficient when Subhansh’s father endured medical treatment for heart blockage. He realised why he needed bigger health cover to meet the expenses.

Even if you wish, renewing insurance policy with a greater sum insured than your current one, after a claim is difficult, when you reach the age of 45 or more. Even if the insurance company agrees, a rigid medical check-up is required again, and your premium and loading will rise as well.

Subhansh was advised to take a top-up cover of Rs. 10,00,000 (lakh) from Star Health insurance providers for his parents. He decided to keep the deductible limit at Rs. 3 lakh so that whenever the base policy cover is over-used, the add-on cover can be used. Unfortunately, he took this decision late, otherwise he could have availed of this plan at a much cheaper price. Now, as his father was diagnosed with heart disease, the insurer will issue a highly priced plan based on pre-existing condition and again, he will be covered for pre-existing conditions after serving a decided waiting period. He left with no options.

To Summarise

Lifestyle diseases have become very common these days. The increasing level of pollution or our eating habits can be the reason that one needs an adequate health cover to avoid unplanned expenses.

Speaking of other factors, smoking comes with health risks like lung cancer, heart disease or respiratory issues. Whether you are a chain smoker or occasional smoker, remember, this will affect your health somehow and this habit can cost you with regard to your insurance premium as well. Owing to the risk involved, there is no wonder you pay a higher premium for your critical illness plan.

If you have, already, purchased a critical illness insurance plan under a smoker’s premium category and you are determined to stop smoking, you can check with the insurer if your premium could be minimised. Consult with your insurer before taking a decision because expert advice always helps.