Zone-wise premiums, consumables cover now available in health insurance

While policies with more robust features are becoming available, subscribers should watch out for sub-limits and caps.

Care Health Insurance has launched a policy called Care Classic, which charges a lower premium from people belonging to non-metros. Over years, insurers have come out with policies offering better benefits. Customers having older products should consider porting to them to enjoy the benefits of these features.

Differential-based premium

In Care Classic, people belonging to non-metros will pay a lower premium. “People who live in smaller towns on average incur lower health care costs and hence merit a lower premium,” says Ajay Shah, director and head-retail business, Care Health Insurance.  

Such products offering zone-wise differentiated premiums were available earlier also. But when a patient from a lower zone went for treatment to a hospital in a higher zone, he had to co-pay, that is, bear a portion of the hospital bill. “The benefits are exactly the same for people residing in metros and non-metros. Non-metro customers will not have to co-pay when they go to a metro hospital for treatment of a major ailment,” adds Shah.

Improved features

With the availability of more data, insurers have become better equipped to cover risks. “Earlier, if a customer had a stent implanted or a lady had undergone hysterectomy, they would have difficulty in getting a cover. But now, with improvements in underwriting, insurers are willing to cover such cases,” says Kapil Mehta, co-founder and managing director, Secure Now Insurance Broker.

During the Covid pandemic, people realised that their health policies did not cover the cost of consumables. They had to shell out hefty sums from their pockets. “Now, some companies offer plans that cover the cost of consumables fully,” says Abhishek Misra, chief executive officer (CEO) and principal officer, Bonanza Insurance Broker.

The Restore feature has been around for many years. But insurers have made it more effective in recent times. “Earlier, if you were hospitalised for one ailment and used up the entire sum insured, you would get the benefit of Restore only for another disease. Now, many insurers offer the benefit of the restored sum insured for the same disease also,” says Mehta. Nowadays, this benefit is also available to the same person who exhausted the initial sum insured (earlier, only other family members could avail of it).

Policies with high sum insured now cover customers if they go abroad for treatment. Many policies now offer the benefit of cashless OPD (outpatient department) treatment. This week Bajaj General Insurance launched the Health Prime rider, which for a small additional premium, offers customers four benefits: tele-consultation, investigations, doctor consultation, and annual health check-up.

Many policies nowadays reward customers for staying fit. “Customers are asked to download an app that tracks their activities. If they perform certain levels of physical activity, they are given a discount on next year’s premium,” says Mishra.

Things to watch out for  

Make sure that the waiting period on pre-existing diseases does not exceed two years. Avoid policies that come with room rent and intensive care unit (ICU) capping. Senior citizens should avoid policies with co-pay or ensure it doesn’t exceed 10 per cent.

In recent times, many policies have begun to impose other sub-limits. “There could be a sub-limit for robotic procedures, treatment of mental health issues, and so on. Such sub-limits have become more common in the past couple of years. Watch out for them,” says Mehta.

Finally, customers relying on non-employer group insurance health policies should beware, even though they are relatively inexpensive. “Such policies could be shut down at any point. For older customers buying another cover then becomes a problem. Sometimes, there is a steep hike in the premiums of these policies,” says Amit Chhabra, head-health business, Policybazaar.com. He suggests that customers rely on a retail health insurance policy. These come with the promise of life-long renewal and insurers have to seek the regulator’s permission for a large premium hike.

 The issue with free annual health checkups

• When a policy offers free annual health check-up, dig into the details of which specific checkups are being offered

•  Often, the checkups are very basic and are inadequate for people in their forties and above  

• PSA (prostate antigen) test, essential for detecting prostate cancer, for instance, is often not included

• People opting for these free annual health checkups may feel they are safe as they have undergone an annual examination

• Actually, they may be falsely complacent: There were several other tests they should have undergone but didn’t