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HEALTH INSURANCE

Health Insurance options for Heart Patients in India

Aniket Thakker Aniket Thakker 07 December 2015

The incidence of heart related ailments is on the rise in India. As per statics show, more and more people are falling prey to the demon called Cardiovascular Disease or in common tongue, heart disease.

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The International Journal of Scientific and Research Publications, Volume 3 gives the following data showing the incidence of cardiovascular diseases in India over a decade.

Shocking, isn’t it? The numbers have almost doubled and what’s more distressing is the fact that even the young are not spared from an ailment believed to affect middle to old aged people. But you should not get disheartened. Realizing the burden of heart diseases, health insurers have come to the aid of the common man.

Star Health Insurance Company has launched a plan called Star Cardiac Care Insurance Plan to cover patients suffering from heart diseases. The plan is a comprehensive plan for individuals who have undergone Angioplasty or Heart Bypass Surgery once prior to applying for the plan.

Let us understand all about Star Cardiac Care Insurance policy better with all its features:

• Variants –

The plan has two variants of Gold and Silver. The Gold and the Silver Plan options offer Rs.3 lakhs and Rs.4 lakhs worth of coverage with different benefit structure and differentiated premium rates.

• Coverage –

Both the variants of the plan cover in-patient hospitalization arising out of illness, sickness, diseases or accidental injuries provided the hospitalization is for a minimum period of 24 hours. Along with this basic coverage, any in-patient hospitalization expense arising out any cardiac related complication which requires medical attention or surgery is also provided for under both the variants.

However, the Gold Plan differs from the Silver Plan in the respect that it also covers Cardiac Medical Management which means ICU hospitalization due to any cardiac complication for monitoring and management of the complication with required drugs without involving any surgery. Pre and post hospitalization expenses are also covered for 30 and 60 days respectively. The limit of post hospitalization cover is 7% of the total hospitalization expenses incurred subject to a maximum limit of Rs.5000

• Age restrictions –

People aged between 10 years to 65 years can buy the plan with the option of renewing it for lifetime.

• Eligibility –

You will be eligible to buy the plan only if you have undergone an Angioplasty or a Bypass surgery only once before you apply for the policy. Moreover, the surgery should have been undertaken before a minimum period of 6 months to a maximum period of 3 years as on the date of applying to the plan.

For instance, if you have undergone a surgery on the 1st of January 2015, you can buy the plan from the 2st of July of the same year to the 31st of December 2017. Policies applied for on any date before the 2nd of July or after the last day of December will be rejected. You will also have to undergo a pre-screening medical examination before the policy is granted to you and also submit all your past medical reports to the company.

• Waiting period –

Cardiac ailments are covered after a waiting period of 90 days after the inception of the policy. Other pre-existing diseases are covered after a waiting period of 4 years. There is also a two year waiting period for certain ailments like Cataract, Hernia, Glaucoma, Fistula, Joint Disease Treatments, Gall Bladder Treatments, Stones, etc.

• Co-payment Clause –

If you are above 60 years of age and apply for the plan, there is a co-pay clause of 10% applicable at the time of purchase and also on subsequent renewals of the policy. The co-pay clause means that in the event of any claim, 10% of the claim amount will have to be borne by you, the policyholder, and the company will foot only 90% of the bill.

• Claim settlement –

The Health insurance Company provides the facility of in-house cashless claim settlement without the requirement of any Third Party Administrator with a tie-up of over 6000 network hospitals across India. However, if the expenses for the treatment availed is billed as a package, only 80% of the claim amount will be settled by the company. This is applicable for package facilities provided by the hospitals for surgeries like bypass, cataract, etc. where the entire expense including the room rent, doctor’s fee, surgeon’s fee, etc. is billed under one amount without separate bills. In such a scenario, the insurer will settle only 80% of the claim raised.

• Premium Rate –

The rate of premium varies between the two plan variants. However, the premium is same for ages 10-60 years and increases only for people aged 61-65 years. Let us take a look at the premium rates exclusive of applicable taxes for a new policy under both variants:

Verdict:

It is no secret that heart related ailments are dangerous and cost a fortune in treatment. Given the current rate, a heart bypass or an Angioplasty costs somewhere about Rs.3-5 lakhs and with an upward trend in medical inflation and development of new and improved treatments, this cost is likely to surge in future. For a middle-class man, the incidence of a cardiac treatment is enough to wipe out his savings. As such, having a health insurance plan which provides for heart related treatments is the best option for heart patients. You may complain that the premium is a bit on the higher side but a look at the bigger picture is required. Firstly, though the premium is higher, the benefits promised outweigh the extra premium paid. Secondly, the plan provides basic health insurance coverage too and can be considered as a health insurance plan rather than only a specialized plan. So, instead of buying a health insurance plan and the Cardiac Care plan, it is better to buy only the Cardiac Care plan because heart patients require specialized care other than normal hospitalization.

In my opinion, if you are a heart patient and are paying about Rs.10,000 – Rs.12, 000 for a normal health insurance plan which excludes heart related complications, it is better to opt for the Silver Plan at Rs.20,610 for Rs.3 lakh coverage which will cover normal hospitalization and cardiac related hospitalization. The extra Rs.8000 will be justified when you require cardiac treatment and the resultant bill amounts in lakhs.

The plan is the best answer for cardiac patients covering them for their specific illness though the premium is a tad bit higher. After all, a few thousand rupees extra in premiums are always better than a couple of lakhs in treatment expenses.

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Aniket Thakker
Written by Aniket Thakker
He lives off TV shows, movies, junk food, comics and sarcasm. When he is not working as a freelance imaginary friend to other beings like him, he works as VP of Marketing at Coverfox.