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Paramjit Singh, 36, is a Delhi-based garments exporter. Five years
ago, Singh, who lives with his wife and two sons, aged seven and
three, respectively, discontinued his health insurance policy because
his new Max New York Life Insurance policy offered him a critical
illness (CI, also called dread disease) cover.
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Parveen Sharma, 49, a Max New York Life agent, also stopped the
Mediclaim policies of his two daughters Neha, 23, and Nidhi, 21,
both call centre workers and, instead, signed on for life insurance
policies with CI riders for them. Reason? "Every year, one
has to pay large premiums for Mediclaim, which does not give any
returns," says Sharma.
CI's 10 Maladies
The critical illness rider with
life insurance policies generally covers 10 illnesses: |
1. First heart attack
2. Bypass surgery
3. Stroke
4. Cancer
5. Kidney failure
6. Major organ transplant
7. Multiple sclerosis
8. Aorta graft surgery
9. Primary pulmonary arterial hypertension
10. Paralysis |
These
two examples highlight what is fast becoming a trend-of people
replacing regular medical insurance with life insurance policies
that come with a critical illness rider. The apparent simplicity
of the scheme almost reduces it to a no-brainer; by investing
a little extra, you get a critical illness rider, which entitles
you to receive a given sum of money in case of a pre-defined critical
illness (see CI's 10 Maladies) during the subsistence of the policy.
For instance, Sharma paid just Rs 173 for a critical illness rider
(30-year duration) with Nidhi's Rs 1 lakh-life policy. Similarly,
Neha's Rs 1 lakh life cover got her a dread disease rider of the
same amount for 20 years at the cost of only Rs 155.
The scheme is attractive and private insurers
are marketing it aggressively. The question, though, is: are CI
riders effective alternatives to medical insurance policies? The
answer to that is a firm 'No'. "A critical illness rider
or policy is not a substitute for a Mediclaim policy," declares
Dalip Verma, Managing Director, Tata aig General Insurance. Verma's
contention is that medical insurance and CI riders are two very
different products; therefore, one cannot be a substitute for
the other.
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Rahul Bose,
43, Operations Manager, IMRB
Family: Wife Nina, 43, government
official; sons Rupayan, 14, and Dipayan, 6, both students
Insurance brief: Bose has a
Mediclaim for Rs 2 lakh, and his sons have medical insurance
of Rs 1 lakh each. Wife Nina's medical expenses are covered
under government schemes. Bose also has an LIC policy (Jeevan
Nidhi) with a life cover of Rs 1.5 lakh and a CI rider of
Rs 1.5 lakh. Total life cover: Rs 5 lakh
Expertspeak: Sudhir Salian,
Head (Strategy and Technology), ICICI Lombard, advises: Bose
should take a family floater medical insurance policy (which
any one family member can use if required) worth Rs 4 lakh.
Should include his wife also because with age, it gets difficult
to get medical coverage |
One big advantage of CI riders is that you
get paid the entire sum assured upon diagnosis of a critical illness.
This means that once you have the money, you can plan your expenses-the
cost of travelling to another city for treatment, compensating
for the loss of income due to the illness, donor expenses in a
transplant surgery, repeated dialysis in the case of a kidney
failure, etc. A World Health Organisation (who) study reveals
that 35-40 per cent of medical expenses incurred by Indians on
critical illnesses relate to travelling and boarding and lodging.
There's a catch here, though. A CI rider
ceases to exist after the sum assured is paid out, although the
underlying life insurance policy continues to be effective. And
you can't take another CI rider with this policy again. A medical
insurance policy, on the other hand, is an annual contract. This
means if you are hospitalised (for at least 24 hours), all permissible
expenses-room charges, doctors' fees, diagnostic expenses and
cost of medicines-are reimbursed, subject to the limit of the
sum assured. You only need to submit the necessary bills to support
your claim. If you are not hospitalised that year, you get nothing.
The policies can be renewed every year, regardless of whether
you make any claims or not. The premiums are, however, higher
than those of CI riders. For instance, a 35-year-old male, buying
a 10-year dread disease cover of Rs 4 lakh from Max New York Life
Insurance along with a life insurance policy, will have to pay
around Rs 2,000 per annum as premium. A medical insurance cover
for the same amount from a general insurance company will cost
more than twice that amount.
What Your Insurance Agent Does Not Tell You |
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CI (critical illness) riders and medical insurance
policies don't cover you for illnesses that were manifested
or contracted prior to the start of a policy
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The CI rider will not be valid if any of the 10 illnesses
(see CI's 10 Maladies) is diagnosed within the first 90
days or if the insured dies within 30 days following the
diagnosis of a critical illness
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Medical insurance policies and CI riders don't cover
HIV/ AIDS
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They also don't cover any treatment arising from
or traceable to pregnancy or childbirth
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Neither policy covers are valid during periods of
war, invasion, terrorist attacks, etc.
»
In the case of Mediclaim, you should be hospitalised
for at least 24 hours
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Mediclaim doesn't cover many common diseases such
as asthma, chronic nephritis, diarrhoea, diabetes, hypertension,
influenza, and all psychiatric or psychosomatic disorders
»
In the first year, medical insurance doesn't cover
treatment of some diseases like cataract, hernia, etc.
»
Mediclaim also doesn't cover general debility, congenital
diseases, sterility, sexually-transmitted diseases, intentional
self-injury and use of intoxicating drugs/alcohol. Nor will
it pay naturopathy bills
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Deepak Bisht,
36, Maintenance Engineer, Transocean Inc.
Family: Wife Benika Deepak,
31, TV actress; son Aidash Deepak, 8, student
Insurance brief: Deepak has
a Rs 4 lakh Mediclaim policy. Benika has a Rs 5 lakh Mediclaim
policy, of which Rs 1 lakh cover is for Aidash. Deepak's life
is insured for Rs 35 lakh, Benika's for Rs 5 lakh. Her policy
covers her son
Expertspeak: Sudhir Salian,
Head (Strategy and Technology), ICICI Lombard, advises: The
medical insurance coverage seems adequate. However, the purchase
of a family floater policy could result in cost savings to
Bisht |
CI riders, being relatively new to the Indian
market, are yet to become as popular as medical insurance. "Every
household must go in for a health insurance product like Mediclaim,"
says Jaya Nagarmat, MD, Investor Shoppe, a Mumbai-based investment
advisory firm. One reason is that CI riders cover only 10 specified
illnesses, whereas medical insurance policies cover a much broader
spectrum of diseases. There's another reason why CI riders are
a wee bit unattractive. "Critical illness riders have more
conditions attached to them; hence, they are more restrictive
and conditional," says Aniruddha Sengupta, Senior Consultant
at Arthashastra Financial Planners, another Mumbai-based investment
advisory firm. For instance, anyone aged between six months and
80 years can be insured through a medical insurance policy, but
CI riders limit this to people between the ages of 18 and 59 years.
That doesn't mean CI riders aren't of any
use. Medical insurance covers are available up to Rs 5 lakh only,
whereas CI riders provide coverage up to Rs 50 lakh. Treatment
for critical illnesses can be prohibitively expensive, so getting
covered for a higher amount is a safer option. Over the next couple
of months, private insurers plan to launch several such critical
illness products. These may even include new diseases-such as
a female diseases cover-and are likely to be sold as independent
policies (not just riders).
That means consumers will soon have a greater
array of products to choose from. So, to cover all fronts, your
best option is to go in for both, like Vinod Shrivastava, 57,
Reader at Delhi's Ram Lal Anand College, who's bought a life insurance
policy with a CI cover as well as medical insurance for his entire
family. "Unforeseen hospital expenses can take their toll
on family finances. I experienced that when my father was unwell,"
he says. Don't wait for a similar experience to make your move.
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