Comprehensive Cover Vs Disease Specific Policy

For novice health insurance shoppers, this is a conflicting decision. Beware! The wrong choice could have devastating outcomes. It’s advisable to thoroughly evaluate your health and financial circumstances before browsing through health insurance available in the market. To choose the ideal policy for yourself and your dependants, identify your personal requirements and study the benefits and coverage offered by insurers.  

 

Choosing unsuitable health insurance has inevitable consequences that could be fatal or financially constricting. These mistakes include purchasing policies with inadequate coverage, insufficient research on covers and policies without considering lifestyle ranges, etc. Unfortunately, you will have to pay out of your pocket for medical expenses incurred from diseases not covered by the policy.  

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

Comparing Different Health Insurance  

Comprehensive Cover  

This plan covers different diseases, including critical ailments and seasonal illnesses. A type of traditional health insurance that covers illnesses listed under the policy selected. While browsing through the plans offered by different insurers, choose one that best matches your coverage needs with good benefits.  

 

This plan usually covers the following,  

 

• Pre-and-post hospitalisation  
• Organ donor expenses  
• Day-care treatment  
• In-patient hospitalisation  
• OPD treatment  
• Domiciliary hospitalisation  
• AYUSH treatment  
• Emergency ambulance  

 

Most experts recommend purchasing comprehensive covers for their spectrum of coverages. Also, these extensive coverages come with a lifetime of renewability. However, you can decide for yourself by checking out these four benefits typically offered! 

 

1. Coverage for Dependants: Extend the security of medical and financial coverage to your family (spouse, children, parents & in-laws), and it’s available individual and family floater basis 
2. Cashless Treatment: Avail hassle-free cashless treatment at any network hospital, as per your plan  
3. No-Claim Bonuses: For every no-claim year, the insurer rewards you with a sum that increases the total sum insured at no extra premium cost  
4. Add-Ons: Fortify your comprehensive plan with riders that boost the coverage of your policy for an additional premium charge  

 

Ideal for: Opt for this plan if you suffer from high stress, sedentary lifestyles, financial crunches, or have no medical family history. A comprehensive cover provides medical and financial support for a host of illnesses, ensuring that you receive timely treatment.  

Disease-Specific Policy  

Also known as a Niche Plan, it only covers the particular disease it’s designed. Built for specific conditions, the range of policies consists of cancer, heart diseases, diabetes, etc. Fortunately, these policies have shorter waiting periods, and they cover diseases at any stage - whether it’s the initial or critical stage.  

 

Depending on the policy’s terms, you might receive a pre-determined lump-sum payout or reimbursement. In some cases, the insurer may waive off future premium payments.  

 

Disease-specific policies have a number of advantages, especially for those with pre-existing conditions. If you’ve been contemplating purchasing this policy, here are a few factors to help make up your mind.  

 

1. Pre-existing Conditions: This policy extends its benefits to those with pre-existing conditions, providing you a shorter waiting period, unlike other plans  
2. Lower Premium: Since it only caters to a specific disease, the premium charged is considerably lesser than a comprehensive cover  
3. Waiting Period: These policies usually have no waiting period, and in most cases, there isn’t any survival period, either  
4. Vast Coverage: It covers diseases like diabetes, kidney diseases, dengue, high blood pressure, heart diseases, and more 

 

Ideal for: Choose this policy if you have a family history of specific diseases like diabetes or cardiac conditions. Those living in regions with outbreaks of particular illnesses, like dengue or COVID-19, should opt for this plan.  

 

The Verdict?  

 

While recommended to choose a policy that suits you the best, most experts suggest purchasing a comprehensive cover instead. However, if you have a family medical history of ailments, use the disease-specific policy to boost your sum insured. If your comprehensive cover sum insured falls short, the remaining is covered by a disease-specific policy. 

Health Insurance Plans Available at Bajaj Markets