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Medical insurance coverage is what permits folks to be ailing relaxed!” This popular quote by Alfred E. Neuman, the fictitious mascot of MAD magazine, will resonate with anyone who has ever used a health insurance policy during a medical emergency. Mumbai-based Hitesh Gajaria is a case in point. Gajaria was diagnosed with a serious ailment in July, which required him to be hospitalized suddenly. After a week’s observation, he was advised to undergo an emergency surgery.
Medical insurance coverage is what permits folks to be ailing relaxed!” This popular quote by Alfred E. Neuman, the fictitious mascot of MAD magazine, will resonate with anyone who has ever used a health insurance policy during a medical emergency. Mumbai-based Hitesh Gajaria is a case in point. Gajaria was diagnosed with a serious ailment in July, which required him to be hospitalized suddenly. After a week’s observation, he was advised to undergo an emergency surgery.
“I used to be not conscious of this situation till I obtained hospitalized. I used to be main a standard life after which, abruptly, I used to be pushed out of motion for nearly 4 months. Soon after the analysis, I needed to do a whole lot of working round—first looking for a very good surgeon after which a mattress in an even bigger hospital. For nearly one-and-a-half days, I couldn’t get a mattress within the desired hospital even in a metropolis like Mumbai,” Gajaria recounts, adding that the diagnosis came as a shock.
“I was not aware of this condition until I got hospitalized. I was leading a normal life and then, all of a sudden, I was pushed out of action for almost four months. Soon after the diagnosis, I had to do a lot of running around—first trying to find a good surgeon and then a bed in a bigger hospital. For almost one-and-a-half days, I could not get a bed in the desired hospital even in a city like Mumbai,” Gajaria recounts, including that the analysis got here as a shock.
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Yet, what helped Gajaria throughout this traumatic interval was his medical insurance coverage. In reality, he had two of them as additionally two top-up covers and he may additionally avail of a no-claim bonus. His whole protection was ₹89 lakh. The value of his remedy got here to ₹17.71 lakh.
Having enough medical protection alleviates the psychological trauma related to hospitalization and the monetary implications, as within the case of Gajaria.
“When you’re not sure in regards to the remedy prices, you may’t suppose straight. It impairs your judgement on the most effective course of remedy. The pressure and stress of economic issues can worsen the sickness,” says Gajaria.
The impact of a sudden illness, in most cases, is however not limited to the patient themselves. In Bangalore, Ravi, who declined to disclose his full name, had to literally step into his father’s shoes overnight and take on all the responsibilities of a head of the family when the latter was diagnosed with advanced stage brain cancer (Glioblastoma Multiforme) in 2013. Ravi was just 25 years old at that time.
“I was pursuing my PhD in computer engineering then and, needless to say, was totally unprepared to take decisions involving medicine, finances, and other things. I felt helpless on many occasions,” says Ravi.
What got here in useful for Ravi was the a number of medical insurance insurance policies that had been purchased by his father, who had additionally saved a separate well being emergency fund of about ₹18 lakh. Though his father didn’t survive the ordeal, the insurance policies and emergency fund helped cowl the remedy prices. “He additionally had 4 insurance policies that paid ₹1,500-2,000 per day of hospitalization,” says Ravi. The total cost, right from diagnosis to his father’s funeral, came to ₹20 lakh. Of this, the insurers reimbursed Ravi a sum of ₹5 lakh .
However, simply having an insurance coverage coverage doesn’t mechanically deal with all of your monetary worries. For one, you possibly can be underinsured. In Ravi’s case, he feels that having too many insurance policies with smaller covers wasn’t a prudent choice. “My father didn’t wish to pay the inflated premiums and therefore opted for a number of insurance policies.” Also, the hospital that he chose for his father’s treatment did not support cashless claims, which added to his challenges. “All insurers settled the claim with some deductions but took a lot of time and requested frivolous information. In one instance, the doctor was asked to give a lengthy explanation,” Ravi mentioned.
A essential sickness cowl would have been helpful right here. “A essential sickness cowl is a profit coverage, versus an indemnity coverage that could be a medical insurance coverage coverage, that pays out the sum assured as a lump sum publish the analysis. A lump sum helps cowl conditions the place the medical insurance coverage coverage cowl falls quick or the affected person goes on depart with out pay after hospitalization,” said Suresh Sadagopan, principal officer, Ladder7 Wealth Planners.
Does that mean everyone should buy a critical illness cover? Sadagopan said it should only be need-based. “If there’s a history of a particular illness in a family, then a critical illness policy that covers those conditions will be very useful. Having said that, it is common these days for people to contract cancer or other serious illnesses even without a family history.”
One can take a look at shopping for a strong medical insurance coverage coverage and on the similar time construct a large medical contingency fund. “Some persons are overly frightened about diseases and wish to cowl all their threat by taking a number of insurance policies. The extra insurance policies you have got, the upper can be your premium. You can both preserve paying excessive premiums or make investments on your objectives. A greater method is to cowl the chance to the extent required by way of a medical insurance coverage coverage and construct an emergency fund as a substitute of shopping for a essential sickness coverage for every member of the family,” said Sadagopan.
That is exactly what Delhi-based Vaibhav Kumar has done. The 40-year-old tech professional has a group health insurance cover of ₹10 lakh provided by his employer and also a separate contingency fund. So, when his mother, Jyoti Ghai, was diagnosed with cervix cancer in 2017, his insurance policy covered 85% of the total treatment cost, while he paid the remaining 15% from the contingency fund. “We did not feel the financial impact at all, which, in my opinion, can be huge if you are not well prepared. One can even fall into debt.”
Financial consultants would argue {that a} ₹10 lakh group cowl is inadequate and relying solely on company-provided insurance coverage will not be a good suggestion.
Kumar disagrees. “Making claims by way of a company cowl is far simpler and the method is easy, versus a private well being cowl. Besides, I’m already paying a premium of ₹50,000. And it makes higher sense for me to create and have management over my very own corpus.”
Nishant Batra, chief goal planner, Holistic Prime Wealth, and a mutual fund distributor, says a medical fund should not be seen as a replacement for health insurance. “It should complement insurance because the latter will not cover everything. Similarly, a corpus doesn’t replenish the way an insurance cover does, so it shouldn’t be the only option,” he mentioned.
A medical corpus can be useful to those that could also be unable to get a standalone insurance coverage cowl on account of an current sickness. In Delhi, a 26-year-old advertising and marketing skilled, who didn’t want to be named, mentioned he did not safe a medical insurance coverage as a result of he has tuberculosis. “After I had two lung surgical procedures in 2018, I attempted to purchase a well being coverage however was refused due to a two-year ready interval. Currently, I’m counting on worker medical insurance offered by my firm,” he said.
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