Health insurance is purchased to hedge health risks which can affect anyone. But certain groups of individuals, irrespective of their current fitness and health, stand to gain a lot by investing in a suitable health insurance. These include those with a family history of susceptibility to certain ailments, women of childbearing age, individuals residing in zones of frequent communicable diseases, and frequent fliers or those in occupations with a higher propensity for disease exposure. These groups can derive maximum benefit by choosing the right insurance product. And as with any insurance product, the earlier the purchase the higher the benefits that accrue. The benefit can be further amplified by reaching for the right product or a right add-on, depending on the risk one is looking to hedge against.

Family history

The list of ailments, chronic or acute, that have a genetic pre-disposition are growing by the day and now include, cardiac ailments, diabetes, and myriad oncological conditions which are the top three killers across countries. Individuals whose family history has evidence of such conditions are now able to financially insure themselves, if health insurance is purchased before the genetic dice is rolled. Pre-existing diseases (PED) are not covered for a period of two to four years across products, and this is the key hurdle for this group which must be overcome. When the policyholder gets affected with any ailment still in the waiting period, he/she misses the prime benefits of insurance.

A few policies offer lower waiting periods of one to two years or others which offer buyback of the waiting period. These can be priced significantly higher (70-80 per cent) along with tougher underwriting (pre-issuance medical checkup). Buying insurance earlier to complete the waiting period and get coverage at attractive rates is critical (and not just advantageous) for this group. Plans are also available for cancer and heart ailment survivors providing day one coverage (30 day waiting period) but will cost 4-5 times the regular insurance with four-year PED waiting.

The average sum assured in health insurance across products - ₹5 lakh, may be insufficient in some specific risks for instance oncological ones. Increasing the sum assured is not proportionally expensive but will still be on the higher side. Few policies are offering ₹50 lakhs – ₹1 crore at 30-40 per cent higher premium compared to ₹5 lakh sum insured. Policyholders also have the option of choosing benefits plans. These plans payout the entire sum insured on being diagnosed with specific critical ailments and terminate the policy, allowing for discretionary spending by the policyholder.

Heat zones

Depending on location and season, various regions in India witness sudden surge in diseases, for instance Malaria, Dengue or Chikungunya. Residents of such regions should hold insurance with emphasis on outpatient (OPD) coverage, in addition to in-patient focused health insurance. Hospitalization charges are well covered with most health insurance, but out-patient charges slip through the net, which can be a significant amount in any year. But most insurance providers are now recognizing the gap in service and providing OPD cover as part of the basic policy or as an add-on. ICICI Lombard’s BeFit, Reliance General Insurance’s Digital Care, or other policies cover OPD charges ranging from ₹1,000 to ₹10,000 per annum at a cost of ₹300 to ₹3,000 for the add-on or with charges included in the basic policy. OPD covers are also being paired with tele-medical consultations and yearly check-ups which further improve the functionality of the cover.

Frequent travellers

Hazardous occupations find tough underwriting standards and may not be insurable. But occupations which involve significant travel are fortunately insurable, even as the risk of exposure to any disease is on the higher side compared to regular occupations. The ideal policy for such policyholders would be the one with the highest network of cashless hospitals. Procedures in hometowns can be financed out of hand and later reimbursed, the same comfort may not be available for policyholders who are hospitalized while on the go.

The problems faced while travelling gets more complex if international destinations are involved. While travel insurance addresses a wide basket of exigencies, health insurance purchased domestically with international cover would be an ideal back-up. ManipalCigna’s Lifetime Health plan covers 27 critical illnesses when abroad, and Aditya Birla’s Activ Health Plan covers 16 major illness, in a cashless manner abroad. Policyholders must opt for higher amount, upwards of ₹1 crore to meaningfully cover health emergencies while abroad.

Women of childbearing age

Most health insurance may not provide maternity cover as part of the basic policy and may need careful reading of terms to ensure the same is covered along with the relevant waiting periods. Group policies offered by employers start coverage very early compared to individual policies.

Sub-limits, which limit the compensation to specific procedures, should also be checked for suitability. For instance, for normal coverage Star Health’s Young Star Gold plan, Tata AIG’s Medicare premiere plan and Future Generali’s ProHealth Plus plans offer maternity cover for ₹30,000-50,000 per instance with waiting period in the range of 2-4 years. Policyholders who desire an extra level of protection including for the newborn can look for such specific policies. For instance, Bajaj Allianz’s maternity specific plans - Health Supreme covers pre & post-natal hospitalization, medical expenses for the treatment of the newborn, and mandatory vaccinations for a period of 90 days. Most family floater plans will include provision to include the newborn on intimations within 90 days of the being born.

Depending on an individual’s priorities in insuring against health risks, the plethora of product options can be scanned and a suitable product can be arrived at. Group insurance offered by employers provides a wide mix of options and starts from Day-1. But for further customization, an individual health policy may be required.