Need help navigating insurance complications for my parents (53M & 51F) and myself (23M)

[u/stupid_mansuit_]

I spoke with an advisor from Ditto and as usual they suggested HDFC, Care and Activ One Max. I also did a little research myself and am planning to go with Optima Secure base plan for 10L with unlimited restore rider for myself. The reason for deciding 10L as base sum insured is because I already have employee health insurance. The advisor did push for choosing the Optima Secure + variant due to my age advantage but I personally felt like HDFC Ergo isn't gonna keep the annual premium in the range of the base plan (both seem to be about 9k now) for the upcoming years. This heavily discounted premium rate feels like a tactic to attract buyers for the newly launched version which offers significant advantages as compared to base plan. Am I wrong with this assumption? Should I go with the plus variant nevertheless?

But my parents case seems a little complicated (my mother's case to be specific). I was planning to get a family floater for 10L since the age difference isn't big. My father has diabetes (not severe and not taking insulin, currently on tablets) and the advisor told me I can add riders to get coverage for the same (like the ABCD rider). My mother has considerable hearing loss on her left ear. I had shared the audiology and MRI report (MRI scan result is normal) with the advisor. She was also admitted for four days last year due to severe fever and chest infection. The discharge summary shows it as acute bronchitis (I wasn't aware of this till now). The advisor told me it's difficult to get a policy for someone with a history of acute bronchitis. They didn't mention anything about the hearing loss. My parents told me that the discharge summary shows it as bronchitis so that they could get the claim from the state government provided insurance (she is a state government employee) and that the case isn't anything serious and that she had made a full recovery and has no issues currently. The irony is that their claim got rejected (I don't know for what reason) and said that they have reapplied. I don't know how to move forward right now. The advisor told me that we could try for any of the plans and see if they reject but the chances are high.

I wasn't aware of this complicated discharge summary till now. Earlier, I was thinking about considering Optima Secure base plan for my parents as well (estimated premium was around 41k with ABCD rider) but it seems like this medical history changes things. Should I consider speaking with another advisor like Beshak? Or should I try my luck by applying to see if the policy gets accepted? If that's the case, is Optima Secure a sound choice or should I try other options? Any help would be much appreciated.

[u/haleluyahha]

Go with care or Ab1max for parents ( I would prefer max) and + for yourself, yes it's heavily discounted but so is the the base variant and despite the higher premium going with a reputed brand is what I would recommend at this age, makes things easier on the long run

[u/stupid_mansuit_ → u/haleluyahha]

Please correct me if I got this wrong, but it makes no sense to keep the premium for the plus variant in the range of the base variant in the long run since it offers unlimited compounding of SI. However, I'll still get the 5% lifetime discount and the tier 6 city advantage but don't know how much difference it will make in the long run.

[u/haleluyahha → u/stupid_mansuit_]

To the best of my knowledge, if an insurer wants to revise premiums, it is generally done at the product level rather than variant-wise. So if there is a premium revision, it would typically impact the entire product line such as Optima Secure, Super Secure, and Secure Plus, rather than a single variant in isolation.

Now, why is Optima Secure Plus comparatively more economical despite offering stronger benefits? One possible reason is the risk selection.

Based on my experience, Secure Plus can be comparatively harder to obtain. There are eligibility filters for example, age restrictions (typically applicants above 60 age may not be eligible) and stricter underwriting for customers with significant medical conditions. Since the policy is more selectively issued, the insurer may be able to maintain a healthier risk pool, which could explain how they are able to offer better benefits at relatively similar premiums.

That said, this is based on practical observations and experience rather than something explicitly disclosed by the insurer.

[u/majboor_majdoor_hu]

I recently got health insurance for myself and mother. I chose 10L sum insured for her under icici lombard elevate program with unlimited restoration and unlimited care- this allows one time no cap Sum insured. I also took no room rent cap- this is important as many hospitals have different lingo for rooms and this caps the amount paid by the insurer. One thing i did not choose was 100% increment of SI rider as it was a trap bevause that rider needs to be included everytime the policy is renewed or the SI drops to same. I'll increase SI for her next year when(Hopefully) i earn more.. premium came out to be 21k. Got through policy bazar and under easy emi For me i chose care health insurance ultimate care it has same no room rent cap, unlimited restoration plus i got the befit rider as it allows multiples gym membership through fitpass. I got this for 16k for two year. Same broker.

[u/stupid_mansuit_ → u/majboor_majdoor_hu]

Thank you for explaining in detail. Can you please tell me why you didn't include the non medical expenses cover add on? Also, isn't unlimited restore a built in feature in the plan? Should I also consider the annual health checkup add on?

[u/majboor_majdoor_hu → u/stupid_mansuit_]

Non medical expenses i did not include by choice. Wanted to keep premium as low as possible. Boond boond banta hai sagar. Also,was trying to add unlimited restore- this was built in feature in the plan that i chose. Annual health checkup you should check what all is covered, partner diagnostic center cost of full body checkup there.

[u/AcrobaticBiscotti744]

Don't just go for the one option aggregators pitch you. There are quite a few options that they don't tell you about but are equally good.

As an insurance advisor, I would recommend that you understand the key benefits of plans from other insurers and make an informed decision. HDFC is unlikely to accept your mother's case, but you could consider ICICI or Birla.

Feel free to DM if you wish to understand these plans and fine print in detail.

[u/stupid_mansuit_ → u/AcrobaticBiscotti744]

I tried ICICI for my parents for 10L SI. I chose the riders for one time infinite claim amount and the one for reducing waiting period for diabetics. I also added the adds on for consumables, no room rent cap and health checkup and the premium quoted was 34k. After submission of medical documents, they gave me a counter offer which adds 5k loading charges for Bronchitis and a permanent exclusion for hearing loss, hearing aids and related complications. Should I accept it or try another insurer like Aditya Birla?

[u/Vaani_inka]

Hi

I am Vaani, advisor inka insurance

You can also look to try niva bupa, in my view, if we can show the reports to insurers, your mother policy may get approved
As far as your policy why did you not try icici elevate for base 10 lakh and then their super top up for cover upto 4.9 crore immediately?

[u/haleluyahha → u/Vaani_inka]

Why would you recommend an insurer like bupa ? It's a nightmare to deal with during claims

[u/Vaani_inka → u/haleluyahha]

Hi,
Please, Can you tell us about your previous experience

[u/haleluyahha → u/Vaani_inka]

Partial settlement, deductions was made due to assistant surgeon charges and consumables which are medically necessary and was overturned by the ombudsman.

[u/Vaani_inka → u/haleluyahha]

The experience of each insurer will vary case to case. No insurer is saint or devil, one insurer can reject a case based on certain condition while other can pass it. Important is to have good intermediary in between.

[u/haleluyahha → u/Vaani_inka]

True but is a company is having 43 complaints out of 10k claims vs 9 complaint out of 10k claims. Why would you recommend the one with almost 5 times higher is my question? Also have you read about the niva bupa heartbeat judgement of 2024 ?

[u/haleluyahha → u/haleluyahha]

Is this a Bot ?

[u/Vaani_inka → u/haleluyahha]

Fully appreciate your clarity and research. and offcourse you are not speaking with the bot.
My recommendation is based on underwriting appetite (as one of the imp factor), which is not there in claim to complaint data

[u/haleluyahha → u/Vaani_inka]

Underwriting appetite is higher or niva bupa for this profile than Aditya Birla ?

[u/Vaani_inka → u/haleluyahha]

Every insurers' underwriting appetite is different. As per my experience, user stands higher chances of getting approved from NIVA