Health Insurance Questions – Is a 3 Lakh Health Cover Adequate for me?

Yes that is a question somebody asked me the other day.

He is 40 years. Has a family of 4. Has a decent family income.

Do you think 3 lakh health insurance cover is adequate for him?

I had the same question a few years back. I believe a lot of you would have this question. Let us analyse if it is adequate.

You know, we are a weird lot. We take a comprehensive car insurance policy for our cars thinking ‘What if the car meets with an accident’.

This policy costs us Rs. 10,000. In return it saves us Rs. 100,000 if the car meets with an accident. If it does not, we renew it the next year.

But when it comes to insuring our health, we do not want to shell out the Rs. 10,000 or 20,000 (does not matter actually).

Is your car more important than you?

Ok… Philosophy aside.

Let us start with the cost of a consultation with a doctor. There are doctors who charge Rs. 200 (yes, in Delhi, even I was surprised) for a visit. If you go to hospitals like Apollo, they charge a consultation fee of Rs. 1000 – 1200 even for a general physician/ internal medicine specialist.

The average being Rs. 400-500.

And that is only consultation. So if you and your family visit a doctor about 10 times in a year, you spend approximately Rs. 5000.

(Disclaimer: Most policies do not cover OPD or consultation fees)

Do a Google search for ‘cost of different health procedures’. Restrict the search to India.

I did and the third result was the website – www.medifee.com

I decided to refer to this website since it has a good alexa ranking. Not sure if the costs are accurate, but then accuracy of cost is not what we are concerned here.

What we would like to know is – Is 3 lakhs cover sufficient.

For that even if there is a deviation of say 5 – 10% up or down it should not matter much in our inference.

So, I decided to check the cost of hernia surgery. It is not supposed to be a very complicated surgery (by the way). At least not in most cases.

So here is the cost for the procedure in different cities in India.

The average cost in a big city would come to about Rs. 60,000.

Here is another table. This is the average cost of Angiography.

What generally happens is that if the doctor sees a blockage they immediately recommend angioplasty which would cost an average of Rs. 100,000 to Rs. 250,000 (depending on the hospital and the city).

And that is only if there is a single blockage, in case of more blockages, the cost keeps going up.

And this is only the cost of 1 procedure on a 1 person. If another procedure is required, for somebody else, then what?

You would have to dig into your saving.

A health insurance policy is basically a cover that helps you protect your savings, in case of hospitalisation.

So coming back to the question, is 3 lakh cover sufficient?

Today, it may be, depends on your health condition and other factors.

Couple of years down… No I don’t think so.

But, I am taking this policy today, you say!

Absolutely correct! But you would continue it lifelong or so I believe.

So if you want to increase the sum assured from 3 lakhs to 5 lakhs in 2 years time then there is a catch.

The 2 lakh increase would come with all the clauses that a new policy comes with. So there would be a waiting period and the likes.

Confused?

Here is my suggestion.

If you want, go for the 3 lakh sum assured basic policy. That would cost you approximately Rs. 10,000- 12,000 per annum (for a family of 4 with the eldest person aged 40 or so).

Top it up with another ‘Top up policy of say 7 lakhs’. This would come in much cheaper than a basic policy.

Because this would kick in only when you have exhausted the basic sum assured.

Now you are covered for 10 lakhs and you can sleep in peace.

Let me end by saying this:

Please go get a health insurance for you and your family.

If you feel 3 lakhs is adequate for you, or you can only afford 3 lakhs, stretch it to 5 lakhs. I know you can, you just have to think how.

If you are still confused or if you can’t think of how to maximise your sum assured, get in touch with me. I will give you solutions.

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