Kamini is a thought leader and expert when it comes to Marketing for Consumer Goods companies. Four months ago, she joined her current marketing consultancy after stints with consumer majors spanning over two decades. Kamini has had a mild Asthma since childhood but never had to worry about her medical bills, insurance, or health facilities or type of accommodation her entire work life. All the companies she worked for over the years had excellent group insurance coverage, generous medical allowances with no caveats on which hospital to choose and what room type to stay, what tests were allowed or the type of hospital facilities. Kamini took to running about a decade and a half ago, initially to fight Asthma and later because she fell in love with it, and hasn't had an Asthma attack over the last 10 years. Though she still carries an inhaler and uses it once in a while, she has enjoyed a period of complete well being all these years. She is a regular at half marathons over the last 5 years, seizing every pportunity to run in the region whenever her busy schedule and family commitments permitted.
Two years ago, she was advised to stop running and choose less impact exercise regime as the wear and tear caused by her years of running were taking a heavy toll on her knees. Though she modified her work outs, she just couldn't give up running totally. Last May, she underwent a knee surgery and after a two month break, she was able to hit the road and was overjoyed at how new and wonderful the knees felt. Two months ago, after she moved companies to join the current consulting major, she developed minor complications and had to get her knees re-examined. The first minor shock came when the insurance company declined her reimbursement citing pre-existing condition and that the coverage kicks in only after 12 months of continued employment. Three weeks ago, she was advised by her knee surgeon to undergo a minor surgery to correct a small bone correction to improve the knee movement as a residual outcome of prior operation. The estimated cost, including hospitalization and surgery has been put at Rs. 2,50,000.
Kamini has two choices, get it operated now and pay the amount from her pocket (the company medical benefits would cover roughly 10% of the cost) or wait another eight months and then use the company insurance. It's not a big amount, considering she is in the top tier salary bracket but what really got her worried was when she went shopping for a personal insurance coverage, no insurance company was willing to cover or quote and cited this is standard industry procedure. Kamini anyway went ahead and bought personal health coverage with the exclusion of her knee with a promise to get the exclusion reexamined after a year of healthy living and was also able to negotiate on her Asthma coverage with a slight increase in premium considering she has been healthy all these years with no major problems. She has also modified her work outs to include cross training and cycling and now runs only once a week. Kamini's case isn't unique, it's what most of us think is an outlier, something that doesn't affect us until someone close to us gets hit similarly when it suddenly takes center stage. Group health insurance plans in general are company specific and cannot be ported over when we move employers. A pre-existing condition that one could have enjoyed coverage from a particular insurer may no longer be covered for another 12 months when one moves employers (or more or never depending upon the group health insurance plan) even if the insurer across the two companies is the same. In addition, even when ported over, it may no longer come at the same premium or with same level of coverage. Most people in their healthy and early years laugh off the idea of personal health insurance when this is precisely the best time when one should go for a health plan. Not only it is much much cheaper for a person in his twenties vs. someone 20 years older (a quick check for a healthy male, in the age group of 20-25yrs vs. one in the age group of 40-45yrs, show a premium differential of approx 40% (approx Rs 4,000)* for a total yearly coverage of approx Rs 10lacs), a healthy body also would ensure no specific exclusions like Kamini's. Some of the insurers also provide coverage for pre-existing illness after you have been a policy holder for a few years. Spiralling medical bills can drain savings and in worse situations could wreak havoc on your assets and retirement planning. A personal health plan would ensure you would never have periods where you wouldn't be fully covered when you move companies or decide to take a break or start something of your own, or god forbid, made redundant. These are the exact times when the last thing you would want would to be worrying about are money and your health. So run a quick online check, avoid rude shocks of hefty medical bills or compromising on the medical facilities, or type of room or tests because you can't afford it. Talk to an insurance expert who can help assess your need and advise you what plan works best taking your lifestyle, savings and income into account. It's a small price to pay for complete peace of mind. Amit Jain www.MyInsuranceClub.com
