Designing Your Health Insurance Portfolio

Thursday, Aug 24 2023
Source/Contribution by : NJ Publications

In today’s world, most people have a sedentary lifestyle with unhealthy dietary habits. Nowadays, we are even more prone to diseases caused due to stress and hectic schedules. According to the World Health Organisation (WHO), India has nearly 50.8 million diabetics, the highest in the world and 25 million people with cardiovascular illnesses accounting for 60% of all cases worldwide. However, with time and inflation, the cost of treating these diseases has also increased substantially. 

Medical treatment cost is one of the prime reasons for people falling back into poverty. According to the National Health Accounts, an average Indian household’s out-of-pocket expenditure (OOPE) on healthcare stood at around 48.21% in 2018-19 which is very high when compared to a global average of around 18.1% in 2019 as per the World Health Organisation (WHO). As per WHO estimates in 2022, high OOPE on health was seen as impoverishing some 55 million Indians annually, with over 17% of households incurring catastrophic levels of health expenditures every year. 

Needless to say, one solution to this challenge is adequate Health Insurance. But we would even go a step ahead and propose a complete health insurance portfolio.

Why should you get a health insurance portfolio?

A health insurance portfolio is like a combination of different types of plans to ensure that you get the maximum benefits and medical coverage as is possible at an affordable cost. The idea is to give you comfort and confidence to not worry about medical expenses in case of any medical emergency when the need arises with your health insurance plans in the portfolio. While counting on your health insurance coverage, you would typically avail facilities such as cashless treatment; pre & post-hospitalisation expenses; no claim bonus, etc along with the tax benefits.

We can choose from different types of health insurance policies depending on our needs and wants. There are three main types of plans under health insurance to choose from:

1) Base Plan:

The base health insurance policy is like your standard, standalone health insurance policy and covers medical expenses up to the sum insured amount. The coverage and benefits of the insurance vary depending on the insurance provider. Some of the common features and benefits to look at while considering a base health insurance plan is a comprehensive coverage, pre & post-hospitalisation expenses and a regular premium. 

2) Top-Up Plan:

A Top-up plan offers extra coverage for a claim exceeding the base amount. Under a typical base health insurance plan, the insurer pays for claims up to the coverage amount i.e. the Sum Insured. A top-up policy is applicable when your insurance claim passes the threshold limit (deductible). The top-up plan typically covers expenses relating to a single hospitalisation and the claimed expenses have to cross the threshold deductible, and anything beyond the threshold can be claimed subject to the limits of the Top-Up cover. For eg., if the top-up plan of 5 lakh cover has a deductible of 2 lakh, then only when the single claim amount exceeds 2 lakh will the top-up plan be triggered.

As seen, the primary /base health insurance is supplemented using top-up health insurance. In the event that your current health insurance policy's maximum sum insured is reached, the top-up plan will provide you with the desirable medical coverage. This is an add-on policy with a lower premium and high coverage limit that provides flexibility in deductibles and can be a great choice if you feel that your current sum insured or coverage amount is insufficient. 

3) Super Top-up:

A Super Top-up plan covers the total amount of all hospitalisation bills in the policy period, above the deductible amount. After the deductible is paid, the Super Top-up plan becomes active for all subsequent claims, just like a base plan in one policy period. Unlike a Top-up plan, there is no limit at a particular claim level, once the deductible threshold is crossed. This plan functions at a cumulative level and becomes effective once the first portion of the deductible is covered by the base health plan. Thereafter, the super top-up coverage becomes active for further claims once your deductible is paid/exhausted in a policy year. 

As can be understood, it is advisable to align the policy period of your base policy and super top-up policy. It means if your base health policy’s coverage period is from 15 January to 14 January every year, you should buy your top-up policy in a similar period to avoid any claim-related hassles.

What does an ideal health insurance cover look like?

A health insurance portfolio will differ based on an individual's age, needs, and budget. Age is an important parameter based on which the amount needed for health insurance coverage is determined. When someone is young and in good health, the need for higher health cover will be minimal but this will increase as people grow old and become more prone to diseases & ailments. Thus, additional coverage can be arranged in the form of a top-up or super top-up health insurance plan. It is important to understand that getting adequate & comprehensive health insurance is recommended when you are young & fit, otherwise, health Insurance companies won’t give health insurance cover when you are old & unfit or develop a medical condition. 

There is no scientific formula to get ideal health insurance coverage. However, the following age-wise categorisation of plans and the minimum coverage necessary can serve reference purposes.

  1. For ages 18-30 years, a Base Policy of 5 lakh + Super Top-up of 5 lakh 
  2. For ages 31-45 years, a Base Policy of 5 lakh + Super Top-up of 10 lakh 
  3. For ages 45 years and above, a Base Policy of 5 lakh + Super Top-up of 25 lakh. A Senior Citizen Policy can also be taken once the person becomes eligible.

Ideally, one should choose a comprehensive portfolio with a coverage of Rs. 50-60 lakhs that includes add-ons like OPD, routine health checks, maternity coverage, etc. But adding these features to your portfolio requires shelling out a larger premium. Therefore, a person on a tight budget should pick a base cover of at least Rs. 5 lakh along with some significant add-ons like the NCB (Non-claim bonus) and restore benefits. Although this will increase your basic coverage premium, it can still be an ideal way to improve your coverage with minimal costs. While planning, one should also keep in mind that the premium for health insurance increases due to age and medical inflation. Hence, you should make the necessary provisions while planning your health insurance portfolio. 

In addition, there are other factors, such as location, that may have an impact on your portfolio. The needed coverage for a person/ family would be higher than that of Tier 2 or Tier 3 cities in this case since Tier 1 cities have high medical costs and lifestyle diseases are more likely to affect an individual. There might also be a case to protect yourself from specific diseases if you are prone to the same or have a family history. In such a case, you should ensure that your policy covers any of such likely diseases. Moreover, in case of pre-existing diseases, you should check the waiting period and the degree of coverage provided by the policy. 

Keeping these things in mind as you plan for your health insurance portfolio becomes crucial. Although one person cannot comprehend all of these nuances, it is thus important to engage an insurance advisor for a portfolio of health insurance that is specifically outlined.

Bottom Line

Usually, health insurance policies are upgraded every 2-3 years by the insurance providers and new features are added to them. As one needs to stay updated with the new technologies & skills, in a similar way, we may need to upgrade our health insurance as well. Either by paying the same premium or a few hundred more, you can upgrade your health cover to a much more comprehensive & feature-rich policy. The cost of health services has increased as a result of the advancements in the treatment of numerous ailments and disorders. And, this rising cost of medical care has further heightened the necessity for health insurance. 

We offer our services through personal counsel with each of our clients after understanding their wealth distribution needs. Our approach is to enable our client's to understand their investments, have knowledge of investment products and that they make proper progress toward achieving their financial goals in life.

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