Which one is better to opt - Retail Health Insurance or Group Mediclaim?

With the given benefits of Health Insurance and growing diseases it’s a burning question that what is the right time for health insurance and which type is right? Noting is right or wrong it is always relative. Same is the case with Group Health Insurance and Individual Health Insurance. To answer the question which among the two is best it would be good to know what it offers and what it not and under what circumstances, then choose what best suits ones need. We all keep hearing from most of the agents that Group Health Insurance is best as it covers the pre-existing diseases. IRDAI (Insurance Regulatory and Development Authority of India) defines Pre-Existing disease as “Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and / or were diagnosed, and / or for which medical advice / treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter”. In group health insurance policy, as the insurance is taken for the whole group no scanning is done for pre-existing disease at individual level. Therefore, pre-existing disease is covered for all individuals in a group. However, ones the individual goes out of the group the cover ceases and he will not have any coverage. The damage is more when he gets diagnosed with any ailment while in the group and now he wants to quit the group. Imagine a healthy employee joined group insurance of an organisation at age of 25years and diagnosed with a heart ailment at age 40years, now he wishes to voluntarily quit the group to start up a business of his own. Whether he will get the benefit of insurance with respect to heart ailment under individual policy? Unfortunately, no. For individuals, the health insurance is only for Healthy people. So, he may not get any coverage in individual policy since now he is already suffering from the disease. Under individual health insurance policy, individuals are required to declare any existing ailments and insurer may choose to decline or load the premium for covering them depending on the severity of ailment. Even if they are given the policy, the pre-existing benefit still takes 24 to 48 months to cover them into the policy. Hence it is better to get once covered under individual policy when he is healthy and is of less age. If he is already suffering from any disease, then the group coverage with pre-existing cover is the best solution. For any further assistance or clarity please feel free to reach us at Ethika Insurance Broking Private Limited.
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