Health insurance is a crucial financial tool, but it’s essential to understand the terms that can impact your out-of-pocket expenses: Co-payments Deductibles While these terms might seem complex, understanding them can help you make informed decisions when choosing a health insurance plan. What is a Co-Payment? Co-payment insured is responsible for a predetermined percentage of the medical expenses, regardless of the total cost of the claim. Eg . If an insured has a policy with 10% co-pay , at the time of claim , if his bill is of 2 lakh , then the insured would have to pay mandatory Rs 20,000/- from his pocket and the rest of the bill would be paid by insurance.If after few months the insured makes another claim of Rs 1lakh, he will pay Rs 10,000 from his pocket. For every claim made by the insured, if copay is opted the insured have to pay the percentage taken as copay Benefits of Co pay : It helps to reduce your insurance premium burden Sometimes insurers make it mandatory to offer a coverage., for eg in senior citizen plans. Here are some things to know about copays: Percentage: The copay is usually a percentage of the total medical bill, typically between 10% and 30%. When to pay: Copays are paid at the time of service. Where to find: The copay amount or percentage is on the policyholder’s health policy wording. When to apply: Copays are not applicable to all medical expenses, and some plans may only require copays for certain treatments. Copay and premiums: Some plans offer a voluntary copay option, which can result in a lower premium. However, the policyholder will eventually pay more toward the cost of treatment. Copay and waivers: Some policies include a waiver of the copay clause, which means the policyholder doesn’t need to pay a copay. However, these policies usually have higher premiums. What is a Deductible? A deductible is a fixed amount you must pay out-of-pocket before your health insurance coverage begins. Once you’ve met your deductible, your insurance will start covering a portion of your medical expenses. For eg. If an insured has opted for deductible for Rs 50,000/ – and insured files for claim of Rs 1,00,000/- he will have to pay Rs 50,000/- from his pocket before making a claim. Now if he raises another claim in the same year, let’s say of Rs 1 L , the company will pay the full amount of Rs 1L. Types of deductibles Compulsory deductibles are mandatory and are set by the insurer. Voluntary deductibles are optional and are chosen by the insured to lower their premium. Cumulative deductible applies to family floater plans, where all family members contribute to total deductible after which the policy will make claim payments. Comprehensive deductible is a single deductible amount that you keep adding till you have made the total payment of deductible amount agreed with the insurer and after this the insurer will make payments. Non- comprehensive deductibles may be applicable to only specific covers and not entire policy, the insured have to pay specific medical costs before raising the claim. How it works You pay the deductible, and then your insurance company pays the remaining bill directly to the healthcare provider. When to pay Health insurance companies can choose to charge deductibles annually or per treatment. How it affects your premium Generally, higher deductibles lead to lower premiums. This can make health insurance more affordable for people who don’t frequently need medical care. How it affects your out-of-pocket maximum Your deductible is part of your out-of-pocket maximum, which is the most you’ll pay during a policy period. Once you reach your out-of-pocket maximum, your insurance will pay all additional expenses at 100%. How it affects your medical care Having a high deductible can lead to delayed care, which can be harmful if you have a serious or urgent medical condition. Advantage : They help in lowering the medical insurance premium. Furthermore, the insurance company may offer discounts if the insured opts for voluntary deductibles. It discourages the insured from raising claims with small amounts, which helps the insured earn a No Claim Bonus (NCB) that can be leveraged to increase the coverage of the primary health policy. A salaried person who has a cover from his office as group health insurance can use this option to keep his insurance premium low as his office is also providing him with the benefit. Disadvantage : Financial burden: You’ll have to pay for medical expenses before you can access benefits. This can be a financial burden, especially if you have multiple medical emergencies. Delayed care: You might hesitate to seek medical care until you’ve met your deductible. Non-preventive care: Non-preventive care won’t be covered until you’ve met your deductible How Do Co-Payments and Deductibles Work Together? Often, co-payments and deductibles work in tandem. You might have to pay a co-payment for a service, even after you’ve met your deductible. Why Do Health Insurance Plans Have Co-Payments and Deductibles? Cost-Sharing: By sharing the cost of healthcare with policyholders, insurance companies can keep premiums lower. Reduced Claims: Co-payments and deductibles can discourage unnecessary healthcare utilization, helping to keep costs down for both the insurer and the insured. Copay vs deductible: A deductible is the amount paid out of pocket before insurance starts to pay, while a copay is a fixed fee for specific services. Copays don’t always count toward the deductible. Conclusion : By understanding these concepts, you can make informed decisions about your health insurance coverage. Remember to read your policy carefully and consult with your insurance provider or a healthcare professional if you have any questions. Read more on how we can help you with best health insurance plans and should you chose a deductible or co pay clause
As a health insurance advisor, I witness firsthand the anxieties families face regarding their senior citizens’ healthcare needs. The rising cost of medical care can be a significant burden, and the prospect of a sudden health crisis can be overwhelming. The launch of Ayushman Bharat, particularly the Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), has been a welcome development. It provides a much-needed safety net for families by offering free health insurance coverage. However, in my experience, it’s crucial to view Ayushman Bharat as a stepping stone rather than the final solution, especially for senior citizens. Before discussing it further let us first understand who can apply and how Who Can Apply ? Anyone aged 70 or above with a valid Aadhaar number would be eligible for applying under the scheme and that initially there would be a pilot launch to sort out any issues that might arise How to Apply ? 1.Visit the official website of Ayushman Bharat ( https://pmjay.gov.in/) 2.Get your Aadhaar or ration card verified at a PMJAY kiosk 3.Provide family identification proofs 4.Get your e-card printed with a unique AB-PMJAY ID. 𝗘𝗻𝗿𝗼𝗹𝗹𝗺𝗲𝗻𝘁 𝗮𝗻𝗱 𝗖𝗼𝘃𝗲𝗿𝗮𝗴𝗲 The scheme is expected to be extended to all senior citizens above 70 years old. A pilot program is likely to start this week in select locations before a nationwide rollout. (The scheme offers free health insurance coverage of up to Rs 5 lakh per family. Senior citizens can choose to continue with their existing public health insurance schemes or opt for Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Understanding Ayushman Bharat’s Benefits and Limitations Let’s break down Ayushman Bharat: Strengths: This scheme offers cashless hospitalization services and covers a wide range of medical procedures, reducing out-of-pocket expenses. It also ensures access to quality healthcare at empanelled hospitals. Weakness : The coverage amount of Rs. 5 lakh per year may not be sufficient for senior citizens with chronic conditions requiring long-term care or expensive treatments. Additionally, the availability of quality healthcare facilities within the network, especially in remote areas, can be a concern. Why Senior Citizens Might Still Need Separate Health Insurance Here’s where separate health insurance for senior citizens comes into play: Enhanced Coverage: Separate plans can provide additional financial protection beyond the Rs. 5 lakh limit offered by Ayushman Bharat. This ensures comprehensive coverage for potentially expensive procedures. Specificity: Senior-specific health insurance plans are often designed to address the unique needs of older adults, including pre-existing conditions and age-related illnesses. Wider Network Options: These plans may offer access to a wider network of hospitals, including private institutions, which might provide specialized care or better amenities. Addressing Existing Concerns While Ayushman Bharat addresses a critical need, there are existing concerns that need to be acknowledged, as pointed out in Deccan Herald. Improving the quality of care within the network and ensuring smoother claim settlements are crucial for the scheme’s long-term success. The Bottom Line: A Tailored Approach Ayushman Bharat is a positive step towards a healthcare-secure future for senior citizens in India. However, for comprehensive protection, especially considering potential limitations and individual needs, exploring separate health insurance is highly recommended. As your health insurance advisor, I encourage you to schedule a consultation to discuss your specific situation and explore the best options for your senior loved ones. Together, we can create a healthcare plan that provides peace of mind and ensures they receive the care they deserve. Click here to book a free consultation
Understanding Waiting Periods Waiting periods in health insurance can be a complex topic, but understanding them is crucial to make informed decisions about your coverage. In essence, waiting periods are specific timeframes during which certain types of claims, such as those related to pre-existing diseases or specified illnesses, are not covered. Pre-Existing Diseases (PEDs) Defined by IRDA , Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and I or were diagnosed, and I or for which medical advice I treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter. Simple words , A pre-existing disease is any condition diagnosed or treated within 48 months before purchasing your health insurance policy. Examples include: High blood pressure Diabetes Asthma Thyroid conditions Chronic obstructive pulmonary disease (COPD) Kidney disease Impact of PEDs on Health Insurance Higher Premiums: Insurers may charge higher premiums to cover the increased risk associated with pre-existing conditions. Waiting Periods: Many policies impose waiting periods for claims related to PEDs. This means you’ll need to wait a specific period before coverage kicks in. Policy Denial: In severe cases, the insurer might deny coverage altogether. Permanent Exclusion: The insurer may permanently exclude coverage for the pre-existing disease and related conditions. Should You Hide Pre-Existing Conditions? Absolutely not! Disclosing pre-existing conditions is crucial. Hiding them can lead to claim denials later, causing significant financial hardship during a medical emergency. Specified Diseases Specified diseases are a list of pre-defined illnesses covered under a specific policy. These often include: Cancer Heart diseases Kidney diseases Liver diseases Paralysis Major organ transplants Multiple sclerosis Alzheimer’s disease Parkinson’s disease Maternity Newborn cover Impact of Specified Diseases Waiting Periods: Similar to PEDs, health policies may have waiting periods for specified diseases. Strategies for Managing Waiting Periods Start Early: Purchase health insurance when you’re young and healthy to benefit from lower premiums and shorter waiting periods. Low Waiting Period Plans: Look for policies with shorter waiting periods for PEDs and specified diseases. Plan Comparison: Carefully read the policy wording to understand how it handles waiting periods. Reduced Waiting Period: Some policies allow you to decrease the waiting period by paying an additional premium. Policy Continuation: Avoid discontinuing your existing health insurance plan to avoid starting fresh with waiting periods. Portability: If switching insurers, utilize the portability feature to transfer your existing policy. By understanding waiting periods and implementing these strategies, you can make informed decisions about your health insurance coverage and protect yourself from unexpected financial burdens. Get Expert Advice Have questions about navigating waiting periods in your specific situation? Feel free to reach out for a consultation. Book Your Free consultation
This I say from personal experience that navigating the complex world of health insurance can be overwhelming. So many questions to be answered – How much coverage is needed? What is covered? What are the extra features? Is the feature required? What is hidden?? The major issue – So many different features in so many different policies and therefore So Much Confusion. And if you make the mistake of providing your details to those who just want to sell, you are doomed !!!! the incessant phone calls and messages without even understanding what you are looking for. That’s where a consultative approach comes in. Unlike traditional insurance sales, a Consultative Approach focuses on understanding your unique financial situation, health needs, and long-term goals. Let us take a minute to understand the key components of a Consultative Approach: Personalized Recommendations: Comprehensive evaluation & Risk identification: A detailed analysis of your current and prior medical history, family size, lifestyle, and financial situation. Coverage requirements: Determining the level of coverage needed for hospitalizations, surgeries, medical treatments, and other expenses. Tailored options: Presenting a range of health insurance plans that align with your specific needs and budget. Trust and relationship building: Establishing a strong relationship based on trust and open communication. Expert Guidance: Insurance knowledge: Providing in-depth information about policy terms, coverage details, deductibles, co-pays, and maximum limits. Comparison analysis: Helping you compare different plans to identify the best value for your money according to industry trends. Ongoing support: Claim assistance: Explaining the claims process and offering support during the claim filing process. Policy review: Regularly reviewing your insurance coverage to ensure it continues to meet your changing needs. By taking a consultative approach, you can make informed decisions about your health insurance coverage and together we can identify the right health insurance plan that truly protects you and your family. Would you like to discuss your specific needs and explore health insurance options? Ready to take control of your health insurance? Let’s chat! #healthinsurance #financialplanning #consultativeapproach #insuranceadvisor #wellness #financialfreedom
Ben Graham the inventor of the phrase “margin of safety” defined investment as “ An investment operation is one which, upon thorough analysis, promises safety of principle and satisfactory returns. Operations Not meet these requirements are speculative” Investing can be an exciting journey that allows you to grow your wealth and achieve your financial goals. But before you dive in, it’s essential to equip yourself with a solid understanding of core investment principles. These fundamental concepts provide a roadmap for navigating the financial markets, making informed decisions, and building a successful investment portfolio. Whether you’re a seasoned investor or just starting out, a grasp of these core principles empowers you to take control of your financial future and make smart choices with your hard-earned money The fundamentals are very easy to grasp and may work as a guiding principle for anybody investing. They do not change for your Mutual fund investing too. Assigning goals: Every investment you make should be tied to a specific financial goal. This goal could be as simple as growing your money by a certain percentage over time, or it could be something more substantial like buying a house, funding your children’s education, or securing a comfortable retirement. Risk : Understanding your risk tolerance is crucial before investing. Mismatching your risk profile with an investment’s risk level can lead to a negative experience. Imagine a conservative investor placed in a small-cap fund, like the Nippon Small Cap Fund, which experienced a significant downturn of -36.19%. This could cause them considerable anxiety and potentially derail their investment plans. Conversely, an aggressive investor stuck in an equity-saving fund during a strong market might feel frustrated watching others earn higher returns . Horizon : Time horizon in investing refers to the amount of time you plan to hold onto an investment before you need to access the money. It’s a crucial factor in determining your investment strategy and risk tolerance Common Time Horizons: Short-Term (0-3 years): Focuses on preserving capital with minimal risk. Examples include savings accounts, money market funds, and short-term bonds. Medium-Term (3-10 years): Aims for a balance between growth and stability. Examples include balanced funds, index funds, and some corporate bonds. Long-Term (10+ years): Prioritizes long-term growth with the ability to handle volatility. Examples include growth stock funds, small-cap funds, and real estate investments. Current asset allocation: Having your asset allocation analyzed is a critical step in successful investing. This process helps you understand the current makeup of your portfolio and how different assets within it have historically behaved. By analyzing your asset allocation, you can identify any areas where you might be overweight or underweight in certain asset classes. This knowledge empowers you to make informed decisions and potentially adjust your portfolio to better align with your risk tolerance and financial goals( i have written about the concept in my blog https://wealthinn.in/asset-allocation-guideline-for-investment/) Diversification : Diversification in investing is a fundamental strategy that involves spreading your investments across various asset classes, industries, and even geographical locations. The core principle is to avoid putting all your eggs in one basket. By diversifying, you aim to reduce the overall risk of your portfolio without sacrificing potential returns. Asset allocation tends to take care of your diversification needs Emergency planning : Building an emergency fund is a crucial principle of sound financial planning. It’s a safety net that can cover unexpected expenses, such as job loss, medical bills, or car repairs. Aim to save 6-12 months of your living expenses in this fund. This amount can be adjusted based on your circumstances. For example, if you have a steady job and good health insurance, you might target 6 months. Conversely, if you’re self-employed or have high healthcare costs, consider saving closer to 12 months. You can store your emergency fund in a highly liquid account like a Fixed deposit account or a money market fund. Remember to regularly review and adjust your emergency fund as your income and expenses change. Insurance planning : Insurance planning is the process of strategically choosing insurance policies to financially protect yourself, your loved ones, and your assets in case of unforeseen events. It’s about identifying potential risks and finding insurance plans that can mitigate the financial burden they might cause. You should at least run one term plan and one health insurance policy apart from your corporate policy if you are salaried . These profiles prepare you and arm you with necessary steps to investment, i always say that products are last to be selected. Once the profile is clear things are done we can move to look into the products and select the products as per the guidelines given below Past performance : Past performance is a tricky concept in investing. While it can provide some insights, it’s not a guaranteed predictor of future results. But we do need to check how the funds are performing as compared to other funds in the category. Rolling returns : Rolling returns are a valuable tool for investors looking to understand the historical performance of an investment over various holding periods. Unlike traditional point-to-point returns, which show the change in price from one specific date to another, rolling returns provide a more nuanced picture. Benefits of Rolling Returns: Provides a Smoother Picture: Rolling returns smooth out short-term fluctuations, offering a better understanding of how an investment performs over different holding periods. Helps Analyze Risk: By analyzing rolling returns across various holding periods, you can gain insights into the investment’s potential volatility and risk profile. Informs Investment Decisions: Understanding how an investment has performed for different holding periods can help you make informed decisions about your own investment horizon and risk tolerance. Ratios : Mutual fund ratios are like little keyholes that give you a glimpse into the inner workings of a fund. They offer valuable insights into a fund’s performance, cost structure, and risk profile. Here are some key ratios to understand: Expense Ratio: This is the annual fee a fund charges investors to
Most firms have set up a war room to triage their immediate response to the crisis. But the lack of visibility around future demand complicates efforts to restart stalled portfolio companies…