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Medical insurance was a rarity 30 years ago with only the four GIC companies offering it. Today with a plethora of companies, it is confusion galore. Normally employers offer health insurance as a part of the CTC package for the whole family. Most companies have a good tie-up with an insurance company and normally one is well covered till retirement.
The killer in the health insurance policy is the exclusions. Every polity will have a list of exclusions about which ailments they do not cover at all, and a few that they offer limited cover. This will need to be read with a magnifying glass. NATURALLY, ANY HEALTH AILMENTS YOU ALREADY HAVE ARE ALMOST INVARIABLY ON THE LIST OF EXCLUSIONS.
For those who are not covered by their employers through an insurance policy, it would be imperative to take a medical insurance policy. There are plenty of options that you can check out from any website and you need to choose a scheme that suits your requirement.
A few jargons
Individual Plans – Covers the individuals
Family Floater – Covers the entire family for an aggregate amount, the insurance can be claimed by any of the family members individually and collectively
Cashless – There is normally a tie-up with the hospitals and you need not pay the hospital bills. This naturally is better than paying and then claiming reimbursement
Critical Care Policies: This covers a few critical illnesses. Just after the diagnosis, you are paid based on terms and conditions without any medical bills. I find this interesting and hassle-free.
GROUP INSURANCE: This is the best scheme and the one that employers take. Under this (available in SBI post-retirement also), a group of persons together take an insurance policy from an insurance company. Since they get bulk business, the premiums come down, almost by 50% (Health insurance is quite costly). Unluckily this is presently limited to a homogenous group of people like employees of a company after retirement etc, though this can be for any group or set of persons
This Tata AIG site will give you a fair idea about the medical insurance schemes and their premiums
https://www.tataaiginsurance.in/…/accidentguard_calculator.…
One serious issue with medical insurance is that the coverage is just for a year (some with a period of 3 to 5 years). Apart from the hassle of renewal, the premiums can change as per your health profile.
AUTISM AND INSURANCE
To my knowledge, there is no insurance for autism and there cannot be a regular one by a commercial insurance company by common sense. As I outlined about the exclusions, in health insurance, the company does not cover an already existing ailment.
However, it is imperative that a person with autism be covered for other health ailments. Today they are kids and thus not very vulnerable. When they reach middle age, they would be as, if not more vulnerable than any other NT folks for all critical illness
They will naturally be covered for all ailments other than autism-related ones in the existing health insurance policies. After retirement, we need to cover them (and ourselves under some health insurance)
Now here is the catch. As the age goes up, so does the premium. However at some point in time, maybe again between the age group of say 30 to 40, one should consider a separate individual policy, preferably cashless or critical care for the person with autism
SPECIAL GOVERNMENT INSURANCE SCHEMES FOR AUTISM/DISABILITIES
In the west am told that the Government through the insurance companies provides medical insurance or reimbursement for autism as a part of their social security. In India, this is at a nascent stage.
There is a Niramaya scheme by the Govt which offers overall insurance up to Rs 1 lac. The link is http://www.thenationaltrust.gov.in/cont…/scheme/niramaya.php
However, the sub-limits of the coverage are so low that it is depressing. Thus despite a very nominal premium (Rs 250 apparently), I have not opted for it.
There is another health insurance for the disabled- Swavlamban. This has coverage of Rs 2.5 lacs pa with a premium of around Rs 350. However, it is only for EWS i.e. income less than 3 lac p.a. The link is http://www.newindia.co.in/Content.aspx?pageid=6363
There are media reports that Star Health Insurance has insurance for autism and has covered around 250 kids in Chennai. Their cover is apparently Rs 1 lac. No further details are known about this except for some press reports.
Health Insurance and assisted living
One of the main issues which the person with autism is likely to face will be hospitalization and medical care after the parents are no more. While this itself will be a challenge. I have faith in humanity that the siblings/family/trustees will ensure this. However, there would be a financial issue given the state of healthcare in India. Thus medical insurance for the person with autism, after the safety net of employer health insurance is gone needs to be a part of financial planning.
I give the disclaimer that I only have theoretical knowledge. Please use this for information purposes only and do not treat this as personal advice. However, though these topics are depressing, we cant keep procrastinating and need to start some planning.
