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Comparison of Health Insurance Schemes for Senior Citizens
It is absolutely important to have a solid health insurance policy as one approaches old age. The possibility of a substantial increase in one’s health care costs is almost a given. In this article, we look at and compare the different health insurance plans for seniors on the market. While every health insurance company wants to cover younger people (who are, almost by definition, healthier), few plans offer health coverage to people over 60. Another interesting thing to note here is that most health insurance plans for senior citizens are offered by general insurance companies in the public sector.
Health insurance plans available for seniors are:
- Varistha Mediclaim by National Insurance Company
- Eastern Insurance Seniors Plan
- Mediclaim for Seniors by New India Assurance
- United India Insurance’s Senior Citizens Program
- Star Health Insurance Red Carpet Program
Varistha Mediclaim by National Insurance Company: Anyone between the ages of 60 and 80 can buy this policy. Renewal can be done up to age 90. Between the ages of 76-80, there is an additional factor of 10% in the premium, and between the ages of 80 and 90, the premium increases by a total of 20%. The sum assured for this hospital policy is Rs. 1 lakh. For critical illnesses, the sum assured is Rs. 2 lakh. Critical illness coverage covers diseases such as cancer, kidney failure, stroke, organ transplant, etc. If the person has been insured through a health insurance policy for 3 years, he or she does not need to have a medical exam, otherwise a medical exam must be done at the prospect’s expense. For home treatment, the maximum claim amount is fixed at 20% of the insured amount. This policy covers ambulance expenses up to Rs 1000. For medical insurance of Rs 100,000 and critical illness insurance of Rs 200,000, the premium ranges from Rs 6200 (60-65 years old) to Rs 9200 (75-80 years old). An interesting feature of the policy is that by paying an additional 10% premium for each of these two conditions, pre-existing hypertension and diabetes are covered from the first year of the policy. Of course, Pre existing does not apply to critical illness insurance policies. Other pre-existing conditions are covered after 1 policy year. Dialysis, chemotherapy, and radiation for pre-existing conditions are not covered. Claims are payable only for events that occurred within India. Claims that occur within the first 30 days after the policy becomes effective will not be covered unless the person has been insured with the insurance company for the past 12 months. For purposes of this policy, pre-existing conditions such as cataracts, hemorrhoids, fistulas, hernias, benign masses, joint replacements, etc. will not be covered within the first 12 months. Excludes war-related medical claims, vaccinations, eyeglass costs, plastic surgery, orthodontic surgery, venereal diseases, vitamins and tonics (not part of treatment), nuclear disaster-related health claims, alternative remedies (such as homeopathy) Wait.
View: We think this is one of the best policies for seniors, just with a lower sum assured. In terms of norms for age of entry and pre-existing medical conditions, they are quite generous.
2. Eastern Insurance Elderly Specific Illness Plan: In this plan, policyholders can choose the sum insured for Rs 1 lakh, Rs 2 lakh, Rs 3 lakh, Rs 4 lakh or Rs 5 lakh. A restrictive feature of the policy is that 20% of any claim amount must be co-paid by the insured. Cashless payments via TPA are limited to Rs 1 lakh. This plan covers 10 specified diseases: Cancer, Kidney Failure, Heart Disease, Liver Related Disease, COPD (Lung Disease), Stroke, Prostate Disease, Orthopedic Disease, Eye Disease, Accidental Injury and Knee Replacement. Claims for specific diseases are limited by a percentage of the sum assured (for example, 50% of the sum assured for cancer and 20% of the sum assured for stroke). A person aged 65 is insured for Rs 100,000 with a sum assured of Rs 4,500, while a person aged 80 or above is covered with a sum assured of Rs 6,400. While this may seem cheaper than National Insurance’s Varistha medical plan, it’s not as extensive. The policy has an interesting premium refund clause if someone withdraws from the policy: If the policyholder withdraws from the policy within the first month, 75% of the premium is refunded if he chooses between 3 and 6 months of the policy Get out and get 25% of your premium back. In this policy, pre-existing conditions are not covered for 2 policy years. Other exclusions are very similar to National’s Varistha health plan.
View: This is a good plan in terms of sum assured and price, but the range of diseases covered is limited. Another problem is that pre-existing conditions are only covered after 2 policy years.
Mediclaim for Seniors from New India Assurance: The policy is for senior citizens aged 60 to 80 and the coverage can be Rs 100,000 or Rs 150,000. Pre-existing diseases will be covered after 18 months of continuous coverage, while diabetes and high blood pressure will require payment of additional premiums. Coverage is 30 days before hospitalization and 60 days after hospitalization. The cost of Rs 100,000 insurance for a 65-year-old is Rs 3,850 while that for an 80-year-old is Rs 5,150. Therefore, premiums are priced very competitively. If you want to extend beyond 80 years, you need to pay a surcharge of 10% or 20%. For those with pre-existing diabetes or high blood pressure, an additional premium of 10% must be paid each. An interesting feature is that there is a 10% discount if one’s spouse is also covered by the policy. This policy also has the same cancellation policy as the Eastern Specific Disease Plan. Claims will only cover medical expenses incurred in India. Exclusions are standard and very similar to National’s Varistha Mediclaim.
View: The price is attractive. The insurance limit is very low. The product manual says nothing about co-payments, so there is likely no co-payment requirement.
Specific Disease Plans from United India Insurance: In this policy, people aged 60 to 80 years get a sum assured of Rs 50,000 to Rs 300,000. A coverage of Rs 1 lakh will cost Rs 3,715 for a 65 year old and Rs 8,613 for an 80 year old. So while it’s cheaper for younger age groups, it’s a bit more expensive for older age groups. An interesting feature of the policy is that hospital cash is paid from the 3rd day of hospitalization after certain additional premiums are paid. While the other exclusion features of this policy are comparable to the previous 3 policies we discussed, the biggest problem with this policy is that it has a pre-existing 4 year waiting period.
View: The pre-existing 4-year waiting period is limited
Star Health’s Red Carpet Program: The program has had decent marketing success. While almost no one has heard of the fairly wide-ranging, well-priced plans from the 4 state-owned companies, the market is very excited about Star Health’s red-carpet plans. The policy can be insured for Rs 1 lakh, Rs 2 lakh, Rs 3 lakh, Rs 4 lakh or Rs 5 lakh. The age limit for entry is between 60 and 69 years. Pre-existing conditions are covered from the first year, except for pre-existing conditions for which the insured received payment within the first 12 months. Subsequently, these pre-existing conditions will be covered. There are sub-limits under this policy where different illnesses have different limits as a percentage of the sum insured. A policy with a sum assured of Rs 100,000 will cost Rs 4,900 while a policy with a sum assured of Rs 500,000 will cost Rs 20,000. The big bonus with this policy is the 50% copay for pre-existing conditions and 30% copay for other illnesses deductible! ! Other exclusions are very similar to those of nationalized companies.
View: Simple, well-marketed statement. But the co-pay clause is a huge negative! The upper limit for the maximum entry age is low (69), but the guaranteed renewal feature is a big plus. Also, the insurance sum of Rs. 5 lakh is quite high which is attractive in today’s scenario of rising medical costs.
All in all, we think National’s Varistha plan is the broadest. The only problem with state-run insurance plans is that the amount of coverage offered may not be sufficient to cover today’s high medical costs. On the other hand, they at least offer a senior citizen health plan. It’s hard to find any private health insurance company other than Star Health that offers any meaningful health insurance plans for seniors. The only issue we see with Star Health’s Red Carpet plan is the co-pay limit.
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