A policy that covers your OPD expenses

Cigna TTK's ProHealth Accumulate can be a good addition to your health insurance contingency

Indian consumers’ hesitation to buy health insurance perhaps stems from the fact that most of the health care expense goes towards outpatient care, medicines and other medical goods, while in-patient or hospitalisation accounts for a smaller share. And, most health insurance policies cover only hospitalisation costs. So, what is the point of buying health insurance if it does not pay for most of the health care costs?

Cigna TTK recently launched a new health insurance policy called ProHealth Accumulate, which includes a Personal Health Wallet. This wallet allows policyholders to accumulate funds to pay for outpatient treatment, including dental, vision, consultation fees, medicines, etc. If you already have an insurance policy, the wallet can be used to pay for co-pay or deductibles, like a top-up plan.

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One can invest in a fixed deposit or a mutual fund, but since ProHealth Accumulate’s wallet can be used only for health-related expenses, it ensures that the money is not spent on other expenses. In ProHealth Accumulate, there is a base cover that offers coverage between Rs 5.5 lakh and Rs 25 lakh, which covers hospitalisation and day care procedures. In addition, there is a personal health wallet benefit option, which offers amounts such as Rs 5,000, Rs 10,000, Rs 15,000 and Rs 20,000.

 
“Even if you don’t utilise any money from the wallet, you don’t lose it. You can carry it forward. It also earns the benefit of five per cent every year on the amount that is not utilised, while in base cover you get a bonus only if you don't make a claim,’’ says Sandeep Patel, CEO and managing director, Cigna TTK Health Insurance Company.

The base cover covers day-care procedures. But, the wallet in addition to day-care procedures also covers deductibles, pharmacy, dental, vision, alternative medicine, and can also be accumulated for future needs. The base cover has a cumulative bonus of minimum five per cent if you don’t claim. The wallet is structured like a debit card and Cigna TTK is working with a bank for operating it.

“The option to accumulate is useful because as you grow older, your out-patient expenses will be higher,” says Patel.

If you want to port out of the plan, you can port only the base cover. But, you can use the money accumulated in the wallet for up to one year for any health-related expense.

Pro Health also comes with an option to accumulate reward points by working on wellness programmes. These points can be used to reduce the premium on your policy or add to the corpus in the wallet.

The savings benefit is a positive feature, if other benefits like No Claim Bonus (NCB), etc are the same, says Yashish Dahiya, CEO and co-founder, PolicyBazaar.com.

“It is a good option for a young consumer who is cost-conscious. But, the No Claim Bonus in Cigna’s product is different from other comparable policies. A higher NCB is more beneficial as the higher sum assured will take care of big expenses. And one can save for other expenses,’’ he says.

There are plans that offer NCB as high as 50 per cent in a year. “I would recommend customers who are looking to set up a contingency fund for healthcare expenses to go for their own overall financial contingency fund, and factor medical emergencies cost in them. This way, they will cover all the risks, have more control over the deposit including the interest the fund makes,’’ says Mahavir Chopra, director - health and life insurance for Coverfox.com, an online insurance broker.