Money Saver India
Do you have one of these health plans?

Do you have one of these health plans?

We’ve examined the policy documents of 20 health plans for individuals, in search of a claim-loading clause. They were to be found in six plans, including the one from ICICI Lombard.

A health insurance plan is to ensure your medical expenses don’t get out of hand, so when a company includes a claim-loading clause in its agreement with you, it will seem unfair. In years that you don’t make a claim, the insurer keeps your health premium, and when you do make a claim, this clause allows it to earn back its money.

The claim-loading clause basically stipulates that, if a claim is made, the premium will increase by a certain percentage. This percentage can be as high as 200% and could even be applicable to all subsequent renewals. Now, imagine making a claim in consecutive years, as would be the case in case of a serious long-term illness. For each year you make a claim, your premium would increase substantially. Even worse, you’ll have no way out, as even with portability, other insurers would be very unlikely to take you on as a customer.

This is why it’s very important to check if your health insurance policy includes a claim-loading clause. If it does, it’s best to get out while you can. In the past 12 months, most insurers (see which insurers don’t have this clause) have expunged this clause from their contracts. However, the following are the plans that still include it:

Claim Loaded Plans

Insurer Plan Name Applicable load When?
Royal Sundaram Good Health up to 100% If your claim is 4 times your premium
Star Health Health Gain up to 75% Claim exceeds 100% of premium
ICICI Lombard iHealth up to 200% Depending on nature of claim
Future Generali Health Suraksha up to 50% In case of any claim
Bajaj Allianz Health Guard up to 50% 3 claims in previous 3 years with total amount exceeding Rs50,000
SBI General Retail Health Plan Not defined In case any disease / illness is contracted during the last 12 months

Here are the insurers whose individual health plans included no claim-loading clause: Bharti AXA, Oriental Insurance, HDFC Ergo, Reliance General, National Insurance, New India Assurance, L&T General Insurance, Max Bupa, Appolo Munich, United Health Insurance, Universal Sompo Insurance, Iffco Tokio, Religare, and Tata AIG.

The absence of a claim-loading clause in these insurers’ policies is no absolute recommendation. Do read the other terms and conditions before making your decision.

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