I have two healthcare policies from different insurers. Is it possible to claim for the same illness from both the insurers?
All general insurance policies, barring defined benefit policies such as personal accident, have a contribution clause. This clause says that if there is more than one policy to cover the same risk, then each policy will pay for the loss in proportion to the sum insured in each. This means that if you have two health insurance policies with sums insured of Rs 1 lakh and Rs 3 lakh, then the total value of health insurance is Rs 4 lakh. The first policy is 25% of the total value and the second is 75% of the total value. Therefore, for each claim the first policy will pay 25% of the claim amount and the second will pay 75% of the claim amount.
However, in practice most insurers do not enforce this clause to avoid inconvenience to customers. This means that if your claim amount is higher than the value of one of your policies, you can get the excess amount reimbursed from the second policy. However, this may not be very convenient and claim reimbursement may take time.
I want to take a health insurance plan for my mother. She is 49 years old, but has been a diabetic for the past 15 years. What kind of a plan should I consider?
Most insurers get health tests done for persons above the age of 45 years while enrolling them for the first time. However, some insurers do not ask for tests up to the age of 50 years; you can get your mother insured with one of them. If there is no claim related to diabetes for the first four years after taking the policy, diabetes will also get covered. The second option is to cover her under health insurance plans especially meant for diabetics. These plans cover main complications arising from diabetes from the first day of coverage. The downside is that these plans do not offer high sum insured and only two insurers are offering them in India currently. If your mother has mild diabetes, you can explore the first option while the second option will be better if she has acute diabetes.
My son has a learner’s licence. He accidentally banged the car against a shop. The car is in my name and I have taken a third-party cover. Will the insurance company compensate the shopowner?
In many countries, car insurance is in force only if the persons mentioned in the insurance policy are driving the vehicle. However, in India car insurance does not have such a restriction as long as the insured vehicle is being driven by a person holding a valid Indian licence. Hence, you will be paid under car insurance.
Rahul Aggarwal is director, Optima Insurance Brokers
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