Deductible and its application are key to top-up health plans

The deductible should not be applied to every claim, but on an aggregate per year basis for all claims. Many such top-ups are available


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My family and parents are covered by a general insurance policy by my employer. I want to buy a top-up health insurance plan. Shall I take it from the same insurer as my employer’s? Explain what top-up plans are.

—Avijit Acharya

Top-up plans are offered under group and individual platforms. A group top-up plan is an extension of group medical insurance offered by the employer, and is linked to your employment. If you leave the firm, the plan may cease to be effective. A group-based top-up plan typically mirrors the group health insurance in terms of benefits. For example, pre-existing diseases will be immediately covered. Such plans are most relevant if the sum assured offered under the employer group health insurance is low, or the people proposed to be covered have pre-existing disease or are above the age of 65, making it difficult for them to get a stand-alone cover. An individual top-up plan functions independent of the group health insurance.

Such plans work out better in the long run, as the continuity is life-long. The plan functions irrespective of employment status and premiums are not linked to last year’s claim status.

Keep two things in mind for a top-up plan: the deductible offered and manner of application of the deductible. A deductible of between Rs.3 lakh and Rs.5 lakh is recommended. The deductible should not be applied to every claim, but on an aggregate per year basis for all claims. Many such top-ups are available.

What are the documents needed for making a motor insurance claim? How long will it take for the claim to be processed?

—Raul Jena

For a motor insurance claim, you need to submit an insurance policy copy, repair estimate from the service centre, copy of vehicle registration certificate, a copy of the driver’s licence, and later the claim bill. In case of an accident, you should inform the insurer immediately. It would appoint a surveyor to inspect the claim, and collect these documents from you. If you get the repair done at an authorised service center, the claim can be processed in a cashless way. The documents are submitted by the service centre to the insurer and you would need to pay only the non-admissible expenses to the centre. If you get the repairs done at a non-authorised service centre, the required documents need to be submitted to the surveyor. After all the documents are submitted, it takes 30 days for the claim to get settled.

Who can avail home insurance? What will be the policy’s start date?

—Roshni Singh

Home insurance can be taken by any home owner. There is no other eligibility criteria, and generally insurers don’t do a pre-inspection before issuing this insurance. A tenant cannot take this cover on the structure of the house, but can take one for covering the contents that she owns. The policy’s start date is generally the premium payment date.

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