My employer gives me a health cover. My mother was hospitalized and I have submitted the bills. But a few original bills were lost in transit but the company wants original bills. Is there a way to get the claim without original copy? If the insurance company does not pay the claim amount, whom should I approach?
Insurance companies require original bills to confirm two things—the amount spent on the treatment and that the amount has been spent on what you have claimed for. In case you have lost the original bills, you can take duplicate copies from the hospital, get them stamped from the hospital and signed by the treating doctor. The insurer will accept them as original copies.
In case the insurance company refuses to pay the claim, you can approach the insurance ombudsman with your grievance. You can get the address of the ombudsman for your state at www.irda.gov.in, the Insurance Regulatory Development Authority’s website.
My father retired last year from a government job and has been taking health benefits under Central Government Health Scheme (CGHS). Is the scheme sufficient for him or should I take an individual health cover for him.
CGHS provides very comprehensive coverage which is equivalent to the cover provided by any health policy. It has some drawbacks—there are limited number of private hospitals under CGHS and treatment is as on CGHS rates and the facility is not cashless.
On the other hand, an individual health cover will extend a cashless facility and can be used at almost all good hospitals across the country. However, it will cost around Rs 20,000 per annum for a value of Rs 5 lakh, which is a recommended sum insured. In case you have a good hospital near your house, which provides treatment to persons covered under CGHS, you may find it sufficient.
I have a health insurance from a private insurer in Delhi but I will have to shift to Mumbai after marriage. Do I need to transfer the policy? Will I be shifted to another third party administrator in Mumbai? —Shabnam
All insurance policies are valid across the country. Your health policy will provide similar benefits in Mumbai as it does when you are in Delhi. Your policy remains in force even when you are travelling or are on a vacation. However, the policy does not cover travel abroad. You should inform the insurer when you shift to Mumbai so that any communication from the insurer can reach you on time. But this is not a legal requirement and does not prejudice your claim in any way.
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