Insurers charge an extra premium equal to the out-patient department cover provided

The underlying assumption is that the insured will claim his full out-patient department limit every year


Ramesh Pathania/Mint
Ramesh Pathania/Mint

Is there any health cover which covers medical tests as well, or is it only for hospitalisation? I need to do medical tests on a regular basis due to diabetes.

—Arjun Singh

There are several health insurance plans that provide outpatient (OPD) cover. Under OPD extension, medical expenses not linked to hospitalisation are payable. This includes diagnostic expenses, doctor consultations and cost of medicines. If you want to get similar expenses covered, you should look for a plan with OPD cover. Medical equipment such as portable dialysis machines or test strips may not be covered by most plans.

Current plans that provide OPD cover are expensive. Typically, insurers charge an extra premium equal to the extent of OPD cover provided. The underlying assumption is that the insured will claim his full OPD limit every year. If you consider the extra administrative task of submitting bills and getting reimbursements, it is not much of a benefit. The major advantage of an OPD cover is that the increased premium can be claimed as a deduction under section 80D of the Income-tax Act, 1961.

If I buy a floater health insurance, will it be transferred to my family once I die?

—Ashok Gupta

In a family floater health insurance policy, it is possible to change the family composition at the beginning of each policy year. You could add or remove members. In case of death of one of the members, other insured members can continue the plan. Waiting periods accrued will be carried forward from the date of policy inception. Policy will be lifelong renewable for the surviving members. It is important that the surviving family members pay the renewal premium on time and inform the insurer about the death, so that the premium can be reduced.

I have an under construction house. Should I buy a house insurance for it at this time?

—Madan Harsh

Yes, you should buy a construction all risk (CAR) policy for an under-construction house. As the name suggests, it is a comprehensive policy to cover several risks that can cause material damage to your house. A CAR policy has specified exclusions such as wilful damage, design defects and faulty material. Other than the specified exclusions, all risks that can lead to physical damage are covered. These include: fire, flood, earthquake, burglary and malicious damage by third party.

Further, the policy has a provision to cover property damage or bodily injury to a third party due to an accident in the insured’s premises.

For a two-storied house in Delhi, which takes about a year to construct, it will cost about Rs15,000 to cover construction cost of Rs1 crore.

I am a practicing general surgeon in Delhi. I have heard about policies that could cover cases filed on me by my patients. Can you please elaborate?

—Ratan Malhotra

Litigation related to medical negligence is being reported increasingly from the metros. This could be driven by the complex nature of cases that make practitioners prone to errors and, as well as increased customer awareness about their rights. You could buy a professional indemnity insurance to protect yourself. A professional indemnity policy covers the cost of defending yourself in a court of law. Additionally, the policy pays for compensation awarded by a court to the patient. The major exclusions under the policy are wilful and criminal acts.

Medical negligence cases are filed much after the treatment is over. So, opt for the retroactive date option that covers historical claims. While renewing your policy, ask for this date to be from the date of inception of the previous policy, assuming you had retroactive date option for all your previous policies. This would ensure that all claims arising after the first policy inception date are covered.

Abhishek Bondia is managing director and principal officer, SecureNow Insurance Broker Pvt. Ltd.

Queries and views at mintmoney@livemint.com.

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