Why don’t health policies don’t cover non-allopathic treatment? There are several Ayurvedic hospitals in the approved list of institutions of my third-party administrator (TPA). If I am not be able to file a claim for treatment availed in any one of them, what is the purpose of including their name?
Most insurance companies do not cover non-allopathic treatment but there are a few who do. The uniform pricing of medicines and uniform line of management of disease has led most insurers to restrict coverage only to allopathic treatment.
While an Ayurvedic hospital might be on the TPA’s approved list, the customer will have to comply with the policy terms and conditions of the particular insurance company with whom he is covered. The customer should also bear in mind that third party administrators (TPAs) may have tie-ups with several insurers—some cover alternative treatment, others don’t—and policy terms and conditions differ with each insurer.
Has the IRDA prescribed any rules that are binding on insurers for cancellation of a health plan in case the policyholder is not happy with the product?
There is no such IRDA restriction. On the contrary, it is the insurer who has certain clauses pertaining to cancellation of a health plan in the policy document.
During the tenure of the policy, the policyholder can opt to cancel the policy and the insurer shall refund the premium under the short-period scale, ranging from 0% to 90%, depending on the balance period of cover. This option is available to the client provided he has not received any claim amount under the policy.
The various policies of insurers and their terms and conditions are uploaded on their websites. The customer can browse the net and compare the terms and conditions of all the insurers. As regards the cancellation of a policy, the insured has to read the policy terms and conditions carefully before taking a decision.
The cancellation clause applies to other insurance products as well, such as motor insurance, marine insurance, home insurance and other general insurance products. However, the terms and conditions for cancellation will differ with each class.
Readers are welcome to write in with their life and general insurance queries to firstname.lastname@example.org. The questions will be answered by senior executives from leading insurance firms.
Ajay Bimbhet is managing director, Royal Sundaram Alliance Insurance Company Ltd.