I want to buy health insurance for my mother, aged 74. Will any company offer me a policy? On what terms?
Although insurance companies offer packages with different rates and conditions, most provide cover up to age of 60 with renewal up to 70 years. So, as of today, a senior citizen beyond 70 is not eligible for health insurance cover.
But, with increasing life spans in India, people above 70 make up an important segment. Following the IRDA’s recommendations to insurance companies to develop products specially tailored for senior citizens, it is possible that in the near future the needs of this segment will be catered to.
Is there a product in the general insurance space that covers loss of salary for non-attendance of office due to prolonged illness?
No insurance policy specifically covers loss of salary. However, there are policies, such as ‘hospital cash’, which could be used to cover such losses.
Hospital cash takes care of incidental expenses such as local hospital conveyance of the family, an extra bed for spouse and special diet by providing daily allowance for a specific period.
This policy offers protection to individuals — businessmen or salaried — compensating, albeit in a small way, for the number of workdays lost due to illness, leading to hospitalization.
A hospital I want to go to is not on my insurer’s list of approved institutions, which means I won’t get the cashless facility. What should I do to file my claim once the treatment is over?
All insurers tie with third party administrators (TPA), who in turn have ties with a network of hospitals across the country. Most major hospitals have tie-ups with a TPA, so one can safely assume all good hospitals will be able to provide you with cashless services.
Those that do not have a prior agreement for cashless hospitalization with your insurer / TPA are called non-network hospitals.
If you have availed the services of a non-network hospital, you can present your bills to your TPA and subsequently claim reimbursement for the expenses incurred.
To file a non-cashless claim, the following documents are required:
• Completed claim form
• Photocopy of the policy
• Original bills, receipts and discharge certificate from the hospital
• Bills from chemists supported by proper prescription
• Receipt and pathological test reports from a pathologist
• Documents from the general practitioner or surgeon prescribing the test
• The type of operation performed and surgeon’s bill and receipt that are stamped and have a numbered receipt
To claim reimbursement, you need to call the toll free number and provide details of your hospitalization, settle the hospital bills directly and then hand over the pertinent bills and documents to the TPA.
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.