BackAll insurers have some restrictions on pre-existing diseases
After a specified timegenerally two to four yearsthe pre-existing ailments become payable
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Which insurers offer a restricted cover for medical emergency due to a previous existing disease? What about coverage for people above 70 years?
—Subramanian .V
All insurers have some restrictions on pre-existing diseases, typically in waiting period. After a specified time—generally two to four years—the pre-existing ailments become payable. Some insurers cover pre-existing diseases for senior citizens without any waiting period, i.e., from the first day itself. But such plans typically levy a high percentage of co-payment, around 50%. The co-pay option is attractive in the short term.
The cover for medical emergency due to pre-existing disease is more common in overseas travel health insurance and several insurers will offer up to 10% of sum assured in a medical emergency even if by an existing condition. Once an individual policy is issued, renewal is guaranteed for lifetime. This provision is stipulated by the insurance regulator. But there is no provision for insurers to compulsorily issue fresh individual policies. Many insurers offer plans that allow entry age of 70. They require a detailed pre-medical examination. Typically, if the prospect has a chronic ailment insurance may not be issued. Your best approach would be to apply to a few insurers and get their feedback. The larger insurers tend to be more liberal in underwriting.
What should I do if my health insurer rejects my claim?
—Anil Singh
You have a few options if an insurer rejects your claim. First, escalate within the claims team and reason out the rejection with them. Second, reach out to the grievances team. If they do not resolve the complaint to your satisfaction within 15 days, you can reach out to the Grievance Redressal Cell of the Consumer Affairs Department of the insurance regulator. They will make sure that the insurer has looked at the case. Finally, you could go to the insurance ombudsman or consumer courts. Before you proceed down this path, make sure you document each stage carefully and get responses from the insurer in writing. Make your representation focused on the reason for rejection.
Health insurance claim is rejected for either of three reasons, a) claim process issue, b) policy exclusion, and c) non-disclosure at underwriting stage.
I plan to buy two health insurance policies for my family. One for my wife (we are both under 30 years) and child (4 years), and one for my parents. My father, 60, has high blood pressure (BP) and diabetes, while my mother, 55, has low BP. What should I look for while buying a policy?
—Ajay Nair
Since your father has high diabetes, look for separate insurance for each parent. Insurers are generally reluctant to cover diabetics. For a list of plans by age group and family size, you could refer to the Mint Mediclaim Ratings.
Queries and views at mintmoney@livemint.com
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