Priyanka Parashar/Mint
Priyanka Parashar/Mint

Medical conditions should be disclosed while buying mediclaim

If problem is minor, it is likely that the insurance will be issued at standard rates

What does it mean when one is asked to claim for domiciliary hospitalization? —Chandana

Domiciliary hospitalization refers to treatment that under normal course would have required hospitalization but was taken at home instead. The reason for taking the treatment at home should be that no hospital room was available or you were not in a position to be hospitalized.

It comes with conditions. Typically, the sum assured is limited; several chronic diseases such as asthma, hypertension, and diabetes are excluded; the claim period should be three days or more; pre- and post-hospitalization charges are not paid; and treatment cost is reimbursed rather than cashless.

Does a minor thyroid problem have a bearing on the amount of premium? Do I have to mention it as a pre-existing condition when buying a health plan? —Akshata Verma

You must definitely mention the thyroid problem in the proposal form. Insurers will ask for more details that you should provide. If the problem is minor, it is quite likely that the insurance will be issued to you at standard rates but with thyroid excluded for a waiting period.

The group mediclaim provided by my new employer is from the same company with which I have an individual health plan. What will the claim procedure in case of an emergency? —Daksh Gill

You should ask the insurer for a cashless payment through the company’s group health insurance. This has several advantages—generally the company will help in follow-up with the insurer; group plans often waive conditions such as exclusion for pre-existing diseases; and you should avail benefits that your company is providing. Save up your personal health insurance for another rainy day.

I suffer from epilepsy but it is under control. Can I get health insurance cover of 15 lakh? —Pinky G.

Unfortunately, most insurers will not issue you a cover if you suffer from epilepsy, particularly if the sum assured required is large. You may, however, be able to get a cover for 5 lakh. Do declare epilepsy in the form.

An insurer has told me that no medical tests are required up to 15 lakh of insurance. Does that mean I will get this insurance even if I suffer from diabetes? —B.R. Narayan

You will need to disclose pre-existing diseases even if there are no medical tests. For some pre-existing diseases, the insurer may increase the premium, put waiting periods or decline an insurance. Do disclose existing diseases. The insurance will be issued to you now but it is unlikely that claims will be paid if the insurer discovers that material facts were not disclosed.

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