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Health plans cover maternity costs after a waiting period

This waiting period is typically two-four years.

I purchased a second-hand car recently and insured it without changing the ownership. A week ago, I met with an accident. How should I make the claim?

—Jay Shah

There are two ways of making a motor claim—cashless or reimbursement. For a cashless claim you need to take your vehicle to one of the authorized repairers. They will liaison directly with the insurer to have a surveyor estimate repair costs, secure the necessary insurer approvals, repair the car and then get paid directly by the insurer. Also, you can call up the insurer and inform about the accident. It will send a surveyor to assess the damage. You can then have the car repaired at a repairer of your choice and claim reimbursement from the insurer. There are two important things to do. First, inform the insurer about the accident immediately. A week’s delay will make the insurer suspicious. Second, pursue the cashless claim process. This may allow you to sidestep the ownership issue. If you opt for reimbursement, the claim will be paid to the registered owner.

I am told that some insurance plans cover pregnancy. What is the kind of cover provided? My wife is six months pregnant. Can I take a cover for her?

—Karthik Bhat

Individual health plans cover maternity costs but only after a certain waiting period. This waiting period is typically two-four years. A few plans offer shorter waiting but is at least nine months. Maternity costs cover hospitalization for a normal or caesarean delivery. Treatment of the newborn is often covered as well. Most insurers will put a limit on the maternity expenses that can be claimed. In your specific case, an individual health plan will not cover your wife’s pregnancy. A fundamental principle of insurance is that the insured event must be uncertain. Once an event has occurred, pregnancy in your case, there is no uncertainty. Insurers will not enter into an insurance that will certainly be loss making for them. An exception to this is group mediclaim insurance offered by employers where insurers sometimes leverage the large group size to cover maternity at any stage.

Is there any time limit for settlement of claims under a householder’s policy?

—Sarah Pillai

The insurer must settle or repudiate the householder insurance claim within 75 days of intimating and providing complete claim documentation.

The first 30 days are given to the insurer to arrange a surveyor report. Another 15 days is given in situations wherein the insurer wants an addendum surveyor report. Finally, the settlement and decision must be made within 30 days of receiving the final surveyor report.

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