NEW DELHI :
My 54-year-old uncle recently ported his health policy of ₹5 lakh to a standalone health insurer. When he had taken the policy 15 years ago, he was absolutely fine. However, he became diabetic in the last five years. Now, while porting the same, he forgot to mention it to the new insurer. He is due to get his gall bladder stone surgery done and is worried about his claim. Will his claim be rejected?
—Name withheld on request
At the time of porting a health policy, it is important to declare your current health condition. This allows the insurer to evaluate whether to accept your application. You currently run the risk of claim rejection if existence of diabetes is discovered at the claim stage and if the insurer determines that the diabetes was a material non-disclosure. To avoid this, you can apply for rectification in the policy along with supporting documentation. If the diabetes is well-managed, then the rectification application could be accepted. Alternatively, you can port the policy with full disclosure to a third insurer at the time of renewal.
I have a ₹2 lakh health insurance plan and another ₹5 lakh top-up plan. I have a planned surgery next month. I was wondering which policy to use. Please advise.
Top-up health plan is an additional plan which gets triggered only after the claim exceeds the deductible amount. If your planned hospitalization costs less than the deductible, then you should make a single claim in the base health policy. In a network hospital of the insurer, you will be able to get cashless facility. If your planned hospitalization is more than the deductible, then the initial ₹2 lakh needs to be claimed from your regular health plan and you can avail cashless for the same. The balance amount that exceeds the deductible can be claimed from the top-up health insurance policy. The standard practice to claim from two insurers is to avail cashless from the first and claim the balance amount as reimbursement from the second.
Abhishek Bondia is principal officer and managing director, SecureNow.in. Queries and views at firstname.lastname@example.org