Group medical cover has many advantages over a personal one

Published in Mint, December 11 2013. Written by Kapil Mehta

I have recently got a medical insurance from my employer. Will this cover any pre-existing illnesses that I may have?
—A. Verma

Much depends upon how your employer has structured the medical insurance. In most cases, group medical insurance offered by companies does cover pre-existing illnesses immediately. If fact, this is one of the most significant advantages of group mediclaim provided by employers.

I have two medical insurance policies—one from my employer, and the other one is personal. Recently, I underwent treatment for a critical illness. The hospitalization was taken care of by the employer insurance cover. But I paid on my own for the post-hospitalization procedures. How do I claim this from my personal insurer? What papers will I have to provide? Please advice.
—Mallika

Generally, personal medical insurance pays for post-hospitalization expenses incurred up to 60 days after hospitalization. You will need to submit the original bills and the hospital’s discharge summary. Do keep a copy of your bills because these can be misplaced in transit.
In the claim form you should mention that you are charging only the post-hospitalization expenses even though you had the option of charging the entire cost to the personal insurance. I think the insurer will be so relieved that it will clear your bills in record time.

I travel abroad frequently and for long periods. What insurance can I buy for medical cover overseas?
—U. Kilam

Consider purchasing a multi-trip annual overseas travel plan. The sum assured can go up to $500,000. You will also need to select the maximum length of overseas travel. This is typically 30 days but some plans offer up to 60 days.
This overseas insurance covers treatment due to accidents, emergency care or sudden disease onset. Planned treatment or pre-existing diseases are not covered. A $500,000 of overseas medical insurance for a 40-year-old person will cost around Rs.5,000.

I have filed a health insurance claim that I thought was routine. But the insurer keeps asking for more documents and I don’t have any. What should I do?
—K. Mishra

Insurers will ask for more documents if there is some indication in your claim that you had a past history. Speak to the claims person or the third-party administrator (TPA) on your case and ask her why she feels you have more documents. If you don’t have any more documents, put that in writing and submit to the insurer, which will then have to decide on your claim within a month.

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