Inform your insurer of hospitalization within 24 hours

Published in Mint on 4th February 2014, written by Kapil Mehta

I am 69 years old and my wife is 63 years old. We already have a health insurance policy (for Rs.5 lakh), which is up for renewal in the next 10 days. I have also taken a policy for my son (35 years) and his wife (27 years) of Rs.3 lakh, which is also up for renewal in 10 days. I want to know how I can choose a health insurance policy. Also, our agent says that under a 2012 mediclaim policy one has to inform the insurance company within 24 hours of hospitalization, whereas under the 2007 mediclaim policy, we had to inform about hospitalization within seven days. Could you throw some light on this as well?

—Naresh Sahu
I think you should renew both the health insurance policies that are up for renewal in the next 10 days. The time period is too short for you to port your existing insurance to an alternate insurer. Without porting, the exclusion period for pre-existing diseases will start afresh in a new insurance and this is not advisable, particularly since you are over 60. However, you could consider enhancing your insurance by purchasing a top-up health cover that pays for expenses over Rs.5 lakh.
Your agent is giving you the correct advice on claim intimation period for your specific insurances. In your specific case, you should ideally inform the insurer before hospitalization in planned situations and within 24 hours of hospitalization in a medical emergency. This information could be sent through an email to the customer helpdesk. Most hospitals have an insurance helpdesk, which could help you with the intimation process.
On what basis do insurers charge premium under a personal accident cover?
—Gauri
In a personal accident cover, the premium is a function of the type of benefit offered, occupation of the insured person and the sum assured. The premium charged is least if the benefit is paid only for accidental death. Benefits for disabilities that may be permanent or temporary, total or partial, increase the premium. The maximum increase comes when medical expenses due to accidents are also included. Occupation determines the risk category. Office-goers are the safest and get the best rates. People in outdoor, physical roles get more expensive rates. Finally, premium increases proportionately with the sum assured. Interestingly, the premium does not depend upon the age or health of the person insured. If a person is in poor health and unable to buy regular term or health insurance, they can buy an accident cover that partially covers their death or ill health risks.

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