Policies do not cover all the treatments done at hospitals

Published in Mint on 5th Aug 2014, Written by Abhishek Bondia

Does a mediclaim cover any treatment done at a hospital? Or, are there some that are not covered?
—Binu Ved

Health policies are meant to cover treatments done at hospitals. However, all treatments done at hospitals are not automatically covered. Generally, those that are experimental, cosmetic and self-inflicted in nature are not covered. You should refer to the exclusions list mentioned for your specific health insurance policy.

My car got scratched recently. Is it better to go for a small claim now or pay for the repairs myself to avail a no-claim bonus?
—Vipul Seth

The expenses to fix a scratch in a regular hatchback or sedan are nominal. A medium-sized scratch should get fixed for under Rs.5,000. After considering non-allowable expenses and compulsory deductible, even if you approach the insurer with a claim, the amount payable would be under Rs.2,000. Considering an average annual premium of Rs.10,000, you are better off with paying for the repairs yourself and going for a no-claim bonus (NCB) next year.
Generally, if the claim amount is less than one-fourth of your current annual premium, it is better to forego the claim. NCB starts at 20% in the first year and goes up to 50% for five consecutive years of no-claim.

Recently, I spent Rs.6 lakh on renovating my house. Is it possible to increase the sum insured of my house accordingly?
—Harita Sehgal

It is, in fact, mandatory to increase the sum assured when the value of an asset increases. If you don’t increase your insurance, the principle of under-insurance will apply on claims. This means that the insurance company will deduct a proportionate amount of claim to the extent of under-insurance.
You should approach the insurer to endorse the increased sum assured. A proportionate premium for the unexpired period of the policy will be charged. Say, if you had initially paid Rs.1,200 for a cover of Rs.12 lakh, and this renovation happened after six months, then you ought to pay Rs.300.

I purchased a health insurance policy and have a cover from my company as well. Can I use both if a claim arises?
—Raghavendra

You can use both the policies to cover your medical expenses. Utilize the full sum assured in one of the policies and then claim the balance amount in the other one. I would recommend that you use the insurance by your employer first. This insurer will give you a “claim settlement letter” and return the original documents duly stamped. Then you need to submit these documents to the second insurer, who will process the balance claim. Do note that it is not possible to claim reimbursement for the same expenses from both the firms.

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