Published in Mint on Sep 06 2016, Written by Abhishek Bondia
I am 50 years old. I want to buy a suitable mediclaim policy. Please advise.
—Surendra Khemka
You could refer to the Mint SecureNow Mediclaim Ratings (www.livemint.com/mediratings) for a suitable plan as per your age. The rating is a comprehensive evaluation that considers factors including price, key benefits, and an insurer’s claim track record, across all health insurance plans in the country. Within the ratings table, the illustration for a 45-year-old individual would be relevant for you. At your age, you should opt for a high sum assured—at least Rs.10 lakh—and a plan with a low waiting period for pre-existing diseases.
I have read that all insurers cover for existing illnesses after a waiting period. My wife was operated on her knees in 2011. But when I went to buy a health insurance policy, they said she would get cover only if she agreed to life long exemption from any knee-related illness. Perforce, we had to take a floater policy with this exclusion. How can I make the insurer agree to cover her for all health issues?
—Ravi Wahal
Based on a prospect’s medical history and pre-issuance medical check-up, insurers are allowed to carve permanent exclusions in the policy. However, this can be done only at the time of underwriting the policy. The insurer has to give an option to the prospect to accept or reject this counter-proposal. So, you are not obliged to accept their recommendations. You can cancel the proposal and your premium shall be refunded to you. If you did not give your assent in writing to the insurer for this counter-proposal, you can escalate the case to senior executives at the insurance company or write to their grievance redressal department.
Alternatively, you could port the policy at the time of renewal. If you have had a claim-free year, other insurers may look at your proposal more leniently. They may consider issuing a policy without knee-related treatments as a permanent exclusion. But they may suggest a loading on the standard premium to account for the medical history. Based on the loading, you can decide whether to port or not. Apply for porting at least 45 days before renewal date.
I already have a group health insurance from my company for Rs.2 lakh. The company has come up with a scheme to increase the sum assured at employee’s personal cost. Should I opt for it or buy a separate health insurance plan from the market?
—Swathi
Invariably, a top-up plan offered by an employer is cheaper than the rates offered for individual plans. It is also likely that the waiting periods in the employer provided top-up product will be lower, and the issuance is generally guaranteed with no medical check-ups or specific exclusions. If all of this is true for the option available with your employer, I recommend you go with the employer provided top-up.
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