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A travel agent is the next best option if you prefer to buy from an individual.
Published in Mint, Augst 14th 2013, Written by Kapil Mehta
My wife and I are senior citizens. My wife is covered under the extra care scheme of a private health insurance company. She was operated before the commencement of the cover for bilateral knee replacement in 2011 which was declared to the insurance company. The company insists that she will not get covered for any aliment directly or indirectly related to her surgery for lifetime. Is such a clause within the purview of any insurance company? Shouldn’t they have a fixed tenor of, say, four years for exclusion?
—R.N. Wahal
Insurers are allowed to exclude health conditions for life based on their underwriting criteria. However, I believe that in your case, they should not exclude knee-related ailments for more than the pre-existing disease exclusion period. I suggest you find an insurer with more reasonable restrictions, where you actually get extra care. Several insurers would meet your requirement. A good starting point could be one of the highly rated products in the mediclaim ratings published in this paper (
I am 45 years old and I have a mediclaim policy since 2001 for myself, spouse and two children worth Rs.3 lakh—Rs.1 lakh each for my spouse and me and Rs.50,000 each for our two children. There was a claim in 2006, but no claim afterwards and we have been paying regular premiums. But this year, my insurance adviser advised me to change from individual to floater policy of Rs.3 lakh. Will this be considered a new policy? Will all the advantages of 13 years be waived? The insurance company is the same.
—Jitendra Deria
Your adviser has made a good recommendation. A single family floater of Rs.3 lakh may not increase your overall expense substantially but has two benefits.
First, each family member has access to a cover of Rs.3 lakh compared with the current Rs.1 lakh each for you and your spouse and Rs.50,000 each for your children. Second, at a sum assured of Rs. 3 lakh, many insurers will allow you to be hospitalized in a better room.
The primary benefit of holding a health insurance for 13 years is that pre-existing diseases will no longer be excluded. You can retain this benefit when you port the policy to another insurer or change products within the same insurer. However, keep in mind that the waiver on pre-existing diseases will be provided only up to the initial sum assured, which was Rs.1 lakh in your case.
If you are net savvy you will probably get the insurance cheaper and faster from the insurer’s portal. However, a travel agent is the next best option if you prefer to buy from an individual. Make sure that the policy specifically covers treatment in the US.