Family Health Insurance

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Published in Mint on Sep 22 2016, Written by Abhishek Bondia

I want to buy a health insurance policy. I am 36-years-old. I underwent a procedure to remove kidney stones a couple of years ago. There are high chances of my application being rejected. What is the way out for me?


Insurers are increasingly declining health insurance coverage to prospects with adverse medical history, in some cases with relatively minor issues. This is probably because health insurance is renewable lifelong. But, people with pre-existing conditions can get health insurance if they identify the right products. I recommend you to consider the following. First, apply for a standard health insurance policy offered by larger insurers since these tend to be more accommodating of minor health issues. A few of these insurers may issue you insurance with a premium increase or an exclusion for kidney-related ailments.

Second, consider top-up health insurance. These plans typically have a deductible of up to Rs5 lakh. Expenses above the deductible are covered. Top-up plans are available at a fraction of the cost of standard health insurance, and are issued more liberally.
Third, take cover through your employer-provided group insurance. Group plans are guaranteed issued to all members. Several employers facilitate employee-paid group top-up health insurance as well. You should subscribe to such programmes if offered by your employer.

My wife had a delivery last month but my employer refused to cover the expenses even though we are covered by group health insurance. Why was my claim refused?

—Rajat Gulati

Maternity cover is an add-on feature in health insurance policies. While it has become almost standard to offer maternity cover under employer health insurance policies, not all subscribe to this add-on. This might be the reason for rejection of your claim. If your employer provides maternity cover, then you should check if there is any waiting period to avail the benefit. Some policies carry a waiting period of 9 months or more to avail this benefit. The waiting period is counted from the date the employee enrols in the insurance.

Is it mandatory to buy home insurance with a home loan?


No, it is not mandatory to buy home insurance with a home loan. But it has become a common practice for banks to insist on this policy to secure their collateral. Banks may also require that you get their name endorsed in the policy as a financier. Due to this endorsement, an insurer will insist on a no-objection certificate from the financing institution before settling a claim.

If you buy a home insurance, be mindful of two aspects. First, sum insured should be based only on the cost of reconstruction. Do not include the cost of land in the sum insured. Second, it is not necessary for you to buy the policy from your bank. There are several low-cost long-term plans that you can choose from. You can buy a plan elsewhere and still endorse your bank as a financing institution.

I want to buy an individual policy. I quit smoking 5 years ago but I could still be refused or charged more premium for it. What should I do?

—Sadeq Mahmoudi

Generally, smokers are not rated differently under health insurance. But in life insurance they are charged a higher premium. Under health insurance, risk rating is done based on the person’s medical condition. For Rs15 lakh sum insured, most insurers will ask for a medical test during the underwriting stage. Only if you have any medical condition such as high cholesterol or a lung problem, would the insurer consider declining your proposal or charge a loading. Standard health insurance policies are issued to smokers routinely.

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