Your Health Insurance Queries Answered

Rakesh Kaul, CDO, Edelweiss General Insurance, answers your health insurance queries.

Do you have health insurance queries? Please mail us at getahead@rediff.co.in with the subject line Ask Rakesh and Rakesh Kaul will answer your health and auto insurance queries.

Karuna: My Health insurance policy waiting period 36 months. I declared pre-existing disease BP and Sugar. Now doctor suggested Aortic Valve replacement for heart which involves substantial amount. If I go for it whether my claim will be considered for settlement or it will be rejected because I have pre-existing BP and Sugar. Please advise me.

Rakesh Kaul: Coverage pertaining to Aortic Valve Replacement for the Heart will depend on the nature and duration of the illness. Your insurance company will ideally seek clarification on the cause and duration of the illness. Basis the medical documents you submit at the time of claim, if it is observed that your medical condition is not a pre-existing one, nor an effect of Hypertension, then your claim should be considered.

NIKHIL KUMAR: I RAJESH KUMAR HAVING A HEALTH OPTIMA INSURANCE POLICY WITH STAR HEALTH W.E.F.19/12/2010 WITHOUT ANY INTERRUPTION, BUT TAKEN A POLICY FOR 3,00,000/- SUM ASSURED BUT GETTING NCB NOT MORE THAN 10000 PER YEAR WHICH IS NOW COVERED UPTO 3,80,000. OTHER COMPANIES OFFER 25 TO 50% EVERY YEAR FOR NCB. SHALL I CONTINUE WITH THE EXISTING COMPANY OR MIGRATE WITH SOME OTHER COMPANY?

PLEASE ADVICE. WAITING FOR YOUR FAVOURABLE ANWSER.

Rakesh Kaul: While Cumulative bonus/ NCB is an important factor to consider for migration/portability of your policy, it should not be the only reason that you should look at. Please also look at aspects like claims service, product coverages, premium, etc. before making a decision.

Ganesh Pillai: I have family floater policy since 5 years with Apollo Munich, Which is changed now to HDFC Ergo. I am paying approximately 36000 for 2 +1 family, I am aged now 62 years.

I am not getting proper service from the person from whom i took the Apollo policy he is called Intermediator in the Apollo company and when it’s changed to HDFC his Records (like his name Mob Number and his Code) are not shown in the policy. In the absence of the above details, I don’t know whom to contact for any information and follow up for claim reimbursements.

In the past years, with Apollo and HDFC Ergo my reimbursement claims was not settled ON TIME as well as the full amount not settled, approximately 50 to 60 percentage only settled even after many follow ups, courier and emails. Though the claims were around 50000 only.

I am the bread winner in my family, after paying so much for Premium, if I get admitted in hospital, the family members can’t do follow up and intermediary is not helpful, even he doesn’t bother to attend phone call, though he is substantially earning 15% premium as his commission (I hope) in such scenarios I am fearing that you won’t get help.

What is your advise? Should I change the intermediary in the policy, if there is provision in system? Why in HDFC Ergo why those intermediary details not there or portability is another option and what are conditions to meet portability at the ripe age/ financial scenario I should not be denied cashless facility/ at the need of my HOUR.

Rakesh Kaul: The intermediary can be changed in the policy by the Insurer upon a request by the customer. However, for claims assistance, I would advise you to connect with your Insurer’s customer service team to get a response swiftly.

Portability of a policy can be done at any age but there are certain guidelines that differ from insurer to insurer. It is advisable to get the complete details of the insurance company you wish to port to and thoroughly understand the portability/ continuity benefits which will be carried forward in your ported policy. Please ensure you check the product/ plan coverages offered and compare it with the existing policy before making your decision to port.