Sanjib Jha answers your health and auto insurance queries.
Please mail your queries to getahead@rediff.co.in with the subject line 'Ask Sanjib' and he will answer all your health insurance queries.
Jitendra Sahu: Recently, I met with a car accident. I am a LMV learner license holder. During accident I was driving the car. My question is whether l will get the claim as a learner license holder as no one accompanied me during my journey?
Sanjib Jha: Hi Jitendra,sorry to hear about your accident. To answer your query, the Motor Vehicle Act 1988 states that nobody can drive a vehicle on public road without a valid driving license.
People with a learning license can drive a vehicle in a supervision of a co-driver, who should hold an effective valid permanent driving license.
In your case, since you were not driving the car in the supervision of any co-driver holding an effective valid permanent driving license, the insurer will not entertain the said claim.
Pradeep Kondayoor: I am an employee of central govt. PSU. My family consists of myself, spouse, two minor children and mother. I am covered by a corporate group medical insurance policy for Rs 2 lakh with an additional emergency coverage of Rs 4 lakh by the employer.
I also have a personal Family Floater policy for Rs 3 lakh and a Sr. Ctzn. Policy for Rs 1 lakh.
I have not used the personal policies till date for any hospitalisation claim.
I am aware that a claim exceeding the corporate policy limit can be claimed in the personal policy. Recently I was made to know that any planned hospitalisation exceeding the corporate claim limit, cannot be done using the second policy.
I also know that there is a product called as top up policy which can be used in such cases.
I have 8 years of remaining service where there is a medical insurance cover during the period.
After retirement, the employer provides a basic policy of 1.5 lakh for the family. The same feels to be insufficient in today’s times.
What would be your advice with regards to the existing medical insurance policies and their amounts? Should I need to undertake any tweaking of the policy amounts or switch to a top up policy?
Sanjib Jha: Hi Pradeep, yours is a legit concern. It would be best if you take advice from a professional person or company – having the necessary qualifications -- after discussing your issue with them.
Insurance is each to its own. Depending on your concerns and requirements a professional service provider will be able to give you the best advice, whether to tweak policy amount or switch to top up.
Syamala Anand: I understand that on completion of continuous 8 years of renewal of health care insurance, insurers cannot reject an eligible claim. Is this correct?
I took a health policy from Max Bupa in Aug 2016 and continued renewal for 4 years until Aug 2020 post which I ported my policy to another company for a period of 2 years.
Will this be considered as 6 years of continuous renewal of my policy or will porting have an impact on the continuity period?
Sanjib Jha: Hi Syamala, to answer your first query, your understanding is correct.As mandated by IRDAI, a health insurer cannot reject an eligible claim if the policy has completed 8 years of renewal.
This period of 8 years is called Moratorium Period.
Except for proven fraud and permanent exclusions specified in the policy contract, no health insurance claim shall be contestable after the Moratorium Period expires.
The policies, however, would be subject to all policy limits, sublimits, co-payments, and deductibles.
As you have mentioned that you ported the policy after 4 years, it will not be an issue as porting is also considered continuous renewal.
Aja Bablu: Hello, can an NRI currently residing outside of INDIA AND SOON BE MOVING TO INDIA ON A PERMANENT BASIS BUY ABHICL SUPER TOP UP PLUS 95 L SI, 5L DEDUCTIBLE?
UPON READING PROSPECTUS for SUPER TOP UP POLICY ELIGIBILITY SECTION STATES NRIs working in INDIA CANNOT.
I need not look for a job in INDIA. I wish to build up my insurance kitty and seek to cover for myself SO THAT WHEN I LAND IN INDIA, I'M
SECURELY COVERED.
EMAILS SENT TO customer care AT ABHICL yielded no result.
THEY KEEP ASKING FOR POLICY NUMBER ON A REPITIVE BASIS. THEY SIMPLY LACK COMPREHENSION TO UNDERSTAND MY VERY BASIC QUESTION.
Thanks in advance for any help you may provide.
Sanjib Jha: Hi Aja, as an NRI, you are eligible to purchase health insurance policy in India, provided you can give proof of residence, ITR (income tax return) and other related documents.
Persons of Indian origin can also produce an Indian passport with other documents to purchase health insurance in India. However, while making the purchase read the policy document very thoroughly as it may have terms and conditions that are different from policies issued to non-NRI policy holders.
Sanjib Jha is the CEO, Coverfox Insurance Broking (external link).
You can find more of Sanjib Jha's answers here.
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