1) Query

My dad (58) has been having a well being coverage since 2016. After 2021, there was an abrupt improve in premiums. For 2022-23, there was a 27 per cent elevate and for 2023-24, the insurer raised it by 34 per cent, resulting in a steep rise to ₹28,303 for a ₹5-lakh cowl.

The insurer attributed it to medical inflation. I sought a change of plan, however the insurer stated it was not doable attributable to pre-existing illness. I even tried porting, however was knowledgeable there can be declare points sooner or later. We’ve got no supply of revenue apart from curiosity on financial savings. I simply wish to know the choices I’ve.

Additionally, 1) Is the rise in premium throughout the sector? 2) Can I complain to the grievance officer? 3) Is porting a viable choice?

Reply

Rising medical insurance premiums are a actuality and, other than the rise in premium whenever you get older and transfer from one age slab to a different, charges are revised to keep up a correspondence with the rising prices of well being care viz. medical inflation.

Even a cursory examine on insurers’ web sites and people of insurance coverage brokers and aggregators will provide you with an image of the state of issues. Having stated that, the extent to which premiums will be raised with advancing age or after claims are stored in examine by the regulator as effectively.

Pricing is a business facet of your coverage and the grievance mechanism is unlikely to have the ability to do something for you about this besides if there’s blatant overcharging. Porting is an choice however it isn’t automated on request.

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The corporate you method for porting can settle for or deny your proposal. In the event that they settle for to underwrite the coverage, they’ve to present you phrases and advantages not decrease than what you get pleasure from at the moment however, bear in mind, pricing continues to be their impartial determination.

Group insurance coverage schemes will be simpler on the pocket, and even free within the case of presidency schemes and you might discover them.

2) Query

The insurer denied my time period insurance coverage coverage proposal as I had diabetes. I’m 33. Please recommend what I can do?

SRINIVAS P

Reply

Many insurance coverage corporations supply insurance policies for these with pre-existing ailments and a fast examine of the web sites or web sites of brokers/insurance coverage aggregators will provide you with the data it’s essential to proceed.

There shall be a loading of premiums and/ or a restriction on the sum assured, however you’re higher off with some insurance coverage reasonably than none.

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3) Query

I work for a PSU financial institution wherein I and my dependents are coated underneath a bunch medical insurance coverage scheme. I’ve additionally availed of one other complete medical insurance coverage coverage for my dependent mother and father.

When a medical declare arises, can I declare underneath each insurance policies? As a result of I’ve learn someplace for the declare course of, authentic medical studies are to be submitted to the insurer.

Therefore, is it doable to assert from each group medical insurers and in addition from one other insurer at a time for a similar medical subject?

RAJESH ANDE

Reply

You’re proper in saying that authentic payments are required for making any hospitalisation declare and therefore, even in the event you declare from each insurance policies, your complete declare can solely be for the bills you’ve gotten incurred as evidenced by the unique payments you produce.

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In a situation the place you’ve gotten a fundamental hospitalisation coverage and a top-up, you may declare first from the essential coverage to the extent of that protection after which declare the bills which are over and above that from the top-up to the extent of the protection underneath that coverage.

For those who had a fundamental coverage and a profit coverage like a most cancers cowl, wholesome coronary heart cowl, or perhaps a private accident coverage, you may declare in opposition to payments from the essential coverage, which is within the nature of an indemnity (or reimbursement) coverage and the flat sum assured from the relevant profit coverage.

(The author is a enterprise journalist specialising in insurance coverage & company historical past)

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