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.

Ans: 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.

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.

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Question by S - Jun 21, 2022Hindi

Dear Sir, Greetings of the day. I have got a health insurance of family floater type from Tata AIG for a sum of four lakhs. Recently, I got hospitalised and full four lakhs was paid by Tata Aig. But my hospital bill was six lakhs and sixty two thousand. So there was a shortfall of two lakhs sixty-two thousands. I have an Aditya Birla health Policy of family floater type for 45 lakhs. But it will come in to effect after 5 lakhs expenditure. So I myself paid one lakh from my pocket. And for rest one lakh sixty two thousand only I applied for cashless to Aditya Birla .But they denied it. Finally I paid that amount myself and came home. Afterwards I kept continuous follow up with them. Reconsideration and reminder letter was sent by TPA and Treating doctor. But again it was rejected. Now Aditya Birla employee is saying apply for reimbursement. When Tata Aig is clearing full amount, how come Aditya Birla is denying it? And how can I bridge the gap one lakh between two policies? Tata Aig says you have taken full claim so we cannot make your limit from four to five lakhs this year. Pls advise suitably. Best Wishes

Ans: Hi Mr. Tripathi, greetings to you. To answer your first question as to why Aditya Birla won’t provide you with cashless claim as opposed to TATA AIG is because the policy you bought from Aditya Birla is a ‘Super top up plan’ which basically means it is an addition to your base policy which in your case is your TATA AIG policy.

Super top up policies do not offer cashless claims but only provide reimbursements.

The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.

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Question by Neeta - Aug 03, 2021Hindi

I have United India health insurance since 2009. I have paid a regular premium with only one claim for hysterectomy in 2012. My renewal date is 12/8/2021. I want to port my UIIC insurance. I have sent a proposal form to HDFC Ergo online for porting with my 2 months back medical test details so that I can get the exact loading amount if any. I am taking medication for hypothyroidism, hypertension and cholesterol at the moment, very minimum dosage. I have sent those details too. According to them the procedure is to pay a premium then you will receive a consent call which will decide about medical test requirements and loading amount if any. For any reason, if we want to discontinue, they will refund the full amount paid by us. This procedure of porting is not mentioned clearly on the website so all are non-proof. My query is: How much I should trust them? I was interested in family floater with my husband, who doesn't have any diseases at present. This is a new policy for him. So no loading for him for sure. HDFC ERGO advisor is suggesting me to go for individual policy as floater has more chance of rejection than individual policy for both of us. So my second query is: Will loading be charged according to floater premium which is almost double than the individual policy? My husband’s new policy without any diseases and mine is porting with pre-existing diseases. Please advise whether individual or floater is better for us with reasons. Seeking your help as soon as possible.

Ans: For your first query it is advisable to speak with the insurance company you wish to port to for understanding the exact procedure for porting. You may also wish to engage a trusted insurance agent to help you with the porting process as they will be fully abreast with the procedure and will guide you well.

Remember to ensure that you fully disclose your existing medical condition at the time of application itself.

As regards your second query it is advisable to go for separate individual policy for your husband because basis your current health status there are high chances of the insurance company charging higher premium for a floater.

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Question by Gora - Nov 24, 2022Hindi

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Ans: Hi Gora Lal Gargi, to solve your query I will need more information. Firstly, please do check if your sum insured value was exhausted in the first claim.

If yes, then check the policy document to know if your insurer provides claim for same person, same illness on the second claim i.e. restoration benefits.