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Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Jul 29, 2022

Sanjib Jha is the CEO of Coverfox Insurance. His expertise includes health and auto insurance. He has over 22 years of experience in the financial sector. He has completed his post-graduation from the Institute of Company Secretaries of India.... more
Murali Question by Murali on Jul 29, 2022Hindi

I have a unique situation and so a unique query. 

I have a medical insurance and a top up insurance since 2020 for my family of 4 (me, my wife and 2 children). I have renewed it on time so far. The current renewal is due soon. 

Meanwhile, I had to travel to the USA to meet my family, where my wife is employed on non-immigration visa for short term, with employer insurance for her and the family. 

During my stay in the USA, I unfortunately had a massive heart attack. The insurance took care of the expenses as per the policy. 

My question is, when I come back to India, will the insurer cover me for this heart attack (does it become pre-existing now?), related treatment expenses?

What are the IRDAI guidelines for such cases? What are my responsibilities? Will premiums increase? Will waiting period increase? Hope you can help. 

Ans: Hi Murali, sorry to hear about your health and wish you a speedy recovery. To answer your question, if there is no waiting period for heart attack in your policy then the same will be covered in the policy for any treatment done in India.

I suggest you to kindly declare the said ailment to the insurer. The premium will not increase considering this factor as the said ailment occurred after the policy issuance.

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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 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?
Ans: 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.

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Asked by Anonymous - Jan 31, 2024Hindi
HI Sir, do you know of any insurance company in India offering overseas travel insurance policy covering pre-existing heart ailments? I would like to know more about such a policy.
Ans: Let me offer some pointers on finding travel insurance for pre-existing heart ailments. It's essential to contact insurance providers directly for the most accurate and up-to-date information. Here are some steps you can take:

Research Insurance Providers:

Start by researching companies like ICICI Lombard, HDFC ERGO, Tata AIG, and others which commonly provide such policies.

Contact Customer Service:

Reach out to the customer service or support teams of these insurance companies. You can find their contact information on their official websites.

Ask about Pre-existing Conditions:

Inquire specifically about travel insurance policies that cover pre-existing heart ailments. Provide details about the condition and ask about coverage, exclusions, and any additional requirements.

Review Policy Documents:

Carefully review the policy documents, terms, and conditions. Pay attention to the coverage limits, exclusions, and any waiting periods that may apply to pre-existing conditions.

Compare Policies:

Compare the offerings of different insurance providers to ensure you get the best coverage for your needs. Consider factors such as coverage limits, premium costs, and the extent of coverage for pre-existing conditions.

Medical Check-up Requirements:

Some insurers may require a medical check-up before providing coverage for pre-existing conditions. Understand any such requirements and fulfill them if needed.

Declare Pre-existing Conditions:

Ensure that you declare your pre-existing heart ailment accurately during the application process. Failure to disclose relevant information may lead to claim rejection.

Seek Professional Advice:

If you have specific concerns or requirements related to your health condition, consider consulting an insurance advisor or broker for personalised guidance.

Remember that policies and offerings can change, so it's crucial to verify the latest information directly with the insurance companies. Always read the terms and conditions thoroughly to understand the coverage and limitations of the policy.

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Ramalingam Kalirajan  |3744 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 08, 2024

I'm an NRI. We're planning to return to India for my wife's health reasons - the family support and help needed at home will be better here in India for changes in her lifestyle due to multiple health challenges she's facing. The question in front of us is, health insurance for my wife. Initially she is returning to India in June/July 2024 and in one year, I will be shifting after sorting out transferring my job from my US company our Hyderabad office - takes time for approvals and official/legal/immigration/financial norms to comply for the transfer. Once I transfer to Hyderabad in June/July 2025, I will get company provided health insurance in Hyd and my wife will be on it. Till then, for next one year, I'm working in US and I've company provided health insurance in US but not in India, but my wife will be in India. Can we buy health insurance as individuals in India? I quickly scanned and found Tata AIG, HDFC, ICICI offering health insurance but it was not clear to me whether private individuals can buy it, will it cover regular hospital visits, medicines, medical equipment supplied and how good the coverage and how well the participating hospitals are across the country and in major city like Hyderabad? My wife is diabetic, needs insulin, has arthritis, has gluten issues. Please help us with any insight, guidance you can provide on health insurance access for my wife.
Ans: Hello,
It's understandable that you're concerned about your wife's health insurance coverage during the transition period before you relocate to India permanently. Here are some insights and guidance to help you navigate this situation:
1. Health Insurance for Individuals: Yes, private individuals in India can purchase health insurance policies. Many insurance companies, including Tata AIG, HDFC, and ICICI, offer health insurance plans that cater to individual needs.
2. Coverage: Health insurance policies typically cover hospitalization expenses, including room rent, doctor's fees, medical tests, surgeries, and medication costs. However, coverage for pre-existing conditions such as diabetes, arthritis, and gluten issues may vary depending on the policy terms and conditions.
3. Policy Features: When selecting a health insurance policy, consider factors such as coverage for pre-existing conditions, waiting periods, network hospitals, claim settlement process, and premium costs. Look for policies that offer comprehensive coverage and benefits suited to your wife's specific health requirements.
4. Network Hospitals: Most health insurance providers have tie-ups with a network of hospitals where policyholders can avail of cashless treatment facilities. Before purchasing a policy, ensure that there are network hospitals available in Hyderabad and other cities where you may need medical assistance.
5. Customized Plans: Some insurance companies offer customized health insurance plans for individuals with pre-existing conditions. These plans may provide enhanced coverage for chronic illnesses like diabetes and arthritis. Consider exploring such options to meet your wife's healthcare needs.
6. Consultation with Insurance Advisor: To make an informed decision, consult with an insurance advisor or agent who can guide you through the process of selecting the right health insurance policy based on your wife's health condition, budget, and coverage requirements.
By researching various health insurance options, comparing policy features, and seeking expert advice, you can find a suitable health insurance solution to ensure your wife's medical needs are adequately covered during the transition period.

Best Regards,
K. Ramalingam, MBA, CFP,
Chief Financial Planner,

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