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Insurance Expert - Answered on Jun 21, 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

Question by THANGAVELU on Jun 21, 2022Hindi

My family (aged 54 years) is covered under ECHS (Ex-servicemen Contributory Health Service) for the last thirty years. I have family floater health hospitalisation policy in two different insurance companies. Three years back, she had some issues related to her blood disorders. During the blood transfusions, we have made claims in the insurance cover.

It took few months to diagnose the issue. Finally it was diagnosed as 'a type of blood disorder'. I have availed the hospitalisation and treatment facilities from ECHS.

Now she has recovered (and under medication) for the last two years. She is leading normal life. My query is:

Can I declare and have Critical illness included coverage in the health insurance? (Earlier I was denied as permanent exclusion -IRDA).

Can I continue the existing health coverage from the insurance from other than Critical illness? (I can get ECHS facility, but there are limitations). Since she is alright, will the insurance companies accept? We are ready for relevant medical tests as required.

We seek your advice.

Ans: Hi Thangavelu, good to know that your wife is doing well. To answer your first query, yes you can declare your critical illness and avail the rider for it. Another option is to purchase a new plan for critical illness from an insurer of your choice. The insurer will ask a set of questions and based on that the coverage will be provided. However, most of the insurers will keep the PED in the Permanent exclusion list. As far as your query on continuation of policy is considered, you can continue with the existing health policies you have.

Any medical condition which arises after the waiting period of the policy will be covered in the health policies. Which is why check for the waiting periods associated with different ailments in your policy document.

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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Insurance Expert - Answered on Jun 10, 2022

Question by THANGAVELU - Jun 10, 2022Hindi

My family is covered under Ex-serviceman Contributory Health Services (ECHS). She is having health insurance coverage from three other insurance entities. Still continuing. So, there was no pre-existing conditions. Two and half years back, we have opted for claim re-imbursement only for blood transfusions during the pre-diagnosis period. Later, her medical condition was diagnosed and the same was falling under IRDA exclusions. She was treated once in-patient and afterwards as outpatient. All claims for admission and medicine re-imbursement were availed from ECHS. (Once I have opted for enhancement of insurance coverage from one insurer and the TPA has refused under these clauses). Now, after two and half years, she has recovered better (Even Doctor's perception). But she is continuing medicine with lessor dosage. Presently, her condition is fine. My questions are: 1. Can I avail insurance facilities from insurance companies for the same issue in future? 2. Can I avail insurance facilities from the insurance companies, for other issues than the specifically excluded? 3. Can I prefer ECHS for any eventualities for the specified issue to the extent admitted, and remaining expenditure from other insurance companies? Please guide.

Ans: Hi Thangavelu, good to know that your wife is doing better. Coming to your questions, yes you can avail the insurance facilities for the same ailment in future from your existing insurance companies. However, if you purchase a new insurance policy from another company, then whether you get the coverage or not will depend on the ailment and the insurer.

For other ailments, at the time of issuance an insurer analyses the risks, given the ailment of the insured. Accordingly, the insurer takes a decision whether the policy can be issued or not, there are few insurers in the market that will keep the pre-existing diseases excluded or will have a waiting period for it. However, if your ailments have developed after the policy issuance then you can avail insurance facilities for those ailments.

Answering your third question, yes you can prefer ECHS for this specific issues and the remaining expenditure can be claimed from other insurers.

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Insurance Expert - Answered on Jul 29, 2022

Question by Murali - 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.

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Question by ANUJ - Jul 06, 2021Hindi

If a person has a family floater policy and 4 members are covered like his wife, daughter, & son. After some time, daughter gets married. If any health problem occurs: a)Would claim be admissible under the father's policy & would be rejected due to status change? b)Would claim be admissible under the husband's policy or both? c)If she is not covered under the husband's policy and under continuation with father's policy then what would be the scene of claim?

Ans: In a family floater policy, the daughter will normally be covered till the age of 21 or 25 years old irrespective of her marital status, of course, depending on the terms & conditions of the specific policy purchased by you. All the benefits remain as it is till the permissible age.

Post the age limit the daughter can be part of a new individual plan and can avail all continuity benefits or part of her husband’s floater plan with terms and conditions applicable to that policy.

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Ans: Hi Subhankar, to answer your query, there are insurers in the market which provide the facility of porting a group policy to family floater policy along with no claim bonus (NCB). However, Critical Illness Continuity will depend upon the coverage of the policy.

If Critical illness is in policy coverage then it will be covered but if the same is included in the policy as a ‘Rider’ then in this case it cannot be ported.

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Question by Pradeep - Oct 12, 2022Hindi

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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.

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