A guide to health insurance

Health insurance is going to get a little expensive in coming days. Almost all insurance companies are planning a hike in insurance costs.

According to the experts, not many people are taking mediclaim insurance policy and its market penetration is less than one per cent. Not even one per cent of the total expenditure on health is being paid through insurance.

Oriental Insurance, deputy general manager, V N Bhargav and ICICI Lombard, national general manager, Karan Chopra gave their opinions about health insurance to CNBC-TV18.

Why is health insurance needed?

VN Bhargav: Considering huge costs involved in health care, it may get unaffordable at any stage. But if you have a mediclaim policy you are able to afford most expensive doctors and treatment.

If I suffer a heart attack in future, will my claim be approved if I take a health insurance cover? I am a hypertension patient? Will I have to give more premium then?

Karan Chopra: Normally, insurance policy is given to you after you undergo a health check up. You will be given policy keeping in mind the health problems you are suffering. If you declare everything and after that you have a health problem, which may be linked to the existing problem, you will get the claims.

VN Bhargav: In future, if any of your body organs get damaged due to hypertension and there is a doctor's certificate saying that all body organs were healthy at the time of applying for the policy, he will get claim under the policy. But one thing should be clear that pre-existing disease is the one you have at the time of taking policy and which you have not disclosed. But in your case no such thing appears.

I have taken medi-claim insurance policy of Rs 250,000 each for my wife and daughter. I have not claimed anything in the past ten years. I have also taken a family insurance policy for Rs 300,000. What is my claim limit if my expenditures on health exceed Rs 500,000?

Bhargav: I would recommend you only one policy. Your current policy cover should be at Rs 500,000. But your total policy cover is for Rs 550,000, which includes the insurance policy for Rs 250,000 each for wife and daughter and the family policy for Rs 300,000. Now when you lodge claim under any of these policies, whether it is from one company or more, the companies will have to give their respective contributions. In order to a this kind of inconvenience, I will advise that you take a policy for Rs 500,000 for yourself and your family from a single company whenever you go for a policy renewal.

What if he doesn't disclose to the other company that he also holds a mediclaim policy from some other company?

If he hides the fact from one company, his claim could be rejected completely. He may not get claim from either company.

Tell us about the clauses relating to mediclaim?

You take a medi-claim policy for bad times. But there are some clauses that you must read the document carefully before subscribing to such a policy. For example, most insurance companies do not accept medi-claim during first 30 days of taking medi-claim.

If someone is suffering from asthama, chronic nephritis, diabeties, epilepsy and hypertension, you can't claim the expenses incurred on the treatment under a medi-claim policy.

If you take an insurance policy from Oriental Insurance Company, you wouldn't get claims for cataract, hernia, arthiritis and congenital diseases. United Insurance Company entertains no claims for these diseases in the first year of the policy term. This period is two years at ICICI Lombard and you have to renew the policy constantly for two years.

Apart from ICICI Lombard, no insurance company includes pregnancy, delivery expenses and non-allopathic expenses in its policy. And most insurance companies don't give claims for pre-existing diseases. But you can't take benefit of medi-claim policy throughout your life.

ICICI Lombard and Oriental Insurance give insurance cover up to the age of 75 years while New India Insurance offers policy till 80 years of age. On the other hand, Bajaj Allianz gives you medi-claim policy if you are less than 50 years while the age limit for senior citizens is 75 years.

My sister took a medi-claim policy in September 2005. In July 2006, she developed abdominal pain and had to be operated in August first week. Would she get a claim, as the problem was detected in eleven months instead of one year? The insurance agent is citing some problems in the claim.

Karan Kapur: She will get the claim if the claimant didn't have the health problem at the time of taking the policy and she developed it later on. It also depends on the terms and conditions of the policy.

VN Bhargav: Cysts of ovaries couldn't have been developed in 11 months. But if the medical report proved that she developed ovary cysts after she took the policy, she would get the claim.