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Health Insurance . concept image of Stethoscope and family on wooden table. top view  

Q. Please advise whether as per IRDAI norms it is mandatory for a health insurance company to provide voice conversation in case policy is purchased online and proposal form is not physically signed? I also request you to provide the relevant IRDAI circular.

J. K. SINHA

A. When an insurance policy is sold by a tele-caller, the call has to be recorded and you, as the customer, are entitled to a voice copy at any time during the term of the policy or until a satisfactory settlement of claim, whichever is later.

Anytime a policy is issued without obtaining a proposal in physical form, your insurer has to send you, along with the policy bond, a verbal transcript of the voice/ electronic record of the queries and the answers to those queries, on the basis of which the policy has been underwritten. The insurer is supposed to also preserve such records securely.

You can download a copy of the Guidelines for Distance Marketing from IRDAI’s consumer education website, www.policyholder.gov.in. On the home page click on Protecting You ‘Already in Place’ ‘Distance Marketing’ and download a copy of the guidelines.

Insurance-related query

Q. My husband and I are working in a private firm. We are planning to take a health insurance cover and a term insurance plan although we are covered by our employer. Can you suggest some of the best health as well as term insurance plans? Also, can we avail a single term insurance that covers both of us?

SRUTHI M. NAIR

A. Taking control of your own health insurance is a good move. It can be a supplement to your employer’s health scheme and also serve as your safety net independently.

Depending on your age, health status and location, please choose the maximum sum insured you can afford the premium for. This way you work off your waiting period for making claims under various clauses and also accumulate incentives for no-claim years.

Keep the policy valid and upgrade your sum assured periodically. At some point supplement your coverage with a top-up policy.

The health insurance company you choose should have the covers and options you require and a reputation for efficiency and customer friendliness.

The former you can find out through old-fashioned research on the internet and talking to representatives of the companies for specific information. The latter will be apparent if you quiz your friends and relatives who are their customers. It is also reflected in a high claims settlement ratio, a number you can find from the company’s websites and also from the regulator’s website.

You will need your preferred hospital to be part of the insurer’s hospital network in order to get cashless claims. This will be a blessing at a time of stress when a family member is hospitalised as it can work seamlessly with the company and its third-party administrator (health services), the TPA, taking care of the paperwork and the payments directly with the hospital while you focus on getting well.

Of course, if you wind up having to go to a non-network hospital, you have to pay the hospital and make a claim with the insurer through the TPA to get a reimbursement.

If you have a satisfactory relationship with a general insurance or health insurance company or its agent/ broker already, consider that company as a first option. The other decision to make is whether to take a family floater cover or individual covers. Individual covers are recommended as they give you better coverage, which will be reflected in the premium cost. Also, each of you is likely to claim tax benefits under Section 80D of the Income-tax Act, 1961 for the premium.

Term policies are an excellent option for life insurance. Starting out at an early enough age, the premium is almost negligible and it will serve as a very price efficient cover. Joint cover versus individual cover is something you can decide on depending on costs and attendant benefits and choosing the company to insure with follows the same broad approach as for the health policy. You can enhance cover by taking additional policies over time. Buying term policies online give you some cost advantages.

(The writer is a business journalist specialising in insurance & corporate history)


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Printable version | Nov 30, 2021 1:38:51 AM | https://www.thehindu.com/business/Industry/ask-us/article36920778.ece

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