Dealing with rejection
Q. My father is 61 years old. He suffered a minor brain stroke in 1999 because of which he was paralysed on the left side. However, he recovered within 6 months and has been doing perfectly fine for last 20 years. He does not have any pre-existing conditions.
I tried several health insurance companies for availing of health insurance for him but all of them rejected the same on account of the history of brain stroke.
Please suggest a policy which is affordable and covers such pre-existing diseases.
ANKIT SAXENA
A. Technically, an insurance company can issue a health policy for your father specifying that hospitalisation due to stroke and related reason is an exclusion. Having said that, the underwriting decision, whether to issue a policy to a particular proposer or not, is entirely in the hands of the insurance company in spite of the background you list.
While you can continue your quest for a good health policy for your father, his age can anyway make it difficult to buy a new policy. Self-financing his health cost needs would be a plan B for you to work on.
Back to basics
Q. My father is 58 and has just retired. My mother, a homemaker, is 51. Both don’t have any prior health insurance covers.
I’m interested in providing them a health insurance cover but am not clear on factors to consider in choosing the best scheme. Also, are Mediclaim and health insurance similar?
VIGNESH
A. Mediclaim is the brand name of hospitalisation insurance provided by the four public sector general insurance companies: The New India Assurance Company Limited, United India Insurance Company Limited, The Oriental Insurance Company Limited and National Insurance Company Limited.
Other general insurance companies and standalone health insurance companies too provide hospitalisation insurance under different brand names.
These policies are indemnity policies which reimburse hospitalisation and related expenses as per the terms and limits of the policy. The claims are against bills and hence can be claimed only under one policy even if you have more than one overlapping policy. You can have multiple policies covering different tiers of your requirement so that higher expenses can also be claimed. These policies are annual in nature and can be renewed for life, and you can continue to make claims when they arise.
There are other health policies that are called benefit policies. They will pay the sum insured on diagnosis of the specific health condition or when a specific major surgery is prescribed, that the policy covers. Once the claim is paid, the policy ceases to exist.
If an insured is hospitalised for a coronary bypass surgery for example, the hospitalisation policy will pay the expenses and, over and above this, a benefit policy covering cardiac conditions will pay the sum insured as a lumpsum. Any health policy offered by an Indian life insurance company will be a benefit policy while both types of policies are available with general insurance and health insurance companies.
Coming to your parents, you should go in for a basic hospitalisation policy from a company of your choice, and you are likely to get only a limited sum insured to begin with and can enhance it on later renewals. You also have waiting periods of pre-existing conditions to contend with. If you want more coverage, choose a suitable top-up policy and supplement this combination with a critical illness policy or a specialised policy for specific health conditions.
(The writer is a business journalist specialising in insurance & corporate history)
