Q. I retired from a bank and the group health insurance policy is due for renewal. The Indian Banks Association’s floater policy has certain stipulations. One, a floater cover is compulsory if both husband and wife are alive and two, the premium is raised annually, which is unaffordable for retirees. Coverage of ₹9lakh/ ₹7 lakh for retired officer/award staff costs ₹72,000 per year for current renewal.
If in a year, the policy amount is exhausted, no coverage is available for the spouse. Only if you opt for the maximum sum insured in this base policy can you subscribe for the super top up. My questions are: Is there any provision to have more than one health policy for the same person. Can we go for the family floater policy and a separate health policy for spouse?
K. NAGARAJAN
A. A person can have more than one hospitalisation policy. If you take the ₹9 lakh floater cover you can take a separate policy for a sum insured of choosing for your wife. This will come to your aid in the situation you described where the ₹9 lakh is exhausted for hospitalisation costs and you need to claim for wife’s hospitalisation in the same policy year.
If only your wife needs hospitalisation, claiming under her policy is logical leaving the floater policy sum insured intact for your use.
Group policies have stipulations and some may suit us while we wish other conditions were not there. But it’s a package deal and comes with an optimum set of coverages and attendant conditions. On premium, you will find an individual policy with ditto coverage would cost significantly more. This is because of the power of collective bargaining, economies of scale and the cost efficiency of marketing and administration for the insurance company.
So, your best strategy would be to take the maximum cover under the group policy and becoming eligible for the super top up, too.
Some insurers do have policies sans sub-limits, and this is a good option to maximise your premium’s worth. Your agent would be best placed to guide you about this and there is a lot of information on the internet too on the websites of each insurance company.
Q. I am a state government pensioner aged 74. I have medical insurance for ₹5 lakh from state government pensioners group insurance scheme. I also have a personal health insurance policy for ₹1.5 lakh. Please clarify whether I can avail benefits under both simultaneously.
GOVINDARAJAN N.
A. Yes, you can avail of benefits under two different health policies or schemes simultaneously. It works like this. If your claim is less than ₹1.5 lakh, claim under your personal policy. This way you conserve the Sum Insured under the group policy for future claims in the policy year.
On the other hand, if the group policy offers a cover your personal policy doesn’t, and your claim comes under that, then claim under group policy. For example, if dental treatment is covered under your pensioners group policy but not under the personal policy, claim it under the former.
Other example of this is if you haven’t worked out your pre-existing conditions waiting period under one policy but the other policy is conducive to a claim. If the hospital you choose to take treatment in comes under one, but not the other insurance company’s hospital network.
What if you can claim under both policies. It is entirely up to you to choose which policy to claim under. You can even claim partially under one and the balance under the other. Unless there is a good reason for it, try restricting the claim to one or the other so that you conserve no-claim benefits. What you cannot do is claim the same expense from both policies since all claims are against bills. If one of the policies is a benefit policy and the other, an indemnity policy, you can claim under both policies. The benefit policy will pay a lumpsum benefit on diagnosis of the specified illness regardless of the expenses incurred while the indemnity policy will pay all the bills.
(The writer is a business journalist specialising in insurance & corporate history)
