Roopam Asthana, CEO and whole-time director, Liberty General Insurance Ltd, answers your queries about HEALTH insurance and AUTO insurance.
Jayesh Sinha: Sir, I had taken family floater health insurance from Oriental Insurance for five years from 2015 to 2020 in continuity.
In March 2020, I underwent colonoscopy day care investigation which was rejected by Oriental Insurance as it is not covered.
Due to this problem, I ported to Star Health. My policy is from December 18, 2020, to December 17, 2021.
However, when I submitted my colonoscopy bill, they repudiated my claim and cancelled my insurance cover on grounds of non-disclosure of material facts -- W E F May 23, 2021, when I told Star that, when porting is accepted, the company has to give credit to all positive and negative settlement occurred with the old insurer.
My family members's insurance is intact.
If I port my policy back to Oriental, will my continuity benefits be restored since colonoscopy history and repudiated claim is with Oriental?
I have represented to ombudsman that, after 48 months, there is no question of taking shelter under pre-existing disease whether declared or not in the proposal. This to the best of my knowledge and I was under the impression that the present insurance must have taken my medical history during porting from the old insurer and must have checked the data in the common portal of IRDAI insurance information bureau of India. But they had not followed this procedure.
Sir, my questions are:
1. What is the probability of restoration and revocation of insurance by Star Health? What is the solution left to me so that my continuity benefits are restored if I port to another company?
2. Also, please advise as per IRDAI norms it if is mandatory for the health insurance company to provide voice conversation in case the policy is purchased online and proposal form is not physically signed.
Roopam Asthana: The portability guidelines are standardised and follow specific norms as mandated by the insurance regulator.
The process allows the customer to port the policy from one insurer to another, along with the continuity benefits of your existing policy.
Since the proposal is new to the insurer you are porting to and this insurer has no access to your past medical history, declaration of pre-existing medical history or claims is mandatory and forms a base while accepting the portability application.
Once the time limit of porting the policy to the new insurer or switching back to initial insurer has elapsed, there is no option left other than continuing with the ported insurer.
If the policy is cancelled based on non-disclosure of a single illness, you may talk to your insurance advisor or directly to the insurance company for reviewing the decision after excluding the pre-existing disease that was not disclosed earlier. This will help you to continue the policy and maintain available credits except for the coverage of that single illness as an exception.
For online policy purchase, insurance companies issue the policy based on the information declared online while purchasing the policy.
The customer's declaration made online has an equivalent weightage to a physical proposal form.
In case of policy purchased through a tele-calling channel, you may ask for the 'confirmation transcript' based on which the policy has been issued.
Santosh Deshpande: Hello. Are there any insurance policies that cover fertility treatment? If yes, how long is the waiting period and how much amount can be covered?
Roopam Asthana: Usually, infertility treatment is out of scope of a policy cover as it falls under standard exclusions.
However, there are a few companies offering plans that cover infertility treatment with a certain waiting period. This means if you opt for such a policy, the claim can be made only after completing a certain number of years of the policy as stated in the policy document and if its requirement was not pre-existing.
If the need for infertility treatment has been diagnosed before applying for such a policy, then the norm of 'pre-existing disease' applies.
You may talk to your insurance adviser and get detailed information about such plans.
Piyush Agarwal: I have an Oriental Health Family Floater policy from past five years, covering my parents and family.
During the first purchase of the policy, there was no mandatory medical check-up for me or my wife but it was done for my parents. When I was recently reviewing the pre-existing conditions submitted five years back, I found that there was no mention of my smoking habit in it.
Till date, I haven't made any claims for myself. Do I need to disclose my smoking habit even after so many years? Will it lead to non-coverage of any pre-existing conditions?
If I disclose now that I am smoker, will it impact my future claims as I have been smoking for the past 10 years?
Roopam Asthana: It is always better to disclose fully and honestly while applying for insurance.
Insurance is based on utmost good faith and the declarations made by you form the base of the policy issuance.
Full disclosure ensures that there are no complications at the time of claim processing.
In your case, if smoking is the only non-declaration, you may write to your insurance company and get the endorsement done in the policy.
Usually, insurance companies consider the smoking habit under regular risk if it is non-extensive, chronic and/or has already had an adverse health effect, which needs to be declared separately.
Do you have health or auto insurance queries? Please mail your queries to firstname.lastname@example.org with the subjectline Ask Roopam and he will answer all your health insurance and auto insurance queries.
Feature Presentation: Ashish Narsale/Rediff.com