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ASK SANJIB: 'I have a unique mediclaim query'

By SANJIB JHA
July 29, 2022 09:24 IST
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'During my stay in the USA, I had a massive heart attack.'
' The insurance took care of the expenses as per the policy.'
'When I come back to India, will the insurer cover me for this heart attack and related treatment expenses?'

Illustration: Uttam Ghosh/Rediff.com

Sanjib Jha, CEO, Coverfox Insurance Broking (external link), answers your health insurance related queries.

Please mail your queries to getahead@rediff.co.in with the subject line 'Ask Sanjib' and he will answer all your health insurance queries.


Srinivas: I have an Individual Mediclaim policy with Star Health, Chennai since March 2015 and have successfully renewed it over the years, as of date.

Couple of enquiries as I am unable to port to other Insurers as:

Sanjib Jha: Hi Srinivas, I will be answering your questions one by one as mentioned below:

1. Renewal notice does not mention Earned/to-be earned NCB, which other insurers expect to know, they just do not bother about any supporting docs like policy write ups, policy document etc.

Sanjib Jha: If there is no claim in the policy then the NCB should be mentioned on the renewal notice. If the same is not mentioned then I would suggest you to kindly raise the matter to the insurer before renewing the policy.

2. For claim-free years, I am allowed eligibility for Rs. 1500 Medical check-up; this has to be lost as well in case of renewal, as new insurers upon porting do not offer this facility rather, they have some lesser benefit tests (or) nothing at all depending on the plans we chose.

Sanjib Jha: This is true. Medical check-up is a kind of complementary service which insurers provide along with selective plans. In case of portability, some of the insurers have waiting period & some insurer provide the same from day one.

3. Also, every year Star Health (twice in a row now) Star Health has played with my NCB reflecting in my policy document and I had fought hard to get correct data printed in document again.

Sanjib Jha: In case of any NCB dispute in the policy, you can raise it to the insurer & if found wrong then the same will get endorsed by the insurer.

4. JUST TOO MANY SERVICE ISSUES WITH STAR

Also, in totality, porting is not a value-added feature if existing benefits are able to be carried forward upon porting with new insurer.

Sanjib Jha: It depends on the insurer to insurer. If you find any better plan from other insurers then porting a policy is a good decision. Benefits of porting the policy are as follows:

- Better Sum Insured Value

- Lowered Policy Premiums

- Get an insurer with a better Claim Settlement ratio

- Better service provider

- No Loss in previous policy benefit

5. IRDA rules are not appreciable in this matter, despite approached, we are being asked to approach Ombudsman / court. Is it not strange? What is the solution here and who to approach to get this resolved?

Sanjib Jha: If the insurer is not responding to your raised concerns, then you can approach the insurer Ombudsman as the next grievance level

Murali sangeetha: I have a unique situation and so a unique query. 

I have a medical insurance and a top up insurance since 2020 for my family of 4 (me, my wife and 2 children). I have renewed it on time so far. The current renewal is due soon. 

Meanwhile, I had to travel to the USA to meet my family, where my wife is employed on non-immigration visa for short term, with employer insurance for her and the family. 

During my stay in the USA, I unfortunately had a massive heart attack. The insurance took care of the expenses as per the policy. 

My question is, when I come back to India, will the insurer cover me for this heart attack (does it become pre-existing now?), related treatment expenses?

What are the IRDAI guidelines for such cases? What are my responsibilities? Will premiums increase? Will waiting period increase? Hope you can help. 

Sanjib Jha: Hi Murali, sorry to hear about your health and wish you a speedy recovery. To answer your question, if there is no waiting period for heart attack in your policy then the same will be covered in the policy for any treatment done in India.

I suggest you to kindly declare the said ailment to the insurer. The premium will not increase considering this factor as the said ailment occurred after the policy issuance.

You can read more of Sanjib's responses here.

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