Health Insurance - Ask me

[sam_boy]

Originally Posted by NetfreakBombay

Its usual delaying tactic.

ONLY thing that matters is, that she was admitted to hospital and undergone"active" treatment (I.e. was not there just for "observation").

You need to reach out to ombudsman. This issue will be sorted out.

How do I reach the Insurance ombudsman in Banglore ??? Any help will be appreciated ...

[rjvora_2000]

Originally Posted by sam_boy

Dont know if it is the right forum to ask my question but I am troubled by the insurance company guys ..

Here is the story. My mom fell down from stairs and broke her leg. She had to undergo a surgery and as my parents stay in a small place in Orissa, the operation was successfully carried out in the Govt Hospital there. Mom spent around 12 days in the hospital. I work for a software corporation and have an insurance cover of 1.5 Lacs/year for my parents. In the hospital they carried out every tests required like ECG/Ultra sound everything and the bill amount was 16K ( Can you believe it ?? ). I claimed the same amount from the Insurance company and submitted all the documents. Now they came back telling they need a circumstantial evidence certified by the doctor that my mom actually fell down from the stairs and broke her leg. When I spoke to the Govt doctor he said he cant give such certificate as he was not present when the accident happened. He is correct in his place. The hospital also told me that they cant issue such certificate. Its a Govt hospital so you must be understanding the level of co-operation. As its a small place people dont understand the Insurance claim part as well.

Now the insurance company is telling they cant process the claim without this document. Dad is telling its a small amount and forget it. But I am not ready to give up as this is a genuine claim. Now kindly advise me what I can do on this ??

Have doctors had ask for police complaint or something? If not then you on your own can write the cause and submit the letter to insurance company. I think that will help you getting the claim.

Write that point also that how can Doctors will write something which they have not seen from there eye.

[NetfreakBombay]

Originally Posted by sam_boy

How do I reach the Insurance ombudsman in Banglore ??? Any help will be appreciated ...

Contacts:

Insurance Ombudsman>>List of Insurance Ombudsmen

Try what previous posts suggests. If that does not work out, reach out to ombudsman.

[ashthedivx]

Very True, If it hadn't been an accident why proper FIR of police complaint was not demanded at first place.

OT: Are you sure docter babu ain't asking for any bribe kinda stuff ?? Usually they do !!

[nishantgandhi]

Originally Posted by rjvora_2000

Your question coming at right time.

Yesterday only I was sitting with one gentleman who has been renewing the health insurance policy with Reliance since more then 4 years.

Last year he had claim of cataract which got reject at hospital (Cashless) then he went to Insurance ombudsmen and claim got settled after one year.

Rejected Reason:- For first two year's cataract claims are not payable. (Policy was in fourth year.)

First year he started with some thing around Rs. 5000 and this year he received a renewal notice of Rs. 9000+. Almost doubled in fifth year.

But isnt doubling of premium the case with all insurance companies, especially with increasing age?

I had cut out the cheque for Reliance and was about to courier my documents. Now you have forced me to think otherwise.

What other options do you suggest for Dad (60) and Mom (57)? Both stay in Delhi.

Originally Posted by rjvora_2000

Your P.S. No. 1 is wrong because Chola has a life long renewal of policy.

I wasnt aware about Chola's medicalim policy. Whats the maximum age of entry? Can I get my dad enrolled? He just turned 60 and most companies (except Reliance) are refusing because of the age.

Originally Posted by rjvora_2000

I think you can only pay premium in Reliance if you have a capacity to fight your own claim even if you are right.

Hmm, thats a tricky case. Dont want parents to go through any hassle. You got me thinking now.

[dvinod]

In tamilnadu STAR health insurance provides good service with low premium.
i don't know whether their service available across the country. tamilnadu government also given health insurance to all its employees through star.check this website Star Health & Allied Insurance

[sam_boy]

Originally Posted by ashthedivx

Very True, If it hadn't been an accident why proper FIR of police complaint was not demanded at first place.

OT: Are you sure docter babu ain't asking for any bribe kinda stuff ?? Usually they do !!

Well .. The doctor does not have any such intentions for sure .. As this is a genuine case I wont even try this ...

[rjvora_2000]

Originally Posted by nishantgandhi

But isnt doubling of premium the case with all insurance companies, especially with increasing age?

I had cut out the cheque for Reliance and was about to courier my documents. Now you have forced me to think otherwise.

What other options do you suggest for Dad (60) and Mom (57)? Both stay in Delhi.

I wasnt aware about Chola's medicalim policy. Whats the maximum age of entry? Can I get my dad enrolled? He just turned 60 and most companies (except Reliance) are refusing because of the age.

Hmm, thats a tricky case. Dont want parents to go through any hassle. You got me thinking now.

Now I have to tell you the most unfortunate part of health insurance, for above age 45 (Yes 45), getting new policy!!!

Very very difficult task.
In chola entry is till 55 and if they are covered as dependent parents then up to 65 you can cover them.

[nishantgandhi]

Originally Posted by rjvora_2000

Now I have to tell you the most unfortunate part of health insurance, for above age 45 (Yes 45), getting new policy!!!

Very very difficult task.
In chola entry is till 55 and if they are covered as dependent parents then up to 65 you can cover them.

So that leaves me with no other (affordable) option than Reliance

Back to Square One I guess!

I agree with your statement. I had a really tough time negotiating with all the insurance companies. They simply refuse even though the medicals are all fine.

I think the best strategy is to buy a health insurance early on in your life (~25 years or so) and keep renewing it religiously every year. I suppose in that case, they cannot refuse once you cross 60, right?

Mr. Rupesh - one more question though. Is it legal to take medical insurance from different companies? e.g. Consider a scenario where one takes a cover of 2 lacs each from 2 insurance companies.

In the even of a claim of say Rs 3.5 lacs, can he claim full 2 lacs from one and the balance 1.5 lacs from the other company?

The Reliance advisor told me that its very much possible under their scheme. However, I have heard people saying that this is illegal under IRDA?

[rjvora_2000]

Originally Posted by nishantgandhi

I agree with your statement. I had a really tough time negotiating with all the insurance companies. They simply refuse even though the medicals are all fine.

I think the best strategy is to buy a health insurance early on in your life (~25 years or so) and keep renewing it religiously every year. I suppose in that case, they cannot refuse once you cross 60, right?

100% they can't say NO. I believe once if they have issued the policy they have to renew that policy for life long!!!

But let me tell you that I have read all the terms and condition of health insurance policy of:- Apollo, Chola, Bajaj, Icici, Reliance, National, New India, United and Oriental, all the insurance companies have not written in the terms and condition that the policy is not renewable after certain age of insured. ONLY EXPECT BAJAJ. Only bajaj has a upper limit that they will not renew the policy after age 75.(Which is very bad.)

Originally Posted by nishantgandhi

Mr. Rupesh - one more question though. Is it legal to take medical insurance from different companies? e.g. Consider a scenario where one takes a cover of 2 lacs each from 2 insurance companies.

In the even of a claim of say Rs 3.5 lacs, can he claim full 2 lacs from one and the balance 1.5 lacs from the other company?

The Reliance advisor told me that its very much possible under their scheme. However, I have heard people saying that this is illegal under IRDA?

You can take how much ever (No. of) policy you want and at the time of claim all the policy will contribute there proportion of claim.

Let me tell you how:-
Policy no. 1 - Rs. 1,00,000/- Sum
Policy no. 2 - Rs. 3,00,000/- Sum
Total you are insured for Rs. 4,00,000/-
Total Claim amount Rs. 1,00,000/-
Policy 1 will pay Rs. 25,000/-
Policy 2 will pay Rs. 75,000/-

[nishantgandhi]

Originally Posted by rjvora_2000

100% they can't say NO. I believe once if they have issued the policy they have to renew that policy for life long!!!

But let me tell you that I have read all the terms and condition of health insurance policy of:- Apollo, Chola, Bajaj, Icici, Reliance, National, New India, United and Oriental, all the insurance companies have not written in the terms and condition that the policy is not renewable after certain age of insured. ONLY EXPECT BAJAJ. Only bajaj has a upper limit that they will not renew the policy after age 75.(Which is very bad.)

I didnt mean they are saying no for renewal. They are saying no for the initial sign on for the policy itself, stating that upper age of entry is capped at 55. Thats where I am stuck.

Amongst the private ones, only Reliance, Apollo and (now I know) Chola allow 55+ aged people to get their policy.

Amongst the nationalized ones, they are obliged to give insurance to people upto 65 years, as per the Govt's notification. However, their premiums are very high (e.g. National Insurance charging Rs 17k odd for a 3/4 lac cover). That makes them comparable to private ones.

Originally Posted by rjvora_2000

You can take how much ever (No. of) policy you want and at the time of claim all the policy will contribute there proportion of claim.

Let me tell you how:-
Policy no. 1 - Rs. 1,00,000/- Sum
Policy no. 2 - Rs. 3,00,000/- Sum
Total you are insured for Rs. 4,00,000/-
Total Claim amount Rs. 1,00,000/-
Policy 1 will pay Rs. 25,000/-
Policy 2 will pay Rs. 75,000/-

But I can claim the complete 1 lakh from either company also in this case na?

[bharanidharang]

I dont understand why as a country, people above 60 are treated this way.

rjvora..thanks for the great service you do on team-bhp. i have one query. i have a oriental mediclaim for myself, wife and my parents. My Dad is now 60. How long can i have my dad as a dependant in the policy ?

[nishantgandhi]

OT - Just downloaded the form for United India Insurance and was quite amused to find that in the Lifestyle column, under Smoking, they have only 2 options:
1. 1 pack/day
2. Less than 1 pack/day

Also, does New India Assurance provide Mediclaim? Its not on their website.

Just spoke to Royal Sundaram. Their maximum entry age is 50.

Hows Star Health for mediclaim?

[anandtheleo]

Originally Posted by nishantgandhi

But I can claim the complete 1 lakh from either company also in this case na?

But during a claim process you would be submitting all the documents to only one insurance company right? you would not have two sets of original documents.

[NetfreakBombay]

Originally Posted by anandtheleo

But during a claim process you would be submitting all the documents to only one insurance company right? you would not have two sets of original documents.

You would give claim to any one of the companies and inform that company about other policies.