Do you have to pay extra premium for cashless mediclaim?

Have a query regarding health insurance or mediclaim policy? Maybe we can help.

Drop us a line and our expert, Harsh Roongta, CEO of Apnapaisa.com, will answer it.

Please write to us at getahead@rediff.co.in with the subject line as: Health insurance query.

I am about 44 years, married with two children. Wife is 37 years, son 12 years and daughter 9 years. I would like to take a mediclaim policy, preferably floater policy so that all the members can be covered, initially, to the extent of Rs 1 lakh. Slowly, I will increase the slab. One small problem is I have been through angioplasty, which was done in September 2008. Please suggest companies, which would accept this criteria and issue mediclaim. What are the ifs and buts? Alternatively, if this is excluded, then after how much they will include it? Is the inclusion based on the date of illness or on the date of taking policy? Other members of the family are perfectly all right.

What would be the premium? What about cashless and mediclaim by paying cash policies? What is the difference between the two and is there any difference in the premium amount? Does the policy automatically become cashless or do we have to opt for it?

Harsh: Cashless is an inbuilt feature of all the policies available in the market and you don't have to pay anything extra for the same. You can apply to the following companies mentioned in the table below. All the companies will cover pre-existing diseases but after certain number of years which is again mentioned in the table. The waiting period starts from the date of the first policy.

We would recommend you buy health insurance for your entire family for at least Rs 3 lakh. Also increasing the sum assured at a later stage for self can prove to be a bit difficult. So opting for a higher cover at this age would be more beneficial to you.

I just checked my policy with IFFCO Tokio which I hold for the last 3 years. It has a condition during these 2, 3, 4, or 5 years, no case or treatment should have been done for the pre-existing condition for it to be covered.

I am on medication for above normal Cholesterol / Triglocerides for the last 5 years. I take Atorvastatin with Ecospirin. The tests are normal now but I am continuing medicine as a caution daily. Will this be classified as a disease, disorder or a pre-existing condition?

I don't have any other complication. Is it wise to continue with IFFCO TOKIO or change the policy to some other insurer? I am 56.

Harsh: It will be treated as a pre-existing disease and your policy will not cover the same. Since you have no other disease, we would recommend you to switch your health insurance from existing to another company that may offer to cover you after say 4 years. Below are a few policies that you may consider while buying the policy. Please do not discontinue the old policy till you have new policy in hand.

I want to know the details about LIC's Health Protection Plus Mediclaim policy. Kindly give me all the details.

Harsh: LIC's Health Protection Plus is a unit linked health plan which combines health protection for the entire family (husband, wife and children). This plan primarily gives your 3 benefits:

Hospital cash benefit: It pays you on a per day basis when insured is hospitalised (Rs 250 to Rs 2,500 per day).

Major surgical benefit: It pays a lump sum in event of the insured undergoing any major surgery defined in the policy (paid as percent age of sum assured as defined in the policy). Both these payments are not dependent on the actual expenditure you incur in the hospital and the payment is over and above any payment you receive on any other health policy.

Domiciliary treatment benefit: The actual expenses can be claimed from the fund value only in case of any domiciliary treatment of the insured (actual expenses are reimbursed) after a period of 3 years.

The fund value is paid in case of death of the all the insured members to the legal heir. Hospital cash benefit and major surgical benefits will cease after the age of 75 years whereas, domiciliary treatment will continue for lifetime.

I am an NRI aged 36 based in the Middle East. I am planning to come back to India within next 1 to 2 years. I would like to buy a health cover for my wife and myself for next 15 years, paying one time lump sum premium. We both are healthy, have no health complication till date. We would like to have cover for Rs 3 to Rs 5 lakh. Kindly suggest if any of insurance company provides similar such plans. There are so many ads we watch on the media but do not get satisfactory resolutions of the queries from these companies provided contact details.

Harsh: Health insurance unlike life insurance is a yearly renewable policy. There is no policy available for which you can pay at lump sum and get the cover for 15 years. We would suggest you to buy a policy when you come back as these policies won't cover you for any hospitalisation expenses outside the geographical boundaries of India. Lot more innovation is expected over the next few years so that you will probably have a better choice.

I have taken a medical policy from my office for my parents and brother and sister from NIC but till now I have not got my mediclaim card even. I have been trying to chase them but of no use. My sister had been admitted to hospital and mother seriously ill and in spite of them being covered, I had to pay heavy hospital expenses, please suggest what should I do in this case?

Harsh: Please immediately file an official complaint with the company in the grievance section on their website giving full details of the policy and claim submitted and asking for immediate claim settlement. If you do not receive a satisfactory response then you should file a complaint with the insurance ombudsman on the following address at ombudsman@vsnl.net.

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