Can you make profits from a mediclaim policy?

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.

Today, Harsh has answered queries about:

a) Claiming mediclaim from two different insurance companies

b) How you lose if you change insurers midway

c) What you can do if your health insurer hikes premium rates suddenly

d) If you could buy group insurance mediclaim for about six people, and

e) If you could claim reimbursement for being hospitalised during the first 30 days of your policy coming into force

I have two mediclaim policies both from different insurance companies and I am paying premium on both and these are active and in effect. In this case can I claim re-reimbursement from both of these?

A mediclaim policy is a reimbursement policy which means you can get back the money that you spend. Obviously, you cannot profit from such a policy. So the total amount you can receive on a valid claim will be restricted to the amount you have actually incurred.

Since you are maintaining two different policies from two insurance companies, they will pay the claim to you on pro-rata basis of the sum assured you have from both the insurance companies.

For example, if you have a mediclaim policy of Rs 1 lakh from company A and Rs 2 lakh from company B and the amount of claim is say Rs 90,000, then according to the 'Principle of Indemnity' company A will pay you Rs 30,000 and company B will pay Rs 60,000.

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I am 28 years of age, husband is 30, and my son is 18 months. I have a mediclaim policy with New India Assurance for the past four years and after marriage I have got a couple of policies in which my husband is included as well.

I have got an offer from Max Bupa also for a higher premium but includes valuable services like vaccination for kids, maternity claims etc. Please suggest whether I should continue with New India or change to Max Bupa keeping in mind some bonuses I would have earned over the past four years for renewing with New India.

Now that your policy has completed four years, you are now allowed to cover your pre-existing diseases. It is not advisable to switch to a new company at this given point of time. As this will result in losing your 'No Claim' bonus and with new company you will have to wait for another four years to cover your pre-existing diseases, if any.

You can consider a new insurance company, if you are looking for enhancing your medical cover.  If you are looking for additional cover, you can compare all the policies on http://www.apnainsurance.com/health-insurance-india/compare.html before deciding to buy from a specific company.

I have a mediclaim policy of Reliance HealthWise. I have been running this policy for three years. Now the company has changed the premium rates all of a sudden.

Are they allowed to do the same? Secondly if we want to change the company will we be eligible for all the benefits which are available after running three years of policy.

As per the IRDA circular No 52/15/IRDA/Health/SN/08-09 dated 31-3-2009, the premium amount from year to year cannot increase by more than 75 per cent of the previous year except with the specific approval from IRDA.

I would suggest you to pay up the enhanced premium under protest (to maintain your insurance history) and then file an official grievance with the company on their website. If you do not receive a satisfactory response within three weeks, you should escalate the grievance to IRDA at its email address complaints@irda.gov.in with full details

Or phone on 155255 which is the centralised complaint call centre of IRDA.

I am working for a start-up company in Bangalore. Right now we are six members in the company. We would like to take medical insurance for the all six members. Please let me know if it is possible to get the corporate group insurance for six members, which will cover employees and their dependants?

In case if we have to opt for individual policy (if corporate group insurance is not possible), which is the best policy which can cover along with the employee dependants?

It would be a bit difficult for your company members to get a group mediclaim as the team size is too small. So we would suggest you to go for individual policies for all your team members and their family members. Any individual policy is unlikely to cover pre-existing diseases for your employees and their dependents.

I have a query regarding the clause in most of the insurance companies 'Treatment of illness/disease/sickness contracted by the insured person during the first 30 days from the commencement date of the policy'.

What happens if a person is diagnosed with a disease after taking the policy and is also within the 30 day period? Can s/he start claiming from 31st day onwards along with whatever treatment expenses occurred during 30 days?

No, you cannot get any claim for a disease/illness/sickness contracted/diagnosed during the first 30 days of buying the first policy. This non-payment will include any claims that arise due to such illness/sickness/disease after 30 days as well.