Moneylife Foundation held an exclusive, in-depth session conducted by Raj Pradhan, in which he delved into various aspects of mediclaim, issues with the product and the different options available to you today
IRDA's (Insurance Regulatory and Development Authority) draft guidelines mandate lifelong renewal will certainly help as some existing products do not offer this vital feature. Senior citizens' mediclaim options come with restrictions and the fine prints have to be studied before buying one. Apollo Munich Optima Senior is a new entrant offering no-claims-loading, a key feature. Some plans load premium up to 200% based on claims history.
Keep all the contact information of the TPA (third party administrator) and insurer ready along with insurance policy at hand, as hospitalisation can be an emergency event, he said. Family members need to understand the product features with respect to room restrictions and other sub-limits like co-pay. In case of an emergency, the policyholder may not be in a position to give the policy details and paperwork to family members. It is important to follow the process laid down in the policy for hospitalisation intimation to the insurance company/TPA and claims filing process. Mediclaim is not a policy you can buy and forget about it. You have obligations to follow the process in case of claims.
Moneylife Foundation hosted its 151st seminar with the event titled "Mediclaim: Make sure You get it Right!" conducted by Raj Pradhan, who has written several cover stories on insurance for the Moneylife magazine. He gave insights to an eager audience, on retail mediclaim options, fine prints of various features and why it is important for family members to know the product and claims filing process.
In case of a cashless claim, it is better to apply before hospitalisation in case of a pre-planned procedure. There will be time delay in getting cashless approval even though companies may proclaim unrealistic timeframes. There will be queries from the insurance company/TPA to the hospital cashless request, which can delay the approval. Try to do the procedure in the hospital, which is a part of cashless network. It is a much better option than a reimbursement claim. Mr Pradhan talked about the nuances of cashless mediclaim and advised the audience to trust their family doctor, as high-end hospitals may not be the best option in all cases.
Segar Sampathkumar, general manager in-charge of grievance department, New India Assurance was also present at the seminar. He has been spearheading the initiative to add hospitals to preferred-provider-network (PPN). He shared helpful insights on mediclaim aspects relating to policy renewal, cashless network, changes in policy terms and conditions, hospitalisation intimation process and grievance management.
The audience was able to get many of their doubts answered with the knowledge shared by Mr Sampathkumar. He emphasized the importance of mediclaim and car insurance policy renewal before the expiration. The renewal notice may not be given, but the policyholder should be proactive to ensure that renewal is done. Mr Sampathkumar gave examples of senior citizens finding it difficult to get another policy once the existing policy is lapsed. Even if they get it, the waiting period for cover on pre-existing diseases (PED) starts all over again. He gave examples of genuine cases of a policy lapse where he helped to get renewal, but it cannot be something policyholder can rely on.
Mr Sampathkumar agreed that corporate policyholders have cashless in more hospitals due to the premium hike they get from the client. New India Assurance's retail policy premium has not increased in over four years, but it is now set to increase. More hospitals are joining the PPN network in Delhi, Hyderabad and Chennai, but the progress is tad slow in Mumbai and Bangalore.
Senior citizens are disallowed any increase in sum insured by insurance companies. Even more so, one may not get insurance after a serious ailment, or be able to increase the sum insured, especially if one seeks protection in the future. Mr Pradhan, in his session, informed the participants on the importance of getting themselves insured as a way to tackle high medical costs. He advised that one can go with a sum insured in the range between Rs5 lakh and Rs15 lakh.
How does one be safe and smart to be able to navigate the complex world of insurance and pick the right insurance policy features was the heart of Mr Pradhan's insightful presentation.
Mr Pradhan is currently Director–New Initiatives at Moneylife and writes extensively about insurance. To read his articles, please click here.
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