Got a query for your health insurance policy?Antony Jacob, CEO, Apollo Munich replies Health Insurance queries of Apnapaisa readers.
17 Feb 2011
1. Would like to know what can I do if my Insurance claim is rejected. The insurance policy was taken on 15th May 2009 and hospitalsation was in December 2010.
All insurance companies have their set of guidelines for claim settlement and it should be noted that every health insurance plan comes with its own set of benefits, terms and conditions. We would advise you to ask for the reason for rejection of claim and then check whether the reason is as per the policy conditions. If you are not satisfied with the rationale for rejection of claim, you may approach the grievance cell of the insurance company. The other forums where you can raise your concerns are the Insurance Ombudsman and IRDA's Grievance Cell.
2. I am looking for Insurance plan which covers regular dieses like diabetes and some time rarely special consultation like orthopedic treatment for back pain. This includes monthly consultation and drugs. I am not aware of any plan which covers such facility. Please help.
There are various plans that extend cover for Out Patient expenses, but the majority of them are basically targeted towards the tax savings incentive. Apollo Munich offers Maxima, a health insurance plan that provides coverage against expenses on doctor consultation, pharmacy expenses, health check-ups, spectacles, and hearing aids on a cashless basis within specified wide network. This may suit your requirement. Diseases such as Diabetes are considered as Pre-Existing Diseases and these are covered in the policy after specified waiting periods, in case of hospitalization. We advise you to read the benefit charts and claims process before choosing a policy over another.
3. I have mediclaim done from my company but the premium amount is deducted from my salary. Do i need to have a personal mediclaim also. If I buy another mediclaim then will there be any problem is getting claims as I have to file partial claims in two companies... The mediclaim done by my company can I continue after i leave the company. Working In MNC For last 3-4 Years. Want to take Own mediclaim Apart From other company. Secondly, what will Be the Process at the time of Claim.
A group cover as extended by an employer to an employee is customized (in terms of benefits and policy conditions) to suit specific insurance needs of the group as a whole and hence it becomes almost impossible to extend a cover post-retirement or at separation.
An individual member of a group at the time of retirement or while shifting a job must have his own health insurance cover to remain insured. Also it is important to remember that an individual policy come with a certain waiting period and is subject to underwriting before it starts covering all diseases. Hence it is advisable for all members of a group to choose a cover with adequate time in hand and remain hedged from financial risks arising out of health concerns.
Availing the benefit of both the policies at the time of claim can be done in case the sum insured in one policy does not accommodate the whole claim amount. Companies have specific claim procedures and document requirements to handle the claim settlement cases where two policies are involved.
4. I would like to know about Mediclaim coverage for New born baby. What are terms and condition for the same.
Apollo Munich's Easy Health and Maxima Plans provide an option for coverage of a newborn baby. The newborn baby cover will be accepted only if the maternity expense in the policy is accepted, that is, specified waiting period for maternity benefit have been completed.
However, Apollo Munich accepts proposals to insure babies over 90 days of age in case either of the parents are insured under the indemnity policy of the company. We would advise you to read the policy terms and conditions before choosing the cover.