If you have diabetes and hypertension, forget that you can rely on your mediclaim or health insurance policy in emergency, if the policy is not at least four years old.

The Gujarat Consumer Dispute Redressal Commission has ruled that if one goes for any surgery within four years of buying an insurance policy and claims refund, it will be considered to be in violation of terms and conditions and the person won’t be entitled to health/medical claim. The commission also set aside an order by the Junagadh forum.

“There is an error in the conclusion of the forum in directing the United Insurance Company Limited to pay health claim to complainant Mahendra Vazirani. As per the policy conditions, even though a disclosure is made about diabetes and hypertension, insurance benefits can be extended only after four years,” the commission concluded.

It added, “In the present case, the complainant underwent a bypass surgery within two years of buying the health insurance policy. It clearly establishes the violation of the terms and conditions of the policy; so the complainant won’t be entitled to a claim.”

The commission’s judicial bench of members VM Chaudhary and MD Gadhvi, while allowing the appeal of the insurance company, opined that there is merit in its submission that diabetes has a direct relationship with hypertension. In support of its contention, it cited the National Commission’s order in LIC vs Srimati Shashi Bala.

In this case, complainant Mahendra had subscribed to an individual health policy from the insurance company for 2009-2010. On August 13, 2009, he underwent an angiography, after which he was asked to undergo a bypass surgery. He was operated upon at a Nadiad hospital and he had paid a medical bill of Rs1.20 lakh. As he had a health insurance policy of Rs1 lakh, he said he was entitled to 70 per cent of the insured amount.

However, the company rejected his claim citing pre-existing diabetes and hypertension which he had disclosed while buying the policy.

An aggrieved Mahendra then approached the Junagadh forum which then asked the insurance company to pay the claim amount. The company challenged the order before the commission.

A CONDITIONAL COVER
The Gujarat Consumer Dispute Redressal Commission has ruled that a person who has diabetes and hypertension cannot demand mediclaim refund within 4 yrs of the policy

source:dnaindia

Ashish Mehrotra

Is there any ceiling on the amount for a floater medical insurance plan?

– Gaurav Rastogi

Maximum coverage amount (known as sum insured) varies from insurer to insurer. It is important for a customer to assess the demographics before deciding the coverage amount. Things to keep in mind are: city in which one is residing as the medical cost varies accordingly; family size (larger the family size more should be the coverage amount; type of hospitals in which one would go at the time of hospitalisation (cost varies with hospitals); medical inflation (a sum insured which looks sufficient today may not be adequate in the future).

Should I go for periodic health check-up after taking a health insurance policy?

—Vipul Nautiyal

Normally, health insurance policies in the market today provide health check-up as a benefit. Policies which provide health check-ups at least on an annual basis should be preferred for monitoring health conditions periodically.

My health insurance company has not paid me the full amount of the hospital bill. How is the claim amount calculated and can I file a complaint against the company?

—Manoj Kumar

There are certain exclusions in the policy which should be read carefully before choosing the policy. Apart from these exclusions, a few policies have in-built cost sharing options like co-payment, sub-limits, deductible, etc.; due to which a part of claim has to be borne by the customer. In case a customer is not satisfied with claim adjudication, he/she can contact the grievance cell of the insurer (details can be found in the policy terms and conditions). If an escalation is required, customer can contact Irdai’s insurance ombudsman. List of insurance ombudsman is available at Irdai’s website (www.irdai.gov.in )

Do I have to inform my TPA before any planned hospitalisation for cashless benefit?

—Vinod Gupta

For availing cashless facility, it is always suggested to take approval from the insurance company directly. It helps in avoiding confusion and reduces the time taken for approval.

source:www.financialexpress

Is health insurance worth buying? Is it good to safeguard your savings because you can be faced with a medical issue any time? If you do not face any health issue, it is a blessing, even though the insurance cover was a wasted expense. Buying early helps; but the premium increases with age. Unlike life insurance, you cannot lock-in the premium for long term. At times, even buying a policy is not possible due to undisclosed underwriting rules. While mediclaim is useful, Raj Pradhan highlights three major issues with mediclaim, which can let down consumers. One of the common ones is your proposal itself. Health insurers dig up issues with your proposal when it comes to paying claims—even though you may have paid your premium diligently for decades. To avoid this, declare every single health issue diligently. Also, expensive medicines and injections, not covered by mediclaim day-care, can defeat the purpose of buying mediclaim. No insurer has addressed this ‘gap’ in cover and no media has talked about it. Make sure you don’t miss this very important Cover Story.

In her Different Strokes column, Sucheta tells you why the Financial Resolution and Deposit Insurance Bill, 2017 (FRDI Bill) may not be as worrying as viral social media messages seem to suggest. Her Crosshairs column is about how dubious promoters game the system with the connivance of international banks and financial intermediaries, to help them bleed Indian lenders – mainly public sector banks. In his legal column, advocate S Prasanna tells us how, and why, the Delhi High Court has upheld the political appointment of BJP spokesperson Dr Sambit Patra as an independent director on ONGC’s board. In Legally Speaking, SD Israni writes about a shocking case where a hapless widow fought a successful battle to force State Bank of India to honour a free insurance on home loans that it had quietly withdrawn without proper notice to borrowers. In his column on stocks, Bala addresses the crucial question of when to invest in commodity stocks. As always, I look forward to your views and suggestions.

source:moneylife

Employees Joint Action Committee (EJAC) president Abdul Qayoom Wani today sought immediate implementation of mediclaim policy in the state.
Qayoon Wani, in a statement today, appealed to the chief minister, minister for finance, state chief secretary and commissioner Secretary finance to implement mediclaim policy in the state and make mediclaim insurance scheme mandatory for all gazetted, non gazetted, public sector, temporary, daily wagers and all categories of employees.
Wani expressed his deep concern for delay in the implementation of the mediclaim policy. “The government is not keen towards this sensitive issue. Any further delay in implementation of health insurance shall prove detrimental and would tantamount to violation of human rights,” Wani said.
He said, “It is the duty of state government to ensure the quality health of its employees. The scheme despite a lapse of one year has not still been implemented and tendering is yet to be done. The period of mediclaim for gazetted employees too has expired in August this year.” “Many employees lost their lives due to non availability of health insurance and many are suffering due to life consuming diseases and have no access to high priced and quality health care hospitals,” Wani said..

source:greaterkashmir

Insurance is a system whereby individuals and companies that are concerned about potential hazards pay premiums to an insurance company which reimburses them in the event of a loss. The insurer profits by investing the premiums it receives, and from underwriting gains and losses.

Some common forms of insurance cover business risks, automobiles, homes, boats, worker’s compensation, and health. Life insurance guarantees payment to the beneficiaries when the insured person dies.

In a broad economic sense, insurance transfers risk from individuals to a larger group, which is better able to pay for losses.

Insurance in some form is as old as historical society. Bottomry contracts were used by merchants of Babylon in 4000 B.C. in which a supplier of capital for a trade venture agreed to cancel the loan if the merchant was robbed.

An extra charged was added to the usual rate of interest as a premium for the creditor, to whom the risk of loss by robbery was transferred. The Code of Hammurabi legalized this practice. The Code also provided for the indemnification, by the state or the temple, of a person whose home was destroyed by fire, and for murder or robbery.

There are many methods of classifying insurance. Distinctions are often made according to the risks covered (personal, property, and liability), the perils covered (accident, sickness, old age, fire, windstorm, riot and civil commotion, crime, and others), the losses covered (expense reimbursement or income replacement), the property covered (such as dwellings, buildings, contents, and money) or the policy term (one year, ten years, or the whole of life).

Insurance contributes a lot to the general economic growth of the society by provides stability to the functioning of process. The insurance industries develop financial institutions and reduce uncertainties by improving financial resources.

Insurance provide safety and security, generates financial resources, promotes economic growth, medical support and mitigates risk etc.

India accounts for 16 percent of the world population, but accounts for approximately 1.68 percent of the world life insurance market (World Insurance Report). India is also far behind world averages in terms of insurance penetration, and insurance density.

The opening up of the insurance to the private sector by the Insurance Regulatory Development Authority (IRDA) Act 2000 has provided immense opportunities for both the public and the private industry for better utilization of insurance facilities.

With this kind of situation prevailing, there has not been much progress in the coverage of our population within this system of insurance; only meagre per cent coverage has been reported. Whether this is due to lack of awareness on part of the public is to be determined.

The Jammu and Kashmir State has a geographical spread of 2, 22,236 Sq. Kms, (including an area of 1, 20,849 SqKms under Pakistan and China), accounting for 7.02% of total area of the country, making it the 6th largest state of the India. With 101.44 lakh population, as per census 2001, it ranks 19th state in India and constitutes approximately 1% of the country’s population. Density (100 persons per sq.km.) places it to be the 31st populous state among the states/UTs of India. The population of the state in 2011 is projected as 125.11 lakh.

The literacy rate of J&K stood at 55.52% with male literacy of 66.6% and female literacy of 43.00% (census 2001) and as per Literacy survey 2008 the literacy rate of J&K has increased to 65.67% with male literacy of 73.30% and female literacy of 57.11%.

Jammu Kashmir has around 4.8 lakh Government employees. Thinking about their risk management is necessary. It is good to know that the Government of Jammu Kashmir is in the process of formulation and finalization ofGroup Mediclaim Insurance Policy but is this group Mediclaim Insurance Policy, making someone an overnight crorepati? Why government chooses a broker (Who will be fed on commission from insurance company), what if a fraud is committed by this broker company? Who will be responsible?

Why government did not entered directly into MoU with insurance company, and asked for discount on Payment of premiums (PoP’s)?

A/C to govt. Order 102-FD of 2017 dated 6/12/2017 issued under seal and signature of Finance Department through GAD Site, which reads: “The Government is in the process of formulation and finalization of Group Mediclaim Insurance Policy for its employees and pensioners which shall interlia be applicable to the employees of all PSUs Autonomous bodies and Universities of the State Government. The autonomous bodies PSUs & universities shall compile and handover the same to the authorized person of M/s Trinity Reinsurance Brokers Pvt. Ltd. who shall be visiting their offices in due course of time.”

It is pertinent to mention here that previously government declaration regarding each employee of Jammu Kashmir government to get group personal accidental insurance of Rs 10 lakh against payment of an yearly premium of Rs 359.90. The government then accorded sanction to direct tie up for the group insurance policies with Oriental Insurance Company Limited

A notification by the Principal Secretary Finance, Navin K Choudhary, reads the policy shall cover staff of the state government including employees of PSUs, autonomous bodies, local bodies, universities, daily workers, casual workers, consolidated workers, contractual and contingent paid workers, adhoc employees and SPOs and a detailed MoU and agreement indicating the terms and conditions and other details were executed between the Government of Jammu Kashmir and Oriental Insurance Company Limited.

The finance department also has sanctioned advance drawal of Rs 12,59,65,000 at the rate of Rs 359.90 per employee under Major Head 8235 for subsequent release of the amount to the Oriental Insurance Company Ltd as premium for the insurance one year from the date of payment of premium.

The question arises why in the case of Mediclaim Insurance Government Involved Non State Entity broker in between which will earn lacks and crores of money? By which method government chooses this broker company and by which method choose insurance companies for these jobs? Is government asking for discounts on payment of premium from these companies?

Public need an answer please.

source:risingkashmir

The health insurance has become much more a need today with the healthcare costs raising day by day and severe health issues like diabetes and cancer are getting somewhat more common.
Manav Bajaj

In the world of high scale uncertainties, health insurance is one of the basic needs of the contemporary world that a smart and erudite person can never skip albeit living in affluence and comfort.

It is a common observation that people who don’t have any insurance policy are quite often deprived of on-time quality medical care that worsens the problem and even deteriorates their family and social life.

Health is the real wealth but to preserve this wealth; one always needs to spare a part of the liquid wealth. Here, nonstrategic saving or money accumulation is never a good idea because rising inflation causes holes in the piggy bank – i.e., depreciation. Ergo, a mediclaim policy is always a smarter idea, once it guarantees complete transparency, minimum exclusions, and adequate returns.

Need and importance of health insurance

Statistics reveal that more than 80 percent of the financial crises are a result of medical emergencies only thus, clearly indicating the severity with which such emergencies can damage one’s finances. Health emergencies are much more of an issue than others as they not only involve funds for treatment but also hurt the ability of the holder to earn.

The health insurance has become much more of a need today with the healthcare costs raising day by day and severe health issues like diabetes and cancer are getting somewhat more common. There’s nothing more satisfying than paying a small price at short intervals and enjoying stable finances even when the worst of health issues hit upon.

Things to keep in mind before buying mediclaim

Health insurance is indispensable, especially for middle-class families, but it’s better to buy a policy from a reputed company only even if it costs a few more bucks instead of getting it done from a cheaper option that in the latter stages starts making troubles when the illness already pains one.

One should also avoid buying online policies quickly as one never knows about hidden clauses that reveal themselves after paying a few initial premiums. Instead, it’s better to go through and compare the policies online and then schedule meetings with executives of different insurance companies one by one. Hurriedness often causes an abysmal decision; so, don’t leave any doubts unclear because. There are many previous cases when the insurer repudiated the claim on the basis of exclusion policy.

‘The New India Assurance Company India vs. Rakesh Kumar’ case is an example which helps to understand that how cautiously an insured must have to deal with an insurance company. In this case, the insurance company used exclusion policy as a pretext for the defense to dismiss claim request against the coronary artery bypass surgery that Rakesh Kumar underwent on October 23, 2012. After a thorough investigation, the Court of Union Territory Consumer Disputes Redressal Commission SCDRC UT Chandigarh reached the conclusion that Rakesh Kumar wasn’t aware of his coronary artery disease at the time of renewing the policy. On the basis of all facts, the commission directed the insurance company to reimburse the mediclaim amount of around Rs 2.25 lakh and Rs 50,000 as compensation for mental agony and harassment and Rs 7000 as litigation charge with interest @ 18% PA. Hence, seeking court’s help is imperative to protect consumer rights for every individual.

Get early protection and choose the right amount as sum insured

Early investment and that too before the age of 40 is key to enjoy the most of the health cover benefits without much pain to the pocket. The earlier one starts with healthcare policies, the more they get to enjoy the no-claim bonus on the original coverage that adds up to quite a significant amount benefitting the person in every claim-free year.

When selecting the sum insured, one needs to keep a tab on costs prevailing at that particular period of time, in case, the insurance holder lives in a small city, the minimum cover range should be between Rs 3 to 5 lakh. If it involves a metropolitan resident, then the cover should be nowhere less than Rs 5 to 10 lakh. Also, if one is shifting from one city to another, then they can port the benefits of the old plan into the new one in the new city instead of, canceling it and then buying a new one. It is also necessary to keep increasing the health cover from time to time to keep pace with the rapid speed of medical inflation.

Pay heed to every detail and stick to honesty

Mutual transparency and trust must be established between the buyer and seller of the policy, the breach of trust brings losses to both the entities. So, before signing the documents, it’s the responsibility of both the parties to provide complete and fair details which may greatly affect the deal in the future. Being a conscious consumer one should take a substantial amount of time in enquiring the details, cross-checking them with the help of experts such as insurance consultants, lawyers, and subject matter experts.

Finally, making the right decision based on a thorough cost-benefit analysis. On the other hand, the consumer should also react honestly and must refrain from hiding any fact related to him/her.

One should declare every problem and ailment in the application form; otherwise, the problem created by undeclared illnesses will not be covered in the medical cover. Make sure to get the ailments one wants in the medical cover even if it requires a waiting period. But today, in most of the plans all preexisting diseases get covered after a time span of 3 to 5 years depending upon the plan. Before investing in such policies, it’s better to check the waiting period and invest in the ones that come up with the minimum of it and maximum of preexisting diseases.

How important is to read exclusion clauses

Majority of denied medical claims have been because of non-disclosure of prior condition. Insurers and insurance brokers need to be aware that many exclusion clauses in policies won’t have the effect that may have been intended when they are tested before a court or tribunal. In the majority of cases, customers remain unaware of the diseases covered in the mediclaim and what procedures they need to comply with to avail maximum benefits from the policy. A complete knowledge of the policy one holds protects the insured of getting cheated by the insurer. Here, the best thing to do is to have a full checkup before subscribing/renewing the policy, so that the insurance company is also assured about the details mentioned in the forms submitted to them.

Never buy a health insurance policy which has a claim loading

If you get a critical illness which requires long-term cure then with a claim loading your premiums will keep on increasing and soon may become unaffordable. So, don’t fall into that trap. Besides, one should always invest in a policy that can be renewed any time during the overall lifetime. The aim of health cover is mostly to secure the people in their old age when they are at the risk of facing many severe ailments and are also not capable enough to adequately fund such healthcare treatments.

Buy a plan with no or minimal sub-limit

Be especially careful of plans which offer a cap on the room rate. You can’t decide the category of the room if you or your family member is carried in an emergency situation to the hospital. Watch out for sub-limits; means that your insurer specifies a limit for an expense and anything above that needs to be borne by you; room rent, diagnostics, and doctor’s fees are the most commonly introduced sub-limits. You need to check the limits while choosing a policy.

And, always try to hook up with the policies that provide one with the benefits of restore limit or super top-up just in case the medical problem needs much more than the amount assured. In such times, this will act as a buffer stocks to meet up and sort out the costs of the unforeseen critical illness like that of cancer and diabetes.

source:moneycontrol

With medical costs increasing rapidly, it is necessary to buy health insurance plans. Such plans cover all hospitalisation expenses, as well as pre-hospitalisation and post-hospitalisation charges. Following are five major advantages of purchasing a health plan:

Coverage of medical expenses

The main purpose of health insurance is to receive the best medical care without any strain on your finances. Health insurance plans offer protection against high medical costs. It covers hospitalisation expenses, day care procedures, domiciliary expenses, and ambulance charges, besides many others.

Coverage against critical illnesses

Insurance providers now offer critical illness insurance, either as a standalone plan or as a rider. Such a policy provides coverage against life-threatening diseases such as kidney failure, bone marrow transplant, stroke, and loss of limbs, among others. Upon diagnosis of any of the critical illness from the predetermined list, you are entitled to receive a lumpsum amount. This amount may be used to meet treatment costs, daily expenses, and any other financial obligations.

Cashless claim benefit

Many insurance providers offer cashless claim facility so you do not have to make any out-of-pocket payments. The hospitalisation expenses are settled between your insurer and the hospital. To avail of this benefit, it is imperative to get admitted at any of the insurer’s network hospitals. You may fill out a pre-authorisation form and display your health insurance card to enjoy the cashless facility.

Additional protection

Many organisations cover their employees with a group insurance plan. However, such policies are not tailormade for individual needs. Besides, you may be left uninsured in case of job loss or change. To protect yourself against this, buy a health cover individually.

Tax benefits

Health care plans provide tax benefits. Premiums paid towards your health care policy are eligible for tax deductions under Section 80D of the Income Tax Act. If you are under 60 years of age, you may claim up to `25,000 tax benefits on health insurance premiums for yourself, your spouse, and dependent children, and an additional tax benefit of Rs 25,000 for parents. If either of your parents is a senior citizen, you may claim up to Rs 30,000 tax benefit.

Keep these advantages in mind and choose from medical insurance plans available in the market. Based on your personal needs, select the best plan and do not miss out on the opportunity to enjoy all these benefits.

source:financialexpress

You can buy health insurance plan with IVF treatment cover I want to buy a mediclaim product for my family with IVF and fertility treatment cover. Please suggest a plan.

– Gaurav Arora

It is prudent to have a health insurance plan for your family. IVF and infertility related expenses are usually not covered in health insurance plans offered by most insurers. Insurance companies are now coming up with policies providing IVF treatment cover with limited sum insured. Coverage is provided for medical expenses incurred by the insured person during the policy period for her IVF treatment undertaken at a clinic duly registered in accordance with applicable law and on the written medical advice of a specialist medical practitioner. Such coverage in the policy comes with waiting period of three years from the policy inception date, it does not provide for such treatments taken after 40 years or expenses for consultation, diagnostic tests or procedure or any such other expenses for diagnosis of infertility.

Can I take renew my car insurance for three year duration to save the hassles of renewing it every year?

—Atul Sharma

Traditionally, general insurance industry has always responded to customers’ needs. It’s true that a long-term policy for cars will save the hassle of renewing every year but currently none of the insurers are offering long term policies for cars. A few insurers are offering two to three years cover for two-wheelers. Nevertheless, there is no denying of the fact that private car insurance for long term cover will be introduced in the market sooner or later.

I would like to know about mobile loss insurance cover for Apple iPhone 7plus. Please suggest.

—Sanjay Kumar

Today mobile handsets have become one of the most important accessories of everyday life for staying updated and connected with each other. Contents in the mobile phones have both monetary and informative value. There is a great risk of losing smartphones with all such precious data. Therefore, if you are planning to buy insurance, you can get your Apple iPhone 7plus completely covered which will give your phone protection against theft as well as physical damages. The insurance is valid up to one year.

source: financialexpress

In India, senior citizens can avail of a host of benefits that add to their convenience and ease their financial burden.

ET Wealth lists some of the most useful facilities available to them.

LOWER TAX
Tax laws are relaxed for the them to ease their financial burden.

* Income of up to Rs 3 lakh is non-taxable.

* For super senior citizens (over 80 year of age), income of up to Rs 5 lakh is non-taxable.

* Health insurance premium of up to Rs 30,000 gets tax deduction under Section 80D of Income Tax Act 1961.

* Senior citizens suffering from a critical illness can avail a tax deduction of up to Rs 60,000 under Section 80DDB. The limit is increased to Rs 80,000 for super seniors.

TRAVEL DISCOUNTS
Senior citizens can avail of various discounts on fares.

Air travel
Air-India: Senior citizens with Indian citizenship, who are over 60, are eligible for 50% discount on economy fare for domestic travel.

Rail travel
Men over the age of 60, and women over the age of 58 are eligible for 40% and 50% discount respectively. The discount is available on fares of all classes of Mail/Express/Rajdhani/Shatabdi/Jan Shatabdi/ Duranto trains.

Bus travel
Some municipal corporation and state governments give concession to senior citizens on bus fare. Certain bus seats are also reserved for them.

* The Senior Citizen’s Saving Scheme is available to all seniors over the age of 60. It offers interest of 8.4% per annum.

* Senior citizens get 0.5% higher interest rate on fixed deposits than the standard rate

SPECIAL SCHEMES
The government has several senior citizen welfare schemes.

* National Insurance offers ‘Varishta Mediclaim Policy’, for seniors aged 60-80. Maximum sum insured offered is Rs 1 lakh for hospitalisation ..

* LIC’s Varishtha Pension Bima Yojana 2017 will provide an assured pension to senior citizens based on a guaranteed rate of return of 8% for 10 years. A maximum of Rs 7.5 lakh can be invested in this scheme and one can get pension on monthly, quarterly, half-yearly or annual basis.

LOWER CHARGES
Their telephone bills are subsidised

* BSNL: Senior citizen over 65 are eligible for registration of telephone on priority. Registration charges are also waived for them.

* MTNL: Senior citizen over 65 are eligible for 25% concession on installation charges and monthly service charges for landlines connections.

OTHER BENEFITS
Banks, hospitals, etc. make special allowances for them
* Separate queues for the elderly in hospitals for registration and clinical examination.

*Senior citizens over the age of 60 can write to the court for preferential hearing of their cases.

* Senior citizens can be issued a passport on post police verification basis if they submit a copy of the passport of their child (above 18) staying abroad (with a page having their name) as an additional document along with their application form.

* Bank branches have separate queues for the elderly.

*Most banks have special accounts for senior citizens that offer facilities like issuing senior citizen cards, priority service at branches, etc