1) Question
My dad (58) has been having a health policy since 2016. After 2021, there has been an abrupt increase in premiums. For 2022-23, there was a 27 per cent raise and for 2023-24, the insurer raised it by 34 per cent, leading to a steep rise to ₹28,303 for a ₹5-lakh cover.
The insurer attributed it to medical inflation. I sought a change of plan, but the insurer said it was not possible due to pre-existing disease. I even tried porting, but was informed there would be claim issues in the future. We have no source of income other than interest on savings. I just want to know the options I have.
Also, 1) Is the increase in premium across the sector? 2) Can I complain to the grievance officer? 3) Is porting a viable option?
Answer
Rising health insurance premiums are a reality and, apart from the increase in premium when you grow older and move from one age slab to another, rates are revised to keep in touch with the rising costs of health care viz. medical inflation.
Even a cursory check on insurers’ websites and those of insurance brokers and aggregators will give you a picture of the state of things. Having said that, the extent to which premiums can be raised with advancing age or after claims are kept in check by the regulator as well.
Pricing is a commercial aspect of your policy and the grievance mechanism is unlikely to be able to do anything for you about this except if there is blatant overcharging. Porting is an option but it is not automatic on request.
- Also read: Tax Query: Clarifying tax implications for payments using international credit/debit card under LRS
The company you approach for porting can accept or deny your proposal. If they accept to underwrite the policy, they have to give you terms and benefits not lower than what you enjoy currently but, remember, pricing is still their independent decision.
Group insurance schemes can be easier on the pocket, or even free in the case of government schemes and you could explore them.
2) Question
The insurer denied my term insurance policy proposal as I had diabetes. I am 33. Please suggest what I can do?
SRINIVAS P
Answer
Many insurance companies offer policies for those with pre-existing diseases and a quick check of the websites or websites of brokers/insurance aggregators will give you the information you need to proceed.
There will be a loading of premiums and/ or a restriction on the sum assured, but you are better off with some insurance rather than none.
3) Question
I work for a PSU bank in which I and my dependents are covered under a group medical insurance scheme. I have also availed of another comprehensive medical insurance policy for my dependent parents.
When a medical claim arises, can I claim under both policies? Because I have read somewhere for the claim process, original medical reports are to be submitted to the insurer.
Hence, is it possible to claim from both group medical insurers and also from another insurer at a time for the same medical issue?
RAJESH ANDE
Answer
You are right in saying that original bills are required for making any hospitalisation claim and hence, even if you claim from both policies, your total claim can only be for the expenses you have incurred as evidenced by the original bills you produce.
In a scenario where you have a basic hospitalisation policy and a top-up, you can claim first from the basic policy to the extent of that coverage and then claim the expenses that are over and above that from the top-up to the extent of the coverage under that policy.
If you had a basic policy and a benefit policy like a cancer cover, healthy heart cover, or even a personal accident policy, you can claim against bills from the basic policy, which is in the nature of an indemnity (or reimbursement) policy and the flat sum assured from the applicable benefit policy.
(The writer is a business journalist specialising in insurance & corporate history)