I am 34, married with one kid and we live in New Delhi. My wife and I have two separate family floater plans of ₹3 lakh each from two different insurers. In case of hospitalisation, can we get cashless coverage from both these policies if the bill exceeds ₹3 lakh? Would this be possible in case the insurer is the same for both policies? Should I consider porting my policy?
—Name withheld on request
When you get admitted in a hospital, you have two ways to make a health insurance claim. You can either opt for reimbursement where you get treated and submit the bills later to get the money back or opt for cashless claim by getting a claim approved before admission.
If you have health insurance from two different insurers, getting a pre-approval for cashless claim from both insurers won’t be possible as only one claim request can be typically handled for cashless claim. So, one would have to get cashless approval from one policy and claim the remaining part of the bill under reimbursement. In case where you have the same insurer, claiming cashless hospitalization from both the policies might be allowed but it is advisable to check the feasibility with the insurer before porting the policy.
It would be prudent to instead look at increasing the sum insured of one family floater policy to ₹10-15 lakh to adequately protect your family and yourself during any major hospitalization.
I am 33 years old and live in Bangalore. I recently had a baby, and I am now looking to buy a health insurance policy for my family. I used to drink and smoke heavily during my college days and was also admitted to hospital twice. However, I do not have any pre-existing diseases like hypertension or diabetes and have completely abstained from alcohol since the last five years. Do I still need to disclose this information to my insurer when buying a policy? Will this impact my insurance premium?
—Name withheld on request
Before a health insurance policy is issued, one is required to honestly disclose all facts relevant to the policyholder, including medical history, details of any pre-existing diseases, family history, lifestyle choices, among others. This forms the basis of the insurance policy that is issued to you and hence you must make sure all such details are disclosed to the insurer in a truthful manner. Different Insurers have different type of questions regarding smoking habits and alcohol usage and how they view your smoking and drinking history.
If the insurers take into consideration a longer history, they might levy a premium loading based on their medical underwriting guidelines. If necessary, the insurer may suggest a medical check-up to rule out any lifestyle or pre-existing diseases. If there are no health complications, the premium is unlikely to be impacted. However, one should check the same with the insurer.
Vivek Chaturvedi is CMO and head of direct sales, Digit General Insurance.
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Published: 29 Dec 2023, 12:47 AM IST