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Discrepancy between policy schedule document and policy wordings document

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18 Aug, 2021 by  Avinash Sonee

Hi,

 

In a Care (Religare) - Care plan, there is a co-payment for members aged 61 & above.

 

In the policy schedule document, it is mentioned as

UIN: RHIHLIP20091V041920 (I couldn't find this on IRDA site)

Co-payment (Applicable where age of member at entry is 61 years or above)

 

while the policy wordings as per latest revision (UIN: RHIHLIP21017V052021) mention it differently

If age of Insured Person or eldest Insured Person (in case of Floater) is 61 years or more, the Company provides an option to Insured Person / Policyholder  to choose for co-payment option of 20% per claim (over & above any other co-payment, if any) which applies to such Insured Person or all Insured Persons (in case of Floater) and thereby get a discount of 20% in Premium to be paid.

 

I've waiting for clarification from the customer care. Wanted to know your thoughts.

 

Similarly, I've seen few more discrepancies in Care brochures vs website vs policy terms etc. I'm not sure if it comes under IRDA purview to validate these before approval.

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2 Answer

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18 Aug, 2021
Satheesh Rao

Dear Avinash,

Para1 of your query: While taking a policy, if age of any member is 61 years & above, co-payment is applicable. Is somebody takes a policy at the age of 59 years & when he turns 61(after 2 renewal) - This clause is not applicable. Also there is an option for waiver of this co-payment with additional premium.

Para2 : This is an optional benefit.Not compulsory. Without age limit any body can opt for reduced premium.


With Regards

Satheesh Rao

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25 Aug, 2021
Avinash Sonee

Can anyone help me in connecting with Care underwriter to get clarification on this question. Because the policy which is issued has default co-payment of 20% added even if the 'age at entry' was less than 61 years. And if the customer wants to get rid of the co-payment, he has to pay an additional premium for 'co-payment waiver' which is against the terms mentioned here.


Mails to customer care have not been responded for over a week now.

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25 Aug, 2021
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