Discrepancy between policy schedule document and policy wordings document

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.

Health Insurance

2 Answer

Post

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

0 Comments

25 Aug, 2021

Avinash Sonee

3.8

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.

1 Comments

25 Aug, 2021

Mahavir Chopra

Founder, Beshak

Hello Avinash,

Articulating your problem:

There is a special condition in the policy schedule - which says there will be a copay applicable for anyone who enters the policy after he completes 61 years of age.
The policy wording extract is talking about a 20% discount for people entering after 61 years against a 20% copay.

It's clear this is applicable only for people entering after they have completed 61 years of age. It is not applicable to anyone else. The mention of Copay in the policy schedule is part of the policy's template - it will be able applicable only if the policyholder has entered the policy after 61 years of age.

Customer Care is able to answer general FAQs. They would have referred this technical question to their superiors and these superiors to theirs. It will take time for them to respond. But keep your follow-up for clarification ON.

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Discrepancy between policy schedule document and policy wordings document

2 Answer

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