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Need Urgent help -Waiver of Mandatory Co-Payment rider issue

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14 Nov, 2023 by  Rayapu Ashok Kumar Reddy

Dear Members,

  1. I have a Base policy in Manipal Cigna Health Insurance for Sum Insured 10 lakhs. Policy took in December 2019.

2. The insured person Diagnosed with Parkinson Disease in November 2020 after inception of policy and underwent DBS surgery in April 2023 and I received the claim for surgery.

3 As per policy terms there is a mandatory co-payment of 20% for all the claims once the insured person attained 65 years age. They also provided  default waiver of mandatory co-payment with some extra premium. They are allowing to opt for this rider only after the person age crossed 65 years. Hence i paid extra premium and applied for renewal along with co-payment rider before 58 days of policy due date on 29.10.2023. They accepted the payment and replied that my renewal policy will be processed in 10 days and after that my renewal copy will be received in 3 days.

4.Once I paid the renewal premium the insured suffered from sudden Chest pain and underwent PTCA Stent to LAD on 04.11.2023 and I received the claim for the surgery.

5.Now when I asked for renewal policy status along with co-payment waiver rider the company replied that they cannot give co-payment waiver rider as their underwriting team rejected because of health conditions.

My Queries are:

6.The company first accepted the payment and said that they would process the request and issue renewal policy along with a co-payment rider. Initially they did not tell anything that the request will be reviewed by the underwriting team.

7. Since I underwent PTCA stent to LAD, the company immediately changed their decision and rejected my co-payment waiver rider and said that they cannot process my request.

8.I raised the issue with their Grievance Team . They replied "We regret to inform you that we are unable to renew the policy with rider of co-pay waiver due to (Rider deleted in view of Parkinson and coronary artery disease)." Kindly provide your consent on renewal of the policy with same terms.

9.In the policy terms and conditions for renewal it says "We reserve Our right to carry out underwriting in relation to acceptance of request for changes of Sum Insured or addition/deletion of members, addition deletion of Medical Condition existing prior to policy inception, on renewal. The terms and conditions of the existing policy will not be altered"

And also in the Waiver of Mandatory Co-pay Clause it says "We will provide an option to remove Mandatory Co-pay which is applicable for persons aged 65 years and above will be available on payment of additional premium.

Nowhere it is mentioned that the waiver of mandatory co-payment rider request will be reviewed by the underwriting team at the time of renewal.

10.So, as per the policy terms it is clearly mentioned underwriting is not applicable for Mandatory Co-pay waiver rider and only an extra premium required for applicability of rider.

11.So, how can the company reject co-payment waiver rider after they accepted the payment and for the health conditions that happened after the policy inception. They are not allowing to opt for co-payment waiver rider till 65 age.

.Kindly advise whether i can challenge the decision of the company as per policy terms.

Health Insurance

1 Answer

22 Nov, 2023
Rayapu Ashok Kumar Reddy

Dear Beshak members,

Kindly provide answer to my question

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