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Urgent and Important query on a Senior Citizens Health Insurance Policy

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14 Jan, 2021 by  Abhishek Aggarwal

We have taken a health insurance policy with United India Insurance for my Dad (aged 73) atleast 12 to 15 years back with basic coverage of Rs 5,00,000. We have another Top up policy on this for Rs 15,00,000 which can be used either by my Dad or Mom as and when required. We have never had to claim as he has been healthy all these years.


My Dad has been critically ill for approx 3 months now and has been in the ICU and on Ventilator for nearly 80 days now. He is slowly but steadily recovering. The hospital bill has crossed Rs 42,00,000 during this period and counting. The insurance company has said that we can claim only after my Dad has been discharged from the hospital. Hence, we cannot claim insurance now. I would like to know if this is correct ?


His insurance policy is now coming up for renewal in another 3 weeks and I wanted guidance from experts on


Should we (or) Can we claim under the current year's insurance so that we get another (upto) Rs 20,00,000 limit in the next insurance year


(OR)


not claim this year and whether it is possible to increase the insurance coverage for Dad to say Rs 50,00,000 or more and claim only once in the next insurance year ?


Your correct and accurate guidance in this matter will be highly appreciated 🙏


Thanks in advance

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2 Answer

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14 Jan, 2021

Hello Abhishek,


  1. Yes, if the hospital is not under the cashless network (Please check on the Insurer's website) then the claim will have to be submitted after your father has been discharged from the hospital. Insurers many times do take an exception and issue an advance in such high expense cases - for this, you will have to personally visit the insurance company's regional manager and make a request.
  2. You would be able to claim from only the policy year in which the hospitalization occurred. You won't be able to claim from the next year's policy. We are however getting this double-checked.
  3. From our past experience, we feel that no Insurer is likely to approve an upgrade in the health insurance given the current medical condition of your father. So the chances of an upgrade, in our opinion, are miniscule.


In our opinion, you must claim in the current year's policy. Hope this helps.


Here's wishing your father a speedy recovery. Take care.


Regards,

Mahavir





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14 Jan, 2021

Hey Abhishek,

Wish your father recovers fast.

I agree with the advice given by Mahavir. Some quick questions:

1. Is the hospital empanelled with your insurance company or TPA? If you are not aware about it, ask the hospital. If you want reconfirmation, you can post the hospital name, your TPA company and I can check it for you.

2. Is the top up policy also from United?


Since the admission date is in the current policy period, the hospital bill can only be claimed within the current policies, i.e you can receive only 20 lakhs maximum either thru cashless or by reimbursement.


Also, if you can get Cashless, then apply that in the 15 lakh top up policy because you may only get cashless in one policy, so prefer the one with higher sum insured. The remaining amount you may have to go for reimbursement in 5 lakh policy. There is an intricate process there.


I am happy to help you, you can reach me directly on anuj@sureclaim.in


Anuj Jindal

Co-founder

SureClaim

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