Know Your Health Insurance Policy

Download Tax Saving Mutual Fund Application Forms

Invest In Tax Saving Mutual Funds Online

Buy Gold Mutual Funds

Leave a missed Call on

94 8300 8300

Know Your Health Policy

Claim-related grievances often corner the largest share when it comes to health insurance complaints lodged with the Insurance Regulatory and Development Authority (IRDA). In 2012-13, delay in settlement, claim rejection and partial claim settlement made up nearly 38% of complaints received by the insurance regulator. The reasons could vary from non-disclosure of pre-existing illnesses by the policyholder and different interpretation of policy wordings to wilful rejection by the insurer or the third party administrator.

Exclusions

In simple terms, this refers to expenses that the insurer will not pay for. Lack of understanding of what is not covered is one of the key causes for disputes. For instance, coverage of preexisting illness is often the bone of contention between the insurer and the policyholder. Most insurance companies cover pre-existing ailments only after a waiting period of four years.

Any ailment or condition that was diagnosed or treated within 48 months prior to the policy being purchased is considered to be a pre-existing disease. Such claims are not entertained if the policyholder was aware of the disease.

The dispute usually arises when there is no clarity on the date of inception of the disease or on the grounds that it was not disclosed by the policy-holder.

Going forward, Irda’s list of 199 items — explicitly indicating their admissibility or otherwise — released as part of standardisation norms could play a role in reducing the ambiguity.

Partial Settlement

Many policyholders’ grievances pertain to insurers reimbursing only a part of the hospitalisation expenses actually incurred. Insurers, on their part, point to policy wordings, which impose caps, termed sub-limits on certain expenses. For instance, many health insurers now restrict cataract surgery cost to . 24,000-25,000. If your expenses exceed this limit, you will have to pay for the balance out of your own pocket. Likewise, room rent payable by the insurer could be limited to 1% of the sum insured.

Remember, when you choose a hospital room, all the other charges, including doctor’s fees, are linked to it. A higher room rent would mean that other expenses would be proportionately higher. Therefore, do your homework while choosing the room in a hospital, wherever possible.

The insurer’s decision on partial settlement could also be based on the reasonability clause, which states that only those expenses that are ‘reasonably and necessarily’ incurred will be reimbursed.

 

 

 

For further information contact Prajna Capital on 94 8300 8300 by leaving a missed call

 

 

Leave a missed Call on 94 8300 8300

 

Leave your comment with mail ID and we will answer them

OR

You can write back to us at

PrajnaCapital [at] Gmail [dot] Com

 

---------------------------------------------

Invest Mutual Funds Online

Invest Any Mutual Fund Online

 

Download Mutual Fund Application Forms from all AMCs

Download Mutual Any Fund Application Forms

---------------------------------------------

 

Best Performing Mutual Funds

1. Largecap Funds             Invest Online
1. DSP BlackRock Top 100 Fund
2. ICICI Prudential Focused Blue Chip Fund
3. Franklin India Bluechip
4. ICICI Prudential Top 100 Fund

B. Large and Midcap Funds         Invest Online

1. ICICI Prudential Dynamic Plan
2. HDFC Top 200 Fund
3. UTI Dividend Yield Fund
4. Birla Sun Life Front Line Equity Fund
5. Franklin India Prima

C. Mid and SmallCap Funds          Invest Online

1. Reliance Equity Opportunities Fund
2. DSP BlackRock Small & Midcap Fund
3. Sundaram Select Midcap
4. IDFC Premier Equity Fund
5. Birla Sun Life Dividend Yield Plus
6. SBI Emerging Businesses Fund
7. HDFC Mid-Cap Opportunities Fund
8. ICICI Prudential Discovery Fund

D. Small and MicroCap Funds   Invest Online

1. DSP BlackRock MicroCap Fund

2.       Franklin India Smaller Companies

E. Sector Funds          Invest Online

1. Reliance Banking Fund
2. Reliance Banking Fund
3. ICICI Prudential Banking and Financial Services Fund

F. Tax Saver Mutual Funds      Invest Online

1. ICICI Prudential Tax Plan

2. HDFC Taxsaver

3. DSP BlackRock Tax Saver Fund
4. Reliance Tax Saver (ELSS) Fund

G. Gold Mutual Funds        Invest Online

1. Relaince Gold Savings Fund
2. ICICI Prudential Regular Gold Savings Fund
3. HDFC Gold Fund
4. Birla Sun Life Gold

H. International funds         Invest Online

1. Birla Sun Life International Equity Plan A

2. DSP BlackRock US Flexible Equity

3. FT India Feeder Franklin US Opportunities

4. ICICI Prudential US Bluechip Equity

5. Motilal Oswal MOSt Shares NASDAQ-100 ETF