Take an additional health cover even if your employer covers you with a group mediclaim. In many cases, claims can be made under both the policies
WHILE spiralling healthcare costs have awakened people to the indispensability of health insurance, the concept of corporate group mediclaim has led to many employees avoiding buying a standalone health cover. A large number of organisations in the organised sector cover their employees as well as their immediate families under corporate mediclaim, resulting in independent health insurance slipping out of their priority list. However, financial planners and health insurers caution against adopting such a lax attitude towards the health of your family as well as your own.
A CASE FOR INDEPENDENT HEALTH COVER
The reasons are multi-fold. Your corporate medical cover is contingent upon you being employed with the organisation — the moment you decide to switch jobs or happen to face a lay-off, it will cease to exist. You may be entitled to the group health cover offered by your new employer, but it will not come into force during the transition period, leaving you exposed to the risk of having to foot your own bill, should any medical emergency arise then. A personal health cover ensures continuous coverage.
Besides, adds Sanjay Datta, head of health and accident of ICICI Lombard General Insurance: "Group mediclaim coverage is decided by the employer and is often inadequate in terms of coverage limits and does not cover the entire family." This apart, the prospect of having a critical illness with little or no earning capability also makes a very compelling case for buying personal health cover.
Health cover provided by the employer does not extend to post-retirement years — the period when you would need it the most, as ailments start taking their toll. This is also the age when individuals find it difficult to obtain a standalone cover at a reasonable premium, making buying health insurance at a younger age imperative.
MAKING A CLAIM UNDER TWO POLICIES
Many policyholders tend to assume that they can file a claim under any of the policies they have signed up for, which may not always be the case; whether the individual can make a choice to claim depends on the provisions made in the policies taken. Also, whether the individual can make a choice to claim, depends on the provisions made in the policies taken. "Typically, there is a declaration sought from the customer on the policies under which s/he is covered, and the total liability is shared by the insurers," informs Mr Datta.
The contribution clause in the policies states that claims can be made under both the policies, in the same ratio as the sum insured. For instance, if you are covered under a corporate policy with a sum insured of Rs 2 lakh, in addition to a personal cover of Rs 1 lakh and make a claim for Rs 1 lakh, the insurer servicing the former will contribute around Rs 66,000 while the balance will come from the other insurer. However, according to Pawan Bhalla, CEO of Raksha TPA, in India, policyholders are not legally bound to disclose the details of any existing policy or make a claim under both the policies. Hence, they can file a claim under any of the two policies they are covered under.
CLAIMS PROCEDURE
The swiftness with which a third party administrator (TPA) processes a claim plays a role in fulfilling the objective of buying health insurance. If your mediclaim policies are serviced by the same TPA, the process becomes simpler, as the documents need not be transferred from one TPA to the other. In cases where the TPAs are not common, a certificate needs to be obtained from one TPA mentioning the claim amount being settled and that original documents have been retained. The insured can submit the photocopies along with this certificate to the other TPA.
