Your Queries (Health Insurance): Some insurers have cap on expenses on certain medical procedures – The Financial Express

Clipped from:

This varies as per the product guidelines of the insurance firm

By Prasun Sikdar

I am 64 years and have an individual health insurance plan. I plan to undertake a cataract surgery. My insurer says it will pay a fixed amount which is half of the amount that the hospital will charge. What should I do?
—Ajit Kurup
This varies as per the product guidelines of the insurance firm. There are some who have a capping when it comes to procedures like cataract. There are some who apply a mandatory age-based co-pay at the age of 64 and there are some who honour the full claim without any co-pay. I would request you to refer to the terms and conditions document in your policy kit and understand the benefit better.

I, along with my spouse and two children, are holding a mediclaim policy. My 81-year-old father-in-law does not have any health cover. Can he be included in our policy?
—Shekhar Chatterjee
In case your policy is an individual policy with four members in it then your father-in-law can be added at renewals. In case it is a family floater, then you will have to purchase a separate policy for your father-in-law. Declare his pre-existing medical conditions while opting for this cover. He may be asked to undergo pre-policy medical check-up. Also check the applicable conditions like maximum entry age, co-pay, sub-limits.

I had a family health insurance floater policy about seven years ago. I went to Dubai and my family had a cover from the employer. I have lost my job and we are back in India. Can I revive the policy and get the benefits?
—Vijay Kumar
This is kind of difficult as the maximum grace period generally allowed for renewing a health insurance policy is 30 days. In all probabilities you will have to opt for a fresh cover.

What is co-pay in a health insurance and will it reduce the premium?
—K Rao
There are different kinds of co-pay such as mandatory co-pay basis entry age, voluntary co-pay, etc. The one which reduces premium is called voluntary co-pay where you agree to bear a per cent of the admissible claim and hence get the premium reduced as per the terms of the product. One takes a call on opting for voluntary co-pay, considering age, health status and possibility of claim etc.

The writer is MD & CEO, ManipalCigna Health Insurance. Send your queries to

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