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Critical Illness And Normal Health Insurance Explained

Monday, August 24, 2015
By Bhaskar Jyoti Sarma

Bhaskar Jyoti Sarma is Managing Director & Chief Executive Officer, SBI General Insurance

Can I get a claim from my own company and spouse’ company in case of an exigency if we are covered under both the companies? Can I shift to other policy once the limit in one of the policy gets exhausted?
Anand Mathew, Bandra

Once you have exhausted the sum insured under one policy, you may opt to claim the balance amount from other policy, but it may require you to provide the certified copies of the original bills and the copy of actual disbursement by the 1st insurer, to the 2nd insurer. Companies may also choose to apply contribution clause, which means that the claim may be paid by each of the policies in the proportion of the respective Sum insured.

I want to buy a health insurance policy for myself. Does Health Insurance cover everything from accident, surgery, normal hospitalization, OPD and other medical tests/ medicines involved? .
Praveen Kumar, Marine Lines

There are various types of policies available in the market. Most of the health insurance policies cover inpatient hospitalisation and associated expenses due to both sickness and accident. Diagnostic tests which are conducted as a part of inpatient hospitalisation are always covered under the policy.

In case you are looking for annual diagnostic health check-ups, then you need to check if the same is being offered under the policy. Similarly, OPD coverage is also available in certain polices which is available separately.

I work for a pharmaceutical company in UK. Can NRI’s take health insurance? Can they travel to India for treatment and claim? What about emergency situations?
Samar Bhatt, Chembur

Most of the health insurance policies are available for residential Indians only, however some of them are extended to cover NRIs as well. But the coverage under all policies is restricted to treatment taken in India only. Some global policies are also available for worldwide coverage.

What is the difference between Critical illness insurance and normal health insurance?
Manoj Patil, Colaba

Normal health Insurance is a basic hospitalisation cover, where the insured is covered up to the specified sum insured for the expenses incurred on in-patient hospitalisation. Insured person is either reimbursed for the expenses incurred during hospitalisation or a cashless facility is extended to cover the expenses in such policies.

Critical illnesses are those diseases/ conditions / actual procedures that have a bigger impact on your life and lifestyle. In such policies, every critical illness is defined by conditions and on sufficing those conditions, a lumpsump amount is payable by the Insurance company to the Insured.

My father has had a heart ailment issue in the past for which I would like to purchase a critical illness policy. Will the new policy cover this ailment, what will be the premium and benefits of a critical illness policy?
Sameer Singh, Kandivali

Different policies cover different types of Critical illnesses; the exact nature of coverage has to be examined before deciding to buy a policy. In case of any pre- existing condition, it is important to disclose the same to the Insurance Company, in order to avail the best coverage without any hassles at the time of claim settlement.

Premium of the policy would depend on the Sum Insured and the age of the person and the coverage provided.

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