I need advice for my sister. She is physically challenged due to spinal muscular atrophy. This has slowed down her leg and hand movement to 25 per cent, but the rest of her activities are normal. Currently, she takes help of a wheelchair. She has a job and travels to office daily. She is not sure if the employer’s group insurance/hospitalisation plan will cover her medical/physiotherapy expenses. She wants to have a life/medical cover for herself from her income. Please help select a policy from the current offerings in the market.
Generally, employer group insurance policies cover treatment for existing ailments, commonly called ‘pre-existing diseases (PEDs)’. Though they provide only inpatient hospitalisation covers, some employers seek outpatient covers as well. It is advisable to check these aspects with the employer. A group health policy, without outpatient extension, does not pay routine physiotherapy charges, unless it is part of 30-day prior to or 60-day post hospitalisation. An individual policy generally covers PED after four years of insurance (few cover PED after two years of insurance). Usually, individual health policies cover inpatient hospitalisation expenses only. Specific product details are available on the websites of insurers. The terms and premium can be compared for taking a decision.
Does a car insurance policy cover people travelling in the car too? If I am hurt in an accident, will my health insurance come into effect?
In a car insurance policy, occupants are covered, and medical expenses can be considered as a third-party claim. If you are hurt in an accident, your health policy will cover the medical expenses. Since most health policies provide patient hospitalisation cover only, your policy may pick up expenses only if you are hospitalised for at least 24 hours. In case your health policy has outpatient cover, it can cover medical expenses for simple injuries that do not require hospitalisation.
I have two insurance policies on an asset. Can I claim expenses under both the policies?
You cannot claim the same expense under both the policies. Both insurers are likely to pay in proportion of their respective sum insured to the overall sum insured.
The writer is managing director, Royal Sundaram Alliance Insurance Company. Send your queries to yourmoney@bsmail.in