Insurance Uncovered

The following are some of the frequently asked questions on insurance compiled from Insurance Regulatory Development Authority of India’s website:

What is the maximum number of claims allowed over a year?

Any number of claims is allowed during the policy period unless there is a specific cap prescribed in any policy. However, the sum insured is the maximum limit under the policy.

What is ‘health check’ facility?

Some health insurance policies pay for specified expenses towards general health check-up once in a few years. Normally, this is available once in four years.

If my policy is not renewed in time before expiry date, will I be denied for renewal?

The policy will be renewable provided you pay the premium within 15 days (called as grace period) of expiry date. However, coverage would not be available for the period for which no premium is received by the insurance company. The policy will lapse if the premium is not paid within the grace period.

What is a TPA and what are its functions?

A TPA is a third party administrator. They are commercial entities duly licensed by IRDA. Their services are utilised by insurance companies, both life and non-life, to render, on their behalf, post-sales services to health insurance policyholders.

They provide services such as: Guiding the insured with regard to claims; issuing photo ID cards to insured persons; issuing pre-authorisation to hospitals to facilitate insured persons to get the cashless facility, and process and settle claims for reimbursement.

Source: IRDAI

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