Personal Finance

Insurance Uncovered

Rajalakshmi Nirmal | Updated on November 11, 2018 Published on November 11, 2018

 

I am a retired bank officer. I am a part of the medical group insurance policy with United India Insurance through my erstwhile employer. But the premium is paid by me.

The coverage provided is ₹4 lakh. For the first year, that is, 2016-17, the premium was ₹7,493.

For the next two years, it was increased to 16,025 and 16,443. For the current year (2018-19), the premium quoted is ₹28,792.

During the last three years, I have not claimed on the policy. I feel that the insurance company should have made proper calculations in the first year itself to avoid increasing the premium steeply in subsequent years. In view of the steep increase in premium, I do not find it worthwhile to continue in the scheme.

Do I have a case to demand refund of the premium paid so far as they have made the scheme not viable for me now, and I am forced to quit?

Can this matter be taken up with IRDA or Insurance ombudsman?

S Kalyanasundaram

Asking for refund of premium now may not work as you were covered for the period. But if you feel you were overcharged or the increase in premium was done without giving an advance intimation or explanation, you can approach the Grievance Redressal Officer in the insurer’s office.

Give a written complaint with supporting documents to the officer at the branch. It is possible that you crossed a milestone year (65 years age) and the premium jumped.

If your problem is not resolved within 15 days or you are unhappy with their resolution, you can approach the Grievance Redressal Cell of the Consumer Affairs Department of IRDAI through the Call Toll Free Number 155255 (or) 1800 4254 732 or send an e-mail to complaints@irda.gov.in

As it is not clear to us whether you are still part of the group policy or have moved to the retail policy with the same insurer, we can’t suggest porting of the policy.

Porting is possible only in retail policies.

But assuming you are in a retail policy, you can’t port now, as you are already in the middle of the year. Porting request has to be made at least 45 days before the expiry of the policy.

You can port to a new insurer in 2019-20 and you will have continuity benefits on the waiting period, though underwriting will be done afresh.

If you are in reasonably good health, you can easily get a regular health insurance cover.

With most insurers today, while the minimum age at entry is specified for buying health insurance, there is no bar for the maximum age. By regulation, health insurers have to give policy to first-time buyers at least till 65 years. No insurer can refuse renewal and they have to do it lifelong if the policyholder continues to pay premium.

The advantage of going with regular health insurance plans is that most of these policies may have no sub-limits or ‘co-pay’ requirements. ‘Co-pay’ is asking the policy holder to share a portion of the hospital bill.

If you go looking for senior citizen plans specifically, the premium may be lower, but these will come with mandatory co-pay requirement of 10-30 per cent. For pre-existing illnesses, the co-pay may be as high as 50 per cent.

Among regular health plans, Royal Sundaram’s Lifeline Supreme, Max Bupa’s Health Companion and Apollo Munich’s Optima Restore, do not have ‘co-pay’ requirements, and are options for you to consider. For a male of 65 years, the annual premium here will be ₹29,000-30,000.

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