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Health Insurance 938 views April 15, 2021
Health insurance companies won’t contest claims once the premium is paid for a continuous period of 8 years, as per the Insurance Regulatory and Development Authority of India (IRDAI) guidelines. And as per the guidelines, this clause is incorporated only in indemnity- based health insurance plans. Indemnity-based health policies provide hospitalization coverage up to the total sum insured, and this type of health insurance plan can be purchased on an individual or family floater basis. Keep reading this post further to know how it will impact your claim settlement in health insurance.
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A moratorium period of 8 years would apply to the sum insured. As per the IRDAI guidelines on after completion of eight continuous years under the policy, no claim shall be contestable except those which are fraudulent and contain permanent exclusions as specified in the policy contract. Indemnity-based Health Insurance is subject to all limits, sub-limits, co-payments, deductibles as per the policy contract. Let’s know about them in detail –
Deductibles: Under this clause, the insurance company deducts a sum from the claim amount and pays the rest of it. Suppose your health insurance plan offers a sum insured of INR 5 Lakh, and the deductible is INR 2 Lakh. So if a risk arises and the cost of treatment is INR 3 Lakh, your insurer will cover only INR 1 Lakh, while you will have to pay the remaining amount.
Note – All indemnity policies don’t have a deductible clause, and the percentage of deductible may vary from company to company.
Co-payment: In a co-payment clause, a certain percentage of the claim amount will be borne by you, while the rest will be paid by the insurance company.
Note – Senior citizen health insurance policies have the co-payment clause. Also, insurance companies may provide you a discount offer on your premium payout if you voluntarily choose to co-pay.
An indemnity based health insurance plan provides you the following benefits –
If you file a claim under an indemnity-based health insurance plan, you should remember the following clauses –