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Read between lines

Women must read the fine print for clarity on features to ensure that they don’t lose out on insurance benefits.

Print Edition: March 19, 2009

A chain is only as strong as its weakest link. Likewise, an insurance cover is only as good as its exclusions. Women buy insurance to cover their risks, but policies often have fine-print exclusions that could lead to the rejection of their claims on technical grounds. A better understanding of what your insurance plan doesn’t cover will shield you from unpleasant surprises.

It helps to read the fine print carefully to ensure you get your money’s worth of insurance. If the jargon has you flummoxed, ask the agent for explanations. As a policyholder, you have the right to seek clarifications on the policy details.

Health cover and riders: Not all hospital bills qualify for reimbursement. The policy comes into effect only when the holder is hospitalised for at least 24 hours. Also, you cannot make a claim within 30 days of buying the policy. Most health insurance plans don’t cover diseases or injuries existing at the time of taking the cover.

Alternative therapies and medication, non-allopathic medication and cosmetic treatment are also not covered. Nowadays, some insurers do cover pre-existing diseases after a cooling-off period ranging from three to five years, but check the details before you buy the policy. In case of surgery assistance riders that provide immediate payment to cover surgical care, the policy may cover only specific surgeries.

Under the critical illness or dreaded diseases rider, you get a lump-sum payment if you contract any illness listed in the policy. This is part of the sum assured on the basic life policy. So if you make a claim, the sum assured and the benefits that hinge on it will be reduced proportionately, as will the future premiums. Other causes of claim denial are failure to seek medical advice, HIV infection, use of alcohol or drugs other than on medical advice, or due to congenital defects, pregnancy and childbirth.

Accidental death and disability rider: Some insurers offer riders that cover the risk of accidental death, permanent disability or dismemberment caused by an accident. However, the insurer will not pay if the injuries are selfinflicted or caused under the influence of liquor or drugs. Death or injuries due to insanity are also not covered. Also, suicides within a year of the issuance of the policy don’t qualify for death benefits.

What doesn’t count
If you do not meet the following three conditions, your insurance claim can be rejected:
  • If you fail to declare a pre-existing medical illness or congenital disease, or do not disclose your complete medical history while taking a health insurance policy or a critical illness rider.
  • If the surgery or the hospitalisation paid for under the cover was for cosmetic reasons.
  • If your policy is not in force, that is, if you haven’t paid the premiums. This means that the policy has expired and you cannot make any claims.

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