Suppose you are a victim of this air pollution and you never had any kind of respiratory problem before, will you be denied health insurance cover in case of hospitalisation?
Frankly speaking, as far as the health insurance is concerned, there is nothing very specific which is covered. It is in general a comprehensive health policy covering each and every hospitalization which is due to any illness. Right now, no cover is available in India which specifically covers anything which is related to the pollution related diseases. But it is always advisable when you are covered with a normal health policy to take a critical illness cover. It is a separate cover which is given by a normal insurance company.
This critical illness cover normally covers very specific respiratory illnesses that can be linked to air pollution. That is something which plays a very important role in what kind of insurance or health insurance you are choosing. But the way air pollution is going on today, it is important for every individual to take an additional policy of the critical illness cover which will take care of any critical illness which a human or individual will have, due to the air pollution.
But will you be denied health insurance coverage, assuming you already have a comprehensive health insurance plan and if anything happens to you which is triggered due to this air pollution, will you be denied the claim? Can that be a base for an insurance company to deny a claim?
No, that cannot be the basis of denying a claim by any insurance company because a normal illness is obviously covered by each and every insurance policy. Only, there can be an extra restriction only in a case where a critical illness happens and there is a waiting period. For every insurance policy, there is a waiting period of three years as far as the critical illness is concerned. So a critical illness, if it happens due to the air pollution or due to any other reason before three years, then most of the insurance policies do not cover it.
But in normal circumstances, any illness which happens which is not a critical illness, would be covered by any insurance, health insurance policy.
I want to understand the kind of difference in coverage that you might see if at all you go for a claim and you have maybe say a family floater, a group insurance and an individual health insurance policy. When you go out to claim under these policies, what could be the difference that you might witness?
Group mediclaims are generally taken by the companies which are taken for their employees where normally, a sum insured is very less for each employee depending on what is the kind of role it is there and kind of a designation it is there. So, it is advisable for every individual to take an individual health policy which can cover most of the medical expenses which has got a higher sum insured because what we have seen over the past years and a lot of times, a lot of things happened during the Covid that a lot of people who went into Covid were not properly sum insured covered. A major reason was that they were covered by the corporate policy which is called the group mediclaim.
So over a period of time, it is very advisable that even if you are covered by your company, it is good if you take an individual health policy which should be a minimum of Rs 10-15 lakh that covers your overall medical expenses.