Government’s Arogyasri or private health insurance? Answers to your personal finance queries


Claiming medical insurance

Q. I am a retired employee of the Andhra Pradesh government. I am covered under the government’s Arogyasri programme. About a year ago, my wife underwent a hysterectomy which cost about ₹2 lakh. I was reimbursed only ₹35,000 as per norms. My wife and I had taken a private health insurance policy for ₹5 lakh. My question is whether I can claim from both Arogyasri and the private health insurance company schemes for the medical expenses incurred?

A. Arogyasri operates like a hospitalisation expenses indemnity policy, that is, expenses are reimbursed against bills and treatment is cashless if availed in a network hospital.

So, if you have an additional cover in the form of a hospitalisation policy from an insurance company, you will be able to make a claim under both as you have to submit bills. Arogyasri is a mass health insurance scheme for beneficiaries defined by their lower income, and has restrictions on claim amounts which has meant, in your experience, that all your expenses may not be forthcoming as claims.

So, while you can claim under Arogyasri where the expense is within its limits, you will have the option of claiming it from your personal policy in hospitalisations which cost above what Arogyasri allows.

Multiple policies, multiple claims

Q. Can one buy more than one term life insurance policy? If I have, say, two or more term life policies of different sums assured from the same or different insurers then, in the case of any disability or loss of life, will my dependent/nominee be paid the claim from any one of the policies or all of them? Is this also applicable to health insurance?

A. There is no bar on the number of term life policies one can purchase. When you buy a policy, you have the responsibility to disclose to the life insurance company details of other life policies you already have. Insurers take into account your income, future income potential and premium-paying capacity before issuing policies as there is a notional limit on the total amount of life insurance you can hold.

Once you do have two or more term life policies, all of them will pay the sum assured to your nominee should you pass away. If there is a disability clause or rider, then those claims will be paid to you as per policy terms.

A hospitalisation policy will not work like this. If you have two hospitalisation policies you cannot claim from both for the same incident. If you exhaust the sum assured under one and still have unpaid expenses, then you can claim under the other in sequence.

If all you want is more sum insured, then you can opt for a basic hospitalisation policy combined with a top-up or super top-up policy to enhance your cover. In this case you can exhaust your sum insured under the basic policy and proceed to claim under the top-up or super top-up policy according to terms and conditions. All these claims will be against bills, so the coverage will be supplementary and not overlapping.

Should you have a hospitalisation policy and a benefit policy like a critical illness or personal accident policy, then you can claim all expenses under the hospitalisation policy as per its terms and conditions and claim the full sum insured under the critical illness policy or personal accident policy provided the hospitalisation is due to a covered peril, namely one of the named critical illnesses or an accident.

(The writer is a business journalist specialising in insurance & corporate history)

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