@Ankush You should first approach the insurer’s Grievance …

Comments Closed

25 Responses

Stay in touch with the conversation, subscribe to the RSS feed for comments on this post.

1. Ajit says

   I have one query on one of the insurance policy ( new india assurance ) that has been provided by my corporate for covering myself and family dependents. As per policy – there is a co-pay applicable for all claims for parents.

   The sum insured amount for family was 5 Lacs. during the course of the year – i submitted various claims. For the last claim – the limit remaining was 3.13 Lacs. when i submitted a claim of 3.78 Lacs – to my suprise – they paid me 3.13 Lacs – 15% ..while i was expecting ( 3.78 – 15% of 3.78 ) subjected to a cap of limit remaining i.e 3.13 lacs.

   In other word if some body presents a claim of 7 lacs under this policy ..so he will get 5 lacs or ( 5 lacs – 15% of 5 lacs ).

   Could you please clarify. I felt strongly cheated by the insurance company as i understand hat co-pay means to share the claims amount but it should not reduced the sum insured.

   January 1, 2012, 11:54 pm
   • Pankaj Batra says

     @Ajit
     Most of the insurance companies follow the same practice in co-payment. Most of the employer provided policies have this catch.
     Therefore its always advisable to have your own medical insurance policy without any co-pay clause.

     January 2, 2012, 5:45 pm
   • Shalin Tejpal Jain says

     Most of the general insurance policies including health insurance policies have a “deductibles” clause like the one you have mentioned above… If not, the premium will be relatively higher and a few more T&Cs will be included. Insurers typically do these to avoid fraudulent claims…

     January 23, 2012, 11:32 am
2. Ajit says

   Thanks Pankaj for your reply..

   I have couple of comments and queries

   1) what is the standard industry practice for co-pay ?. I have googled it a lot but unable to find a industry standard document or IRDA guidelines on this. My perspective in co-pay is ..if i am already paying from my pocket an amount that should be considered as a co-pay. As an example – I have a policy cover of 5 lacs and i had a medical bill of 7 lacs. The 2 lacs extra for the bill anyway i am paying ..so why the insurance company is deducting another 15% co-pay from 5 lacs.

   2) In India – apart from corporate ..no company issues a policy for elder parents and even if they issue they have lots of clauses and condition which are practically impossible to met ( as an example – will not pay for existing diseases for 5 yrs etc …)

   January 2, 2012, 5:58 pm
   • Pankaj Batra says

     @Ajit
     1. Corporate policies don’t have any standard practice but are formed based on agreement between insurer and company. Most of the employers have their own policy with different conditions on co-pay, maternity, parent inclusion, child inclusion etc.
     You are right in saying that if you are already paying from your pocket, then co-pay should not come into picture after deducting max coverage amount. Unfortunately insurers are not that consumer friendly and they try to save their money by creating such rules.
     It would be better if you can get a copy of detailed policy document from your employer and study that. If same rule has been mentioned in it, you won’t have any option. If its not mentioned on policy, Try to raise your concerns with company HR and they may be able to settle it with insurance company. Or raise a complaint against insurer with IRDA.

     2. Because of high medical expenses at old age, no insurance company want to take risk with their profits. So they discourage senior citizen policies and if they good coverage, they charge huge amount for same. That’s the reason its said that one should take medical insurance as early as possible in life.

     January 2, 2012, 6:43 pm
3. Ankush says

   What’s about when we buy the insurance policy with monthly premium mode by ECS and insurance company did not present any ECS in our bank account and said after sometime that your policy has been lapsed and that policy bought from same bank where the ECS should be present by insurance company?

   January 10, 2012, 7:14 pm
   • Pankaj Batra says

     @Ankush
     You should first approach the insurer’s Grievance Redressal Mechanism as written in the insurance policy document. Check link of insurance companies here:http://www.igms.irda.gov.in/WebPages/ListofCompanies.aspx.
     In case the complaint is not fully attended to by the Insurer within 15 days of lodging it, you may use IRDA IGMS for escalating the complaint to IRDA. It can be done here: http://www.igms.irda.gov.in/

     January 10, 2012, 10:05 pm
4. Kedar says

   Sir,
   I have invested in ICICI Pru Pinnacle Super High NAV Fund B ULIP. 10yrs policy term / 50k yly premium for 5yrs / 2.5 Lac insurance cover. Is it worth to keep in force. Please advise.
   Thanks.
   Kedar

   January 13, 2012, 5:34 pm
   • Ajit says

     All ULIP Plans are very costly and expensive. Just ask the Agent who sold you the policy that if you gave you 100 rs as a premium – how much of that will be invested in the plans & how much will be the fund managment , Premium allocation charge , Mortality charges. In some cases the charges are as high as 25% for the first few years.

     My suggestion would be
     1) Buy a Pure Term plan. For 5000 rs a Year – You may get 15-20 lac of Insurance cover

     2) Invest in Mutual funds ( Debt/Equity ) or Recurring deposits or Corporate deposits for good return over a period of time

     January 14, 2012, 12:40 am
     • Pankaj Batra says

       @Kedar
       I agree to Ajit’s comments.
       ULIP are bad product both for investment or insurance.
       If you have already invested a huge amount in ULIP, don’t exit it and stay invested for long term. Stop all future premium payment. Pay only till 3-5 years (till which payment is mandatory).

       Get a term insurance for risk coverage and invest into mix of equity and debt based mutual funds for growth.

       January 15, 2012, 5:06 pm
   • Shalin Tejpal Jain says

     @ Kedar – When did you buy this ULIP plan? If it’s after Sep. 2010, there will be a minimum premium payment term of 5 years, otherwise 3 years. If you stop your premium payment prior to that, your policy will go in to lapsation stage and after 2 years, surrender value will be provided or paid premium will be shifted to insurer’s policy discontinuance fund.

     January 23, 2012, 11:40 am
5. Prabhu says

   Sir Can we buy Term insurance from same insurance company as the one I have already bougth ULIPs for different stages. endowment , child and pension.

   January 24, 2012, 7:01 pm
   • Pankaj Batra says

     @Prabhu
     Most of the insurance companies sell term plans as well apart from ULIPs, endowment, children and retirement plans.
     You should be able to buy term insurance from same company.

     January 24, 2012, 7:34 pm
   • Shalin Tejpal Jain says

     Yes… You can buy term plan from the same insurance co. If it’s a term plan, also check online term insurance plans. They’re relatively cheaper. Also ensure to compare the term plans of a few insurers before buying one.

     January 24, 2012, 7:54 pm
6. annapoorani says

   I have invested in SBI ULIP for 15 years paying a premium of 25k annually. The fund value as on date is equal to the investment value. would like to whether it is advisable to continue the policy or exit out

   February 2, 2012, 1:41 pm
   • Shalin Tejpal Jain says

     @ Annapoorani – ULIPs typically should be seen as a long-term investment. So, either you can hold on to your ULIP plan (based upon your planned financial needs) or ditch it to buy a term cover and a mutual fund. Also, consider the charges that are currently applicable under your plan, performance of your ULIP, sum assured, etc. and then decide upon your course of action.

     February 3, 2012, 4:42 pm
7. Aravind says

   Hi pankaj

   I want to know why some companies pay less for same premium and some other companies pays very high – for eg, child plan if we pay 20k the sum assured is 10lacs some other companies pay 25- 35lacs, can we trust these companies

   March 22, 2012, 5:57 pm
   • Pankaj Batra says

     @Aravind
     Each company have different operating margins, risk ratio, use different mortality charts etc, on basis of which premiums are computed.
     New companies may give more sum assured for less premium in order to attract more customers.

     March 22, 2012, 7:27 pm
     • Aravind says

       Dear Pankaj

       Thanks for the reply, people call me for investing in insurance, but i dont get the clarity in which plan to invest in, can u suggest, which insurance would be good for me and my family, i have invest in 2 insurance 1. Child plan 2. retirement plan. can suggest me good insurance plan.
       Thanks in advance
       Aravind S

       April 9, 2012, 10:13 am
       • Pankaj Batra says

         @Aravind
         Only insurance good for your family is Plain Term Life insurance. Any insurance plan mixed with investment is not that good.
         For investment purposes better invest into Equity mutual funds, PPF and NPS.

         April 9, 2012, 5:48 pm
8. Firoz Ahmed says

   Pankaj Sir,
   I want to share an important issue with this forum: One Mr. Omar Ali purchased a life insurance policy(Pol.No. 004482496 SA: 3.789Lacs) on 28-10-2010 from Birla Sunlife Insurance, Barpeta branch, Assam where he nominated his cousin Abdul Latif and died on 25-01-2011 leaving behind two small daughters with his poor wife Ms. Shajeda Begum. The policy was in force and the said company settled the death claim through the concerned branch and a cheque was issued on 31-03-2011 in the name of the nominee, Abdul Latif. Ms. Shajeda Begum handed over the policy bond and other supporting documents to the nominee for speedy settlement the claim and kept nothing with her. But the nominee became belligerent when he received and encashed the cheque saying that he neither knew about such policy nor did he encashed any such cheque i.e. he is refusing altogether about all this things. Ms. Shajeda Begum met the Branch Manager(BM) with an application u/s 4 of the RTI Act. and prayed for a proof in support of the death claim settlement but the BM didn’t receive the application saying that the branch is not authorised to receive such application and disclose any information ( off course he admitted verbally). Pls help by giving opinion and suggestion.

   April 7, 2012, 6:13 pm
   • Pankaj Batra says

     @Firoz
     You may file complaint with IRDA here: http://www.igms.irda.gov.in/

     April 9, 2012, 4:53 pm
9. ARVIND MUGAL says

   I have made a proposal with eagon religare to purchase online term insurance of 60 lakh on 11/06/12.My proposal no.is 512073029429.I have made online payment of premium towads this proposal on 11/07/2012.I have send cancel request to insurance company before my medical test doen due to non cooperation from insurance company.They do not handle my proposal propely.I want to know that after how many days i will get refund of my money?Is any amount will be deucted by insurance company? If insurance company do not pay me refund within stipulated period to whom & where should i complaint to getmy refund?

   July 18, 2012, 10:17 am
   • Pankaj Batra says

     @Arvind
     If medical tests were not done, insurance company should not deduct any charges from premium payment.
     In case payment is not done by insurance company within 30-45 days, you should complain with IRDA. Toll Free Number is 155255 and Email for complaints is [email protected]
     Check these links for more details:
     http://www.igms.irda.gov.in/
     http://www.irda.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo225&mid=14.2
     http://www.irda.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo226&mid=14.3

     July 18, 2012, 12:14 pm
     • ARVIND MUGAL says

       Thanks me for giving advice regarding my insurance proposal

       July 19, 2012, 1:08 pm