Reader's corner: What do 'co-payment conditions' in insurance claims mean?

Readers' queries on general insurance answered

I am 22 with no health issues. I am planning to buy health insurance that has no co-payment or sub-limits. What is the minimum sum insured I will need to take if I don't want to compromise on these two conditions?

It’s a good decision to go for a policy without any co-pay and sub-limits. Depending on where you live (metro, tier-2, tier-3 cities, or semi-rural area), we would suggest a sum insured in the range of Rs 5 lakh to Rs 10 lakh (higher if you live in a metro or tier-2 town)

I had bought a Maruti Swift last year through a loan and had purchased motor insurance from the same bank that provided the loan. It has come for renewal. If I approach the insurer directly, will I save on commissions and get the policy at a cheaper rate?

If you approach the insurance company directly, there is a good chance that you will get the policy at a cheaper rate. Some companies offer better pricing for online policies. Such rates will vary from one company to another.

I was hospitalised and treated for jaundice recently. My insurer declined the claim and said that this was due to co-payment conditions. Can you please explain what this means? What should I do now?

In insurance, co-payment usually means that the policyholder has to pay a certain percentage of the admissible claim amount (for example, 10 per cent or 20 per cent). The percentage of the amount is as specified in the policy terms and conditions. To get clarity on the latter part of your query (claim declined), we advise you to talk or write to your insurer and get the precise reason for refusing the claim.

I have a Chevrolet Cruze. Since General Motors is no longer in India, I have not renewed my car insurance. I am not sure which garage will accept this car in case of breakdown. What should I do?

You should go for the motor package insurance policy with insurance declared value (IDV) according to the current market value of the vehicle. It will help you in getting protection for your car if it gets damaged.

I accidentally crashed my car into a tree to avoid a pothole. Will I be able to claim insurance?

A comprehensive private car package policy covers the loss to the vehicle by accidental external means. So if you hold a valid driving licence and were not driving under the influence of alcohol, you can definitely claim insurance for the damage to your car.

I have seen a few companies launching insurance covers for specific diseases like malaria, dengue and other vector-borne diseases. I am 39 and don’t have health insurance. Does it make sense to opt for one such cover?

We would suggest that you buy a comprehensive and complete health insurance policy cover instead of a disease-specific product. You may find the premium cheaper for it, but for getting a complete cover, you will end up buying multiple policies. The cumulative premium of such plans will be higher. Additionally, handling multiple policies is cumbersome.

I am a 29-year-old woman. I am planning to buy a health insurance plan with maternity benefits. These products usually come with a four-year waiting period. I am concerned that in case I get pregnant immediately after marriage and face any medical condition, would I get insurance benefit? 

Maternity benefit and medical conditions have been considered separately in insurance. Thus, irrespective of whether your maternity waiting period is completed or not, your medical condition would get covered as per the policy norms. However, if your medical condition is related to maternity then waiting period would be applied.