Not All Plans Have Pre-Existing Cover

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Not All Plans Have Pre-Existing Cover
Not All Plans Have Pre-Existing Cover
OLM Desk - 06 February 2024

Keshav Gulati, Delhi

I am 29 years old and had to stop working two years ago due to an accident. I got reimbursement for hospitalisation expenses from my company, but I was suggested six months of bed rest. It took more time than six months to recover, and I had to leave my job. During this period, I developed a nervous condition, and that’s why I cannot balance myself when standing. I have no health insurance at present. My father is a government teacher. Can he show me as a dependent and get the medical expenses reimbursed? Can I get a health insurance in this condition?

Based on certain pre-existing disease (PED) coverage terms and conditions of the health insurance policy, you can try applying with various health insurance companies, but ensure that you declare your condition with reports and doctors’ notes. Insurance companies may or may not accept the proposal with a PED waiting period or permanent exclusion. It depends on the insurer’s discretion.

Your father may check in his office for reimbursement of hospitalisation costs or medical expenses of the dependent son as it may be available based on rank and other conditions.

The Mental Healthcare Act, 2017, defines that every person with a mental illness is considered equal to a person with a physical illness when it comes to health insurance and healthcare in India.

As per the Insurance Regulatory and Development Authority of India (Irdai), if the insured was diagnosed with a disease or medical condition up to 48 months before buying the policy, it is termed as a PED. The regulatory authority has standard wording prescribed to avoid any confusion about the exclusions and inclusions to ensure that a claim does not get rejected.

Health insurance companies will now cover treatment for mental illness, stress, or psychological and neurodegenerative disorders, apart from other physical ailments. The PED condition, and whether it will cover only hospitalisation or OPD charges, will depend on and vary from company to company and the products. Insurance companies will have to cover mental disorders at par with physical ailments. It does not mean the insurer will have to cover pre-existing mental illness, but if they cover after the waiting period, they cannot deny the claim. If it is diagnosed after buying the policy, then also they cannot deny the claim.

If the illness qualifies for partial or complete disability, and if you can get a doctor’s certificate based on the illness/disability, your father can claim for dependent disabled immediate family members expenses up to Rs 1,25,000 under Section 80DD based on the category of disability proof you have obtained.

One can obtain these certificates, which is not easy due to bureaucracy, etc. But since your father is in a government job, he may get preference over others. You may check the article, ‘Disability Certification in Psychiatry’ published in the Indian Journal of Psychiatry to know the process for getting certification.

There have been different initiatives launched to support differently-abled people such as loan for business, reservation in jobs, etc.,  that you may check for employment.

Hina Shah, CFP®

Rajesh Kalra, Ludhiana

I retired from a private sector company in 2022. During my working years, the National Pension System (NPS) was not popular. So, I did not invest in it. I used the money I received from Employees’ Provident Fund (EPF) to buy an annuity of Rs 9,000 per month. I have Rs 2 lakh which I want to invest in mutual funds and stocks. What are my options?

Investing in stocks and mutual funds is recommended for a minimum of five years. It comes with upside and downside risks. One should be comfortable with short-term loss which can go up to losing 10 to 20 per cent or more of the capital. Based on your risk appetite and goal, you can start with hybrid mutual fund with a mix of 65 per cent equity and 35 per cent debt. It is tax-efficient too as it falls in the category of equity mutual funds.

Hina Shah, CFP®

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