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GENERAL INSURANCE: If room rent exceeds specified limit, co-pay will apply

Hence, it's always advisable to carefully go through and understand your policy document, so you are not caught unaware at the time of claim

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I recently underwent surgery and applied for reimbursement of the bill from my insurance company. My policy has a room rent cap. The room I choose was higher than the room rent my policy allows. But the hospital I was in clearly states in the bill that the doctors charges, operation theatre rates and other rates are fixed no matter what the room rent is. In this case my insurance company should pay me entire money, but they are saying they will deduct 33%. Is this correct? 
– Paras Khilachand

The admissibility of claim amount depends on your policy terms and conditions. Hence, it's always advisable to carefully go through and understand your policy document, so you are not caught unaware at the time of claim. In your case, the situation seems to be that, policy covers hospitalisation expenses up to certain pre-approved limits of room rent. Wherein, if the policy has specifically mentioned that other expenses are in accordance with the room rent and in case of room rent exceeding the specific limit, a co-pay would apply in percentage of the exceeding limit. This co-payment, however, won't apply on consumables/ medicines. Alternately, if the hospital in which you underwent the surgery has no differentiation of expenses basis on the room rent, you can take a letter from them to that extent and approach your insurance company for review of your claim.

I am going for USA for higher studies and have taken student travel insurance. But if I travel to another country will it be valid? Or will I have to take another insurance? For that should I buy it from a USA insurance company or can I buy from my current insurance company? 
– Siya Trivedi

Student travel insurance is generally issued for a year and is accepted throughout the world. Any travel exigency during the period of insurance gets covered under the same. Although, you need to be vigilant of the geographical coverage opted for insurance and the country of travel. If the geographical coverage opted for is worldwide including USA & Canada, travel to any country is covered barring the countries that stand on the decline list of the insurance company. In case the geographical coverage of insurance differs from the country of travel, you can always buy the cover from your current insurer for the short-term travel you may undertake to another country.

My home insurance is coming up for renewal. Will the sum assured change when I renew it assuming property value has gone up? If so how is it calculated? 
– Bhaskar Ramachandran

Sum Insured for home insurance is the cost of rebuilding from scratch excluding the cost of land. The cost of rebuilding may vary from year to year depending on the cost of material and labour. Considering the inflation, it is advisable to increase the Sum Insured accordingly. It is your responsibility to keep the sum insured adequate. Inadequate sum insured may lead to under insurance and would then affect you at the time claim.

There is no specific rule to arrive at the exact sum insured. The best possible thing is to keep track of the inflation, and accordingly revise the sum insured. In case you have done any new modifications to your home, consider those costs too while revising it. I would also recommend that you get a professional building valuation done, say once in 5 years, if not every year. Having said that, some insurance companies offer policies with auto escalation of sum insured, and it would be good to opt for such a provision. Alternatively, you can opt for the policies on Agreed Value Basis, being offered by most insurers. Under this, claim resulting in total loss of property is paid as per the amount agreed upon between you and the insurance company at the time of policy purchase, irrespective of market fluctuations in the actual value of that property.

The writer is MD & CEO, Bajaj Allianz General Insurance

Send your queries related to general insurance to personalfinance@dnaindia.net.

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