The Cost Of Cancer: How To Make Your Claim (4 of 5)

This article is the fourth of a series on financial advice for families who are dealing with cancer, written by our guest author and renowned financial planner, Lovaii Navlakhi. Cancer Awakens is very grateful to Lovaii for contributing so whole-heartedly to our site and to our readers.

Steps to redeeming your insurance policy

Even if you are among the few who have planned for contingencies, when cancer strikes, it can still be scary and leave you confused and vulnerable. Let’s say that you have medical insurance along with critical illness cover. How do you go about claiming your expenses and redeeming your policy? I recommend taking the following steps.

• Meet with your financial advisor (or if you don’t have one, speak to your insurance agent).
• Tell him (or her) about your illness in detail: the diagnosis, the prognosis, the when-and-where of prescribed treatments, implications on your work/ employment/ family life, etc. Please include more details rather than less, bearing in mind that he has probably dealt with these kinds of situations before. It is usually helpful to put it down in writing, via an email, before or after your meeting.
• Ask for a list of documents that he will need, including the number of copies and if any attestations are required … they often are.
• Ask him to take you through the forms to be filled out, line-by-line, so that you are absolutely clear about what you need to do.
• Ask him to spell out the exact step-by-step process and the typical time-lines involved in each step. Check carefully who is responsible for completing the process and who is responsible for the follow-up.
• The most important thing is to get a reasonable idea of when the payments can be expected … explain that you will have to plan on this basis.
• When you complete filling out the forms, attach all relevant documents and if necessary, include a cover letter which lists out the attachments.
• Follow up with him if the payment does not come on time; inform him if it has.

Medical Insurance Claim

While it is not possible to standardise claim processes (different insurance companies may have slightly different processes), here are some things to bear in mind.

• For a treatment which requires hospitalisation, the insurance company needs to be notified about the claim immediately and in any event at least 48 hours prior to the Insured Person’s admission to the hospital.
• For a treatment which requires emergency hospitalisation, the insurance company needs to be notified about the claim within 24 hours of the Insured Person’s admission to the hospital.
• In many cases, cashless service is available to the extent of your sum assured, directly to the network hospital. (This means the insurance company will pay the relevant amount directly to the hospital, assuming that all the required conditions are met.)

Medical Insurance: Supporting Documentation

Either you (the Insured Person) or someone claiming on your behalf is required to provide the insurance company with any documentation, medical records and information within 15 days of the Insured Person’s discharge from Hospitalisation or completion of treatment. The documentation will include the following:

• Claim form, duly completed and signed for on behalf of the Insured Person.
• Original Bills and any attachments like receipts or prescriptions in support.
• All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries.
• A detailed list of the individual medical services and treatments provided and a unit price for each.

Critical Illness Claim

In order to claim your critical illness cover, you will need to submit the following:

• Fully completed claim form along with your original policy document
• Original certificate from your doctor and notarised copies of your medical reports
• Once the insurance company verifies the documents, the applicable benefits will be paid to you.
• Once again, please stay in touch with your advisor (or agent) until the process is completed.

Please note that in most critical illness policies, the following claims are likely to be treated as invalid:

• Where the date of diagnosis falls within 180 days of policy issuance or reinstatement.
• Where death occurs within 30 days of the date of diagnosis
• Under 2 definitions for the same condition (for example, Alzheimer’s Disease or Loss of independent existence)
• Where the policy has lapsed on the date of diagnosis
• Where the waiting period for submission of claim documents is not met
• Where the specific critical illness not covered under the policy
• More than one claim in respect of any single critical illness
• Non-fulfillment of eligibility criteria of critical illnesses covered under the policy
• Where the total claim payout since policy inception already exceeds 100% of the Sum Assured.

If you follow these guidelines, we hope the claim process will be smooth and hassle-free… after all, you’re dealing with many other challenges and you don’t want to add this one too!

Reflection

• Making an insurance claim can be a very tedious, what can you do to be better prepared should a situation arise?
• What are the different things you need to do and people you have to contact in order to make a claim?

Author

Lovaii is a Certified Financial Planner and Managing Director of International Money Matters Pvt Ltd. He features regularly on NDTV’s “30 Minutes to Wealth”, CNBC Awaaz and UTV Bloomberg. He is a panelist on various websites like moneycontrol.com, myiris.com, investmentyogi.com, etc. He also writes regularly for Outlook Money and Economic Times. He is the author of “A Guide to Retirement Planning” published for Outlook Money in 2007. He can be contacted on lovaii@immpl.com. For more details, visit: www.immpl.com.

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