The recent stand-off between public sector health insurers and specialty, tertiary care hospitals has led to scores of policyholders being deprived of the cashless facility. While the insurers have agreed to extend the facility on a case-to-case basis and the hospitals have made their intention known to work towards reconciliation with health insurance companies, the issue is far from being resolved.

The deadlock, expectedly, has forced many policyholders to contemplate switching to private health insurers, who have so far managed to steer clear of the cashless controversy. While shifting from one insurer to another is not very difficult in the absence of a well-defined portability mechanism at the moment, it could mean losing out on any no-claim bonus accumulated with the earlier insurer and going through the waiting period - period during which the cover is not applicable - for pre-existing policies all over again. However, some companies do make concessions or waive the waiting period for certain illnesses.

THE PROCEDURE

If the policyholder intending to make the switch is under 45 years of age, chances are that he/she may not be asked to go for a medical check-up prior to the granting of the cover. However, most insurance companies insist on such tests for those who have crossed the 45-year mark. "If such policyholder has made a claim in the immediate past, say, that is related to a cardiac-related ailment, doctors will evaluate the proposal and take a call on whether health cover can be extended. Generally, the cover is not to be granted immediately in such cases," says Shreeraj Deshpande, head, health insurance, Future Generali. If the insured has undergone treatment for, say, typhoid or appendicitis - ailments of non-recurring nature - it may not be treated as a pre-existing illness. If the claim pertains to knee replacement, the new insurer could stipulate a waiting period of three years for the same in the new policy.

THE WAITING PERIOD

"Typically, the 4-year waiting period for pre-existing illness is applicable even to rollover cases. However, what is considered as a pre-exiting illness will depend on the nature of ailment," says Mr Deshpande. Waiting period for conditions like cataract or hysterectomy could range from 1 year to 3 years and when an insured shifts his/her policy from one insurer to the other, continuity for such waiting period is granted, considering the period the person has been covered in the earlier policy.

For instance, in the case of cataract, if the waiting period is two years and the individual was covered under an individual health policy for the same sum insured, there would be no waiting period applicable when he/she shifts to the new insurer for cataract. If s/he was covered for one year in the earlier policy, then the waiting period would be only one year with the new insurer. Again, the terms and conditions could vary as per the insurer's policy, necessitating thorough scrutiny of such clauses while deciding on making the switch.

Source: The Economic Times