Difference between continutiy of plan & continuity of cover

POSTED BY Mahesh ON May 14, 2012 7:40 pm COMMENTS (3)

Dear Manish,

I have been holding a Family Floater – bank group health policy bank group from a public health insurer for last 5 years. All throughout the policy has been renewed without any delays / breaks, however this FY (last June), there was a delay in renewing the plan due to some delay from our side and then from Bank’s side in getting the DD created and sent to the Insurance company. It took 16 days to clear this and renew and bank & insurance company said that there is no problem (though verbally) because of the delay.

Last month when I applied for a claim settlement, the TPA raised an exception saying that there is a break of 16 days and asked us to get a clarification from the Underwriting officer if the policy can be considered as continuous?

My question is even if there is a gap of premium beyond the allowed 15 days, can the insurance deny me the claim since the claim period is not during those 16 days when the delay occurred? Will the continuity of plan break due to delay in paying the premium? What I agree is that continuity of cover cannot be applied for these 16 days.

What are your views?

Regards,
Mahesh

3 replies on this article “Difference between continutiy of plan & continuity of cover”

  1. Mahesh says:

    Just an update folks, the insurance company heard to the request in person and agreed to settle the claims as the delay was due to multiple parties. Though it was quite a pain explaining the reasons, giving in writing and following up with multiple parties, Glad that it went through. The effort was worth it.

    Thanks for your guidance.

    1. Congratulations .. Glad to see your pursued your case and finally got it ! ..

  2. Dear Mahesh, the delay may affect your continuity & the related benefit if any say increased sum assured in the form of NCB but certainly not your basic claim. To me it seems that your TPA is merely using this renewal delay to prolong the claim process or creating hurdles.

    Contact your insurer for claim settlement.

    Thanks

    Ashal

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