At the time of buying a life insurance policy, we look at several factors like cost, the sum assured, exclusions, policy coverage and so on. Here is the general process and documents required for filing insurance claims under both the scenarios.
How to file a death claim?
When a person with a life insurance policy called a life assured – dies, a claim intimation should be sent to the insurance company as early as possible. The assignee or nominee under the policy can do this. Any close relative or the agent who handles the policy may also do the needful.
The claim intimation should contain information like the date, place and cause of death. The insurance agent has the duty to help the life assured’s family or assignee to deal with the insurance company to fulfill the formalities for a claim.
The insurance company will respond to this intimation and will ask for the following documents:
> Filled-up claim form (provided by the insurance company)
> Certificate of death
> Policy document
> Deeds of assignments/ re-assignments if any
> Legal evidence of title, if the policy is not assigned or nominated
> Form of discharge executed and witnessed
Other documents such as medical attendant's certificate, hospital certificate, employer's certificate, police inquest report, post mortem report etc could be called for, as applicable. The requirement of these documents depend on the cause of death.
How to file a maturity claim?
Where a life insurance policy is maturing, the insurance company will usually send intimation to the policyholder along with a discharge voucher at least two to three months in advance of the date of maturity giving details like the maturity amount payable.
The policyholder has to sign the discharge voucher, which is like a receipt, get his signature witnessed and send it back to the insurance company along with the original policy bond to enable it to make the payment.
If the policy has been assigned in favour of any other person or entity, like a housing loan company, the claim amount will be paid only to the assignee who will give the discharge.
How to file a death claim?
When a person with a life insurance policy called a life assured – dies, a claim intimation should be sent to the insurance company as early as possible. The assignee or nominee under the policy can do this. Any close relative or the agent who handles the policy may also do the needful.
The claim intimation should contain information like the date, place and cause of death. The insurance agent has the duty to help the life assured’s family or assignee to deal with the insurance company to fulfill the formalities for a claim.
The insurance company will respond to this intimation and will ask for the following documents:
> Filled-up claim form (provided by the insurance company)
> Certificate of death
> Policy document
> Deeds of assignments/ re-assignments if any
> Legal evidence of title, if the policy is not assigned or nominated
> Form of discharge executed and witnessed
Other documents such as medical attendant's certificate, hospital certificate, employer's certificate, police inquest report, post mortem report etc could be called for, as applicable. The requirement of these documents depend on the cause of death.
How to file a maturity claim?
Where a life insurance policy is maturing, the insurance company will usually send intimation to the policyholder along with a discharge voucher at least two to three months in advance of the date of maturity giving details like the maturity amount payable.
The policyholder has to sign the discharge voucher, which is like a receipt, get his signature witnessed and send it back to the insurance company along with the original policy bond to enable it to make the payment.
If the policy has been assigned in favour of any other person or entity, like a housing loan company, the claim amount will be paid only to the assignee who will give the discharge.
Throughout my school and college years, Bai lived with us, moving across cities, helping us grow, for all practical purposes a dear family member. As she grew older, Bai began imagining that people were attacking her. We could not understand what had happened, but she went back to her village and died a few years later, untreated for schizophrenia. Mental illnesses are prevalent, some consider it an epidemic, and this has only worsened during this pandemic.
The challenges in addressing mental illness are considerable: building patient, doctor awareness and treatment capacity. Insurance currently has a minor role in mental illness and we could do more.
The first issue is that the mentally ill find it difficult to buy health insurance, even in minor conditions. This leaves them uncovered even for physical illnesses. I have seen many proposals rejected for conditions such as stress and anxiety, and proposals for more serious mental conditions get turned down. So, most persons with mental health issues will not disclose their condition, exposing themselves to claim rejection later. Some families with mentally challenged children have health insurance because this was bought many years ago when the child’s health condition was not asked for. Today that would be difficult.
The second issue is that guidelines to insure persons with mental health issues are not explicit. In June, the regulator asked all insurers to upload underwriting approaches for mentally ill on their websites by 1 October. The thought being that such people or their guardians should know how insurers will treat their application. When I checked some days ago, only a handful had complied and the policies put up were not meaningful. For example, insurers said, “we treat physical and mental illnesses at par. Like physical illnesses, mental illnesses will be subjected to evaluation and basis the outcomes would either be accepted as standard or with additional premium and/or waiting periods or rejected basis the chronicity, severity and complications due to the disease or treatment, and “acceptance of proposals with declaration of any conditions falling under the mentioned categories would be as per underwriting guidelines of the product and pre-policy medical tests." This is difficult to decipher, unhelpful and appears to be a declaration to tick the regulatory box.
The third, more complex issue is to design products that cover the largely out-patient (OPD) and caregiver cost. Most insurances cover hospitalization costs, but these are relatively infrequent in mental illness. Treatment is mostly provided on OPD basis. Sessions are expensive as there are few specialised counsellors, psychologists or psychiatrists and sessions take a long time. A full treatment cycle can cost ₹10,000-20,000. Caregiver cost is high for more advanced conditions. Often such care is needed lifelong. I recall a panel discussion some years ago where a dignified gentleman in his 80s told me about his severely autistic daughter. He worried about who would look after her when he died and I had no answer. I do not expect insurance to solve all these problems but there have to be ways that we can chip in more.
Insurers could be more open in selling health insurance to persons with minor, manageable illnesses. They could develop products or add-ons specific to mental illness. Most importantly, insurers could consider building capacity for mental health issues and price this as a value-added service. Recently, we started a complimentary OPD service for employees working at our clients and a large number of people reach out every week. This can be done for mental health on a much larger scale. Insurers could partner with mental health institutions to create capacity. There are some institutions that offer free and high-quality counselling, and understand the issues and solutions deeply.
The challenges in addressing mental illness are considerable: building patient, doctor awareness and treatment capacity. Insurance currently has a minor role in mental illness and we could do more.
The first issue is that the mentally ill find it difficult to buy health insurance, even in minor conditions. This leaves them uncovered even for physical illnesses. I have seen many proposals rejected for conditions such as stress and anxiety, and proposals for more serious mental conditions get turned down. So, most persons with mental health issues will not disclose their condition, exposing themselves to claim rejection later. Some families with mentally challenged children have health insurance because this was bought many years ago when the child’s health condition was not asked for. Today that would be difficult.
The second issue is that guidelines to insure persons with mental health issues are not explicit. In June, the regulator asked all insurers to upload underwriting approaches for mentally ill on their websites by 1 October. The thought being that such people or their guardians should know how insurers will treat their application. When I checked some days ago, only a handful had complied and the policies put up were not meaningful. For example, insurers said, “we treat physical and mental illnesses at par. Like physical illnesses, mental illnesses will be subjected to evaluation and basis the outcomes would either be accepted as standard or with additional premium and/or waiting periods or rejected basis the chronicity, severity and complications due to the disease or treatment, and “acceptance of proposals with declaration of any conditions falling under the mentioned categories would be as per underwriting guidelines of the product and pre-policy medical tests." This is difficult to decipher, unhelpful and appears to be a declaration to tick the regulatory box.
The third, more complex issue is to design products that cover the largely out-patient (OPD) and caregiver cost. Most insurances cover hospitalization costs, but these are relatively infrequent in mental illness. Treatment is mostly provided on OPD basis. Sessions are expensive as there are few specialised counsellors, psychologists or psychiatrists and sessions take a long time. A full treatment cycle can cost ₹10,000-20,000. Caregiver cost is high for more advanced conditions. Often such care is needed lifelong. I recall a panel discussion some years ago where a dignified gentleman in his 80s told me about his severely autistic daughter. He worried about who would look after her when he died and I had no answer. I do not expect insurance to solve all these problems but there have to be ways that we can chip in more.
Insurers could be more open in selling health insurance to persons with minor, manageable illnesses. They could develop products or add-ons specific to mental illness. Most importantly, insurers could consider building capacity for mental health issues and price this as a value-added service. Recently, we started a complimentary OPD service for employees working at our clients and a large number of people reach out every week. This can be done for mental health on a much larger scale. Insurers could partner with mental health institutions to create capacity. There are some institutions that offer free and high-quality counselling, and understand the issues and solutions deeply.
Life insurance was always an important financial buy, but it has become imperative especially in the current times. Having said so, purchasing one is really a task, as there are too many types of life insurance policies in the market.
You might have been suggested about endowment plans and their maturity benefits, or about term plan and how they provide more coverage for a lesser premium. Experts say, people often get confused, and end up buying the wrong product. Hence, it is important to know about different kinds of life insurance policies and their benefits so that you can make an informed decision while getting an insurance policy. For instance, whole life insurance offers coverage till 100 years of age of the policyholder, an endowment policy provides the combined benefit of life insurance along with savings, whereas money-back insurance policies offer periodic return along with the benefit of life insurance cover. On the other hand, savings and investment insurance plans offer the policyholder an opportunity to save and gain long-term returns, while a retirement insurance policy helps to create a retirement corpus, ULIPs offers the benefit of investment along with life insurance, whereas term insurance provides full risk cover against any type of eventuality to the policyholder.
Life insurance in India can help investors achieve financial freedom. Having said that, one should choose their product carefully.” For instance, a risk-averse investor should look at traditional products like endowment plans, that provides the combined benefit of life insurance along with savings. Whereas, a money-back plan can help a family for long-term or even short-term financial goals, as they offer periodic returns. However, investors who are investing in the long term and can take some amount of market risk, they can look at unit-linked insurance plans (ULIPs).
Additionally, for retirement one can look at annuities, whole life, or retirement plans, that will helps the policyholder to create a retirement corpus. Goyal says, “In short life insurance has multiple products for every life stage of an individual which can not only give the insurance protection but even the investments return.” Experts say, investors should keep in mind, to have discipline in their investments, if they remove money or don’t pay the insurance premiums the investment portfolio can have a negative impact.
You might have been suggested about endowment plans and their maturity benefits, or about term plan and how they provide more coverage for a lesser premium. Experts say, people often get confused, and end up buying the wrong product. Hence, it is important to know about different kinds of life insurance policies and their benefits so that you can make an informed decision while getting an insurance policy. For instance, whole life insurance offers coverage till 100 years of age of the policyholder, an endowment policy provides the combined benefit of life insurance along with savings, whereas money-back insurance policies offer periodic return along with the benefit of life insurance cover. On the other hand, savings and investment insurance plans offer the policyholder an opportunity to save and gain long-term returns, while a retirement insurance policy helps to create a retirement corpus, ULIPs offers the benefit of investment along with life insurance, whereas term insurance provides full risk cover against any type of eventuality to the policyholder.
Life insurance in India can help investors achieve financial freedom. Having said that, one should choose their product carefully.” For instance, a risk-averse investor should look at traditional products like endowment plans, that provides the combined benefit of life insurance along with savings. Whereas, a money-back plan can help a family for long-term or even short-term financial goals, as they offer periodic returns. However, investors who are investing in the long term and can take some amount of market risk, they can look at unit-linked insurance plans (ULIPs).
Additionally, for retirement one can look at annuities, whole life, or retirement plans, that will helps the policyholder to create a retirement corpus. Goyal says, “In short life insurance has multiple products for every life stage of an individual which can not only give the insurance protection but even the investments return.” Experts say, investors should keep in mind, to have discipline in their investments, if they remove money or don’t pay the insurance premiums the investment portfolio can have a negative impact.
One of the most important terms that one must understand while buying health insurance cover is the ‘waiting period’. Under a comprehensive health insurance policy, the waiting period refers to a fixed time duration in which the policyholder cannot avail certain benefits or coverage. All comprehensive health insurance plans come with different waiting periods for different coverages and the waiting period may differ from insurer to insurer. Only after the policyholder serves the waiting period, the coverage for that specific condition can be availed. Insurers generally apply a waiting period in order to avoid any kind of fraud and misuse of the health insurance for pre-existing ailments.
Types of waiting periods
When you buy a new comprehensive health insurance plan, it comes with a waiting period of 30 days that you need to serve before filing a claim for hospitalisation. This is known as the initial waiting period under a health insurance policy. However, there is no waiting period on hospitalisation due to an accident. Once the policy is issued to the customer, a claim for hospitalisation due to an accident can be filed from the very next day.
Apart from this, many insurers apply a two-year waiting period on certain specified illnesses such as cataract, hernia and knee replacement. As these are slow growing illnesses, these attract a waiting period across all insurance plans.
Pre-existing diseases
Additionally, most insurers apply a waiting period on the pre-existing diseases of the customer. While buying a comprehensive health plan, the insurer asks you if you have any pre-existing condition such as diabetes, hypertension, kidney-related ailments or any other disease for which you are on continued medication. For any such pre-existing condition, the insurer applies a waiting period ranging from 12 – 48 months from the date of policy issuance. This means the policyholder will be covered for hospitalisation due to any pre-existing ailment after serving a waiting period of 48 months.
Not all comprehensive health insurance plans offer you maternity benefits, and those that offer maternity benefits come along with a waiting period of 12-36 months. Then there are some illnesses that fall under the permanent exclusion category and an insurer will never provide you cover for those illnesses. Some of such illnesses include HIV, hepatitis B, cosmetic surgeries and malignant Neoplasms.
If you feel that the waiting period is too long for any particular ailment, you may choose to reduce the waiting period by paying a little extra from your pocket. For those who want to port their policy to a different insurer, if they have served the waiting period with the current insurer, no fresh waiting period will be applied. However, if the waiting period with the current insurer has not been completed, the remaining waiting period will be applied by the new insurer.
Types of waiting periods
When you buy a new comprehensive health insurance plan, it comes with a waiting period of 30 days that you need to serve before filing a claim for hospitalisation. This is known as the initial waiting period under a health insurance policy. However, there is no waiting period on hospitalisation due to an accident. Once the policy is issued to the customer, a claim for hospitalisation due to an accident can be filed from the very next day.
Apart from this, many insurers apply a two-year waiting period on certain specified illnesses such as cataract, hernia and knee replacement. As these are slow growing illnesses, these attract a waiting period across all insurance plans.
Pre-existing diseases
Additionally, most insurers apply a waiting period on the pre-existing diseases of the customer. While buying a comprehensive health plan, the insurer asks you if you have any pre-existing condition such as diabetes, hypertension, kidney-related ailments or any other disease for which you are on continued medication. For any such pre-existing condition, the insurer applies a waiting period ranging from 12 – 48 months from the date of policy issuance. This means the policyholder will be covered for hospitalisation due to any pre-existing ailment after serving a waiting period of 48 months.
Not all comprehensive health insurance plans offer you maternity benefits, and those that offer maternity benefits come along with a waiting period of 12-36 months. Then there are some illnesses that fall under the permanent exclusion category and an insurer will never provide you cover for those illnesses. Some of such illnesses include HIV, hepatitis B, cosmetic surgeries and malignant Neoplasms.
If you feel that the waiting period is too long for any particular ailment, you may choose to reduce the waiting period by paying a little extra from your pocket. For those who want to port their policy to a different insurer, if they have served the waiting period with the current insurer, no fresh waiting period will be applied. However, if the waiting period with the current insurer has not been completed, the remaining waiting period will be applied by the new insurer.