Many leading insurance companies have of late marketed Health Insurance Policies for those over 60 years of age, with endearing names given to these policies.

While the terms and conditions appear to be attractive it provides a wide latitude to the company to drastically reduce or even totally reject claims for re-imbursement. While the maximum payment permissible is very low, due to the age constraint, invariably the insurance companies even refuse to pay the maximum under various pretexts and the subtle interpretation of the provisions in the policy.

I obtained a Health Insurance Policy from a leading insurance company, the policy stipulated a maximum of Rs.40,000.00 for any one event and in a year. While I was hospitalized for a period over 3 weeks paying a hospital bill over Rs.350,000.00. I submitted a claim for re-imbursement of a sum of Rs.40,000.00 (Forty Thousand) the maximum permissible under the policy, the claim was supported. I was however, surprised when the company paid only Rs.28,000.00 disclaiming any further liability. The company refused to pay the balance under various excuses which were vague, consequently I feel deceived. While some insurance companies continue unabated to deceive, mislead prospective policy holders and avoid re-imbursing legitimate claims of those who have secured policies, there appears to be no effective control of these companies.

What safeguards or protection is there for policy holders against the subtle manipulation by insurance companies disclaiming and refusing legitimate claims for re-imbursement.
Ruben Fernando
Nawala