Medical Insurance

Your uncle in Kharghar is admitted for a knee replacement. The hospital desk says the cashless approval is pending, and the insurer later rejects part of the bill because the policy has a waiting period for that condition. Who is right? A health insurance policy is a contract, but it is a contract about the most stressful moment of a family's life, written in small print by one side. This topic looks at what the law counts as health insurance, who regulates it, what principles govern claims, and where a policyholder can go when a claim is refused.

In two minutes

Medical insurance is a contract under which the insurer, on payment of premium, agrees to pay medical and health expenses or sickness benefits; it is regulated by the Insurance Act 1938 and the IRDA Act 1999, governed by utmost good faith, and disputes can be taken to consumer commissions.

The rest of this chapter

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