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Can I claim the expenses of a follow up surgery?

Dr Deepak Mendiratta
Health Insurance, Max Healthcare Institute Ltd, New Delhi

Q: I have taken a Mediclaim policy of United India Insurance Co. Ltd. last year. I had an attack of pancreatitis the following month. The reimbursement was not given as I was admitted a day before completion of one month from the date of taking the policy. I extended the policy for this year too. Now I need to undergo another surgery for post-operative complications caused by the first surgery. Can I claim the expenses now?

A:The claim to you was not paid earlier due to the 30 day exclusion clause. While now after the renewal of the policy and the time period between both the incidents, this episode would be treated as a fresh incident (normally 45 days after the last incident, any incident, even similar to the first, is treated as a fresh case/claim). The presumption here is that even the first incident of pancreatitis was not classified as a preexisting illness. Therefore, you should not face any problem in claiming for this from the insurance company.