Is my health policy a lemon?

I did not read the fine print when I bought the health insurance I freely admit thatYou know I know and insurance companies know that no one reads terms amp conditions even millennials with perfect vision Most people can manage a couple of Facebook posts at a time before tachycardia sets in This is true whether yoursquore buying a car a house or a health insurance policy But those TampCs are a minefield A clever salesman could bury a lot of bad news and cunning escape clauses in the fine printIf you have a problem with a policy itrsquos your problem Itrsquos called caveat emptor You bought it yoursquore responsible for ensuring its good quality and suitability before shelling out moneyI bought my health insurance in August 2022 from one of the few companies at that time with plans for Indians over 70 For coverage up to Rs 10 lakh I pay about Rs 1 lakh annually as premium In other words each year I pay about 10 per cent of my sum assured as a premium Never mindWhen the policy document arrived I learnt from the Benefits Summary that I was covered up to Rs 80000 for all hernias surgeries for benign prostate hypertrophy and surgical treatment of kidney stones and up to Rs 3 lakh for cerebrovascular disorders cancers other renal problems and broken bonesI practically felt immortalI made my first claim last month after two healthy noclaim years It started with some blood in the urine but the investigations could not identify the cause or the source More and more expensive tests revealed nothing My urologist decided to put me under general anaesthesia at Breach Candy Hospital and check out my plumbing with a catheter a camera and a light and do a biopsy while he was at it in case a cancer was creeping upAll was well there was no cancer I was immortal again But the insurance company rejected my claim of about Rs 27 lakh saying that they were among many conditions excluded for two yearsHuhI called a company representative The policy document only mentioned my two preexisting conditions as exclusions I told him No one told me anything else was excludedItrsquos all in the Terms and Conditions sir he replied Yoursquore supposed to have read thatHe was right the policy brochure lists 23 categories of conditions surgeries and treatments that would not be covered by the policy for 24 monthsmdashincluding arthritis osteoarthritis gout spinal disorders joint replacement surgery enlarged prostate cataracts fissures piles ulcers hernias all possible cancers cysts kidney stones pancreatitis and others And surgery of genitourinary systems which I underwent and could not claim reimbursement forThe 23 categories excluded in the policy brochure encompass at least 129 diseases including 63 cancers and 66 procedures from policy coverage for two yearsLet me be blunt though I bought my policy in 2022 I could effectively claim nothing till 2024 Because itrsquos all there in the TampC which no one reads the insurance companyrsquos corporate posterior is legally covered The first clause in the policy document that I signed reads I have read and understood the Terms and Conditions of the policy and confirm to abide by the sameI have a word for such moments HuhI also have questions How come the policyrsquos Benefits Summary did not even hint that there was a boatload of additional excluded diseases in the brochure I know why they know no one would buy their policy if they understood they could make no claim for two years Itrsquos in the insurance companyrsquos interest that no one read the brochure and understand exactly what is included and excludedTherersquos a word for people in my condition Swived Look it upMy narcotic is research How did the company come up with that exclusions listThe list of exclusions is issued by the Investment Regulation and Development Authority of India an independent regulatory body under the Ministry of Finance An insurer may include all or some of that list but he may not add to itNot that therersquos much he could addAll insurance companies include a similar 24month exclusions list The ethical ones ensure you know and understand it before selling you the policy The unethical ones wait for you to find out the hard way They understand that one way to confuse ordinary people is to swamp them with fine print and information Itrsquos not their fault if you donrsquot read itThe rationale for so many exclusions is that by withholding payouts for two years they stay profitable and can offer lower premiums But Irsquom paying 10 per cent of my sum assured as a premiummdashand still footing my own medical billsTherersquos something wrong with an insurance system that considers it equitable to collect premiums but offer nothing in return for two years Click the QR code below to share your thoughts and experiences on thisIf there are enough others with similar stories perhaps we can bring the monster to its kneesYou can reach C Y Gopinath at cygopigmailcomSend your feedback to mailbagmiddaycomThe views expressed in this column are the individualrsquos and donrsquot represent those of the paper