I have been taking Mediclaim from National Insurance Company since 2009. Due to some mistake, there was a break in Mediclaim Insurance for 11 days in the year 2012 fro 12/7/12 to 23/7/12. On receipt of the Health Card I did not check the dates etc as I was residing outside West Bengal due to job.

In 2014 I was diagnosed with Gall Bladder Stone. But on approaching the Insurance TPA, was declined and informed that I can claim only after 2 years of starting the Policy. It was only then that I checked my Papers and saw that it was valid from 23rd July instead of 12th July 2012. As per NIA Guidelines, All Policy Holders are given a Grace Period of 30 days and the policy benefit is continued without break. But I was not informed of the discontinuation and that I would not be eligible for any mediclaim for next 2 years when the same was renewed in 2012 after 11 days gap. Now the Insurance Company is blaming me that since I did not dispute the date on the card it means that I accepted the break in policy and have no right now claiming the Insurance. But since I myself was not aware of the Break and the Grace Period it was not my fault. Only when the card was dishonoured by the TPA that I came to know of the problem but on checking the NIA website of NIA, found that NIA extends Grace Period of 30 days. But why wasn’t I given the benefit and why wasn’t the policy continued as per provision given in the NIA. On checking with NIA officials was informed that It was entirely my fault and they did not respond to any querry related to Grace Period. I need help to claim my Bill through Mediclaim as I have been deligintly paying the premiums since 2009 and had no intention of discontinuing the same in 2012 but was a mistake of wrong issuance of cheque but at the same time the total premium was deposited within 7-8 days and the Healthcard mentioned the effective date as 23rd instead of 12th of July.

Rajat Sarkar
15 Bhuban Mohan Roy Road, Barisha, Kolkatal, West Bengal
Email: rajat_1965@yahoo.co.in / 27/10/2014 / 10:42 pm

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