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What happens to health insurance when the policyholder dies?

Team AckoJan 17, 2024

If the policyholder dies while the health insurance policy is still active, a death benefit clause comes into the picture. This death benefit clause can have different outcomes depending upon the type of a health plan. Through this article, we aim to clear the confusion regarding the death benefits of each type of policy. Read ahead to know more.

Contents

How to check the policy document for death benefits
Types of policies and examples of how death affects health insurance
Frequently asked questions

How to check the policy document for death benefits

To check the policy document for death benefits, you can read your health insurance policy document and see what happens to your coverage in case you are no longer around. A death benefit clause may also mean that the coverage can continue for the other family members. There could be other members listed under the plan that are qualified to receive health insurance benefits after the policyholder's death. They are generally qualified to get health insurance coverage based on their age and income.

For example, Mr. John and his immediate family members were covered under a Family Floater Health Plan. Unfortunately, he suffered a cardiac arrest and passed away. The policy's death benefit mentioned that other family members would continue to get health insurance coverage in case of Mr. John's death. The policy was helpful when his ageing mother was hospitalised after his passing.

A medical insurance policy mentions a clause that states — in case of an insured person’s death, policy benefits shall be paid to the beneficiary named in either the death certificate or the health insurance policy.

If you are worried about the financial well-being of your loved ones, then buying a Family Floater Plan can ensure that they have adequate insurance coverage in case of your absence.

Types of policies and examples of how death affects health insurance

Let’s understand how each type of health insurance policy deals with the policyholder’s death and what exactly happens to the coverage.

Individual health Insurance policy

The policyholder is entitled to the full amount of the sum insured in this type of health plan. They can claim for hospitalisation and other benefits like Day Care treatments, ambulance expenses, etc.

Death benefit

If the Individual health plan covers only one insured member (the policyholder), then the policy will cease to exist upon death. In this case, the family member can raise a claim if the policyholder suffers death during hospitalisation.

Under Individual medical insurance, a person can also name their spouse as the second insured member. The nominee will continue to receive insurance benefits upon the policyholder's death.

Example 1

Mr. Kedar, bought a health insurance policy where he was the sole insured member. He had appointed his wife, Mrs. Kedar as the nominee. Unfortunately, Kedar had a major accident and was hospitalised. He succumbed to the injuries 12 days after hospitalisation. Mrs. Kedar was eligible to get the claim for hospitalisation expenses as she was the nominee of Kedar's health plan.

If he had not appointed Mrs. Kedar as the nominee, she would not have directly received the claim amount. In such cases, the insurance company seeks a succession certificate from the court of law and pays the claim amount to the next of kin.

Example 2

Some health insurance plans offer coverage to two individuals under the same policy. For example, say Vivan and his wife, Tina were covered under health insurance with a sum insured of Rs. 5 lakhs. Sadly, Tina passed away during childbirth. In this case the health insurance policy will continue to cover Vivan up to the sum insured until the plan expires. He can then choose to buy a new plan to cover himself and the newborn. Tina's hospitalisation expenses for delivery will be paid to Vivan as per policy terms.

Family Floater health plan

Policyholder’s immediate family members are covered with health insurance benefits under a family health insurance plan. The sum insured is used by all members until exhaustion.

Death benefit

A Family Floater Health Insurance Policy continues offering coverage to the remaining insured members in case the primary insured member dies. If the person paying the premium suffers death, the next of kin must contact the insurance company and inform them about the death. The insurer will try to make an endorsement in the current policy and send the updated policy details.

Example

Ms. Taniya was covered under a Family Health Plan where her father was the primary insured member. He died of natural causes during the policy period. After a month, Taniya had a minor accident. Note that the health insurance policy is still active, but she was not aware of the coverage benefits.

The death benefit of the Family Floater Policy allowed continued health insurance coverage for Ms. Taniya, her two siblings and her mother. But, since she was unaware of her father's coverage, she paid for the cost of treatment out of her pocket.

Group Health Insurance Policy

An employer usually offers a Group health insurance policy to the employees. It is similar to a Family Floater Health Plan, but the employer has major control over the policy and its benefits. This is because the employer pays the premium for basic health insurance coverage.

Death benefit

If the employee suffers death, then the policy ceases to exist. The coverage cannot be offered to the dependants unless explicitly mentioned in the policy. If there is a death benefit clause in the policy, the next of kin may receive a lump sum.

In another situation where a covered family member dies, the policy will be endorsed, i.e. updated with the list of remaining dependants. Thus, the rest of the family members can continue to avail health insurance coverage.

Example

Mrs. Shruti worked for a multinational company, and health insurance for the family was one of the benefits of working with them. Unfortunately, she died in a road accident. The health insurance policy ended upon her death. The employer paid compensation to the family but could not continue to provide medical insurance benefits to them as there was no such clause in the policy.

Critical Illness Plan

This particular health insurance policy offers a lump sum payout to the insured member upon the diagnosis of a listed illness.

Death benefit

Usually, a Critical Illness plan does not offer a death benefit. In fact, the insured person must survive for a fixed number of days after diagnosis to be able to make a claim. The policy becomes void if the insured member suffers death during this window.

Example

Mr. Diwan purchased a Critical Illness Health Plan that included coverage for cancer. After around three months of buying the plan, he was diagnosed with the disease. The survival period under Mr. Diwan's health plan was 20 days, but unfortunately, he passed away 15 days after the diagnosis. The insurance company could not pay the death benefit to his family under the terms of the policy.

Senior Citizen Health Insurance

This type of health insurance plan is similar to an Individual Health Insurance Policy. However, the benefits are offered to a person above the age of 60 years.

Death benefit

The policy ceases to exist if the insured person suffers death.

Example

Mr. Ansari bought a Senior Citizen Health Plan for his widowed father. After a while, his father passed away due to old age. The insurance company paid the applicable treatment costs, ending the health plan; there was no death benefit as per the policy.

Note: Kindly refer to the policy wording of your health insurance plan to get an in-depth understanding of the coverages, benefits, and exclusions.

Takeaway

It is crucial to be informed about the death clause of the policy and inform your family about it. For example, under a Family Floater policy, the policyholder's death may not terminate the health insurance policy. It may continue as long as premiums are paid and the information given to your insurer is accurate. Another insured member can pay the premium after informing the insurer about the policyholder's unfortunate demise.

On the other hand, it is also incorrect to assume that health insurance coverage will continue as before, even after the policyholder's death. Thus, make an informed decision by weighing all possibilities while buying your health insurance coverage and creating a financial backup.

Frequently asked questions

Here is a list of common questions about death’s implications on a health insurance policy. You can get in touch with ACKO by sending an email at [email protected] in case of more questions.

Will my Family Floater health insurance policy's premium increase if I am no longer around?

If you are no longer around, the policy's premium may remain unchanged if the sum insured amount is not increased or decreased. Under a Family Floater health plan, the person paying the premium after your death can decide if they want to make changes to the policy and its benefits in case of the primary person’s death.

Is the policyholder's death certificate required to raise a health insurance claim?

Yes, the policyholder's death certificate is required to raise a health insurance claim. The next of kin or the beneficiary of the health insurance policy must produce the deceased policyholder's death certificate while claiming an Individual Health Insurance Plan. This document will also be necessary to continue availing of health insurance coverage (if applicable).

Does health insurance cover death?

Yes, a health insurance policy can cover death depending upon the terms and conditions of the plan. Such coverage is known as death benefit.

How to claim the cost of treatment for the deceased insured member?

To claim the cost of treatment for the deceased insured member, the next of kin must inform the insurer and produce a death certificate of the deceased. This is applicable to all types of health insurance plans. The insurance company must be informed about this event as soon as possible.

When to cancel Family Floater Health Insurance after death?

The unfortunate death of the insured may not terminate the coverage of a health insurance plan. Usually, under a Family Floater Plan, the coverage will extend as long as the demise of the insured is reported and the premium is paid regularly. Thus, you may have to take a call on whether you want to terminate a health plan or continue to use it. If you prefer to terminate it, we recommend that you do so after settling all the medical expenses incurred by the insured.

Will our family’s health insurance plan expire if one of our parents dies?

Usually, under a Family Floater Plan, the coverage will continue for the rest of the insured family members as long as the demise is reported and the premium is paid on time. So, check with your insurer if this is the case under your plan.

How long does health insurance last after death?

Health insurance can last up to the policy expiry date depending upon the terms and conditions of the plan. The other insured person listed in the plan must renew health insurance to continue receiving coverage.

How to claim health insurance after the death of a spouse?

In the unfortunate event of your spouse’s death, you may be able to settle their previously incurred medical expenses if they are covered under your health insurance policy. If you are not selected as a nominee, you may have to obtain a succession certificate from the court of law. Usually, if this certificate is issued and produced, the claim amount should be provided to the deceased’s next of kin.

Can we claim a health insurance refund if the policyholder suffers death?

Claiming a health insurance refund when the policyholder suffers death may depend upon the terms and conditions of the policy. For example, if you are a nominee, you might be allowed to claim a refund if the policyholder’s death occurred during the free-look-up period (if applicable).

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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