Why health insurance claims get rejected
What
if you are not paid on time despite buying a policy? Here's what you should do
to avoid such a situation
You buy a health insurance policy to protect
yourself from unforeseen contingencies. It protects your savings accumulated
over many years of hard work. But what if your claim gets rejected? Things such
as late renewals or missing documents can trouble you at the time of applying
for a claim and, consequently, substantial medical debt. Some of the common
mistakes to avoid:
Pre-existing illnesses
·
Pre-existing illnesses
are not covered from day one.
·
The regulator has
prescribed the maximum waiting period of four years for pre-existing illnesses.
·
After four years,
insurers are bound to cover all pre-existing illnesses.
·
Companies may offer
policies that have shorter waiting period.
·
Diseases such as
hypertension and cataract are covered after two years.
·
All diseases arising
out of earlier complications, such as obesity and hypertension, may be
considered as pre-existing illnesses.
·
To avoid last-minute
hassles it is always good to disclose all health-related problems at the time
of buying the policy.
Not covered in health plan
·
It is always good to
know what a policy excludes if it is difficult to understand what it includes.
·
Since every policy
comes with a set of exclusions, read them carefully.
·
Some illnesses are
covered only after a certain number of years.
·
Understand who all are
included in your family floater policy and group policy.
·
In case of a critical
illness plan check out the number of diseases covered.
·
You should know in
critical illness plans, the insured has to survive for at least 30 days after
the diagnosis.
·
A critical illness
policy doesn't cover pre-existing diseases and no claim can be made during the
first 60-90 days of the policy.
Gap in renewal
·
Always renew your
policy before the due date.
·
A new policy is
assigned if you do not renew the policy on time.
·
Claims filed during
the gap period are rejected.
·
Moreover, you are
denied the no-claim bonus for not renewing the policy on time.
·
For every no-claim
year, you get a bonus of 5 per cent up to a maximum of 50 per cent.
·
Apart from no-claim
bonus it affects your waiting period.
·
Waiting period starts
afresh if your policy lapses, unless you port the policy.
Policy wordings
·
Legal language of the
contract can be complicated.
·
Take time out and sit
with your agent to understand what it means.
·
Be aware of sub-limits
under different heads such as room and consultancy fees.
·
Make sure the patient
is in hospital for at least 24 hours before making a claim.
Incorrect information
·
Fill correct
information while buying a policy.
·
Any revelation about
health at a later stage could lead to claim rejection.
·
Even at the time of
applying for a claim incorrect information could lead to rejection of the
claim.
·
Spell the name of the
patient and doctor correctly, otherwise it leads to unnecessary hassles.
·
Give correct set of
papers, such as hospital bills, when applying for a claim.
For Any Query Feel Free to Call our Most
Wanted Insurance Guru
Gaurav Kansal - 9313368533
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