Your health claim can be rejected for these reasons!

Considering the high cost of medical treatment, health insurance is essential. It prevents your pockets from being emptied by hospital expenses. If 2-3 family members fall prey to a normal viral or dengue, the hospital bill can easily amount to 2-3 lakh rupees. In case of heart surgery or kidney transplant, the expense can reach 10 to 15 lakh rupees. Without health insurance, getting into debt is almost certain. Many times, even though you have health insurance, you are unable to benefit from it because the insurance company refuses to pay the claim. As a policyholder, you should be aware of the reasons why a health insurance claim can be rejected.

Documentation:

A major reason behind the rejection of claims is paperwork and documentation. In fact, when making a health insurance claim, certain paperwork, documentation, and specific guidelines need to be followed. Any mistake in submitting paperwork and documents can lead to the rejection of the claim. Therefore, fill in all the necessary forms correctly and submit all the documents requested by the insurance company. Delay in submitting documents or missing any document can lead to the claim being rejected.

Remember the deadline for submitting claims. The insurance company may not even consider claims submitted late. Every insurance policy has a deadline for claims, which can be between 14 to 30 days after discharge from the hospital. This depends on the insurance company and the terms of the policy.

Pre-existing diseases:

Pre-Existing Disease is an important term in health insurance. Almost all health insurance policies have a waiting period for Pre-Existing Diseases, meaning diseases that were present before taking the policy. During the waiting period, the expense incurred for the treatment of these diseases is not covered. If you have a pre-existing disease and need treatment during the waiting period, your claim may be rejected. The waiting period for Pre-Existing Diseases is usually 1 to 4 years, depending on the policy terms and the insurance company.

Similarly, there is a waiting period for serious and certain specific diseases. Additionally, when you take a new policy, there is a waiting period of 30 days, during which claims other than accidents are not covered. When purchasing a health policy, honestly inform the insurance company about any pre-existing health conditions.

Policy Expiry:

Health insurance policies are usually valid for one year. If your policy has expired, it is of no use because it has lapsed. If you make a claim after the policy has expired, it will be rejected. Therefore, it is important to keep an eye on the validity of the policy and renew it on time.

Understanding exclusions in health insurance is also very important. In fact, health insurance policies exclude certain treatments or surgeries from coverage, such as cosmetic or plastic surgery, gender change treatment, injuries from adventure sports like rock climbing, motor racing, horse racing, gliding, scuba diving, treatment for addiction to alcohol or drugs, and expenses related to infertility. Most health policies do not include these things. If you make a claim related to these treatments, it will be rejected. To know which treatments are not covered, read the ‘exclusion clause’ in the policy document.

Full information:

When buying a health policy, the insurance company asks for important information like medical history, lifestyle, and bad habits like smoking or drinking. You should provide complete and accurate information to the insurance company. If the company finds out that you intentionally did not disclose this information when making an insurance claim, your claim can be rejected.

Health insurance is as important as being truthful to the insurance company about yourself. Often people wonder how much cover their health plan should have. In fact, there is no one thumb rule that applies to everyone. The size of the health cover depends on factors like your age, your and your family’s medical history, and the type of hospital you want to be treated in. In times of inflation, you should have a cover of at least 10 lakh rupees. Taking a health policy at a young age means paying a lower premium because the chances of falling ill are lower at a young age.