The ongoing pandemic has made us realize how crucial it is to have a health insurance policy as a backup plan. In a race to beat the soaring medical inflation and unpredictable medical emergencies, a health insurance policy is your best friend. However, selecting the right insurance cover can be confusing for a common man. But gathering some basic information about insurance policies like terminologies used, the implication of different clauses, how to optimize coverage can help you seek the right health insurance for you and your family.
Among these, when it comes to raising a claim, not all claims made by policyholders get sanctioned. Some of these claims can be rejected due to various reasons. This article enlists five such situations where a claim can be denied that you should be aware of. Let’s have a look –
- Improper information while buying or in claim form
The number one reason for the rejection of a claim is incorrect information. Starting with buying the policy, be it cashless health insurance or reimbursement cover, you must not provide false information concerning your health. This leads to wrong premium determination by your insurer and thereby leading to a rejection of your claim application. On similar lines, mentioning improper information in your claim form about the treatment sought or about the illness can be an outright reason for the rejection of your application.
- Overlooking terms concerning pre-existing diseases
Some insurance companies may require you to wait for a specific duration to cover already existing ailments faced by you. This duration varies among the insurance companies and is based on the type of pre-existing disease. So, if you happen to overlook these terms concerning pre-existing diseases, your claim application might get rejected. For that reason, it is advised to thoroughly read the policy document before buying the policy and stay informed of any such caveats in your insurance plan.
- Ignoring the exclusions of your policy
As every insurance policy has an exhaustive list of ailments and treatments covered under it, it also has some exclusions that expressly declare to not cover some treatments or events. These events are known as exclusions. At such juncture, if you make a claim for an event that is not covered by your insurance plan, the insurance company rejects the claim thereby requiring you to bear the entire cost of the treatment.
- Procrastinating filing a claim
Every health insurance plan, be it an individual policy, family floater or a critical illness insurance, mentions a specific duration within which claims need to be reported to the insurance company. These details are mentioned in the terms of the insurance contract and any delay in such period may lead to rejection of your claim. This depends on the insurance company on what is the duration within which the claim needs to be filed but it is advisable to report at the earliest to the insurance company.
- Exclusions regarding waiting period
Every health insurance policy has a specific duration as a waiting period. Here no claims are entertained by the insurance company till the completion of such waiting period. Some of these are generic waiting periods whereas some are case-specific coverage like maternity cover. Thus, any claim during such a waiting period as mentioned in your policy may get rejected.
Now that you know five of the most popular reasons for rejection of claims, avoid this rookie mistake and stay covered under your insurance plan. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.
