Health Insurance Works only Under These Conditions

The health care costs are rising steadily, and not everyone can afford to get the best medical care out of their own pockets. That’s the reason health policies are in demand, and more and more people are investing in them. However, just buying a mediclaim policy is no guarantee that at the time of need, it will come to your rescue. There are various instances where claims are rejected and not just because insurance companies want to deny the claims, but for certain lapses or mistakes on the insured’s end. Health plans are for your benefits as much as they got to make sense for an insurance company as well.

Let’s see the situations where your health claims will be entertained:

1) If you have updated any and every change in your health condition after buying the health policy, it will help you in the case of hospitalization during the term of the plan. The insurance company will know it beforehand about the increasing risks with you and can act accordingly.

2) The form that you fill while applying for the policy is a detailed one and requires you to furnish all possible information about you, your lifestyle, drinking/smoking habits, etc. If you have filled that information correctly, it will give fewer reasons for insurers to reject your claim. Being totally honest with the insurance company is a major requisite to get your health insurance claims approved.

3) The policy documents that we receive after buying the policy have terms and conditions mentioned in detail. Many times we ignore reading them out of sheer laziness or because they are quite complicated and technical. However, that’s where the secret lies. Sometimes we only read that the health policy covers pre-existing diseases, but we don’t read the detail wherein a pre-specified period is mentioned about the date from when this clause will be applicable. Knowing this information can help us to plan our health expenses accordingly and get our claims approved.

4) Planning in advance about renewing the health plans is extremely important. Never allow the policy to lapse because the benefits immediately cease to exist in that event. Unfortunately, if you’re hospitalised exactly during that time, you will not get any medical cover and the entire cost of health care will have to be borne by you from your own pocket.

5) Always mention your income correctly, so that insurance companies can also calculate if you deserve the amount of coverage you’re seeking and whether you will be able to afford the premiums. As mentioned earlier, even if you have the best health insurance plan, incorrect information can lead to denial of claims on an immediate basis without them even looking into the other genuine facts of the file.

6) If you have more than one health insurance cover with two different health insurance providers, it should be clearly mentioned in the policy.

7) Sometimes we get the proposal form filled by our insurance agent and upon receiving the policy documents, we don’t check the details mentioned therein. If your name, age, profession or any other vital information is incorrectly mentioned just because of a careless mistake on your agent’s behalf, your claims can be denied. As soon as you receive the policy documents, go through them in detail and report any discrepancies with the insurer immediately for them to be rectified and updated.

8) Lastly, the only health claims that will be considered will be those that the insurance companies feel are genuine. Sometimes hospitals ask the patient to undergo unnecessary medical treatments to earn extra bucks. If the insurer believes, based on your overall medical history, that you don’t need it, it can deny you the coverage. In that case, the decision is yours whether to go ahead with the procedure or not.

To make your health policy the best health insurance plan for you, it is your responsibility as well to do your bit in terms of furnishing correct information and following the appropriate protocol as mentioned by the insurer.

Harjot Singh Narula

Harjot Narula is founder and CEO of ComparePolicy.com, an IRDAI approved insurance web aggregator focussed on selling online insurance for companies. Harjot has more than a decade of experience in software development and has also spent 5 years in US working for the mortgage and risk management industry.

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