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News & Views

Wednesday, Mar 1, 2017

Smart things to know about why health cover claims get rejected

[Source : The Economic Times]

1. Pre-existing disease

Medical conditions that exist before obtaining the health insurance policy are not covered from day one. A waiting period of up to four years can apply for such conditions.

2. Policy exclusions

Some illnesses covered only after a few years. Standard exclusions are cost of spectacles, dental and cosmetic surgeries, expenses for diagnosis and treatment relating to pregnancy, etc.

3. Gap in renewal

The health insurance policy is renewable provided you pay the premium within 15 days of the expiry date after which it lapses. During this gap period, coverage is not available.

4. Policy coverage

The health insurance policy will mention sub-limits under heads such as room rent, consultancy fees, ambulance charges, etc., and amounts over which costs will not be covered.

5. Incorrect information

If it is discovered at a later stage, while making a claim, that wrong information was given at the time of purchasing the policy, it could lead to claim rejection.

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