When you have a Health Insurance policy, you don’t need to worry about medical bills if you are hospitalised. However, a rejection of your insurance claim could catch you off guard and could potentially drain your life savings.
In order to avoid being the unhappy victim of a claim rejection, you must attain a thorough understanding of your own policy’s term and conditions, and avoid making some of these mistakes.
Claims made for pre-existing illnesses during the waiting period
If you buy a health plan after the diagnosis of a condition, also referred to as a pre-existing illness, you will have to wait for a period ranging from one to four years before you are able to make a claim. If you avail of any treatment for this pre-existing illness during the waiting period and raise a claim, you could face rejection.
Additional Reading: Common mistakes to avoid while buying Health Insurance
Making a late claim
Every Health Insurance policy has a specific time frame within which a claim needs to be raised. In case of emergency hospitalisation, you are required to intimate your Health Insurance provider within 24 hours of your admission to avail benefits. For planned hospitalisation, such intimation is usually required to be made weeks in advance. If you do not follow the stipulated time-frame prescribed, your claim might get rejected.
Claim for expenses not covered by the plan
Every Health Insurance plan has a list of exclusions and if you make a claim for something which is explicitly not covered by your plan, your claim could get rejected. Some conditions which are excluded in almost all health plans include suicide or self-inflicted injury, alcohol and drug abuse, radioactive contamination, etc.
Your health plan has lapsed
If you have not continuously renewed your Health Insurance plan without a gap, you should not be surprised if your claim gets rejected. Your claim will be payable only if the policy is in-force, i.e. you have paid the stipulated premiums for the policy. If your policy has expired , you will face rejection.
Additional Reading: Health Insurance plans in 2016
If the details provided to the insurer are not correct
When you buy a policy, you are required to fill out a proposal form and submit it along with the premium. The law mandates that the proposal form should be filled out correctly and truly, as the company issues the policy based on the information provided in the proposal form. Incorrect information may lead to a claim rejection if the insurance company finds out about it.
All you need to do to minimise your chances of rejection is be well-versed with the terms and conditions associated with the policy you are purchasing and adhere to them.