Get <strong>₹5 Lac</strong> Health Insurance starts <strong>@ ₹315/<span>month*</span></strong>
Get ₹5 Lac Health Insurance starts @ ₹315/month*
Get ₹5 Lac Health Insurance starts @ ₹315/month*
250+ Plans 18 Insurance Companies
₹ 5 Lakh Coverage @ ₹ 10/day
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Can Health Insurance Claims Be Denied?

Health insurance is the need of the hour. Developments in medicine have increased the life expectancy of an average human. Coupled with it, the fast-paced lifestyle of modern generation has increased the incidence rate of ailments and diseases.

If we add the rising medical costs to this equation, the result only states the obvious – disaster! There is only one hope of battling out the highly probable medical costs that would befall us and that hope is a health insurance policy.

Perhaps, people have imagined the aftermath of a medical complication and that is why awareness of a health insurance policy is very high. The benefits of from a health insurance claim should compensate the substantial hospital bills accrued in the event of a medical emergency and as such becomes the lifeline of many individuals.

 

All of us invest in a good health insurance plan thinking it to compensate us whenever any claim falls. Is this thinking correct?

It may sound like bursting your bubble, but, your health insurance claim might be denied. Though the insurance company strives to fulfill the claims raised, there are certain instances which may result in a denial of claim settlement.

Reasons For Denial of Health Insurance Claim Settlement:

Misrepresentation or non-disclosure of material facts:

Though we blame the insurer if the health insurance claim is denied, do we ever blame ourselves? A health insurance policy is issued on the understanding that the proposer has stated all his required details truthfully and correctly in the proposal form. This is in compliance to the Principle of Utmost Good Faith which is the basis of all insurance contracts. Based on your stated facts, underwriting is done by which the insurer evaluates the risk you present. If you hide important information or lie about any medical condition you suffer from, you are in a diabolical position. In case of a claim, the insurer determines the cause of the claim and if it is discovered that the claim arose because you hid or lied about an important fact, the company has the authority to reject your claim.

Incorrect health insurance claim procedure:

 The insurance provider prescribes certain steps which the policyholder is required to follow when making a claim. Informing the insurer of the emergency, seeking treatment in a recognized hospital, filling up the required claim form, attaching all the relevant bills and reports are some of the required things to do for making a claim. If your claim filing is improper or incorrect, your claim stands to be denied

Health insurance claims for permanent exclusions :

Every health insurance plan has an exclusion list, incidences which are excluded from the scope of coverage. These are the permanent exclusions and any claim made in respect of these excluded instances would be denied.

Health insurance claims for temporary exclusions:

Pre-existing ailments have a waiting period and there are other ailments which are covered only after a prescribed waiting period. Claims raised for such exclusions which have a waiting period during the waiting period would be denied

Claims on lapsed policies:

If you delay in paying the premium beyond the due date, the policy will lapse. A lapsed policy pays no claim so, even if it has been 2 or 4 days since a lapse, your claim would be denied.

How can you avoid health Claim Rejection?

Full disclosure

Yes, stating every personal detail asked, even if it is unfavorable is in your interests. It may increase your premium outgo if you have any existing ailment, but you would be ensured of your claims to be honored.

Following the claim procedure 

After you buy the plan, you should be fully conversant in the steps to be followed for raising a valid claim. Seek the help of your broker if needed because the broker can guide you properly.

Renew your plan every year 

 Though you might not face a claim as soon as you buy a health plan, someday you would. When disaster strikes, you need a valid plan to pay the related expenses. You should, thus, renew your plan every year to ensure a continued coverage.

So, now you know why your claim can be rejected and how you can avoid it. Be aware and follow the guidelines to ensure that your health insurance claims get honored.

673,165 Confirmed Cases in India*
11,812,443 Confirmed Cases worldwide*
528,465 Confirmed deaths worldwide*
Search
Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
Sign up for newsletter
Sign up our newsletter and get email about health plans.

You May Also Want to Know About

Best Health Insurance Plans in India 2020

Best Health Insurance Plans in India 2020

Health insurance is amongst the most intricate insurance products, as it comes with numerous riders and benefits, and hence, there are so many variants to it. The insurance marketplace nationwide is quite competitive. You must consider comparing th...
Best Health Insurance Companies in India

Best Health Insurance Companies in India

Every year, a list of top health insurance companies in India is declared which helps in taking the right insurance decision. There are few important features that help it to rate the insurance companies, such as their performances, Incurred Claim ...
Top Maternity Insurance Plans

Top Maternity Insurance Plans

Maternity or pregnancy is an important phase of life, and one needs to prepare in advance to embrace parenthood. Though rearing a child is an expensive affair and may require good financial backup to meet the requirements of a growing baby. From ho...
Health Insurance Companies in India

Health Insurance Companies in India

There are lots of options as far as health insurance companies are concerned as both public as well as private health insurance providers are offering health insurance coverage in India. Every health insurance company offers different health insura...
Top Family Health Insurance Policies in India 2020

Top Family Health Insurance Policies in India 2020

From the air we breathe to the food we eat; everything is intentionally or unintentionally subjected to adulteration. Due to this, the disease rate in India is rising drastically. Naturally, more and more people are visiting hospitals frequently. A...