Common reasons for health insurance claim rejection

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Health insurance is to protect you and your family during health emergencies. It provides financial support by reimbursing hospital bills at the time of crisis. But what if your claim gets rejected? There are many reasons such as incomplete documents to a delay in policy renewal that can create hassle at the time of claim settlement. Here are a few common reasons, which you should know beforehand, that can lead to health insurance claim rejection.

Pre-existing illness

• If a person is suffering from an illness then an insurer can reject the claim under pre-existing illness clause • There is a maximum waiting period of 2-4 years for pre-existing illnesses • After the completion of the waiting period pre-existing illnesses get covered

Exclusions

• Read the fine print to know what all the policy excludes

• There are also time exclusions for diseases such as hypertension and cataract, which are covered after two years. • If you have bought a critical illness plan check out if the particular illness is covered under the policy • There is a survival clause in policies. For example, the insured has to survive for at least 30 days after the diagnosis under critical illness plans • One cannot make a claim during the first 60-90 days of the policy in case of a critical illness policy, as pre-existing illnesses are not covered

Lapsed policy

• Don’t let your policy lapse. Renew it before or on the due date • You will have to buy a new policy if not renewed on time • Continuity benefits are lost in case of shifting to a new policy • Waiting period starts afresh in the new policy • Claims filed during the grace period are rejected • No-claim bonus gets lost for not renewing on time

Medical disclosure

• Any medical facts not disclosed at the time of buying the policy can lead to claim rejection • Fill all the details in the form correctly • Submit a complete set of papers such as hospital bills, discharge slip, among others for smooth settlement of the claim