Smart things to know about why health cover claims get rejected

Posted by: Girija Gadre, Arti Bhargava and Labdhi Mehta on Feb 27, 2017, 06.05 PM IST

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 4 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 expiry date after which it lapses. During this gap period, coverage is not be 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
Any wrong information given at the time of purchasing the policy if making a claim when discovered at a later stage could lead to claim rejection.

(The content on this page is courtesy Centre for Investment Education and Learning (CIEL). Contributions by Girija Gadre, Arti Bhargava and Labdhi Mehta.) This article appeared in Economic Times dated Feb 27, 2017, 06.05 PM IST