The steep costs of medical care and our vulnerability due to COVID-19 and increasing lifestyle diseases imply that owning a health insurance policy is more critical now than ever. While it provides us with a sense of security and stability, it’s up to the policyholder that the claim is approved if and when they raise it. And you can ensure that with full disclosure and complete honesty while providing information when you buy health insurance and fill up the proposal form. Any discrepancy in your details or failing to declare pre-existing diseases will only lead to the company rejecting the payout.
Information That You Need to Disclose Honestly
When buying online health insurance or from an agent, the customer diligently checks factors such as sum insured, features, claim settlement ratio, cashless network hospital, etc. Similarly, the insurer considers various parameters to decide whether or not to provide you with the policy and calculates the premium amount depending on the risk profile. The aspects that health insurance companies consider include:
Policyholder’s Age
Since youngsters are usually in better health and safe from severe or chronic conditions, their premium amount is less than older proposers. Typically, the age group is 26-35 years, 36-40 years and so on, with the premium sum increasing by 30 to 60 per cent with each band.
Medical History
You need to be upfront about your medical history, including any procedures or surgeries you have undergone in the past or medication you were on. If you hide any of these from the health insurance provider to get better coverage, lower your premium or evade the waiting period, they may reject your health insurance claim when you submit it.
Habits and Lifestyle
Insurers will consider your lifestyle and habits such as smoking, consuming tobacco, drinking or any other addiction. Your premium changes depending on your habits and the quantity and frequency of consumption.
Pre-existing Conditions
Insurers have a team to investigate your claim, and the seamless nexus with medical institutions ensures they get all the correct information they need while approving a claim. So, they will examine your bills, prescriptions, case papers, medical procedures, and so on. It could make them reject your request if they discover a pre-existing condition. You will then end up footing the medical bill yourself. Beware, as agents often dissuade you from disclosing pre-existing conditions. No matter what, full disclosure is the right and sensible thing to do.
Family’s Medical History
Since many diseases are hereditary, the insurer would want to know about your family’s medical history as the likelihood of the policyholder suffering from the same increases. This will determine the amount of premium. So, you must mention it while applying for the policy.
Income
Your income plays a vital role in getting insurance, especially from the top players in the market. Someone with a full-time job will not default on premium payments, and a good pay package can ensure better coverage. Self-employed professionals needn’t worry as they can show their contracts with employers when they buy health insurance.
Occupation and Education
The policyholder’s job is also a factor since some occupations are more hazardous than others. Or, if someone has a desk job, they may suffer from lifestyle diseases due to their sedentary nature. Similarly, educated people may be more mindful of their habits as they know about the risks of a bad lifestyle.
Dos and Don’ts to Avoid Rejection of Claim
Whether a cashless health insurance or reimbursement, ensure to follow these pointers to prevent the insurer from rejecting your claim:
- Enter correct and factual information in the form.
- Keeping your needs and future risks in mind, buy adequate coverage.
- Dedicate time to understand the types of health insurance that will work for you and read the policy wordings, terms and conditions and all the nuances carefully.
- Find out everything about sub-limits and exclusions.
- Be clear about the waiting period, terms and conditions in critical illness and family floater health insurance plans.
- If the policy requires, get a medical checkup when you apply.
- Be completely honest and disclose your health-related information.
- Submit all the original proofs such as diagnosis, prescriptions, medical bills and so on when you file a claim.
- Pay your premium timely so that the policy doesn’t lapse.
- As medical expenses inflate, periodically increase the sum insured at the time of health insurance renewal.
- Disclose medical history in the previous year so that the insurer can decide to increase the sum insured.
Conclusion
Insurers trust you to be honest with them when you buy a policy. You need to be truthful about your information, medical history, lifestyle, and pre-existing diseases and submit original documents to prevent your claim from being rejected.
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