5 Ways To Avoid Rejection Of Your Health Insurance Claim

Health insurance helps policyholders financially by covering things like ambulance costs, hospitalisation costs, consultation costs, and medical expenses. It gives the insured person mental security and comfort.*

  1. Policy tenure: Most health insurance plans are time-limited agreements that must be renewed annually to remain in effect. Policyholders occasionally realise that their contract has ended after their claims are denied, which comes as a major shock to many. Please be aware that the insurance carrier is not responsible for paying the claim if the policy has expired. It is essential to maintain a close eye on policy renewals to make sure that coverage is complete in order to prevent such unpleasant occurrences. If you forget to renew your insurance, don’t worry; most insurers include a 15-day grace period during which you can do so without losing any benefits accumulated throughout the policy. However, the insurer may not consider any claims during the break-in time.*
  2. Not disclosing a pre-existing illness or other vital details: It is crucial to report any pre-existing problems or illnesses the insured may have, such as high blood pressure, heart disease, hypertension, etc. One must also report any prior major surgeries they may have had. At the time of insurance renewal, it’s crucial to identify any new medical issues that have arisen during the year.*
  3. Waiting period: In the context of health insurance, the waiting period refers to the period that the policy specifies before a claim cannot be made for the specified illness or condition. The waiting period begins when the policy is first issued and varies from insurer to insurer and condition to condition. Before the insurer is responsible for paying for the specified illness, the policyholder must fulfil the waiting period. To understand the length of the waiting periods against the stated ailments, the policyholder should carefully read the waiting period provision of the policy. A health insurance claim can be rejected if it is submitted during the waiting time.*
  4. Ailment coverage provided by the policy: All insurance plans clearly state the list of coverages and exclusions; if a policyholder submits a claim for a condition that is specifically listed as being excluded, the claim can be denied.*
  5. Time limit for filing a claim: The health insurance plans specify a window of time during which the policyholder must register a claim; typically, this window is between 60 and 90 days after the discharge date. It is a good idea to file the claim as soon as you are discharged. The insurer might accept the claim if there was a legitimate reason for the submission delay.*

It is also strongly advised that you choose a preferred network hospital for treatment to ensure a smooth claim settlement. In these hospitals, you can use health insurance benefits like cashless services, better rates, waivers on some fees, and advantages for other non-insurance products.*

A hassle-free claim settlement is made possible by the large network of hospitals that most insurers have empaneled with them and are dispersed around the nation. As long as a policyholder fills out the claim form completely and provides all necessary supporting documentation, they won’t have any significant problems with claim settlement, even if they submit a reimbursement claim. The policyholder can be confident that a claim can be paid as long as it is genuine and acceptable under the terms of the policy.*


Also, remember that sometimes, claims, particularly reimbursement claims, are denied because they lack or contain the wrong information. To avoid problems, the policyholder must submit all the original paperwork, including test results, doctor consultation letters, and other necessary documents, together with the properly completed claim form.*

* Standard T&C Apply

** Currently, there are 2 tax regimes in India – new and old. To get the tax benefit you desire, choose the correct one after consulting an expert. You can opt for a regime change during the next financial year.

# Visit the official website of IRDAI for further details.

## All savings are provided by the insurer as per the IRDAI-approved insurance plan. Standard T&C apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.