Suprit has recently been diagnosed with a critical illness. He has a health insurance policy and intends to use it for medical emergencies. But, the TPA has refused to honor the cashless facility, stating that the illness could have been caused due to a pre-existing medical condition. He pays the entire medical bill from his pocket and feels cheated. What is wrong in this case? It is due to the non-disclosure of pre-existing medical conditions.
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You have to disclose the pre-existing medical conditions if any to the insurance company, at the time of availing health insurance. Based on the type and seriousness of the disease, the insurer has a waiting period. If you are suffering from thyroid or high BP or diabetes, you are asked to undergo certain medical tests, to assess the level of impact of the disease. Based on the medical reports, you may or may not be offered a health insurance policy.
If the insurer accepts the proposal, they may ask for a waiting period of 4 years. After 4 years, the hospitalization expenses related to the pre-disclosed disease may be claimed. Within this tenure, if the insured is diagnosed with some other disease, the medical expenses can be claimed, but the doctor has to certify that the disease has not been caused by a pre-existing condition.
There is a possibility that a pre-existing disease can cause another disease. The insurer must be informed on a pre-existing illness for a hassle-free health insurance claim.
Read the terms and conditions of the policy very carefully and also understand the inclusions and exclusions. How can you expect the insurer to process the claim for something not covered under the health insurance policy? Medical expenses for pre-existing diseases are not covered. Life-style illnesses are also not covered. Health insurance does not entertain alternative treatment systems like Naturopathy, Unani and Ayurveda. Childbirth and pregnancy are not covered by a majority of health insurance policies.
Health insurance does not cover cosmetic treatment like laser treatment, weight loss or weight gain programs, eye treatment and liposuction. It has a ceiling limit on the amount to be spent on room rent, consultation, transportation and so on.
The major inclusions are pre and post-hospitalization expenses, organ donor expenses, domiciliary treatments, daycare treatments and so on. While buying health insurance, spare some time to understand what is covered and not covered.
Just like car and life insurance policies, health insurance policies must be renewed on or before the due date to enjoy continuous coverage. It can be done offline and online. If you do not renew the policy, it’s invalid. Inactive or invalid policies are of no use.
Renew the plan well in time, for a hassle-free claim. While renewing the policy, check sum assured, the inclusions and the exclusions. Assess the present and future health insurance requirements for yourself and family. At the time of renewal, any new illnesses must be disclosed. Check the nominee details and update them if required.
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