One of the most important aspects associated with taking up health insurance is the time when claims are filed. After all, is that not the very point of taking up health cover in the first place? However, reports from IRDA state that an increasing number of claims on medical health insurance are being repudiated, or not being honoured, by providers of health policy.
However, that does not give the full picture. While there may be an increasing number of health policies that may be repudiated, there are also a large number of policies that have been honoured. While technical glitches and not adhering to policies with regard to claims of health policy cover may be reasons for delays, the vast majority of reasons why health policy may be repudiated or annulled, have to do with hiding of health facts.
Medical Checkup: Most providers of health polies tend to make availability of insurance benefits contingent on the successful completion of medical checkup. This is more the case when people taking up health cover tend to be of and above a certain age group. The medical checkup involves checking of certain elementary and predetermined criteria with reference to pre-existing conditions, to be confirmed through approved diagnostic centres.
Repudiation of claims: Complications arise in honouring of health cover when there is enough reason or ground to repudiate the claims. One of the main reasons why such repudiation could occur is lack of honesty in terms of disclosure of pre-existing conditions or ailments on the part of the insured. While insurance benefits are for everyone, it is also standard regulation that the health policy not be misused for personal gains.
It is important to go through proper medical checkup and adhere to standards of disclosure of pre-existing conditions or ailments when people take up health polies. If it is found that certain health facts have not been shared or have been withheld, the policyholder may be deprived of insurance benefits, and the entire health insurance policy may get annulled.
Grievance Cell: It is not a one-way track after all, when it comes to health cover. While people who hide health facts away and do not disclose their health conditions may not get away with partial disclosure, it is also a fact that there is room for grievance redressal if there is repudiation of medical health insurance under insufficient grounds.
If your claim on health insurance has not been honoured, you could appeal to the regional insurance organisation, or the Chief Manager of the grievance cell of the organisation. Another option is to approach the office of the Insurance Ombudsman.
However, it is important that health facts be shared in their actual reality for insurance benefits to be accrued when they matter the most.