pays for your hospital bills for diagnostics, surgery etc.
Insurance companies often try to withhold a customer’s Health Insurance Claim citing one or the other reason. These reasons could be legitimate or unreasonable. However, as a customer, you are not under any obligation to accept any decision that you feel is unjust and without reason. The following are areas that are clearly defined, which you can use to accept or reject a decision made by your insurer.
Health Policy claims can’t be refused without providing valid reasons. Genuine reasons for rejecting a policy claim could include providing incorrect details regarding age, profession, Pre-existing illnesses etc. or not submitting the claim form on time.
Though the insurance company has the right to decide your health insurance Premium amount, it can’t be done arbitrarily. The amount has to be legitimate and there are certain guidelines and rules to be followed for the same. First of all, the company has to submit to Insurance Regulatory and Development Authority (IRDA), the premium calculation details when they register a particular policy. They also have to display a Premium Details Chart on their website. This chart will show details of policy premiums based on factors such as age, claims history etc. If there are substantial difference premiums charged by two companies with the same kind of product, one of the companies is overcharging or providing many additional benefits compared to the other.
During the initial 15 days after you purchase a policy, you can return it and cancel the policy if you are not satisfied or have been misled. In such cases, the company is bound to return the premium after deducting any applicable fees and charges. It is mandatory to mention details such as the duration of the Free look period in the policy document. Also, the company cannot employ delaying tactics to approve your policy after the free look period. If the company does not take care of these guidelines, you can complain to IRDA.
Insurance company has to ensure timely processing of claims, mostly within a month of your submission of the claim forms along with original documents such as medical reports and hospital bills.
Policy renewal cannot be refused without providing valid reasons. Genuine reasons for rejecting a policy renewal could include crossing the Age Limit of the policy, providing incorrect details regarding age, profession, pre-existing illnesses etc. or not renewing the policy on time.
As a policyholder, you must know your rights when you purchase health insurance cover. Only awareness will enable you to make complete use of your health policy and get full benefits. If at any time you feel that you are being overcharged or being unfairly dealt with, you can compare similar policies and products from other companies to get a good idea. You must then approach IRDA to get justice if the other means have all failed.