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 insurance 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 insurance policy.
However, that does
not give the full picture. While there may be an increasing number of
health insurance 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
insurance cover may be reasons for delays, the vast majority of
reasons why health insurance policy may be repudiated or annulled,
have to do with hiding of health facts.
Most providers of health insurance Policy 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
insurance 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.
Complications arise in honouring of health insurance 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 insurance 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 insurance policy. 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.
It is not a one-way track after all, when it comes to health
insurance 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.