Denial of health insurance claim is something that most of you worry about. While we understand that this can be daunting, but the denial of health insurance claim can be avoided with a very simple trick.
The trick is to go through your policy document thoroughly, so that you are aware about health insurance coverage, inclusions, benefits, features, SI (Sum Insured) opted by you and the exclusions of your health insurance policy. Knowing these details about your policy is very important because it ensures that you have a smooth claim settlement process.
If you file a claim for a treatment that is not included in your policy (is an exclusion), your claim will be rejected straight away. And, we do not want this to happen to you. So, here're some of the general exclusions of your health insurance policy that you should know, so that you face no trouble while filing a health insurance claim.
- Pre-existing conditions : Pre-existing illnesses such as heart disease, kidney disease, diabetes, cancer and more are not covered immediately after the commencement of your health insurance policy. They have a certain waiting period and the coverage for the same starts after this waiting period gets over. The waiting period for the pre-existing illnesses differs for each insurance company and may vary from one year to three years.
- Alternative therapies : At Bajaj Allianz General Insurance, we provide coverage for Ayurvedic and Homeopathic hospitalization. But, other treatments such as naturopathy, acupuncture, magnetic therapy, acupressure etc. are not covered in health insurance plans.
- Cosmetic surgeries : Health insurance policies do not cover cosmetic surgeries (plastic surgeries), hair transplant unless the procedure is prescribed by a medical professional following some grave incident like deformation caused due to an accident or critical illness such as cancer.
- Dental surgeries : Health insurance policies cover only the accidental damage done to your natural teeth, subject to hospitalization. Any other type of dental procedure is usually excluded from health insurance plans.
- Self-inflicted injuries : If you seek treatment for any self-inflicted injury, it won't be covered by your health insurance policy. Also, injuries caused due to suicide attempts, which might leave the person in disabled/injured state will not be covered under any health insurance policy. Additionally, injuries caused during war are excluded from your policy.
- Other diseases and treatments : HIV-related treatments, congenial diseases, treatments for use of any substance such as drug & alcohol, treatment for de-addiction, any fertility related procedure, experimental treatments etc. are not covered under health insurance policies.
- Mandatory waiting period : Most of the health insurance policies do not cover you for a mandatory waiting period, which might span from one month to three months. However, accidental injuries are covered right from the commencement of your health insurance policy.
Primarily, it is advisable that you understand the various types of health insurance policies and their offerings. Furthermore, you can read our detailed brochure for each health insurance policy on our website, where you can know the specific exclusions and the generic exclusions as well. As we mentioned earlier, it is very important be aware of the exclusions of your health insurance policy, so that you do not face any problem when filing a claim.
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