Policyholders should keep in mind several crucial points to effectively navigate their insurance claims journey. Failing to disclose details in the proposal form, adequately conveying policy details with your family or not understanding the claims process can result in the insurance policy not working for you when you need it.
1. Diligently declare medical conditions in the proposal form and not be casual about it. For instance, suppose a policyholder had a minor ailment like stomach ache, which he unawarely left out when inputting details in the proposal form. Later when he was diagnosed with stomach cancer, the insurance company investigated and found out that he had shared about a stomach ache with many of his friends and accused him of suppressing that information to reject the claim.
The proposal form is the cornerstone document and most important document of the entire insurance process and leaving it in the hands of insurance agents to be filled is a grave mistake.
2. Though policyholders are not contractually bound to inform their insurers about the onset of any diseases once they have purchased the policy, doing so will help them when making claims. This can be done via emails to their customer care ID or during policy renewals.
For instance, someone buys a claim for their father at 60 years old and then has a stomach ache at 64. If a stomach ache has been communicated upon onset, if he makes a claim when the father reaches 70 years, an insurer can easily understand when the onset happened, which will reduce investigations and make claim settlement smoother.
3. The necessity of educating immediate family members about the history of your diseases, is paramount. Inform them about all declarations or information communicated at the time of purchasing the policy. Otherwise, if the primary policyholder who bought the insurance is hospitalised and becomes unable to communicate, it could pose problems.
For instance, if the immediate relative unsure of the medical history poses some unassuming doubt about blood pressure, and the doctor who is bound to record it, records it in your case history, it can affect the claim settlement.
4. Do not entirely rely on cheap insurance plans provided by banks or your employers, as these are typically one-year plans. The employer is not contractually obligated to renew it and the plan is subject to change or cancellation or even can be dropped. Do not purchase comprehensive personal insurance policies and that too online to save money.
5. In view of the advancements in medical technology, choose policies with no limits on number of day-care procedures covered. As medical technology advances, more procedures, for instantly even angioplasty, have become a day care procedures, now allowing for same-day discharge from hospitals. Such changes can get you excluded if daycare procedures are not covered by your insurer and they are not willing to pay citing hospitalisation was less than 24 hours.
Health insurance typically covers only active treatment in hospitals, excluding admissions for tests or monitoring, and will not cover outpatient department (OPD) services.
6. All policyholders should be aware that under Section 45 of the Insurance Act, death benefits cannot be rejected in term insurance after three years of continuous renewal, under any circumstances. Being aware of such rules can help policyholders prevent unnecessary delays when insurance companies give reasons with no sense that they are investigating when they cannot reject claims under any circumstance. A moratorium cannot be rejected if a five-year renewal of policy is done, barring proven fraud.7. Cashless hospitalisation is not an emergency feature. It depends on how the hospital submits documents to the insurer and typically takes around one to six hours, and can even take a day. If you get admitted at midnight in a hospital, the cashless feature may not work immediately, because though the insurer’s helpline works 24x7, the hospital's insurer desk will close by evening.
