Health Insurance Rules: Disclosing all past and existing medical conditions is crucial when purchasing health insurance. Failure to do so can lead to the denial of coverage for your entire family. This is a common reason for disputes between policyholders and insurance companies.
The Insurance Ombudsman’s annual report reveals that 95% of health insurance complaints relate to partial or complete claim rejections. If you fail to disclose a chronic illness under a family floater plan, your family’s claims might also be rejected.
What Happens if You Forget to Declare a Chronic Illness?
- Free-Look Period Adjustment:
Health insurance policies often come with a free-look period of 15–30 days after purchase. During this time, you can update the information provided in the policy or even cancel it. If you forgot to disclose a chronic illness, this period gives you a chance to make corrections. - Policy Renewal Updates:
If the free-look period has expired, you can declare the illness at the time of policy renewal. However, the insurance company may decide whether to accept the updated disclosure, adjust premiums, continue coverage, or cancel the policy. - Switching or Buying a New Policy:
You can also purchase a new health insurance policy or switch to a different insurer. Be sure to accurately disclose any existing medical conditions this time. - Protection After 60 Months of Premium Payments:
According to the Insurance Regulatory and Development Authority (IRDA), if you have paid premiums continuously for 60 months, your claim cannot be rejected unless fraud is proven.
Steps to Take if Your Health Insurance Claim is Denied
- Correct and Resubmit:
If the claim was denied due to incomplete or inaccurate information, update the necessary details and resubmit your claim. - Contact the Insurance Company:
If your claim is denied for an invalid reason, reach out to the insurer and dispute the decision.
Clear communication and full disclosure are critical when dealing with health insurance policies. Ensuring all details are accurate can save you from potential disputes and claim rejections in the future.
