Health Insurance Claim- Do You know can’t be rejected after 8 years?
Health Insurance Claim can not be rejected after 8 years.
Yes, What you read above is right.
As per IRDAI guidelines, Health Insurance Companies can not reject claims after years.
If it becomes a law, then it will be a big advantage for many of us.
Read the article about Arogya Sanjeevani Policy. Click this link to read.
Also, read this article about health insurance.
Many people are not buying insurance policy health or life, thinking that there is no guarantee that the insurance will pay the claim, when it is needed.
In addition, In spite of the client has given honest information, the insurance may decline the claim.
As the people have this doubt, they are staying away from the insurance even they know the risks that they have to face without insurance.
But in Life Insurance Company can not reject claim after 3 years. This rule in life insurance already exists.
There are so many exclusions in the health insurance policy.
But very few people can not understand these exclusions.
As a result of this common man may give the wrong information to the insurance company due to lakh awareness.
But this information may be important for the health insurance company.
If the insurance company founds the real fact in the future, then the company may deny the claim and also can deny the total policy also.
So, to protect innocent policyholders IRDAI on 16th, May 2019 had given some guidelines for the standardization Exclusions for the Health Insurance Claim in a Draft.
In addition, It will be a beneficial move by IRDAI and it will benefit all policyholders of health insurance.
I will explain the wordings of the draft in this article.
Let’s learn more about these guidelines by IRDAI.
First I will explain a few exclusions in Health Insurance Policy…
30 Days waiting period for Health Insurance Claim from the commencement of policy…
Health Insurance companies will not pay any claim for any health-related issues for the first 30 days of the policy.
In addition, but for accidental injury claim will be given immediately after the commencement of the health insurance policy.
Waiting Period for some kind of illness/surgeries…
If a person wants to go a cataract surgery or piles treatment etc.
You can not get treatment for the above for the first 2 years.
In addition, there may be few more exclusions apart from above for the first 2 years depending on the health insurance company.
Waiting Period for Pre- Existing Deceases…
All health insurance companies will not cover some pre-existing deceases for the first 4 years from the date of commencement of the policy.
So, any illness arises due to pre-existing decease, it will not be covered for the first 4 years.
Some Deceases are permanently excluded…
Pre-existing deceases like HIV, AIDS, HEPATITIS, etc are permanently excluded.
So, the waiting period for these deceases is infinite.
IRDAI also has given a list of 17 deceases which can be permanently excluded.
Some treatments are also permanently excluded…
Treatments related to cosmetic surgery, injuries due to hazardous sports also will be permanently excluded.
In addition, consumables, E-mail charges, Internet Charges, and food also excluded permanently.
Why Your Health Insurance Claim can not be rejected after 8 years?…
As per the IRDAI proposal, if your policy completed 8 years ( i.e if you have paid 8 years premium continuously), your claim can not be rejected except in case of fraud or and for permanent exclusion.
So, Your health insurance policy will not be rejected after the 9th year onwards.
unless you made a fraud or claiming for permanent exclusions.
which I have explained already.
The above waiting period is called the “Moratorium Period”.
However, sub-limits, co-payments, and deductibles will be as per the policy purchased only.
In addition, if you have increased your sum assured after some years, then increased sum assured also should complete the Moratorium Period
However, your claim will be settled based on existing coverage, if it has completed this Moratorium period.
Most of us will buy the health insurance policy at age 25 years to 3 years.
In addition, we may not claim anything until 40 to 50 years as we are young now.
So, with this new guideline by IRDAI, you will be protected from the health insurance companies not settling the claim.
These rules not yet became law, If it becomes a law, then it will be very beneficial for all of us.