Why health cover claims get rejected?

Why health cover claims get rejected?

Pre-existing disease: Medical conditions that exist before obtaining the health insurance policy are not covered from day one. A waiting period of up to 4 years can apply for such conditions.

Policy exclusions: Some illnesses covered only after a few years. Standard exclusions are cost of spectacles, dental and cosmetic surgeries, expenses for diagnosis and treatment relating to pregnancy etc.

Gap in renewal: The health insurance policy is renewable provided you pay the premium within 15 days of expiry date after which it lapses. During this gap period, coverage is not be available.

Policy coverage: The health insurance policy will mention sub-limits under heads such as room rent, consultancy fees, ambulance charges etc. and amounts over which costs will not be covered.

Incorrect information: Any wrong information given at the time of purchasing the policy if making a claim when discovered at a later stage could lead to claim rejection.

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