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YOU are young and your health is good. In any case, you have an insurance policy to deal with hospitalisation.

You feel secure, as you should. But one day, you find yourself being admitted to a hospital, and undergoing an expensive surgery. " Thank god for the insurance policy," you think. The insurer, however, rejects your claim citing the ' pre- existing illness' clause. This is not even a very rare occurrence.

While some claims are rejected due to specific exclusions in the policy, others could just have fallen prey to a technicality.

Here we talk about one of the most common reasons that insurers reject claims- pre- existing illnesses.

WHAT ARE PRE- EXISTING ILLNESSES? In insurance parlance, these are medical conditions that existed before the health insurance policy was purchased. According to the Insurance Regulatory and Development Authority of India ( IRDAI), pre- existing conditions can be considered for coverage after completion of 48 months of continuous insurance cover. Though the standard waiting period is four years, many insurers offer shorter waiting periods too.

Galling though it is, during this period, medical bills arising from a pre- existing condition won't be covered by your health policy.

DISEASE- SPECIFIC WAITING PERIOD Apart from waiting periods for pre- existing illnesses, there could also be waiting periods for specific diseases.

For example, several insurers do not cover cataract- and hypertension- related bills for two years after the purchase of the policy.

FUDGING ON HEALTH STATUS If you do not disclose a pre- existing illness to your insurer at the time of buying a policy, it will be seen as misrepresentation of facts. If you suffer from a disease at the time of buying the policy, or have had it from earlier, make sure to disclose it. This is a serious matter- claims can be rejected even five or seven years into a continuously running policy if it transpires that an illness was intentionally not disclosed at the time of purchase.

YOU SHOULD KNOW Different insurers have different standard waiting periods. They might vary for specific diseases as well. Study the policy offer carefully before making a purchase, especially the sections relating to illnesses you might have/ might be prone to getting because of your lifestyle or family history. If you are migrating a policy from one insurer to another, note that you might have to sit through additional years for coverage of preexisting diseases under the new policy if it has a longer waiting period.

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Publication:Mail Today (New Delhi, India)
Date:Oct 6, 2016
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