As we move ahead in lives and shed away the skin of pandemic, the last year has brought ‘health’ of self and loved ones in the spotlight. We were exposed of our vulnerability to health emergency preparedness. The impact was huge and the price paid was extraordinary in terms of money and emotions.
With our parents being at the highest risk in this pandemic, the need for securing them comprehensively becomes an imperative. Acknowledging the rising medical cost burden, weakening immunity and being prone to medical conditions of ageing parents can have a financial and emotional impact on the entire family. As there are many types of health insurance policies available for senior citizens, one should not just look for affordability of premium as a criteria but a holistic coverage which takes care of various needs in old age.
Such health insurance policies can prove beneficial as it would cater to many miscellaneous medical expenses. The claim procedure for senior citizen health insurance policies should be dealt with extra attention as few policy features may vary for senior citizen health insurance.
Let’s look at the 10 things which one should pay attention to before raising a claim and avoid denials
Understanding the policy
First and foremost, read the policy documents i.e. its terms and conditions, exceptions, inclusions and exclusions at the time of new policy purchase. Policies with low premiums may limit your usage of the policy significantly. If you have opted for a low premium policy plan, then be mindful about the features you can raise a claim on. If you have opted for wide coverage, then ask your insurer about exceptions.
It is vital to provide accurate and crucial information about policyholder’s health condition, employment status, correct age of the policyholders, complete documentation etc. These are some important factors which help an insurer to determine the premium amount. Disclosing incorrect information will cause claim denial.
It is the percentage of hospital expenses that has to be borne by the Customer. The percentage is as per the policy terms which the policyholder must clearly understand during the purchase of the policy. The percentage could vary from 20%-50% of the approved claim amount. One should check with the insurer before making a claim so to manage finances accordingly.
The waiting period is different for each insurer’s policy plan. It could vary from 30 days to two or three years for certain listed conditions. A policyholder can’t pursue a claim during the waiting period. Corporate health policies typically do not have a waiting period if your parents are covered under such policy.
Pre-existing illness or disease
Senior citizens should preferably select plans which have a provision for covering pre-existing ailments. Many companies may reject claims basis of pre-existing illnesses/disease/ailments within a certain tenor as per the policy terms. Check with your insurer about the inclusion of pre-existing illness coverage, specific waiting periods. For e.g. a policy may cover a percentage of the cover for specific diseases like hernia. For claiming against a specific disease treatment, you may want to check with your insurer.
Know your deductibles
Certain policies have deductibles as an option i.e. the amount a policyholder agrees to pay by himself during the claim . Be mindful of the deductible amount while making the claim
Carry complete, original, documents before pursuing the claim process. If the documents are found to be incomplete or not verified by the hospital authority, then in such cases the claim gets rejected. For an insurer to admit your claim, you need to have proper documents, reports, etc, supporting your claim. A few insurers proactively support the consumer to handhold during the claims process to guide on requirements for submission.
If you are opting for home care treatment then inform your insurer Home care treatment should only be considered on the prescription of the medical practitioner and it should follow the policy guidelines to avoid claim denial.
Some health insurance policies are now offering alternative treatments like Unani, homeopathy, Ayurveda. Such treatments are claimable. However, you may want to check with your insurer before claiming for alternative treatments.
Organ Donor Expenses
Some of the insurance policies do cover medical expenses of organ donation. Confirm if the medical expenses can be claimed under your health insurance policy with the insurer.
Anuradha Sriram is the chief actuarial officer at Aditya Birla Health Insurance. Views expressed are personal.