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Did You Know This About Health Insurance Claims?

Jun 04, 2018 | 2 years ago | Read Time: 2 minutes | By iKnowledge Team

The dictionary defines the word claim as a demand or request for something considered one’s due. The meaning is no different in the world of insurance either. When you raise a claim, you request the insurer to compensate you by paying the sum assured.  Let’s get to know the terms and conditions better.

You only claim what’s yours….

When you buy a health insurance policy, you enter into an agreement with the insurer. In return for a premium, the insurer promises to take care of your medical expenses. This is, however, subject to a maximum limit – the sum assured. For example, if the sum assured is Rs 10 lakh, the insurer guarantees to pay up to that amount during a medical emergency.

Another point you need to remember is that higher the premium amount, the higher is the sum assured.

But you don’t always get what’s yours…

Yes, your health insurer has the right to reject your claims in certain cases. This is regardless of the fact that you make timely premium payments. Non-disclosure of facts while purchasing the policy can be one of the reasons for your rejection. Your claim may also get rejected on account of lapsed policy.

You can claim when you need…

According to the Insurance Regulatory and Development Authority of India (IRDAI), you can make any number of claims during the policy tenure. However, this cannot supersede the terms of your policy. Thus, the number of claims allowed varies from policy to policy.

And, claiming it is not a difficult process…

The insurance claim process is simple. There are two types of claims – cashless and reimbursement. The former allows you to get treated in the hospital listed by your insurer. You do not pay anything in this case. For the latter claim, the insurer reimburses the medical expenses to you at a later date.

The last word

Different insurance plans have different terms and conditions. It is imperative you read the offer documents carefully while buying insurance.

Advt. no.: IA/MAY 2018/4007


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