Tweaks In Health Cover
Outlook Money|November 2020
Always disclose a pre-existing health condition and pay premium on time
Debjoy Sengupta

As an executive with a large corporate, Anand Tripathi (name changed) thought he had his life figured out financially. Till he was diagnosed with a heart ailment requiring immediate hospitalization and possible surgery. Those were tense times for the family but Tripathi was not too worried, sure that his hospital bills would be settled by his insurer. He was admitted and treated at a multi-specialty hospital in a large metro. When the hospital presented a ₹3-lakh bill for his treatment it was sent to the third-party administrator for cashless claim settlement.

And that’s when Tripathi received a rude jolt—the third-party administrator informed that his claim was rejected by the insurer on the ground of pre-existing disease. The doctor’s diagnosis of Tripathi’s ailment indicated that he was suffering from hypertension, which led to further complications requiring the treatment. Tripathi had not disclosed his pre-existing condition while buying the policy some four years ago. Had Tripathi disclosed his condition, the insurer might have charged him a little extra premium, but he would have been covered and his claim paid.

A simple health insurance is now worth its weight—value, if you please—in gold. The COVID scare has made the world sit up and take health insurance as far more important than ever before. Insurers too are scanning claims with a fine-tooth comb. And so are the authorities. The regulator has introduced several changes for policyholders’ benefits and ease-of claim settlement processes.

High-risk diseases such as HIV and cancer, conveniently excluded by health insurance providers to control their outgo, are now part of health policy. Claims will now be settled or rejected within a set deadline—if not, the insurer will pay interest at enhanced rates on claims payable for each day of delay. The regulator introduced these changes for policyholders’ benefits and ease of claim settlement processes.

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