Friday, June 14, 2024

3 Reasons That Can Lead to Denial of Your Family Health Insurance Claim

3 Reasons That Can Lead to Denial of Your Family Health Insurance Claim: Family health insurance provides protection to the entire family under one plan. Depending on the insurer, you can cover your spouse, dependent children, parents and in-laws, and siblings under your family health insurance plan. At a time when diseases are on the rise and hospitalization costs are on the rise, it becomes imperative to protect yourself and your loved ones with such health insurance.

A good insurer will ensure that your family’s health insurance claims are settled on time. However, there are certain circumstances that may cause your claim to be rejected. In this article, we look at 3 such reasons that you need to be aware of.

Filing a claim under the ‘Exclusion’ category

Any family health insurance policy will have several exclusions. Along with a thorough understanding of the inclusions, it is also important to know about the various exclusions. If you are making a claim for a disease/procedure that is not clearly mentioned in the inclusion, you should contact your insurer and inquire about the coverage you can claim for, if any. If you fail to do so, your claim application may be rejected. If the condition/health problem is specifically mentioned in your policy then your claim will not be valid.

It is also advisable to be aware of the coverage for pre-existing conditions as these will also be excluded for certain waiting periods.

Also, your claim can also be rejected if the insured family member is admitted to a hospital blacklisted by the health insurance company.

Filing a claim on a lapsed policy

Before making a claim, it is important to ensure that the policy has not lapsed. Health insurance companies will not accept claims on expired policies. Unless you have a multi-year health insurance policy, you will need to renew your policy every year as the renewal date approaches. Insurance companies also offer a grace period of a few weeks after the renewal date in which you must ensure renewal with the required premium payment.

When renewing your policy, also be sure to review your coverage to see if it meets your family’s growing needs.

Providing false information

When a health insurance company issues an insurance policy, they do so under the concept of ‘utmost good faith which obligates the contracting parties to provide accurate and complete information for any reason.

If you have misrepresented a family member’s health history to the insurance company, or suppressed or misrepresented facts, the insurance company will deny your claim. Thus, be completely honest about any pre-existing diseases or habits while applying for health insurance coverage.

Keep in mind that this is not an exhaustive list; Your family health insurance claim may be denied on other grounds as determined by the health insurance company. If you believe your claim has been denied on unreasonable grounds, contact your insurer and ask them about the next steps you can take to appeal.


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