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Crucial Insights into Health Insurance: Avoiding Pitfalls and Maximizing Benefits

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Crucial Insights into Health Insurance: Avoiding Pitfalls and Maximizing Benefits

People often fail to disclose their Pre-Existing Diseases (PED) when buying insurance. Filling out the proposal form is essential for this. If the policyholder overlooks this, the insurance company may reject their claim.

Many individuals opt for health insurance to cover expenses related to serious illnesses or emergencies. However, insurance companies often reject claims. This is because many people do not disclose their pre-existing illnesses (PED) when purchasing insurance. Filling out the proposal form is crucial for this. If the policyholder misses this, their claim may be dismissed by the insurance company. Therefore, it is mandatory to fill out this form when buying insurance.

IRDA Reduces Waiting Period

The Insurance Regulatory and Development Authority of India (IRDA) recently made significant changes to the rules related to health insurance. Under this, the waiting period for covering pre-existing illnesses has been reduced. This will directly benefit consumers purchasing health insurance.

Previously, any illness existing up to four years before applying for a policy was considered a pre-existing illness. Now, this period has been reduced to three years. This means that illnesses up to three years prior to purchasing the policy will fall under the category of PED, but the benefit will only apply if the policyholder has filled out the proposal form at the time of purchasing insurance.

What is a Proposal Form?

Whenever an individual buys health insurance, the insurance company requires them to fill out a proposal form. This form includes various questions related to the applicant’s lifestyle. Additionally, details of any illness the applicant suffers from are requested. According to IRDA regulations, illnesses and injuries up to 36 months prior to purchasing health insurance fall under the PED category. Diseases such as high blood pressure, asthma, thyroid, and diabetes are considered under PED.

The Company Can Reject Claims

Experts in the insurance sector emphasize that pre-existing illnesses are a crucial issue when purchasing health insurance. They should not be concealed. If these are discovered later, the policyholder may incur significant losses. For example, if an individual applies for health insurance and, as per IRDA’s new rules, has a pre-existing illness or is undergoing treatment for one up to three years before purchasing the policy, they must disclose it in the proposal form.

If the insurance company discovers during the proposal form filling process that the applicant or any member included in the policy has an illness, it can increase the premium, add conditions, or reject the application altogether.

If an applicant conceals an illness and later during treatment, the company discovers it to be pre-existing, the claim can be rejected. Moreover, the policy may be terminated.

Precautions to Take

  1. Fill out the form yourself: Ensure that you fill out the proposal form yourself. Do not let anyone else fill it out, nor allow someone else to fill it out for you.
  2. Do not leave any columns blank: Fill out the form completely and accurately with all the necessary information. Do not leave any columns blank.
  3. Understand all questions: Ensure that you understand all the questions asked in the form correctly. Declaration of this should be made in the form.
  4. Do not conceal any information: Do not conceal any information or facts while purchasing insurance. Doing so may lead to complications when making an insurance claim.
  5. Keep a copy with you: Keep a copy of the signed proposal form with you. This will serve as a record of mutual agreement with the company.
  6. Include your phone number: Make sure that your phone number is registered with the insurance company. In case of claim rejection, you will receive a message.
  7. Check coverage: Also, ensure that the policy covers your health-related needs and serious illnesses. Also, check what is included and what is not in the policy.

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