Smart things to know about why health cover claims get rejected

1. Pre-existing disease
Medical conditions that exist before obtaining the health insurance policy are not covered from day one. A waiting period of up to four years can apply for such conditions.

2. Policy exclusions
Some illnesses covered only after a few years. Standard exclusions are cost of spectacles, dental and cosmetic surgeries, expenses for diagnosis and treatment relating to pregnancy, etc.

3. Gap in renewal
The health insurance policy is renewable provided you pay the premium within 15 days of the expiry date after which it lapses. During this gap period, coverage is not available.

4. Policy coverage
The health insurance policy will mention sub-limits under heads such as room rent, consultancy fees, ambulance charges, etc., and amounts over which costs will not be covered.

5. Incorrect information
If it is discovered at a later stage, while making a claim, that wrong information was given at the time of purchasing the policy, it could lead to claim rejection.

(The content on this page is courtesy Centre for Investment Education and Learning (CIEL). Contributions by Girija Gadre, Arti Bhargava and Labdhi Mehta.)