Family health insurance provides protection to the entire family under one plan. Depending on the insurer, you can include your spouse, dependent children, parents and parents-in-law, and siblings under your family health insurance plan. During a time when diseases are rampant and hospital costs are on the rise, it becomes essential to have the security of such wholesome health insurance for yourself and your loved ones.

A good insurer will make sure that your family health insurance claims are settled on time. However, there are some situations which could lead to the rejection of your claim. In this article, we look at 3 such reasons that you need to be aware of.

  1. Filing a claim under the ‘exclusions’ category 

Any family health insurance policy will have a number of exclusions. Along with a thorough understanding of the inclusions, it is also important to know about the various exclusions. If you are raising a claim for a disease/procedure that is not explicitly mentioned in the inclusions, you should contact your insurer and get information about the coverage you can claim, if any. If you fail to do so, your claims application might get rejected. It goes without saying that your claim will not hold if the condition/health issue is specifically mentioned as an exclusion in your policy.

It is also advisable to be aware of the coverage for pre-existing conditions since these would probably be excluded for a particular waiting period too.

Apart from these, your claim may also be rejected if the insured family member has been hospitalized in a hospital that is blacklisted by the health insurance company.

  1. Filing a claim on a lapsed policy

Before you raise a claim, it is important to ensure that the policy has not been lapsed. The health insurance company is not going to accept claims on an expired policy. Unless you have a multi-year health insurance policy, you have to renew your policy every year when the renewal date comes near. Insurers do also offer a grace period of a few weeks post the renewal date within which you must ensure to make the renewal with required the premium payments.

Make sure to also review your coverage when renewing your policy ensure that it meets with the growing needs of your family.

  1. Providing wrong information

When a health insurance company issues an insurance policy, they do so under the concept of ‘utmost good faith’ which obliges parties under the contract to provide correct and complete information for any reason that may arise.

If you have provided wrong information to the insurance company regarding the health history of any family members, or have suppressed or misrepresented facts, the insurance company will reject your claims. Thus, be completely honest about any pre-existing illnesses or habits when applying for health insurance coverage.

Do bear in mind that this is not an exhaustive list; your family health insurance claim may be rejected on other grounds as decided by the health insurance company. If you feel that your claim has been rejected on unfair grounds, do reach out to your insurer and ask them about the next steps you can take to make an appeal.

Tips to ensure a smooth claim process 

Keep these tips in mind when raising a claim – 

  1. If you are planning to raise a claim for cashless treatment, make sure to choose one of the network hospitals only.
  1. Make sure all the documents relating to your family health insurance policy, including the health card you would have been issued, are in good order and accessible to you.
  1. Insurance companies usually have a time frame within which the policyholder is expected to raise claims. Ensure to contact your insurer and raise the claim within the stipulated period of time.
  1. Make sure that your other family members also know about the claims process so that they can raise claims independently or help you when you are unwell.

We hope this article helps you raise claims on your family health insurance policy more effectively. Good luck!

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