Here’s why you need to make full disclosure to health insurer

Published: January 8, 2019 1:06 AM

ealth insurance plays a critical role in case of any unforeseen medical exigency.

Here?s why you need to make full disclosure to health insurer

Bhaskar Nerurkar

We are seeing steep escalation of medical costs making it unaffordable for many to opt for quality treatments. Health insurance plays a critical role in case of any unforeseen medical exigency. To have an appropriate and uninterrupted health cover, it is vital for you to make proper disclosure to your insurance company.

Here are the stages during which you need to make proper declaration to your health insurer.

Purchase of health insurance
An honest proposal from your end is quite important for the insurance company. The declarations made by you on your health status in the proposal form is the basis on which your insurance company will underwrite your policy, that is, gauge the risk and calculate the premium to cover that risk. Hence, while buying your health insurance policy, it’s important for you to make full disclosures, especially about your health and not just in the present, but also in the past.

How healthy you are or were in the past is a determining factor for the insurance company. For instance, if you had any ailments, say around three to four years before buying the policy, it is considered a pre-existing ailment. Insurers usually apply waiting period or choose to load premium for the pre-existing ailment. Concealing any such facts will amount to misrepresentation or non-disclosure of material facts. Such act may mean that insurer may reject your claim and you will be left with no cover when you need the most.

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At the time of claim
There are two ways in which you can make health insurance claim—cashless claim or reimbursement. In case of cashless claim, the insurer and hospitals are connected through a seamless network where the hospital shares all the medical reports and bills with insurer. The policyholder has very little role to play here. However, in case of reimbursement, the policyholder needs to fill the claim form and disclose all the details about the medical treatment.

Necessary original documents like diagnosis report, medical bills, health check-up reports, treatment details, etc., need to be shared with the insurer based on which the claim will be paid. Before lodging the claim, it is essential to be aware of what is covered under your policy terms and conditions. Especially, whether or not your medical condition is related to pre-existing ailment, which may have a certain waiting period for it to be covered or may be excluded for coverage by the insurer.

At the time of renewal
It is always advisable to increase your sum insured and revisit your coverage at the time of renewal keeping in mind medical inflation and your medical needs. If you wish to do so, the insurance company will review your claims history. Be honest about the medical details furnished at the time of renewal to avoid any hassle when you need to make a claim in future.

It is also your responsibility to disclose any health history of the past one year during which you held the policy with the insurer and for which you may not have claimed. Such history is important for the underwriter to decide the increase in sum insured and change your coverage.

It is always advisable to be safe and disclose the facts about your medical history, than be sorry when the policy will be cancelled due to non-disclosure of material facts. Read policy terms and conditions carefully, make full disclosure so that when you or your loved ones are unwell you can focus on nurturing yourself or your loved one back to proper health rather than being worried about paying out of your pocket for any non-disclosure to your insurance company.

The writer is head, Health Administration Team, Bajaj Allianz General Insurance

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