Health insurance is extremely important to safeguard one’s investments particularly because of the current coronavirus scenario and the uncertainty of a medical emergency.
While several insurance policies covering COVID-19 have been recently launched, it’s important to understand their claim parameters. There may be cases where the claim may be rejected due to one of the many reasons.
Here are some conditions under which COVID-19 insurance claim may be rejected:
If the insurance policy mentions that it does not cover pandemics, the claim for COVID-19 treatment will be rejected. This may be the case when the policy was purchased before the pandemic.
There are also chances when a policy bought before the pandemic may cover the disease but may not cover the cost of consumables used during treatment, say experts.
For treating COVID-19, PPF kits such as mask, gloves, face shields, shoe covers, sanitizers, and disinfectants are required.
At instances when the insured is not hospitalized for a minimum of 24 hours, the policy may not cover the claim.
If the insured is already a patient of any respiratory disease for the past one month or more than that, then the coronavirus specific insurance policy or a basic health insurance policy might not get approved, according to Naval Goel, CEO and Founder of PolicyX.
If the policyholder and his/her family members have a recent travel history to the worst coronavirus affected cities/countries, the company might not entertain the claim.
“If the insured gets COVID-19 infection from any of the infected family members with a travel history to selected countries such as China, Italy, Hong Kong, Macau, Japan, Kuwait, Singapore, Thailand, and others, the mediclaim won’t get settled," explains Goel.
Moreover, if the policyholders have been suffering from cough, flu, respiratory issues, breathlessness, and planning to go for a treatment, only to find that the symptoms have transformed into coronavirus disease, the health insurance company might reject the claim.
A claim during the waiting period is also not liable to get the required coverage. Every policy has a waiting period for pre-existing diseases. This means if a policyholder has a disease prior to purchasing a plan, a claim for treating the disease can only be made after insurance premiums have been paid for a certain period.
Customers should also note that miss-interpretation of any fact can also lead to rejection of claims.
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First Published: IST