A large number of Covid-19 related claims were made following the increase of Covid cases during the second wave. As of May 5, 2021, about 47.8K covid-19 claims were repudiated while about 187.8K claims were still under review, consistent with the info published by the overall Insurance Council. The insurance claims mainly excluded for lack of proper documentation, waiting period, and exclusions. The waiting periods and exclusions still form a crucial part of any health plan.
Pre-existing illness exclusion during the waiting period
The Turtlemint Co-Founder said that if you’re affected by any medical condition, like diabetes, hypertension and therefore the like, such condition would be called a pre-existing condition.
Standard waiting period
Besides the waiting period for pre-existing conditions, there are other waiting periods during which specified coverage not available. These periods include the following:
Initial waiting period:
Mahyavanshi said this is often also called a cooling-off period from the date of shopping for the policy. Illnesses incurred during this era aren’t covered.
Specific waiting period:
Illnesses and coverings like hernia, fistula, tonsillectomy, cataract, joint replacement surgeries, etc. aren’t covered within the first one or two years of the policy.
Maternity waiting period:
If the plan allows maternity coverage, there would be a waiting period within which the coverage wouldn’t be available. The amount ranges from 9 months to 48 months.
Cosmetic surgeries aren’t medically necessary, except once they become important for treating an injury.
If you avail of unproven, experimental, or unscientific treatments, the value of such treatments wouldn’t be covered under your insurance plan.
Injuries or Illnesses suffered thanks to self-harm attempted suicide, deliberate actions of the insured, or self-inflicted injuries aren’t covered under the policy. This is often because health plans are meant to hide uncertain medical emergencies over which you’ve got no control.
Allied perils and War:
Medical injuries suffered when the country is at war, or if there’s a mutiny, rebellion, or civil unrest, wouldn’t be covered. Illnesses and Injuries thanks to radiation or chemical ionization also are not covered.
Investigation and evaluation costs:
The medical costs incurred on investigative tests are covered provided they’re incurred about the treatment that you’ve got been hospitalized. If the tests aren’t associated with the treatment that you’re making a claim, their costs wouldn’t be cover.
The prices incurred on buying vitamins, minerals, and other dietary supplements aren’t covered under the policy.
Cost of consumables and non-payable items:
Consumables are one-time use objects which are utilized in the course of treatments. For instance, cotton, bandages, syringes, face masks, sanitizers, etc. constitute consumables.
Three conditions to urge insurance claim
An insurance claim would be admitted as long as all the three conditions are fulfilled, like the doctor’s advice of hospitalization, the standard protocol for treatment, and a lively line of treatment has been administered.