7. THAT'S NOT GOOD. OKAY, IF I AM GOING TO BE HOSPITALIZED, BY WHEN DO I NEED TO LET YOU KNOW?
As per your policy terms and conditions, you would have a specific deadline to inform us about the hospitalization. If you've not intimated us or the TPA within the stipulated timeframe, your claim may be rejected. Typically you need to inform us 2-3 days in advance about planned hospitalizations. In case of emergency hospitalization, intimate us or the TPA within 24 hours.
8. IF I HAVE JUST BOUGHT THE POLICY AND NEED TO BE HOSPITALIZED, CAN I MAKE A CLAIM?
There is a 30-day initial waiting period on most health policies, except accident-related claims. The waiting period is 15 days for COVID-19 claims. There is also a separate waiting period of specified duration like 1 year, 2 years or 3 years as per the customization of your policy. Most of the elective surgeries like cataract, kidney stones, gall bladder stones, joint replacements, maternity-related etc. fall under this condition. Read your policy documents thoroughly to know more.
9. WHAT IF MY POLICY HAS EXPIRED? CAN I CLAIM DURING THE GRACE PERIOD THAT YOU PROVIDE FOR RENEWAL?
If you miss the insurance renewal date and end up filing a claim on the expired policy, your claim would be rejected. Renewing the policy in time is crucial to ensuring you don't miss out on a claim during a medical emergency. Although there is a 15-day grace period for renewals, insurance companies usually don't service your claim during this period. So it's best to renew in advance and stay protected against any unexpected health concerns that need immediate treatment.
10. I HAVE ALREADY MADE A COUPLE OF CLAIMS IN THE YEAR. WHAT IF MY SUM INSURED IS EXHAUSTED AND I WANT TO MAKE ANOTHER CLAIM DURING THE POLICY YEAR?
If you've already made a few claims in the policy year and your sum insured (the maximum amount available in the year as per your policy) is used up, then your subsequent claims may be denied. Opting for a higher sum insured is a better idea, especially if you're buying a single policy for the whole family. ICICI Lombard Health AdvantEdge Health Insurance also comes with a reset benefit, whereby we rest up to 100% of the sum insured within the same policy year, in case the sum insured is inadequate due to previous claims and the claim is for a new diagnosis. The reset benefit doesn't apply for the first claim of policy year.
11. I PREFER AYURVEDIC TREATMENT. WHAT DO I NEED TO KNOW TO ENSURE MY AYUSH CLAIM IS NOT REJECTED?
Most insurance companies, including ICICI Lombard, will not cover hospitalization expenses for evaluation or investigation only. Also, treatment taken at a healthcare facility which is not a hospital is not covered. When you're planning to undergo AYUSH treatment, be sure to choose a Government Hospital or any institute recognized by the Government and/or accredited by Quality Council of India/National Accreditation Board on Health.
Apart from the reasons we've covered, there may be other causes for claim rejection too. To avoid the pain of a denied claim, we recommend reading the policy documents thoroughly so that you're aware of all the terms and conditions. These documents clearly outline the inclusions, exclusions and deductibles of the policy. Moreover, you must keep yourself informed about the claim process and have the contact numbers of your insurer/TPA handy for assistance. ICICI Lombard has a simple, app-based claim process to make your experience hassle-free. You can intimate us for a claim, submit your documents, and check your claim status easily on our IL Take Care app. If you're interested in insuring your health with us, take a look at health insurance.
12. WHAT TO DO IN CASE OF A CLAIM REJECTION:
If you've filed a claim and your insurer rejects it, you can still try to find a solution. Go through your policy documents again and understand the reasons behind the claim rejection. Here are some steps you can take -
- In case your claim was rejected due to missing information, contact us or the TPA and share the pending details. Maintain a record of all your interactions with the insurer for future reference.
- If your claim was rejected due to unfiled documents, submit all the pending documents within the specified timeframe. If you filed the claim with the help of your TPA, take their assistance to submit the missing documents again.
- Sometimes a claim may be rejected if the treatment was medically unnecessary. In this case, you can share the accurate medical details by providing a supporting letter from your doctor, an expert opinion or even medical research. You can file an appeal for the denial of your health insurance claim in this case.
After taking the above steps, if your claim is still denied and you're not satisfied with the reason, you may provide a written complaint to the Ombudsman. You need to do this within 30 days of receiving a response from the insurance company.
ICICI Lombard also provides health insurance plans like Health Booster , Arogya Sanjeevani Policy , Corona Kavach Policy, Personal Accident Insurance which offers people with the much needed financial backup during any medical emergencies.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the Insurance industry and products. It is advised to verify the currency and relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.