4 Things You Should Know To Get Your Health Insurance Claim Approved

So you worry if your health insurance claim rejected? Before you go further it’s better you give attention to these 4 things.

Many people get mad when their claim is rejected because they already pay the expensive premium before, and the insurance company can’t give claim approval for some reasons.

But I think these peoples reaction is normal because anybody doesn’t want if their claim is rejected, including you isn’t right?


claim health insurance


When I did an evaluation of my friends claim, I was found that the documents which are submitted aren’t fulfilled the requirements according to the insurance policy.

The provision in the policy is the legal basis and it must be met by both policyholder and insurance company.

But the problem is many insurance holders who do not read the policy properly.

So, following is the important points you need to look at the policy before you claim your insurance.

1. Waiting period for your health insurance claim

Generally, health insurance has a waiting period as the requirement.

Health insurance requires a waiting period (grace period).

During the waiting period, the insured is not allowed to make a claim.

Usually, the waiting period is 30 days or 60 days after the policy is approved.

For example, the policy approved on April 1, 2017. With the 30-day waiting period, you can only claims after 30 days from the date of May 1, in that case on May 1, 2017.

So, if you or your family member are hospitalized during the waiting period, for example, on 15 May 2017 (we using the example above), then it’s clear that the claim will not be accepted by the insurance company.

So, make sure you understand how long the waiting period of your health insurance.

Because of that, the sooner you apply for health insurance it will be better. Because when the policy is approved, you are not immediately able to claim before the waiting period passed.

2. Some Diseases Can’t Be Claimed In the First Year

Not all diseases have a waiting period of 30 days or 60 days.

There are diseases that have a longer waiting period, which is 12 months.

I take an example there is a health insurance company that lists 19 specific diseases that can only be claimed by the insured after 12 months since the policy was approved.

If you claim these diseases before 1 year since the policy was approved, then your claim will be denied.

3. Make sure you do not claim pre-existing condition

The pre-existing condition is a health insurance provider that says participants already suffers a disease or condition that existed before.

The insurance company will not pay anything in case the insured had a pre-existing condition.

So, all the diseases that are suffered by the insured before a health insurance policy was approved, it will not be covered by insurance.

4 Eligibility Claims To Hospitalization

Claim application must be eligible for hospitalization.

The requirement at least fulfills the following conditions:

First, the definition of hospital and clinics as determined by the insurance.

Make sure you read and meet these conditions when you need to hospitalization. Because if the hospital or clinic where you stay does not comply with prevailing regulations, the claim will be rejected.

The second is the provision of what is meant by hospitalization.

These provisions vary on each insurance, for example, about how many days the insured must be hospitalized so that the claim can be filed.

There is insurance that requires a minimum of 2 days of hospitalization as a requirement to be able to make a claim.

But there is also other insurance that requires only 1 day of hospitalization to be able to make a claim.

So make sure you understand this provision in the insurance policy.

The conclusion is how to make a claim is not rejected?

Of course, you have to understand the provisions of the insurance policy, because there has stated the rules of claim payment.

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