Bug, not a feature.
Most health insurance sold today, even for people who have crossed their 50s, do not require a medical test.
The instant cover is sold like a feature, but to be honest, it is a bug.
The insurer saves time and money on a medical test, and entirely burdens, us customers, to declare our family’s medical conditions.
Now most people I speak to forget or mostly want to forget (read as “remain in denial”) about their medical conditions. In my own experience with my own friends, the same medical history question needs to be asked in different angles to extract the complete answer which is “3 mahine pehle BP ki dawaai shuru ki thi doctor ne”
This is the problem, but there is a bigger problem.
Speaking from experience, Insurers are fast and agile when issuing a policy, but can go slow and cold when there is a claim. That doctor they did not call for before the policy is issued, will be there to deeply evaluate whether you declared everything correctly, at the time of claims.
The logic is purely commercial.
Say claims are 5% of total policies - the evaluation expenses are reduced by 5%. That too is covered by claim rejections/deductions.
What does this mean for us, customers?
It means that we are on our own. We need to be diligent and dig into every small medical history that we can accumulate and inform the insurance company. Especially for parents, one should not go by oral answers they give. One must check their medical file - for recent tests, treatments, medicines they take, and any doctor prescriptions.
Also, remember, even when insurers conduct tests, they are not comprehensive, they don’t test you from head to toe to get all the information they need. Insurers still depend on declarations for evaluation.
Make real effort, so that you can declare to the best of your knowledge.
Here are some FAQs:
What about a disease I have in my body, but I am not aware of?
Remember, if insurers cannot prove you knew about a disease, they won’t be able to reject a claim.
What about 5 years moratorium period?
Yes, health insurance policies do have a moratorium period of 5 yrs. Beyond 5 continuous renewals, an insurer cannot reject claims due to non disclosure, unless they can prove fraud. Still one should be careful in declaring medical conditions, and even declare missed conditions, because, I have seen insurers use the fraud exception to cancel policies and reject claims.
What actually protects you during a claim?
The proposal form. Ensure you fill it diligently, after doing the detailed homework around medical history I explained earlier. Even add more details by sending email to the insurance company, and taking an acknowledgement.
What to check after policy is issued?
Once you received the policy document, check if all the disclosures have been recorded in the policy or the attached proposal form. If it has not been recorded properly, then send a follow up email
What to do if you now remember you missed something?
Go clean, and write to the insurer and inform. It’s better to have a clear policy, instead of remaining iffy at the time of claims, and keep paying the premium.
I am busy, this is too much work, can I get someone else to do this for me.
Most of us are, and that’s where I get to plug our expert community. Of course, we have built a solid community of professional experts, with average 9 years of experience, who can guide you right from choosing the right policy, to filling the proposal form, and of course at the time of claims. Just click here, to book a free consultation:
Hope this newsletter was useful. Do share it with your friends, colleagues and help them also learn about this - very very crucial.
And yes, if you still have questions, or have any feedback, you can simply write back on this email, and I will get back to you.
Cheers,
Mahavir