Knowledge Centre

Avoid Denial of Your Health Insurance Claims with this Guide

Health insurance claims are on a rise across the world, especially in the wake of the Coronavirus pandemic. But this novel virus is not the only reason why people claim insurances - it can be for a surgery or a chronic disease treatment. At times, the claims can get rejected and the reasons can be varied, such as:

  • Wrong Information : This can be a simple error while you are filling the form or withholding information or giving false details to the insurance provider.

  • Ignoring Exclusions : Many times, policyholders do not go through the exclusions listed and raise claims, only to have them rejected. 

  • Raising Claims after the Allotted Time Window: Most insurance providers need to be informed within 24 hours of your hospitalization. Failure to do so can lead to rejection of claims. A third party nominee can help get insurance in certain critical situations where the policyholder is unable to undertake the process. 

Benefits of Health Insurance

Accidents, sickness, and other health ailments are never pre-planned. So, during a medical emergency, the rising medical costs can be a burden on the patient or his family. However, a comprehensive health insurance plan can help you meet your medical expenses and avoid financial woes. Here are some of the benefits of having a health insurance policy:

  • You will receive cashless treatment for admissible ailmentsn if you are in a network hospital and thus save yourself from taking money out of your account for the treatment. 

  • Getting a health insurance policy early in your life can offer a plethora of benefits at lower premiums. 

  • The health insurance plan can help you avail high cost treatments and skip paying the expensive bills from your own pocket. 

  • Having health insurance can sometimes also cover preventive health measures like health checkups and screenings.

  • Cumulative Bonus (CB) is another added advantage if you don’t claim your insurance for some amount of time whereby your coverage amount is increased. In addition to )CB_, if you are a long time policyholder, you might also be eligible for a long term policy discount. You can talk to your insurance provider for more details on this.

  • Health insurance is a great tax saving instrument too. With a comprehensive health insurance policy, you can save up to Rs. 75,000 in tax annually, under section 80D with health insurance plans. A win-win situation indeed!

Information Disclosure

Informing your insurance provider about any pre-existing conditions is very important. Health insurance policies can protect the policyholder against future health crises and hospitalization, but they often do not offer any coverage for a pre-existing illness. 

Policyholders should also inform about any changes in their health conditions at the time of renewal, which will help them get the right coverage without being held responsible for false claims. If the policyholder is diagnosed with a disease after buying the pplicy, he/she can increase the sum insured of the pre-existing policy, which can be claimed for treatments after a certain period. It will not affect the health insurance cover but you will of course, end up paying more premium. 

Medical Test

Undergoing regular medical tests can help you stay informed about your health, and accordingly, customize your insurance plan to get maximum coverage. A medical test can be considered as a proof of the policyholder’s existing medical conditions, and it can significantly reduce the chances of the claim getting rejected.

Buy Adequate Cover

This is one of the most overlooked parameters, as buying adequate insurance can often win you half the battle. Your insurance purchase should depend upon your current health, lifestyle, city of residence and a lot more. For instance, if you are living in a Tier-1 city, the treatment is most likely to be more expensive than in a Tier-2 city. Similarly, age group and current health vitals also play a role in deciding the policy amount that will be enough to cover the expenses. 

Claims Process to be Followed

End-to-end insurance providers usually make registering health insurance claim a breeze. However, policyholders must bear in mind the difference between cashless claims and reimbursement claims. Here are some steps you need to follow:

  • Hospitalization: The policyholder needs to be preferably admitted in the nearest network hospital for a cashless claim. 

  • Documentation: Collect the cashless form from the hospital and fill it up with the right information. Submit it along with identity proof and the health insurance card.

  • Pre-Authorization: Upon receipt of the documents, the insurance team will scrutinize their authenticity and will approve/reject the claim accordingly.

  • Claim Settlement: If the claim has been accepted, the insurance provider will directly settle the claim without the policyholder paying up the cost. There might be a few transactions not covered, for which the policyholder needs to pay separately. 

In case of a reimbursement claim

  • Hospitalization: Notify your insurance provider of your admittance into the non-network hospital. 

  • Post Discharge: Policyholders should assemble all the documents, along with the filled claim form and submit it at the insurance branch office or directly mail it to the head office. You have also the option of uploading the claim documents through our web portal or mobile app.

  • Claim Status: Based on the documents sent, the insurance provider will accept/reject the claim. If accepted, the amount will be settled and reimbursed to the policyholder. 

Renew Plans on Time

By renewing health insurance on time, you can negate the chances of the insurance service provider rejecting your claim on the ground of an expired policy. Nothing is worse than paying your hospital bills because you forgot to renew health insurance on time.


Many policyholders are often scared of the prospect of undergoing the insurance claims process. So, stay rest assured when it comes to claims at HDFC ERGO, our claims process is easy and simple and hassle-free. You can simply pick up the phone to call a customer care executive or drop an email with your queries to get a detailed analysis to help you with the claims procedure. Don’t have insurance already? Buy HDFC ERGO health insurance to live life stress-free.

Disclaimer : The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales. *T&C apply. my:health Suraksha HDFHLIP20049V041920, UID No: D2HI705

This blog has been written by Diwaker Asthana Health Insurance industry experience of 20 years

Diwaker Asthana recommends buying my:health Suraksha Insurance to get the benefit of a wide range of coverage that the plan offers.For some unique benefits like cashless home health care and in-patient treatment for mental illness,he believes this plan will benefit customers in the long run.

Awards & Recognition