Understanding Health Insurance: Bridging the Gap Between Policy and Policyholder in India

In India, health insurance claims often face rejection due to misunderstandings, non-disclosure of pre-existing conditions, and false information. Experts emphasize transparency, proper customer education, and improved rural healthcare infrastructure. Government schemes like Ayushman Bharat are raising awareness, while ombudsman support aids wrongfully rejected claims.

Health insurance claims in India face frequent rejections, predominantly due to policyholders misunderstanding policy terms, failing to disclose pre-existing conditions, or submitting inadmissible claims. Industry experts stress that enhanced awareness and transparency are pivotal for a smooth claims process.

Rakesh Jain, CEO of Reliance General Insurance, highlights the financial distress policyholders endure during medical emergencies when claims are rejected. Misunderstanding of policy wording, non-disclosure of pre-existing conditions, and procedural lapses are primary culprits.

Amit Chhabra from Policybazaar.com reveals claims rejections often occur due to lack of comprehension regarding policy terms, waiting periods, required documentation, and undeclared medical history. Moreover, the rural population faces unique challenges, including inadequate healthcare infrastructure. Nonetheless, government initiatives like Ayushman Bharat spark awareness and increase policy uptake in non-urban areas, while ombudsman services provide a resolution avenue for wrongful claim denials.

(With inputs from agencies.)