You don’t want your health insurance file to be rejected? Read the fine print carefully


Insurance companies mostly promote attractive features of health insurance plans to attract people. However, apart from the broad coverage, several terms and conditions come into play when handling the claim.

So, while taking an insurance cover, one has to read between the lines to know what is in the fine print of the policies that can cause problems at the time of claims settlement.

Dr Pallavi Seth, Faculty, Amity School of Insurance, Banking and Actuarial Science, Amity University, Noidahighlights those terms and conditions that are hard to find in the fine print of health insurance policies.

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“The pandemic has changed people’s perception of insurance products. People have started to care deeply about their health and well-being. This also includes buying the right health insurance plans. Although people have started buying health insurance, many of them still do not understand the details of these plans. And when they raise a health insurance claim, the company either partially pays or refuses to pay the claim. In order to avoid this situation, one must read the fine print of the policy very carefully,” she said.

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Dr. Seth lists the following terms and conditions that you should read carefully when applying for a health insurance policy:

Waiting time

Most insurance companies have waiting periods for pre-existing conditions. There are plans that cover pre-existing conditions after a one or two year waiting period, but some companies only cover them after 4 years. There are also specific wait times for specific diseases/procedures such as cataracts, joint replacements, etc. You should try to choose the company with the least waiting time in order to get full coverage for your health.

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There are sub-limits on the rent for rooms in hospitals and also on certain specific procedures. Although choosing the health insurance plan with high sub-limits may seem cheaper, you may actually be paying more out of pocket. You must choose the policy without sublimits.

Catering service

An insurance policy may seem cheaper to you, but if the policy does not offer a restoration benefit, you may be on the losing end of the long run. As healthcare costs have ballooned in recent years, you can use up the entire sum insured in a single operation or hospitalization. If your policy has a restoration benefit, the insurance company restores the original sum insured after it is fully depleted for the treatment of illnesses. Suppose you have a health insurance policy with an insured sum of Rs 5 lakh, and all the insured sum is exhausted in the treatment of heart surgery. If you get the restoration benefit, your policy will reinstate the original sum insured of Rs 5 lakh, which can be used for the remaining period of the policy.

Claim sharing

If your insurance policy includes a co-payment clause, you will agree to pay part of the medical costs out of pocket and the insurer will cover the rest. If the copayment amount is high, you may have to pay a huge share of the claim. You must choose a policy with no co-pay or with a minimum co-pay.


Many insurance companies track your data through wearables and health apps, like weekly steps, calorie counter, and healthy heart rate. If you show healthy behavior, insurance companies give a discount on the renewal premium or increase the sum insured. You should always consult your insurance policy if these benefits are provided so that you can benefit from them at the time of renewal.


Health insurance policies have a list of exclusions which should not be ignored at all. When purchasing the policy, you should review any treatments, procedures or illnesses that are excluded from the policy. This way, you can arrange separate funds for medical expenses incurred under these exclusions.

Pre and post hospitalization expenses

Pre-hospitalization medical expenses refer to medical expenses incurred during a predefined number of days preceding the hospitalization of the insured person, while pre-hospitalization medical expenses refer to medical expenses incurred during a predefined number of days preceding the hospitalization of the insured person. To be included in a claim, both expenses must be for the same condition for which the Insured Person was required to be hospitalized. Most insurance companies pay for pre-hospital and post-hospitalization costs, but you may not know this and cannot claim incurred costs here.

“You should understand that every health insurance plan comes with a 15-day free consultation period option. This period gives you an opportunity to review the policy after purchase and understand the finer details of the You have the benefit of canceling the contract in the event of unacceptable terms, and the insurance company will refund any amount paid if the policy is canceled during the free review period, provided no claim is made in the police,” Dr. Seth said.

“Therefore, it is very important that the buyer knows all the clauses of the policy and reads in detail all the terms and conditions of the policy so that you do not have nightmares when applying for health insurance” , she added. .


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