One in four health insurance claims gets rejected due to undisclosed pre-existing diseases: Analysis

One in four health insurance claims get rejected due to a lack of understanding of policies and undisclosed pre-existing diseases, according to data compiled by insurance aggregator Policybazaar. The analysis was based on data derived from about two lakh claims made between April and September. Out of these claims, about 30,000 were rejected.

Here are some of the key findings of the analysis:

• A significant proportion of 25 per cent of the claims get rejected due to not disclosing pre-existing conditions like diabetes or hypertension
• Claims that are outside coverage also take up a considerable 25 per cent rejection volume, including claims filed for ailments as well as at OPDs that were not covered at a 16 per cent rejection rate and also daycare claims that were not payable at a 9 per cent rejection rate
• About 18 per cent of the claims get rejected because of an incomplete waiting period (the policyholders filed a claim before the end of the waiting period after buying the policy)
• Non-submission of queries accounts for more than 16 per cent of the claims rejected
• Additionally, 4.5 per cent of the claims get rejected due to wrongly filed claims with exhausted limits, taking up 2.12 per cent of the share
• In cases where the policyholder cannot justify their hospitalisation, the rejection rate is 4.86 per cent, including cases that did not meet the criteria as per the policy

The data revealed that the highest number of rejected claims, or 53 per cent of the rejected claims, was in the sum insured category of Rs 5 lakh, whereas the lowest number of rejected claims, at 2 per cent, was in the Rs 50 lakh-Rs 1 crore category, according to Policybazaar.

Catch the latest stock market updates here. For all other news related to business, politics, tech, sports, and auto, visit Zeebiz.com.