Health Insurance - Delay in pay out

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You should know
  • Cancel an insurance policy within 15 days from the date of receipt of the policy document, if you disagree to any of the terms or conditions in the policy.
  • You can
    • Return the policy by stating the reasons for the objection.
    • You will be qualified for a refund on the premium paid. 
    • Any costs brought about by the insurer to attempt the maintenance of your policy will be deducted. 
    • If there should arise an occurrence of unit-linked insurance policy(ULIP) likewise, the insurer can repurchase the units at the cost on the cancellation date.

How to claim Health Insurance?

One can plea a claim against an event that is covered by the insurance policy. Following are two claim processes:

  1. Expense Reimbursement: You can get your medical expenses reimbursed by the insurer, based on the policy terms documented. Bed charges, medicines, lab tests, surgeon‘s fees etc. are paid back to the insured at the time of claim. You have to pay the (hospital) expenses but it will get reimbursed by the insurance company later.
  2. Cashless Treatment: Insurance companies provide you with a wide network of hospitals to get medical treatment without having to make upfront payments. No payment is required to be done by the insured, since the clause involves a mutual agreement between both the parties, i.e. the insurer and hospital. In contrast, availing cashless benefit requires TPA approval. The insured can also show the insurer-issued health card at the particular hospital as proof of medical insurance cover along with a valid government ID.

 

How to address an issue with Health insurance provider?

Before lodging a complaint with the health insurance provider, you have to approach the Grievance Redressal Office of the branch. You have to file the complaint in writing with associated documentation. A written affirmation will be given to you alongside the date of submission of the complaint. Generally, the insurance provider has to resolve the issue within 15 days. In case this does not happen, the issue can be escalated to the IRDA (Insurance Regulatory & Development Authority).

 

How to file a complaint with IRDAI?

To lodge a complaint with a health insurance provider with the IRDA, the policyholder has to get in touch with the Grievance Redressal Cell of the Consumer Affairs Department of IRDA via email or customer care helpline. You can use the Grievance Management System offered by the IRDA to monitor your complaint and its progress. You can also contact the Insurance Regulatory and Development Authority (IRDAI) via letter or fax.

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