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One in 4 medical health insurance claims get rejected because of a lack of know-how of insurance policies and undisclosed pre-existing illnesses, based on information compiled by insurance coverage aggregator Policybazaar. The evaluation was based mostly on information derived from about two lakh claims made between April and September. Out of those claims, about 30,000 have been rejected.
Listed here are a number of the key findings of the evaluation:
- A major proportion of 25 per cent of the claims get rejected because of not disclosing pre-existing circumstances like diabetes or hypertension
- Claims which can be exterior protection additionally take up a substantial 25 per cent rejection quantity, together with claims filed for illnesses in addition to at OPDs that weren’t lined at a 16 per cent rejection price and in addition daycare claims that weren’t payable at a 9 per cent rejection price
- About 18 per cent of the claims get rejected due to an incomplete ready interval (the policyholders filed a declare earlier than the top of the ready interval after shopping for the coverage)
- Non-submission of queries accounts for greater than 16 per cent of the claims rejected
- Moreover, 4.5 per cent of the claims get rejected because of wrongly filed claims with exhausted limits, taking on 2.12 per cent of the share
- In instances the place the policyholder can not justify their hospitalisation, the rejection price is 4.86 per cent, together with instances that didn’t meet the standards as per the coverage
The information revealed that the best variety of rejected claims, or 53 per cent of the rejected claims, was within the sum insured class of Rs 5 lakh, whereas the bottom variety of rejected claims, at 2 per cent, was within the Rs 50 lakh-Rs 1 crore class, based on Policybazaar.
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