Should we disclose newly diagnosed medical conditions at the time of renewals or just keep quiet?
There is a saying, “You should never hide anything from your doctors and lawyers. Doctors give you the right direction to your present and lawyers give the right picture to your future”. Nothing could be truer for health insurance as well! A good health insurance plan takes care of your present and future medical expenses by covering you for unanticipated as well as intended medical treatments. So, to secure your current and subsequent medical costs and to continue availing policy benefits, it is important that all your health-related details are consistently and truthfully shared with the health insurer.
It is well known that one must disclose all previous and ongoing medical conditions at the time of purchasing a health insurance policy. Given that health insurance is an annual plan, one should keep renewing the policy every year to continue coverage. Once the policy is issued, medical expenses arising from any condition that subsequently develops can be claimed from the insurer, subject to the waiting period they have specified. For example, if you develop a condition 1 year into your policy, for which the waiting period is 3 years, you will have to bear the expenses for the same by yourself for 2 years and thereafter the policy will cover it.
The onus is on the policyholder to be truthful and transparent. Keeping quiet and withholding information about any newly diagnosed condition will have immediate or long-term adverse implications such as:
- Claim rejection or denial: Your medical records are sought by the insurance company at the time of claims submission. If the newly diagnosed medical condition is revealed in the health records, insurance companies can deny or reject claims due to non-disclosure.
- Pre-existing disease conditions: If the newly diagnosed medical condition is one identified by the insurance company as PED, the claim could get rejected and the policy could get cancelled. Non-disclosure of a pre-existing medical condition is one of the top three reasons for claim rejection.
- Cancellation of policy: If the insurance company feels that there has been gross misconduct due to extreme and intentional non-disclosure, they could cancel the health insurance policy. This would leave the policyholder completely uninsured and vulnerable.
- Other family members suffer: In case of cancellation of a family floater policy due to non-disclosure, the other insured members would also lose medical coverage for no fault of their own.
- Repeat serving of waiting periods: In cancellation cases, the policyholder and other insured members have to forego all the waiting periods that were served thus far. If and when they apply for another policy, they will have to begin serving waiting periods for as long as the new health policy specifies.
- Financial impact: If a claim is rejected the insured member or policyholder would have to pay for the treatment cost themselves. Besides, upon cancellation of health insurance all premiums paid till then would have to be written off since there are no grounds for any refund. If the policy was active for long then the financial impact would be that much higher.
- Adverse impact on future coverage: If the policy has been cancelled or the claim was rejected and the policyholder tries to apply for health insurance with another insurer, then this information would have to be divulged at the time of fresh application. The new insurance company will take a call at that time, whether or not to issue the policy. Insurance companies do their due diligence to reveal such details. Plus, your previous medical records could reveal the newly diagnosed condition, which when submitted to the new insurer could cause claim-related issues in future.
To avoid these issues, it is best to disclose all facts about your health and medical condition to the insurance company whenever it arises.
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Wish you a healthy and happy life!