Trigger Rejection Of Health Insurance Claims, Get To Know More About What Is Pre-Existing Condition

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JAKARTA - Some time ago, a public figure made a scene by complaining about being a customer of domestic health insurance products. In his upload, he was disappointed because he couldn't get the protection benefits he needed, despite paying health insurance premiums for years.

After being investigated, it turned out that the root of the problem was the limitation of submitting a health insurance claim due to a pre-existing condition. In these insurance products, health insurance service providers generally have provisions for pre-existing conditions which can lead to the cancellation of the agreement and protection claims.

So, what is meant by this pre-existing condition and how do you get around it so that you can get the maximum benefit of health insurance? To answer this question, the following review is worth listening to.

What is a Pre-Existing Condition in Health Insurance?

Pre-Existing Condition is generally defined as a medical or health condition that has been suffered by the insured before applying for health insurance or the policy is valid. This makes the health insurance company to provide exemption protection or insurance benefits to its customers.

For example, a health insurance customer suffers from a congenital heart disorder and has suffered before applying for an insurance policy. Then, when applying for a health insurance claim or life insurance, the congenital health problem was not conveyed to the insurance company.

Thus, after the insurance policy is in effect and the customer intends to file a claim against the illness, the insurer cannot give approval. In the end, submitting a claim resulted in rejection and the benefits of the insurance product could not be felt. This problem is often felt by health insurance customers who do not understand the rules for pre-existing conditions.

How to Anticipate Pre-Existing Conditions

Cancellation of health insurance claims due to the rules of this pre-existing condition can actually be avoided in several ways. The first is to provide information regarding the medical and medical history of prospective policyholders in a transparent and open manner.

That way, the insurance provider can consider and decide to accept the service application made by the prospective customer based on any medical conditions or health risks he suffers.

Even if it is accepted, the health insurance will usually add some special requirements. This special requirement is generally in the form of delaying the application of coverage for diseases that may arise from the pre-existing condition.

Usually, coverage for the disease only applies after a certain time limit or period, for example 1 or 2 years after the health insurance policy is active.

So, to anticipate special rules for conditions or illnesses that have been suffered by health insurance customers, you need to clearly inform the medical history to the insurance service provider in order to create a win-win solution for both parties.

Solutions for Choosing the Right Health Insurance so You Don't Feel Lost

Actually, the problem regarding refusal to submit a health insurance claim due to a pre-existing condition is not entirely the customer's fault. The insurance provider should also provide clear education to prospective customers through their insurance agents regarding this matter in order to avoid the risk of misinformation.

On the other hand, the public also needs to understand the clauses or explanatory points written on the health insurance policy. That way, if it turns out that there are articles that you feel are detrimental, do not match your needs, or are not clearly understood, you can file an error.

It should be understood that after registering for insurance, the policyholder has time to observe and study the contents of the policy to be issued. This time is called the free look period.

In this period, if there is a policy clause that is deemed inappropriate to the needs or agreement, the policyholder may decide to cancel the insurance contract and get the premium paid back. Generally, the duration of this free look period is 14 days after the customer gets a health insurance policy.

Of course, you need to make the most of this period by understanding all the points written in the policy that has been issued. That way, the risk of getting a health insurance product whose protection benefits do not match your needs can be avoided.

Transparency Can Prevent Health Insurance Customers from Feeling Harm Due to Pre-Existing Conditions

In general, rules related to pre-existing conditions are owned by almost all health insurance products and need to be considered by potential customers. In order for the application process to run smoothly and policies issued according to needs, there needs to be information disclosure between insurance companies through their agents and prospective customers during the application process.