JAKARTA - Product Marketing and Health Services Allianz Life Indonesia Sukarno explained several reasons why claims for health insurance products by customers were rejected by insurance companies.
He explained the reasons why health insurance claims were rejected, among others, documents were incomplete, did not meet the policy provisions, outside the scope of the policy, and the policy was in a state of lapse.
Regarding not meeting the policy provisions, he gave an example, for example, health insurance, whose coverage area is in Indonesia, but undergoing treatment abroad, will be rejected because it is not in accordance with the provisions.
"Meanwhile, beyond the scope of the policy, for example, the mandatory benefits of inpatient health insurance, it turns out that the claim is not staying overnight, but outpatient treatment, this claim will be rejected," Sukarno said in a webinar entitled Allianz Media Workshop 2022- Life & Health Insurance 101 quoted by Antara, Wednesday, November 16.
In addition, other reasons, namely, included in the exception, have not gone through waiting, pre-existing conditions, and non-disclousure.
Regarding the exception, he gave an example, for example, health care aimed at aesthetics, for example to lose weight, will be rejected because it is not in accordance with the provisions of health recovery.
"Meanwhile, this pre-existing conditions is sick/injury that happened earlier, this is important to convey at the beginning, so insurance can select the risks later. If it is not conveyed, it will enter pre-existing conditions", said Sukarno.
During the application for insurance products, He emphasized that it is important to fill in according to the conditions and medical history of the insured candidate.
"Illah, according to the conditions and the appropriate and actual history," said Sukarno.
The English, Chinese, Japanese, Arabic, and French versions are automatically generated by the AI. So there may still be inaccuracies in translating, please always see Indonesian as our main language. (system supported by DigitalSiber.id)
