After a health insurance policy is issued, the insurance company will send the policy document to you. You’ll receive a soft copy of the policy document on your registered email id and some insurers may also send a hard copy to your address. This policy document serves as proof of the agreement between you and the insurance company. It contains all the details about the insurance policy you purchased, such as your personal information, coverage-related details, etc.
It is essential that you read the policy document carefully and check that everything is mentioned correctly. Why? So that you don’t face any problems when you apply for a claim in the future. But, what are things you must check after you receive the policy document from the insurer?
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Things To Check After You Receive Your Health Insurance Policy Document
Here’s a list of things you must check as soon as you receive your health insurance policy document from the insurance company -
Check your personal details as well as the details of all the family members covered under the policy. See if information such as name, age, date of birth, etc. are mentioned correctly.
If there is an error, it may cause a problem during the claim process. So, make sure you notify the insurer and have it corrected as soon as possible.
Proposer And Insured Details
Next, check if the details of the proposer and the insured are mentioned correctly in the policy document.
- The proposer, also known as the policyholder, is a person who proposes to enter into a contract with the insurance company.
- The insured is the person who is protected against the risk under the policy.
- In most cases, the proposer and insured are the same person. They can be different in some cases, especially if there is an insurable interest. For example, if you buy a policy for your spouse, then you’ll be the policyholder and your spouse will be the insured.
Your communication details, such as your email address, phone number, postal address, etc. are very crucial because the insurer will send alerts related to your policy via these mediums. So, you must ensure that they are properly mentioned in the policy document.
Let’s say the postal address is not mentioned correctly in the policy document - and you fail to notice it. A few weeks later, there is a slight change in the terms and conditions of your policy. Your insurer sends such details via a letter on their letterhead, but it never reaches you because your address is incorrect. When you make a claim in the future, this can cause problems.
Hence, it is very important that you review your policy document for any inaccuracies in the communication address and have them corrected by the insurer.
Some health insurance policies, such as personal accident insurance or critical illness insurance, will pay the sum insured to the appointed nominee in the event of an unfortunate circumstance.
Hence, it is crucial that you verify your nominee's name, age, and relationship are mentioned properly in the policy document. The information must be accurate so that your nominee does not have to jump through hoops at the time of claim.
A pre-existing disease is defined as any condition, ailment, injury, or disease that is diagnosed or treated by a physician 48 months before the date of issuance of a health insurance policy.
The insurance company needs this information to assess the risk you pose to them. If you mentioned details about pre-existing diseases in the proposal form, they must be included in the policy document under the section on pre-existing illnesses.
If the section is left blank or contains incorrect information, notify the insurer as soon as possible and have it corrected. If you do not have it fixed, you may encounter difficulties when filing your claim.
The sum insured is the amount up to which the insurance company will provide coverage in the event of a claim. You must ensure that the sum insured specified in the policy is the same as the sum insured you selected when purchasing the policy.
Riders are add-ons that you can purchase with your health insurance policy to enhance the scope of your coverage.
If you have opted for any riders with your policy, check if the name, cover amount, etc. of the rider are included correctly in the policy document. If any details related to riders are missing or mentioned incorrectly, get them rectified.
The policy tenure is the period of time during which your policy will be active and you will be covered.
You must check if the policy's start and end dates are stated correctly in the policy document. In case of any errors, make sure to inform the insurance company and have it corrected as soon as possible.
Every policy that is purchased from an insurance company is identified by a unique number known as the policy number. It is a unique identification number that is used to identify your policy, and insurers save your information with this policy number for easy tracking.
In the event of a claim, the insurance company will be able to retrieve your information quickly if you give them your policy number. So, when you receive your policy document, make sure you check if the policy number is mentioned - to avoid any hassles during claim.
TPA Details/Claims Helpline Number
If your insurance company has tied-up with a third-party administrator (TPA), the policy document will include the TPA's phone number, address, email address, etc. TPAs are licensed by IRDAI and they process the claims on behalf of the insurance company. In case the insurer has a dedicated claims team, the policy document will include the phone number to contact that team.
Make sure to verify the policy to see if such information is provided. You can also add these details in your contact list so that it is easy to find in an emergency.
Network hospitals are those that have an agreement with your insurance company for providing cashless treatments. They are listed by either the insurance company or the insurer’s third-party administrator (TPA) to facilitate cashless claims.
You can go through the list of network hospitals mentioned in the policy document and make a note of it. This list may come in handy when you or your family members who are covered under the policy need to be hospitalised.
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Process Of Correcting Errors In The Policy Document
If you find any information in the policy that is incorrect, such as your personal information or coverage details, here’s how you can have it corrected -
If you discover an error in the policy, the first thing you should do is notify your insurance company. This can be done either by -
- Calling their toll-free number
- Sending them email
- Visiting their branch office
- Some insurers also provide an option to make certain corrections online. If your insurer provides this option, you can go to their website and make the changes there.
- Next, you’ll have to explain the correction that needs to be made in the policy document
You might be asked to provide specific documents by the insurance company for verification depending on the changes that need to be made.
For example, if there is a spelling mistake in your name in the policy document. So, when writing an email to the insurer, make sure you mention the spelling error and the correct spelling that needs to be written. The insurance company may request proof of identification to verify the same.
- When the insurance company receives the details and the documents, they will make the necessary changes, and send you a corrected document with the updated details.
So, these are the things you must check as soon as you receive your health insurance policy document from the insurance company. If there are any errors, make sure you get them corrected at the earliest to avoid difficulties at the time of claim.