What to Do After Buying a Health Insurance Policy

Neha bought a policy and filed it

Neha bought her first individual health policy last month, which was the right decision and the hard part. The document arrived by email, she saved it somewhere sensible, and that was the end of it.

If she needs it in four years, several things will determine whether the claim goes smoothly, and every one of them is decided now rather than then. None takes long. All of them are easier while the purchase is fresh and while nobody is unwell.

Read the policy once, looking for four things

Not the whole document. Four specifics, which are the ones that decide what happens at claim time.

What is excluded, and for how long. Every policy has waiting periods — for pre-existing conditions, for specified treatments, and an initial period during which most claims are not paid. Write those dates in a calendar. Knowing that a particular condition is covered from a particular month is worth more than a vague sense that "it takes a few years".

What the limits are. Room-rent category, co-payment, and any sub-limits on specific treatments. These decide how much of a bill the policy pays, and a reader who knows their room-rent category will choose a room that does not scale the whole claim down.

What is covered before and after hospitalisation. Most policies pay for a period of consultation and tests before an admission and for follow-up afterwards. People routinely fail to claim these because they did not know to keep the receipts.

What is not hospitalisation but is still covered. Day-care procedures, and increasingly a list of modern treatments. These are commonly assumed to be excluded and frequently are not.

Check what you told them

This is the most consequential item on the page. The single most reliable way to have a large claim rejected is a discrepancy between the medical history on the proposal form and the history that emerges when a claim is investigated.

What was declared on her behalf is worth reading, particularly if an agent completed the form. If anything is missing — a condition, a medication, a past procedure, a family history question answered too quickly — it is worth having added in writing now.

Insurers can and do reject claims on non-disclosure, and the fact that the omission was accidental, or made by somebody else filling in the form, is a much weaker defence than most people assume. Correcting it while healthy costs nothing and may result in a loading or an exclusion, which is enormously better than a rejected claim.

Set up the practical things

Register on the insurer's app or portal and check that the policy appears there, since that is where the e-card and the claim process live.

Save the health card and the policy number somewhere reachable from a phone, because the moment they are needed is a moment when nobody wants to be searching an email archive.

Find the network hospitals near home and near work, and check which of the hospitals the family would actually choose are on the list. Cashless treatment is available at network hospitals, and knowing which ones in advance removes a decision at the worst possible time.

Note the insurer's claim intimation window — the period within which they must be told about an admission — and the number to call. Planned admissions usually require pre-authorisation, and emergencies usually require notification within a stated period.

Tell somebody else

A policy only Neha knows about protects a family that cannot find it.

At least one other person should know the insurer, the policy number, where the documents are, and that the policy exists at all. This applies with more force to anybody living alone, and it is the same problem as the family financial continuity file, which has its own page.

Then set two recurring reminders

The renewal date matters more than anything else in this article. A lapsed health policy restarts the waiting periods, which destroys the accumulated value of having held it — and a policy can lapse over a failed payment on a card that expired. Set the reminder for a fortnight before, and set up auto-payment.

The second reminder is annual: check whether the sum insured is still adequate. Medical costs rise faster than general prices, and a sum insured chosen years ago quietly becomes a smaller amount of protection every year it is left alone. Many policies allow an increase at renewal, subject to underwriting, and doing it early is easier than doing it after a diagnosis.

Keep the paperwork habit

Keep every hospital bill, prescription, diagnostic report and discharge summary, since claims are paid on documentation and reimbursement claims are rejected on missing paper more often than on disputed treatment.

Keep them for the pre- and post-hospitalisation window too, which is the part people throw away.

What to take away

Read the policy once for exclusions, limits, waiting periods and what is covered outside a hospitalisation. Check that your declared medical history is complete and correct it in writing now if it is not, because that is what most large rejected claims turn on.

Register on the portal, save the card where a phone can reach it, know your network hospitals and your intimation window, and make sure somebody else knows the policy exists. Then set a renewal reminder and an annual reminder to check the sum insured is still enough — because the two ways a good policy fails are lapsing and never growing.