What To Check Once You Receive Your Health Insurance Policy Document?

Buying health insurance for yourself and your family is a commendable act. You may think that your responsibility ends after purchasing and receiving a policy document, but this is far from the truth.

Your health insurance policy document is a proof of contract between you and the insurance company. Furthermore, it serves as a guide to your coverage, benefits, exclusions, claims procedure, etc. So, ensure that you read the policy document carefully and that everything is mentioned correctly. By doing this, you can avoid problems in the future if you ever have to file a claim. 

But! But! But! What are the things you must check after you receive the policy document from the insurer? 

Let's take a look!

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Here's a checklist of things you should check after receiving your health insurance policy document from the insurer:

👉 Personal Details
Ensure that your personal information, such as name, age, date of birth, etc., is correctly specified in the document. Also, verify whether your family members' details are accurate as well. Any discrepancy could cause complications at the time of claim. So, make sure you contact your insurer and have it corrected as soon as possible.

 👉 Proposer And Insured Details
The next step is to check if the insured and proposer details are correctly mentioned in the policy. Here, the proposer (policyholder) is the person who enters into a contract with the insurance company and the insured is a person who is protected by the policy from possible risks. The proposer and the insured can either be the same or they can differ - particularly when an insurable interest is involved. Say you purchase a policy for your child. Here, you are the proposer and your child is the insured.

👉 Contact Details
Ensure the policy document contains the correct contact information, such as your email address, phone number, postal address, etc., as all important updates or alerts will be shared via these channels. Say you fail to notice the incorrect email address in the policy document. And, there is an amendment to your policy a few weeks later. Your insurer sends an email to you regarding the recent update, but you never receive it because your email address is incorrect. This could lead to problems if you file a claim in the future. Hence, if there is a mistake in the communication details, contact the insurer and have them corrected.

👉 Nominee Details
In certain health insurance policies, such as critical illness insurance, personal accident insurance, etc. the sum insured will be paid to the nominee in case of an unfortunate event. You appoint a nominee at the time of policy purchase. The nominee can be anyone in your family - your spouse, your child, your parents, etc. Make sure the policy document specifies all the nominee's details, such as name, age, and relationship. These details must be accurate so that the nominee does not run into any hassles at the time of claim.

 👉 Sum Insured Details
The sum insured is the maximum amount that an insurance company will cover in the event of a claim. Make sure the sum insured specified in the policy matches the amount you selected at the time of policy purchase.

👉 Details Related To Pre-Existing Conditions 
Any condition, ailment, injury, or disease that was diagnosed or treated by a physician 48 months before the date of the policy issuance is considered a pre-existing condition. If you have a pre-existing condition, you need to disclose it to your insurer. In this way, the insurer can determine the degree of risk you pose to them. If you have mentioned details about any pre-existing diseases in the proposal form, you can find the same under the pre-existing illnesses section in the policy document. Suppose the section is blank or contains incorrect information, you should notify the insurer immediately. If you do not correct it, you may face trouble at the time of claim.

👉 Policy Tenure Details
Policy tenure refers to the period of time during which you are covered by your policy. Make sure the policy's start and end dates are correctly specified in the policy document. Any errors should be reported to the insurance company and corrected promptly.

👉 Policy Number
Every insurer uses a unique number to identify each policy, known as the policy number.

How does it help the insurer?
The policy number makes it easy for the insurer to access and track your information. If you file a claim, the insurer can easily find your policy details with your policy number and expedite the process.

Hence, make sure you check if the policy number is mentioned on your policy document when you receive it - to avoid any hassles during claims.

 👉 Rider Details
Riders are optional add-ons that can be purchased with your base policy at an extra cost. They widen your base coverage. If you have added any riders to your policy, ensure the rider details such as name, coverage, etc. are correctly reflected in the policy. If any details are incorrect or missing, make sure they are fixed.

👉 Network Hospitals Details
Network hospitals are a set of hospitals that have a tie-up with your insurance company for providing cashless facilities. They are listed by either the insurer or the insurer's third-party administrator (TPA) to provide cashless claim services. Make note of the list of network hospitals provided in the policy document. You may find this list useful if you or any of your family members need to be hospitalised.

👉 TPA Details/Claims Contact Information
The IRDAI licences third-party administrators (TPAs) to process insurance claims on behalf of insurance companies. If your insurance company has a tie-up with a TPA, the policy document will include the TPA's phone number, address, email address, etc. If the company has a separate team dedicated for claims, the policy document will contain their contact details. Ensure that such information is included in your policy. You can also store this information in your contact list - so that they are easily accessible in case of an emergency. 

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If you discover any inaccurate information in your policy, here's how you can fix it - 

1️⃣ Notify The Insurer
Your first step should be to inform your insurance company, if you find an error in your policy. You can either -

• Call their toll-free number
• Send an email to them
• Visit their branch office

 Note: Some insurers offer online correction facilities as well. In that case, you can make changes on the insurer's website.

2️⃣ Inform About The Corrections
After that, you'll need to explain what needs to be corrected in the policy document.

3️⃣ Submit The Proof Of Identification
Based on the changes that need to be made, the insurance company may ask you to submit specific documents. For example, let's say your residential address is incorrect in the policy document. In this case, you can contact the insurer by email - and mention the incorrect address as well as the correct address. Now, the insurer may ask you to submit a proof of address as part of the verification process.

4️⃣ Receive The Updated Document
Once the insurance company receives the relevant details and the documents, they will make the necessary changes and send you the corrected document. So, once you receive the policy document in hand, make sure you check all the details are correctly mentioned in it. In case there is any discrepancy or incomplete information, be sure to inform the insurer as soon as possible and have it corrected. This will prevent any difficulties during the claim process.

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