Tricks to Apply for Health Insurance – Many do not know that health insurance will actually be very useful if taken while still healthy. Because most health insurance will reject claims if a history of illness is found that has been obtained before having the health insurance. Finally, the insurance owned becomes less useful or cannot be maximized its function.
It should be noted that the submission of a claim by a medical insurance participant may be accepted by health insurance if the claimed illness was never suffered by you prior to the creation of medical insurance. Because if it is the other way around, then the insurance company will automatically not accept your application, even though the medical checkup has proven that at that time you did not have the disease you claimed.
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Tricks to Apply for Health Insurance
Some health insurance policies generally stipulate the following general provisions:
Pre-Existing Condition
In this provision, the health insurance policy will not cover or cover the medical expenses of diseases that have been suffered before becoming a medical insurancepolicy holder.
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For example, before registering as a health insurance policyholder you already have high blood disease. Therefore, medical insurance will not accept your high blood disease claim if it recurs at any time.
More fully, some of the conditions that fall into the Pre-Exsisting Condition category are:
Existing
This condition has been explained above, where the health insurance policy holder has a history of illness that has occurred or has been owned before becoming a health insurance policy holder.
The cause of the disease is known or ever known
The “cause of the disease” in question is a factor that can influence the onset of the disease in the health insurance policyholder, or there are already symptoms that can provoke certain diseases. for example, you have disorders such as dizziness, shortness of breath, chest pain, and cold sweats and nausea which can refer to one particular disease, namely heart disease.
Therefore, if after you become a medical insurance policy holder then experience heart disease, then the health insurance policy will reject your claim related to heart disease. This is because you already have a cause of heart disease before becoming a medical insurance policyholder.
In addition, the results of laboratory tests or other investigations that can be used as authentic evidence of the health insurance policyholder’s condition have the possibility of a certain condition or illness before the date of issuance of the health insurance policy or the date of the change in clause, taken the most recent date.
1. 30 Days Waiting Period (All Diseases)
The health insurance policy has a provision that the policyholder cannot file a claim for the same disease within 30 days of the first disease claim being filed. This applies if the illness suffered by the medical insurance policyholder is given treatment or treatment by the hospital by becoming an inpatient at the hospital. if the treatment or treatment is carried out in an outpatient manner without hospitalization, the provision of a 30-day waiting period does not apply.
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In other words, the health insurance policyholder can file a claim for the same disease 3 days after the filing of the first same disease claim or based on the advice/certificate from the doctor when to return to the doctor for control of the progression of the disease. Medical insurance policyholders can file different disease claims indefinitely. In the sense of being able to re-claim a different disease on the same day. For example, you file a flu claim in a hospital, at that time you can file a claim for high heat disease/disorder/fever on the same day/moment.
2. Waiting Period 12 Months (Special Illness)
For special diseases, the health insurance policy sets a waiting period of 12 months or 1 year. This treatment or treatment is usually done by hospitalization because of special treatment until the patient with the disease is fully cured. The 17 specific diseases that to date have been designated as special diseases by all medical insurance policies, include:
- All types of hernias
- All types of tumors/lumps/cysts/cancers
- Tuberculosis
- Endometriosis
- Hemorrhoidal
- Diseases of the tonsils or adenoids
- Abnormal conditions of the nasal cavity, nasal septum, or nasal shells (concha), including sinuses
- Diseases of the thyroid gland
- Hysterectomy (with or salpingo – oophorectomy)
- Diseases of the heart and blood vessels (cardiovascular) including any kind of stroke
- Hemorrhoids and fistulas in the anus
- Stones with a bile duct system
- Kidney stones, urinary tract or bladder
- Cataracts
- Gastric or duodenal ulcer
- All types of reproductive system disorders, including fibroids/myomes in the uterus
- Intervertebral disc prolapsed
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Convey Information Must Be Honest (IMPORTANT)
In the policy clause, the insurance company usually sets the following conditions:
“In the event of providing information, statements, or explanations in the Life/Health Insurance Request Letter and/or Insurance Request Form for Prospective Dependents’ Data and/or its changes submitted by the Policyholder, there is an element of fraud and/or forgery, the Insurer has the right to refute the correctness of the Policy at any time so that it has the right to cancel the Coverage”
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From the above statement, the insurance company reserves the right to cancel the claim of the insurance policyholder if it obtains evidence that there is a lie of information about the state of health of the health policyholder. therefore, you should provide honest information to the medical insurance so that there are no unwanted events such as the cancellation of the claim you filed. The loss is on your side, because the insurance cannot return the premium you have given to the health insurance company and in return, your health is covered by health insurance.
Understand the Risks of Applying for Insurance
From the long explanation above, it can be concluded that the submission of a health insurance claim has the possibility of being rejected due to evidence that can be submitted by the health insurance company, such as filing a claim for illness that has been suffered before becoming a medical insurance policyholder.
Basically insurance wants healthy participants. Because the risk as an insurance company is to cover the medical/treatment costs of the medical insurance policyholder. It is possible that the medical/treatment costs of the health insurance policyholder are greater than the premiums paid by the medical insurance policyholder. Therefore, insurance companies also do not want to accept potential participants with unsanitary body conditions.
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