Infomediakunet | Want to Apply for Health Insurance? Pay Attention to the following things
Many people do not know that health insurance will be very beneficial if taken while still healthy. Because most health insurance companies will reject claims if you find a history of diseases that you have obtained before having health insurance. Finally, the insurance that is owned becomes less useful or its function cannot be maximized.
It should be noted that the submission of a claim by a health insurance participant can be accepted by health insurance if the disease claimed was not suffered by you prior to the creation of health insurance.
Because if the opposite is true, the auto insurance company will not accept your application, even though the medical checkup has proven that at that time you do not have the disease that you claim.
Some health insurance policies generally apply the following general conditions:
In this provision, the health insurance policy will not cover or cover the cost of treatment for diseases that have been suffered before becoming a health insurance policyholder.
For example, before registering as a health insurance policyholder you already have high blood pressure. Therefore, health insurance will not accept claims for your high blood pressure disease if it recurs at any time.
More specifically, several conditions fall into the Pre-Existing Condition category, namely:
This condition has been described above, where the health insurance policyholder has a history of disease that has occurred or has been owned before becoming a health insurance policyholder.
“The cause of the disease is known or has been known”
“Cause of disease” is a factor that can affect the onset of illness in a health insurance policyholder, or there are already symptoms that can trigger certain diseases.
For example, you have disorders such as dizziness, shortness of breath, chest pain, and cold sweats, and nausea which can lead to one particular disease, namely heart disease.
Therefore, if after you become a health insurance policyholder then you experience heart disease, 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 health insurance policyholder.
In addition, the results of laboratory tests or other investigations that can be used as authentic evidence of the condition of the health insurance policyholder having the possibility of certain conditions or diseases prior to the issuance date of the health insurance policy or the date of the change in the clause, are taken the latest date.
1. Waiting Period of 30 Days (All Diseases)
Health insurance policies stipulate that policyholders cannot file a claim for the same disease within 30 days after the first disease claim was filed. This applies if the illness suffered by a health insurance policyholder is given treatment or treatment by the hospital by being an inpatient at the hospital.
If the treatment or medication is carried out in an outpatient manner without being hospitalized, the 30-day waiting period provision does not apply.
Health insurance policyholders can file the same disease claim 3 days after filing the first claim of the same disease or based on a recommendation/certificate from a doctor when to return to the doctor to control the progress of the disease.
Health insurance policyholders can claim different diseases at an unspecified time. In the sense of being able to claim back a different disease on the same day. For example, you file a claim for flu at the hospital, at that time you can file a claim for illness / high fever/fever on the same day.
2. Waiting Period of 12 Months (Special Diseases)
For special diseases, health insurance policies specify a waiting period of 12 months or 1 year. This treatment or treatment is usually carried out in an inpatient manner because of special handling until the patient with the disease is completely cured. 17 special diseases that have been designated as special diseases by all health insurance policies, including:
- All types of hernias.
- All types of tumors / lumps / cysts / cancer.
- The disease of the tonsils or adenoids.
- Abnormal conditions of the nasal cavity, nasal septum, or nasal shells (konka), including the sinuses.
- Thyroid gland disease.
- Hysterectomy (with or salpingo-oophorectomy).
- Heart and blood vessel (cardiovascular) disease, including all types of stroke.
- Hemorrhoids and fistulas in the anus.
- Stones with the bile duct system.
- Kidney, urinary, or bladder stones.
- Gastric or duodenal ulcers.
- All types of reproductive system disorders, including fibroids/myoma in the uterus.
- Intervertebral disc prolapse.
The Steps for Submitting a Health Insurance
If you have confirmed the points above, now is the time to understand the steps that can help you submit a health insurance claim.
- When you are admitted to the hospital and need to be admitted, you first need to call the insurance agent and let them know that you are being treated. The insurance agent will later tell you what steps you need to take. Some insurance companies also provide representatives at the hospital who can assist you with the claim process.
- Keep all medical transaction receipts for reimbursement purposes.
- When you have been discharged from the hospital, immediately start the claim submission process by filling out the claim form. You can get this form by downloading it from the insurance company’s website.
- Do not delay the claim process, because most insurance companies only accept health insurance claims no later than 30 days after the incident.
- Follow the claim procedure which you can usually take in three ways:
- Submit the original claim form and supporting documents manually to the health insurance company office.
- Upload claim forms and claim documents online via the website.
- Upload the claim form and claim documents.
- After you send the claim form and supporting documents, the insurance company will then check the completeness of the documents to be confirmed to the customer.
- If your documents are complete and your claim is accepted, the insurance company will pay your medical expenses according to the protection benefits stated in the policy.
Understand the Risks of Applying for Insurance
From the long explanation about apply for health insurance above, it can be concluded that submitting a health insurance claim has the possibility of being rejected due to the evidence that can be submitted by health insurance, such as filing a claim for an illness that has been suffered before becoming a health insurance policyholder.
Basically, insurance wants healthy participants. Because the risk as an insurance company is to cover the cost of treatment/care for health insurance policyholders.
There will be a possibility that the cost of care/treatment of health insurance policyholders is greater than the premiums paid by health insurance policyholders. Therefore, insurance companies also do not want to accept potential participants with unhealthy body conditions.