I recently raised a health insurance claim, but did not receive the full settlement. Why was it so?

Gopal Vaidya, Bhopal

Not receiving the full claims settlement could be due to several reasons. For instance, it could be because of the co-pay clause, wherein a specified percentage is to be borne by you. Normally, co-pay is applicable for people above a specified age, or for specific ailments, or could have blanket applicability in all situations.
Likewise, the cashless settlement could be lesser than the actual costs because of sub-limits in the policy, such as cap on room rent. In case the claim breaches this limit, the insured has to bear the incremental costs on the room and any medical costs linked to the room facility. What it means is that for the same treatment, a doctor’s fee may vary depending on the room that you opt for. Moreover, there are non-medical expenses such as admission charges, registration charges and consumables which are not covered by insurance. If you have paid some part of the insurance claim, it could be owing to any of the above possibilities.

olmdesk@outlookindia.com