Faced with Health Insurance Premium Hikes and Claim Disputes? Here’s What Policyholders Can Do

Health insurance is a critical financial safeguard, ensuring access to quality healthcare without excessive out-of-pocket expenses. However, many policyholders find themselves grappling with rising premiums and claim disputes, making it essential to understand how to navigate these challenges effectively.

Understanding Premium Hikes

Health insurance premiums tend to increase due to several factors, including:

Medical Inflation – Rising healthcare costs contribute significantly to premium hikes.
Policyholder Ageing – Older policyholders may see higher premiums due to increased health risks.
Claim Experience – Insurers may adjust premiums based on the claim history of the insured or the risk pool.
Regulatory Changes – New government policies or coverage mandates can impact premium structures.

What Policyholders Can Do About Premium Hikes

Compare Plans Before Renewal – Review different insurance providers and compare premiums, benefits, and exclusions. Switching to a more affordable policy with similar benefits may help reduce costs.
Opt for a Higher Deductible – Choosing a plan with a higher deductible can lower premium costs while still ensuring substantial coverage for major medical expenses.
Utilize No-Claim Bonuses – Some insurers offer discounts or increased coverage for policyholders who haven’t made claims in previous years.
Consider Family Floater Plans – For families, switching to a floater plan rather than individual policies can reduce overall premiums.
Wellness and Preventive Health Programs – Some insurers provide discounts to policyholders who maintain good health through wellness initiatives.

Handling Claim Disputes Effectively

Claim rejections or disputes can be frustrating, but policyholders can take the following steps to ensure a smoother claim process:

Understand Policy Terms Clearly – Carefully review the inclusions, exclusions, waiting periods, and sub-limits before purchasing or renewing a policy.
Maintain Proper Documentation – Keep records of all medical bills, doctor’s prescriptions, test reports, and hospital discharge summaries to support claims.
Engage with the Insurance Company – If a claim is rejected, request detailed reasons and provide additional documentation if needed.
Approach the Insurance Ombudsman – If the insurer fails to resolve the issue satisfactorily, policyholders can escalate their complaint to the Insurance Ombudsman for impartial resolution.
Seek Legal or Consumer Forum Assistance – As a last resort, policyholders can take legal action through consumer courts if their claim is unfairly denied.