42-year old Yogesh Gupta, head of operations at a leading MNC, had availed a ₹50 lakh health coverage from an insurance company about two years back. Everything in his professional and personal life was going quite smoothly; Yogesh was at the top of his game. One fine day, however, in November 2017, Yogesh started feeling uneasy. He was finding it difficult to breathe and so his family took him to the hospital. The doctors told Yogesh that he needed to be admitted to the hospital, following which they conducted a few tests, including angiogram, to see what was wrong with him. The tests revealed that Yogesh had multiple blockages in his heart.
Yogesh then contacted OneInsure, which is the broker through whom he had purchased the particular cover, right away. OneInsure in turn contacted his insurance company to let the provider know that he was admitted in the hospital for surgery. Now, since the hospital that he was admitted in was not part of his insurance company’s network hospitals, Yogesh decided to go ahead with the operation and then file a reimbursement claim with his insurance company. After he was discharged, he approached OneInsure for reimbursement of his medical expenses. The broker collected all the necessary documents (few of the documents were missing, but OneInsure provided the necessary assistance and helped him get it) and Yogesh file a claim. However, post examination, it was found that the claim had been filed before the waiting period was over. He had a week to go until his pre-existing condition would be covered. (Note - A pre-existing condition is a medical condition that an insured individual suffers from prior to the date of purchase of a health cover. Health insurers generally have a waiting period of two years until they cover medical expenses associated with treating pre-existing conditions.)
To substantiate its claim, OneInsure collated all the necessary documents, which reinforced customer commitment towards maintaining good health. At the time of policy purchase, when it was found out that Yogesh suffered from hypertension during a health check up, the insurance company had advised him to eat right, take his medicines on time and participate in physical activities so that he stays fit. And so, Yogesh did – he never skipped out of his medicines, participated in at least two marathons a year and joined a joggers club. He even claimed for expenses from his joggers club under OPD. After OneInsure conveyed all of this information, the insurance company took a compassionate view, examined the claim and gave its approval. In the end, Yogesh stood to receive a sum of ₹3.25 lakhs in the form of reimbursement benefit from his insurance company.
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