Buying Health Insurance? Key Details You Must Disclose to Avoid Claim Rejection

Health insurance is meant to provide financial protection during medical emergencies. Yet many policyholders are surprised when their claims are delayed or even rejected despite having an active policy. In most cases, the issue does not arise at the time of hospitalization but much earlier — while filling out the proposal form.

Understanding what information must be disclosed to the insurer can help you avoid unnecessary complications during claim settlement. Here is a detailed guide on what you should always declare when purchasing a health insurance policy.

Why the Proposal Form Is So Important

When buying health insurance, most people focus on coverage amount, premium cost, and the list of network hospitals. However, the proposal form is the foundation of the contract between you and the insurance company.

This document records your medical history, lifestyle details, and previous insurance background. Insurers assess risk and determine policy terms based entirely on the information you provide in this form. Any incorrect, incomplete, or misleading detail can create problems at the time of claim processing.

The proposal form is not a mere formality. It is a legal declaration that shapes the conditions of your policy.

Always Declare Pre-Existing Diseases

One of the most common reasons for claim disputes is non-disclosure of pre-existing illnesses. If you have been diagnosed with conditions such as diabetes, high blood pressure, thyroid disorders, asthma, heart disease, or any other chronic ailment, you must disclose them.

Even if the condition is under control through medication and does not currently cause discomfort, it should still be mentioned. Insurers apply waiting periods and specific terms for pre-existing conditions. Hiding such details may lead to claim rejection later if medical records reveal prior treatment history.

Transparency at the beginning can save significant stress during emergencies.

Mention Past Hospitalizations and Surgeries

Have you ever been admitted to a hospital? Undergone surgery? Received treatment for a major illness — even years ago?

All such details must be disclosed. Insurers consider your complete medical history when assessing risk. Even if the treatment occurred long ago and you are now healthy, it remains relevant information.

Failure to mention past hospitalizations can result in disputes if medical documents submitted during a claim reveal earlier treatment.

Ongoing Treatments and Medications Matter

If you are currently taking medication, under medical observation, or consulting a specialist for any symptoms, this should be clearly stated in the proposal form.

Many people assume that minor issues do not need to be disclosed. However, from an insurer’s perspective, every medical fact is important. A seemingly small condition today could become relevant during future hospitalization.

Full disclosure ensures that your policy terms are defined correctly from the start.

Answer Lifestyle Questions Honestly

Insurance companies typically ask about lifestyle habits such as smoking, alcohol consumption, and body weight. These questions are part of the risk evaluation process.

Providing inaccurate or incomplete answers may not cause immediate issues, but discrepancies can surface during claim investigation. Medical reports often reveal lifestyle-related factors, and inconsistencies between records and the proposal form can complicate claim approval.

Honesty in answering lifestyle questions protects you from potential disputes.

Disclose Previous Insurance History

If you have held a health insurance policy before, you should mention it. Inform the insurer if:

• Your previous policy included special exclusions

• Certain illnesses were not covered

• A proposal was rejected

• Claims were filed in the past

Sharing your insurance history promotes transparency and reduces the likelihood of claim complications later.

Claims Are Settled Based on Agreed Terms

According to industry experts, every health insurance claim is processed under a defined and regulated framework. Decisions are based on the terms and disclosures agreed upon at the time of policy issuance.

If medical records reveal a condition that was not declared earlier, insurers may apply waiting periods or other policy rules during claim evaluation. However, when documentation is clear and disclosures are complete, most claims are processed smoothly.

Treat the Proposal Form as an Opportunity

Financial advisors recommend viewing the proposal form not as a burden but as an opportunity to present an accurate picture of your health profile.

The more complete and transparent your disclosures, the easier the claim process will be in the future. Health insurance is designed to provide financial relief during difficult times. A few extra minutes spent carefully filling out the proposal form can prevent significant stress later.

In the end, honesty and attention to detail at the time of purchase are the strongest safeguards against claim rejection.