When buying health insurance, it is important to read the policy documents carefully and understand what the cover includes and what it might not.
Pay attention to coverage limits, exclusions, waiting periods and renewal conditions. What is qually important is providing accurate personal and medical details when filling out the application.
Leaving out medical information or giving incorrect details can create problems when you file a claim. In some cases, the insurer may reject the claim, leaving you to bear the treatment costs despite having paid premiums over the years.
However, the rules also provide some protection to policyholders who may have missed disclosing certain details. The Insurance Regulatory and Development Authority of India (IRDAI) has introduced a five-year moratorium period for health insurance policies.
Under this provision, once a policyholder has completed five continuous years of coverage, the insurer generally cannot question the policy or reject a claim on grounds of non-disclosure or misrepresentation. The exception is established fraud. In other words, after five years of continuous coverage, insurers have limited grounds to contest claims over information that was not disclosed or was incorrectly reported when the policy was taken.
This makes it important to maintain continuous coverage and understand the protections available under the policy.
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What To Know About This Rule
- You must maintain your health insurance policy continuously for five years. Otherwise, your five-year clock will reset in case of policy discontinuation.
- If you increase your sum assured during this period, the newly added amount starts its own fresh 5-year moratorium period.
- Insurers can still reject your policy in cases of established fraud. However, this is not something that can be done casually. The insurance company must have valid evidence to support its allegation.
- If your insurer rejects your claim despite you having completed five years of continuous coverage, always ask for a written explanation with proper reasons and supporting documents. You can then use this document to challenge the rejection if it violates IRDAI guidelines.
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