IRDAI Makes Health Insurance Claims Non-contestable after 8 Years of Paying the Premium

The Insurance Regulatory and Development Authority of India (IRDAI) in its latest guidelines has prohibited insurance companies to contest health insurance claims after 8 years of receiving premiums. The insurers also have to pay an interest of 2% above the bank rate to the policyholder for a delay in claim payments, applicable from the date of receiving all the documents.

Read More

Policybazaar exclusive benefits
  • 30 minutes claim support*
  • 50,000 claims approved in last 15 months*
  • Schedule home visit with our advisors
  • Get a plan based on your medical needs

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Back
All health plans cover Covid-19 treatment
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    Continue
    By clicking on “Continue”, you agree to our Privacy Policy and Terms of use
    Previous step
    Continue

      Popular Cities

      Previous step
      Continue
      Previous step
      Continue

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      What is your existing illness?

      Select all that apply

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step
      Advantages of
      entering a valid number
      You save time, money and effort,
      Our experts will help you choose the right plan in less than 20 minutes & save you upto 80% on your premium

      This new amendment does not permit the Health insurance companies to contest claims if the policyholder has been paying premium continuously for a period of 8 years. The guidelines are issued in order to standardise and simplify the indemnity-based medical insurance terms and conditions. It is not applicable to personal accident and international and domestic travel insurance plans. The idea is to bring uniformity across the health insurance industry.

      It further mentions that the health insurance contracts that are not in compliance with these new set of guidelines need to be modified when they are due for renewal on or before April 01, 2021.

      As per the guidelines issued on Standardization of General Terms and Clauses in Health Insurance Policy Contracts, this duration of 8-years is also termed as the moratorium period, which would be applicable to the sum insured of the first health insurance plan. The moratorium of 8-years applies would be applicable from the sum insured enhancement date only on the enhanced limits.

      After expiry of eight years of moratorium period the medical insurance claims are not contestable unless it is a fraudulent act or is mentioned under the policy exclusions. However, the co-payments, sub-limits, deductibles shall follow as per the Mediclaim policy contract.

      Moreover, at the time of claim settlement, IRDAI instructs the insurers to reject or settle health insurance claims within 30 days on receiving the last essential document. And if the claim settlement is delayed, then the insurance company would be liable to pay interest to the insured at a rate of 2% above the bank rate. Any misinterpretation or non-disclosure by the policyholder would call for fortification of the premium paid and the policy will be cancelled.

      And if the policyholder needs to port the policy as per the guidelines, he can do that and port it for all the family members and it needs to be done a minimum of 45 days before the renewal date. And if someone is insured under a health insurance policy at present and has been paying the premium continuously without any lapses, the proposed policyholder will get the accrued benefits of the waiting periods.

      Search
      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      Health insurance articles

      Recent Articles
      Popular Articles
      Should You Buy a Super Top-up Health Insurance Policy?

      18 Jan 2023

      India is abuzz with a variety of health insurance plans to cater
      Read more
      6 Reasons Why Your Cashless Health Claims Can Get Denied

      18 Jan 2023

      Cashless claims are one of the most lucrative benefits of buying a
      Read more
      Check Out the Mandatory KYC Documents for Health Insurance

      30 Dec 2022

      The Insurance Regulatory & Development Authority of India
      Read more
      What to Look for in a Health Insurance for Cancer Plan?

      20 Dec 2022

      Cancer is one of the biggest demons that the world faces today
      Read more
      What are the Factors Affecting Health Insurance Premium?

      20 Dec 2022

      Demand for insurance products in India, especially health
      Read more
      What are the Normal Thyroid Stimulating Hormone (TSH) Levels as Per Age?
      The thyroid gland is an important gland responsible to produce the right amount of hormones for normal body
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal
      Read more
      Income Tax Slab for Women: Guide to Exemptions and Rebates
      In India, every person who earns beyond a certain limit is liable to pay income tax to the government. The tax
      Read more
      Best Health Insurance Plans for Senior Citizens in 2023
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance
      Read more
      10 Major Benefits of Ayushman Bharat Yojana
      Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat Scheme. PM Narendra Modi
      Read more

      top
      Close
      Download the Policybazaar app
      to manage all your insurance needs.
      INSTALL