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Missed Disclosure in Health Insurance: 3rd Year Confusion

Ramalingam Kalirajan |7758 Answers |Ask -Follow

Mutual Funds, Financial Planning Expert - Answered on Aug 28, 2024

Ramalingam Kalirajan has over 23 years of experience in mutual funds and financial planning.
He has an MBA in finance from the University of Madras and is a certified financial planner.
He is the director and chief financial planner at Holistic Investment, a Chennai-based firm that offers financial planning and wealth management advice.... more

Asked by Anonymous - Aug 12, 2024Hindi

How Do I Address a Missed Disclosure in My Health Insurance Application? Hi, could you please tell me what I should do to get everything sorted out in a proper manner? I bought Star Health Insurance two and a half years ago from an agent residing in our locality. At that time, to be frank, I didn't know much about health insurance. All I knew was that if something happened to me, hospital expenses would be covered by the insurance. In the past few months, through some reels, ads, and financial YouTube videos, I’ve learned a few things about health insurance, such as pre- and post-hospitalization cover, restoration benefit, room rent limit, co-payment, deductible, etc. That's why, on my 3rd renewal, I ported my Star Health Insurance to Niva Bupa. My question is that I used to smoke five years ago, but I didn't mention this on my application when I got health insurance from Star because I wasn't aware that I needed to declare my smoking habits. At the time of my application, I gave all my documents to my agent, and he didn't even ask me if I had smoked before or not; he just processed everything for me. I didn't intend to hide this information, as I was simply unaware. So, what should I do now? It’s my 3rd year, and my two-year waiting period has also been completed. I'm confused about how to handle this. If I report that I used to smoke five years ago, what will happen? Will I have to wait for the waiting period again or not?

Ans: It's important to address the missed disclosure to avoid future complications. Here's what you should do:

Steps to Take
Notify the Insurer:
Contact Niva Bupa and inform them about your past smoking habit. Transparency is key to avoid claim rejection.

Submit a Written Explanation:
Provide a written explanation, stating that the omission was unintentional due to lack of awareness. Mention that you quit smoking five years ago.

Medical Check-Up:
The insurer may ask for a medical check-up to assess any potential risks. This could help avoid future disputes.

No Waiting Period Reset:
Usually, if the insurer accepts your disclosure, the waiting period should not reset. However, confirm this with Niva Bupa to be sure.

Policy Terms:
Review your policy terms post-disclosure to understand any changes or exclusions that might apply.

Handling this promptly and honestly will ensure your coverage remains intact without issues during claim time.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.

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I am a mild smoker aged 47 years. I am already having medical insurance for the past 10 years. When I tried to include the concept "smoker" in the renewal application, the agent does not accept and want us to lie with the insurance company. In view of the above the real truth is not disclosed. In this situation, whether any claim particularly related to heart or BP or hospitalization will be affected? Whether full claim will be affected? Please clarify sir. If I particularly want to include the smoker in the application, whether the premium will be high?

Ans: Hi Harinarayanan, to answer your question if it will affect your claim settlement, yes it will and I suggest that you should declare and be transparent with the insurer.

If you have started smoking after the purchase of the policy, then at the time of renewal you should declare it to the insurer. In fact, any material change in activities between renewals should be declared to the insurer; it is then up to them to either adjust your premium accordingly or accept it without a change in the premium amount.

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Question by Gora - Nov 24, 2022Hindi

I was customer of Oriental Bank of Commerce. Being a customer of Oriental Bank of Commerce, Oriental Insurance Company provided Group Health Insurance Policy and inception date was 04-05-2015. My policy with them continued till 03-05-2021 without any break. Because Oriental Bank of Commerce merged with Punjab National Bank, Oriental Insurance Company discontinued that policy from 03-05-2021 onward. Being a customer of Punjab National Bank, I approached them, and they migrated my Group Health Insurance Policy of Oriental Insurance Company to Star Group Health Insurance Policy for customers of Punjab National Bank from 04-05-2021 to 03-05-2022. As All my policy periods were continued from 04-05-2015 till 03-05-2021 with Oriental Insurance Company, Star Health Insurance given me the benefit of pre-existing disease waiting periods being waived because of continuity (They mentioned it in Policy Document too). They reimbursed my 1st claim of 15 July to 22 July 2021 (Non Empaneled Hospital) and Cashless claim of 16 December to 19/12/2021 but denied reimbursement of 19/12/2021 to 26/12/2021 with the excuse of pre-existing disease even I directly shifted from cashless hospital to non-Empaneled Hospital for same problem because Empaneled hospital having been less facilities. Here I want to address that I was discharged from Cashless Hospital, on request, to get treated in Higher Hospital and treatment was in continuation of previous cashless hospital to new hospital. So, sir, please guide me accordingly as my correspondence with them is not fruitful.

Ans: Hi Gora Lal Gargi, to solve your query I will need more information. Firstly, please do check if your sum insured value was exhausted in the first claim.

If yes, then check the policy document to know if your insurer provides claim for same person, same illness on the second claim i.e. restoration benefits.