If you can kindly tell something on 8-year clause by IRDA. Can the health insurance claim be rejected even after 8 years of paying continuous premium without any claim taken?

Ans: The clause is termed as ‘Moratorium Period’ and according to this after the completion of 8 continuous years no health insurance claim shall be contestable for non-disclosure of relevant information at the time of policy issuance except for proven fraud and permanent exclusions specified in the policy contract.

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Question by THANGAVELU - Jun 10, 2022Hindi

My family is covered under Ex-serviceman Contributory Health Services (ECHS). She is having health insurance coverage from three other insurance entities. Still continuing. So, there was no pre-existing conditions. Two and half years back, we have opted for claim re-imbursement only for blood transfusions during the pre-diagnosis period. Later, her medical condition was diagnosed and the same was falling under IRDA exclusions. She was treated once in-patient and afterwards as outpatient. All claims for admission and medicine re-imbursement were availed from ECHS. (Once I have opted for enhancement of insurance coverage from one insurer and the TPA has refused under these clauses). Now, after two and half years, she has recovered better (Even Doctor's perception). But she is continuing medicine with lessor dosage. Presently, her condition is fine. My questions are: 1. Can I avail insurance facilities from insurance companies for the same issue in future? 2. Can I avail insurance facilities from the insurance companies, for other issues than the specifically excluded? 3. Can I prefer ECHS for any eventualities for the specified issue to the extent admitted, and remaining expenditure from other insurance companies? Please guide.

Ans: Hi Thangavelu, good to know that your wife is doing better. Coming to your questions, yes you can avail the insurance facilities for the same ailment in future from your existing insurance companies. However, if you purchase a new insurance policy from another company, then whether you get the coverage or not will depend on the ailment and the insurer.

For other ailments, at the time of issuance an insurer analyses the risks, given the ailment of the insured. Accordingly, the insurer takes a decision whether the policy can be issued or not, there are few insurers in the market that will keep the pre-existing diseases excluded or will have a waiting period for it. However, if your ailments have developed after the policy issuance then you can avail insurance facilities for those ailments.

Answering your third question, yes you can prefer ECHS for this specific issues and the remaining expenditure can be claimed from other insurers.

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