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Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on Oct 12, 2022

Sanjib Jha is the CEO of Coverfox Insurance. His expertise includes health and auto insurance. He has over 22 years of experience in the financial sector. He has completed his post-graduation from the Institute of Company Secretaries of India.... more
Syamala Question by Syamala on Oct 12, 2022Hindi
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I understand that on completion of continuous 8 years of renewal of health care insurance, insurers cannot reject an eligible claim. Is this correct?

I took a health policy from Max Bupa in Aug 2016 and continued renewal for 4 years until Aug 2020 post which I ported my policy to another company for a period of 2 years.

Will this be considered as 6 years of continuous renewal of my policy or will porting have an impact on the continuity period?

Ans: Hi Syamala, to answer your first query, your understanding is correct.As mandated by IRDAI, a health insurer cannot reject an eligible claim if the policy has completed 8 years of renewal.

This period of 8 years is called Moratorium Period.

Except for proven fraud and permanent exclusions specified in the policy contract, no health insurance claim shall be contestable after the Moratorium Period expires.

The policies, however, would be subject to all policy limits, sublimits, co-payments, and deductibles.

As you have mentioned that you ported the policy after 4 years, it will not be an issue as porting is also considered continuous renewal.

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 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.

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