Porting health insurance: Will your claims be rejected because of non-disclosure?

Many people have complained about not getting health insurance benefits, as they didn't reveal pre-existing conditions while porting their insurance cover. However, the Insurance Regulatory and Development Authority of India (IRDAI) mandates that the insured doesn't lose their benefits when they switch from one insurance provider to the other.

IRDAImandates a moratorium clause. Under this, if a police officer has been active for five years, a claim can't be denied on grounds that the insured didn't disclose or misrepresent. However, the only exception to this rule is proven fraud.

Even when the five-year thresholdhasn't been reached, insurers are expected to consider the policyholder’s continuous coverage history. Portability ensures that exclusions for pre-existing conditions should not reset, reported ET.

However, it is best to disclose preexistinghealth conditions before porting. However, insurance providers can't deny claims purely on technical grounds if there is no evidence of wilful fraud and continuity is maintained.

If a person's insurance claim is rejected based on these conditions, she can write to the Grievance Redressal Officer (GRO). To escalate, she can complain to the Bima Bharosa portal. One must keep the policy copies, premium receipts, medical records, hospital bills, and other documents for this.

They can also approach the Insurance Ombudsman with their complaint.

What is The Insurance Regulatory and Development Authority of India?

The Insurance Regulatory and Development Authority of India is a statutory body responsible for supervising and developing the insurance sector in India. It was established in 1999. It regulates the industry, protects policyholders, promotes the growth of the industry, and prevents malpractices.