When Delhi-based Kriti Mehta (name changed) and her husband Girish ported their health insurance policy in 2020, it was to save on premium costs as the new insurer offered a cheaper policy. Little did they know that the switch would prove to be more costly.
The couple had purchased a family floater policy from an independent private health insurer in 2018. In 2020, Mehta underwent a hysterectomy.
“Two years later, they transferred their policy to another insurance company to avail of cheaper premium rates on offer, but did not disclose the surgery she underwent in 2020,” said Shilpa Arora, chief operating officer of Insurance Samadhan, a platform that helps aggrieved policyholders escalate their grievances against insurers.
This year, Mehta developed complications from the procedure and had to be hospitalised again. “The new insurer denied the claim, citing non-disclosure of the hysterectomy,” she says.
This is not uncommon. According to the Mumbai insurance ombudsman’s office, the most common reason for claim rejection was suppression of pre-existing conditions.
What is a pre-existing condition and why does it matter?
Any health condition, injury, illness or disease that has been diagnosed and treated up to 48 months before you take out a new policy is called a pre-existing condition.
Such conditions are usually only covered after a waiting period of between one and four years, depending on the product and insurer. Policyholders must disclose any illnesses or conditions they have ever been diagnosed with.
Based on their underwriting – risk assessment – guidelines, insurers will calculate the premium and make a decision on whether to issue the policy. Typically, people with diabetes (type 1 and type 2), hypertension, heart problems or other conditions will pay a higher premium.
However, illnesses such as H1N1 flu or appendicitis that have been treated and cured will not attract an additional premium.
