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Did not disclose Pre existing disease

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rohit911

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My father took start health's family floater plan of 5L sum in 2019.
Today when I was going through the policy document, I saw that he did not disclose his diabetes in pre-existing diseases.
What shall I do now?
Will other family members insurance be affected because of this ?
Need help Asap !
 
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No , others family member insurance will not get affected by this . But it will certainly affect claim processing in your father case if doctor mentions something about diabetes in the ipd card at the time of hospitalization.
 
quino said:
The policy is past the moratorium period of 5yrs, so no claims can be rejected on the grounds of non-disclosure, or misrepresentation. So it should be fine.

Anyone working in the insurance industry should've known this.
Click to expand...
As of now i.e 28th sep .. Moratorium period is still 8 years for most of the companies. 30th sep is the last date to comply with updated IRDAI guidelines of 5 years moratorium period which may get extended as well if companies request time from IRDAI for compliance.
 
quino said:
The policy is past the moratorium period of 5yrs, so no claims can be rejected on the grounds of non-disclosure, or misrepresentation. So it should be fine.

Anyone working in the insurance industry should've known this.
Click to expand...
There is a catch in this...If the company prove that there is a fraud then the claim will be rejected...Definition of fraud is that the fact is intentionally concealed...Best solution is to cancel the existing policy and buy new one with complete disclosure.
 
sunit123 said:
Definition of fraud is that the fact is intentionally concealed
Click to expand...
that's a general definition, but according to irdai it's something different (see below)
sunit123 said:
Best solution is to cancel the existing policy and buy new one with complete disclosure.
Click to expand...
that will lead to loss of the waiting period accumulated by all of the policy members. they have 2 options:

1. to port into a new policy during the time of renewal, during which they'll get a chance to disclose material facts to the insurer.
2. disclose everything to the insurer & admit the honest mistake from their side. since 5yrs have passed, the insurer might allow continuing the policy without issues.
 

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quino said:
that's a general definition, but according to irdai it's something different (see below)

that will lead to loss of the waiting period accumulated by all of the policy members. they have 2 options:

1. to port into a new policy during the time of renewal, during which they'll get a chance to disclose material facts to the insurer.
2. disclose everything to the insurer & admit the honest mistake from their side. since 5yrs have passed, the insurer might allow continuing the policy without issues.
Click to expand...
If I port, and disclose diabetes, would it be considered that diabetes occurred during the old policy period or does it even matter at all when the diabetes occurred?
Because my father got diabetes 12years back.
 
rohit911 said:
My father took start health's family floater plan of 5L sum in 2019.
Today when I was going through the policy document, I saw that he did not disclose his diabetes in pre-existing diseases.
What shall I do now?
Will other family members insurance be affected because of this ?
Need help Asap !
Click to expand...
its fine.. declare it now... any claims taken so far?... Also buy a new policy now.. with PED.. many available
 
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quino said:
that's a general definition, but according to irdai it's something different (see below)

that will lead to loss of the waiting period accumulated by all of the policy members. they have 2 options:

1. to port into a new policy during the time of renewal, during which they'll get a chance to disclose material facts to the insurer.
2. disclose everything to the insurer & admit the honest mistake from their side. since 5yrs have passed, the insurer might allow continuing the policy without issues.
Click to expand...
Pls check clause 6 in the following link..In fraud they mentioned "the active concealment of a fact by the insured person having knowledge or belief of the fact" This clause defeats the whole purpose of moratorium period. Hiding pre existing disease is "active concealment of a fact"...Unfortunately, any future claim linked to pre-existing disease will be rejected....It is very sorry state in India that insurance companies work hard to reject claims rather providing relief to insured person in distress of health emergency

Document Detail - IRDAI

irdai.gov.in irdai.gov.in
 
sunit123 said:
Pls check clause 6 in the following link..In fraud they mentioned "the active concealment of a fact by the insured person having knowledge or belief of the fact" This clause defeats the whole purpose of moratorium period. Hiding pre existing disease is "active concealment of a fact"...Unfortunately, any future claim linked to pre-existing disease will be rejected....It is very sorry state in India that insurance companies work hard to reject claims rather providing relief to insured person in distress of health emergency

Document Detail - IRDAI

irdai.gov.in irdai.gov.in
Click to expand...
right, and how is the insurance company going to prove they actively concealed the diabetes condition.

fraud is not a word the insurance company can throw around, and if they do, they should have clear proof about the same.

most claim rejections, if u see them, say "PED not disclosed", not fraud. because once they use that word, the burden is on the insurer to prove the same & it'll be easy for the insuree to lodge complaint with IRDAI or the courts.
 
Zacobite said:
its fine.. declare it now... any claims taken so far?... Also buy a new policy now.. with PED.. many available
Click to expand...
my suggestion is this.

communicate about the PED with the insurer through emails & get written confirmation about policy status in light of the new information. if they're fine with it, cool. otherwise shop around for a new policy.

IMPORTANT: don't close the current Star's policy on your own. all the waiting period will be lost. always port.
 
rohit911 said:
No claims taken.
Which company's health insurance is better ?
Also which method is more beneficial to buy, through agent or online ?
Click to expand...
icici elevate is the new darling.. Aditya Birla also has a new policy that covers PED quicker.. there are some specific plans for diabetes as well... chk online
 
quino said:
right, and how is the insurance company going to prove they actively concealed the diabetes condition.

fraud is not a word the insurance company can throw around, and if they do, they should have clear proof about the same.

most claim rejections, if u see them, say "PED not disclosed", not fraud. because once they use that word, the burden is on the insurer to prove the same & it'll be easy for the insuree to lodge complaint with IRDAI or the courts.
Click to expand...
Bro...Behind your back so many things are happening which you are completely unaware of...You will be shocked to know that all the health records are digitised including OPD records...Just search about EHR or ABDM..All health insurance companies have access to these records.

So at the time of claim settlement, health insurance company will check all your OPD records and they will know how many times you visited doctor and for what purpose...

They will prove in 1 minute that you are lying and submitting fraudulent claim.

Don't forget to thank Modi ji for this.

akashrajput-aa.webp
 
Last edited:
I had Care Supreme for 2 years and I added pre existing disease after 2 years of the policy while renewal. Now they are degrading my policy to Care Freedom and not giving me the option to continue Care Supreme.
Knowing the nuances of Care Freedom, should I port to any other policy?
If yes which one is preferably better?

PEDs include - Thyroid, Hypertension & Psoriasis (Skin disease) to one member
 
harshgupta940 said:
I had Care Supreme for 2 years and I added pre existing disease after 2 years of the policy while renewal. Now they are degrading my policy to Care Freedom and not giving me the option to continue Care Supreme.
Knowing the nuances of Care Freedom, should I port to any other policy?
If yes which one is preferably better?

PEDs include - Thyroid, Hypertension & Psoriasis (Skin disease) to one member
Click to expand...
elevate icici L
 
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