Moratorium period in health insurance: why it matters for policyholders?
Recently, the Insurance Regulatory and Development Authority of India (IRDAI) revisited the moratorium period in health insurance policies—a step likely to offer significant relief to policyholders over time while enhancing transparency within the sector. However, very few customers truly understand what a moratorium period entails and how it impacts them. This article breaks it down for clarity.
What does a moratorium period mean in health insurance?
A moratorium period in health insurance refers to a specific timeframe after which an insurer cannot deny claims related to pre-existing conditions or the non-disclosure of material facts—unless fraud is involved. Essentially, it acts as a ‘cleansing period’ for your policy. Once this period passes, claims cannot be rejected due to previous medical history or alleged nondisclosures made at the time of policy purchase. Think of it as a grace milestone—after reaching it, your policy becomes robust and much harder for the insurer to dispute.
How does the moratorium period impact policyholders?
The moratorium period gives long-term assurance and peace of mind for the policyholder and serves multiple purposes:
Protection against rejection: No rejection of claims by insurers on grounds of pre-existing diseases after the moratorium period, with the exception being if the insurance company can establish intention to defraud.
Enhances assurance: A long-term policyholder feels secure and confident, as they know that their determination for a long-run policy is reciprocated, and claim settlement is easy for them.
Transparency and fairness: It prevents insurers from evading legitimate claims through technicalities.
However, for moratorium periods to help policyholders, it’s necessary that they don’t allow their policies to lapse, as moratorium period needs 5 years continuous coverage to kick in.
IRDAI new guidelines on moratorium period
IRDAI had already implemented a moratorium period of 8 years. In other words, insurers could not refuse to pay a claim after 8 consecutive years of health policy, whether on the grounds of pre-existing conditions or non-disclosure (unless fraudulent claim was proven). IRDAI also shortened the moratorium period from 8 years to 5 years, in March 2024. This change will be effective for health insurance policies issued after April 1, 2024.
Key highlights of the moratorium conditions change:
- Shorter moratorium period: The new rules reduce the moratorium period to a flat 5 years after which, as long as continuous policy is held, claims won’t be rejected for any past disclosures.
- More flexibility: Even if a policyholder has ported the policy from one insurer to another, continuity will ensure that the change applies.
- Applies to all policies: This rule applies to single and family floater medical insurance plans, i.e. retail and group policies.
Conditions when the moratorium period does not apply:
It is important to note that the moratorium period is not applicable under all circumstances, and there are exceptions to this rule. These are:
Fraud:
If a claim is fraudulent or was made under false pretenses, the insurer can deny it at any time, regardless of the moratorium period.
Lapsation or Break in continuity of policy:
If you do not pay within the grace period, then the moratorium clock resets.
Permanent exclusions:
There are some conditions that the policy permanently excludes (e.g., cosmetic surgery, infertility treatment etc.) and these will never be covered under moratorium or not.
Non-Portability cases:
If you change your insurer without maintaining the policy (switching insurers without porting) continuity, you will not be eligible for moratorium benefits with the new insurer.
Newly acquired conditions:
Conditions diagnosed after the beginning of the policy are still subject to normal claims processes, and so are not subject to moratorium clauses.
Why the changes in Moratorium clauses matter?
IRDAI’s initiative is widely regarded as a pro-customer move in the rapidly expanding health insurance sector in the country. The rising awareness and increasing insurance penetration have motivated more people to opt for long-term coverage. A shorter moratorium period strengthens customer rights and simplifies the claim settlement process. According to insurance experts, this change is likely to encourage policyholders to remain dedicated to their plans—both by ensuring their policies stay active and by reducing the likelihood of canceling coverage over the long term.
FAQs
It is the period after which insurers cannot refuse claims on the ground of pre-existing diseases or non-disclosure as long as the insured person is not guilty of fraud.
IRDAI has prescribed a 5-year moratorium period (as against 8 years now) for policies issued after April 1, 2024.
Yes, the moratorium period will still count as long as your policy remains in force and there are no breaks in the cover.
Except in cases of fraud, or of a claim that fits into exclusions, claims cannot be denied.
A suspension in continuity restarts the moratorium period. However, you must begin the 5-year count all over again based on the new policy start date.
Yes, but it applies to both group and individual policies, provided the coverage remains continuous.
The reduction in the moratorium period is a significant step forward for policyholders in India, offering greater certainty around claims and reinforcing insurer accountability. However, honesty during policy purchase and prompt renewals remain just as crucial. As always, the most reliable first step to safeguarding your health and finances is carefully reading the fine print of your health insurance document.
Omprakash Lanjewar is passionate about making health insurance simple and accessible. With a background in finance and strategy, he shares clear, practical insights to help readers navigate their insurance choices. Outside of work, Omprakash enjoys swimming, cycling, and staying connected with industry trends.
