Answer Book question
No, and not long. Under IRDAI's Master Circular of 29 May 2024, once a health policy has run 60 continuous months, the insurer cannot reject a claim on the ground that you failed to disclose something when you bought it, unless it proves fraud. The same circular requires cashless pre-authorisation within one hour of the hospital's request and final discharge authorisation within three hours; if the insurer is late and the hospital charges for the extra time, the insurer pays. Reimbursement claims must be settled within 30 days, with interest for delay.
No, and not long. Under IRDAI's Master Circular of 29 May 2024, once a health policy has run 60 continuous months, the insurer cannot reject a claim on the ground that you failed to disclose something when you bought it, unless it proves fraud. The same circular requires cashless pre-authorisation within one hour of the hospital's request and final discharge authorisation within three hours; if the insurer is late and the hospital charges for the extra time, the insurer pays. Reimbursement claims must be settled within 30 days, with interest for delay.
A 62-year-old in Thiruvalla bought a policy in 2019, did not mention a mild thyroid condition, and in 2025 claims for an unrelated cardiac admission. The insurer's desk says 'non-disclosure at inception'. The policy has crossed 60 months without a break. Unless the insurer can prove deliberate fraud, the moratorium bars that ground. Separately, the hospital's discharge is held three hours past the request; any extra bed charge is the insurer's.
The moratorium was 96 months under the 2016 health regulations and was cut to 60 months by the 2024 Master Circular. It runs on continuous coverage, including renewals, portability and migration; a lapse can reset it, and the moratorium on an increased sum insured runs afresh only for the increase. It does not erase permanent exclusions written into the policy.
Cashless timelines: insurers were to have systems in place by 31 July 2024; the one-hour and three-hour clocks are binding on every IRDAI-licensed insurer and the costs of delay are borne by the insurer from its own funds. The circular also entitles you to a 30-day free look on new policies, to portability credit for waiting periods already served, to a claim settlement within 30 days of the last document, and to interest at 2% above the bank rate on delayed settlements.
Grievances: the insurer's grievance officer first, then Bima Bharosa, then the Insurance Ombudsman.
Policy inception date and whether every renewal was on time; the 60 months must be continuous Whether the rejection letter says 'non-disclosure' or 'permanent exclusion'; the moratorium beats the first, not the second Time-stamped copies of the hospital's pre-authorisation and discharge requests; ask the TPA desk for them Any extra charges billed because of delayed discharge, for recovery from the insurer Ported policies: the moratorium carries over with continuity
Letting the policy lapse for a month during a Gulf posting and restarting the clock. Also: not asking the hospital's insurance desk for the time-stamps. Without them the delay cannot be proved.
Parents in Kerala insured by children abroad are the classic case: the policy was bought quickly, the medical history was thin, and the claim comes years later. After 60 months the thin history stops mattering. For discharge delays, Kerala's larger private hospitals now log TPA request times; ask.
Policy bought 1 September 2020, renewed each year on time. Moratorium complete 1 September 2025. Claim in 2026 for a condition arguably undisclosed in 2020: insurer cannot repudiate on that ground. Discharge request 10 am; authorisation 2:30 pm; hospital bills four hours of additional room charge ₹3,200: payable by the insurer.
Fraud is still a ground, and a permanent exclusion stated in the policy (for example, a specific condition excluded by name at issue) stays. The moratorium is about non-disclosure, not about the scope of cover. Waiting periods still apply within their terms.
Check the inception date and renewal history; note the 60-month date On any rejection after 60 months, reply in writing citing the Master Circular's moratorium clause Escalate: insurer's grievance officer (15 days), Bima Bharosa, Insurance Ombudsman
My parents are over 70. Is there free hospital cover for them regardless of income? What is a waiting period? (Vol 1)
Health, disability & life events
IRDAI Master Circular on Health Insurance Business, IRDAI/HLT/CIR/PRO/84/5/2024, 29 May 2024 · IRDAI (Protection of Policyholders' Interests) Regulations, 2024 · Your policy schedule and renewal receipts Last checked: 22 August 2026. Rates, limits and whether you may qualify change. Confirm with the official source before you act. Ask Kerala Rising: Use only general, non-identifying facts.
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