When you buy health insurance, you want assurance that your medical expenses will be covered. The moratorium period is the time you must keep your policy active before the insurer can deny claims for pre-existing conditions or health issues you didn’t disclose.
Understanding the moratorium period in health insurance helps you plan renewals and ensures your policy protects you when you need it most.
What Is the Moratorium Period in Health Insurance?
The moratorium period in health insurance refers to the period a policy must remain active before an insurer can no longer reject claims for certain reasons. It generally applies to pre-existing or undisclosed conditions. During this time, claims may be contested for non-disclosure or misrepresentation of past health history, except in cases of proven fraud.
Why the Moratorium Period Was Introduced in Health Insurance
The moratorium period protects policyholders by limiting an insurer’s right to reject claims for past non-disclosures. After maintaining continuous coverage for a set period, you gain stronger claim security and reduced disputes over pre-existing conditions.
How Does the Moratorium Period Work?
The moratorium period starts from the day your policy becomes active and continues as long as your coverage doesn’t lapse. Any break will reset the period. After 60 months with the same sum insured, the insurer can’t deny claims for past non-disclosures, unless there is fraud.
Rules can differ by insurer and policy, and increasing your sum insured may start a new moratorium for the extra amount.
Moratorium Period vs Waiting Period in Health Insurance
To understand how the moratorium period differs from the waiting period, here is a clear comparison of their purpose, coverage, and duration.
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Aspect
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Moratorium Period
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Waiting Period
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Purpose
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Ends insurer’s right to reject claims for non‑disclosure
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Restricts coverage for specific conditions initially
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Typically Applies To
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Pre‑existing or undisclosed conditions
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Specified illnesses, treatments, or surgeries
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Duration
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60 months (5 years)
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Usually 30 days to 36 months (as per policy)
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When Claims Are Covered
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After period ends (with conditions)
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After period ends and policy is renewed
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Note: This is an indicative list. Please read the policy wording for the complete list of inclusions/exclusions.
The waiting period doesn’t prevent insurers from requesting disclosures or from rejecting a claim on disclosure grounds; it simply delays coverage for certain conditions.
The moratorium period, on the other hand, limits the insurer’s ability to contest a policy or claim after a longer duration of continuous coverage.
Conditions Covered After the Moratorium Period
Here’s what you need to know about claims for pre-existing and related conditions after the moratorium period:
- Claims for previously undisclosed pre‑existing conditions cannot be denied solely for non-disclosure, unless fraud is proven.
- Protection also applies to similar or related illnesses, provided there is no intentional misrepresentation.
- Waiting period conditions for specific illnesses (like cataract or joint replacements) are served separately.
- Fraud or permanently excluded conditions may still lead to claim denial.
Note: This is an indicative list. Please read the policy wording for the complete list of inclusions/exclusions.
Role of Health Insurance Policy Terms in the Moratorium Period
Your policy document determines how the health insurance moratorium period applies. Things like the type of policy, increasing your sum insured, renewing without gaps, and switching insurers can affect the moratorium period. A break in coverage can reset it, but moving to a new insurer without a lapse keeps it intact. Always read your policy for the exact rules.
Impact of the Moratorium Period on Pre-Existing Diseases
According to IRDAI rules from April 2024, the moratorium period health insurance has been reduced from 8 years to 5 years. After 5 years, insurers cannot reject claims for pre-existing conditions because of past non-disclosures.
This change gives more certainty for claims and makes health insurance easier to access for people with existing health issues.
Conclusion
For older adults, managing medical expenses and pre-existing conditions becomes increasingly important, making it essential to choose the senior citizen health insurance. Understanding the moratorium period is key, as it helps protect pre-existing conditions and ensures reliable claim support.
FAQs
1. Can the moratorium period vary for different sum insured amounts?
Yes, if you increase your sum insured, a new moratorium may apply only to the enhanced portion.
2. Does the moratorium period apply to family floater policies?
Yes, but the period may be calculated separately for each insured member depending on the policy terms.
3. Are pre-existing conditions automatically covered after five years?
Coverage is not automatic for permanently excluded conditions. Always check your policy wording for exclusions.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.