Importance of Accurate Disclosure While Buying Health Insurance

Vivek Law: Saurabh aged 28 years from West Bengal has a question. He says he recently bought a health insurance policy with a sum insured of Rs 3 lacs. He had surgery at the age of 12 but forgot to mention it. Will it create any problem in the future? 

Dhruv Sarin: It depends on the kind of surgery. Even if it was a surgery due to a road accident, ideally, it should be mentioned in the proposal form. It's because if anything happens due to the surgery after 5-10 years, the doctor will declare that you were operated back then and you need surgery again. So, the claim will get rejected. My suggestion will be that he needs to declare his surgery at the time of renewal of the health insurance policy. 

[ Also read | How To Buy A Health Insurance Cover If You Have A Pre-Existing Disease]

((calculator))

Vivek Law: If someone had forgotten to mention a particular ailment while purchasing health insurance unintentionally and three years have passed, can they still get rejected for a pre-existing disease claim?

Dhruv Sarin: Yes, the Insurance Regulatory and Development Authority of India (IRDAI) mandates that an insurance company can not reject a claim on a pre-existing illness after three years of the waiting period. But that's a grey area. Insurance companies reject claims. To be honest, that's not wrong because the customer hasn't been transparent when he bought the policy. Insurance works on the principle of utmost good faith.