Excluded! What Insurance Agents Won't Tell You

Most sales conversations naturally focus on benefits, coverage amounts, and attractive features, because those are easier to communicate and align with what buyers want to hear, but it's important to get into the details to avoid surprises at the time of making a claim

- Meghna Maiti

After five years of continuous coverage, Abhishek Shukla, 29, a Mumbai-based finance professional, ported his family floater health insurance policy in September 2024 as he was dissatisfied with the offerings. At the time of porting, he was assured that the waiting period benefit he had accumulated in the previous policy for certain diseases would continue in the new policy as well. However, earlier this year, when he raised a hospitalisation claim for his mother, Kusum, 52, the new insurer rejected his claim of ₹56,156, citing the waiting period exclusion related to an intervertebral disc disorder.

Usually, health insurance policies do not cover certain pre-existing diseases and related treatments for a fixed number of years. That is known as the waiting period.

However, once that period is over, the disease gets covered. Health policy is renewable annually and is considered continuous if renewed regularly.

Says Abhishek: "After years of continuous coverage and clear portability assurances, my mother's hospitalisation claim was denied, citing 'misrepresentation', a vague term. The medical clarifications I had submitted (including the doctor's note saying that the medical records were accurate) were ignored. Health insurance should protect families.

This claim needs a fair, transparent, and urgent review." Under the Insurance Regulatory and Development Authority of India (Irdai) rules, waiting periods are not reset when you port a health insurance policy, but are carried forward with specific conditions.

The new insurer had initially rejected the claim due to the waiting period issue. Later, when Abhishek called the insurer again, it said that was not a concern, and the reason for rejection was the alleged misrepresentation of documents, but gave no further clarification.