Health Insurance Moratorium Period Explained: The Thin Line Between Missed Disclosure and Fraud

The 5-year moratorium period in health insurance is one of the most misunderstood concepts among policyholders.

Many believe it offers absolute protection against claim rejection.
Others fear that any past medical issue—however small—can invalidate a claim.

The truth lies somewhere in between.

The moratorium period is meant to protect honest policyholders—but not fraudulent non-disclosure. Understanding the difference is critical.

As per IRDAI guidelines, once a health insurance policy is continuously held for 60 months (5 years):

✔️ Claims cannot be rejected for non-disclosure
✔️ Pre-existing conditions cannot be questioned
✔️ Past medical history becomes irrelevant

But only if the non-disclosure was unintentional.

This protection exists to safeguard policyholders from:

1. Genuine mistakes
2. Misunderstanding medical terminology
3. Errors in proposal forms

It is important to be clear:

 Every policyholder must disclose their complete health condition while filling the proposal form.

Insurance contracts are based on utmost good faith. The moratorium period does not replace this responsibility—it only provides protection against honest errors.

This is where most disputes arise.

Missed (Unintentional) Disclosure

Examples:

1. Minor symptoms not diagnosed
2. Tests done but results were normal
3. Medical terms not understood by the policyholder
4. Conditions never communicated by the doctor

These cases are generally protected after 60 months.

Fraudulent Non-Disclosure

Examples:

1. Diagnosed conditions deliberately hidden
2. Ongoing treatment concealed
3. Hospitalisation history suppressed
4. False declarations despite medical evidence

The moratorium period does not apply Claims can be legally rejected, even after 5 years

When a claim is disputed, insurers don’t rely on assumptions—they rely on evidence.

They typically examine:

1. Past medical reports
2. Diagnostic tests and prescriptions
3. Hospitalisation records
4. Dates of diagnosis vs policy inception

This is why documentation is crucial.

If you face a claim rejection or investigation due to non-disclosure:

1. Review past medical records
2. Check whether a diagnosis existed before policy purchase
3. Identify whether treatment was ongoing or concluded
4. Avoid accepting rejection without understanding the basis

Most importantly—
Consult an expert before responding or escalating

Many genuine claims fail simply because they were poorly represented.

At Insurance Samadhan, we regularly handle cases involving:

1. Moratorium period disputes
2. Non-disclosure allegations
3. Wrongful claim rejections

We help by:

1. Analysing medical records objectively
2. Differentiating between error and intent
3. Structuring grievance representations
4. Escalating cases to insurers, IRDAI, and Ombudsman

Our goal is simple: ensure honest policyholders are not penalised unfairly.

The moratorium period is a powerful consumer protection, but it is not a loophole.

Understanding the fine line between missed disclosure and fraud can be the difference between a rejected claim and a settled one.

If you’re facing uncertainty, don’t navigate it alone.

📌 Reach out to Insurance Samadhan for expert guidance on health insurance claim disputes.

Click here to register your complaint with Insurance Samadhan

Visit our website: insurancesamadhan.com

Mail us at corporate@insurancesamadhan.com