In recent months, the Insurance Samadhan team, while building our Know Your Policy feature, discovered an alarming trend in a few retail health insurance policies from Acko, ICICI Lombard (Elevate / AdvantEdge), SBI General (Arogya Supreme / Super Health) and Zuno General Insurance. A clause titled “Material Change” has been quietly introduced — requiring policyholders to declare any new illnesses or health conditions at the time of renewal.
At first glance, it sounds harmless, but this clause gives insurers the right to:
- Reassess or increase premiums,
- Modify or restrict coverage, and
- Apply limitations selectively.
This directly contradicts the IRDAI Master Circular on Health Insurance (May 29, 2024) and the Policyholder Protection Regulations, 2024, both of which uphold the principle of lifelong renewability.
What IRDAI’s Circular Says
According to Section 2.11 of the IRDAI Master Circular, every health policy must offer lifelong renewability except in cases of fraud, misrepresentation, or non-disclosure. The circular also clearly prohibits insurers from:
- Undertaking fresh underwriting at renewal,
- Loading premiums for individual claim experience, and
- Altering terms without Product Management Committee (PMC) and IRDAI approval.
Hence, requiring policyholders to disclose “material change” at renewal — or using such disclosure to hike premiums or deny renewal — goes against both the letter and spirit of the regulation.
Why This Matters for Every Policyholder
Health insurance renewability isn’t just a contract term — it’s the foundation of consumer trust. Once you’ve honestly disclosed all medical information at the time of purchase, the insurer cannot ask you to re-declare new ailments every year. Illnesses that develop after the policy begins are covered events, not grounds for reassessment.
At Insurance Samadhan, we help consumers who face claim rejections, renewal disputes, or policy cancellations due to such unclear clauses. We urge the regulator to take suo motu cognizance and ensure that no insurer penalizes a policyholder for conditions developed post-policy issuance.
How Policyholders Can Protect Themselves
- Read your renewal notice carefully – if it mentions “material change,” seek clarification in writing.
- Do not volunteer new medical declarations unless specifically required by IRDAI norms.
- Renew on time and keep all payment records.
- File grievances through Bima Bharosa, Ombudsman, or Insurance Samadhan if any unfair renewal demand is made.
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FAQs
A “material change” clause asks you to declare new illnesses or medical conditions during renewal. It can be misused to hike premiums or restrict coverage.
Not if it violates IRDAI’s Master Circular on Health Insurance (May 29, 2024), which guarantees lifelong renewability and prohibits fresh underwriting at renewal.
No, premiums cannot be increased based on individual claim experience. Any change must apply uniformly to the entire product with IRDAI approval.
Ask for a written explanation. If it contradicts IRDAI norms, raise a complaint via Bima Bharosa or approach Insurance Samadhan for guidance.
We specialize in resolving health insurance claim disputes, policy cancellations, and mis-selling grievances, ensuring that policyholders’ rights are protected under IRDAI’s framework.