Does your policy cover ‘future’ ailments?

livemint.com:

I bought a comprehensive health policy in 2015. At that time, I was healthy and did not have any pre-existing conditions. Now, I am diabetic. Do I need to update the health insurer and can the company reject any future hospitalization claim? —Vishwas Gupta You need to declare all prevailing health conditions at the proposal stage.

It is not mandatory for you to share new health developments with the insurer. In your specific case, you have also crossed the contestability period. This means that the insurer cannot question your proposal for non-disclosure.

So, there is no basis for the insurer to reject your claim due to your diabetes. To avoid similar ambiguities, it is best for individuals to go through medical underwriting at the proposal stage. This requires proposer to go through a standard list of insurer prescribed diagnostics at insurer’s network of labs.

Common tests include Hb1aC, and cholesterol. This would establish the presence of any chronic conditions at the times of proposal stage. Thereafter, the insurer has limited grounds to suspect non-disclosure.

Does claim approval rate differ for a basic policy with top-up compared to a stand-alone policy for a higher amount? —Name withheld on request The basic claim settlement principles are same for a regular health insurance and a top-up plan. Both plans would process the claim based on their respective terms and conditions. For example, if the regular plan has a co-payment clause, then the claim amount admissible under the regular plan would be subject to a copay.