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Disclosures in health insurance

LiveMint logoLiveMint 18-07-2017 Deepti Bhaskaran

When you buy a health insurance policy from your insurer, there are many health-related disclosures that you need to make. In fact, knowing your health status is quite important for an insurance company to underwrite your policy. Underwriting is a process by which the insurer gauges the risk and prices its products accordingly. 

Underwriting therefore involves a lot of disclosures that need to be made from your end. But what happens if you don’t disclose your medical condition accurately? Your claim may get rejected in the future on grounds of non-disclosure.

Therefore, it is important that you make full disclosures, especially about your health and not just in the present but also in the past.

Your insurer needs a full account of your medical condition and history at the time of insuring you. It needs to ascertain two facts: are you insurable and does the price justify the risk. 

So the proposal form given by your insurer that you fill will also ask for all your medical details in detail other than just asking for usual information like your smoking and drinking habits. For instance, we looked at the proposal form of a standalone health insurance company in which medical details is slotted in three categories.

The first category asks for past policies: life insurance or health insurance which was declined or postponed or loaded. Loading means bumping up the premium to insure the customer and this typically happens due to customer’s health. The second category has specific questions. It asks if the customer ever suffered or suffers from conditions such as high or low blood pressure, cardiac disorder, lung or respiratory disorder or any other ailment which is not listed in the proposal form. 

The third category is much detailed and wants to know if you have undergone any surgery in the past or took lab tests, or any medical scans in the last five years or so other than your routine and pre-employment check-ups. It also asks the person to list if she has suffered from any ailment, disease, accident or injury other than common cold or viral fever.

Make sure you answer each of these questions accurately and to the best of your knowledge and don’t entrust your agent to fill up this form.

If you had any ailments, say in the four years before buying the policy, it is considered a pre-existing ailment and the insurer, after a waiting period which is usually up to 4 years accepts to insure you these pre-existing ailments. But this doesn’t mean you can hide ailments that you contracted several years back. 

That is because how healthy you are or were in the past has a bearing on insurance underwriting. You need to disclose all the information and after that the insurer may agree to insure you. 

It can choose to load your premium or put certain conditions, but it can not deny a claim subsequently. So non-disclosure of material information that have a bearing on giving you a health insurance policy in the first place or a claim that is related to the non-disclosed ailment may mean that insurer may reject your claim. 

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