Health Insurance Moratorium Period in India

After you complete 60 months of continuous coverage under a health insurance policy, your insurer can no longer reject your claim or cancel your policy on grounds of non-disclosure or misrepresentation. The only exception is established fraud. This protection is called the moratorium period, and IRDAI reduced it from 8 years to 5 years through its Master Circular on Health Insurance Business dated 29 May 2024.

This matters most when a claim arrives years after you bought the policy and the insurer suddenly says you hid a pre-existing illness. If your policy has crossed the moratorium, that defence is closed to them.

The moratorium period is a fixed stretch of continuous coverage after which an insurer loses the right to question your policy. Once it ends, the insurer cannot dig back into your original proposal form to find a missed disclosure and use it to deny a claim or void the contract. The clock is counted in months of unbroken cover, not in claims made.

In plain terms, it is a time-based shield. Buy and keep renewing a health policy, and after five years the insurer has effectively accepted your full medical history, except in cases of proven fraud.

The rule comes from the IRDAI Master Circular on Health Insurance Business, reference IRDAI/HLT/CIR/PRO/84/5/2024, dated 29 May 2024. It is issued under section 14(2)(e) of the IRDAI Act 1999 and under the IRDAI (Insurance Products) Regulations 2024.

Clause 13 of that circular says:

No policy and claim of health insurance shall be contestable on any grounds of non-disclosure and/or misrepresentation except for established fraud, after the completion of the Moratorium Period, i.e. 60 months of continuous coverage.

Two things stand out. First, the period is 60 months, which is five years. The older rule from 2020 set it at eight years, so this is a real reduction in favour of policyholders. Second, the only carve-out is established fraud. The insurer must actually prove fraud, not merely claim it.

1. You buy a health insurance policy and the moratorium clock starts.
2. You keep the cover live through continuous renewals, including any renewal made within the grace period.
3. After 60 unbroken months, the moratorium is complete.
4. From that point, the insurer cannot reject a claim by saying you failed to disclose something or gave wrong information in your proposal.
5. The insurer can still refuse a claim only on proof of established fraud.

One honest caution. The moratorium closes the door on non-disclosure and misrepresentation defences. It does not force the insurer to pay every claim. Permanent exclusions written into your policy, sub-limits, deductibles and ordinary policy terms still apply. The 2020 IRDAI guidelines stated this plainly, noting that after the moratorium a claim is not contestable “except for proven fraud and permanent exclusions specified in the policy contract.” So read your policy schedule alongside this protection.

The circular protects your accrued time even when you change products or insurers.

• Renewals. Continuous renewals build the count. If you renew within the grace period, all credits, including the moratorium period, are protected. The grace period is 15 days for monthly instalments and 30 days for quarterly, half-yearly or annual premiums.
• Migration. When you migrate from one policy to another with the same insurer, the credits already gained, including the moratorium period, carry over.
• Portability. When you port to a new insurer, you are entitled to transfer the credits you earned, including the moratorium period. The circular adds a clear note: “The accrued credits gained under the ported and migrated policies shall be counted for the purpose of calculating the Moratorium period.”

So switching insurers to get a better deal does not reset your clock to zero, as long as you port correctly and keep cover continuous.

This is where you should be careful. The 2024 circular states the 60-month period as a flat rule and does not spell out a separate fresh clock for an enhanced sum insured. What the circular does say, in clause 10, is that an insurer “shall not resort to fresh underwriting unless there is an increase in sum insured,” and where you ask for more cover the insurer “may underwrite only to the extent of increased sum insured.”

In short, your existing sum insured carries its earned moratorium time, but the extra cover you add later can be freshly underwritten. Treat the top-up portion as newer for moratorium purposes and ask your insurer in writing exactly how the moratorium applies to the enhanced limit before you raise it.

Many disputes follow the same script. A family makes a large hospital claim years into a policy, and the insurer rejects it saying a pre-existing condition was not declared at the start. If your policy has crossed 60 continuous months, that rejection ground is no longer open to the insurer under clause 13. You can point to the moratorium in your complaint, your grievance to the insurer, and your case to the Insurance Ombudsman.

If you are buying fresh cover, the lesson is simple: keep your health policy continuous and never let it lapse. Every unbroken year takes you closer to a claim that cannot be picked apart over old paperwork.

For a deeper guide on asserting your rights and writing effective complaints to public bodies and regulators, see The RTI Playbook.

It is 60 months, which is five years, of continuous coverage. IRDAI reduced it from the earlier eight years through its Master Circular on Health Insurance Business dated 29 May 2024 (reference IRDAI/HLT/CIR/PRO/84/5/2024).

Not on grounds of non-disclosure or misrepresentation. After 60 months of continuous coverage, the only ground left to the insurer is established fraud, which it must prove. Permanent exclusions, sub-limits and other policy terms still apply, so the moratorium is not a guarantee that every claim is paid.

No, provided you port correctly and keep cover continuous. The circular lets you transfer your earned credits, including the moratorium period, to the new insurer. The accrued credits from ported and migrated policies are counted toward the moratorium.

The 2024 circular states a flat 60-month rule and does not restate a separate clock for enhanced cover. Your original sum insured keeps its earned time, but the extra cover can be freshly underwritten, so confirm in writing how the moratorium applies to the enhanced limit before raising it.

A waiting period is a stretch at the start of a policy during which specified diseases or treatments are not covered. The moratorium period is different. It is the 60-month mark after which the insurer cannot contest the policy or a claim for non-disclosure or misrepresentation, except for established fraud.

1. Check your policy schedule for the start date and count your continuous months of cover.
2. If a claim is rejected for non-disclosure and you have crossed 60 months, cite clause 13 of the IRDAI Master Circular in your grievance.
3. Keep renewing within the grace period so your moratorium credits stay protected.
4. If the insurer still refuses, escalate to the Insurance Ombudsman with your policy dates and the moratorium clause in hand.

By Dr. Shrawan Kumar Pathak