My insurer refused to renew, changed the terms or raised my premium after a claim — is that allowed?

An insurer cannot refuse to renew your health policy because you made claims, and it cannot load your individual premium on your own claims history. Renewal can be refused only for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn — and then you must be offered options. Terms and premium rates can change at renewal for everyone on a product, so the question is whether a change was made to the product or aimed at you.

The core renewal rules come from IRDAI's 2024 product regulations, which apply them to health policies of general and health insurers, but not to travel or personal accident policies.^[1]

What an insurer cannot do at renewal

• Refuse renewal because you claimed: An insurer shall not deny renewal on the ground that you made a claim or claims in earlier policy years. The exception is a benefit policy that ends once its benefit is paid, such as a critical illness policy.^[1]
• Load your premium on your own claims: For individual products, renewal loadings must be set for the whole portfolio, not on your policy's claims experience. A discount for good claims experience is allowed.^[1]
• Re-underwrite you at renewal: There is no fresh underwriting — no new medical examination or proposal form — at renewal unless the sum insured changes. If you ask for a higher sum insured, only the increase can be underwritten.^{[1, 2]}
• Change the premium mid-term: The premium stays unchanged for the policy term.^[1]

When renewal can be refused

A health policy is renewable except on grounds of established fraud, or non-disclosure or misrepresentation by the insured, and provided the product has not been withdrawn. If an insurer relies on one of those grounds, ask it to say which one, and what it is based on.^[1]

If the insurer withdraws the product, you must be offered a one-time option to renew the existing product if your renewal falls within 90 days of the withdrawal, or migration to another suitable product. Migration carries your credits across; continuous coverage explains why that matters.^[2]

Changed terms or a higher premium for everyone

A health policy must tell you that, on renewal, its terms and conditions and premium rate could change. One insurer's wording, for example, says it may revise terms including premium rates only with IRDAI's prior approval, and will notify policyholders three months before the change.^{[3, 4]}

So a higher renewal premium is not by itself a breach. What you can question is a loading added to your policy alone after a claim, new medical questions at renewal when the sum insured has not changed, or a refusal that gives no permitted ground.^[1]

What to do now

1. 1

   Renew within the grace period while you dispute

   Paying within the grace period protects your waiting-period and moratorium credits while the disagreement is resolved.^{[2, 1]}

2. 2

   Ask for the reason in writing

   Ask the insurer to state the clause and the ground for the refusal, loading or new term, and keep the renewal notice.

3. 3

   Complain to the insurer

   Write to the insurer's grievance officer. It must acknowledge your complaint immediately and should resolve it within 14 days, with reasons if it does not accept your complaint. Senior citizens can use the separate channel every insurer must run for their health claims and grievances.^{[5, 1]}

4. 4

   Escalate if you need to

   You can also register the complaint on IRDAI's Bima Bharosa portal. If the insurer rejects your complaint, does not reply within a month, or replies unsatisfactorily, the Insurance Ombudsman can consider disputes over premium paid or payable and other policy-servicing grievances.^{[5, 6]}

ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.

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