What is the moratorium period in health insurance?

The moratorium period is sixty continuous months — five years — of health cover, after which the insurer cannot contest your policy or a claim on grounds of non-disclosure or misrepresentation, except for established fraud. Time under ported and migrated policies counts towards it. It does not remove the policy's permanent exclusions, and if you increase your sum insured, the extra amount needs its own five years.

IRDAI's 2024 Insurance Products Regulations set the rule: after sixty continuous months of coverage, including portability and migration, no policy and no claim can be contested by the insurer on grounds of non-disclosure or misrepresentation, except on grounds of established fraud. The clause applies to health policies issued by general and health insurers.^[1]

What the moratorium protects you from

Before the moratorium, an insurer that finds something you did not disclose in your proposal can argue non-disclosure or misrepresentation against a claim. After sixty continuous months it cannot, unless it can establish fraud. IRDAI's standard CIS adds that the policy stays subject to the permanent exclusions it specifies.^{[1, 2]}

• Still possible after the moratorium: A challenge for established, or proven, fraud — and the policy's permanent exclusions.^{[1, 2]}
• No longer possible: Contesting the policy or a claim because of non-disclosure or misrepresentation.^[1]
• Not affected: Ordinary claim questions: whether the treatment is covered at all, whether a sub-limit applies, whether the paperwork is complete.

How the five years are counted

1. 1

   Continuous months

   The count is of continuous coverage. A break in policy can restart it, while renewal within the grace period protects the credit you have built up.^{[1, 3]}

2. 2

   Ported and migrated cover counts

   Credits gained under ported and migrated policies are counted for the moratorium.^[3]

3. 3

   Increases in sum insured

   The moratorium applies to the sum insured of the first policy; an enhanced amount completes its own five continuous years from the date of the increase.^[2]

Does it apply to my policy?

Products had to be revised under the 2024 framework by 30 September 2024, and moratorium credits already earned had to be protected and carried forward to the revised policy, but extending the new benefits to existing policyholders was left to the insurer. Check your current wording for a moratorium clause and its length.^[3]

Life insurers' health products fall outside this clause, which is written for general and health insurers. For life insurance, Section 45 of the Insurance Act sets a separate three-year rule — see Section 45 explained.^{[1, 4]}

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