Gopal and Gauri are discussing the recent GST cut on health insurance, but the interaction veers towards a specific niche of waiting periods which are critical: moratorium and pre-existing disease waiting period or PED.
Gopal: The recent cut in GST taxes must be driving a mad rush to buy health insurance. I too would like to join the rush, but I am stuck on the aspect of waiting periods.
Gauri: Yes, the big one is the dreaded PED. If you have a condition or received treatment for a condition any time before policy issuance you must declare them to the insurer. The insurer takes these into account and fixes a price for issuing you a policy. These are known as PEDs. Any health claim on account of a PED will not be met by the insurer in the PED waiting period, which is three years.
Gopal: Three years is a long time to be out of the health net.
Gauri: Well, it used to be four years. IRDAI, the regulator reduced it to three years for all insurers last year. Please note that waiting period is only for the declared PEDs. Any other condition can be claimed after an initial 30-day waiting period.
Gopal: So the conditions that we declare are PEDs with a 3-year waiting period. I have a follow-up.
Gauri: I can sense your follow up. Yes, declared conditions are treated as PEDs.
But there will be conditions which you are suffering from silently or asymptomatically. And no, the claim will most likely be rejected even if you have grounds to prove that you were not aware of the condition prior to signing on the policy. If you are admitted for that undeclared condition, the doctor’s notes at the time of discharge will discuss if the condition was pre-existing or not. Even otherwise, the insurer’s team of doctors may also raise an issue if the attending physician doesn’t.
Gopal: Hey! If I fail to declare a condition, will it always be ‘not eligible for claim’?
Gauri: This is where moratorium period can be helpful. Essentially after a moratorium period of five years since policy issuance, insurer cannot reject a claim on PED, non-disclosure or any other issue, except in cases of fraud.
The moratorium period also used to be eight years but cut down to five years now.
Gopal: Correct me if I am wrong. Three years waiting if I declare a PED and get an insurance. But, after five years, claim rejection on PED or wrong declarations are out of the window.
Gauri: Yes. Do you know that the major reason for claim rejections is mostly to do with pre-existing diseases. Either people claim before their PED waiting period is over, or do not declare them at the start. The insurance companies are always on the lookout for such cases. As a policyholder, make a tight case from your end from the first day. Always declare everything. Even if you got a minor surgery or treatment several years ago, one that you may feel is not relevant.
Gopal: Yes, be well prepared to aid the insurance guys who are paid, yearly, to serve you in times of need. Interesting times.
Published on September 27, 2025