Health Insurance: Know What You Are Entitled To As A Policyholder

Do you know your rights as a health insurance policyholder? You should. Mahavir Chopra, founder of Beshak.org, a discovery platform for insurance, recently outlined these key rights in a detailed thread on the social media platform X (formerly Twitter). We take a look at some of them.

Health insurance is supposed to be your safety net, but too often, policyholders aren’t aware of the protections already built into the system.

Over the years, India’s insurance regulator, the Insurance Regulatory and Development Authority of India (Irdai) has introduced several rules to tilt the balance a little more in favour of consumers.

Yet, most people never get around to reading the fine print. So here’s a guide to your most important rights under your health insurance policy—and why they matter.

Lifelong Renewability: You cannot be denied insurance just because you are old or ill. Once you have bought a health insurance policy, the insurer is not allowed to deny renewal just because you have aged, made a claim, or developed a new illness. As long as you have paid your premiums on time and haven’t lied or hidden facts, your coverage continues, year after year. This right, known as lifelong renewability, is what ensures you are not left without cover exactly when you need it most.

Portability: If your current insurer is giving you grief—maybe they are slow to settle claims or have hiked premiums—you don’t have to stick around with them. You can switch to another insurer at the time of renewal without losing out on the waiting periods you have already served.

The new insurer has to acknowledge your time served under the previous policy, especially for pre-existing diseases. Of course, they can still choose whether to accept your application. So, the best time to port is when you are in good health and haven’t made big claims yet.

No Claim-Based Loading: Before 2013, insurers could hike your premium if you made a claim or got diagnosed with something serious. But that’s no longer allowed. Claim-based loading—where the premium goes up just because you used your insurance—is now banned. Insurers can still revise premiums across the board, or charge more for different age bands, but they cannot single you out for being unwell. Illness shouldn’t come with a price tag attached—and now it doesn’t.

Moratorium Rule: Let’s say you forgot to mention a minor ailment when you signed up for your policy. As long as it wasn’t intentional, and you have held the policy for five uninterrupted years, the insurer cannot use that oversight to reject a claim. This is called the moratorium period, and it kicks in after five years of continuous coverage. Think of it as a statute of limitations for minor non-disclosures. Major ones, or deliberate omissions, can still void your policy—but honest mistakes won’t haunt you forever.

Free-Look Period: Ever bought a policy and then regretted it after reading the documents? You have 30 days from the day you receive your policy to cancel it. This is called the free-look period. If you back out within this window, the insurer has to refund your money after deducting a few basic costs, such as stamp duty or any medical test charges. It’s your chance to take a breath, read the fine print, and walk away if the product doesn’t feel right.

Cashless In One Hour: Starting July 31, 2024, insurers must approve or deny your cashless hospitalisation request within an hour. No more waiting endlessly at the hospital admission desk while your family scrambles to arrange funds. And here’s the kicker: if your discharge is delayed by more than three hours because the insurer hasn’t cleared final bills, they—not you—must bear the cost of your extra stay. That money has to come from the company’s shareholders, not from the collective pool of premiums.

Bima-ASBA: From March 2025, when you apply for a new policy under the Bima-ASBA system, the premium amount will only be blocked in your account, not deducted immediately. The money will actually go to the insurer only after your policy is issued. If the insurer rejects your application, the blocked amount gets released back to your account. It's very simple, transparent, and safe. You don’t pay until they are ready to insure you.

Most of us think of health insurance as something we buy and forget—until something goes wrong. But these rights aren’t just lines in a rulebook. They are meant to give you confidence, reduce your financial stress, and ensure that insurers treat you fairly. If you have a health policy, remember you are not just a customer, you are protected by a set of rules that back you up.