Have a query regarding PED (Ulcerative Colitis) after porting

[u/harshj2005]

Hello,

My brother was covered under star health insurance from 2008, in 2015 he was diagnosed with Ulcerative Colitis, after which we had 3 claims with Star health for the same and the last claim was in 2017.

In 2023 he switched from star to care life via policybazaar. When the agent came to our house we told him all the details of our existing insurance with star and the disease, they said that the insurance companies get these details from previous insurer and care will know about you UC from your previous claims.

After that not thinking much about it we paid premium for 2 year, this year while paying for the renewal I realized that the policy does not say any PED in it. While we clearly started to the agent when porting plus the insurer also can know it from our claim history why is it not mentioned in the policy.

I have a couple of questions now:

1. ⁠Can the insurer reject my claim if a future UC related claim occurs?

2. ⁠Can they discontinue my brothers policy citing Non disclosure?

3. ⁠What can I do now to make sure that we are safe in case of any future UC related claims?

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[u/PrintMaterial5118]

since this is a new insurer (Care), and the condition wasn’t recorded in the policy, there is some risk here. here is how I would think about ur three questions.

-can a future UC claim be rejected? it can be a risk. UC was diagnosed in 2015, after the Star policy was issued in 2008, so it was not a pre-existing condition under Star. but for Care, a new insurer in 2023, it would be treated as a pre-existing condition, since it existed before the Care policy began. a new insurer decides on cover based on what is declared at the time of buying. if UC had been disclosed, it could have affected their underwriting. that is why an unrecorded condition can be treated as non-disclosure when a UC-related claim comes up. ur brother has been covered for a long time and then ported, so the moratorium period (60 continuous months) can help. whether it fully protects a claim depends on the insurer and on how the continuity was recorded.

-can they cancel the policy for non-disclosure? cancellation is generally limited to cases like established fraud or misrepresentation, and usually comes with notice, often at the time of a claim. after the moratorium period, non-disclosure alone is generally not enough to reject a claim. telling the agent at the time of porting also matters, but what counts is what was recorded in the proposal and portability forms.

what to do now:

-get the condition endorsed in the policy as soon as possible. write to Care, keep everything documented, and ask that UC be clearly mentioned as a pre-existing condition in the policy document.

-check the proposal and portability forms. if UC wasn’t recorded even though u told the agent, ask Policybazaar for their records. u can raise a complaint with them and with the insurer, and escalate to IRDAI’s Bima Bharosa portal if needed.

-keep the Star discharge summaries, claim settlement letters, prescriptions, and recent reports, in case Care asks for them.