What counts as a pre-existing disease, what people forget to declare, and why the 5-year moratorium does not protect a fraud.
What to disclose when buying health insurance
The proposal form is the most important document you sign. What you declare decides how the insurer treats every future claim. The rule is simple: if in doubt, declare it.
What counts as pre-existing
Current wordings use a standard definition. A pre-existing disease is any condition, ailment, injury or disease that was:
- diagnosed by a doctor within 36 months before the policy starts, or
- one for which a doctor recommended or gave advice or treatment within those 36 months, or
- declared by you or found in a pre-policy health check.
What to declare
- Any condition you are being treated for, and the medicines you take regularly.
- Surgeries and hospital stays, even small ones like a septoplasty.
- Test results a doctor acted on, such as high cholesterol or blood sugar.
- Habits the form asks about, like smoking, tobacco and alcohol.
Answer every question as asked. If a question is unclear, write a short explanation rather than skipping it.
After you buy
An illness that starts after your policy begins is not pre-existing for that policy. Some wordings still ask you to tell the insurer about material changes at each renewal (Narayana Arya, clause 13.4). Telling them does not take away cover you already have, and renewal cannot be refused because you claimed.
The 5-year moratorium
After 5 continuous years of cover, the insurer cannot look back at your past. In Care Supreme's words: "no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract." So after 5 years, an honest mistake on the form cannot be used to reject a claim, but deliberate concealment still can.
What a disclosure can lead to
- Cover after the pre-existing disease waiting period (often 36 months, sometimes less).
- A premium loading, which some wordings cap (Narayana Arya at 50%).
- A special condition or exclusion for that condition, or in some cases a decline.
Any of these is better than a policy that looks clean and rejects your first big claim.
Frequently asked questions
What is a pre-existing disease in health insurance?
A condition diagnosed, or for which a doctor advised or treated you, within 36 months before the policy starts, or one you declared or that a pre-policy check found.
Should I declare a small surgery from years ago?
Yes. Declare surgeries and hospital stays even if they seem minor. An undeclared surgery can be used to question a later claim.
Do I need to tell my insurer about a new illness after buying?
A new illness after the policy starts is not pre-existing for that policy. Some wordings ask you to report material changes at renewal; doing so does not remove existing cover.
What is the moratorium period?
After 5 continuous years, the insurer cannot contest a claim on the basis of non-disclosure, except for proven fraud and permanent exclusions.