When purchasing a health insurance policy, a policyholder is required to disclose their health history, such as pre-existing medical conditions, past surgeries or hospitalizations, current medications, and family medical history.
Recently, the State Consumer Disputes Redressal Commission, Madhya Pradesh, dismissed an appeal against LIC because the deceased, who was the insured suppressed material facts about his illness. Whether it is life or health insurance, it is based on good faith and suppression of any information by the insured can lead to the policy being null and void.
Let us look specifically at health insurance. When purchasing a health insurance policy, a policyholder is required to disclose their health history, such as pre-existing medical conditions, past surgeries or hospitalizations, current medications, and family medical history. “Additionally, lifestyle information must be provided, including smoking status, alcohol consumption, etc. These disclosures help insurance companies assess risk and determine the appropriate coverage terms,” says Siddharth Singhal, head, health insurance, Policybazaar.com.
Medical Conditions:
Pre-existing medical conditions (such as diabetes, hypertension, asthma, etc), Medical Health conditions
Past surgeries or hospitalizations
Current medications being taken
Chronic illnesses if any
Lifestyle Factors:
Smoking status (whether the policyholder is a current or former smoker)
Alcohol consumption (frequency and quantity)
If the policyholder does not disclose all facts during the time of insurance purchase, claims of the policyholder might get rejected based on the treatment they are currently undergoing.
“If the treatment is related to any pre-existing medical condition that has not been disclosed, there is a very high chance that the claim will be rejected. This would ultimately defeat the purpose of having an insurance policy,” says Sanil Basutkar, co-founder, Bharatsure, an insurtech company.
It is important to answer all the questions in the proposal form accurately and completely. “Do not leave questions blank. If you do not know the answer, ask for clarification. If any questions are open-ended, like whether you have had any history of hospitalizations, please include all hospital admissions without leaving anything out. Do not assume that something is not relevant or is trivial and leave them out. In case of doubt, the course of action is to ask, not assume,” says Hari Radhakrishnan, expert member, Insurance Brokers Association of India (IBAI).
To sum up, to comply with health insurance disclosure requirements, policyholders should accurately complete application forms, and gather and submit all relevant medical documents. They must provide truthful lifestyle information, promptly update the insurer with any changes, review policy terms, and ask for clarification if needed. These steps help avoid issues with coverage.