In case of a break in the Health/Medical Insurance but the renewal within 30 Days that will be treated as Continuous Insurance without break, but the said break period was not insured/covered.
IRDA also issued the guidelines in this regard
NOTIFICATION Hyderabad, the 16th February 2013 Insurance Regulatory and Development Authority (Health Insurance) Regulations, 2013 Clause F.
Renewal of Policies
i. A health insurance policy shall ordinarily be renewable except on grounds of fraud, moral hazard or misrepresentation, or non-cooperation by the insured.
ii. The renewal of a health insurance policy sought by the insured shall not be denied arbitrarily. If denied, the insurer shall provide the policyholder with cogent reasons for such denial of renewal.
iii. A insurer shall not deny the renewal of a health insurance policy on the ground that the insured had made a claim or claims in the previous or earlier years, except for benefit-based policies where the policy terminates following payment of the benefit covered under the policy like critical illness policy following payment of the critical illness benefit, the policy terminates.
iv. The insurer shall provide a mechanism to condone a delay in renewal up to 30 days from the due date of renewal without deeming such condonation a break in policy. However, coverage need not be available for such a period.
v. The promotion material and the policy document shall explicitly state the conditions under which a policy terminates, such as on the payment of the benefit in case of critical illness benefits policies.
Even the New India Assurance Co. Ltd. Issued the circular LRO/Health/2020 Dated 27.02.2020 on the basis of aforesaid IRDA Circular and Circular No.HO/HEALTH/CIR.№07/2015–2016 Marketing IBD.ADMN:291 Dated 21.03.2016 and also decided that DO in Charge/BO Incharge can condone the break in insurance from 31 Days to 60 days based on merit.
This fact was never disclosed to the customers/insured by the insurance companies.
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