🛡️ The Golden Shield After 5 Years

It is every policyholder's nightmare. You dutifully pay premiums for 6 years. Then, you are hospitalized for a heart condition.

The insurance investigator digs into your past and finds a doctor's prescription from 7 years ago that mentions "mild hypertension." They reject your claim, stating: "You concealed this Pre-Existing Disease (PED) when you purchased the policy."

This rejection is now illegal. Following the landmark IRDAI reforms effective from April 2024, once you complete 60 continuous months (5 years) of a policy, your coverage enters the "Moratorium Period." Crossing this line means the insurer CANNOT reject a claim based on non-disclosure or PEDs.

The concept is simple: The insurer has 5 years to investigate your health profile. If they accepted your premiums for 5 years without raising an issue, they have accepted the risk permanently. 

Scared Your Claim Will Be Rejected for Pre-Existing Disease?

What Does the 2026 Rule Say?

IRDAI Master Circular (Effective 2024)

"After a period of sixty continuous months (reduced from the previous 8 years), no health insurance policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract."

  • Incontestable: They cannot argue about your medical history or "forgotten" symptoms.
  • Fraud Exception: This is the only loophole. If you submit a fake hospital bill, you face criminal charges. But "forgetting to mention BP pills" is NOT considered fraud after the 5-year mark.

The "Portability" Trap

This is where smart policyholders make mistakes.

Scenario: You have held a policy with HDFC Ergo for 6 years (you are in the safe zone). You decide to port to Star Health for a cheaper premium.
👉 Does the Moratorium clock reset?
Technically, portability transfers your "Waiting Period" credits (for specific diseases). However, the Moratorium Period interpretation can be tricky. The new insurer may argue they have not had 5 years to underwrite you personally.

Strategy: If you have completed 5+ years with one insurer, think twice before porting. You are effectively trading a "Bulletproof" policy for a potentially "Contestable" one just to save ₹2,000 on premiums.

What If I Forgot to Pay? (Break in Policy)

The rule explicitly requires "Continuous Coverage."

If you miss your renewal date and the Grace Period (typically 30 days) expires, the policy lapses.
When you purchase a new policy (even from the same company), the 5-year clock resets to ZERO.
Never, ever let a long-standing policy lapse.

🛡️ Chief Editor’s Verdict

Loyalty pays dividends in health insurance.

  1. Disclose Everything Initially: Do not rely on the 5-year rule to hide conditions today. You might need to claim in Year 3, and you will be caught. Be honest now, and become invincible in Year 6.
  2. Maintain Your Paper Trail: Keep your very first policy document and every subsequent renewal receipt. If an insurer attempts to reject a claim in Year 7, the burden of proof is on you to show the continuous chain of coverage.

Survive the first 60 months, and you are safe for life.

Disclaimer: This article provides general information regarding IRDAI Health Insurance Regulations current as of January 2026. It does not constitute legal or financial advice. Policy terms regarding the Moratorium Period can vary slightly between insurers. Please read your policy document carefully and consult with a licensed insurance advisor to understand your specific coverage rights.