In India, millions buy health insurance every year hoping for a safety net during health emergencies. But most policyholders are unaware of the rights they’re entitled to. The Insurance Regulatory and Development Authority of India (IRDAI) has clearly outlined 11 key rights that protect you. Knowing these rights can help you avoid getting exploited, delay in claims, or outright denial of your rightful benefits.
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1. Right to Lifelong Renewability
Your insurer cannot deny renewal just because:
- You’ve aged
- You made claims
- You developed a new illness
Exception: Renewal can be denied only if the insurer can prove fraud or intentional misrepresentation on your part.
2. Right to Portability
If you’re unhappy with your current policy or insurer, you can switch without losing your waiting period credits.
Exception: Porting is not guaranteed. The new insurer may assess your health profile and decline your application.
Tip: Port while you’re young and healthy for better chances.
3. Right to No Claim-Based Loading
Your premium cannot be hiked just because:
- You made a claim
- You developed a new or serious illness
Exception: Some insurers may still attempt to do this subtly. Know your policy terms and challenge unfair hikes. Since 2013, IRDAI bars this practice.
4. Right to Moratorium Period
If your policy has run without a break for 5 years, insurers can’t deny claims for minor non-disclosures.
Exception: If the non-disclosure is major, deliberate, or fraudulent, the insurer can reject the claim and cancel the policy.
5. Right to a Free-Look Period
Bought a policy but changed your mind? You have 30 days (from receiving policy docs) to cancel.
You’ll get a refund after deductions like:
- Stamp duty
- Medical tests
- Pro-rated premium
6. Right to Timely Cashless Claims
Effective July 31, 2024: Insurers must approve or reject cashless authorisations within 1 hour.
Delays can be escalated. Insurers are now required to have efficient tech systems to comply.
7. Right to Payment for Delayed Discharge
If hospital discharge is delayed by over 3 hours due to insurer’s delay:
- The extra cost must be paid by the insurer
- This cost must come from shareholders’ funds, not your premiums
8. Right to Pay Premium Only After Acceptance
Starting March 2025, under Bima-ASBA, your premium won’t be deducted upfront.
- It will be blocked in your account like IPO funds.
- If the policy is not issued → Money auto-refunded.
Exception: Some policies may not be Bima-ASBA compliant yet. Always ask your insurer.
9. Right to Advance Notice on Policy Changes
If your insurer:
- Changes policy terms
- Increases premiums
They must inform you at least 3 months in advance.
Exception: Many fail to do this. You have the right to file a complaint if not informed properly.
10. Right to File a Grievance
If you face any unfair treatment:
- Raise a complaint with the insurer
- Escalate to their Grievance Officer
- Reach out to IRDAI
- Approach the Insurance Ombudsman
- Move to Consumer Court, if needed
11. Right to Receive Claim Post-Ombudsman in 30 Days
If the Ombudsman rules in your favour, the insurer must:
- Settle your claim within 30 days
- Any delay beyond that = ₹5,000/day penalty on the insurer
Final Thoughts:
Most policyholders don’t read the fine print, and insurers don’t highlight your rights. But being informed can save you stress, money, and time during critical moments.
Bookmark this. Share it with friends and family. Let’s make sure no one is in the dark when they need help the most.
