Moratorium period in health insurance: the 60-month rule, porting and your own date

What is the moratorium period in health insurance?

The moratorium period is the first 60 months of continuous cover, after which your insurer can no longer challenge what you disclosed when you bought the policy. Schedule III, clause 8 of the IRDAI (Insurance Products) Regulations, 2024 says that after 60 continuous months of coverage, including portability and migration, no policy and no claim can be contested on grounds of non-disclosure or misrepresentation, except on grounds of established fraud.

In practice, a claim made after the moratorium can’t be refused because the insurer finds an old diagnosis or prescription that wasn’t on your proposal form, unless it establishes fraud.

It isn’t a waiting period. Waiting periods decide when a condition is covered; the moratorium decides when your disclosure can no longer be questioned. For the waiting periods, see waiting periods in health insurance.

The clause is headed as applying to health policies issued by general and health insurers. Health plans sold by life insurers, such as fixed-benefit cancer or critical illness plans, may have different terms, so check their wording.

When did the moratorium change from 8 years to 5 years?

On 1 April 2024, when the IRDAI (Insurance Products) Regulations, 2024 came into force. Before that, IRDAI’s 2020 standardisation rules set the moratorium at eight continuous years (96 months). IRDAI’s Master Circular on Health Insurance Business of 29 May 2024 repeats the 60-month rule in paragraph 13 and confirms that credit from ported and migrated policies counts.

Explainers and policy wordings from before 2024 still show eight years, and some are still online. Check the date on anything you read.

How do you work out your moratorium date?

Take the start date of your first continuous policy, add 60 months, and check there has been no break since. Do the same separately for every increase in sum insured.

Example. You buy a ₹5 lakh policy on 1 January 2026 and raise the sum insured to ₹10 lakh at renewal on 1 January 2028.

Now suppose you are admitted in March 2031 with an admissible bill of ₹8,00,000, and the hospital notes mention a heart condition that wasn’t on your proposal form. The insurer can’t contest the first ₹5,00,000 on non-disclosure grounds unless it establishes fraud. The other ₹3,00,000 would come from the increased cover, which is still inside its own 60 months, so that part can still be contested.

Does the moratorium continue after porting or migration?

Yes. The 2024 Regulations count continuous cover carried over through portability (to another insurer) and migration (to another plan with the same insurer). Paragraph 12(d) of the Master Circular lists the moratorium among the credits that move with you when you port.

Example. You held a ₹5 lakh policy with one insurer from 1 July 2023, and port to another insurer on 1 July 2026 with a ₹10 lakh sum insured.

• First ₹5 lakh: the clock started on 1 July 2023, so it is protected from 1 July 2028.
• Extra ₹5 lakh: the clock starts on 1 July 2026, so it is protected from 1 July 2031.

The new insurer still underwrites your portability proposal and asks its own health questions. Answer them fully, especially for the increase, which starts from zero. Port before your current policy lapses: the credit depends on continuous cover. See health insurance portability for the steps.

What can an insurer still reject after the moratorium?

Quite a lot, because the moratorium only removes non-disclosure and misrepresentation as grounds to contest. After 60 months, the insurer can still:

• Act on established fraud. The rule keeps this exception. Deliberately hiding a known condition can be argued as fraud, so the moratorium is no reason to leave things off a form.
• Apply permanent exclusions. IRDAI’s standard Customer Information Sheet (CIS) wording says that after the moratorium no policy is contestable “except for proven fraud and permanent exclusions specified in the policy contract”.
• Apply the normal policy terms. Room rent limits, sub-limits, co-payment, deductibles, non-payable items and general exclusions still apply.
• Contest the increased sum insured until its own 60 months are complete.

Does the 60-month rule apply to a policy bought before April 2024?

Confirm it in your current wording rather than assume. IRDAI’s 2024 Master Circular told insurers to bring existing products in line with the new rules by 30 September 2024, protecting moratorium credit already earned, and says insurers “may extend” the new benefits to existing policyholders. Search your latest wording for “moratorium”. If it still says eight years, or doesn’t say, ask the insurer in writing for your moratorium date.

What to check in your policy

1. CIS item 12, “Things to remember”: the “Moratorium Period” paragraph and the “Change in Sum Insured” note.
2. Policy wording: search for “moratorium”. Check it says 60 months or five years, mentions portability and migration, and explains increases in sum insured.
3. Policy schedule: a field such as “first policy inception date” or “continuous coverage since” for each insured person. This is when your clock started. If you ported, check it shows your old policy’s start date.
4. Your sum insured history: note each date it went up. Each increase has its own clock.
5. Renewal receipts: proof that you renewed within the grace period every year, which is 30 days, or 15 days for monthly instalments.
6. Permanent exclusions: any condition excluded for good in your schedule or endorsements stays excluded after the moratorium.

Where people get caught out

• A break in cover. Renewing after the grace period is a break in policy, and the 60 months can start again.
• Porting after a lapse. Credit carries over only with continuous cover.
• Assuming the whole sum insured is protected. Only the amount held for 60 months is. A recent increase isn’t.
• Treating it as cover for everything. It stops disclosure disputes, not the rest of the policy.
• Relying on an old explainer. A page that says eight years describes the rule before April 2024.