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Can Insurers restrict upgrading health insurance at the time of renewal?

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04 Sep, 2020 by  Questions On Social Media

Hope you are well. My father and mother have separate health insurance policies from National Insurance. Unfortunately since the past 5-6 years my father had to take about 5-6 claims due to some issues in his abdomen. He was hospitalized in May of this year also. The agent harassed us to the core, he never told us what documents are required so we had to go to the hospital again and again. He lost the documents set once. We were not aware of the room limit clause so money was deducted. We asked him about the calculation but he told us to talk to the TPA. TPA didn't answer any query. So, we complained to the IRDA then they admitted their mistake and released about 2500.

Now my father's age is 60 years. Two years back I was told that he has taken claims so his sum insured cannot be increased. Is it true that if a claim is taken for even once we cannot increase the sum insured?

My mother's age is 54. Her policy is due in 2 days. Agent is ignoring us as we filed a complaint. Called him from another number he said that his office will not accept our cheque or cash for premium and told us to pay online if we want to continue with the insurance. I told him that on national insurance's website we cannot increase the limit online. Then he said that he cannot do anything. What should we do in this case?

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Health Insurance
Parents-Health-Insurance

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04 Sep, 2020

Here are our responses. Hope this helps. 


1) Yes, insurers look at every upgrade as a new policy request - They can restrict the increase in sum assured based on past claims history. 

2) Regarding the request for an upgrade for your mother, would suggest you escalate the matter to the following email address: customer.relations@nic.co.in and smvt@nic.co.in. Would recommend you just focus on requesting upgrade while communicating - do not confuse with anything else - like complaining about the agent. That can be handled later. 

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04 Sep, 2020
Questions On Social Media
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04 Sep, 2020

1) No, that's not how it works. Depending on the age of the person, the type of disease for which the claim was made, the insurer takes a decision. It's an insurer's right before it gives you additional coverage. Hence it is always advisable to buy adequate cover as soon as possible. 

2) Yes, you can upgrade next year. We too would recommend that instead of waiting. You need to start the process of porting atleast 60 days before the expiry and ensure your proposal is submitted before 45 days. 

3) Most insurers allow a jump an upgrade to the next sum insured in the grid. For instance if your sum insured is 2L and the next sum insured in the grid if 2.50 Lakhs - then the insurer may allow upgrading only till 2.50 Lakhs. This rule may be relaxed for people who are younger than 45 and who do not have a medical history. 

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12 Sep, 2020

Hey there,


Let me try and address the two followup questions you asked Mahavir.


  1. Increasing sum insured has nothing to do with any prior claim history. Let me explain how this thing works. I had no problem in 2002 when I bought my policy of 3 lakhs. I was admitted for viral fever in 2005. I tried to increase my sum insured to 5 lakhs, insurance company allowed that because viral fever was not a declined risk. Now, in 2011 I am diagnosed with cancer. At the next renewal I try to increase my 5 lakh cover to 7 lakhs. This time insurer will not allow me to add another 2 lakhs to my existing 5 lakhs, because my risk has changed (cancer is a denied risk). However, my 5 lakh policy will continue as long as I keep my premium on time. Hope this gives you clarity.
  2. (a) Yes, you must renew your policy on time and attempt increasing SI or policy porting next year only. Don't take any panga this year due to time constraints. (b) Again brother, SI increase has no relationship with previous claim history. Your policy may allow you some no-claim bonus upto a certain limit (50% or 100% of SI). Bas utna hi maximum jayega in current policy.
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