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Congenital disease and health insurance

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09 Apr, 2021 by  amitabh upadhyaya

Hi Experts,

If a person has a congenital internal anomaly then can he get health insurance? My son has is suffering from such a disease and insurer has declined him a health cover? As per my understanding after new guidelines by IRDAI, he was eligible for a health cover, but they say as per their under writing policy he can not be considered for a health policy?

Please advise how can we get a health cover for him!

Amitabh Upadhyaya

Health Insurance

1 Answer

Regional Director, Amicus Insurance Broking

As per the IRDA regulations, internal congenital diseases cannot be excluded. It essentially means after taking the policy, if such a condition manifested and there is a claim, it cannot be denied. However this does not mean that proposals of persons with known congenital conditions should be accepted and not denied. The insurers cannot be forced by the IRDA to accept a proposal. That is subject to the underwriting guidelines of the insurer.

I don’t have the specifics of your son’s illness, but in his case, if there is an internal congenital condition that is likely to trigger a claim after taking the policy, then the insurer will deny the proposal. The alternative that could be explored with the insurers is whether they are willing to put the condition as an exclusion on the policy and give coverage for unrelated illnesses. If that is also not working out, unfortunately it may be difficult to get insurance coverage.

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10 Apr, 2021
amitabh upadhyaya
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