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Portability with Pre Existing Disease

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29 May, 2021 by  Yash Shah

If a person is having insurance for the last 20 years and has ported to a new insurer and while porting has declared Diabetes and Hypertension as Pre Existing Disease. Is the new insurer liable to pay for the claim which has arisen due to the PED where the PED waiting period clause is 4 years but the claim is made in the second year itself?


where PED declared is - Diabetes & Hypertension

and the cashless claim is denied saying - Patient is diagnosed with hypertensive cardiomyopathy where HTN is disclosed PED hence current claim is not payable in Cashless

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If the policy was in existence for 20 years and during that time diabetes and hypertension was detected, that is not pre-existing for the purpose of the ported policy.


Any illness contracted after taking the policy is not pre-existing.


So your new policy cannot exclude any claims arising out of diabetes or hypertension, if that condition been declared to the insurer at the time of porting.


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29 May, 2021
Yash Shah
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Hi Yash,


If the policy is ported, it means continuity benefits are carried forward and no waiting periods are applicable through the new insurer.


Also, please check if the PEDs that you have disclosed - Diabetes & Hypertension are well mentioned in the policy, if they are then the claim should be paid.


As per my understanding, they may have denied cashless treatment which means that they may require to further investigate the claim which requires some time, and in cashless, the decision has to be given in few hours.


You can approach the company for reimbursement for this claim.


Hope this helps.


Thanks

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29 May, 2021
Yash Shah
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The conditions of diabetes and hypertension need not be mentioned in the policy for them to be covered, so long as they were disclosed in the proposal form.


Once the proposal form is accepted and policy issued by the insurer, it follows that the insurer has waived the diabetes and hypertension as PED exclusions and they stand covered, as it is a ported policy benefit under the policy.


If the policy is not a ported one, then the situation is obviously different as PED exclusion will kick in for diabetes and hypertension.

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