'I've had health insurance for 8 years. How can my claim be rejected?' Here's why insurers can still deny claims after policy portability

Having health insurance for several years does not automatically guarantee that every claim will be approved, especially after switching insurers. Experts say many policyholders misunderstand how portability works, leading to unpleasant surprises when they need to make a claim.

Many health insurance policyholders believe that maintaining continuous coverage for eight or even 10 years ensures that future claims cannot be rejected. However, insurance experts say this assumption is often incorrect, particularly when a policy has been ported from one insurer to another.

According to Abhishek Kumar, a SEBI-registered investment adviser (RIA), claim disputes frequently arise because customers fail to understand that a new insurer carries out its own underwriting process before accepting the risk.

"I've had health insurance for eight years. How can they reject my claim?" is a question he says he hears regularly from policyholders who have switched insurers without fully understanding the implications of portability.

Portability doesn't mean automatic acceptance

Health insurance portability allows customers to transfer their policy to another insurer while retaining certain continuity benefits. However, the new insurer does not simply continue the previous policy on the same terms.

Instead, it conducts fresh underwriting, which involves reassessing the customer's health profile before issuing the policy.

During this process, applicants must disclose their complete medical history, previous insurance claims, existing illnesses, medications, lifestyle habits such as smoking or alcohol consumption, height, weight and any other relevant health information.

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Experts caution that policyholders should avoid withholding information, even if it appears insignificant.

An innocent omission can become the basis for claim disputes during the initial years of the policy, while deliberate concealment or fraud can lead to claim rejection even after several years if material facts were intentionally hidden.

What continuity benefits actually protect

Although underwriting starts afresh, policyholders do not lose all the benefits accumulated under their earlier insurer.

One of the biggest advantages is the credit for waiting periods already served. If a customer has completed waiting periods for specified diseases under the previous insurer, those benefits are generally carried forward up to the earlier sum insured.

Similarly, the accumulated No Claim Bonus (NCB) and any enhanced coverage earned over the years are transferred proportionately when the policy is ported.

Another important protection is the moratorium period. Once a policy completes the prescribed moratorium period—including years completed with the previous insurer after portability—claims generally cannot be rejected for innocent non-disclosures. However, this protection does not extend to cases involving fraud, deliberate misrepresentation or permanent policy exclusions.

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New insurer can still impose conditions

Portability also does not prevent the new insurer from reassessing future risks.

If underwriting identifies new medical conditions or higher health risks, the insurer may charge a higher premium, introduce waiting periods for those conditions or permanently exclude certain illnesses from coverage. These decisions are part of the underwriting process and are permitted under policy terms and regulatory guidelines.

Experts therefore advise policyholders not to assume that years of uninterrupted coverage automatically translate into unrestricted protection from the first day with the new insurer. 

If you've had health insurance for 8 years...	What it means
You port to a new insurer	The new insurer conducts fresh underwriting.
You've completed waiting periods	You generally get credit for them under portability.
You've built a No Claim Bonus	It is generally transferred to the new policy.
You unintentionally missed disclosing a minor fact	The moratorium may offer protection after the prescribed period, subject to policy terms and regulations.
You deliberately hid a disease or previous treatment	Your claim may still be rejected, even years later, if fraud or material misrepresentation is established.
You chose a cheaper policy	Lower premiums may come with different coverage terms, exclusions or underwriting decisions

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Read the fine print before switching

Insurance advisers recommend that policyholders disclose every medical detail in writing, maintain copies of all declarations and obtain written confirmation regarding waiting period credits, No Claim Bonus and moratorium benefits before completing the porting process.

They also caution against switching insurers solely to save a few thousand rupees in premium.

A cheaper policy may appear attractive, but inadequate disclosures or misunderstandings about portability can lead to claim complications when medical emergencies arise.

Health insurance portability remains an important consumer-friendly feature, allowing policyholders to move to better products without losing key continuity benefits. However, experts say it should be exercised only after understanding that while continuity benefits continue, underwriting begins afresh—and that distinction can make all the difference when filing a claim.