What is the moratorium period in health insurance?

Under IRDAI's Master Circular on Health Insurance (May 2024), once a policy has 60 months (5 years) of continuous coverage, the insurer cannot contest a claim on grounds of non-disclosure or misrepresentation, except for established fraud. Ported tenure counts towards the 60 months.

Can an insurer reject a claim for a pre-existing disease?

Only within the policy's pre-existing disease waiting period, which IRDAI's 2024 rules cap at 36 months, and only if the condition was genuinely pre-existing. After the 60-month moratorium, non-disclosure cannot be used to reject a claim except for established fraud.

Is the Insurance Ombudsman free?

Yes. Filing with the Insurance Ombudsman is free, no lawyer is needed, and it can hear health insurance complaints with a claim value of up to ₹50 lakh. File within one year of the insurer's final reply, after first complaining to the insurer.

Does MediclaimSaathi take a percentage of my claim?

No. Every account gets 1 free check. Basic (₹49) adds 2 checks and Pro Complete (₹99) adds 4 checks, one-time with GST included; credits add up and never expire. MediclaimSaathi takes no commission on any money recovered; the insurer pays you directly.

Is MediclaimSaathi available in Hindi?

Yes. The whole site, your results and explanations are available in English, Hindi and Hinglish.

Health insurance claim rejected? Find out why in 90 seconds — free

MediclaimSaathi helps Indian families understand and challenge rejected or short-paid health insurance claims. Upload a photo of the rejection letter and see, in plain English, Hindi or Hinglish, why it was rejected, whether IRDAI rules were broken, how strong your case is and which deadline comes next.

Check my letter free · Read the complete guide

How it works

Upload your letter. Photo or PDF. Sign in with Google (free account, no password); every account gets 1 free check.
We check it against IRDAI rules. The cited clause is compared with the IRDAI Master Circular on Health Insurance (2024), moratorium and waiting-period rules, and past Insurance Ombudsman decisions.
Send the appeal. A ready grievance letter for the insurer, then Bima Bharosa and Insurance Ombudsman drafts if needed. Every deadline is tracked.

Pricing: account credits, zero commission

Free — ₹0: every account gets 1 free check: reason in plain words, case strength, next deadline.
Basic — ₹49 one-time: adds 2 checks; each includes counter-arguments, a missing-documents checklist and a ready grievance letter.
Pro — ₹99 one-time: adds 4 checks; each includes everything in Basic plus Bima Bharosa complaint text, an Ombudsman complaint draft, charts and a PDF dossier.

Credits add up and never expire. GST included. Recovery agents often take 15–25% of the claim. MediclaimSaathi takes zero commission on any money recovered; the insurer pays you directly.

Rules that protect you

60-month moratorium: after 5 years of continuous cover, a claim cannot be contested for non-disclosure or misrepresentation, except for established fraud.
Pre-existing disease waiting period: capped at 36 months under IRDAI's 2024 rules.
Cashless decisions: insurers must decide cashless requests within 1 hour and final discharge authorisation within 3 hours.
Insurance Ombudsman: free, no lawyer needed, claims up to ₹50 lakh; file within one year of the insurer's final reply.

Common questions

What should I do if my health insurance claim is rejected?

Write to the insurer's Grievance Redressal Officer with your counter-arguments. If they reject it or don't reply within 30 days, register on IRDAI Bima Bharosa and file with the Insurance Ombudsman.

Is MediclaimSaathi a law firm?

No. MediclaimSaathi is an information and document-preparation platform. You approve and send every letter in your own name. It is not legal advice.

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