Ported Policy, Fresh Waiting Period

No, the position is not correct on these facts. Portability is designed to preserve continuity of cover. When a policyholder moves from one insurer to another without a break, the new insurer must give credit for the waiting periods already served with the previous insurer. The policyholder should not start a fresh pre-existing disease clock simply because the insurer changed.

Application

• Mrs. K's original cover began in March 2019. By the time she ported in June 2023, more than four years had elapsed.
• Her hypothyroidism and hypertension were disclosed and the policy was continuous.
• Any pre-existing disease waiting period should therefore be counted from 2019, not from the porting date. Even if the earlier policy had a longer waiting period, only the unserved balance could be imposed - not a fresh 36 months.
• The schedule wording is contrary to the portability framework and should be corrected.

The insurer must reassess the claim on the correct waiting-period calculation. The fact that the angioplasty relates to a disclosed condition strengthens the case; the insurer cannot use a schedule error to defeat a claim that should have been covered. The family should request the policy's portability endorsement and the original waiting-period records.

Procedural failures

• The cashless request was made at 4:30 pm and rejected at 7:00 pm. Health-insurance rules require a decision within a short, defined window - broadly, initial authorisation within one hour and final authorisation within three hours. The rejection came outside that discipline.
• The rejection was communicated orally to the hospital and not in writing with clear reasons.
• Asking the hospital to collect cash from the patient while the authorisation process was unresolved is inconsistent with the cashless framework.
• The subsequent reimbursement rejection repeated the same ground without a written, reasoned order.

What the family should do

1. Write to Insurer B's grievance redressal officer, attach the portability form, the old policy, the discharge summary and the cashless correspondence, and demand a written decision.
2. Escalate to IRDAI's Bima Bharosa portal if the insurer does not resolve it within the prescribed period.
3. Approach the insurance ombudsman having jurisdiction if the grievance remains unresolved.
4. Complain separately about the hospital's cash collection and the TPA's delay.

The family should not accept a fresh reimbursement claim form that omits the portability history. The key evidence is continuity, not a new proposal.

The analysis would shift from portability to disclosure and policy terms. If the condition was first diagnosed in 2025, after the ported policy was issued in 2023, it is not a pre-existing disease at the time of porting. It is a new condition and would be covered subject to the policy's initial waiting period and any specific-disease waiting period. Non-disclosure at porting cannot apply to a condition that did not yet exist.

If, however, the condition was diagnosed before porting and Mrs. K failed to disclose it in response to a specific question, the insurer may examine non-disclosure. It would still have to show that the question was asked, that the answer was false, and that the fact was material. The three-year contestability period under Section 45 of the Insurance Act and the health-insurance moratorium rules would also be relevant. The insurer cannot rely on a blanket 'not disclosed' statement without evidence.

The distinction matters because the remedy differs: a portability error is corrected by crediting the earlier waiting period, while a genuine non-disclosure may lead to a proportionate or repudiated claim depending on the policy wording and the regulator's rules. The family should ask the insurer to state, in writing, exactly which condition and which proposal question are in dispute.