Mediclaim Redressal

Life and non life companies providing Indivisual Health or Mediclaim policies impose conditions that  pre existing disease shallnot be covered for 2 years from date of inception of first policy ( beleiving there shall be no break/gap in continuation of the policy) and in case of diseases like hypertension, diabetes etc, this can be 3 years.

The conditions may vary from company to company.

A competent and experienced lawyer may help you get relief from consumer forum as the purpose and intent of insurance is to provide cover.

In this case Kidney stone seems to be a pre-existing condition. ("pre-existing" means it required prior treatment and you had knowledge of the condition.) I'm not sure if pre-existing conditions are covered in your plan (some policies do cover it) please check. I'm not a legal / medical expert

Yes, i agree with uma advise.Before you take a policy principal of utmost goodfatih is important.

If you haven't disclose the info.about kidney stone operation in policy then it will be trouble for you thats sure.

Also Please check your policy's condition.

Hi Harshal,
Health insurance policies in India offer coverage for pre-existing diseases, however, only after 4-5 years of continuous coverage with your health insurance provider. No health insurance provider in India offers coverage for pre-existing diseases form the start.

In your case, since your father -in-law had undergone his first kidney stone operation in 1988, it will be considered pre-existing and no medical insurance policy would provide coverage for it unless the policy is 4-5 years old and is in continous force without any break.

Hi Harshal
I completely agree with the views of other members in the forum that pre-existing disease coverage is available in India, however, only after 4-5 years of continuous coverage with your health insurance provider. If the medical insurance policy taken by your grandfather is 4-5 years old without any break, the health insurance provider ought to provide coverage for the same.

However, if the medical insurance policy is recently bought, your grandfather would not be offered cover for the same since the kidney stone is considered pre-existing. I am sure the case would remain the same even if you think you have opted for the best health insurance plan in India.

There are legal consultants/lawyers who specialize in consumer cases.

Kindly visit a competent lawyer at your location, and show all docs. Your lawyer may refer to some decisions in similar cases. The purpose of insurance is to provide cover. A citizen who has suffered from a disease can not guarantee that he shall not contract it again, or he should wait to remain disease free for years. Based on your declarations as per principle of utmost faith, in PF, company can impose loading charges.

Once you and your lawyer are satisfied with facts of your case, and  decision in similar cases you can take a qualified decision to contest your case.