Dear Manish,

I have been holding a Family Floater – bank group health policy bank group from a public health insurer for last 5 years. All throughout the policy has been renewed without any delays / breaks, however this FY (last June), there was a delay in renewing the plan due to some delay from our side and then from Bank’s side in getting the DD created and sent to the Insurance company. It took 16 days to clear this and renew and bank & insurance company said that there is no problem (though verbally) because of the delay.

Last month when I applied for a claim settlement, the TPA raised an exception saying that there is a break of 16 days and asked us to get a clarification from the Underwriting officer if the policy can be considered as continuous?

My question is even if there is a gap of premium beyond the allowed 15 days, can the insurance deny me the claim since the claim period is not during those 16 days when the delay occurred? Will the continuity of plan break due to delay in paying the premium? What I agree is that continuity of cover cannot be applied for these 16 days.

What are your views?

Regards,
Mahesh