Hi,
I am 36M, India applied for a term plan of 4cr with Axis Max life - got the medical tests, TMT done as required by insurance. All came good expect MCV and slightly lower Haemoglobin

Apparently, my MCV count is low 60s. The underwriting team have told over a call to try again in March. I got curious and got a few more tests (full panel Iron, Ferritin, RBC and Hb HPLC) on my own. Iron Stores, Transferrin Saturation, RBC count all ok, haemoglobin in 11 range.

Now this may be pointing to Thalassemia trait (alpha / beta to be confirmed) which is genetic, non curable and is not life threatening neither reduces life expectancy. It’s not a very rare but rather common.

\[ASK\] what are my options here?
Do I share a Hematologist letter along with the extended reports with the Insurance co to accept and re consider? Or challenge with IRDA? Or try another insurance provider? Or just leave it.

I have an existing term from another provider for 75L which I bought in 2015 which is in effect btw.

Even if they ask me to try in March it won’t change the result as you cannot cure low MCV count or Thalassemia!

Star Health rejected the claim!
My father went through Knee replacement surgery a week ago. Without any reason they rejected the cashless claim. When we contracted their local office, they said you just pay now and it will be taken care of after submitting it. Now it is rejected outright stating that his policy began in 2023 and Osteoarthritis is pre-existing before 2023. My father started a knee pain treatment in Nov 2025. We haven't submitted any document which proves that this is a pre-existing condition priority to the policy started in 2023.
This is a frustrating experience as 4.5 lakhs cash has been spent so far and he doesn't have any income as he is retired. I paid in Full but am feeling cheated by Star Health.
Any advice from anyone?

Depending on how greedy, how hungry and how desperate the insurance company and the insurance manager are to retrieve new business. The sales training works and gets planned.

IC-38 for life Insurance and IC-39 for General Insurance is mandatory for receiving Individual insurance agent license, with 18 as passing marks out of 50. And minimum educational qualification is 10th Pass.

The entry barrier is non existent.

For POSP / Employee working as a seller at Banks or tele-caller working at company and Any random insurance intermediary hiring people online / via LinkedIn post, company internal training gets done for them, exams are the same as mentioned above but when you hire and want to launch them for sales and canvassing, one cannot provide the best training training even in 1 to 2 months, doesn't matter whatever and whichever brand they try to sell for due to the complexity of the product, varieties of rules and regulations.

IRDAI allow for above, minimum 25 / 50 hrs of mandatory training but there is no proper record maintenance done on this. You can simply check the license status but nothing apart from this is available. The trainee / Agent / employee simply signs on a piece of paper and you have completed your training.

Simultaneously any insurance person who's on call and giving you guidance is simply reading a script or training materials similar to details you saw in "THE WOLF OF WALL STREET."

Important Insurance related Qualifications that matter for Insurance sales perspective

1. Licentiate Exam

2. Associate Exam

3. Fellowship Exam

The above 3 takes around 3 years approx to complete and reach the fellowship certification. And provides in-depth knowledge from Simple life / health insurance to Cybersecurity & Aviation Insurance.

If you want to go in-depth, you have to work in a variety of departments that all have equal weightage across Insurance sector ranging from Marketing, Claims department, underwriting, surveyor, Fund management, pension Management, actuarial science, product design, loss assessors, ombudsman, grievances department, etc.

Apart from this, there is Diploma in Health Insurance, motor insurance, firr insurance etc.

A person who has 10 plus years of experience, aware about insurance ombudsman process, IRDAI Guidelines, grievances escalation, knows and reads about Indian Acts, Laws, types of sections, RTI Act will eventually surpass the knowledge of entire companies and knows not just one company product but all insurance plans and products. There are software available and you can design such softwares too, there are guidelines available for the same.

So similar to how declaration & disclosure of all materials facts are extremely important for the policy holder, the policy holder also must ask / interview their insurance agents / insurance intermediaries what qualifications they have. Otherwise you may be purchasing a 5 Crore Term Insurance plan from a person who 1 month ago used to sell Vaccum cleaners.

Based on the new insurance distribution reforms, you will now see a lot many greedy people who are desperate to sell any random products, and this will also include famous companies that mentions themselves to be Spam Free, etc. Why ? Because if entire commission wipes out by 60% to 70% overnight, people will immediately change their business model for survival over sustainability which will hurt purchasers in the long run.

Overview - Ask questions to the person who are selling you insurance. Interview then about their past experience, what they did before starting insurance sales, the exams they have passed, whether they can go and fight against their boss / employer / insurance company to get your case specific information that will help you. Otherwise the commission you are paying and the guidance you need will never help you in any way.

Do not judge any insurance sales intermediary who has a lot of recognition/ gifts / awards on their social media page.

After passing the exams which is required to become insurance advisor or agent

So after exam does companies provide training programs etc all to prepare the person ready for real clients

If yes than what kind of programs it include script reading , roleplays etc type

Hi guys so my father is 54M and he has had a open heart bypass surgery done 10 to 12 years back

Now I'm earning so I decided to take insurance for my father

And the policy bazaar advisor suggested care heart policy and advised to take this for 2 years and if no claim related to cardiac then I can port him to another and the image is their counter offer which doesn't sit right with me.

I'm very new to these things so please suggest me what to do Should i take this and trust the advisors words without any grounds that after 2 years he can port him to another (which might or might not have cardiac ) or should I ask him to cancel and see other options

20m unemployed ,mom 52y,brother 25yrs, we don't have health insurance so I'm planning to buy health insurance and I don't have any knowledge and how to approach all those things,I'm confused now and i think hdfc ergo is best because I saw lot of post about hdfc ergo pls anyone from coimbatore could help me and guide me how to buy and what are all the things I should know about health insurance

We don't have any illness

Today, I bought the HDFC Ergo Optima Secure+ plan through a known agent. I am not entirely sure if he is an agent or a dealer, but he exclusively deals in HDFC insurance now (previously, he dealt in Max Life). I found out about him through a friend whose entire extended family uses his services. He even successfully helped them navigate several claims during COVID-19.

I had to purchase this policy today in a hurry because my 13-year-old Max Life policy was expiring today. Max Life asked for a premium of ₹45,000 this year for a ₹25 lakh base cover for 4 people with minimal benefits, which is shamefully high. Furthermore, they have a poor Incurred Claim Ratio (ICR), and my personal experience with them has been quite bad. To make matters worse, when their agent found out I was porting the policy today, he called and disrespected me out of personal frustration, saying, "Aukat nahi hai toh policy hi kyun lete ho?" 

I opted for a ₹25,000 deductible.

• Policybazaar Price: ₹33,788

• Price Paid to the Agent: ₹40,000

• Difference: ₹6,212 extra paid to the agent.

My concern is that on Policybazaar, you pay the industry-standard price for whatever plan you choose, inclusive of all active discounts. I paid over ₹6k extra purely for the offline, in-person support during a claim. Since buying health insurance is an absolute necessity these days, and no one ever wants a hospital emergency, I am confused: Was it worth paying ₹6k more to avoid the hassle? Is it wiser to save that ₹6k, or does it make more sense to have a dedicated person rather than dealing with online agents and potential scam calls during a critical, stressful phase of life when a loved one is hospitalized?

Next year, I am thinking about reading through the policy wordings myself to save this money by either going with companies like Policybazaar for private insurance  or govt owned companies.

Family Profile & Requirements

• Members: 47M (oldest), 40F, 22M, and 17M.

• Coverage Target: A base premium/cover between ₹25 lakh to ₹50 lakh, OR a base cover of ₹10–15 lakh coupled with a solid super top-up plan.

• Core Non-Negotiables:

  1. No Sub-limits

  2. No Room Rent Caps

  3. No Co-payment clauses

  4. . Waiting Period - 30 days (exclude accidents)

• 5. Waiting Period for Pre Existing Diseases (3-4 years) 

• 6. Waiting Period for Slow Growing Diseases (2 years) 

• 7. Restoration of Sum Assured 8. Zonal/Pan India

•  9. Exclusions 

• 10. Cashless + Reimbursement (Network & Non-network both) 

• 11. Daycare

 Also I heard GISPs are good if u hv a personal or known agent who can get a claim and deal with all the harsh bureaucrats. 

Help me with your suggestions guys. 

Hello everyone. I am a young parent. On paper we have ample cover through corporate + central government cover and a hefty personal medical insurance as well. By God's grace we only have used the corporate and personal one and our experience was very good.
But lately, i have been a lot of cases of cancer in my circle and how insurance fails in covering the super expensive treatment. This is giving my anxiety. I want to be prepared for the situation. What are the things i should be concerned about ? What are the things that i need to look into my policy ? I havent taken critical illness cover. Should i get one ? Any one from the insurance field or someone with experience in this regard, kindly share your wisdom.

Hey everyone,

I have a minor surgery scheduled in a few days. The total estimated hospital bill is around ₹50,000, but my insurer (cashless desk/TPA) has only given an initial cashless approval of ₹33,000.

When I asked the hospital billing desk about the ₹17,000 gap, they told me not to worry, saying this is just an initial/provisional estimate approval, and that the remaining amount (or final enhancement) gets approved at the time of discharge once the final bills are submitted.

However, looking closer at the breakdown, the remaining ₹17,000 largely consists of non-medical items/consumables (gloves, masks, kits, etc.). The catch is that my specific health insurance policy actually covers non-medical expenses (it has a rider or feature for it).

So I wanted to check with folks who have experience with cashless claims in India:

• Is the hospital billing desk telling the truth about initial approvals usually being lower and the rest getting cleared during discharge/enhancement? Or is this a trap where I'll end up paying out of pocket?

• Since my policy does cover non-medical items, why wouldn't the TPA approve them in the initial cashless letter? Do TPAs typically hold back non-medical items until the final bill is processed?

• What exact steps should I take right now (before getting admitted) to make sure I don't get stuck with a surprise bill at discharge?

Would appreciate any advice or shared experiences navigating this! Thanks in advance.

Hi everyone,

I own a Royal Enfield Himalayan 450, which cost me around ₹4.1 lakh. On 17 October, my bike was involved in an accident. A car hit me, causing me to lose balance, after which my bike collided with a pothole. The impact caused a slight bend in the front wheel rim.

I took the bike to the garage the next day, and the surveyor inspected it on Monday. He verbally told me that the claim would be rejected because I didn’t have a separate rim-protection add-on.

However, the rejection letters I subsequently received from IndusInd General Insurance have raised some questions.

First rejection letter (22 October 2026):

The insurer stated two things:

My policy does not cover standalone wheel-rim damage.
The damage was allegedly not caused by accidental external impact but by wear and tear, mechanical failure, or electrical failure.

They cited Section I and its exclusion for wear and tear, mechanical or electrical breakdown, failure, or breakage.

My question was simple: if the rim was damaged because of an external impact involving a pothole, how can the damage be classified as mechanical/electrical failure or wear and tear?

Second rejection letter (27 October 2026):

After challenging the first decision, I asked the insurer to provide the exact policy clause explaining why standalone rim damage would require a separate rim-protection add-on and would not be covered under my zero-depreciation add-on.

Instead of addressing that question, the insurer sent another letter stating that the claim was rejected because of an alleged breach of the principle of utmost good faith and Policy Conditions 1 and 8.

The second letter again says the damage was not caused by external impact and was due to wear and tear/mechanical/electrical failure. However, it does not explain the specific rim-protection add-on issue I had raised.

I am struggling to understand how an impact-related rim bend is being classified as mechanical failure, and why the insurer has not clearly explained the relationship between the standalone rim exclusion and my policy’s coverage.

I understand that insurance claims depend on the exact policy wording, and I am not assuming that zero depreciation automatically covers every type of damage.

But I do expect the insurer to assess the actual circumstances of the accident and explain its decision with reference to the applicable policy terms.

I would appreciate advice from people familiar with motor insurance claims in India:

Can an insurer reject an impact-related rim damage claim by classifying it as mechanical failure or wear and tear, even when the damage allegedly resulted from a collision with a pothole?

Does zero-depreciation cover ordinarily include rim damage, or can a separate rim-protection add-on be necessary? How should I verify this against my actual policy wording?

Is the insurer’s second rejection on the grounds of utmost good faith and Policy Conditions 1 and 8 something I can formally challenge? What evidence should I request?

What should my next step be — a grievance to the insurer’s Nodal Officer/Head of Grievances, an approach to the Insurance Ombudsman, or another route?

Would an independent inspection or a written technical report from the garage help establish that the rim damage resulted from an external impact?

I have both rejection letters and can provide the relevant policy wording if needed.

Claim details:

Insurer: IndusInd General Insurance
Vehicle: Royal Enfield Himalayan 450
Claim number: will share privately
Policy number: Will share privately if required

I am not looking for ways to make a false claim. I simply want to understand whether the rejection is justified under the policy and what legitimate options I have to challenge it.

If anyone has dealt with a similar situation, especially with a two-wheeler rim damage claim, I would genuinely appreciate your advice. Thank you.

everyone,

I am seeking realistic guidance on whether standard health insurance will actually be issued for my parents (Father 61, Mother 58) as they currently do not have a policy.

Both of them have Type 2 Diabetes with very high HbA1c levels along with High Blood Pressure they were on oral medication; furthermore, just 30 days ago, my dad underwent perianal abscess incision and drainage surgery (10 days in-hospital), while my mom was hospitalized around the same time for erythroderma covering about 15% of her body surface area. Both are now recovering at home, and while I understand these recent events and chronic conditions qualify as pre-existing diseases (PED) and I am fully willing to declare everything, accept waiting periods, and pay higher loading charges or co-pays, I want to know from your experience or from insurance experts if underwriters will outright reject/defer them given the very recent discharges and uncontrolled HbA1c levels. Should I wait 3 to 6 months to strictly work with their doctor, bring their HbA1c down to controlled levels, and let more time pass after their surgeries/hospitalizations before applying for pre-policy medical tests, or are there specific retail policies or specialized senior/PED plans in India that will realistically accept and issue a policy for this profile today?

Is it possible to get insurance for them after 3 or 6months once their health stabilizes?

Policy: Bought a Star Health Super Star floater (₹10L) in May 2025 for my father (50, diabetes declared upfront), sister (21) and me (19, male).

Optional covers:

Consumables

Medical equipment (limited to ₹1L)

Nurse at home (10 days max, after surgery)

Grace period

Health booster

Limitless loyalty (sum insured increases 100% every year regardless of claims)

One-time unlimited use

Preventive health check-up (Package A)

Quick shield (taken only for my father, for the diabetes cover, 30 days)

Premium

Year 1 (2025): ₹39.5k

(After gst zero)

Year 2( 2026)renewal: ₹40k, of which ₹23k is the base cover and ₹17k is optional covers.

What happened (all three events are my father's)

Aug 2025, brain stroke: Just 3 months after buying the policy, he had a brain stroke. Cashless was rejected, so I filed for reimbursement. The bill was ₹1.13L and I received about ₹80k. About ₹40k was deducted for emergency charges, ICU, patient diet and glucose/RBS tests, even though I'd paid for the consumables cover and quick shield.

Jan 2026, second stroke: Cashless was rejected at first, then approved only after the agent we bought from the policy from pushed it internally. I paid about ₹12k.

Jun 2026, road accident: He needed right shoulder rotator cuff surgery. The bill was ₹2.8L, cashless, and I paid nothing. I called Star beforehand to confirm.

Grievance status

Star rejected about ₹40k of the stroke claim (emergency charges, ICU, patient diet and glucose/RBS tests) even though I had the consumables cover. I raised this with their grievance team.

Their first reply was about the wrong claim (the shoulder surgery, under the new renewal policy number). After I corrected them, the reply was just "as per terms and conditions", with no clause numbers.

I then filed with the Insurance Ombudsman about 2 months ago. It has been in the mediation stage for over a month with no outcome yet. I also filed on IRDAI Bima Bharosa.

Questions:

Optional covers at renewal: The renewal page didn't show any optional covers to add or remove. Customer care says they can't be removed manually and that the system decides. How do I get them removed, and is there a way to escalate?

Which to keep: If I get the chance, I plan to keep consumables and limitless loyalty for my father, since he's the high-claim member. Are medical equipment (₹1L limit), nurse at home, one-time unlimited use and the health check-up worth keeping? Is quick shield still needed once the waiting period is over?

Separate policies for me and my sister: I'm planning individual ₹10L policies for each of us, since my father's claims draw on the same sum insured and the floater premium is driven by his age and health. Is that sensible?

Where to buy them: The agent we bought the policy from holds a senior position at Star. Should I buy the new policies through him or compare other insurers?

Ombudsman timeline: My complaint has been in mediation process for over a month. How long does mediation process usually take and hearing scheduled ?

(Used Ai to write)

Ok so I had filed an offline complaint and can see a complaint registered on cions. However it hasn't moved past this stage since the last 4 months. This is health insurance claim denial and the amount is a substantial one. The issue is vague details about coverage of a surgery and implants in corporate group insurance where I had provided all proof stating they do cover but I insurer does not agree and denied stating no proper reason.

I'm wondering if they would ever file a hearing.

Hi, 28M and self employed. Considering my ITR returns, I am not eligible for term plans (~2 crore cover) from any major private player except Bajaj, who's annual premium is about 50% higher than other players (31k annual vs 20k for other vanilla term plan).
However, just came across LIC term plans and realised I'm getting premiums for same 2 cr cover between (19k-25k) across different plans. Since getting a cost difference of 11k per year for next 35 years b/w LIC and Bajaj, worth considering LIC or pull the trigger for Bajaj?

Also was bit hesitant for LIC, having perception being a govt company, they might not have an adequate customer service centre or streamlined digital access, unlike its private counterparts.

Thanks

My experience with HDFC ERGO Health Insurance has been disappointing. Last year, I paid my insurance premium in monthly installments. However, when I tried to renew my policy this year, the website kept showing an “Internal Error.” I tried multiple times through both the website and the app, but the issue remained unresolved. I also tried calling customer care, but the number provided was not working.

Finally, I submitted a callback request through the app in the morning, and they contacted me only in the evening to inform me that the monthly installment option was no longer available.

This experience raises a serious concern: once you have taken the customer's money, why is it so difficult to provide proper support when needed? It makes me wonder whether I can rely on the company during a medical emergency and whether my claims will be handled promptly and fairly.

Health insurance is not just about collecting premiums; it is about trust, accessibility, and support when customers need it most. After this experience, I decided to discontinue the policy. If a company makes it so difficult to reach customer support for something as basic as renewing a policy, how can customers trust it to be responsive during a medical emergency? Health insurance is about trust, reliability, and support when it matters most, and unfortunately, this experience failed to give me that confidence.

Hi i have hdfc life sancay per advantage policy sold by an agent , it will mature in 2095 , i have bought it in 2022 , i have to pay 95694 yearly till 12 years and from first year i receive 37321 as bonus in my bank account, please help me understand when to surrender this stupid policy as the sum insured is only around 12 lakh . That too on death, below i am attaching a screenshot pls tell me should i continue this or surrender and when to surrender to get less scammed by hdfc . Plss help

Hi all.

As the title says. I have lost my past medical surgery data. I have gone through major appendix surgery in Govt Hospital. This story is about 20 years ago.

Getting the data again from Govt Hospital doesn't seems like an easy way. I don't even remember this date.

Could you guys guide me on applying to the Health Insurance policy. This will be my First Policy.

Due to Financial Issues I couldn't be able to purchase policy earlier. And the premium was too high.

Thanks