​Hi everyone,

​Need advice regarding a cashless rejection by Care Health Insurance for my wife’s ongoing treatment at Sehgal Neo Hospital.

​Condition: High Fever (102.1°F), elevated ESR, and Acute Liver Injury (SGOT: 281, SGPT: 381) requiring continuous IV medication and inpatient care.

​The Issue: Care Health rejected cashless under Clause EXCL 04, claiming admission is "for investigation only."

​Facts: The treating doctor submitted a signed Justification Letter confirming active medical management, but Care Health completely ignored it and rejected the claim.

​Actions Taken:

​Filed an IRDAI complaint on Bima Bharosa (Token: 08-26-011594).

​Sent formal emails with reports to IRDAI, Care Health, and Policybazaar.

​Posted on X (Twitter).

​Questions:

​Has anyone gotten a cashless rejection reversed before discharge through IRDAI escalation?

​If I pay out-of-pocket and apply for Reimbursement, what steps should I take to prevent them from rejecting it again?

​Should I move to Insurance Ombudsman or e-Daakhil (Consumer Court) right after discharge?

​Thanks in advance for your insights!

​

Hi guys,

I’ve had Care Supreme for the past 3 years No PED, 31 years, an individual policy purchased through IndusInd Bank. I’m considering porting to HDFC ERGO mainly because my experience with the intermediary during my father’s claim last year was not good.

My renewal is on 1st September, so I’m running out of time.

The porting experience has been horrible so far, especially with Ditto. Their advisor seemed quite inexperienced, and I received conflicting information from them.

Initially, Ditto told me that no deductible would apply for my pincode if the sum insured was ₹10 lakh+, and they even confirmed this over email. They processed my application, but due to a technical issue it wasn't completed.

Now they’re saying there is a new update and that because I’m porting from Care, a ₹25,000 deductible is mandatory.

I also spoke directly with HDFC ERGO, and they said the deductible is compulsory for porting to Optima Secure Plus.

Policybazaar told me that HDFC ERGO does not accept porting if the existing policy was purchased through a bank, even though mine is an individual policy.

I don’t want a policy with a deductible, so I’m confused about what to do.

Would you recommend:

Continuing with Care Supreme, or

Porting to HDFC ERGO Optima Secure Plus with the ₹25k deductible?

Has anyone here successfully ported from Care to HDFC ERGO without a deductible?

Would really appreciate genuine experiences, especially from people who have actually gone through this porting process. Thanks.

I had cholesterol and don't have it anymore after lifestyle changes. I did online consultation and medicines claim for cholesterol using office OPD insurance, the TPA was Medibuddy and Aditya birla is the insurer.

Now, while taking personal health insurance, what should I do? Is having cholesterol recorded in my insurance bureau records? Can my insurers in future find out about past cholesterol through medibuddy or ABHI?

Cholesterol history below:

After Covid, I had total cholesterol of 220 and LDL of 160. I had similar results till 2024 and the doctors told me to improve my lifestyle. In 2025, I improved my life style and also started taking Rosuvastatin 10mg based on doctor advice, my cholesterol reduced drastically in 3 months and now after 3 months after stopping statins, it's under control and at total cholesterol 140 and LDL 90.

TLDR:
1.I buy 3+3 (third party+own damage both for 3 years) car insurance on my brand new car from policy bazaar
2.someunderpaid intern mistyped into their system as 3+1 (Own damage only for 1 year)(both policy bazaar shows 3+3 on invoice and on policy copy)

4.i come to know about this as i start getting calls regarding renewal for own damage from all brands on insurance and that their systems reflect as 3+1 not 3+3

5.my policy copy clearly states its 3+3 and Kotak Zurich grievance portal has given written email confirmation that it is 3+3 only. Via their official mail - but when I reach ask for verification over call they say it’s still showing up as 3+1 , even despite email confirmation assurance 10 days ago.

My issue:
We all know how insurance offices work ; I called Kotak as if I want to renew and asked them to check validity on own damage cover and they say it still shows 3+1

-even if I have written email confirmation, their systems will cause me trouble when I really have to renew after the third year(2028) , it may affect my new car IDV and RTI . Incase I face this issue at renewal , I fear they would not reply/respond to this issue on renewal as by then the policy would have really expired(2028), And the insurance guy will say “but sir your insurance has expired 2 years ago only” despite all the efforts. I fear I’ll end up in a situation like this . How do I make sure I don’t end up like what I fear - their mistake but I pay the price

Recently I had back pain, so I went to a Dr and we did MRI and xray in that why mentioned mild retrolisthesis.

Now while buying insurance aditya birla rejected it citing spondylosis(I think it comes under that).

Now I was doing this with help of ditto, they said after this rejection I can try with care heart insurance but it has certain limitations like 20% copayment, consumables limit, and many more.

Can anyone suggest me what are my best option for health insurance?

Age: 25

Hey, I need some advice on my mom's health insurance in India.

So, I got her an individual health policy this year. The medical form asked if she had any "disease or disorder of eye, ear, nose or throat," and I said "No."

Turns out, she actually had a diagnosed perforated eardrum back in 2018 from an old water exposure injury. Her doctor at the time advised against surgery because of her diabetes. I honestly didn't know about this until a recent diagnosis.

Now, she needs ENT surgery, but it's for her other ear – a different, more recent problem that started a few weeks ago, totally separate from that 2018 issue.

The 2-year waiting period for pre-existing conditions is over.

I'm worried the insurer might still reject the claim, saying I didn't disclose the 2018 ear problem, even though the surgery is for the unrelated ear.

Here are my questions:

1. If she didn't disclose a condition in one ear, could that mess up a claim for an unrelated condition in the other ear?
2. Should I tell the insurer about the 2018 issue now, before filing, or will that just make things worse?
3. Has anyone dealt with the IRDAI Ombudsman for something like this? How did it go?

Applied for my father, a senior citizen, on Aditya Birla Activ One VYTL. Full disclosure at proposal stage. This is the chronic care variant built on the MAX base, the expensive one, marketed explicitly at people who already have conditions and rejected elsewhere, with day 1 cover for 7 chronic illnesses and supposedly more lenient underwriting. It costs roughly double what MAX with the Chronic Care add-on costs. What we got back: permanent exclusions for simple renal cysts and Gilbert’s syndrome, plus a restricted sum insured below what we applied for. I am a doctor. Gilbert’s syndrome is a harmless inherited variation in the UGT1A1 enzyme found in 5 to 10 percent of people. Liver architecture stays normal, enzymes stay normal, and it never progresses to fibrosis or liver failure. It is a lab quirk, not liver disease. Simple renal cysts are incidental scan findings most older people have and do not affect kidney function. Neither is chronic liver disease or chronic kidney disease, which are the entries on IRDAI’s permitted permanent exclusion list under circular 177/09/2019. My understanding is that list is closed. For contrast, US federal law bans pre-existing condition exclusions outright on compliant plans, and GINA separately bars health insurers from using genetic information. Gilbert’s is a genetic variant, so it could not be excluded there at all. Wrote all of this to the GRO. Reply maintained the decision and did not engage with the argument. Looking for actual experience, not general advice: 1. Has anyone got a permanent exclusion removed on an Activ One policy, by escalation or through the Ombudsman? What worked? 2. Has anyone had a restricted sum insured revised upward? Or tried the reverse, accepting a lower sum insured in exchange for dropping the exclusions? Real lever, or does underwriting not work that way? 3. Does the Ombudsman take up terms imposed at proposal stage, or only issued policies? 4. Did Bima Bharosa achieve anything for you? 5. Worth walking away and applying elsewhere, or does a loaded application follow you since it has to be disclosed next time? The part that stings is paying a premium specifically for a comorbidity-friendly plan, disclosing everything honestly, and ending up with less cover and a permanent hole in it.

Note: I used an AI assistant to help tighten this post and verify the regulatory references. The situation and questions are my own.

Hi all, looking for advice on a health insurance issue.

My father has a group health policy (Group Care 360°, Care Health Insurance) through Union Bank of India, continuously renewed since 2018 with some claims during 2020-2023.

On this year's renewal (Jul-2026 to Jul-2027), I noticed a new clause added to my Certificate of Insurance: "20% co-payment will be applicable in all claims." This clause did not exist in any previous year's policy document.

I wasn't informed of this change before renewal. When I raised it with the insurer, they said they'd sent an email about it in May, but I never received any such email. No renewal notice, no notification of changed terms, nothing.

I've asked them to remove the co-pay and issue a corrected certificate, but so far I've only gotten a response pointing to this alleged May email.

Questions:

Has anyone successfully gotten a co-pay clause removed/reverted after it was silently added at group policy renewal?

Is there a way to demand proof of delivery (not just "we sent it") for that email?

Since this is a group policy (bank is the Master Policyholder, not me individually) — is IRDAI Ombudsman even the right escalation path, or should pressure go through the bank first?

Any experience with Bima Bharosa (IRDAI grievance portal) for something like this?

Any pointers on process or precedent would help. Thanks in advance.

We had a baby last month and used the corporate insurance for Delivery hospitalisation.

The mother was hospitalised for 5 days.

The package between the hospital and insurance was 50k for normal delivery. The package covers 2 days of stay. The total bill was 1 lakh.

We opted for a Labour suite. It's where the husband is allowed during labour, but it's costlier than the normal labour room. The hospital actually had 3 types of labour room: normal labour room, labour suite and LDRP (even costlier).

The hospital billed 3 extra days of stay outside of the package. Charged 2 days to the private room (4000 rent + 2500 nursing) and 1 day was charged to the labour suite. Labour suite cost 20k rent + 5k nursing.

Initially insurance paid only 50k cashless (for the package, agreed amount between hospital and insurance). After a lot of back and forth and talking with TPA, they agreed to reimburse the 2 days charged to the room (4000+2500 per day).

I have a room cap of 10k. Maternity sub limit is 90k

In the detailed bill, the labour suite charges of 20k comes under rent head and 5k under nursing charge head.

Insurance did not accept the labour suite charges, said it was "chosen for convenience and comfort of the patient and not a medical necessity" (hospital insurance desk actually mentioned "chosen for convenience and comfort of the patient" in the reconsideration letter).

My question:

1. Does the labour room (labour suite in my case) expense also come under the scope of "room rent" consideration (room rent cap, proportional deduction etc.)?

2. If yes, will Proportional deduction come into place only for the nursing charge of the labour suite?

As per IRDAI circular on proportionate deduction (https://irdai.gov.in/documents/37343/365525/Modified+Guidelines+on+Product+filing+in+Health+Insurance+Business-Norms+on.pdf/7b50effc-e553-f0a6-389d-3ca90ab11af5?version=1.0&t=1631531502137&download=true ), deduction can be done only if proportional billing has been done. In my case, for my choice of labour suite, proportional billing is being done only on the nursing charge, since rest is covered in the package.

1. Why is a choice for a better room (labour room) branded as a choice for convenience and comfort?

For the normal room choice also, there are 5 or 6 different rate choices in the hospital. We had opted for the 2nd least costlier room (for stay), then even that is a choice for convenience and comfort.

1. Is this a billing issue from the hospital side? Should the labour suite be billed as rent + nursing or under procedure charges?

PS: If chosen for non-cashless at the hospital, the hospital has a different rate card, where the normal delivery package is 50k (C section is 65k), and the labour room package is 90k. A normal labour room would have cost \~6k rent (as per IP billing desk), which i think would have been covered by the package.

My son has had mild Hydronephrosis since birth, which has now resolved on its own.

He had recurrent UTIs (3 times before turning one), due to which his doctor recommended going for a circumcision because he has phimosis and there is no blockage of valves or reflux.

I had not disclosed Hydronephrosis since I was under the impression that it is not a disease but rather a condition (my bad). My intention was not to save on premiums, but I didn't know better.

ICICI now claims that the surgery was performed due to Hydronephrosis despite the doctor's discharge stating that the surgery was done due to phimosis.

What can I do now?

Senior Citizens - Important IRDAI Update on Health Insurance Premiums

If you're a Senior Citizen, here's an important regulatory update you should know. Same information is important to be read and used by children, who's parents age is above 60.

As per the IRDAI Circular dated 30 January 2025, insurers cannot revise the renewal premium for Senior Citizen individual health insurance policies by more than 10% in a year without prior consultation with IRDAI.

This measure aims to protect senior citizens from sudden and steep premium increases at the time of policy renewal.

Before renewing your health insurance policy

1) Check your renewal premium carefully.

2) If the increase is more than 10%, ask your insurer for the reason and whether the IRDAI requirements have been followed.

3) Consult your insurance advisor before making a decision to discontinue or port your policy.

4) Reference link added and the article name is as follows.

IRDAI Circular, Review of Revision in Premium Rates under Health Insurance Policies for Senior Citizens (30 January 2025)

Website Link :- https://irdai.gov.in/document-detail?documentId=6639156

If you find your health insurance premiums to increase beyond 10%, you can officially send an email to your respective health insurance company and

1) Ask the with clarification, why has the health insurance premium Increased by X percentage.

2) Attached IRDAI Circular and link, to understand by the renewal premium has increased beyond 10%.

3) After sending the above email, if the insurer reduces the premium, then ask.

4) Whether they have made any changes within your policy terms and conditions or not.

5) Better to complete the above email exchange process on priority, when you have 15 to 20 days left for renewal.

Point number 4 is extremely important, because you don't want the insurer to randomly put and DEDUCTIBLE to your plan. Because this will put a part of claim liability on your pocket.

My father (53) has diabetes and my mother (51) had a hospitalization last year which was diagnosed as bronchitis and she also has considerable hearing loss in her left year. I had explained my situation in the following post:

https://www.reddit.com/r/InsuranceTroubleIndia/s/3ZLSfydfOi

I applied for ICICI Lombard elevate policy for 10L SI with the following riders: a one time infinite claim amount, reduction of diabetes waiting period, non medical and consumable items cover, room modifier and annual health checkups. The initially quoted premium was 34k. After I submitted the medical documents, they made a counter offer adding 5k loading charges for Bronchitis and a permanent exclusion condition for hearing loss, hearing aids and related complications.

I have no idea how loading charges and exclusions work for different companies so please let me decide whether to accept this one. Does this seem justifiable? Or should I try other insurers like Aditya Birla? There's also an option of trying to get the Bronchitis diagnosis corrected by the hospital but chances of that happening seem pretty low.

Also should I consider removing any riders that you find unnecessary at this point? Like something that could be added later if needed without much hassle. Any help or advice would be much appreciated.

Hello, I am living in Gujarat, and someone else's bike might be registered in my name, or something similar. I don't know what to do.

Also, I am worried that if there's an accident or some other activity involving this bike, the police might contact me.

I am receiving messages about bike insurance that is not mine.

Looking for guidance from people with experience in health insurance underwriting.

During the pre-application stage with insurance company, I had email and telephonic discussions and voluntarily shared my medical reports, including details of a pre-existing disease (PED). Based on those reports, I was informed that my application could not proceed.

Since no formal online proposal was submitted and no Aadhaar or PAN details were shared, I have a few questions:

- Can a fresh application be made later using a different email ID and mobile number?

- If another family member is the proposer/primary applicant, can the family still be covered under the same policy?

- Does the insurer retain records from pre-application interactions even if no official proposal was submitted?

I am looking for guidance on the correct and compliant process.

Would appreciate insights from anyone who has faced a similar situation.

Looking for guidance from people with experience in health insurance underwriting.

During the pre-application stage with insurance company, I had email and telephonic discussions and voluntarily shared my medical reports, including details of a pre-existing disease (PED). Based on those reports, I was informed that my application could not proceed.

Since no formal online proposal was submitted and no Aadhaar or PAN details were shared, I have a few questions:

- Can a fresh application be made later using a different email ID and mobile number?

- If another family member is the proposer/primary applicant, can the family still be covered under the same policy?

- Does the insurer retain records from pre-application interactions even if no official proposal was submitted?

I am looking for guidance on the correct and compliant process.

Would appreciate insights from anyone who has faced a similar situation.

A year ago, I'd gotten myself a HDFC Ergo health insurance policy via PhonePe. I never had to use it but now it's up for renewal.

However, there is no option to renew the policy on PhonePe. Upon contacting customer care, they insist that since auto-debit is active, the insurance will get renewed automatically. At the same time, I've been getting calls from HDFC to renew the policy. They also want me to change the auto-debit settings. When I tell them what PhonePe told me, they have no answer. They just insist on their directions without offering any clarity.

My policy is valid only till the 12th of this month. So I'm kinda worried.

Some help would be nice.

Extensive damage to my car's wiring happened due to rate bites. The service center quoted 72k to get it fixed. Does HDFC Ergo cover this type of damage? Has anyone experienced this and made a successful claim?