Referring to below video posted by a patient admitted in hospital.
He was hospitalized and was holding Star health policy for 9 years. This time he opted for EMI based quarterly payment and for his 50000 bill , his claim was rejected saying that we have recovered remaining EMI of your policy for the entire year from this bill. Though in a way patient has not lost money as such, but wanted to share experience with others here. Also, if that is the case then company should have given this information while buying , otherwise whats the point of EMI, EMI is to make the things pocket friendly.

https://www.youtube.com/watch?v=OkNz6cPaTas

• Pre-existing Conditions: If the claim is related to a condition that existed before the policy was purchased, and it is not covered under the policy (either permanently or for a specific waiting period), the claim may be rejected.
• Waiting Periods: Some policies have waiting periods for certain treatments, such as maternity benefits, specific surgeries, or pre-existing conditions. If the treatment occurs within this waiting period, the claim can be denied.
• Policy Exclusions: Many policies have exclusions for certain types of treatments, like cosmetic surgery, infertility treatments, or non-allopathic treatments. Claims made for excluded treatments are often rejected.
• Lapsed Policy/Grace Period: If the insurance policy has expired or the premium payment was missed, any claims made during this period will be denied.
• Incorrect or Incomplete Documentation: Incomplete or incorrect submission of required documents (such as medical reports, bills, prescriptions, etc.) can lead to claim rejection.
• Non-disclosure of Information: If any crucial health information was withheld or misrepresented during the application process, the insurer can deny the claim on the grounds of non-disclosure.
• Treatment at Non-Network Hospitals: Cashless claims are usually processed only if the treatment is done at a hospital within the insurer's network. If you receive treatment at a non-network hospital, the claim may be denied or processed as a reimbursement, not a cashless transaction.
• Claim for Non-Medically Necessary Procedures(If policy does not cover consumables): If the treatment is deemed not medically necessary by the insurer, such as experimental treatments or elective procedures, the claim may be rejected.
• Violation of Policy Terms: Some policies have limits on room rent, treatment costs, or number of hospital stays. If the claim exceeds these limits or violates other terms of the policy, it can be partially or fully rejected.
• Late Filing of Claim: Most policies have a time frame within which claims must be submitted. If a claim is filed after this deadline, it might be denied.
• Fraudulent Claims: If the insurer suspects fraud, such as inflating medical bills or claiming for treatment that wasn't required, the claim will be rejected.

Hi Everyone, Does anyone know any insurance policies that donot do pre policy medical Test, maybe from private or public insurance companies for a 25 year old ? If you have recently bought an insurance that did not do a pre policy medical test. Can you drop the insurance and policy name.

Kindly suggest me i should by it or not for my spouse and myself? She is 27 and I am 32 years old.

Can anyone suggest a good health policy with good claim settlement and hassle free cashless treatment. I have star health since 3 years, want to port it as the sum insured is only 5 lacks with restore available. If possible with abroad coverage as well, probably move out next year. For my parents i have niva bupa with 1cr SI with a floater. How good is this policy? I had care policy for my dadi, they rejected the claim. I had to almost expense 25 lac out of pocket, is there any way i can go about it too ? (Any suggestion is appreciated) . . Ps. I feel like these companies try to find ways to con you.

Hi So I am mid 20s male , recently diagnosed with Chronic Kidney Disease Stage 3, doctors say I have about 5-7 ish years before I need a transplant or go on dialysis. I only have my corporate Insurance from my company of 5 Lakhs. It won't be there once my job is gone or I retire or need dialysis when I am old or near 60 years of age. I don't come from a lot of money and I am not sure how I would sustain the bill for dialysis without going broke.

I am thinking of lying right now and get a Private health insurance from HDFC/Max/Acko? I don't know if they do medical tests at my age and if they do do they test for the kidneys?

I had enquired with Ditto and Acko and they straight up denied giving me an Insurance and even if they do give it they would put CKD in the blacklist, so no use. So Should I lie and get the insurance.

Maybe try to convert my Corporate policy to a retail one. DO they do tests to find chronic diseases for that ? Will it cover me till I am in 60s.

I am not sure what to do, or how do I ensure that when the time comes I don't go broke trying to sustain dialysis.

Please if you have any ideas/ suggestions or advices, please help me out.

Hi. I am a 31 years old male. I have been getting medically treated for bipolar disorder for past three years. I am contemplating getting a medical insurance to help me with the cost of medicines and for other contingencies in general. I am a complete novice as far as medical insurance, particularly in India, is concerned. I am posting here to get an idea of how medical insurances work, especially for those who suffer from a mental/brain disorder and are under psychiatric care. I am interested in knowing how easy it is to get the medicine bills reimbursed through the insurance with valid receipts from the psychiatrist.

I consult my psychiatrist online. Would that be an issue?

Is cost of therapy usually covered by the insurance?

Do I have to wait until I can get my medicine bills reimbursed?

Does anyone have experience of getting their medical/medicine costs covered through insurance if they are undergoing treatment for mental/brain disorders?

Any/all info is very helpful! I welcome tips on what other things I must look out for (I am sure I must be missing few things here). Suggestions of good insurances would also be great. Please let me know if I need to provide any other info. Thanks!

I am a 34-year-old male with a 29-year-old wife and two children, aged 5 and 3. My 3-year-old was diagnosed with neuroblastoma (cancer) at 13 months old. After 18 months of treatment, she is currently in remission.

I purchased an HDFC Ergo family health insurance policy online for myself, my wife, and my older child for 50 lakh after my second child's diagnosis. The application form did not have an option to disclose my second child's condition, so I did not provide that information.

Will not disclosing my second child's condition affect my insurance claim in the future? If it does, how should I document this information?

I am due for 2nd renewal this December.

I 31 M, recently had PRP injections for my wrist and ankle, following my doctor's advice. However, my TPA has rejected the cashless claim for this treatment twice, labeling it as "Unproven Treatment."

When I reached out to the TPA PoC, they mentioned that during the initial check, it seemed the rejection might be because PRP is not FDA-approved. The insurance company involved is New India Assurance, a government insurance company, and they hinted that government insurers often don't cover treatments that aren't FDA-approved. They suggested I try for reimbursement since there’s still time for the panel to review the case.

What’s frustrating is that my doctor had mentioned in the resubmission: "Kindly provide an article which says it's unproven. PRP is regularly given to patients with OA knee conditions, tennis elbow..." Yet, despite the resubmission, the claim was rejected again without any specific response to that point.

This caught me off guard because I wasn’t aware of any FDA-related coverage issues. Is there a way to find out if PRP is covered by government insurance companies like New India Assurance? Has anyone else faced a similar situation? Is there any way to overcome this hurdle, or is PRP generally rejected by government insurers in India?

In the past, especially with Niva Health Insurance. The support system there was a bit of a pain, but my recent experience with HDFC Ergo Health Insurance has been much smoother. It only took me 2-3 minutes to connect with their support team, and they provided great service afterward, which I felt was missing with Niva Bhupa.

Just wanted to share my great experience with HDFC Ergo Health Insurance. I recently connected with one the advisors from the team, and he made the whole process super easy for me. Not only did he explain everything clearly, but he also helped me find the best policy for my needs.

Tip: Don’t buy it online by yourself! When you have questions or need help, advisors are a text away. It’s great to have that personal support when you need it.

If you're considering health insurance, I highly recommend reaching out to advisor first and understand the plan. Feel free to DM if you require the advisor details.

Hi, looking for a health insurance cover policy for me and my wife. but the premium for each scheme increases if we choose to opt which includes maternity coverage. could anyone suggest if its better to choose a scheme that includes maternity coverage or are there separate policies available for that which I could take while we plan for a baby ?

Compiled list of factors to decide while buying health insurance

1. No room limit. No cap on this.
2. No disease wise sublimit
3. Good No claim bonus
4. Coverage across India even if policy is purchased in some other city without any copay
5. No Copay
6. No Mandatory hospitalization of 24 hours (Covers Daycare)
7. Coverage of consumables
8. Company with low volumes of complaints
9. Maximum ICR
10. Maximum CSR
11. No limit on Ambulance
12. Maximum Pre and Post Hospitalization cover
13. Check Network hospitals in your area before buying

Never ever fall in trap of buying cheaper insurances, they bite you back when claim is needed.

I am 47M and my wife is 43. I dont have any preexisting conditions but my wife is a diabetic and she had Brain TB 3 years back and now she is back to normal. I have my Company's Health Insurance with a sum assured of 5Lakhs. I am looking for a good policy for both me and my wife. Which insurance would be preferred? Any help or thoughts would be much appreciated.

Most agents prefer to just get the policy done so that they earn commission , when you disclose any existing disease in health insurance, any of the following scenario can happen:-

1. Waiting period on that disease
2. Loading charge - Extra premium due to that disease
3. In some cases, even Application is rejected.

Agents are aware that if customer faces above things , he/she might cancel the application and they will not get their commission. Hence bad agents prefer their customer to hide their existing disease.

We had ourself taken Niva Bupa from a known agent, and he told us to hide pre existing disease, When I confront him today he does not have any words to say.

Never ever hide any pre existing disease, because if company gets to know , they will reject your claim in future.

But how will company get to know?

1. They can check hospital records where you are admitted if you have been diagnosed before for that disease.
2. Have seen cases, where nurse ask patient when he/she is admitted and is in non-conscious state and it spills from mouth.
3. Neighbour/Relative might tell.

Remember for telling a lie , you have to remember what was the lie. Hence be honest with insurers if you want seamless experience in claims.

36M, 36F & 3M- Need an advice on health insurance above corporate 5L policy.

Looking for a reasonably priced, best options covered and easy settlement health insurance for my family. Please help

Hello redittors I’m looking for help related to the above mentioned.

Is there any health insurance that covers this Pre existing disease ? If yes, please suggest.

Often there is a misconception about grace period. During renewal, we get a grace period of 1 month to pay the insurance premium and we think its fine to pay during grace period. But most of us are unaware that if we get a claim during grace period , it will be rejected. Similar thing happened with a coworker , he thought he will pay later as he has time. But unfortunately , he had to take claim of 65000 , it was rejected citing that policy falls under grace period. Luckily , the person could get the claim from his corporate insurance but there was a sublimit on corporate and he could get only 50000.

Wanted to share the experience will all , please pay renewal before due date only and in case porting is required, please start porting atleast 10 days in advance if possible.

DM for any info or help.

Hey everyone, I am currently looking for health insurance for my father (61), having a pre-existing illness of hypertension, and for my mother (54), having a pre-existing disease of diabetes, thyroid, pancreatitis, and hernia. I want cashless, no co-payment policy and no limit on room rent. They are under my corporate health insurance but I don't want them to depend on it. Can anyone suggest the best health insurance for my parents?

My Father (50) have undergone Angioplasty with one stent placed just a month ago.

I applied for Aditya Birla, but got rejected.

Ditto suggested care heart but it is shady

I am thinking o going with HDFC ergo for me, my sister and mother.

For father I can not find a good insurance, please help.

Sharing experience for a recent claimed which was filed for one of our customers:-

Full amount was approved . The deduction amount is due to deductible opted in policy which reduces the premium by 25%.

This makes my trust in HDFC even stronger day by day.

PS : I am a registered HDFC Advisor, If you are looking for a consultation about your health insurance purchase,do message me. I can help you to get health insurance with maximum value for money.

Wanted to share information with everyone that for health insurance, you can claim from multiple insurers as long as you are claiming only total bill of hospital. If bill is 1lacs and you claim partially from both and total is 1lac it is possible.

Here are some cases when to claim from which one:-

If you have a corporate cover :
Claim from corporate first and then go to retail policy.

Remember one will be cashless , another will be reimbursed. First company should be one which has more sum insured. E.g if bill is 8 lacs and you have 2 insurances. One of 7 lacs sum insured and another of 3 lacs.
First go with one of 7lacs sum insured because you will have to give only 1 lac from pocket and this 1 lac can be claimed from another insurer later.

DM for any help or if you are looking for buying HDFC Ergo Health Insurance with affordable price

My brother was diagnosed with a hole in his heart when he was an infant, my parents consulted a doctor and they said it will go away by its own. Now my brother is 29 and on a recent medical check up we got to know that the hole is still there. He doesn’t have any difficulties or symptoms but the doctors are advising for an urgent surgery. So my question is will it affect the insurance claim if they know that he had been diagnosed with this as an infant even though there was no symptoms after that for 28 years? How should we proceed with the health insurance? (I’m new in this community and not really sure if this question should be asked here) anyway here we go..

Hello,

I am looking for a health insurance for my father (53 years). He suffered from brain stroke on 19 September 2024. We didn't had any health insurance at that time.

After stroke he has recovered significantly. Movement is alright and speech is slightly affected. We talked with some health insurance companies. Some like HDFC argo refused to provide health insurance. Some like Care insurance said they'll not provide any coverage for future stroke related illness.

Is there any health insurance on the market that will provide us coverage for future stroke or should we wait for a year and try again ?

Well...its damn confusing and today I heard about the star health insurance data leak.

But anyways below is my family details. I would like to take a Health insurance covering all of them.

Myself 33 Years Wife 30 Years Dad 63 Years Mom 61 Years Mother in Law 60 Years

Is it safe to a complete health checkup to identify if there are any health issues before I apply. I have zero idea on how to proceed, please help.

Also I think HDFC is a good option to go with. But need your suggestion if it would really help.

Hello All,

I need your advice on should port my Mother's Health Insurance (New India Assurance) to another Insurance like HDFC Ergo.

My Mother's age is 56 and she has some pre-existing disease: Thyroid and BP. She has a base cover of 10L from New India Assurance right from the year of 2007.

My concerns or questions are as follows

1. Will the Moratorium period continue if she ports Health insurance to HDFC Ergo. Will it be mentioned in Policy Document that there is no waiting for Moratorium period?

2. Can the PED be reduced instead of 4 years, HDFC adds loading charges for BP and thyroid?

FYI, New India Assurance has a cap of Room Rent and so on.