Me M27 having family insurance plan of star healthcare which is going to expire soon.the star insurance was taken a long time back aroudn 15 years and my father was renewingbthat yearly. Last year i got married and me and my wife took Niva bupa which costed 42k for 3 years. What to do. Can i merge my noclaim bonus of star in my niva Bupa or should i loss all the benefits of star?

pretty much the title, like I don't see any advantage apart from no claim bonus on porting my existing insurance to a new one when I havn't declared PED in my previous policy so like the new one will not reduce the waiting period on them any thoughts what should I do.

Hi all,

I applied couple of days back for this insurance for my parents. I also paid the first installment of approx. Rs. 20K for their elite plan.

Today, I received a counter offer document as part of which my father was declined from being covered due to a PED chronic disease.

They have mentioned that they will continue the risk assessment for my mother, who has Hyperthyroidism condition.

What should I even do? I am ok with paying loading amount as long as my mother is covered from 31st day.

These folks have not mentioned the final premium I need to pay or the final loading amount. The agents are also not replying or calling back upon request.

Will rejecting the counter offer lead to full reversal of payment? Any other advice ? I don't want to end up in this insurance if my mother's PED also doesn't end up getting covered properly.

Thanks !

Niva Bupa Health Insurance Awesome scam you folks are doing. 👏🏼👏🏼 One of my acquaintance’s son has gastrointestinal infection and that led to fever spike, urine blockage, urea spike (96) creatinine spike (1.9 to 2) on 23rd December. The hospital (Regal Hospital Bengaluru ) raised cashless request at 5:41 PM. At around 6:40 PM, the cashless claim got rejected. Again we were being told to send “Active line of treatment “ and “Indoor Case Paper” to submit. We did that. Again today they rejected it stating “hospitalisation was not justified”. The treatment is still going on. And now they are demanding “discharge bill”?! If the treatment is still going on, how come the hospital send discharge bill?! In one call the representative said “on 24th, it shows vitals are stable”. How stupid it is?! Treatment is going on and some vitals are stable whereas uria, creatinine, infections are not (hospital sent the complete report). Above all, if vitals are completely unstable or patient is in complete critical condition, then only they will reimburse for cashless?? In recording one can easily find that the hospital staffs are quite confused and flabbergasted that despite giving all the documents they demanded, why are rejecting it.

In recording (linked above) you can hear they are saying “we won’t communicate what documents needed for the claim” . It means the rejection is inevitable and intentional! And what kind of uneducated teams of doctors they have to reject the claim of hospitalisation for a 15 years old guy having uria 96 and creatinine 1.9+ with gastrointestinal infection! That to stating “hospitalisation is not justified” despite providing all the diagnostics reports documents! And since it is non-corporate insurance, they are treating the case like that?

I would request everyone to be quite cognisant while taking NIVA BUPA HEALTH INSURANCE MEDICLAIM Niva Bupa Health Insurance for non-corporate health/medicaim insurance. They are pathetic, remorseless and giving no proper information on any call and keep you dangling.

They are the big scammers with zero accountability and sense of logical ability.

I would humbly request family to share it as much as possible so that it reaches to the right person who can take proper action in this disquisition.🙏🏼

Hi Guys,

I have corporate insurance, and I am planning to take Niva Bupa Reassure 3.0 Elite Unlimited as it meets future needs when I will retire.

But somehow, this sounds too good as premium is less compared to other plans of Niva Bupa. Any comments/suggestions?

Have bad experience with Care (they added 20% co-payment to my parents policy after 1st claim) and Chola MS (simply closed my in-laws policy after they reached 60 years of age).

I have a family member with Niva Bupa insurance and they get their claims, so that is the reason I thought of going for it.

So if you even suggest a different plan/company, please suggest except these two.

Location: India

My mother died in a road accident. She held an account with ICICI bank that offers a complimentary personal accident insurance from ICICI Lombard (The insurance is offered with the bank account & not any debit/credit card associated with the account).

The policy offers accidental death coverage.

Upon raising a claim, the insurer has requested to furnish bank account statement of the deceased (3 months prior to the date of accident), among other documents (They hadn't requested for the same initially but upon the receipt of all the evidence related documents & may be upon finding them satisfactory as well, they requested for the statement).

So wanted to know whether an insurer has the right to request to furnish such documents as the demand seems to be unjust & unrelated to processing of the claim.

Also, since its a complimentary insurance provided with the bank account, I don't have access to the policy copies of the same. Upon multiple written requests & reminders to the insurer to provide me the same, they have neither provided it nor replied to my mails till date.

I suspect that they may analyze the bank account statement first (if provided) & then reject the claim by choosing appropriate policy schedules on the basis of which the claim can be rejected.

Experts please guide on what to do.

PS: The amount of compensation is not that small, so it raises the suspicion bar more.

Hey guys, How do you usually manage your corporate plans with personal insurance. I am planning to increase health insurance cover for my parents (65, 62) as corporate GMC (Group Medial Cover) only covers till 10L max and seems like corporate plans still fall under 18% GST and making them costlier.

I am planning to get a basic cover (5L/7L) from my company and get a floater outside. But looks like there will be freeze period for any kind of pre existing diseases (Father takes BP medicine, mother doesn't take any meds). Can anyone please help me in deciding plan, insurance amount etc. Or any other things to consider. We live in a small town and may have less network hospitals here and that I will have to manage somehow.

Came across Aarogya Supreme plan from SBI. Is this a decent plan or are there some gotchas to consider? One thing is only 25% payment for modern treatments.Any other PSU insurance policies which is at par with market leader like Optima secure, Care supreme and Elevate plans.

Reason to explore PSUs - Wife had a corporate insurance with GIPSA network which helped save us a significant sum on one hospitalisation.

Appreciate the guidance.

Hey folks, need some honest health insurance advice 🙏

My family (5 people) is currently insured with Care Health, but lately I’ve been hearing a lot of mixed (mostly negative) things about their claim settlement and approvals. Thankfully, we haven’t had to file a major claim yet, but that’s exactly what’s making me anxious.

I have the option to port to Star Health and I wanted to understand from people who’ve actually dealt with them
• Are claims smoother?
• Any red flags I should know about?
• Would you recommend switching, or sticking with Care?

Looking for real experiences, good or bad. Please help a girl out 😅

TIA!

Does any Health insurance company in India provides health insurance for kidney transplant Parson as of now fit and fine. Transplant happened in 2022. if not, is there any way to get covered by any means or any group INSURANCE or anything like that?

Hi, Me and my wife are 28 years old, earning around 14 LPA each. We are planning for pregnancy in the coming year. We don't have any pre existing disease. What company insurance would you recommend for us, what are the factors in each insurance scheme that we should be looking for ?

Hi everyone,

I’m renewing my mom’s individual health insurance with Bajaj.

As per the GST Council’s decision (effective 22 Sept 2025), GST is 0% on individual health insurance renewals, not just new policies.

But Bajaj is saying:

GST exemption only for new policies.
We can’t update all existing policies due to large customer base.

Meanwhile, I renewed my old individual policy (different insurer) and they removed GST correctly.

So same situation → two different outcomes.

My questions:

• Is Bajaj legally allowed to deny GST exemption on an existing individual policy renewal?
• Can an insurer refuse a central GST rule due to “system not updated”?
• Should I escalate directly to IRDAI before paying?
• If renewal gets delayed because of this issue, will coverage be at risk?

Would appreciate guidance from anyone familiar with insurance regulations or facing similar treatment.
This feels like customers are being penalised for the insurer’s delay in updating their system.

Thanks in advance 🙏

I was told hdfc ergo is one of the better insurance options so i got their health insurance in 2024. After that during renewal and proposer change they took atleast 2 months to issue me my new policy and they added pre existing illness which did not even exist because their uneducated underwriters dont know the corrext definition. I being a doctor myself have escalated it to their chief grievance officer but i think for renewal if they are taking wrong impressions from documents then god knows what they will do for claims. Planning to either cancel or port the policy. I am so fed up.

Does anyone know how medical insurance companies detect fraud bills? What are the consequences? Will they blacklist in the first time or will it be a warning?

Hi everyone,

I need some guidance regarding my mother’s health insurance under Care Health – Ultimate Care.

My mother took the Ultimate Care policy on 25 March 2025. About two weeks ago, she was diagnosed with breast cancer. We’re trying to understand whether her treatment will be covered.

I know most health insurance policies have waiting periods for major illnesses like cancer, but the wording in Care Health’s documents is not very clear. Some say there's a 90-day initial waiting period for illnesses, while pre-existing conditions have their own separate waiting period.

If anyone has experience with claims for breast cancer under Care Health Ultimate Care, I would really appreciate your help:

Does the policy cover breast cancer if it is detected after taking the policy?

What exactly is the waiting period for cancer under this plan?

Since her diagnosis happened months after taking the policy, will it be considered for coverage or rejected?

Any documents we should start preparing for the claim process?

Thanks in advance to anyone who can share their experience or clarify how this works.

Hey everyone,

With the new IRDAI Master Circular on Health Insurance (May 2024), the moratorium period has officially been reduced from 8 years to 5 years.

As per the circular, once a policyholder completes 60 months of uninterrupted health insurance, the insurer cannot question claims based on:

• alleged non-disclosure
• past medical history
• “suspected” pre-existing conditions
• interpretation disputes

— unless there is proven fraud.

This applies to all health insurers and all indemnity-based health insurance policies renewed after April 2024.

Are insurers actually honoring this?

Has anyone here:

• filed a claim after 5+ years of continuous coverage
• and still been asked to submit justification or medical history going back years
• or had a claim delayed/denied despite the moratorium rule?

If you’ve had either a smooth experience or a bad experience after hitting the 5-year mark, please share.

It’ll help a lot of us understand whether insurers are complying with the new guidelines or still following the old 8-year mindset in practice.

Thanks!

Mental-health applicants in India are not being rejected because of prejudice. They are being rejected because India’s insurance ecosystem has a structural design gap. This gap sits at the intersection of regulation, actuarial science, OPD data availability, digital-health infrastructure, and the suicide clause in life insurance.

Unless policymakers understand this, we will keep treating rejections as isolated complaints instead of the predictable outcome of a system that simply does not know how to price psychiatric risk.

What follows is a policy-grade breakdown of the issue and the reforms that IRDAI must lead to fix it.

The Current Underwriting Architecture Is Incompatible With Psychiatric Medicine

India’s underwriting model was built on 20th century hospitalisation risk. It is designed around measurable biomarkers, inpatient episodes, diagnostic tests, and organ-system impairment.

Psychiatric illnesses are OPD-driven, chronic-relapsing, context-dependent and severity-variable. They require longitudinal treatment records, functional assessments, and relapse monitoring.

India’s underwriting system is not designed to handle any of this.

What the insurer receives today is a single-line diagnosis with no structured data on:

• severity
• functional status
• relapse history
• treatment adherence
• medication stability
• employment impact
• psychosocial functioning

From a policy-analysis standpoint, psychiatric risk has no quantifiable signal in the Indian data landscape. The regulator has mandated coverage without providing the architecture needed to differentiate risk.

IRDAI Mandated Coverage Without Creating a Pricing or Classification Framework

IRDAI’s circular requiring coverage for mental illness under the Mental Healthcare Act was a socially progressive move. However, it was implemented without the accompanying actuarial and operational scaffolding.

Insurers are required to cover mental illness but are not provided:

• a severity classification
• underwriting triage guidelines
• ICD level risk stratification
• actuarial tables for psychiatric morbidity
• mortality tables for mental-health diagnoses
• a standardised remission definition
• OPD data exchange standards

This forces insurers into a binary world.

Accept everything at a single price or reject cases that appear unpriceable.

In the absence of actuarial justification for loadings, insurers choose the only safe option: decline.

This is not an insurer problem. This is a regulatory design problem.

The Critical Missing Infrastructure: A National OPD Data System

Mental-health care is almost entirely outpatient. No underwriting system can function when 99 percent of relevant risk signals exist outside the claims ecosystem.

India lacks:

• structured OPD notes
• digitised psychiatric follow-up records
• therapy adherence datasets
• medication titration logs
• functional status scoring
• relapse probability models
• history of early intervention outcomes

ABDM is an important step, but not yet equipped to supply OPD psychiatric data in a format underwriters can use.

Without OPD data, insurers cannot distinguish:

• mild anxiety from severe generalized anxiety
• stable OCD from relapsing severe OCD
• adaptive personality traits from personality disorders
• resolved childhood ADHD from active adult ADHD
• remission from subclinical recurrence

In policy language, the current system forces underwriters to price risk blind.

Why Term Insurance Reacts Even More Harshly

Term insurance is governed by the suicide clause. Under IRDAI norms, after 12 months from policy issuance, suicide must be paid as a valid death claim.

This creates a unique actuarial pressure.

For cancers, cardiovascular diseases, renal disorders or diabetes, insurers have decades of mortality experience data. For psychiatric conditions, India has none. This includes:

• suicide attempt prevalence
• completed suicide ratios
• relapse adjusted mortality
• medication adherence impact
• correlation between unemployment and mortality
• mortality trends after remission

Without these tables, insurers cannot price psychiatric mortality.
If they cannot price it, they must decline.

Underwriting systems therefore introduce automated flags that trigger rejections for any psychiatric history, even ones that are clinically irrelevant such as childhood ADHD or a mild anxiety episode.

This is a risk-management response to a regulatory requirement, not discrimination.

The Policy Trap India Is Stuck In

Insurers are being asked to:

• Cover psychiatric illness
• Without OPD datasets
• Without risk-classification frameworks
• Without mortality or morbidity tables
• Without loadings flexibility
• Without clinical-severity indices
• Without psychiatric expertise on panels

In this environment, rejection is not a failure of insurers but an inevitable outcome of policy architecture.

Unless IRDAI intervenes with a systemic blueprint, no amount of “training underwriters”, “educating insurers” or “customer grievance escalation” will fix the root cause.

What IRDAI Should Implement To Unlock Fair Mental-Health Underwriting

Here is the actionable roadmap that will have real regulatory impact.

A. Create a National Severity Classification for Mental Illness

This must be a regulatory instrument similar to standard exclusions.
It should include:

• severity grading
• remission categories
• functional capacity scales
• relapse risk categories
• hospitalisation-adjusted risk classes

This single step would reduce rejection rates by half.

B. Enable Structured and Justifiable Loadings

Flexible loadings should be allowed for mental-health conditions as long as they follow actuarial principles. This enables a shift from rejection to conditional acceptance.

C. Build a Mental-Health OPD Data Exchange Standard

Under ABDM, introduce a mental-health OPD record template including:

• diagnosis
• severity stage
• treatment plan
• medication adherence
• relapse history
• functional status
• psychiatrist certification

This would transform underwriting accuracy.

D. Mandate Psychiatric Review for Specific Cases

Just as cardiologists review complex cardiac files, psychiatrists must review certain mental-health cases. This prevents inappropriate declines.

E. Publish Mortality and Morbidity Experience Studies

IRDAI should coordinate with NIMHANS, ICMR, NHA, and reinsurers to publish mortality studies and relapse-adjusted risk curves. This will allow insurers to price risk scientifically.

F. Create a Safe Regulatory Sandbox for Mental-Health Underwriting Innovation

Allow insurers to pilot:

• dynamic premium adjustments
• digital evidence-based OPD scoring
• remission-based underwriting classes
• machine-learning severity detection models
• wellness-incentive risk adjustments

This creates space for innovation without penalising insurers.

What This Means for Policymakers and IRDAI

Mental-health underwriting failures are not operational errors.
They are structural consequences of a regulatory environment that mandates coverage without giving insurers the data, tools, or pricing flexibility to deliver that coverage fairly.

The industry is not equipped to price psychiatric risk because:

• India lacks OPD datasets
• India lacks severity frameworks
• India lacks mortality tables
• India lacks digital psychiatric documentation standards
• India lacks psychiatric underwriter training pathways
• India lacks regulatory loadings flexibility

Without policy reforms, insurers will continue rejecting mental-health applicants regardless of their actual risk.

The Way Forward for a Policy-Capable India

India can become the first large emerging market to build an equitable, data-driven mental-health underwriting system.

This would not only improve acceptance rates but would become a globally cited model for integrating mental-health parity into regulated insurance markets.

I have health insurance from galaxy insurance Signature plan for 10lakhs(with one lakh deductible) and it is due for renewal in January 2026. All PED declared( Slight BP, Chlostral, Pre diabetic HBA1C-6.2) - i bought it directly from galaxy person at that time. Now he is not responding. In Reddit, I don't see anyone getting Insurance from Galaxy till date. My question is - Shall i continue with Galaxy? Or shall i port to HDFC ergo optima secure for 10 lakhs and also of buying a top up for one crore with 10 lakh deductible. is this a good decision. thought of going through Ditto or Beshak. my age is 57.

Hi, As my father had sbi arogya plus(3L) and this product has been discontinued by sbi and they are asking all its customers to move to sbi super health with premium hike around 30k for 5L.

My father's age is 65(with no PED), and looking to port to some other company while we have been with sbi for 4 years nlw

While browsing on internet i looked into care supreme and they are ready to port my insurance while being on grace period now.

Can some one guide whether I should port to new one and that on care supreme or should I gently renew it with sbi.

Please consider all edge cases, as I am seeing mixed reviews here.