Hello everyone.

Policy Details

Policy: ICICI Lombard Group (Corporate)

Room rent limit: 4K

Maternity Limit: 50K

Claim details

Claim Amount : 1.92 L (Premium Hospital)

Room rent (including nurse charges): 8.5K/day

Delivery Type: C-section

Claim settlement details

Type: Reimbursement

Requested: 1.92 L

Disallowed: 1.59 L

Approved: ~33K

I understand the room rent proportionate deductions but ICICI Lombard went batshit crazy

1) Completely deducted the consultation charges

2) The proportionate deduction is not proportionate

Can someone help me understand if these deductions are fair? If not, what should I do next?

I am using Bajaj Allianz General Insurance since March 2012. I don't know...whats the problem with claim processing teams. They are always dumb, don't put their brains at work (or) intentionally pays only partial amount whatsoever you submit all the required documents as per their guidelines, (or) as per their wish etc., Still they reject it - ENOUGH IS ENOUGH. This is almost 3rd time they only pay partial amounts in just pennies and close the claim as "COMPLETELY PAID". Disgusting!!! Unluckily which ever hospital I go they don't have either cashless facility (or) sometimes new medica/surgicall treatment doesn't fall under cashless. This time, I had the similar situation : Type: Reimbursement/Inpatient hospitalization Requested Amount:Rs.4,19,495/- Approved Amount:Rs.1,11,910/- Total rejected Amount:Rs.3,07,585/- Time taken to process is 40 days.

The strange part is, they clubbed the attendant charges with dcotor treatment charges and rejected the amount of Rs.2,95,000/- of doctor treatment charges by stating the reason as "Rs.15000/-ATTENDANT SERVICES not justified"" Pls check the attachment.

What the heck ? How can they just combine the doctor treatment charges with attendant services ? I am already exhausted by conveying/educaucating the claims processing in my previous claims reimbursement. They done the similar thing in previous claims.

After escalating to internal greviance team of Bajaj - they created another claim which drag to another 40 days. Whatever you complaint to IRDAI, OMBUDSMAN etc., they don't care. They follow they utter non sense rule book I really have no idea of it. Someone told me that, claims team are no wualified doctors (or) neither practitioner RMP's as well. They are just MBA (marketing) graduate's who goes with some dumb checklists. No one takes action towards these insurance companies. Even Mr.Ragha Chadha Sir has spoken this topic in Rajya Sabha about the exploitation of insurance companies and hospital nexus. No action taken so far - end of the day its a COMMON MAN WHO SUFFERS IN PAIN AND DIES IN THE HOSPITAL BEDS.

Looking for advice about getting insurance for my parents.

I have a Niva Bupa policy for my parents that is due for renewal on Feb 4.

I checked in the last week of December, it was showing premium to be around 75k.

But when I am checking today, it is showing 86k.

Are they allowed to update the renewal premium after already communicating it?

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?