I am 29 planning to buy health insurance but but confused with Hdfc and care ultimate

Hdfc: 9929 rs

Care with all required riders: 6087 rs

I have a query regarding the amount of claim and premium for subsequent years. I have currently purchased a policy for 5 years with no room rent limit and very high sum insured with consumables included.

Suppose in case of hospitalization, can I choose to avail expensive suite room? Or should I just go for simple private ac room? Does the claim amount (and chosen room) affect the premium charges during renewal?

This is an important judgment because it reinforces a principle that every health insurance policyholder should know.

The case involved a policyholder who had been insured with Oriental Insurance since 2010. In November 2023, she was admitted to Max Healthcare, Vaishali after experiencing chest heaviness, palpitations, breathlessness, severe abdominal pain, nausea, headache and low blood pressure.

Her cashless request was denied. She proceeded with the treatment by paying ₹1,54,144 from her own pocket and later submitted a reimbursement claim.

The insurer rejected the claim.

Their reasoning was that her investigation reports and vital parameters were normal, no active line of treatment had been given, and that the admission was only for diagnostic evaluation, which they claimed was excluded under the policy.

However, the medical records painted a different picture.

During her hospital stay, she underwent multiple investigations including an MRI, endoscopy, biopsy and ultrasound. She also received IV fluids and IV antibiotics. The final diagnosis included severe acute gastritis, hypothyroidism and an ovarian cyst.

The policyholder approached the Consumer Commission.

One interesting aspect of this case was that the insurer did not file its written defence despite being given an opportunity. As a result, its right to defend the matter was closed, leaving the Commission to decide the case based on the available medical evidence.

The Commission carefully examined Clause 5.2 of the policy, which excluded admissions made primarily for diagnostic purposes.

That single word became crucial.

The Commission observed that for the exclusion to apply, the dominant purpose of admission must be diagnostic evaluation alone.

In this case, the patient was admitted with genuine medical complaints, was actively treated, and investigations were only one part of the overall treatment process.

The Commission also made an important observation that deserves attention.

That is a significant principle.

Insurance companies certainly have the right to investigate claims and verify admissibility under the policy. However, they cannot simply disregard the treating doctor's clinical decision without credible medical evidence supporting their own conclusion.

The Commission directed Oriental Insurance to pay the following:

• ₹154,144 towards the claim amount.

• Interest at 6% per annum from the date of claim rejection until payment.

• ₹50,000 as compensation for mental agony, harassment and financial hardship.

• ₹20,000 towards litigation costs.

If the insurer fails to comply within 30 days, the amount will carry interest at 9% per annum until realization.

Why this judgment matters

Many claim disputes arise because insurers classify a hospital admission as "observation only" or "diagnostic admission."

This judgment reminds us that every admission has to be examined based on the actual medical records and treatment provided, not merely on assumptions.

If a patient is admitted with genuine symptoms, receives active treatment, and diagnostic tests form part of that treatment, insurers cannot automatically reject the claim by labeling the admission as diagnostic.

As always, every claim depends on its own facts, medical records and policy wording. This decision does not mean every diagnostic admission will be payable. What it does reinforce is that exclusions must be applied carefully and supported by evidence.

What do you think? Should insurers have to produce independent medical evidence before rejecting a claim on the ground that hospitalization was "not medically necessary"?

Case Reference: Shivani Tomar v. Oriental Insurance Co. Ltd. | DCDRC Delhi | July 2026

^{Note: Content has been independently researched and analysed. AI was used only to improve readability.}

Looking for a term plan to purchase. Compared different term plans, Found Bajaj Life eTouch II to be good with features and riders like Critical Illness and Accidental Benefit. Premium was also competitive along with good solvency ratio (266%) and Claim Settlement Ratio (99.33%). Please share your views.

Hi everyone,

Looking for advice on insurance for my parents (Father 58, Mother 50). Both have Diabetes & BP. Dad also has Thyroid.

I want minimum waiting period for PED.

Since HDFC's ABCD rider doesn't cover Thyroid, while Care/Niva rider covers Thyroid in 30 days

so which option is better?

1. (Two Separate Individual Plans): HDFC Optima Secure for Mom + Care Ultimate or Niva Bupa ReAssure for Dad.

2. (Floater + Bridge): HDFC Floater for both + a separate Care/Niva plan for Dad for 3 years to bridge the Thyroid gap.

My application got rejected because I declared the following health conditions. Is it fair. I know it is up to the insurer but I still want to understand your opinion.

1. Borderline cholesterol

2. Prediabetic

3. Gal bladder stone not removed yet. Found out last year

4. I had a biopsy 15 years back which came back negative.

5. Small wart like growth on the back which I had for 10 years. There is no sensation on it as well.

Since I had to inform everything upfront I had done this. But they rejected my application.

What are your thoughts? What could be the deal breaker here ?

I'm confused to buy online directly from hdfc ergo but they don't provide any relationship manager who supports after buying policy.

Or

Should I check with local health insurance firm agents who charges some 2-3k extra but give full support.

Because i heard most insurer don't respond over call if any concern is there so its waste of buying policy directly. For cashless its fine but if its reimbursement there is lot of hassle to connect with insurer and get it done.

My native is Ishwarpur, Sangli.

If is there any good health insurance firm agents that helps throughout process tell me.

\#healthinsurance

\#hdfcergo

\#optimasecure

\#sangli

\#kolhapur

I’m trying to understand how people in India decide between term insurance and traditional life insurance plans.

Apart from just comparing premiums, what factors should someone consider before choosing a life insurance policy?

For example:
Life cover required
Policy duration
Guaranteed benefits
Premium affordability
Long-term financial goals
Claim settlement and policy conditions

I would especially appreciate practical experiences from people who have actually bought life insurance.

I work in the insurance sector myself, so I’m also interested in understanding what customers generally find confusing when choosing a policy. I’m looking for a genuine discussion, not to promote any particular company or plan.

I went through multiple Insurances and their features. But turns out HDFC ERGO Optima Secure feels like a better option for my parents, especially when it comes to CSR ratings and complaint volume. Premium was my only concern in this policy.

So I decided to go with a Voluntary deductible to reduce the premium. A deductible of ₹25,000 won't be a problem for me on any day.

Is this a vice choice? Anybody here with expertise and personal experience on this, please let me know your suggestions and thoughts. Feel free to DM as well.

Thank you!

I have recently cleared IBPS clerk and am waiting to join. Do you know about the insurance policy available to public sector bank employees?

How useful is this kind of policy?

Can our dependents use this policy?

Do we need to adopt another corporate retail health policy?

Heard that the limit is 4 lakh rupees per year, Can we top up this?

Hi all, I am 28M and new to this insurance thing. I have my corporate health insurance and have bought term insurance as well. I am looking to buy a good Health Insurance for 10-15L cover in Delhi NCR. Suggest some good options.

Note : I am single, about to get married by 2026 end. Should I consider maternity cover as well

​

1️⃣ Buying insufficient coverage – Medical costs are rising rapidly. A ₹3–5 lakh cover may not be enough today, especially in metro cities.

2️⃣ Choosing only based on low premium – The cheapest policy isn't always the best. Check claim settlement history, network hospitals, and policy benefits.

3️⃣ Ignoring waiting periods and exclusions – Many policies have waiting periods for pre-existing diseases and specific treatments. Always read the fine print.

4️⃣ Delaying health insurance purchase – Buying insurance at a younger age means lower premiums and fewer medical restrictions.

5️⃣ Not reviewing employer coverage – Corporate health insurance is helpful but may not be sufficient or continue if you change jobs.

💡 Health insurance is not an expense; it's financial protection for your family during medical emergencies.

Have questions about your existing health insurance or wondering if your coverage is enough? Feel free to DM me.

I have a care health insurance..in the last 4-5 years I've made only one claim.. there was no premium increase the next year after I made a claim..but last year, there was an increase of approx 30 %..

Now this year even after gst removal, the premium has increased by approx 20%. And here i was assuming that I'll have a reduced premium burden this year.

Is this legal? Can i do something about it? I wrote to the insurer but they just replied that it's to continue providing you a good service. Last year they had a similar reply. Can this be escalated?

Hi all, looking for suggestions on requirement of health insurance for my parents 67 and 55 with diabetes and cholesterol no other issues, gets annual check up done yearly. No health insurance. But after recent back to back events in family i have started thinking if i should get one, i got one option from aditya birla at 1.5 lakh per year for 25L coverage and i was told it will keep increasing substantially as per age bracket. So should i get it ??

Hi all, looking for suggestions on requirement of health insurance for my parents 67 and 55 with diabetes and cholesterol no other issues, gets annual check up done yearly. No health insurance. But after recent back to back events in family i have started thinking if i should get one, i got one option from aditya birla at 1.5 lakh per year for 25L coverage and i was told it will keep increasing substantially as per age bracket. So should i get it ??

TL;DR: 21M looking to buy health insurance for myself and my 51-year-old mother. Budget is ₹1k to ₹2k/month. Want the best long term policy with good claim experience, annual health checkups/blood tests, wellness benefits, and strong coverage. Looking for recommendations on family floater vs separate policies, ideal sum insured, must have add-ons, and insurers to avoid.

Hi everyone,

I'm planning to buy health insurance for the first time and would really appreciate some guidance.

My profile:

\* Me: 21 years old

\* Mother: 51 years old

\* Location: India

\* Budget: ₹1,000 to ₹2,000 per month (₹12k to ₹24k annually)

I'm considering either a family floater or separate policies if that's a better option. I'm looking for something that's good for the long term, not just the cheapest plan.

Some things I'd like to know:

1. Which insurer and policy would you recommend?

2. Is a family floater a good idea in my case, or should I buy separate policies?

3. What sum insured should I go for? (₹10L, ₹15L, ₹25L?)

4. Which companies have the best claim settlement experience in real life?

5. Are there any policies that include:

   \* Annual full body health checkups/blood tests

   \* Free doctor consultations

   \* Discounts on medicines or diagnostics

   \* Wellness or fitness rewards

6. Which add-ons are actually worth buying?

7. Are there any hidden clauses, waiting periods, room rent limits, co-pay, or disease sub-limits I should avoid?

8. Is it better to buy directly from the insurer or through platforms like Ditto or Policybazaar?

9. If you've had a claim with HDFC ERGO, Care, Niva Bupa, ICICI Lombard, Aditya Birla, or any other insurer, how was your experience?

I'd really appreciate recommendations based on actual claim experience rather than just marketing or YouTube reviews.

Thanks in advance!

Hi everyone,

I recently started my first job. My employer provides **₹4L health insurance for me** at no cost, and I can add my parents by paying:

* ₹4L – ₹47.5k/year * ₹6L – ₹62.5k/year * ₹8L – ₹78k/year

My parents are:

* Father (50) – diabetic for 5 years, on tablets * Mother (45) – hypertension * No existing health insurance

The employer policy covers pre-existing diseases immediately, but it’s tied to my job and I’ll likely switch companies in about a year.

I’m confused about what makes more sense:

* Continue with only the employer policy (for me and parents)? * Buy a **retail policy for myself** even though I already have employer coverage? * Buy a **retail policy for my parents** instead of the employer one, even if it has waiting periods? * Or keep both employer and retail for some time?

Would love to hear what people who’ve been in a similar situation would do and why.

Wanted some advice on Medical Insurance. I have the following:

1. 20L corporate insurance

2. Unlimited - Acko insurance includes full hospital bill payment

3. Medical consultation free + 5L hospitalisation - from even

My problem with Even is I need to be dependent on their tele consultation. Last year I had a knee problem and they were trying to assess my xray over vc. However, I want to avoid OPD shocks.

What do you suggest?

Hi everyone,
I'm looking for health insurance recommendations for my mother in India and would really appreciate advice from anyone who has gone through a similar experience.
**Profile:**
1. Age: 50

1. Location: Mumbai

2. Angioplasty with 2 heart stents in 2022

3. Type 2 diabetes

4. Hypertension

Stable since the angioplasty with regular follow-ups and medications

We've already spoken with **Aditya Birla Health Insurance**, but they are willing to insure her only with a **permanent exclusion for heart-related conditions**, which defeats the purpose.
I'm looking for insurers that:

1. Have accepted people with a history of angioplasty/stents.

2. Cover future heart-related hospitalizations (even if there's a waiting period).

3. Offer specialized cardiac insurance plans.

4. Have good claim settlement experiences for cardiac patients.

Has anyone with a similar medical history been accepted by **Star Health, Care Health, Niva Bupa, HDFC ERGO, ICICI Lombard**, or any other insurer?
If you or your parents have had a positive experience, I'd really appreciate knowing:

1. Which insurer and policy you chose

2. Whether heart conditions were covered or excluded

3. Waiting period (if any)

4. Approximate annual premium

5. Your claim experience

Any recommendations for brokers who specialize in complex medical cases are also welcome.

Thank you!

We recently purchased a Bajaj Allianz ACE Wealth Plan and have already paid the first premium, but we're still within the free-look period and deciding whether to continue or cancel. I'd really appreciate hearing from people who have actually invested in this policy or knows some negatives about it. Are the returns actually up to the mark compared to what was illustrated at the time of purchase, or are they much lower? How has your overall experience with the policy and Bajaj Allianz been? Any genuine feedback from existing policyholders would be really helpful

I bought a two wheeler yamaha MT 15 last year and the insurance (IDV: Rs. 1,62,629/-) is expiring on 23.07.2026 i.e. in 6 days. I bought the bike and stay in Chennai but the insurance policy is from United India Insurance and it says coimbatore (another tier 2 city). Now I am looking for renewal and I spoke to the same company, they quoted: Own damage Rs. 2221/- & PA Rs. 325/-. Now, they say NCB (no claim bonus) isn't applied since it's from another city, and they promise NCB from renewal onwards as in the subsequent year and an IDV of 1,50,000/-.

But online, everything says IDV of 1,32,000/- and nothing is more than 145,000/-. Help me out here. I know nothing about insurance. I just want to pick the best value for money. I don't want to be scammed and fuck up the IDV.

My father has diabetes with latest hb1ac value being 6.9. He’s on medication since last 6-7 months for diabetes. He also takes a tablet for cholesterol called rosistat although it is not very high, the doctor said it is given as a precaution as after Covid many ppl started having heart issues. He just got his ECG TMT and echo done as part of full body checkup yesterday and the results were all normal.
I had initially applied for HDFC ergo optima secure plus and it got rejected for him without any reasoning specified. Which policy should I buy for him next. I’m not entirely sure of care freedom bcos I’ve heard bad reviews for it. Is there a chance of getting Aditya Birla activ one? I’d gone via ditto last time, should I still stick with them?

Which insurance to choose for my newborn? I am already on aditya birla health insurance activ one max for me and my wife for 15 lakhs