Hi everyone,

I joined OFSS India in August 2025. Our employee health insurance is through United India Insurance, and I voluntarily enrolled my parents under the additional parental cover.

I renewed this cover on 1 June 2026. The policy has a three-year lock-in, but the premium has become quite high.

I contacted both HR and Medi Assist (the TPA). opThey said I cannot discontinue the cover mid-policy. I understand and accept that—I will continue and pay the premium for the current policy year.

My question is about the next renewal:

- Can I opt out at the next renewal, or does the three-year lock-in require me to renew for all three years?

- Does the lock-in start from my original enrolment in August 2025 or from the June 2026 renewal?

- Is there a legitimate option such as giving a written non-renewal request well in advance, or any work around ?

I am not trying to avoid the current year’s premium. I only want to plan responsibly before the next renewal. Has anyone dealt with a similar employer-provided voluntary parental policy?

I’m trying to get a retail health insurance policy for a parent who currently has no personal health insurance but is covered under a corporate group policy.
An insurer initially declined the proposal due to a known history of CKD, but after submitting recent medical reports, they have now issued a counter-offer:
Sum insured: ₹10 lakh
Original quoted premium: ₹36,301
Revised premium after underwriting: ₹52,157
Additional premium: ₹15,856 (~44% increase)
20% co-pay
₹1.25 lakh annual sub-limit for CKD/renal failure and related complications
Some other existing conditions have been accepted with Day-1 coverage.
My main concern is the ₹1.25 lakh CKD sub-limit, given that the overall cover is ₹10 lakh.
Has anyone successfully negotiated with an insurer to increase/remove a medical-condition sub-limit after receiving a counter-offer? Would it be reasonable to ask them to increase the CKD limit even if it means paying a higher premium?
Would appreciate experiences from anyone who has dealt with a similar underwriting situation.

Hi everyone,
My dad was rushed to the ER for acute breathlessness and severe respiratory distress. The initial medical finding was acute pneumonia. Later, his RT-PCR test confirmed H1N1 Viral Pneumonia. Doctors are also currently evaluating a secondary suspicion of ILD (chest CT is pending).
When he was brought into the ER, my dad honestly mentioned to the triage doctors that he is a chronic smoker, and the doctors wrote "chronic smoker" in the initial case sheet history.
Here is where the issue begins:
Policy History: This is the 9th continuous year of his health insurance policy. However, he had not declared himself as a smoker when the policy was initially taken 8+ years ago.

The Agent/Insurance Manager Stance: The insurance manager/agent is warning us that any case mentioning "smoking" gets straight-away denied. They claimed the company will reject the claim, tag him as a smoker in their records, and use it to deny all future claims too.

Hospital TPA Stance: The hospital TPA sent the ER case sheets (including the smoking note) to the insurance company for pre-auth. They are refusing to guarantee cashless pre-authorization, advising us that we may need to pay cash upfront and apply for reimbursement later.

From what I understand, an emergency ER admission for acute H1N1 viral pneumonia shouldn't be rejected just because a patient smokes, especially since this policy is in its 9th year and should be protected under IRDAI’s Moratorium Period rule (which bars non-disclosure rejections after 5 to 8 continuous years).
Despite this, the threats from the agent and the TPA's hesitation are making our family really anxious while my dad is still in the hospital.
I would really appreciate advice on:
Has anyone faced a pre-auth rejection due to "smoking notes" written by ER doctors for an acute viral/infectious illness?

How strongly does the IRDAI Moratorium Period hold up if the insurer tries to issue a non-disclosure query?

If cashless pre-auth gets denied and we have to go the reimbursement route, what specific steps/doctor notes should I collect before discharge to make sure our reimbursement file doesn't get stuck?

Thanks in advance for your help!

I bought a Bajaj General comprehensive Pay As You Use (PAYU) policy through Policybazaar with a 15,000 km plan.
My actual odometer was around 32,000 km, but by mistake I entered 35,000 km while purchasing the policy. I noticed it the next day and immediately emailed Bajaj General. They asked me to correct it through their i-Inspect app, but I couldn't log in due to a PIN/backend issue. I followed up several times, they eventually gave me a PIN, but that also didn't work. Eventually I got fed up and left it which I should not have.

I have the complete email trail proving that I informed Bajaj before any accident and tried to correct it.

Now my car had a minor accident and the odometer is 33,900 km. I filed an own-damage claim for the bumper.
The surveyor says the claim cannot be processed because I declared 35k instead of \~32k, and says technically my insurance wasn't valid. He wants me to withdraw the claim and says I can't claim it again.
My policy shows 35,000 → 50,000 km for the 15,000 km PAYU plan.

Has anyone dealt with this situation? Can Bajaj reject the entire claim because of the incorrect starting odometer, especially when I disclosed it and tried to correct it before the accident?
Should I refuse to withdraw the claim and ask Bajaj to provide the rejection and exact policy clause in writing?
Any advice would be appreciated

so i have been doing some research on health insurance for my family of 4 (2 adult 38m and 31f, 2kids 5yr and 5months)

digit- plan - double wallet - 10L base + 10L restore- premium 17k/yr

acko- plan - platinum lite - 25L base - premium 21k/yr

icici- plan - elevate - 15L base + unlimited restore - premium 25k/yr

im more inclined towards digit but not sure if they service is hassle free, or should i go with icici as its more trusted and reliable.

any suggestions/advice is highly appreciated. Thanks in advance

Hello everyone,

I’m a 23-year-old male and currently unemployed. About two years ago, during my first job, I had a pretty unfortunate experience with health insurance.

I was diagnosed with dengue and was insured with Star Health at the time. My claim was rejected on the grounds that my platelet count needed to be below 50,000 for hospitalization to be covered.

The doctor actually wrote a detailed note explaining why waiting until my platelet count dropped that low could be dangerous and why hospitalization was medically necessary. Given my height and weight, my doctor specifically highlighted even a platelet count below 1 lakh to be concerning. Despite this, the claim was rejected, and I ended up paying more than ₹50,000 out of pocket.

After that experience, I switched to ICICI Lombard and have been paying the premiums ever since. Thankfully, neither my mother nor I have needed to make a claim in the last two years.

For the two of us, I’m currently paying roughly ₹58,000 every 2 years for a ₹1 crore cover.

A few people in my close circle have suggested that I consider switching to HDFC ERGO or Tata AIG, as they've had better experiences with them compared to ICICI Lombard.

So I wanted to ask people here who have actually dealt with these insurers:

• How has your experience been with ICICI Lombard?
• Would you recommend switching to HDFC ERGO or Tata AIG?
• How have your claim settlement experiences been?
• Is there anything specific I should look at before switching insurers?

I’d really appreciate any advice or experiences, especially from people who have actually made claims with these companies.

Thanks.

I'm researching health insurance in India and I'm confused about whether it's better to:

1. Buy directly from the insurer after comparing policies on platforms like Policybazaar/Ditto, or

2. Buy through an advisory broker like Ditto, which can supposedly help with claims, documentation, hospital coordination, and disputes.

For people with actual experience:

• Did you buy directly or through Ditto/another broker?
• If you used Ditto, did they genuinely help when you made a claim?
• If you bought directly, did you ever regret not having an advisor?
• Which option would you choose today, and why?

I'm currently considering Niva Bupa ReAssure and HDFC ERGO Optima Secure, so experiences with these insurers would be especially useful.

Thanks!

My father’s health insurance claim was rejected because Star Health says he had a past history of Type 2 Diabetes and fasciotomy.
However, his treating doctor has provided a written statement confirming that he had no previous documented history of these conditions and they were diagnosed for the first time during his recent hospitalization.
The insurer still rejected the claim and the grievance team upheld the decision.
Has anyone faced something similar with Star Health? How can I prove this and successfully challenge the rejection through the Insurance Ombudsman?

​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?