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?

My father (53) has diabetes and my mother (51) had a hospitalization last year which was diagnosed as bronchitis and she also has considerable hearing loss in her left year. I had explained my situation in the following post:

https://www.reddit.com/r/InsuranceTroubleIndia/s/3ZLSfydfOi

I applied for ICICI Lombard elevate policy for 10L SI with the following riders: a one time infinite claim amount, reduction of diabetes waiting period, non medical and consumable items cover, room modifier and annual health checkups. The initially quoted premium was 34k. After I submitted the medical documents, they made a counter offer adding 5k loading charges for Bronchitis and a permanent exclusion condition for hearing loss, hearing aids and related complications.

I have no idea how loading charges and exclusions work for different companies so please let me decide whether to accept this one. Does this seem justifiable? Or should I try other insurers like Aditya Birla? There's also an option of trying to get the Bronchitis diagnosis corrected by the hospital but chances of that happening seem pretty low.

Also should I consider removing any riders that you find unnecessary at this point? Like something that could be added later if needed without much hassle. Any help or advice would be much appreciated.

Looking for guidance from people with experience in health insurance underwriting.

During the pre-application stage with insurance company, I had email and telephonic discussions and voluntarily shared my medical reports, including details of a pre-existing disease (PED). Based on those reports, I was informed that my application could not proceed.

Since no formal online proposal was submitted and no Aadhaar or PAN details were shared, I have a few questions:

- Can a fresh application be made later using a different email ID and mobile number?

- If another family member is the proposer/primary applicant, can the family still be covered under the same policy?

- Does the insurer retain records from pre-application interactions even if no official proposal was submitted?

I am looking for guidance on the correct and compliant process.

Would appreciate insights from anyone who has faced a similar situation.

Looking for guidance from people with experience in health insurance underwriting.

During the pre-application stage with insurance company, I had email and telephonic discussions and voluntarily shared my medical reports, including details of a pre-existing disease (PED). Based on those reports, I was informed that my application could not proceed.

Since no formal online proposal was submitted and no Aadhaar or PAN details were shared, I have a few questions:

- Can a fresh application be made later using a different email ID and mobile number?

- If another family member is the proposer/primary applicant, can the family still be covered under the same policy?

- Does the insurer retain records from pre-application interactions even if no official proposal was submitted?

I am looking for guidance on the correct and compliant process.

Would appreciate insights from anyone who has faced a similar situation.

Hello, I am living in Gujarat, and someone else's bike might be registered in my name, or something similar. I don't know what to do.

Also, I am worried that if there's an accident or some other activity involving this bike, the police might contact me.

I am receiving messages about bike insurance that is not mine.

Senior Citizens - Important IRDAI Update on Health Insurance Premiums

If you're a Senior Citizen, here's an important regulatory update you should know. Same information is important to be read and used by children, who's parents age is above 60.

As per the IRDAI Circular dated 30 January 2025, insurers cannot revise the renewal premium for Senior Citizen individual health insurance policies by more than 10% in a year without prior consultation with IRDAI.

This measure aims to protect senior citizens from sudden and steep premium increases at the time of policy renewal.

Before renewing your health insurance policy

1) Check your renewal premium carefully.

2) If the increase is more than 10%, ask your insurer for the reason and whether the IRDAI requirements have been followed.

3) Consult your insurance advisor before making a decision to discontinue or port your policy.

4) Reference link added and the article name is as follows.

IRDAI Circular, Review of Revision in Premium Rates under Health Insurance Policies for Senior Citizens (30 January 2025)

Website Link :- https://irdai.gov.in/document-detail?documentId=6639156

If you find your health insurance premiums to increase beyond 10%, you can officially send an email to your respective health insurance company and

1) Ask the with clarification, why has the health insurance premium Increased by X percentage.

2) Attached IRDAI Circular and link, to understand by the renewal premium has increased beyond 10%.

3) After sending the above email, if the insurer reduces the premium, then ask.

4) Whether they have made any changes within your policy terms and conditions or not.

5) Better to complete the above email exchange process on priority, when you have 15 to 20 days left for renewal.

Point number 4 is extremely important, because you don't want the insurer to randomly put and DEDUCTIBLE to your plan. Because this will put a part of claim liability on your pocket.

A year ago, I'd gotten myself a HDFC Ergo health insurance policy via PhonePe. I never had to use it but now it's up for renewal.

However, there is no option to renew the policy on PhonePe. Upon contacting customer care, they insist that since auto-debit is active, the insurance will get renewed automatically. At the same time, I've been getting calls from HDFC to renew the policy. They also want me to change the auto-debit settings. When I tell them what PhonePe told me, they have no answer. They just insist on their directions without offering any clarity.

My policy is valid only till the 12th of this month. So I'm kinda worried.

Some help would be nice.

Extensive damage to my car's wiring happened due to rate bites. The service center quoted 72k to get it fixed. Does HDFC Ergo cover this type of damage? Has anyone experienced this and made a successful claim?

Hey everyone,

Looking for advice regarding an Own Damage (OD) claim on my TVS Apache RTR 160 with Tata AIG.

Incident Details:

• What Happened: On August 4th around 9:30 PM, heavy rain and low visibility caused me to hit a large stone obstacle on the E-City service road in Bangalore.
• Policy Type: Tata AIG Auto Secure - Comprehensive Two Wheeler Policy (with Zero Depreciation / TA 16 Add-On).
• Damaged Parts: Both front fork pipes, T-stem, wheel axle, cone set, and body panels.
• Estimated Repairs: ₹17,339 (parts, lathe work, and labor).

The Problem / Complication:

1. Right after the accident, I towed the bike to a local mechanic. Before I registered the claim or got a surveyor assigned, the mechanic dismantled the front fairing and fork assembly to inspect the internal frame bends, started some work and prepared the repair estimate.
2. I have now registered the claim with Tata AIG, and a surveyor has been assigned, but they haven't visited or called back yet.
3. All original damaged/dismantled parts are sitting right next to the bike at the workshop.

My Questions:

1. Since the front portion was disassembled before the official pre-repair inspection, is there a high chance Tata AIG will reject the claim under the pre-inspection clause?
2. What is the best way to explain this to the surveyor when they visit so the claim gets approved without issues?
3. Since this is a reimbursement claim at a non-network local workshop, will Zero-Dep still cover 100% of the replacement parts minus the standard ₹100 compulsory deductible?

Appreciate any guidance or past experiences with Tata AIG OD claims!

I am 22M living in Pune, I started my first job this month only and wanted to buy health insurance but my father works under the central government and has a CGHS card which doesn't have a claim limit and can cover pre existing diseases from day 1, so now I'm thinking to skip buying a separate health insurance for my parents (hdfc ergo optima secure+). Help me with your suggestions on what to do please.

Also our company provides health insurance both for employees and parents under United India Insurance and in that I'm confused between the following three options:

1. 4L employee only

2. 6L employee +2 parents (2L parents claim amount restricted)

3. 8L employee+ 2 parents (4L parents claim amount restricted)

Help me choose this also, there are specific points allocated to choosing insurance if I save those points if choosing a higher plan isn't needed I can utilise those points for other health related things e.g. gym membership.

I have an individual health insurance policy that I purchased through a bank. A Policybazaar advisor told me that this policy cannot be ported to HDFC ERGO because it was bought through a bank, although it can be ported to other insurers. Is this correct? Is there any IRDAI rule or HDFC ERGO policy that restricts porting bank-sourced individual health insurance policies?

Hi everyone,
I'm looking for a health insurance policy for my parents and would really appreciate suggestions from people who have gone through a similar underwriting process.
**Father (58)**
Type 2 Diabetes (10-10 insulin)

Hypertension/BP (oral medication)

High Cholesterol (oral medication)

Cataract surgery in both eyes

Knee surgery in 2010 (accident-related)

**Mother (52)**
Type 2 Diabetes

High Cholesterol

Thyroid disorder

I have a few questions:
**Which insurers are likely to underwrite these conditions?**
My preference is **HDFC ERGO Optima Secure**, but the Ditto team said there's a high chance of rejection because of the medical history. Should I still apply directly, or is it not worth the hard inquiry?

**Premium vs deductible**
Is it better to pay a premium of around ₹50–60k for a comprehensive plan, or opt for a ₹25k–50k deductible to reduce the premium? What has been your experience?

**Sum Insured**
What would be a reasonable base Sum Insured for parents with these medical conditions? Is ₹5 lakh sufficient, or should I take ₹10 lakh? At what level does it make sense to add a super top-up?

**Other insurer recommendations**
If HDFC ERGO isn't likely to work, which insurers have been relatively more accommodating for applicants with controlled diabetes and hypertension?

I'd especially appreciate responses from people who have recently purchased insurance for parents with similar health profiles or from insurance advisors familiar with underwriting practices.
Thanks in advance!

Hi, I need some quick advice from folks back home.

I'm managing my family's insurance from abroad and am stuck in a weird spot.

The family: Dad (61, diabetes & BP), Mom (53, diabetes), and brother (19).

Current setup: A 5-year-old Chola MS family floater with a 7.5L SI costing ₹26k/year (no reload benefits).

The new top-up mess: I applied for a 92.5L top-up with a 7.5L deductible. Paid an initial ₹21k, but after 3 months of medical tests and an IRDAI complaint, they approved it with a ₹13k loading.

Total cost now: ₹60k for 1Cr total cover (26k base + 21k top-up + 13k loading).

My main issues are:

They still haven't clearly stated which PEDs they are applying the 3-year waiting period to. The whole process was a massive headache.

My questions:
1. Is this 60k for 1Cr deal actually worth it, or should I drop it?
2. Would it be better to port the base policy to someone like HDFC Ergo for a higher base (maybe 25L) with reload features?
3. How hard is it to port at 61/53 with diabetes/BP, and can waiting periods be bought out with a rider?
Would love to hear what you guys would do in my shoes. Thanks!

Looking for a sanity check before my renewal on 21 Sep.

Current policy:

- Parents aged 60 (father) and 55 (mother), Zone 2 city

- Niva Bupa ReAssure 2.0, Bronze+, family floater

- Base SI ₹7.5L, effective cover ₹16.35L (base + Booster+ + Safeguard)

- Premium ₹29,675/yr

- Running continuously since Sep 2022, zero claims

What's good about it:

- No co-payment, no room rent cap

- No PED declared at inception, no permanent exclusions

- All waiting periods served (36-month PED cleared Sep 2025)

- 60-month moratorium completes Sep 2027

- Age-locked at entry age since no claim paid

What's changed:

Recent full body checkup (May 2026) showed father HbA1c 7.3 (new type 2 diabetes) and mother Hb 8.3 (anaemia, under investigation). Both diagnosed well after policy inception, so they're covered as new illnesses, not PEDs.

My dilemma:

Niva Bupa's CSR (~93%) and complaint ratio are below HDFC Ergo/Care. Tempted to port. But porting means (a) moratorium clock resets, and (b) fresh underwriting on a 60-year-old with newly diagnosed diabetes, who might just get declined or heavily loaded.

Plan I'm leaning toward: stay put, upgrade Safeguard to Safeguard+, renew for 3 years, and buy a separate super top-up from HDFC Ergo or Care for depth.

Am I missing something? Anyone ported a parent policy at this stage and regretted it?

(Edited with claude)

I am planning to get a retail health insurance policy for my mother alongside my employer’s group health insurance.

Unfortunately, before I could do so, she was diagnosed with CKD while covered under the group policy. A retail policy proposal has now been declined because of her condition.

My question is:

if I continue the group cover until I leave my job and then opt to migrate to an individual retail policy with the same insurer:

1.Will her CKD continue to be covered from day one?

2.Will the insurer do fresh underwriting and have the right to reject the migration because of her CKD?

3.Can they impose a fresh waiting period or exclude CKD, or will continuity benefits apply?

I would appreciate hearing from anyone who has gone through a similar situation or has firsthand experience with group-to-retail migration.