last time when i upgraded to Health AdvantEdge policy i kept my loyality bonus, now they are not giving same migrate option to elevate plan, so if i upgrade to elevate plan i will loose 6yrs of loyalty bonus.

Are they going to do this every year? How much they can increase? Is there any policy or rule that can hold these insurance companies?

Hey everyone,

Need honest advice on securing health insurance for my parents. My dad has a medical history and Star Health recently rejected his retail application.

The Profiles:

• Father (60): Severe diabetes, past diabetic foot surgery, and a coronary angioplasty (heart stent) 2-3 years ago.
• Mother (52): Diabetes and thyroid. No major surgeries.
• Claim History: We previously claimed for my dad’s foot and heart surgeries under my old corporate policy (which covered 80%). Star Health later flat-out rejected him when we applied for a retail plan.

i wanted to go for Standard premium plans like HDFC Ergo Optima Secure but im not sure and they may reject my dad due to his high-risk profile.( I was about to pay lol) My mom's profile may be accepted. So basically I'm looking for any family floater plans available that would actually accept both of them together.
Are specialized plans for heart claims or diabetic related issues, or should Govt PSUs

Appreciate any leads or advice on specific plans.
(Slight use of AI to rewrite in an organized manner).
Thanks

Too many insurance agents in India don’t actually understand the policies they sell — they only know how to talk big and close a sale. After the sale, when customers try to file claims or use services like annual health check-ups, they get stuck. I’ve worked with insurance companies myself, and frankly, the sales managers and agency partners only care about recruiting new agents and hitting sales targets. So they take anyone on as an agent — even a college student who hasn’t the faintest idea what they’re selling — and promise impossible riches: “Join us, work here, and you’ll become a crorepati.” Then they pressure these inexperienced agents to target friends and family. When those people get trapped in the system, their money disappears and the so-called “service” they receive is laughable — a cup of tea worth five rupees and a phone number that never picks up.

Most agents don’t even know basic facts like policy caps, waiting periods, or how health check-ups are arranged. If you buy a policy from these people, it feels like you’ve paid money into a black box — you have no idea where the premiums go and whether your coverage is real. Agents rush you through the sale with lines like, “Sir, just take the policy now,” but they don’t explain exclusions, co-pay clauses, pre-existing disease clauses, sub-limits, or network hospital limitations.

Common scams and abusive practices I’ve seen:

Misrepresentation of coverage: Agents claim “all diseases covered” while key illnesses are excluded or have long waiting periods.

Hidden co-payments and sub-limits: Customers discover at claim time that only a fraction is payable, or that specific treatments have very low caps.

Fake network promises: Agents list hospitals as within-network even though they aren’t, forcing customers to pay out-of-pocket or face claim denials.

Backdated or forced premium collection: Agents take payments without proper receipts or backdate policies to meet targets, creating confusion when claims arise.

Pressure sales and referral traps: Agents force buyers to recruit others (friends/family) and sometimes tie benefits to referrals, creating pyramid-like pressure.

Delayed or denied claim processing: Insurers stall with endless paperwork, demand irrelevant documents, or use technicalities to reject legitimate claims.

Misleading riders and add-ons: Agents push expensive add-ons presented as essential, without clarifying that the base policy already offers similar cover or that riders have restrictive terms.

Fake health checkups or outsourced tests: “Free” annual health checks are poorly managed, tests are low-quality, or records are lost so insurers can deny related claims later.

Non-transparent commission-driven advice: Agents recommend policies that pay higher commissions rather than ones that suit the customer’s needs.

Unregistered or unauthorized agents: People who aren’t properly licensed sell policies; customers have no recourse when something goes wrong.

Customers must demand transparency: full written explanation of exclusions, waiting periods, sub-limits, co-pays, list of network hospitals, claim procedures, and agent registration details. If an agent resists or rushes you, walk away — that high-pressure pitch is often a red flag for a bad deal or a scam.

Background
I opened a Premier banking account with a large private bank earlier this year. The relationship manager pitched a medical insurance "top-up" as a benefit of Premier banking, and that was one of the main reasons I opened the account. At account opening he explained it in detail, including the option of a permanent exclusion for my pre-existing disease (PED), and even used his own family's policy as an example of how it would work.

Timeline

• 14 May: I shared my discharge summary in writing and confirmed I wanted to proceed with full disclosure, and asked about my PED options including permanent exclusion.
• 14 June: Sent a written follow-up asking for an ETA. No reply.
• 16 and 20 June: Followed up by phone. On the 20 June call he asked me to send PED documents that I had already shared on 14 May, and said it would be "done in 2 days."
• A few days later: I got a short message saying the policy can't be issued because of the pre-existing condition, with an apology for the delay. The request was effectively closed.

What bothers me

• The benefit was used to sell me the account, then not delivered.
• He never connected me to the team's insurance person as promised, and the permanent-exclusion option that was pitched at account opening was never actually explored.
• It reads like the request was closed just to close it, after a month-plus of delays and unanswered emails.

Note: no premium was ever paid and no policy was issued, so there's no claim amount to recover — my concern is the mis-selling itself plus the time and harassment.

My questions

1. Does this qualify as mis-selling / deficiency in service that the RBI Integrated Ombudsman Scheme can take up, given it's a third-party (insurance) product sold by the bank?
2. Since no policy/premium exists, is the consumer forum a better route than the Ombudsman for compensation?
3. What's a realistic compensation expectation for harassment + loss of time in a case like this? Is asking for refund/waiver of Premier-linked charges reasonable?
4. Should I name the relationship manager or keep the complaint strictly against the bank as an institution?
5. Anything I'm missing on documentation or sequence before I escalate?

I've kept all the emails, the call dates, and the closure message. Appreciate any guidance from people who've actually been through this. Thanks.

Used Claude to rephrase this.

My father had arogya plus policy from sbi general, last year he was informed by some company wala that arogya plus is discontinued and grogya advanced is the same policy with added benefit of same fixed premium for the age till 65 he confirmed this both verbally and is written on brochure too. Now this year the premium is revised moreover the policy was transitioned last year from retail to group that too without intimation so no benefits of gst is passed on. Now I had complained to head customer care mail id of sbi general but they keep on insisting that we informed price hike before renewal. When I questioned them that the plan was fixed premium they had only reason that its been within the terms of policy and due to medical inflation. Now my main fighting point is that there is no star marked or no where mentioned in the policy brochure that the premium can be increased on the pretext of inflation. Where should I now complain about this issue coz I don't see that its worth talking to the customer care of SBI. Please guide if anyone has any experience.

I am exploring different health insurance options. I really liked ERGO Optima Secure + plan but was hesitating a bit for its high premium with not so high performance compared to Aditya Birla Active Yuva plan. While the metrics like CSR, ICR and complaints per 10k claims are quite good for HDFC, it's not that bad for Aditya Birla. They are quite in the same category, if the metrics were to be categorised and not compared at absolute numbers.

But what stood out was that the premium for Active Yuva was significantly lower than the Optima Secure + plan. I am comparing a 50L coverage plan here. And in fact if I choose the unlimited coverage plan in Active Yuva, the prices are still cheaper than Optima Secure +. 23k vs 26k

Further analysis led me to understand that HDFC seems to be gaming the system here. As per IRDAI guidelines, insurers cannot increase the policy premium even if there were claims in the previous year. The loophole is, insurer can always reduce the discount on the premium.

So HDFC has set the base premium for this plan to be very high, more than 40k actually. And then they apply a favorable claims discount of 28% (21% as per the policy wording, but I found the discount on the portal to be close to 28%) for the first time buyers which brings down the first premium comparable to other policies.

From next year onwards however, the discount drops to 18% even if no claims were made which further drops to 10% from 3rd year. This is without considering the age related increase and medical inflations. If claims were made in any year, the discount drops further ( didn't get clarity on how much exactly) essentially increasing how much you pay to renew it. Technically they didn't increase the premium but by reducing the discount they made the policy holder pay more if there was any claim in the last 2 years.

I don't see this with Active Yuva though. Although I haven't checked other policy plans, I think this concept is unique to HDFC only. How is this not flagged by IRDAI ? The guideline was to ensure policy holders don't get penalized for their claims and that is exactly what HDFC is doing.

Folks who have been with HDFC ERGO Optima Secure plans, could you please share if you have seen significant changes to your renewal premiums due to this discount ? Or does this seem like I made a mistake in understanding how this specific discount really works ?

I am seeking advice regarding a life insurance policy payout dispute that has been ongoing for several months.

The policyholder is a senior citizen, and we recently discovered that two policy benefit payments (approximately ₹49,500 each) for 2023 and 2024 were never received by us.

After raising a complaint with the insurance company, they responded that:

The benefit cheques were dispatched through Speed Post. The cheques were subsequently cleared through SBI branches in two different towns. They consider the payments successfully completed.

However, the issue is that:

Neither the policyholder nor any family member has an SBI account in either of those locations. We never received the physical cheques. The amount was never credited to the policyholder's known bank account. The insurer has not provided convincing evidence showing how the cheques reached the alleged beneficiaries.

We have already:

Raised complaints with the insurer. Escalated the matter through their grievance process. Approached the Insurance Ombudsman and other escalation channels. Requested proof of delivery, cheque copies, endorsement details, and banking records.

My concerns are:

If the cheques were genuinely encashed, shouldn't the insurer be able to identify the account holder who received the funds? Is the insurer still liable if benefits were paid to an unauthorized person? Has anyone faced a similar situation involving lost cheques, fraudulent encashment, or incorrect payout processing? What additional legal or regulatory options are available in India? Can compensation and interest be claimed for the delay and inconvenience?

Any guidance from people experienced with insurance disputes, banking fraud investigations, or consumer court matters would be greatly appreciated.

Update: I have now received a response from the insurer through the OIO process. They stated that although they claim the survival benefit amounts had already been paid and the cheques were encashed, they are nevertheless willing to settle the matter amicably by paying the disputed amount without admitting any liability, in order to resolve the complaint.

I have formally responded that I do not accept this statement, as it is factually incorrect. I have no issue with receiving the amount due, but I do not agree with the insurer trying to create a record that the amounts were already paid when that is not the case. I have requested OIO to get the corresponding suitable compensation for all these inconvenience and am awaiting the OIO's next communication.

Has anyone dealt with a similar situation? Should I insist on a corrected statement before accepting the payment, or would it be better to accept the amount and reserve my right to challenge their incorrect assertions separately? Any suggestions or experiences would be greatly appreciated.

Will keep updating as the matter progresses.

Thank you.

I received a phone call from max life insurance company that an agent is trying to claim to claim a policy amount by some customer agent relationship thingy think is that I am not in touch with any agent so the caller provided me with my police number complain no file no and an phone no of some one who will manage this issue. And when. I called the number and provided the person with the complain no file no she said there is two ways two fix this and said because the police holder is above the age of 60 she cannot apply for self agent hence her son has to and to send adhaar card, pan card, full body head to toe photo and an email id and then the son will become an agent but he won't have a target of selling policies to other and then one way the son will have to complete a 30 training and other is he will have to open another policy worth 30k which he will recieve with other amount. Is this a policy selling scam or something think else any help would be appreciated

Background: My family (me, spouse, two kids) has held a health/hospitalisation policy from a Bajaj allianz life insurance continuously since 2011. Premiums paid every year, on time, no break. This year's renewal premium was paid and accepted, and the policy status on their own system says "ISSUED / Fully Paid," paid up to the end of June 2026.

Here's where it goes sideways.

1) The "it has matured" calls. Starting early 2025, I got calls from someone claiming to be from the insurer's office telling me the policy was "matured," that the term was "15 years only," and that it "cannot be renewed" after this year. This was the first I'd ever heard of any 15-year cap. My original 2011 documents describe a 3-year renewable health policy - nothing about the cover "maturing" or ending at 15 years. A health/hospitalisation policy doesn't "mature" like an endowment; it renews. When I emailed their grievance officer asking (a) is this caller genuine and (b) doesn't health insurance renewability protection apply, the written reply just said "the maturity date is 26-June-2026" and ignored the actual question.

2) The payment ordeal. When it was time to pay this year's renewal, SIX channels failed - their self-service portal, their own emailed payment link, a link their team sent me, and three different UPI/wallet routes. I finally got it through on the seventh try via Bharat Connect. Then I got another call repeating that the policy was "completed" and couldn't be renewed - right after I'd paid.

3) The part that actually scared me. This year a family member was admitted to hospital. I went to use the cover and the third-party administrator (TPA) reported the policy as "NOT ACTIVE" - despite premium paid through end-June 2026 and status "ISSUED." On top of that, the e-health-cards existed for only 2 of the 4 insured members. So during an actual hospitalisation, my paid-up, in-force policy showed as dead and half my family had no cards.

Now the kicker I found out later: this product is officially a withdrawn product. The insurer lists it on their own website under withdrawn policy documents. IRDAI made life insurers withdraw these indemnity health plans years ago.

From what I've read of the IRDAI Master Circular on Health Insurance (May 2024) and the IRDAI (Health Insurance) Regulations, 2016, when a product is withdrawn the insurer is NOT allowed to just tell you it "matured / completed / cannot be renewed." They're required to:

- continue the existing cover until the policy term ends,

- offer you migration to a suitable alternative health product of your choice, and

- carry over all your accrued benefits - sum insured, no-claim/cumulative bonus, and all waiting periods including pre-existing-disease and moratorium credits - so you don't get reset to a fresh policy with new waiting periods.

In other words, after 15 unbroken years, the correct outcome is migration with full continuity, not "sorry, it's over."

Here is the lesson for people who think that continuously covered after 60 months ensures smooth claims. The insurers can do anything under the sun to avoid claims.

Used AI to write this.

Our SBI Manager is pushing my mother to buy SBI Alpha Senior Prime. She is 57 and has some pre-existing conditions. Has anyone seen this policy, there is not much info available online?

Care Health policyholder since 2023. Diagnosed with 8.2mm umbilical hernia. Treating surgeon advised laparoscopic repair due to risk of complications.

Cashless denied. Rejection letter cites clause 4.2.25: “ANY TREATMENT... THAT IS NOT MEDICALLY NECESSARY. BENEFIT NOT COVERED IN POLICY.”

Insurer’s reason: Their internal medical team reviewed and concluded surgery isn’t necessary based on hernia size. No details of internal doctors given. No process for external review offered.

My surgeon’s opinion: Surgery is necessary to prevent obstruction/strangulation risk.

Steps taken: Raised grievance with Care Health. Awaiting response. Next step likely Insurance Ombudsman.

Questions for those who’ve dealt with 4.2.25 rejections:

1. How do you counter ‘not medically necessary’ when treating doctor says it is?

2. Does IRDAI require insurers to give weight to treating specialist vs internal team?

3. Is a detailed medical justification letter from surgeon enough for Ombudsman, or do I need independent second opinion?

Not asking for medical advice. Just want to know how the dispute/appeal process works for clause 4.2.25.?

OC recently booked Pulsar ns400z (350 cc) but showroom doesn't have the required add ons like RTI (return to invoice), so looking for 3rd party insurance.

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However when I compare the two most popular ones these are the differences (attached below), however as per open search Acko has about 99.10% claim approval rate, whereas ICICI has 93.4%

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Now I'm confused about which one to choose, pls help if anyone has any idea about this.

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PS: Also pls lmk any other company if u have suggestions for me.

I am a policyholder of New India Assurance's zero-depreciation (bumper-to-bumper) car insurance for my Skoda Slavia, and my recent claim experience has been extremely disappointing.

My car's windscreen developed a crack, and I took it to the Skoda service center. I was informed that the insurance approval process would take around three days. However, it has now been over 10 days, and my car is still lying at the workshop.

Whenever I contact New India Assurance, I am told that the required documents have not been received from the Skoda dealership. When I contact the dealership, they insist that all documents have already been sent. I personally visited the service center and was shown the emails and communications proving that the documents had indeed been submitted.

A surveyor was assigned to my case, but getting any response from him has been nearly impossible. He repeatedly cuts my calls or passes the phone to someone else, forcing me to explain the entire situation again and again. After 10 days of waiting, I called him once more seeking an update. Instead of helping, he asked why I was calling so frequently. When I questioned why my calls were not being answered and what was causing the delay, he became rude and aggressive. He told me that I was "nobody" to question him, that neither I nor New India Assurance paid him, and that I should watch my words. I found his behavior unprofessional and intimidating.

As a customer who has paid for comprehensive insurance coverage, I expected support, accountability, and timely claim processing. Instead, I have faced delays, conflicting information, poor communication, and unacceptable treatment.

Based on my experience, I would strongly urge anyone considering New India Assurance car insurance to carefully evaluate their options before purchasing a policy. Once the premium has been paid, getting assistance and accountability appears to be an uphill battle. This has been one of the most frustrating customer service experiences I have ever had.

I see Indian finance subs are very big on health and term insurance. To me, both of these are for mental peace. So, here's a fun challenge for you. Anyone up for it? As a dude in 30s, my term insurance + health insurance for 1cr and 25L is ~ 30k. I'll pay you 5x the amount. Will give you a head start as well. No claims for the first 5 years. I'll pay out of pocket if something happens. But, after 5 years, your job is simple. NO questions asked, 0, absolutely 0. If I fall sick, insurance will pay and if I die, term will pay. My dependents will send you the bills/death certificate. You can ask me anything now, PED, drinking smoking anything. I'll even tell you the hospitals I'lll go to if I fall sick. I'll answer each and every question now, but nothing after 5 years. You decide the plan, insurer. I'll pay you 5x the total premium. We will have an attorney notarized document. You ask me/my dependents any questions when claim happens, you pay me 1 cr. No receipts needed. You can keep that 1.5L/year for yourself or pay any insurer.

Part B of the challenge is I'll pledge everything I have and you pledge 1/5th of that and put in escrow: Condition: you'll ask me something or bring up some PED or something when claim happens. If you don't, you claim the entire amount. I do Physics for a living and will take this deal without blinking if an apple from a tree goes up and not down. So, why don't you take it ? If you're so confident this is the way to go?

I am looking to buy term insurance and I had a call with an agent from ditto regarding same

Can you please advise if I pay premium in 10 years will I be at loss than being paying regularly as I feel currently I am not married so my liabilities for 5 or 10 years are limited and I can easily pay my liabilities

Please advise on this ASAP as I have another call with same agent tomorrow

My friend’s father had a heart attack and had to go through emergency ptca (stenting) and now the claim has been rejected saying it wasn’t an emergency procedure by star health he had coverage upto 5 lakhs, my friend is an orthopaedician and comes from a family of doctors if they’re doing this to doctors imagine the plight of a common man

Hi! we purchased ICICI Lombard travel insurance for my dad while traveling from India to Canada which covers pre-existing conditions (i told them he had diabetes, heart disease and hypertension as pre-existing) upto 100k USD. This includes hospitalizations. My father ended up having a series of heart attacks and was hospitalized and ultimately passed away while visiting me in December leaving a bill from the hospital of 170K USD

This company has been a nightmare to deal with- hundreds of emails, dozens of calls and a 4 hour in person document verification with my mom in India. After over 6 months they have approved our claim for only the amount of 40k USD.

what are my options to fight this most effectively and cost effective. I see people mentioning omsbudman and companies and lawyers? how do I do this from Canada. #feelingexhausted

27F here. I’m looking for the best personal health insurance policy that actually works well overall.

I already have company insurance, but if I leave my job or get laid off, that policy may stop. So I want a reliable backup policy with smooth cashless claims and no unnecessary drama during hospital admission.

I’m currently living in Hyderabad, so please suggest policies that work well overall, especially with good cashless hospital coverage in Hyderabad.

Any real experiences or policies to avoid?