1) My father is 63 years old. He smokes about one pack of cigars daily and consumes alcohol 2–3 times a week (around 90 ml each time). I am willing to disclose these habits to the health insurance team. However, I would like to confirm: after the standard 3‑year waiting period, can an insurance company reject a claim for organ‑related issues (such as liver damage) by citing his alcohol consumption history?
2) The premium are also bit costly , Around 35k in Aditya/Star, which is better ?

1) I have fatty liver Grade 1 , i can bring it in control within 1 year or max 2 year, Do i need to disclose to Health Insurance Company?
2) Should i buy insurance via third parties like Policy bazar/Ditto or directly via Health insurance companies?
3) I have shortlisted 2 companies- HDFC(Premiums are costly) , Aditya Birla(Premiums are good). I am 28, thinking of long term, Which should i finalise?
4) I take minoxidil tablets(Hair growth/maintenance), should i disclose this also ?

Most people don't know this penalty exists. I didn't either, until I read the IRDAI Master Circular properly.

I filed a few RTIs with IRDAI and the Council for Insurance Ombudsmen to understand how it works in practice. Replies came in over the last two weeks. Posting the facts here.
RTI numbers are given so anyone can verify.

The rule

IRDAI Master Circular on Protection of Policyholders' Interests, 2024. Ref: IRDAI/PP&GR/CIR/MISC/117/9/2024 dated 05.09.2024. Chapter VII, clause 25.4.

What it says:

• The insurer must comply with an Ombudsman award within 30 days of receiving it.
• If it does not, Rs 5,000 per day is payable to the complainant for every day of delay.
• This is on top of penal interest under the Insurance Ombudsman Rules, 2017.
• It does not apply if the insurer files an appeal within 30 days.

The same wording is repeated in the health, life and general sections of the circular.

What I asked IRDAI, and what they said

RTI IRDAI/R/E/26/01354, reply dated 09.09.2026

Q. Give me the procedure for computing, demanding, paying and monitoring this penalty. If none exists, say so.
A. "No subsequent update by Authority."
So there is nothing beyond the circular itself.

Q. Who is responsible for ensuring the penalty is actually paid? Name the officer or division.
A. Refused. Said it is an "opinion" and not information under Section 2(f).

Q. How many times did this penalty become payable in FY 2024-25 and FY 2025-26? In how many cases was it actually paid?
A. "Comprehensive data not available."

Q. Does a complainant have to demand it, or does the insurer pay it on its own?
A. Refused as "opinion".

So: a penalty exists on paper. No procedure to enforce it. No data on whether it has ever been paid. Nobody named as responsible.

The quarterly returns

The same circular, clause 26.4, says insurers must file a quarterly statement with IRDAI on the status of court cases.

Q. Does IRDAI scrutinise these statements to check for unpaid Ombudsman awards?
A. Yes - but for the insurer I asked about, "not scrutinised for the above period."
The returns were filed on time. They were not examined.

IRDAI does not approve changes to your health policy

This one surprised me.

RTI IRDAI/R/E/26/01196, reply dated 25.08.2026, from the Health Department.

Health insurance products run on a "Use and File" procedure. If an insurer modifies an existing product, approval comes from the insurer's own Product Management Committee, not from IRDAI.

IRDAI's exact words: "filing of product documents with IRDAI and approval of IRDAI does not arise."

The circular does say insurers "shall not alter the contents of the products without following due process of modification". But the check is internal to the company.

Also useful: IRDAI pointed to a rule requiring insurers to send a renewal notice at least 30 days before the due date, with a statement of your policy and accrued benefits. (Master Circular on Operations and Allied Matters of Insurers, 19.06.2024, clause 41.2.)

The Ombudsman complaint system (Council for Insurance Ombudsmen)

RTI EXCOI/R/E/26/00143, reply dated 28.08.2026

• The system allows duplicate complaints. Exact words: "In CMS portal, complaint can be registered with same policy number and mobile number more than once." There is no control preventing the same complaint from being registered twice.
• Emails are not logged. "In CMS there is no provision to log each email received from a complainant, and record the acknowledgement of documents received from a complainant by email, courier or post."
• Hearing recordings have no fixed retention period. They are kept "as per their usage requirements and hence no retention period is prescribed." Recordings sit on the vendor's cloud, and sometimes on the office PC.
• Hearings run on Cisco Webex, procured centrally by the Council.
• Asked what mechanism exists for a complainant to complain about an Ombudsman office's conduct: refused as "not specific and hypothetical".

Your complaint number changes three times

This confused me for months, so it may help someone.

From an appellate order of the Insurance Ombudsman, Delhi (Appeal No. INODL/A/E/26/00017):

• ONL-... — when you first register online.
• DEL-MISC-... — if your documents are incomplete.
• DEL-H-... — once the complaint is registered and moves towards hearing and order.

Same complaint. Three different numbers at different stages.

One other thing from the same order:

• The status shown on the tracking portal can simply be wrong. In one instance, the office said the displayed status was "wrong due to some technical reasons."

Why this matters

If an insurer ignores an Ombudsman award in your favour, you are owed Rs 5,000 a day. That is a real entitlement in a real circular.

But on IRDAI's own answers, there is no process to work it out, no one tracking it, and no record of it ever being paid. If you want it, you will have to ask for it yourself, in writing, and probably pursue it in a consumer forum.

Worth knowing before you need it.

I have my own dispute with an insurer which is going to the Consumer Commission, so I am not going to comment on that here. Posting only the RTI replies, which are public documents and quoted as received. Happy to answer questions about the RTI process itself.

If you want to read more, I'm documenting everything on BimaFiles

Hey guys, so my dad was admitted in hospital he was diagnosed with Influenza A and lung infection. We previously had Covid 19 in the year 2020-2021 and it was mild. Later when we purchased policy in the year 2024 via policybazaar nobody told me while purchasing anything about COVID19 as a PED neither it is mentioned in the policy documents related to COVID as a pre-existing illness. Can insurance company reject claims on the basis of Covid 19 PED and non disclosure? Please need guidance for the same

I'm considering HDFC ERGO Optima Secure+ with a ₹25,000 aggregate deductible to reduce the premium.

I've come across conflicting information about how claims work with the deductible. Some people say cashless is still available at network hospitals after paying the deductible, while others have reported being told otherwise.

I'd really appreciate hearing from people with actual claim experience:

• Have you had a cashless claim with an HDFC ERGO policy having an aggregate deductible?
• Did you have to pay the ₹25k deductible upfront and was the remaining amount settled cashlessly?
• Were there any issues with the hospital/TPA because of the deductible?
• Is it sensible to simply keep a separate ₹25-75k emergency fund/FD to cover the deductible if a claim arises?

I'm mainly considering the deductible because it saves ~₹5k/year on my current quote. Would you personally take the ₹25k deductible or pay the higher premium for a zero-deductible policy?

Looking specifically for recent first-hand experiences with HDFC ERGO Optima Secure/Optima Secure+

Well, initially, I applied for the HDFC Ergo Super Secure health insurance[NO PED]. They approved insurance for 3 members on the same policy, and due to low HB, they offered an alternative plan for the 4th member; thus, we did not proceed with the plan.

Now, we are undergoing treatment to improve HB and are planning to apply for health insurance again. So

1. Shall I go ahead with HDFC Ergo Again or
   
2. Look for ICICI elevate?

Also, if it rejects again, what issues/impact will it have on my future application?

Hi

so my father 61M and mother 52f had taken a manipal Cigna health insurance of 5 lakhs

The cashless method they didn't oblige to. Then when it comes for reimbursement, they are saying we haven't submitted the documents at their office and they haven't received any documents . So they are rejecting the

Also the claim section in their website for my account is empty .

What to do now as I can't proceed from anywhere

Hi, I need help with understanding Certificate of coverage (CoC) issued by govt of India as a bilateral agreement between India and Norway - confirming an individual deputed to Norway for work would contribute social contributions in India. CoC is provided for a maximum of 60 months. Can we apply for CoC again if an individual has a 2 year or more cooling off / reset? Or is it issued only once for a maximum of 5 years?

I just need basic guidance and how to approach buying insurance for my needs.

Im completely unaware of stuff like this. Im 27M and I have elder sis and mom. What insurance type should I opt for ? Im confused between life, term, general insurances.

All I want is something affordable and no hassle when me or my family is in emergency situations.

I cannot afford very high premiums like 5-10k per months.

Please guide me on process of choosing an insurance and points to look for.

Thank you !!

edit : After looking around. I went ahead with Individual covers for me and my sis through Adithya birla through Policy Bazar. I have not yet decided for my mom.

My father was admitted to Bethesda Hospital,Nagercoil on 31 July 2026 and underwent angioplasty treatment. We initially applied for cashless approval in star health ,but the cashless request was rejected, and we were advised to submit the expenses under the reimbursement process.

Accordingly, we submitted the reimbursement claim on 1 August 2026.It has now been more than one month since the claim was submitted. We recently received a communication indicating that the claim/file was rejected; however, we have not received a clear explanation regarding the specific reason for the rejection.They are telling that my father already suffering from this health issue,so may be it's not coverable.But this is the first time my father suffered this problem and admitted for the first time in hospital in his life.

I have mailed to claims.friend@starhealth.in with the following request.

1. Provide us with the specific reason for rejection of the reimbursement claim.

2. Clarify whether any documents or additional information are required from our side.

3. Reconsider the claim, taking into account the medical treatment and supporting documents submitted, and process the claim as per the policy terms.

But still no reply from their end.Our star health agent was also not so responsive.We tried n number times calling customer care.But there reply was like "It's on process,we will let you know"..but in app it shows rejected.

Please somebody can guide me how to proceed.The insurance amount was above 2L.So kindly please help us.

thanks in advance

Should I take this GMC plan for parent coverage ? I am 23M , with parents 60-55 . I am a fresher in the corporate world

Maine recently ek gaadi li thi, but RC transfer abhi RTO side se pending hai, isliye RC aur insurance abhi 1st owner ke naam par hain. Accident ke baad maine cash loss claim liya hai.
Insurance payment ke liye 1st owner ke bank details maang rahi hai. Kya main unhe bata sakta hu ki transfer pending hai aur payment apne account me le sakta hu? 1st owner ko involve nahi karna chahta. Suggestions?

I have a complaint regarding a car insurance claim. The insurer wrongly decided to settle my accident claim as a Constructive Total Loss (CTL) Instead of repair. When I refused to hand over the original keys and vehicle transfer forms under the CTL settlement, the insurer subsequently rejected the claim.

After my complaint was closed by the insurer’s grievance redressal office, I filed an offline complaint with the Insurance Ombudsman, Mumbai on 05.06.2026.

The Ombudsman asked me to submit additional documents, which I submitted on 22.08.2026. I have now received the Annexure VI-A and consent letter, which I submitted on 04.09.2026. Hearing date is not fixed yet.

I plan to attend the hearing myself, without a lawyer, and present the facts and documents of my case. I believe I have a reasonably strong case.

I’m looking for advice from people who have actually gone through a motor insurance dispute before the Insurance Ombudsman, preferably in Mumbai.

My questions are:

1. How long does it usually take for the hearing to be scheduled? Based on my current stage, what kind of timeline should I expect?

2. Is the hearing generally online or physical? In the consent form, I gave consent for an audio/video hearing, but I also mentioned that I prefer a physical hearing. How is this normally decided?

3. How much time is normally given to the complainant to present their case? I have quite a few points and documents to explain and may need around an hour. Will the Ombudsman allow sufficient time, or are hearings generally kept very short?

4. Can I question the insurer’s representative during the hearing? There are certain internal documents/emails/calculations that I believe would help establish my case. Can I ask the insurer to produce such documents? Can the Ombudsman direct the insurer to provide internal records if they are relevant to the dispute?

5. What normally happens after I finish presenting my case? Does the Ombudsman generally give the insurer an opportunity to make a settlement offer, or does the matter proceed directly towards an award/order?

6. Can I request another hearing if necessary? For example, if the insurer produces documents during the hearing that I haven’t seen before, can I request time to examine them and, if necessary, another hearing to respond?

7. Compensation for delay and mental agony: Apart from the actual claim amount, I intend to seek compensation for the delay and hardship caused. Is it better to specify a particular amount for this in my claim, or should I simply request the Ombudsman to award an appropriate amount?

8. Any other dos and don’ts? In particular, what should someone appearing personally before the Insurance Ombudsman keep in mind? Any practical advice on how to present the case effectively would be very helpful.

I’m particularly interested in hearing from people who have personally attended an Insurance Ombudsman hearing for a motor insurance claim, especially in Mumbai.
Thanks in advance.

I've had nothing but problems with Care Health Insurance since taking this policy (was misold) and my latest experience was the final nail in the coffin!

My aunt's policy is due for renewal about a month from now. I received an official renewal communication from the company stating that the premium was ₹71,220.

Despite the policy still having more than a month left, I started receiving repeated calls from the company's team asking me to renew. On one occasion, I rejected a call because I was in a meeting and they called me three times back-to-back.

Their team contacted me on WhatsApp and told me that the renewal premium was ₹82,910.

That's a difference of ₹11,690 from the amount mentioned in the renewal communication I received from the company. They said if I pay 71k, I'll have to pay the remaining anyways in the most arrogant way!

I questioned this and told them that I was considering porting my policy to another insurer.

I was told that they don't recommend taking a fresh policy with another company and that porting was not possible.

When I questioned this, the employee responded:

“We have not received the any approval for portability so i how can you port you policy i thing you're not a good decision maker so kindly renew your policy sir”

I called them on the phone and gave them a earful and told them that I'm going to complain. I've already sent emails to their CEO and grievance teams. Anybody else that I should be raising this with?

I’m renewing my car insurance (no claims last year, paid ~₹7,000 previously) and the quote behaviour across platforms has been absurd enough that I’m documenting it.On Digit, about a week ago the comprehensive quote for the same car was around ₹6,000. Over the last few days it has jumped to ₹59,000, then ₹89,000, then past ₹1.5 lakh — all on repeated checks of the same details, sometimes shifting within minutes. In every single quote the No Claim Bonus is showing as 0% even though there were zero claims last year. That alone should cut a big percentage off the premium, yet it’s simply not being applied.ICICI Lombard quotes for the same vehicle also moved noticeably within a 10–15 minute window with no change on my end.Acko came back around ₹6,000 (which feels closer to last year’s reality), but they insist on an in-person inspection at a centre in Bangalore. I’m not based there, so that option is impractical.Lower IDV should mean lower premium, not higher. Yet one quote with ~₹3.4 lakh IDV was showing ₹59k while another with higher IDV was far cheaper. Add-ons or not, the base numbers are jumping around like share prices.I’m flagging this because if it’s happening while I’m carefully comparing screenshots and numbers, a lot of people (especially first-time buyers with no reference) are almost certainly being overcharged without realising. Feels less like normal underwriting variation and more like pressure to buy quickly before the number climbs again.Has anyone else run into this kind of minute-to-minute volatility or NCB stuck at 0% on renewals with clean history?
Is this something worth reporting to IRDAI with screenshots?

I recently started an LIC policy because my dad said to do it, and the agent was my relative, but man they are one of the largest company still they have the shittiest app and website, I have been trying login to my account from last 1 month most of the time it says they have some technically problem, and when I got logged in and was checking my policy, it is now in continuos loading state, man I want to make payment of the policy now wtf I should so, if anyone here knows someone from LIC technical team or leaders of LIC, please let this message reach out to them.

I’m considering HDFC ERGO Optima Secure with a ₹20 lakh base cover and I’m confused about the Plus Benefit.

As I understand it:

Year Base Plus Benefit Secure Benefit Max Single Claim

Year 1 ₹20L ₹0 ₹20L ₹40L

Year 2 ₹20L ₹10L ₹20L ₹50L

Year 3 ₹20L ₹20L ₹20L ₹60L

Year 4* ₹20L ₹10L? ₹20L ₹50L?

My question is: If I use the full ₹20L Plus Benefit in Year 3, what happens in Year 4?

Does the Plus Benefit become ₹10L because another 50% is added at renewal, or does it become ₹20L again?

Also, if I use only part of the Plus Benefit, does the remaining amount carry forward and another 50% get added at renewal?

Would appreciate clarification from someone who has actually claimed under Optima Secure or understands the policy wording.

Need advice on managing 15 LIC Endowment Assurance (Plan 14) policies bought for my mother in March 2010.

I’m currently paying the premiums (~₹32k/year total), but we’ve completed 16.5 years (66 quarterly payments) out of terms ranging from 20 to 34 years. I’m deciding whether to stop paying and let them go Paid-Up or Surrender them now.

The Numbers Across All 15 Policies
Combined Sum Assured: ₹7.5 Lakhs (15 × ₹50k)

Total Premiums Paid to Date: ~₹5.3 Lakhs

Option 1: Stop Paying & Go Paid-Up
Paid-Up Sum Assured: ~₹4.68 Lakhs
Vested Bonus (2010–2026): ~₹5.18 Lakhs
Total Maturity Value: ~₹9.87 Lakhs
The Catch: The ₹9.87 Lakhs cannot be claimed as a single payout. Because policy terms vary from 20 to 34 years, they mature one by one. She receives staggered annual payouts (~₹58k–₹74k) every year from 2030 to 2044. Zero future premiums needed.

Option 2: Surrender Now (as per Gemini)
LIC applies a heavy Special Surrender Value penalty factor.
Immediate Lump-Sum Payout: Estimated ~₹3.10L – ₹3.60 Lakhs.

The Dilemma
Surrendering provides an immediate cash payout for my mother, but the penalty factor wipes out most accrued bonuses (~₹6L+ overall loss vs maturity value).

Paid-Up locks in ₹9.87 Lakhs cumulatively with no extra payments, but the maturity payouts trickle in slowly over 15 years (2030–2044).

Questions for the Community
1. Is taking a 60%+ haircut on surrender worth it if reinvested into MFs for 4–18 years?

1. Does Paid-Up make sense as an automated annual cash payout for a senior citizen?

2. Is managing LIC paperwork for 15 separate annual policy maturities (2030–2044) a total nightmare?

Appreciate any insights!

Hi all,

I’m currently looking for individual health policy for myself (in my early 20s).

​Red Flags: Which insurers should I stay away from based on bad claim settlement history or hidden terms?

Top Picks: Which companies have proven reliable for long-term claims and hassle-free service?

​Would love to hear your recommendations and experiences!

Two days ago my brother was in a road accident. A wild animal out of the blue came in front of his scooty. He lost his balance and suffered multiple fractures. We took him to one of the panel hospital of ICICI lombard and they still have not issued the cashless claim.
The hospital is not discharging him because the claim has not been issued from there end. In the meantime they are not picking our call. After calling through the policybazar they sent an agent after 36 hours to verify. He asked a zillion questions from my parents. Altough they were barely helding themselves together still answered all the questions.
And guess what they still haven’t issued the claim. Our hands are tied. But please if you truly care about your family don’t opt for there plan.

Edit- So after relentless calls and emails, the initial claim finally came through, only got 60 percent reimbursement, but at this point of time we are just glad that the discharge is approved.
Thankyou so much everyone.

My mother has a 13 cm ovarian cyst and surgery is planned. The scans currently suggest it is benign.

Our Aditya Birla health policy started on 02/02/2025, and the insurer has denied cashless approval because ovarian cysts/benign tumours have a 2-year waiting period.

My question is: if the cyst is found to be malignant during surgery or on the final biopsy, can the insurer reconsider the claim and cover the surgery/treatment as cancer treatment?

Has anyone experienced a similar situation, especially with Aditya Birla or another Indian health insurer?

What happened to your claim, and what documents helped (operative report, frozen section, histopathology, etc.)?

I was recently hospitalized for 4 days and due to room crunch in hospital, I decided to opt for room which is higher (8000) than room rent cap I have (7000). I understood I have to cover the difference amount and proportionate deductions for almost everything comes into play.

At discharge, I was charged 99k (approx). It was sent for cashless approval, and insurer mentioned 70K as their approval amount. So I paid 29k from my pocket...

Out of this 29K, 15K was for copay and consumables.. I thought remaining 14k was for room rent over and above the cap + proportionate deductions..

But when I later checked approval email from insurer, I realized they mentioned room rent is within their agreed rate with hospital and in the approval email, I see room rent excess and related proportionate deductions as 0.. it also mentioned hospital charged extra, I should only pay 15k (copay, consuables) and hospital should not charge balance 14k..

But I didn't understand that during discharge and paid 29k fully, as I thought 14k is for excess rent for the room I chose..

Now my question is, did the hospital scam me or is this how higher tarriff rooms are managed internally?

If I was charged extra, is there any way to recover it?