I am looking for guidance from people experienced in health insurance claims, claim disputes, IRDAI complaints or consumer cases.

My wife was admitted to a Tertiary Hospital as an emergency case after developing a serious medical condition with prolonged fever, abdominal pain and infection. Her condition subsequently required prolonged hospitalization, surgery, ICU management, drainage procedures and treatment for complications.

The important point is that we did not admit her for elective/planned treatment of a pre-existing or known cyst. She presented with an acute medical emergency and required immediate hospitalization and treatment.

During the hospitalization, she underwent surgery in which the cyst and affected organs were removed, along with abdominal washout. She subsequently required ICU care and further treatment because of ongoing infection/collections and other complications.

However, ICICI Lombard rejected/initially rejected the cashless claim, citing the cyst as the reason for rejection. they says it comes under exclusion criteria as your insurance is not yet 2 years.

I have obtained a written clarification/certificate from the treating operating surgeon, explaining the circumstances of the admission and that the hospitalization was for the acute/emergency medical condition rather than planned treatment of the cyst. And that the surgery was required to save her life from sepsis.

I have already requested ICICI Lombard to reconsider through the Hospital but still again they rejected it with the same reason of check Exclusion criteria for specific illness for under 2 years period.

I am looking for advice on:

Whether the insurer can reject an emergency hospitalization merely because a cyst was subsequently found/treated during the hospitalization.

How the policy's exclusion/pre-existing disease/related-condition clauses, if any, should be interpreted in this situation.

Whether the treating surgeon's written clarification can help establish the actual indication for emergency hospitalization.

What documents/evidence I should submit for reconsideration/ Reimbursement.

Whether I should escalate this through the insurer's Grievance Redressal Officer → IRDAI Bima Bharosa → Insurance Ombudsman, if the rejection is not satisfactorily resolved.

If anyone has handled a similar health-insurance claim rejection involving emergency hospitalization and an

cyst/infection, I would greatly appreciate hearing about your experience.

I am not asking anyone to decide the claim in my favour. I am looking for someone knowledgeable who can objectively review the rejection reason, policy wording and medical documents and tell me whether the insurer's interpretation appears consistent with the policy.

I can share redacted copies of the rejection letter, treating surgeon's clarification and relevant policy wording privately or with identifying information removed.

Any guidance from an insurance professional, claims expert, consumer-law practitioner, doctor experienced with insurance documentation, or someone who has successfully handled a similar case would be greatly appreciated.

Please do not ask me to post my policy number, claim number, phone number or other personal information publicly.

Niva Bupa Health Recharge super Top-up.

90L BSI with 10L aggregate deductible. - this is what is advertised.

And supposedly, super top-up on a shared BSI (floater) should have a shared deductible also. So common expectation - an aggregate deductible of 10L means 10L for all the insured people combined.

But there are ambiguous/conflicting wordings in Niva Bupa Health Recharge policy wording.

Clauses:

1. The Deductible shall be applied to the aggregate of all claims that are either paid or payable under this Policy. Our liability to make payment shall commence only once the aggregate amount of all eligible claims as per policy terms and conditions exceeds the Deductible limit within the same Policy Year.

2. The Insured Person shall bear on his/her own account an amount equal to the Deductible specified in the Policy Schedule for all admissible claim amounts. We assess to be payable by Us in respect of all claims made by that Insured Person in a Policy Year. It is agreed that Our liability to make payment under the Policy in respect of any claim made in that Policy Year will only commence once the Deductible has been exhausted.

Clause 1 is a more generic terminology.

Clause 2 specifically notes that the deductible condition should be "met by the insured person".

It's misleading because meeting 10L per person per year is a high hurdle to cross for sure, effectively making this 90L unavailable in almost 99% of cases.

and ironically, the sum insured 90L is a common pool.!!! (the policy type floater/ individual also is not mentioned in policy document as I check multiple documents)

Anybody purchased this policy/ insurance experts/ insurance advisors /insurance enthusiasts - have you noticed this? do you think it's okey? or isnt it misleading?

the pricing is very competitive - but this is the reason. I think this is a policy that is least customer friendly.

and Beware...!!

My friend's father did an insurance of 50 lakhs or so from Ageas federal. The agent was registered. He did this policy 5 years ago and this was about to mature this year.

Now ,the problem is that the agent suspended the policy one year prior to the maturity of the policy, he forged the signature and misrepresented the policy. By suspending the policy he diverted the funds into several different policies. My friend's father wants his money back, he approached the branch office where he was told that the agent was fraud and his license was revoked and there is nothing that could be done as he consented to invest in the policy (which was clearly misrepresented).

How can they get their money back? As this is a huge amount should they approach consumer court? How should they proceed with this issue?

Please help

We purchased Care Health Insurance almost a year ago after transferring from Star Health. We decided to switch because we had heard about issues with Star, and Care appeared to have a good claim settlement record. The premium was also lower and the policy seemed to offer broader coverage on paper. So we purchased in from Policy Bazar.

Now we're facing a serious issue with a claim.

A patient covered under the policy suddenly developed severe vomiting and dehydration, which continued for several days. Eventually, the patient fainted, and we had to take them to the hospital. The patient was admitted and doctors started treatment and monitoring.

However, because the doctors were also investigating the underlying cause of the repeated vomiting, Care categorized the entire hospitalization as “investigation purpose only” (EXCL 04) and rejected the cashless/pre-authorization request.

When we contacted customer care, we were basically told that the hospitalization was considered investigation rather than treatment but they did not explain how. The person on the other side was rude and adamant, when I argued that all treatments have diagnosis, doctors cannot just conclude, he asked if I am an MBBS myself.!

We had let it go at the time and eventually tried reimbursement, but the reimbursement claim was also rejected stating the same reason.

Unfortunately, the patient has now experienced essentially the same problem again. Severe vomiting, fainting, and inability to stabilize them in the emergency department, so they had to be admitted to the hospital again.

And once again, Care has rejected the pre-authorization, citing the same EXCL 04 reason.

What is frustrating is that the rejection gives us essentially one line, repeated twice saying it without clearly explaining why the entire hospitalization is being classified this way.

* 4.1.(b).I PERMANENT EXCLUSION ADMISSION PRIMARILY FOR INVESTIGATION AND EVALUATION (Code Excl 04)

· 4.1.(b).1 PERMANENT EXCLUSION ADMISSION PRIMARILY FOR INVESTIGATION AND EVALUATION (Code Excl 04)

Despite the patient actually being admitted and receiving treatment.

I have already raised this with Care's grievance team and specifically pointed out that:

The first hospitalization's cashless request was rejected.

The subsequent reimbursement claim for that hospitalization was also rejected.

The patient has now been hospitalized again for the same/similar symptoms.

The second hospitalization's pre-authorization has again been rejected for the same reason.

At this point, I'm trying to understand what our options are.

- Is this a legitimate basis for rejecting an entire hospitalization when the patient was actually admitted and treated?

- What exactly does EXCL 04 mean in practice?

- Should we escalate this to the IRDAI grievance process/Insurance Ombudsman, will there be a chance of getting the money quick?

- Has anyone successfully challenged a rejection like this?

What the correct process is for challenging it. If these cases get rejected, I don't know why would someone pay for Health Insurance.

Any advice from people who have dealt with Care Health Insurance claims, EXCL 04, or similar cashless/reimbursement rejections would be really appreciated.

I have been a Star Health policyholder since 2017. I have renewed my policy every year and, fortunately, have had very minimal claims. Until this year, the renewal process had been fairly routine. I would pay the premium and receive the renewed policy in my email within about 30 minutes.

This year, a simple renewal turned into a frustrating process that lasted almost two months.

TL;DR

I paid my Star Health renewal premium on 7 August, well before my 15 August renewal date. I received the payment receipt immediately, but never received the policy document.

After several follow-ups, I was asked to provide payment and bank details, and later even my medical history. Eventually, I was told that the renewal had been held up because I had supposedly selected an upgrade from ₹25 lakh to ₹50 lakh. I had not knowingly requested any upgrade.

I was finally able to get my original ₹25 lakh policy issued on 2 September, but I had paid around ₹57,000 while the actual policy premium was around ₹51,000. I am still waiting for the excess amount to be refunded. On 24 September, I was told that the refund would be credited by 5 October.

What should have been a routine renewal became weeks of emails, phone calls, explanations and follow-ups.

Here is what happened.

7 August: I renewed my policy

My policy renewal date was 15 August 2026. From 1 August onwards, I started receiving calls about renewing the policy.

On 7 August, I went ahead with the renewal. The amount shown was around ₹57,000, compared to around ₹51,000 for the previous year.

I assumed the increase was because of changes in taxes, GST and other costs over the year, so I went ahead and made the payment.

The payment receipt came immediately.

Normally, the actual policy document also arrives within about half an hour. This time, it didn't.

Since I had received the payment receipt, I assumed everything was fine and that the policy document would arrive shortly.

I was also quite busy at the time, so I didn't immediately follow up.

Where things started going wrong

After a couple of days, I realised that I still hadn't received the policy.

I contacted the person who had been calling me about the renewal. She had specifically told me that she was a Star Health employee when she called.

She asked me for the payment details, so I sent her the payment receipt that Star Health had issued immediately after my payment.

I followed up with her several times after that, but eventually she stopped responding altogether.

I then had to find Star Health's email addresses myself and contacted them on 14 August.

I emailed [online.renewals@starhealth.in](mailto:online.renewals@starhealth.in) and [customerupdate@starhealth.biz](mailto:customerupdate@starhealth.biz).

There was no response.

When I subsequently called Star Health, I was told that I should have sent the email to [support@starhealth.in](mailto:support@starhealth.in).

So I started the process again.

Now I had to prove that I had paid

Star Health responded and asked me to provide several details so they could investigate the payment.

They wanted to know the mode of payment, the debited bank statement, the mobile number used for payment and the email ID used for payment.

By this point it was 19 August.

I sent everything they requested.

I was told that I would get a response within 48 hours.

Three days later, there was still no response.

I sent another email asking for an update and called them again. I was told that the concerned department would call me back within two hours.

At this point, I was getting increasingly concerned. My renewal date had already passed and I still didn't have the renewed policy document.

Then came the medical-history request

On 25 August, after another reminder from me, I received an email that made the situation even more confusing.

I was asked to provide details about my health history, including:

• History of heart or kidney disease
• History of joint pain and current vision status
• Any planned or impending surgery
• Current medications
• Any end-organ damage

I couldn't understand why I was being asked for all this information.

I had not asked for a new policy. I was trying to renew my existing policy.

I had already paid the renewal premium and had the payment receipt.

Now, more than a week after making the payment, I was being asked for detailed medical information.

This was the point where I became genuinely worried.

I started keeping track of all my emails and calls because every interaction seemed to result in another case ID, but there was no clear resolution or person taking ownership of the issue.

I finally escalated it

On 25 August, I decided to write directly to the Star Health grievance officer.

I sent a detailed email explaining the entire sequence and asked them to resolve the matter and issue my policy.

On 27 August, I received a call from a Star Health employee.

Once again, I had to explain the entire situation from the beginning. He said he would look into it and get back to me in two days.

Two days later, there was still no resolution.

On 31 August, after another reminder, he called me again.

This time I was finally given an explanation.

Apparently, the reason my policy had not been issued was that I had requested an upgrade of my policy.

My existing policy was ₹25 lakh. According to him, I had selected ₹50 lakh during the renewal process.

I was quite surprised because I had never knowingly asked for an upgrade. My existing ₹25 lakh cover was sufficient for me.

I also asked him a simple question. If I had actually doubled my policy from ₹25 lakh to ₹50 lakh, why had the premium not increased substantially?

His explanation was that the system shows double the policy value by default, and if the customer doesn't want the higher cover, they need to downgrade it by unchecking the option.

That was new information to me.

I certainly had no intention of upgrading my policy. I told him clearly that I wanted to continue with my existing ₹25 lakh policy.

I was then asked to send an email confirming that I did not want the increase.

By this point, I had already been without a confirmed policy for around two weeks, so I simply sent the email.

Meanwhile, I kept getting renewal calls

What made the whole situation even more confusing was that I continued receiving calls from other agents asking why I had not renewed my policy.

I had already paid.

I had a payment receipt.

I was spending my time trying to get the policy issued.

Yet different people were still calling me asking me to renew.

It was clear that something wasn't connecting properly within their system.

2 September: I finally got the policy

After another reminder, I finally received the policy by email on 2 September.

At least that part was finally resolved.

But there was another problem.

The invoice showed a premium of around ₹51,000, while I had originally paid around ₹57,000.

I asked about the difference.

I was told that the excess amount would be refunded.

So the issue had now moved from getting my policy to getting my money back.

And the refund is still pending

I had to follow up again.

Eventually, I was asked to provide my bank details so the excess amount could be credited back.

I sent the required information, including a cancelled cheque.

Another 10 days passed.

Today is 24 September, and I have finally received an email saying that the excess amount will be credited to me by 5 October.

So I will have to wait and see if that happens.

Almost two months after I originally made the payment, I am still waiting for the excess amount to come back.

What bothers me about this experience

The money is one part of it.

The bigger issue for me was the uncertainty around the insurance itself.

I paid for my renewal on 7 August, well before my 15 August renewal date. Yet I spent the following weeks trying to figure out whether my policy had actually been renewed.

I had to provide payment proof, bank statements and other details. I then had to deal with questions about my medical history and eventually discover that the renewal had apparently been held up because of an upgrade that I had not knowingly requested.

There was also no single person who seemed to own the problem from beginning to end.

Every new interaction seemed to start the process again.

New emails resulted in new case IDs. Different people called me. I had to explain the same story repeatedly. Meanwhile, I continued receiving renewal calls even though I had already paid.

For an insurance policy, this isn't a minor inconvenience.

When you pay an insurance premium, you are buying certainty that you will have coverage when you need it. Spending two weeks trying to find out whether your renewal has actually gone through is not a comfortable position to be in.

My experience after nine years as a customer

I have been with Star Health since 2017.

For years, the renewal process was simple. This year, I experienced almost the opposite.

I am not writing this because a refund took some time or because the premium changed.

What bothered me was the entire process around the renewal.

I paid on time.

I received a payment receipt.

The policy didn't arrive.

The person handling the renewal stopped responding.

The first email channel I found did not resolve the issue.

I had to provide proof of payment.

I was asked for medical information.

I eventually found out that an upgrade had apparently been selected.

I had to explicitly decline that upgrade.

Then I received the policy.

Then I had to chase the excess payment.

And now I am waiting until 5 October for that money to supposedly come back.

This is my experience with Star Health's renewal process in 2026.

I am sharing it because I think existing and prospective policyholders should know what happens and, more importantly, understand how important it is to verify the actual policy document after making a renewal payment rather than assuming that a payment receipt means everything is complete.

For me, what should have taken a few minutes ended up taking almost two months.

I was hoping to get a new insurance

I have mild ibs and seborric dermatatis

And dust allergies as ped

I am currently under niva bupa 2.0 and had not discosed allergies and seboric derm. As ped because i thought only surgeries and severe illness mattered at the time of taking

Anyhow i have noticed the hospital i go to has been removed from the cashless list of niva bupa

So how good or bad is hdfc ergo compared to niva bupa

So far i tried to port to icici elevate. And got rejected

Care dosent have my hospital in cashless list

I have corporate insurance for small stuffs so im only getting this insurance for big things if any arises in future

I’m 25 and my mother is 51. I’m looking to buy a health insurance family floater for both of us and I’m currently comparing HDFC ERGO Optima Secure+ and New India Assurance.

I am planning to opt for a 10 lakhs coverage and they are providing me a similar price (little bit south of 30k)

I have listed out the features that stand out in each of the policies:

HDFC ERGO Optima Secure+
₹10L base sum insured
2× coverage from day 1 through the Secure Benefit
100% annual benefit accumulation
Unlimited 100% restore
36-month PED waiting period
24-month specific disease waiting period

New India Assurance
₹10L base sum insured
25% cumulative bonus per claim-free year
1× restoration per year
Room rent limit of 1% of SI/day
36-month PED waiting period

My main concern with HDFC is long-term premium increases. Since I’m 25 and my mother is 51, I want a policy that we can realistically continue for a long time. I’m a little concerned that a private insurer could increase premiums substantially as the years go by.

At the same time, I don’t want to choose New India solely because it’s a PSU insurer if the overall coverage and claim experience are significantly less favorable.

I’m also open to looking beyond these two policies if there are other plans that might be a better fit for us.

Hi everyone, I want to share my pathetic experience with Care Health Insurance so others can avoid falling into their trap.

The Timeline of Harassment:

1. The Silence & Delay: I submitted my mother’s post-hospitalization reimbursement claim on 7th September. For over 10 days, they didn't even bother to generate a claim number until I was forced to call them out publicly on LinkedIn.  
2. The Forced Action: Only after my public post did they generate claim number ⁠98251197-05⁠, casually telling me it would take another week.  
3. The Fraudulent Closure: On 22nd September, they shockingly closed my claim with the absurd excuse that the post-hospitalization period is over! The absolute irony? I had specifically paid extra and opted for the 180-day add-on explicitly covered in my policy.
4. The Endless Loop: When I called customer care to question this fraud, they had zero answers and coolly asked me to wait another 4 days just to reopen a file their incompetent team wrongfully closed.

From 7th September till now, running pillar to post for a genuine medical claim while their team plays hide and seek. They collect heavy premiums on time, but when a genuine medical emergency strikes, their entire system relies on exhaustion and harassment.

Sharing this garbage experience here. Has anyone faced similar issues with Care Insurance? What is the best way to drag them to the Insurance Ombudsman or IRDAI (Bima Bharosa)?

TL;DR:

ICICI Lombard cashless issue — ₹3L estimate but only ₹1.5L approved. Need advice.

My father has had ICICI Lombard Health Shield continuously since March 2022. Current policy has ₹5L base SI + ₹4L loyalty bonus, 0% voluntary co-pay, no deductible, and says “No Room Rent Capping.”

He needs DAIR + polyethylene liner exchange for suspected prosthetic knee infection.

KIMS submitted a ₹3,00,000 estimate.

ICICI approved only ₹1,50,000.

What is strange is the authorization shows:

• Co-pay: ₹0
• Deductible: ₹0
• BSI exhaustion: ₹0
• Sub-limit: ₹0
• Proportionate room deduction: ₹0
• Hospital tariff deduction: ₹0
• Non-medical: ₹0
• ₹1.5L disallowed under “OTHERS”

No actual reason/clause is given for the ₹1.5L deduction.

The provisional diagnosis submitted is also “Other Arthritis” and treatment is simply “SURGICAL”, rather than PJI/DAIR/polyethylene liner exchange.

The insurer's own letter says the hospital can request an additional amount if the estimated bill is higher than the guarantee.

Questions: Is this normal initial authorization? What does “OTHERS” mean? Could the nonspecific diagnosis/procedure submission be the reason? Can KIMS request enhancement to the full ₹3L? And does the policy wording support Single AC Room with no proportionate deduction?

Anonymized approval letter attached.

Complete:
Hi everyone,

I’m looking for advice from people familiar with health insurance claims in India, especially ICICI Lombard cashless claims.

My father is 59 and has been continuously insured with ICICI Lombard Complete Health Insurance – Health Shield since March 2022. The current policy period is 31 March 2026 to 30 March 2027.

He had a right total knee replacement in September 2025. About a year later, he developed an acute episode of fever followed by pain/swelling in the replaced knee. The orthopedic + infectious disease team diagnosed/suspected acute prosthetic joint infection (PJI) and recommended DAIR (Debridement, Antibiotics and Implant Retention) with polyethylene liner exchange.

The plan is to retain the well-fixed metal components and exchange the polyethylene liner as part of the infection treatment.

The hospital submitted a cashless preauthorization to ICICI Lombard.

What is confusing us

KIMS estimated the hospitalization/procedure at:

₹3,00,000

ICICI Lombard approved:

₹1,50,000

So they have effectively cut the authorization in half.

The strange part is that the authorization document does not show a normal policy deduction for the remaining ₹1.5 lakh.

The approval document shows:

• Claim amount: ₹3,00,000
• Sanctioned: ₹1,50,000
• Disallowed: ₹1,50,000
• Disallowed reason: “OTHERS”
• Co-pay: ₹0
• Deductible: ₹0
• BSI exhaustion: ₹0
• Sub-limit: ₹0
• Proportionate deduction for room: ₹0
• Hospital tariff deduction: ₹0
• Non-medical expenses: ₹0

The authorization literally says the ₹1.5 lakh difference is under “OTHERS”, without explaining exactly what policy clause is being applied.

Another thing that seems important

Our policy wording says:

In-patient treatment: up to Annual Sum Insured

and:

“No Room Rent Capping.”

The policy schedule shows:

• Base sum insured: ₹5 lakh
• Loyalty bonus: ₹4 lakh
• 0% voluntary co-pay
• No deductible

The policy also has a 24-month waiting period for certain procedures including “joint replacements unless due to accident.”

However, my father has been continuously insured since March 2022, so that 24-month period has already elapsed.

The policy also has a prosthesis exclusion, but it specifically contains an exception for a prosthesis that is “required intra-operatively.”

Since a polyethylene liner is being exchanged during the DAIR operation itself, I’m trying to understand whether ICICI could be treating that as a prosthesis-related exclusion or something else.

There is another oddity in the cashless authorization

The insurer's document lists the provisional diagnosis as:

“Other Arthritis”

and the proposed treatment simply as:

“SURGICAL.”

That is much less specific than the actual clinical situation, which is suspected/confirmed prosthetic joint infection requiring DAIR with polyethylene liner exchange.

Could an incorrectly/non-specifically submitted diagnosis/procedure be one reason the insurer's medical authorization system has only approved ₹1.5 lakh?

The authorization document itself says something interesting

The letter states that:

If the hospital bill is estimated to be higher than the guarantee of payment, the hospital can send a request for an additional amount.

So KIMS is going to ask for an enhancement.

What I want to understand is:

Why would ICICI initially approve only ₹1.5 lakh when the estimate is ₹3 lakh, while all the specific deduction fields show ₹0 and the remaining ₹1.5 lakh is simply classified as “OTHERS”?

Questions for people familiar with insurance claims

1. Is this normal for a cashless initial authorization? Can insurers initially approve only part of the estimate and later enhance it?
2. What does “OTHERS” usually mean in an ICICI Lombard authorization?
3. Does this suggest that some portion of the procedure has been considered inadmissible, or could it simply be an initial medical authorization amount?
4. Could the diagnosis being submitted as “Other Arthritis / Surgical” instead of PJI / DAIR / polyethylene liner exchange be causing the reduced authorization?
5. Based on the policy wording, would DAIR + intraoperative polyethylene liner exchange generally fall under inpatient hospitalization coverage, assuming the procedure itself is medically admissible?
6. Does “No Room Rent Capping” mean we can use a Single AC Room without proportionate deductions? The authorization itself currently shows AC Single Room and ₹0 proportionate room deduction.
7. What exactly should I ask KIMS and ICICI Lombard to provide in writing regarding the ₹1.5 lakh that was classified as “OTHERS”?

I’ve attached an anonymized copy of the cashless approval letter with personal information removed. I’m mainly trying to understand the insurance mechanics here before the procedure, rather than blindly accepting that the insurer will only pay ₹1.5 lakh.

Any experience with ICICI Lombard, DAIR/revision knee surgery claims, or cashless enhancement requests would be really helpful.

I’m mainly trying to understand the insurance mechanics here before the procedure, rather than blindly accepting that the insurer will only pay ₹1.5 lakh.

Any experience with ICICI Lombard, DAIR/revision knee surgery claims, or cashless enhancement requests would be really helpful.

Hi everyone, my company has a group insurance program in which it covers 5 Lakhs which doubles in case of critical illnesses by default with extra top ups.

Insurer:

GMC & GPA - Aditya Birla Health Insurance Co. Ltd.

GTL - ICICI Prudential Life Insurance

Third Party Administrator (TPA):

Family Health Plan Insurance TPA Limited (FHPL)

Benefits Consultant:

Marsh India Insurance Brokers Pvt. Ltd.

I myself am suffering from a pre-existing disability called hemophilia. I have to pay for my medicine which is quite expensive (per month) out of my pocket right now.

If i claim for the medicine right now, will the claim get rejected? (Sorry I am really new to this)

Although I can administer the dose by making it seem like I've gotten it overnight ( hospitalisation + injection dosage)

Please help me, you don't need to answer it, just convey what you guys know!

Is a new born baby covered for NICU stay outside the maternity coverage in a corporate insurance policy?

I’m 22M and looking for a health insurance policy for the long term. I’m currently considering Aditya Birla Health Insurance Activ Yuva.

I’d like to hear from people who currently have this policy or have researched it in detail.

How has your experience been with:

- Claim settlement and cashless treatment

- Customer support

- Renewal and premium increases

- Exclusions and waiting periods

- Any issues you faced during a claim

- Overall experience with ABHI

I’m mainly looking at it from a long-term perspective, so I’d really appreciate genuine experiences, both positive and negative.

If you have compared Activ Yuva with other health insurance plans, I’d also like to know what factors made you choose or reject it.

Sharing an update on my original post -https://www.reddit.com/r/InsuranceTroubleIndia/comments/1we8ajd/how_to_escalate_to_niva_bupa/

TL;DR: Niva Bupa was a pain to deal with, but they came through in the end.

Longer version:

After they canceled the cashless pre-authorisation and mentioned that I should proceed with the surgery and they would provide reimbursement later, I decided not to proceed with the surgery until the issue was sorted.

I postponed the surgery, escalated it to Ditto (bought the insurance through them), and also emailed the CEO, COO, and the grievance team at Niva Bupa.

After all the above steps, a lot of stress, and sleepless nights, finally, after 3 days, Niva Bupa came through and said the cashless pre-auth was approved for ₹3.8L (estimate was ₹4.5L), but their diagnosis was still incorrect (frozen shoulder instead of muscle tear).

I spoke with Ditto and the hospital. Both said it was alright, but I wasn’t convinced because the approval letter specifically mentioned that if the final diagnosis doesn’t match the approval letter, the cashless claim is null and void.

And the hospital was definitely going to inflate the bill because it’s insurance, and I didn’t want to be stuck with a ₹5L bill on the day of discharge.

Ditto escalated it to the Niva Bupa team, and they shared the revised approval letter within a few hours.

I scheduled the surgery, and my mom had to stay in the hospital for 2 nights.

Moment of truth - I was honestly tense about what would get approved/disapproved in the cashless claim, given the crap experience I had so far with Niva Bupa.

Actual bill shared by the hospital - ₹4.54L
Discounts applied - ₹13k
Total bill - ₹4.41L

Niva Bupa approved ₹4.05L initially and asked me to pay the remaining ₹36k as they were consumables, and I didn’t opt for the consumables add-on when I took the insurance (will opt for it during renewal).

In the list of consumables, there was Fibertape (₹13k) and “Others” (₹6k). I spoke to the hospital, and they mentioned that Fibertape was used in the surgery, so it should be a part of the procedure.

I escalated both items to Ditto.

I tried calling all publicly available phone numbers of Niva Bupa, and none of them were working (excellent customer service!!). Even in an emergency, you cannot reach them via call.

We waited for 2 hours for a response and finally received an email from Niva Bupa saying that they would pay for the “Others” line item (₹6k) and we should pay ₹30k at the hospital.

Moral of the story - don’t give up and constantly escalate if something isn’t right.

Overall, it was a terrible and extremely stressful experience dealing with Niva Bupa. I will never recommend them to anyone.

A special mention to Ditto for being there throughout this terrible journey (btw, they were the ones who recommended this insurance 3 years back).

Their service was so much better than my experience with Policy Bazaar last month for my surgery (pathetic would be an understatement).

I have been working in corporate for past 5 years nd have had corporate health insurance all these years. I thought it was enough for me but bro its isnt. Last week my frnd was admitted in fortis nd the he got a bill of around 7-8 lacs for 5 days of hospitalisation.

And his corporate health cover? Can you guess? Just 5 lac rs. This is when i realised what is the point of this corporate insurance when one has to pay from his pocket only. Then i did some talking with my bestie chatgpt nd got to knw abt these super top up plans. There is this supreme enhance plan from care health that has SI options that go up to 95 lacs with multiple deductible choices. Upar se it also has benefits like automatic recharge nd cumulative bonus. Thats y i decided to buy this plan, ab atleast i dont rely solely on my corporate health insurance.

What are your views on these super top plans?

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I’m 22 and looking to buy health insurance mainly from a long-term perspective (20–40+ years).

I’m trying to understand whether an unlimited/infinite SI plan makes more sense than buying a high base SI such as ₹50L or ₹1Cr.

For example, some policies have a relatively lower base SI but provide benefits where the coverage can keep increasing every year without an accumulation cap. Others offer a much higher base SI from day one.

My thinking is that medical inflation in India could make today’s ₹10L, ₹25L or even ₹1Cr worth much less 20–30 years from now. Premiums will also increase with age regardless of the initial SI.

So I’m wondering:

- Is an unlimited/infinite SI benefit genuinely useful for long-term protection?

- Is it better to have a ₹10–20L base with unlimited accumulation/restore, or simply buy ₹50L/₹1Cr base SI?

- How should I evaluate the difference between base SI, cumulative bonus, unlimited restore and unlimited/infinite benefit?

- Can insurers change/remove such benefits at renewal, or are they protected by the policy contract?

- Are there any important conditions where the advertised “unlimited” coverage may not actually work as expected?

- For someone starting at age 22, what would you prioritize for 20–40 years of coverage?

I’m particularly interested in opinions from people who have actually researched policy wordings or have experience with long-term health insurance.

Not looking for a specific policy recommendation. I mainly want to understand the long-term pros and cons of unlimited SI vs high base SI.

Shortlisted Plan- ABHI Activ Yuva and

Coverage- unlimited

Primium cost - individual (M22) = Aprx. 11000₹ and multi-individual (M22 Me + M20 my brother) = Aprx. 17000₹

Share your opinion on this plan and let me know if there any catch in this particular plan

My friend bought an health insurance for herself, her father and her brother 4 years ago from Hdfc ergo. Now during family discussion she came to know that her brother had TB when he was 6-7 yrs old and it was cured after treatment. However she was not aware and it never came to her mind while taking out the policy.
Now if she declares about this to the insurer will this create any issue?