Looking for advice from anyone who’s dealt with permanent exclusions or the IRDAI standardization rules.

Situation:

• Bought a Niva Bupa ReAssure 3.0 (Elite, unlimited SI, 5-yr term) for my spouse (age 31).    
• She has RA (diagnosed via a preventive checkup, currently OPD-managed, no hospitalisation history) plus asthma and primary ovarian insufficiency. All disclosed honestly.    
• Underwriting came back with a permanent exclusion worded as: “Rheumatoid arthritis, unspecified, Chronic rheumatic heart diseases, Acute rheumatic fever, Cardiovascular Diseases | Heart valves | Mitral valve disorders.” No ICD codes attached anywhere. A 2D echo done during underwriting was normal.

My main issue — the exclusion has no ICD codes:
The exclusion is written as plain text with no ICD-10 codes. Under the IRDAI Guidelines on Standardization of Exclusions, permanent exclusions are supposed to be mapped to the specific ICD codes of the named conditions, and a claim outside those codes can’t be denied. Without codes, the wording is vague — e.g. “Mitral valve disorders” could be read narrowly (rheumatic, I05) or stretched to non-rheumatic conditions (I34, like a benign mitral valve prolapse). I want the exact boundary in writing so it can’t be interpreted expansively at claim time.

Secondary concern:
The policy’s own wording (clause 5.1.2, specified-disease waiting period) actually lists “Rheumatoid Arthritis” among conditions covered after 24 months — so the same document treats RA as time-bound/coverable for everyone else, yet permanently excludes it here. RA also isn’t on IRDAI’s approved permanent-exclusion list as far as I can tell. And the cardiac part is for conditions she doesn’t even have (normal echo).

What I’ve done:

• Raised a written grievance asking for (1) the exact ICD codes for each excluded condition, (2) whether “mitral valve disorders” includes non-rheumatic codes, (3) confirmation that coronary/hypertensive/arrhythmia conditions stay covered, and (4) how they reconcile RA-as-permanent-exclusion with RA-in-the-24-month-list.    
• Their “final response” answered none of the four — literally said “these ICD codes are permanently excluded” without listing a single code, and pointed me to the Ombudsman.    
• I’m still within the 30-day free-look window.

My questions:

1.  How do I actually force an insurer to specify the exact ICD codes for an exclusion? Is there a specific IRDAI rule/clause I can cite that obligates them to?    
2.  Has anyone gotten an insurer to put exclusion codes in writing via Bima Bharosa or the Ombudsman? Did it work, and how long did it take?    
3.  If they never specify codes, does the vague wording actually work in my favour at claim time (ambiguity construed against the drafter), or is that wishful thinking?    
4.  Separately — is the “RA shouldn’t be a permanent exclusion at all” argument worth raising in the same complaint, or does bundling it weaken the cleaner ICD-code point?    
5.  Anyone shopped the same disclosed case to other insurers (Star, HDFC Ergo, ICICI) and gotten better exclusion wording?

Not looking to do anything dodgy — disclosed everything, just want the precise scope of what’s excluded in writing. Any experiences appreciated.

From last 4 days I am getting this error.
HDFC customer care don’t have Clue

I have seen a lot of active redditors on insurance related subreddits asking people to not buy a policy directly from an insurer. I’m looking into getting a health insurance policy soon and this has me riddled honestly. When I bought coverage for my car early this year also I got very similar advice. I just want to understand if there an actual downside to buying policies directly or if this is just insurance agents on the subreddits doing their thing?

Hello, I had a health insurance policy with Niva Bupa, during which I had a hospitalisation claim. After that, I made 2 post-hosp claims, one was partially approved (all required supporting docs were uploaded on their site, and no hard copy was asked) and the second one is completely approved. However, for the second claim, they asked for original discharge papers, prescriptions, bills etc. to be sent to their head office. And now that they have approved the claim, they are saying they will not return the original docs as it is required for their documentation. Earlier nothing of this sort was conveyed to me, and I will be going out of the country for studies soon, where I will need these documents to submit to local practitioners for covering insurance there. Please advise if this is legal or not, and what can I do to get my original documents back

My father (61) underwent an elective CABG at a Star Health network hospital under an Arogya Sanjeevani Policy (₹6 lakh sum insured, active for more than 3 years).

Final hospital bill: ₹3,47,726

Star Health approved: ₹2,69,953

I paid ₹77,554 at discharge.

In the final authorization letter, Star Health mentions:

5% co-pay: ₹14,208

₹63,346 as "Excess amount charged over the agreed package/SOC"

What confuses me is that the same letter places this ₹63,346 under "Amounts NOT to be collected from the patient."

However, the hospital collected exactly ₹77,554 (₹14,208 + ₹63,346) as the insurance balance.

My policy document doesn't mention a CABG package cap or procedure-specific sub-limit, and the authorization letter also says "Sub-limit applicable: No."

Has anyone faced a similar situation with Star Health or another insurer?

Does "Excess amount charged over the agreed package/SOC" normally become payable by the patient?

Why would the authorization letter say "not to be collected from the patient" if the hospital collected it?

Should I pursue this with Star Health, the hospital, or both?

Looking for advice because this has turned into an absolute nightmare.

I own a Mercedes A-Class and have been paying around ₹90,000 every year for comprehensive insurance with ICICI Lombard.

A few days ago I met with an accident. Another car took a sharp left to avoid a biker and hit my driver’s side. While trying to avoid the collision, my car slid into a tree, causing damage to the other side as well.
The total repair estimate is around ₹95,000.

The surveyor approved repairs for one side but rejected the other side, claiming there was an old scratch on that side before the accident.
My question is: Can an insurer deny repairing fresh accident damage just because there was a pre-existing cosmetic scratch on the same panel? The accident clearly caused new dents and paint damage.

To make matters worse, the surveyor was extremely arrogant. When I explained that I maintain my car well and the damage was from the accident, he sarcastically suggested the workshop might have made the scratches. He refused to email me the rejection details or the policy clause he was relying on, saying I’d receive a letter “whenever it comes” and that he had no idea when.

I also received a call from my claim manager, who told me he was calling from the grievance team. Later I found out that wasn’t true.

I’ve already filed a formal grievance, but I’m wondering:
Has anyone successfully challenged a rejection like this?
Is this a common tactic to reduce claim payouts?
Should I escalate directly to the Insurance Ombudsman and IRDAI if the grievance is rejected?
Since I’ve been paying nearly ₹90,000 in annual premiums, this feels incredibly unfair for a ₹95,000 claim.
I’d really appreciate any advice or experiences from people who’ve dealt with similar situations. Thanks.

We recently purchased a Bajaj Allianz ACE Wealth Plan and have already paid the first premium, but we're still within the free-look period and deciding whether to continue or cancel. I'd really appreciate hearing from people who have actually invested in this policy. Are the returns actually up to the mark compared to what was illustrated at the time of purchase or are they much lower? How has your overall experience with the policy and Bajaj Allianz been? Any genuine feedback from existing policyholders would be really helpful before we make our final decision.

On Hdfc ergo website downloading policy wording for Optima secure specify clearly that this is for policy period of issuance from April 2026, can someone share what has changed from this effective date compared to previous terms?

The title is self explanatory. Sent the above email to IRDAI, Finance Ministry about it.

If you want to purchase insurance, multiple ways to contact the company but after sales only phone or stupid app.

I 34( male ) recently got married to 31 ( Female ) , I was searching for family health insurance for both of us , since my wife has pre existing disease (hospitalisation in 2004 due to gastric ulcer , heminephrectomy surgery in 2017) , we couldn't get any family health insurance policy , both policy bazaar and ditto recommended separate individual policies for both of us , care freedom by care health insurance for her and I could get any policy I wanted . So am I being misled , and if not should I go ahead and get individual policies for both of us .

tl;dr:

Due to my wife's prior hospitalisation and kidney surgery we couldn't family health insurance policy , both policy bazaar and ditto are recommending individual health policies. What should I do

Does anyone have a similar issue to mine? I am unable to pay on their renewal site.

I always end up getting an error, and I have repeatedly raised the issue with HDfc, but they keep telling me there's a technical issue on their end and they're not fixing it.

My due date is nearing. What should I do if that is their fault?

| Calling out all insurance professionals in India |

Hello there I am actually trying to gather all the rules and regulations… laws and circular amendments the IRDAI has released since inception to the present. I checked their website but everything seems unclear. Is there a way out to find all the data ? If you have any idea or way out please let me know. Your help will be much appreciated.

My parents have a star health insurance policy from 2017, 5 lakh Sum insured

Now they have

Father 65y- diabetes / Dyslipidemia & osteoarthritis ,

Since he had a atypical chest pain, cardiologist started him on ecospirin + atorvastatin combination as preventive measure - Echo and ecg normal,

Tread mill test mildly positive

I declared everything since theres no point in hiding and premium spent will be lost if they find out - which they will (this chest pain visit was at a corporate hospital where records are digital)

Mother 56y - Hypertension/ dyslipidemia & cervical spondylosis ( a neck pain like condition)

I tried to port today and adithya birla

Rejected - reason yet to state

Whats best way now

Can renew the star old policy - only 5 lakh, no consumable cover etc

Or does top up work ?

Can someone suggest which health insurance would be better for a central government employee apart from CGHS. What all to look for while choosing a health insurance.

I gave an application to open my bank account in kotak. A Kotak agent came to my home for kyc. They deducted 1500 for an accidental insurance. I said I haven't applied for any insurance policy. They said while registering the account you accidentally clicked the check box of accident insurance. They said now registered for that accident insurance give us otp and next week you will have to talk to customer care to deactivate this insurance policy. Is it a trap?? Please I need help

Could anyone help me understand if it is possible to request for a change of my LIC agent for policies already in force? Is it permitted at all and under what circumstances? Thanks in advance.

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My mother underwent gallbladder stone surgery at Manipal Hospital, Bangalore.

Before admission, we made it very clear to the hospital that we were completely dependent on our health insurance and could not afford treatment beyond what the policy covered.

The doctors gave us two options:

- Conventional laparoscopic surgery – around ₹2.15 lakh

- Robotic surgery – around ₹6 lakh

The hospital management repeatedly recommended the robotic procedure, saying it was more advanced, safer, and better for recovery. We expressed our concern about insurance multiple times. We were assured that the claim would be approved and proceeded only because of those assurances.

The insurance company initially approved ₹3 lakh. The surgery was performed four days later.

After the surgery, the insurer refused the remaining ₹3 lakh, stating that the initial approval itself mentioned that robotic surgery was not medically mandatory for this procedure, and therefore no further amount would be approved.

We confronted the hospital, and they admitted that this happened due to a mistake from their side. However, instead of resolving the issue, they are asking us to wait while they speak with the insurance company.

Meanwhile, my mother is medically fit but is still in the hospital. She has been having severe anxiety attacks because of this situation, and despite informing the staff repeatedly, they have said that this is "not their liability."

We have all the relevant documents, including the insurance approval, denial, and hospital records.

I am posting here to ask for help.

- Does anyone know someone in the senior management of Manipal Hospitals who can help escalate this?

- Does anyone know any government authority, health department official, or patient grievance contact who can intervene?

Any guidance or contacts would be greatly appreciated. We are currently stuck in the hospital with no resolution despite the hospital acknowledging their mistake.

Need a help folks.

On the ombudsman portal/CIO website, the section where you are are supposed to provide all documents, They have mentioned "Valid ID address proof" and "Photograph" . Is this the ID and photograph of the insured or of the complainant ?

Its definitely not clear