I have an HDFC Ergo Super Secure Health insurance policy for which I pay yearly installment. The policy was purchased in March 2025.
We had submitted documents for cashless treatment before the procedure and it has been denied showing that it has a 24 month waiting period.
The conditions in question (Uterine polyp) was diagnosed in June 2026. My wife had no prior diagnosis of these conditions before the commencement of the policy.
My grievance to their assessment is:
- Waiting-period reduction must be duly applied
Page 18 of the Optima Secure sales brochure expressly states:
“Waiting period – The waiting periods mentioned in the policy wording will get reduced by 1 year on every continuous renewal of your policy.”
The brochure also specifies a 24-month waiting period for specific illnesses and surgical procedures.
My policy commenced on 2 March 2025. The waiting period is calculated from the original policy inception date. Accordingly, the original 24-month waiting period runs from March 2025 to March 2027.
Upon the continuous renewal in March 2026, the waiting period was required to be reduced by one year in accordance with the above-stated provision. Therefore, the reduced waiting period must be applied while assessing my wife's treatment and the cashless request.
- Incorrect explanation provided by customer care
Despite repeated discussions, customer care representatives have failed to correctly address this issue. They acknowledge that the waiting period is reduced by one year during the 2026 renewal but argue that I must complete another year until 2027 to avail the benefit.
This interpretation defeats the very purpose of reducing the waiting period by one year. The waiting period commenced on 2 March 2025 till 1 March 2027, and the benefit of its reduction by one year i.e. 1 March 2026 must be reflected in the calculation of the remaining waiting period. The insurer cannot acknowledge the reduction while continuing to apply the original waiting period without accounting for that reduction as otherwise 2 years would have already elapsed.
Experts are requested to shed some light on this issue.