u/Puzzled-Ebb1204

M28 here, In 2025 I got myself a standalone OPD insurance from star health, I was lucky to get in because some months later only they stopped taking new members and kept it strictly as an (very expensive) add on to existing heath insurance. My first year was a breeze I paid 5k for 25k cover and went through it in 6 months, everything was cashless and was accepted and arranged without much scrutiny like medicines, diagnostic tests and consultations. I felt so good about the policy that enhanced the cover for it to 75k and paid 9k for it on renewal in March 2026.

In April-May around this year I noticed a disturbing detail in the policy that offline reimbursements for medicines were not allowed even though the policy clauses detail a reimbursement process and never mentioned everything has to be compulsorily cashless. Since I planned to keep this policy life long I realised in case of any serious disease like TB or Spine or anything a lot of meds are exclusively sold offline hence it will become useless once I get old and when I actually need a OPD cover, but since this violated my point of sale policy wordings I did a lot of back and forth with customer care on this finally raising it to GRO level but got the same template reply "reimbursement is not available on your policy"

In june I decided to put a complaint to bimabharosa and Ombudsman. And since exactly this point my policy experience has been worse. Basic tasks of policy like uploading consultations prescriptions post bookings are met with very heavy scrutiny (like I receive 3-4 scrutiny calls for 1 line prescriptions), they are now rejecting my regular medicine deliveries giving random and vague reasons which are no where in the policy wordings. On a call a customer care executive admitted that policy wordings on the website are not "updated" and they have an internal policy which is not yet on the website and if I have any issues I raise a customer ticket, which takes weeks to get resolved and is met with same templated responses. Another disturbing issue which happens is that my app tickets go missing or stop showing up on the app randomly so I am unable to track or see any updates in the same

I am so confused about what to do, what are my options? The ombudsman complaint I referred to above is going nowhere, they asked for a bunch of docs on mail but never replied since ~1 month, the complaint number itself is not showing up on their portal

Given how blatant star health has been in violating given policy wording on their website I am not sure what new reason they will give to reject my new claims. What can I do? I don't have resources and time to go to an actual court. Is there someone else who can help?

M28 here, In 2025 I got myself a standalone OPD insurance from star health, I was lucky to get in because some months later only they stopped taking new members and kept it strictly as an (very expensive) add on to existing heath insurance. My first year was a breeze I paid 5k for 25k cover and went through it in 6 months, everything was cashless and was accepted and arranged without much scrutiny like medicines, diagnostic tests and consultations. I felt so good about the policy that enhanced the cover for it to 75k and paid 9k for it on renewal in March 2026.

In April-May around this year I noticed a disturbing detail in the policy that offline reimbursements for medicines were not allowed even though the policy clauses detail a reimbursement process and never mentioned everything has to be compulsorily cashless. Since I planned to keep this policy life long I realised in case of any serious disease like TB or Spine or anything a lot of meds are exclusively sold offline hence it will become useless once I get old and when I actually need a OPD cover, but since this violated my point of sale policy wordings I did a lot of back and forth with customer care on this finally raising it to GRO level but got the same template reply "reimbursement is not available on your policy"

In june I decided to put a complaint to bimabharosa and Ombudsman. And since exactly this point my policy experience has been worse. Basic tasks of policy like uploading consultations prescriptions post bookings are met with very heavy scrutiny (like I receive 3-4 scrutiny calls for 1 line prescriptions), they are now rejecting my regular medicine deliveries giving random and vague reasons which are no where in the policy wordings. On a call a customer care executive admitted that policy wordings on the website are not "updated" and they have an internal policy which is not yet on the website and if I have any issues I raise a customer ticket, which takes weeks to get resolved and is met with same templated responses.

I am so confused about what to do, what are my options? The ombudsman complaint I referred to above is going nowhere, they asked for a bunch of docs on mail but never replied since ~1 month, the complaint number itself is not showing up on their portal

Given how blatant star health has been in violating given policy wording on their website I am not sure what new reason they will give to reject my new claims. What can I do? I don't have resources and time to go to an actual court. Is there someone else who can help?

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Hi All,

I bought Star Health's standalone OPD insurance last year (got lucky as they have stopped taking in new customers).

The policy works very simply — we have to book doctor consultations, tests and medicines via the Star app.

I am M27 and most of my OPD needs are fairly basic, and the insurance has been fruitful to me so far. I even increased my cover from 25K to 75K this year, keeping long-term usage in mind (i.e. to add my fiancée to it post marriage).

But there is a caveat in this policy which is bothering me. The medicines and tests are only allowed to be booked via the app through Tata 1mg or equivalent e-pharmacies and empanelled labs, and no reimbursement mechanism exists — even via network hospitals.

This bothers me on 2 accounts:

1. What if an urgent test is required at one of the network facilities?

2. There are plenty of medicine classes — like neuropathic painkillers (particularly opioid-based) and TB medications, off the top of my head — which cannot be sold online and have to be bought via offline pharmacies only. This effectively removes cover for these types of diseases from the insurance.

Now, I had downloaded the detailed policy document, still available on their public website, along with all the docs I received from them once the policy was bought — and this "online only" clause is nowhere to be found. In fact, the policy document does detail a reimbursement mechanism for expenses at network hospitals.

When I raised this with their voice agent, they had no idea about this dilemma and asked me to raise a ticket, which I did. I got it in writing that "no reimbursement is allowed on the OPD policy," to which — in the heat of the moment — I replied that I was going to report this to IRDAI. Suddenly, the ticket and its reply stopped showing in my app.

I had noted down this exchange and have raised a complaint with IRDAI regarding misrepresentation at the point of sale. But based on the experience of others in this group, do you think this can be resolved and I can realistically have an option to raise offline bills under this policy?

I was thinking of keeping this product long-term, which is why I am thinking this through — otherwise I will have to look at other options.